PL-11-10234,
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 164867 Permit Number: PL -6 -11 -1023
Scheduled Inspection Date: September 28, 2011
Inspector: Hernandez, Rafael
Owner: BROWN, DANA
Job Address: 302 NE 97 Street
Miami Shores, FL
Project: <NONE>
Contractor: STATEWIDE SEPTIC CONNECTIONS
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Septic
Phone Number
Parcel Number 1132060135870
Phone: (954)963 -0082
Building Department Comments
REPLACE TANK & DRAINFIELD
Passed
x
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
CREATED AS REINSPECTION FOR INSP- 160633. HRS IN FILE missing
sod
September 27, 2011
For Inspections please call: (305)762 -4949
Page 25 of 26
DIVISION OF
Environmental Health
Florida Department of Health
Nliami-Dade County Health Department
OSTDS/Well Division
ii805 SW 26 St. - Miami, FL 3.317
inspector Date
Address
Comments:
Signature
1
1
Project Address
Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138 -0000
Phone: (305)795 -2204
Parcel Number
Expiration: 12/04/2011
Applicant
302 NE 97 Street
Miami Shores, FL
1132060135870
Block: Lot:
DANA BROWN
Owner Information
Address
Phone
CeII
DANA BROWN
302 NE 97 ST
MIAMI SHORES FL 33138 -2406
Contractor(s) Phone
STATEWIDE SEPTIC CONNECTIONS (954)963 -0082
CeII Phone
Type of Work: SEPTIC
Type of Piping: TANK AND DRAINFIELD
Additional Info:
Bond Retum :
Classification: Residential
Scanning: 1
Fees Due
Bond Type - Owners Bond
CCF
DBPR Fee
DCA Fee
Education Surcharge
Permit Fee
Scanning Fee
Technology Fee
Total:
Amount
$300.00
$1.80
$2.25
$2.25
$0.60
$150.00
$3.00
$2.40
$462.30
Pay Date Pay Type
Invoice # PL -6 -11 -41136
06/03/2011 Check #: 4439 $ 300.00 $ 162.30
06/03/2011 Check #: 2237 $ 50.00 $ 112.30
06/07/2011 Cash $ 112.30 $ 0.00
Bond #: 2047
Amt Paid Amt Due
Available Inspections:
Inspection Type:
HRS Approval
Final
-1
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL PLUMBING, MECHANICAL WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNERS 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. Futhermore, I authorize the above -named contractor to do the work stated.
June 07, 2011
Authorized Signature: Owner / Applicant / Contractor / Agent
Building Department Copy
Date
June 07, 2011 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
I /
JON
20/,
BUILDING Permit No. 171—A 001i6
PERMIT APPLICATION
FBC 20
Master Permit No.
Permit Type: PLUMBING (�
y �' tJ1-�0 Phone #: `5 (15G ^ O %1 2.
OWNER: Name (Fee Simple Titleholder) .,3 1 �Q n.�
Address: '302 lei e cri "r
City: "A ro+; -Selo 4es State: ci Zip: 3 9 ( 38
Tenant/Lessee Name: Phone #:
Email:
JOB ADDRESS: 302- N E 9' 7 .54-
City: Miami Shores County: TM Miami Dade Zip: 3'1',
Folio/Parcel #: (1 - ?J' z®, - c srl®
Is the Building Historically Designated: Yes NO Flood Zone:
CONTRACTOR: Company Name: 'q^�P�! iok �� G CONAi'+4 Phone #: 3' 661- (0 (' 33
Address: .3 sc O s M 1 24.
City: %`� aryl State: FL, Zip: '330Z3
Qualifier Name: �r eCc (Q Phone #:
State Certification or Registration #: Sr- C' 1 kft-C, Z. Certificate of Competency #:
Contact Phone #: Email Address:
DESIGNER: Architect/Engineer: Phone #:
Value of Work for this Permit: $ 2®'* Square/Linear Footage of Work:
Type of Work: ❑Address ❑Alteration ❑New ' Repair/Replace
0, Cf2- -t orc—rcvdtkd
Description of Work:
❑Demolition
°Ieo 4110,0, kGrE 225' OY'a+,n c\-e d .
** *+***** * * *x�**** ** * * * * * * * * * ** **** x�* x:: x*** pees:x *�xx�x�a�:xx�** **** ** * *** x:x **** * *******�x** **** * **
Submittal Fee $ Cam) Permit Fee $ .70 v - CCF $ CO /CC - $-
�
Scanning Fee $ Radon Fee $ DBPR $ Bond $c 7�-� ‘�
Notary $ Training/Education Fee $ Technology Fee $r
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $
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 $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signatur8J Ah ?4f" *i Z
Owner or Agent
The foregoing instrument was acknowledged before me this 2-
day of , 20 11 , by , ,k
who is personally known to me or who has produced 1)f '''o°
L' c a, V As identification and who did take an oath.
NOTARY PUBLIC:
Q•
Contractor
The foregoing instrument was acknowledged before me this 5
day of Lh .- , 20 tl , by i fL CY3- SAk9r t$
who is sonally knowirteplie or who has produced ct.
as identification and who did take oath.
NOTARY PUBLIC:
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Print: cared' �1 ri,:fiNavv.,04,74,:ls nevveevsevveeevvueseeevea - �:• 03\061 �®\ \C •:
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APPROVED BY
Plans Examiner Zoning
Structural Review Clerk
(Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09)
STATE OS FT,OXIDA
DEPARTMENT OF HEALTH
(MUTE SEM= T1 EATIONT AND G.Q P'Y'
SYSTEM
cONBTRVt:Troi+t pERNIT Miami -Dade County Health Dapdnmet PAID: —
O.8.T.D.S. & W II Program cH =PT':
9:PFts a
PERMIT .:111Y244121461---
APPLICATION At Ap1037662
DATE PAM_ —
141
CONSTRUCTION PERMIT POR: OSTD$ Repai ---r
APPL=C1,NT; Joy g Dane Brown_
PROPERTY ADDRESS: 302 NE 97 st
LOT! 11-12
Miami, FL 33138
9LQCx: 43 8tr8DTvi8IONt Mlernl Shores
(SE:CT=ON, ToNISBIP, RANGE, PARCEL SOMBER]
tOR Tax TD =NM]
PROPERTY m it: 11-3206;0134870
SYSTEM MUST SE CONSTRICTED IN ACCORDANCE MITE SPECIFICATIONS AND STANDARDS OF SECT=
391.0065, S.S., AND CRAPTSR 94E -6, S.A.O. DEPARTleti1QT APPRCDAL OP BYl9'l'EN DOES NOT' GQARANTBB
SATIBPACTORy ONCE FOR ANT BPECYFIC PER= OF TIME. ANY DRAM IN ILATERIAL FACTS,
WHIC6 SERVED AS A 811858 rOR ISIDANCE OF THIS PERMIT, REQUIRE TE8 APPLICANT TO mars TPIF
PEN NI! APPLICATION. SUCH MODIFICATIONS MAT RESULT IN THIS PERMIT BEING MADE NULL AND VOID.
ISBTANOE OF THIS PERMIT D0$8 NOT EXEMPT THE APPLICANT PROM COMPLIANCE WITH OTHER FEDERAL,
STATE, Op LOCAL PERMITTING REWIRED SOR DEVELOPMENT OP THIS PROPERTY.
BMX DESIGN AND SPECIFICATIONS
T [
A [
N [
R [
900 1 GALLONS / GPD Septic
0 3 Ort►LLONB / 6PD
CAPACITY
0 ] GALLOAB GREASEERCEPTOR CAPACITY CAPACIT7[
aosrR;G TAM CAPACZ [ cAPACrTY sums TAli1x:1250 =SONS]
3 •bQNS T= [ ]GALZONa et ]DOSES PER 24 Rgn *spa t 3
SYSTEM
SYSTEM
I CC F GQRATIQN. [X] TRENCH t t3 �r [ 3 [ ] MOUND ( ]
LOCATION OF EEN07 ARx; F �.E.;12.g0' NGVD.
ELEVAT =OR OS PROPOSED SYSTEM SITE
BOTTOM OP' ER*INPTIyD TO DE
D t 225 7 SQUARE FEET
R t 0 ] RODARE BEET
A TYPE SYSTEM [a] DMill6ARD.
L
D
0
T
H
E
R
FILL PNQUIRBD, t 0.00 3 ZNOHE9
EXCAVATION REQUIRED: t 30.00 1 INCHES
1- Install 900 gal. category-3 septic tank equipped with an approved )liter. 2 -The Itrensed
System Is reaponsibi�a far Installlrtg the minimum contractor Installing the
sf st of m la rea In trend r In to rng th. minimum category of tank in accordance with sec. 64E.8.013(3)(f). 3- Install 2 5
proposed absorption bed. G- Invert a ev t;on of drainfeld to be no Tess than 8.12tNOVO, 8, wider
Bottom of dralnfteld the
elevation to be no lase than 7.52' NOVO.
THIS PERMIT IS NOT FOR ADDITION(s)
[ 29.701 [ D B FT 1 r ABOVE
[
59.70 t�IttCtiegl PT 3 [ AUOVE
NENC C /REPZIENCR POINT
1[/ E5'E ENCE POINT
aveozrzcArmts
APPP.OVED BY:
DATE I38DED:
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100 /l00 fifJ
Ap1037 62
=Tun= DATE: 0813_
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