PL-11-1184Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 161510
Scheduled Inspection Date: August 31, 2011
Inspector: Hernandez, Rafael
Owner: DELHOMME, CHARITABLE
Job Address: 262 NW 111 Terrace
Miami Shores, FL 33168-
Project: <NONE>
Contractor: A AARON SUPER ROOTER
Permit Number: PL -6 -11 -1184
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Drainfield
Phone Number
Parcel Number 1121360010610
Phone: 305 - 944 -8886
Building Department Comments
REPALCE DRAINFIELD
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
HRs
August 30, 2011
For Inspections please call: (305)762 -4949
Page 11 of 34
Inspector
Addre s
Comments:
Signature
PL6-11-1184
Borld #(240/4_9
DIVISION Of
Environmental Health
Florida Department of Health
Miami-Dade County Health Departmen
OSTDSOrgrbivision
11805 SW 26 St, • Miami, FL 33175
•."
Ofir
411.
Date
0STDS #
fi
642.41tt - LO FULL-
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
JUN 2 (3 R EID
BUILDING Permit No .R.-
PERMIT APPLICATION
FBC 20
Master Permit No.
Permit Type: PLUMBING
Abe, hon'Irryt
OWNER: Name (Fee Simple Titleholder): 01r% O`er 'C ti CV, 44' b Pe' Phone #: 50C S2 , o
Address: 2- b L V1
City: MICtorki ,S State: f Zip: 33I S�
Tenant/Lessee Name: Phone #:
Email:
JOB ADDRESS:
City:
Folio/Parcel #:
2 N v4 t
Miami Shores County:
R-2-13E 001- 06f0
Miami Dade
Zip: 3°3i 5-6
Is the Building Historically Designated: Yes NO 1. Flood Zone:
CONTRACTOR: Company Name: A ,, .0 (2...,, i ,, 4_ Phone #: ,)i q`i 2
Address: C ® 2-7- ..'...1 Cl-
City: \ ca State: F5— Zip:
33'C)z3
Qualifier Name: J0 CAek. TO Phone #:
State Certification or Registration #: (f00° Certificate of Competency #:
Contact Phone #: Email Address:
DESIGNER: Architect/Engineer: Phone #:
Value of Work for this Permit: $ 2-2 ®` Square/Linear Footage of Work:
22.5
Type of Work: ❑Address ❑Alteration
Description of Work:
UNew • epair/Replace
Grae .lot 141-ad
❑Demolition
**** * *** * ** **** *+ x*+ x*+ x+ xx: *** ********* Fees****** **+ x****+ x*********************+x********
Submittal Fee $' ;- 1� Permit Fee $ CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $ ">
Bonding Company's Name (if applicable)
Bonding Company's Address 1
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 exceed g $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure ll be delivered to the person
whose properly is. subject to attachment. Also, a certified copy of the recorded notice of conunenceme' must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the a ce of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature
or Agent
The foregoing instrument was acknowledged before me this 2.
day of Juv ,20 .,by RO cj ure Gelb o
who is personally known to me or who has produced
L
As identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print: k ,c d i�
My Commission EittftW:IEgg. SOLOMO7
Comm# DD0733344
r%
' Expires 111612011
T' �c
******* ******sI* **VI No I ***iNiN*sk*****Nk*:N******
Signature
Contractor
The foregoing instrument was acknowledged before me this
day of C_�k , 20 .�, by (" 'f"
who is personally known to me or who has produced
OVVJ tiCir'" as identification and who did take an oath.
NOTARY PUBLIC:
f ViOa,; olffitesan.
PQ733346
111W2011
APPROVED BY
''",q110R ++ eeeeeee De' „epeeeeeee7eO
nmme9eeepmee' eee
Plans Examiner
Structural Review
(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09)
Zoning
Clerk
06/27/11 03:03PM STATEUIDE SEPTIC CONNECTIONS INC
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pl-u-
i'''STATE 08 FLORIDA
DEPARTMENT or HEALTH
ON$ITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION PERHQT
CONSTRUCTION PramIT sox: OSTDS Repair
APPLICANT: a Charitable
PROPERTT At Wain ; 282 NW 111 Ter Miami, FL 33188
LOT: 13 MOM 3
PRomer xe 1': 11- 2138 - 1104 -0620
amammemmommomc
9549630085
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IMMO x;1340- 4366462
APPLICATxa t #: AP 1 Q39672
DATE LAID;
rre PAID
RECEIPT #:
DOCUMENT #J P848119
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t81SCTION, T'OtE'Y$Sixp, RANDS, PARC$A = R)
(OR ` aX Ile Maturimj
STUNK NM DR cossee ic'1'zo X1 =OXMAN= WXTH SPPCIPICATX0133 AND mamma or s1'CTYO1'
381.0015, 8'.H., Ate? COAST= 64E -6, B'.A.C. DIPARDEENT AP8*o!QL OP MUM DOES NOT =RAZ=
SATx$8ACT0ar PSRPORMANCE > ANY &P&CZP'XC Plane or TIM ANY' CHANCE TN 40a2Malt
ETCH S>F:RVSm► AS A SLOTS FOR ISSt1 C£ or TAU PERMIT, REQUZAN TEE APPLICANT TO 2 0DINT T'$8
PERMIT APPLEORTxON. $CMOE MDDiPICATTON'8 MAY MOLT TV THIS ITIANXT gS g NCLL AND VOID.
ISSUANCE 08 THI8 MUM DOES NOT EXEMPT THE APPLICANT PROD! COMPLIANCE ME OTHER MUUNOW4
STATE. OR LOCAL sluoinTraa min= FoR DZ'V>CLOPD!&!4T 0S' Tun =mum?.
02 1'.
SISTEM I:NEtiDt AND 8PSCEPTCRTION9
T
A t
R't
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750 7 CALLC1S / 0140 Septic CAPACITY
0 3 0ALL041$ / GPD CAPACITY
0 ] =moss Maas =mouton CAPACITY to AIMOM CAPACItTT 8ZSe;so TIM R0250 G5X 3
3 GALLONS DOSING TANS C1D8AC.i3'Y t j0*L ON$ Of jn0SES TNA 24 001 Sirumps t
D t rah 3 SQUARE FEET SYSTEM
At 0 3 eQuium 12ET
SYSTEM
T11E SYSTEM; tzj SURD t 3 FILLED t 3 M0p3W t 3
I OaNPICORATION: 1x3 TUMOR [ 3 E1'D i 3
N
1P Locooxow or nooc : F.F.E.: 11.8' NOVD
I ELEVATION car PRCaasma SYSTEM mg t $-40 1 INCR3 = TT 3 t A1i0V0 _,: , �.,�. .,...._.,
1S 1DC1TTC4d OF D DLO TO RD t 38A0 3
'f i FT 1 t ABOVE /i S N 3311EMMINIS2PERMECE POINT
L
Dmu e
3
ID: t 0.00 .3 ids EX�A' VATIt3'N 04srs1 D: t 30.001 =CM
11 -ding 790 gal. septic tank ecrtcll9ed by u A Aar Super Roofer" on 06121/2411 to remain. 2 -Install 225 if of
0 dns€nflefd)n trench
s (absorption tram. 4-Invert etevaticm of drallnfletd to b lees than 9.0' NGVD. 5, gym of nfia elevation
t be
no less than 41.60' NOW.
a
THIS PERMIT IS NOT FOR ADDITION(c)
BPECEFIC7►TIONS
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CID
STATEWIDE SEPTIC CONNECTIONS INC
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9549630085
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STATE OF FLORIDA
DEPARTMENT OF HEALTH
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT „ I I ��
Permit Application Number z .
• PART II - SITE PLAN-
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Site Plan submitted by
Plan Approved
By,
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ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
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