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PL-11-1232if Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 161836 Permit Number: PL -7 -11 -1232 Scheduled Inspection Date: December 09, 2011 Inspector: Hernandez, Rafael Owner: BLONDET, RICARDO Job Address: 1096 NE 97 Street Miami Shores, FL 33138 -2556 Project: <NONE> Contractor: STATEWIDE SEPTIC CONNECTIONS Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Drainfield Phone Number Parcel Number 1132050170180 Phone: (954)963 -0082 Building Department Comments DRAINFIELD 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 08, 2011 For Inspections please call: (305)762-4949 Page 2 of 14 la DEC 08 2011 z B Y \! DIVISION or Envima6tal Health Florida Department of Health Miami -Dade County Health Department OSTDS/Well Division-' 11805 SW 26 St. • Mlsmi, FL 33175 Ilupector• .t1�. -... _ 4 Date . L AaanU ,icy QSTDS # 6 P10 V(9 Y7 Comments: •`') ' i -1/9 - , s Signature. A-4- 2d STATE.OF FLORIDA ,-- 1°2 DEPARTMENT OF HEALTH 1 ONSITE SEWAGE TR:E4TtENT AND DISPOSALSYSTEM CONSTRUCTION IINI6 aITION AND FINAL .APPROVAL PERMIT NO DATE PAID: 'FEE: PAID: RECEIPT #: PROPERTY :ADDRESS , LOT: I3LOPItt. 1, t;BC�AIS((1 CHECKED - -[q 4 EMS ARE NOT tN .cU117IRLIMIr TANK INSTALLATION [ „ I [01] TANK'. SIZE [1] % ! [[2], [ —.1 [021 e-..TANK °MATERIAL [ ems] [031 OUTLET DEVICE - [ - [04} MULTI-CHAMBERED ' a [ - (08] - OUTLET-FILTER [ ] [06] . ; LEGEND iMlTki , STATUTE-OR-:RULE _RULE AND MUST BE CORRECTED. [ [07] WATERTIGHT [ —1 [08] LEVEL 4 .. -- [691.. D;kt TAI,iJ SETBACKS S9RFACE WATER [28J DITCl4ES [29] PRIVATE WELLS [30] PUBLIC WELLS 131] IRRIGATION WELLS'1 [32] ` . POTABLE WATER LINES 133}- BUILDING 'FOUNDATION -. PROPERTY. LINES OTHER- fitl�l`:f15 9 p7,10'S.YSTEM (36]' D AFNFIELD COVER , [3]; SHOULDERS [3!I] [391; # STABILIZATION s' ApOMONAL ::INFORMATION UNOBSTRUCTED'tAREIk .5-TOAMWATER RUNOFF (42] ;n AL4fIMS 431 s I I EN I OE J, etiEENIENT C44] " UIL AREAi . = [45] x4 p I GON % S WNT.:1, SITE.. �FiIN01yLR1TE. GRADUyp DIRER •EXPLANATIO1 PI'ROV DH• 4016 (Page CHD DATA At 1O/97 (Pr9Vlous Editions Maur Ue Us' Stock Numb'e[2'074..4 -00?4 i6-4 P71: •Applltant • t'T 1nstatler/Gontractor -PT BuadIn Department '14,t 4r Health Department • • 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 BUILDING PERMIT APPLICATION FBC 20 JUL 1 1 2011 ,�„ „o Q1 11-1233 Permit Master Permit No. Permit Type: PLUMBING OWNER: Name (Fee Simple Titleholder): Citw O 6) iZ _ Phone #: 3© S 34-7.---U7 50 Address: C 9 C r4- 97 T � City: S 1"'t2.S‘ State: f 3 .. Zip: /3& Tenant/Lessee Name: Phone #: Email: JOB ADDRESS: • lo.9& Ne Si- City: Folio/Parcel #: Miami Shores County: Is the Building Historically Designated: Yes Miami Dade pito Zip: 3'3 /38 NO CONTRACTOR: Company Name: ��++ (�:���.l s City: _ a v Qualifier Name: Address: Flood Zone: 1--66 33 Phone #: ( r. •-O.- Phone #: State Certification or Registration #: cOv10 91 ( L Certificate of Competency #: Contact Phone #: Email Address: DESIGNER: Architect/Engineer: Phone #: i� y Value of Work for this Permit: $ V `-0 Square/Linear Footage of Work: '225 Type of Work: DAddress ❑Alteration ❑New epair/Replace ❑Demolition Description of Work: 1V V ‘')- td, ')+ **** ** *+ r********* ************** ***** **+ Fees*, x****** ***, x***+x *+x+x*********** * * **** u******* Submittal Fee $ Permit Fee $ ) SO 00 CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ CC t —7- Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ (6,(0 . .30 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 t be approved and a reinspection fee will be charged. Signature ( 4 Owner or Agent The foregoing instrument was acknowledged before me this 0 6 day of (30 tQ , 20 I L , by g'‘Ceri re o who is personally known to me or who has produced ®� V • ��-- As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: emmmmasamaamauaumamammuumamaaaaaauammamaa 'TERESA J. SOLOMON e•"u' "a Comm# DD0733348 1 a res 11/8/2011 ry Assn.. Inc My Commission Expires: PAY TO ME ORDEN OF WACNOVIA BANK, NA. **nk+ H*****B**+k*x+ ***sk***** t- N_ t*+ k+ k**+ k* *dssNsk+ k**+ k✓ E+ N*Hs ** ***** skNaikax*********A k**+ k* ***yA****K k*+k+k+k*+kKa*+k+F****** Signature The fo day of who • Contractor g instrument w''as��acknosledged , 20 by 'Gl to me or who has produced as identification and who did take an oath. Sign: Print: My Commission Expires: QA #01.X11 :Cot ,...- ,,, •, . • i 'Eaves' sofa" DEPOSIT r' ` C'.'!?'l_NECTIONS, INC. APPROVED BY �A Plans Examiner Structural Review (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) Zoning Clerk 07/11/2011 08:45 FAX STATE OF FLORIDA DEPARTMENT OP HEALTH MITE SEA TREAMMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT CoNBTRHCTToN PZPMtT FOR: OSTDS Repair APPLICANT; Ricardo Blondet BROPEATY ADD, SS! 1096 NE 97 St Miami, FL 33138 LOT: 6 BLOCK: 181 sonoivISYQN: Miami Shores PROPERTY ID #1 11- 205 -017 -0180 IJ001/002 PIANZT *:13 -SC■1358808 APPLSCASr0N +: AP1040947 iE PAID: sae PAIDi RECEIPT 81 DDCOoNT •: PR849174 [SECTION, TOH88813, RANGE, PARCEL NOMBER] Loa TAB ID =OM SYSTEM MUST 88 CONSTRUCTED IN ACCORDANCE WITH SPACIFICRr' EONS AND MIMED!) Op SECTION 381.0055, 1.8., AND CURTER 64E -6, F.A.C. DEPARTMENT APPROVAL 08 SYSTEL= MS ROT =Rams SATISFACTORY VTAFORNANaN FOR ANT SPECIFIC 13RI00 OF TINE. ANA CEA= IN W ERYAL FACTS, MICR SERVED AS A BASIS FOR ISSUANCE OF THIS PERMIT, REQO'>it8 TEE APPLICANT TO Moaz>i's TEE PERMIT APPLI CATION. SVCS MODIFICATIONS 101T RESULT IN TAMS PEAIIT RRII,IG RADE MULL AND 'VOID. ISSUANCE OF THIS PERMIT DOER NOT EXEMPT TAN APPLICANT FROM COMPLIANCE WITS OTR$E FEDERAL, STATE, OR LOCAL PERMITTING REQUIRED v'OR DEVELOPMANT OF TRIG PRO$RTY. 8Y80 N DESIGN AND SPECISTCATI@IS T [ A N [ K [ 900 ] GALLONS / GAD Existinu septic tank to remain CAPACITY 0 l GALLDNB / CIO CAPACITY 0 ] GALLOWS GREASE INTZPODPTOK CAPACITY POUCORECCAPACITY SIITQLA TA3SC:1.250 GALLONS] 3 GALLONS D08n80 TANK CAPACITY L NALL= 81 Men PEA 24 ARS SPures [ 1 D [ 225 ] WARE FEET Trenoh configuration draL SYSTEM R [ 0 ] SQUABS FEET SYSTEM A TYPE SYSTEM; Ls] BTANDA5D 1 ] SUM I] NOONE I C0NFIGURATIO1I: [x] TRENCH [ 3 saw ( ] N B' X.00ATION OF SENCRMAKK: F.F.E., 12.40' NOVD I ELEVATION OF PROPOSED 818T881S SITE [ 2520 ] E >ti0TTWQ OF DEAINF78LD TO SE [ 61.20 ] L a YILL REQUUID: 0 T R INCHES FT 31 ABOVE FT 3 (ABOVE DELCO 88liCE193Z/REISSZV0g some DEN 801PT [ 0.00 I ID=1:13 Ex0A4ATI0N ANQUIRT03 [ 36.00 3 130833 'Invert elevation of drainfield to be no less than 7.80 ft. NOW. *Bottom of d:ainfield elevation to be no leas them 7.30 R. N(31HD. THIS PERMIT IS NOT FOR "ADDITION(e) ", R SBECIFICATiO2IS 8Y: lo■ 1d Ivaaa APPROVED EY, DATE TRACED: 07/08/2011 DR 4016, 08/09 (Mapleton all pr vioas edition, which agy not be wad) 1noorporatodi 64E- 6.003, FAC v1.1.4 A0000441 Dade EXPEEsTiom DUE: 10/05/2011 W47710 ORD Page 3. or 3 07/11/2011 08:46 FAX I NOTICE OF RIGHTS A party whose substantial interest is affected by this order may petition for an administrative hearing pursuant to sections 120.588 and 120.57. Florida Statutes. Such proceedings are governed by Rule 28 -108, Florida Administrative Code. A petition for administrative hearing must be in writing and must be received by the Agency Clerk for the Department, within twenty -one (21) days from the receipt of this order. The address of the Agency Clerk is 4052 Bald Cypress Way, BIN # A02, Tallahassee, Florida 32399 -1703. The Agency Clerk's facsimile number is 850 -410 -1448. Mediation is not available as an alternative remedy. Your failure to submit a petition for hearing within 21 days from receipt of this order will constitute a waiver of your right to an administrative hearing, and this order shall become a 'final order'. Should this order become a final order, a party who Is adversely affected by it is entitled to judicial review pursuant to Section 120.68, Florida Statutes. Review proceedings are governed by the Florida Rules of Appellate Procedure. Such proceedings may be commenced by filing one copy of a Notice of Appeal with the Agency Clerk of the Department of Health and a second copy, accompanied by the fling fees required by law, with the Court of Appeal In the appropriate District Court. The notice must be filed within 30 days of rendition of the final order. 41 002/002