PL-11-71Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
inspection Number: INSP- 154926 Permit Number: PL- 1 -11 -71 1
Inspection Date: August 15, 2011
Inspector: Hernandez, Rafael
Owner: CABALLES, FLORENCIO
Job Address: 45 NW 95 Street
Miami Shores, FL
Project: <NONE>
Contractor: A SUPER SEPTIC TANK, INC.
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Septic
Phone Number
Parcel Number 1131010330580
Phone: (05)364 -0113
Building Department Comments
DRAINFIELD
Inspector Comments
hrs in file
I/
v
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
August 15, 2011
For Inspections please call: (305)762 -4949
Page 1 of 1
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
BUILD. Gc"
PERMIT APPLICATION
FBC 20
Permit Type: PLUMBING
Owner's Name (Fee Simple Titleholder) ` ��� � /IA"' 'fif et,Plione #
mcmgvml
at JAN 2010
Permit No.? L' 1 1 '- I
Master Permit No.
Owner's Address
City /144'1,47 r 5'h �.�-.P f State 2(G�
Tenant/Lessee Name
Email
Job Address (where the work is being done)
City Miami Shores Village
FOLIO / PARCEL #
County
3k 9--7/J
Zip 3 /.5--
Phone #
Miami -Dade Zip
Is Building Historically Designated YES
Contractor's Company Name .5 5
Contractor's Address 4 / ^7 7 7 / j - /
( , -
City C Q e? State (,
NO Flood Zone
L. Phone # j a f 3; i9 e // 3
) - ? i 4 6-(a'
zip ,3 i / ,-
Qualifier Name /9 4ri1� 4e ®- Phone
State Certificate or Registration No. .5-7/7---y ' 7 22--Certificate of Competency No.
Contact Phone '� eia j 9-14 2-t 5-
Architect/Engineer's Name (if applicable)
Value of Work For this Permit $
E -mail
Phone #
qsoo c.)1
Type of Work: EAddition ❑Alteration
Describe Work:
Square / Linear Footage Work: $7
['New Repair/Replace ['Demolition
li
******** ** * ** * * * * * * * ** ** * * * * * * * * * * ** * ** Fees************** * *,* * * ** * * * * * * *** * ** * ** * * ** * * **
Submittal Fee $ Permit Fee $ /56
Notary $ Training/Education Fee $
CCF $ CO /CC $
Scanning $ Radon $ DPBR $
Double Fee $ /5'0 Violation date:
Structural Review. $
Technology Fee $
Bond $ —
Total Fee Now Due $
See Reverse side -+
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City State Zip
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all
applicable laws regulating construction and zoning.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR
IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN
FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORDING YOUR NOTICE OF COMMENCEMENT."
Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspec ion which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not . ri e approved a r- . spec .'on fee will be charged.
Signature
Signature
Owner or Agent ntractor
The f going instrument was a lwledged before me s ) The fo oiyn}g�instrument was ackno led d before
day o 0 ft, by �'� 'ry t ' ��1 ( day of MD , 2011 , by Al 0
who is .ersonall kn.wn t me or who has roduced
�y r'� p � � who is per onally wn tope or who has produced
)5 / -0 V1- 1 l entification and who did take an oath. OD 2..-0 12, altification and who did take an oath.
N TAR PUBLIC:
q
NOT
Sign:
Print:
My Commission Expires:
0
Sign:
Print:
My Commission Expires:
***************** * *Ar9r*9r**Ar*#r4r4r*** *de dc9e*9e**9c9e****k ***9t****** *9riraYa'e** ** 9c****9e***9e3r& ***,Y****dr**9r:Fdr*****k***
APPROVED BY
tY-
Plans Examiner Zoning
Engineer
(Revised 07 /10 /07)(Revised 06/10/2009)
Clerk checked
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION' INSPEC IN AND FINAL APPROVAL
PERMIT NO0 79- ' of
DATE PAID.
FEE PAID.
RECEIPT #:
APPLICANT;
AGENT:`+'
PROPERTY ADDRESS:
L01" 3 - BLOCK /3
PROPERTY ID #'
CHECKED .[X] ITEMS ARE NOT IN CO
TANK INSTALLATION
•j01]• TANK SIZE [1] [2]
[02] TANK MATERIAL
[03]. OUTLET REVICE
{04] MULTI - CHAMBERED
OUTLET FILTER
PLIANCE WITH STATUTE OR RULE,; AND MUST BE CORRECTED.
SETBACKS
[27] SURFACE WATER
[28] DITCHES
[29] PRIVATE WELLS FT
[30] ' ° PUBLIC WELLS FT
] [31] IRRIGATION WELLS , FT
[32] POTABLE WATER LINES YO FT
[33] BUILDING FOUNDATION FT
[34] PROPERTY LINES d-r' FT
[351 OTHER FT
FILLED i MOUND SYSTEM
[36]; GRAINFIELD COVER
[37] SHOULDERS
[38], SLOPES
[39] STABILIZATION p
[06] L °'
[07] WAT
[08] LEV' .
[09] DEP
DRAINF4D
[10] Ali
[11]
[1.2] NUM
STALLATION
'DIS ® IBUTION BOX
R OF D .' a r ""
LINE SEPA T No`
INLINE SLOP
TH OF CO/1
ATIOt [AB
[ ]
[ ) 4] D
[ ; ] _[ 5] ` DE
[ ] [ 6] EL;
[ ] [ 7] SY EIVI LOGATIO
[ j [ :] DO IMO PUMPS
[ ] [ 9] .. AGO ® :GATE SIZE
] ,.. ,[ of AGG'REGATE€CC`•
[21] AGGREGATE DEPTHf,/s
SIVE FINES
FILL / EXCAVATION MATERIAL
[22].'; H1712 AM60 Ij1T `
[23] FILL TEXTURE'
] [25]'AREA REPLACED
] [26] RERLAO MENT MATERIAL
PLANATION OF V]Ot,,4TI'ONS /,REMA_F
ADDITIONAL INFORMATION
[40] UNOBSTRUCTED. AREA
[41] STORMWATER RUNOFF
[42] ALARMS
[43] MAINTENANCE AGREEMENT
[44] BUILI?ING.AREA
[45] " . LOCATION CONFORMS WITH SITE PLAN
[]- FINAL SITE GRADING"
[47] ; CONTRACTOR'°°`
,[4;.. is OTHER
�[3A#j4QNME tJT
[4�3] TANK PUMPED"
[50f TANK CRUSHED & FILLED
CONSTRUCTIO PPRV+E , SAP-PROVED
FINAL SYS APPI VE DISAPPROVED].
CHD IaATE
DH 4016 {Page 2), 10197 (Previous Editions May Be Used)
Stock Number: 5744;002- 4016 -4
PT 1: Applicant
PT 2: Installer/Contractor
PT 3: Building Department
(805) askAr— or&VA
STATE OF TLOORIDA
DEBT OF HEALTH
ONSITE =NAGE =Mow AND DISPOSAL
MUM
comsanucTias URN= VON!
APPLICANT: Fiarencio Caballero
=OPIUM J1DDNN= : 45 t4{N 95 St
OSTDS Repair
Ft. 33150
0;13404295M
APPLICATION a :AP989668
DAMS MUD.
VMS PAID:
ASC£I1T 0:
noctutsm a: 3135$
LOT: 22-23 BLOCK: 131
FROP3RTY ID 8:
9D'J 0 142ad'f: Miomi Shores
2P, PaSaS , Ply 1
(03 2*2 IN COMM
015= MOST No coATTAOCINO ACCOFDANtsi oiTo evaerriCaTiOss Ato STANIMINDO Of 9I T =N
381-006s, F. s . , AND =Aft= 641-6# I.A. c. OCIANMABAT ABANOWAL or SYS= DOTS SOT
SATISFACTORY TOR ANT o;I• T3SR. ABM MAMBO IN MA R2 LL MTS.
W➢BXCB SERVAD A3 A PASIS 808 Tssoftmcc OF TRIG , MOO= TAB APPLICANT MO NDDZ!"Y Tag
939012 A13LSCATZ01. SVCS ADDISICATIONS NON BABOLT OS TAI* PARNIT BRING MAW NULL AND VOID.
10901303 O£ MI6 =OMIT DOSS NOT =Mrs Tim APPLICANT Pmt R MONAAL,
02023, OR LOCAL PASAMTITAG =sumo FOR DIVISIONNANT VS ISIS TROPINATI.
SYBTI 1 NUM AND APIC IPICATtl1l4t3
T
A t
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xt
900 1 TAI&ONO / AND Senile
O 1 0oxLoNS / GPD
O 1 GALLONS CANADA INISPORVAO% CAPACITY
CALICOS DOSING TRAT CAPACITY
CAPACITY
0515022
sawasai maw= ma= CALM 1250 c*trlA03I
8t )DOORS 10112 24 AN2 #Pwwcs
u t 225 WASS TEST
SYWNSM
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I I0s: (01 =NM t1aND t1
!' LOCATION O8 BANCANAAKI
t J
F.F.E.: 11.813' NOW
i 8LTVAT20N OF AMMO= 0302S 81'23
3 BOTTOM OF DRAINFISLD TO HA'
L
t 10.80 zNoNTABOT- E 10203
t 34.80 FT 11 ABOV8 MAIM ININTETSBNONPANTNCT POINT
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I THIS PERMIT IS NOT FOR ADDITION(*) E "."'
vlv' Cnc wn•'htax!
DAIS 1saUPD: 01/1111011
Dada
on a016. 08/09 (ODaol*taa all pravianse edition which saw oaths us*011
Incazporat*d: 623 - 6.003. SAC
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9SS332f1.
04/11/2011
CUD
Paco 1 aT 3
01/10/2011 MOD MISCELLANEOUS APPLICATION PAGE 1
14:18:13 BOVEA
APPLICATION DATE 01/10/2011 PROCESS NO. X2011035396
OTHER DEPT. APPLICATION # OR BLDG DEPT. PERMIT # /ADDRESS: AP 989668
CONTACT NAME ANDY A SUPER SUB TOTAL $200.00
ADDRESS 7701 W 18 LANE
CITY HIALEAH STATE FL ZIP 33014 PHONE 3053640113
COUNTY AGENCY
SALES FEE UNIT USER PAID
TYPE CODE UNITS DESC FEE DESCRIPTION ID FEE IND DEL
DOH H015 1 EACH IRRIGATION WELL BOVEA 200.00
PF1 = UPDATE PF5 = ADD MORE FEE PF8 = NEXT PAGE
NEXT SCREEN NEXT KEY
PF9 = ADD MISC APL
dISC APPL FEES SUCCESSFULLY MODIFIED—ENTER NEXT KEY TO CONTINUE
MIAMI-D COUNTY, ;
MIAMI —DADE COUNTY
BUILDING AND NEIGHBORHOOD COMPLIANCE DEPARTMENT
11805 SW 26 STREET
MIAMI, FL 33175 -2474
(786) 315 2000
ROCESS NO o X2011035396
NDY A SUPER
701W 18 LANE
I AL AH, FL 33014
REVIEW FEE
TYPE CODE
DOH H015 IRRIGATIO
01/10/2011
UNIT FEE
DESC AMOUNT
200.00
200.00