PL-11-2164f
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 166920 Permit Number: PL -11 -11 -2164
Scheduled Inspection Date: December 02, 2011
Inspector: Hernandez, Rafael
Owner: SCHACHL, ALEXANDER
Job Address: 77 NW 107 Street
Miami Shores, FL 33168-
Project: <NONE>
Contractor: STATEWIDE SEPTIC CONNECTIONS
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Septic
Phone Number
Parcel Number 1121360070420
Phone: (954)963 -0082
Building Department Comments
SEPTIC TANK REPLACEMENT
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
HRS IN FILE
December 01, 2011
For Inspections please call: (305)762 -4949
Page 8 of 16
O /VISIOS OF
Environmental Hem
Florida Department of Health
Miami -Dade County Health Department
P rtmeat
OSTDS/W
Ines SW 26 sr. sion
Miami, FL 33175
Date
OSTDS #1477,1c-5--31°t? - .�....�.__.._
,�-�-
Miami Shores Village
Building Department
NOV NO,CrEiT,Tal
La 2 1 2011 ,i1J
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949 ,,
BUILDING Permit Noi2l I1 �. /04--
PERMIT APPLICATION Master Permit No.
FBC 20
Permit Type: PLUMBING
OWNER: Name (Fee Simple Titleholder): So, :41c, L "2Or Phone #: ciS 9÷2-1±6q
Address: 1l 1 J V J 0 7
City: n h; `p �, State: Zip:
Tenant/Lessee Name: i'Y4 4 Phone #:
Email:
JOB ADDRESS: 11 0,1 SI(
City: Miami Shores County: Miami Dade Zip: 3 i &' o
Folio/Parcel #: b d G, ° C O
Ls the Building Historically Designated: Yes
CONTRACTOR: Company Name: Steik4re,j.
Address: -° ,= CI-
City:
NO ;; Flood Zone:
Vkl+ �� a� State: Zip: 5"' )C;Z,
Phone #:
Qualifier Name: � ��'�„ a ?��- ��•,r'��,: �;%�,,�
State Certification or Registration #: Certificate of Competency #:
Contact Phone #: Email Address:
DESIGNER: Architect/Engineer: Phone#:
Valu �. Work for this Permit: $ �'� Square/Linear Footage of Work: N (4
T , of Worlg,
D tiptiou ;Q0 VOrk.
ONew ORepair/Replace
**************** *** ** * *** * ***** ** **** **Feesm+x** •*** *** *mix * * ***** * ***** ** :***********
Submittal Fee $ Permit Fee $ CCF $ CO /CC $
Scanning Fee $ Radon Fee $ �s • 0 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
City State
Zip
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City State �� Zip
Applicati n is her by made to obtain a permit to do the work and installations as indicated. 1 certify that no work or installation has
comma ed prior to a issuance of a permit and that all work will be performed to meet the standards of all laws regulating
constru +tion in this juris ion. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNAC BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC
OWNER'S - 11 AVIT: I certify that,all the foregoing information is accurate and that all work will be done in compliance with all
applicable laws regu . ;'ng construction and zttjning.
"WARNING TO OWNER: \, YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMEN MAY RESULT IN YOUR PAYING TWICE FOR
IMPROVEMENTS TO, YQI R 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 ofuilding 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 issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
SignaturX dam- Signature , Uv-)C � b�
C0 er Agent Contractor
The foregoing instrument was acknowledged before me this. a i The foreg ing in�'. ment was ackn
1,, 11
day of � , 20� � , by ��a ����� �� h +� -( �u � ,; � day of `� - / , 20 , by
who is personally known to me or who has produced P6`'
G ' l y As identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC:
edge. befor: r 1
■iL.A_J l '1;11,
who is personally known to uie or who has produceX1
Sign: ��.'t6: e:�
Print:
My Commission Expires:
* ****** * * * ** * * * * * ** *mix **** **
APPROVED BY
NOTARY PUBLIC:
Sign:
Print:
My Co
d
********************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
/P)114� Plans Examiner
Structural Review
(Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09)
Zoning
Clerk
11/21 / 2011 14 :58 3 05220V28
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