PL-11-1543Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 163628 Permit Number: PL -8 -11 -1543
Scheduled Inspection Date: December 14, 2011
Inspector: Hernandez, Rafael
Owner: GRATEROL, RAFAEL
Job Address: 240 NE 99 Street
Miami Shores, FL 33138-
Project: <NONE>
Contractor: STATEWIDE SEPTIC CONNECTIONS
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Septic
Phone Number
Parcel Number 1132060134330
Phone: (954)963 -0082
Building Department Comments
TANK AND 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 13, 2011
For Inspections please call: (305)762 -4949
Page 10 of 53
12,0
la DEC p 8 2011
BYNN, ------------
*
DIVISION OF
Environmental Health
Florida Department of Health
Miami-Dade County Health Department
OSTDS/Well Division
11805 SW 26 St.* Miami, PL 33175
Inspector'- Date — 3 C)— /
AddressA Yo fJ.LE. ?:;)--r--;,- 05TDS #19 ifY0 y ti 3 ?,
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
WE IC
AUG 222011 all
Y:
Permit No.�� 1
Y:
4I/
Master Permit No.
Permit Type: PLUMBING
OWNER: Name (Fee Simple Titleholder): ) FAg _ t-t r '6L Phone #:
Address: - c l 1 Sr
City: /4/A111/ 'ADP'6 State: Zip: 5 913'
Tenant/Lessee Name: Phone #: S6 / 7
Email:
JOB ADDRESS: 2 t+O (v G GI
City: Miami Shores County: Miami Dade Zip: ( 8
Folio/Parcel #: 1' ` -5 o 6 °' U (3 - L4-330
Is the Building Historically Designated: Yes NO Flood Zone:
r - 9) Ck1,663s
CONTRACTOR: Company Name:
,,��� +e�7 ci.�,> �+ �' �� Phone #:
Address: 3(_.) S, St ' • zG
City: PI i\ Q /Flat v State: Zip: '3 03
Qualifier Name: ..r � . ,-e'a-1,c: --> Phone #:
State Certification or Registration #: ` Tj 0 q'7 f 2- 6 Certificate of Competency #:
Contact Phone#: Email Address:
DESIGNER: Architect/Engineer: Phone #:
Value of Work for this Permit: $ -i�Cs Square/Linear Footage of Work:
Repair/Replace
Type of Work: ❑Address ❑Alteration New
Description of Work:
22 S
❑Demolition
pic,(12 .1)7 ;r]
**** ***+ x+ x***** *****+a******* ************ Fees**** ***** *******+x+x+u *+x****** * * ****** ** *******
Submittal Fee $ Permit Fee $ 3t 0%— 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) 2
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 $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature
Owner or Agent
The foregoing instrument was acknowledged before me this 19
day of () , 201[ 1 , by ROB ( 6`v'
who is personally known to me or who has produced Pi) V
1
62/1J As identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
'17/'° V.. neeaI at Z e a v0 0 iltrtl \�Mt
'TERESA J. SOLOMON
Comm DD0733348 1
Expires 111812011Y
Fb Assn., •tc
My Commission Expires:
APPROVED BY
1
Signatur
The fore
day of
who is perso
ing in
Contractor
ment was ackno ledged beti
,20 JJ --eire
lly known to me or who has produced
as identification and who did take an oath.
Sign: ?IOWA
Print: �� i .,.� �I1 TB
�,.masae au�° DU717 °13
My Commission Expires: , _Commission 23 Nil
.„fii : Wires: 9EP' ' it
N.„,,,00$
,Q
+ k*+ H*ffirk+ Hrk+ kW HrNaMi ***** Hsayrk***** *** ***** * *** *** * * **************
i--? y f % Plans Examiner
(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09)
Structural Review
Zoning
Clerk
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION PERMIT
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: Mark Beggs
PERMIT #: 13-SC-1364180
APPLICATION #: API 044389
DATE PAID:
FEE PAID:
RECEIPT #:,
DOCUMENT #: PR852106
PROPERTY ADDRESS: 240 NE 99 St Miami, FL 33138
LOT: 6
BLOCK: 32 SUBDIVISION:
PROPERTY ID #: 11- 3206- 013-4330
(SECTION, TOWNSHIP, RANGE, PARCEL NUMBER]
[OR TAX ID NUMBER]
SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF SECTION
381.0065, F.S., AND CHAPTER 64E -6, F.A.C. DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE
SATISFACTORY PERFORMANCE FOR ANY SPECIFIC PERIOD OF TIME. ANY CHANGE IN MATERIAL FACTS,
WHICH SERVED AS A BASIS FOR ISSUANCE OF THIS PERMIT, REQUIRE THE APPLICANT TO MODIFY THE
PERMIT APPLICATION. SUCH MODIFICATIONS MAY RESULT IN THIS PERMIT BEING MADE NULL AND VOID.
ISSUANCE OF THIS PERMIT DOES NOT EXEMPT THE APPLICANT FROM COMPLIANCE WITH OTHER FEDERAL,
STATE, OR LOCAL PERMITTING REQUIRED FOR DEVELOPMENT OF THIS PROPERTY:
SYSTEM DESIGN AND SPECIFICATIONS
T [
A
N [
R [
900 ] GALLONS / GPD Septic
0 ] GALLONS / GPD
0 ] GALLONS GREASE INTERCEPTOR CAPACITY
] GALLONS DOSING TANK CAPACITY
CAPACITY
CAPACITY
(AXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
]GALLONS 0( ]DOSES PER 24 HRS #Pumps [ ]
D [ 225 l SQUARE FEET SYSTEM
R [ 0 ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [x] STANDARD [ 1 FILLED [ ] MOUND [ ]
I CONFIGURATION: [x] TRENCH [ 3 BED [ ]
N
F LOCATION OF BENCHMARK: F.F.E.: 13.5' NGVD.
I ELEVATION OF PROPOSED SYSTEM SITE [ 37.20]['INCHESI
E BOTTOM OF DRAINFIELD TO HE
L
D FILL REQUIRED: [ 0.00 ] INCHES
1— Install 900 gal. category-3 septic tank equipped with an approved filter. 2 -The licensed contractor installing the system
FT ] 1 ABOVE A BELOW b BENCHMARK/REFERENCE POINT
[ 67.20 ] [) INCHES f FT l [ ABOVE 4 BELOW b BENCHMARK /REFERENCE POINT
EXCAVATION REQUIRED: [ 30.00] INCHES
0
T
H
is responsible for installing the minimum category of tank in accordance with sec. 64E- 6.013(3)(f). 3- Install 225 sf of
drainfield in trench configuration. 5- Perimeter of excavation area shall be at least 2 ft wider and longer than the proposed
absorption trench. 6 -Invert elevation of drainfield to be no Tess than 8.40' NGVD. 7. Bottom of drainfield elevation to be
no less than 7.90' NGVD. the
E /me °Orlog%7Or for
R
//) adiaeentd Fns}
THIS PERMIT IS NOT FOR ADDITION(s)
SPECIFICATI
APPROVED
DATE ISSUED:
BY:
re
Ospina ap /�SPe o fh
0
08/16/2011
REPAIR
o MIAMI•DADE C4UNTY HE01 *►a r+eneIN�► t/f
Old d10pa
ill b 4e et, 1/ for a/q�prfration brn? a Dade
anQc'0 Sep' Cif/ s. °.
-Or)? ►TION DATE: 11/14/2011
tune ile =o, lea a 0e
ch may not be ud fo qs
DH 4016, 08/09 (Obsoletes all previous editions whi
incorporated: 64E- 6.003, FAC
v 1.1.4
AP1044389
not
sg850177
Page 1 of 3
STATE OF FLORIDA
DEPARTMENT OF HEALTH •
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PE
Permit Application Number
PART II SITE PLAN --
rf
Scale: Each block. represents 5 feet and 1 inch= 50 feet.
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Notes:
nI •j' .:4ii bJd. fie.,:' t r .a FT t t(r t
s� rarer - . PI MO
7i�? � tt�t>arr mmn■i wales 11 U. ■..■M(
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ma a ■r . papappomppos mpg
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nfm ,m °" • ss//�it a ., tlrr�l ■.rom 1gri 1[na.
,� ��• 11•111111 �r t � ■ rruiaiIatw r 5r
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iur i i i _ . **** * i
Stl�erereJrtteear _..,� '*�? I `K`� 4 ?�`
flOVAIIIII
rrtt
4•arre7
Site Plan submitted by:
Plan Approved
By
tgnature
i1
Date
County Health Department
ALL CHANGES .MUST BE APPROVED' BY THE COUNTY HEALTH DEPARTMENT
OH 4015.1W96(Rep1aaea HRS-H Form 401S width may be used
(Stodb Number:5744 002.4015A
Page 2 of 3