PL-11-2245Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 167357 Permit Number: PL -12 -11 -2245
Scheduled Inspection Date: December 28, 2011
Inspector: Hernandez, Rafael
Owner: WALLACE, JOHN
Job Address: 518 NE 106 Street
Miami Shores, FL 33138 -2046
Project: <NONE>
Contractor: MR C'S PLUMBING SEPTIC INC
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Drainfield
Phone Number
Parcel Number 1122310140211
Phone: (305)651 -7859
Building Department Comments
INSTALL DRAINFIELD
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 28, 2011
For Inspections please call: (305)762 -4949
Page 14 of 28
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
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JAL I
DEC 052019
•
Permit No. 11
Master Permit No.
Permit Type: PLUMBING
OWNER: Name (Fee Simple Titleholder): L34AA 4 c, . Phone #: 716 3s 3 ?G 7
Address: S C (Ss roe-- told it
City: MA CAA � � State:
N�
Zip: 3'13 '
Tenant/Lessee Name: Phone#:
Email:
JOB ADDRESS: SI S` / iei /O t Sr
City: Miami Shores County: Miami Dade Zip: 3 S ! 3 r
Folio/Parcel #: /1 -+ 422g19 - ()Pk 6a1/
Is the Building Historically Designated: Yes NO Flood Zone:
CONTRACTOR: Company Name: m/` C S IO ii-et" Phone#: leg4 57 Y
Address: l' -$ Z. M,t) 2 ** 4,4
City: /'4b ..•.; State: Zip: 3316
Qualifier Name: ''''s/Mt. 4744. Phone#:
State Certification or Registration #: GiY ' l `E• a C 75" 1 Certificate of Competency #:
Contact Phone#: Email Address:
DESIGNER: Architect /Engineer: Phone#:
Value of Work for this Permit: $ as 1( • 00 Square/Linear Footage of Work:
Type of Work: ❑Address ❑Alteration
Description of Work: a"41
❑New ❑Repair/Replace
'ex,/
❑Demolition
e******* * * ** *** **** * * * * *** *************p ees****** ********* ****** **** ********** *****+ ***
Submittal Fee $ Permit Fee $ /5 ' 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
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 �%, (O okeeeae' 1?
Owner or Agent
The foregoing instrument was acknowledged before me this as
day of C ,20 t‘ ,by ikr1 `Nailcce
who is personally known to me or who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission Ex
a�• P� '' MY COMM "
r : WON # OD 89�' 40
* "� : *= tember 14, 2013 EX. �`, 8ondedRhm Note Public OndenMiters
•
Contractor
The f o r e g o i n g instrument was acknowledged b e f o r e m e this.!' °
day of Thee , 20 1 L by ' kn.
who is personally known to me or who has produced �1
as identification and who did take an oath.
NOTARY PUBLIC-
4410,
Sign: •I�
Print:
My Commis
******** *** ******w ************ a#* *+ x** **************** **********+x********
APPROVED BY
X- 62 -7-0
(Revised 07 /10/07)(Revised 06 /10/2009)(Revised 3/15/09)
Plans Examiner
•
KEMBLF. E?'r'RICK
comossioti # 00 891340
, Sr i EXPIRES NSeo:eembar�14,, 20hers
* * *** * * * * * * * * * * * * * ** * * * * * ** * * * **
Zoning
Structural Review Clerk
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM
CONSTRUCTION PERMIT
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT:
John Wallace
PERMIT #: 13-SC-1380655
APPLICATION #: AP1053953
DATE PAID:
FEE PAID:
RECEIPT #:
DOCUMENT #: PR860066
PROPERTY ADDRESS: 518 NE 106 St Miami, FL 33138
LOT: 10,11 BLOCK: 110
PROPERTY ID #: 11 -2231- 014-0211
SUBDIVISION: amd pl miami shores
[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 [ 900 ] GALLONS / GPD Septic CAPACITY
A [ 0 ] GALLONS / GPD CAPACITY
N [ 0 ] GALLONS GREASE INTERCEPTOR CAPACITY EmAx MUM CAPACITY SINGLE TANK:1250 GALLONS]
K [ 1 GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ 1
D [ 300 ] SQUARE FEET SYSTEM
R [ 0 1 SQUARE FEET SYSTEM
A TYPE SYSTEM: [x] STANDARD [ ] FILLED [ ] MOUND [ ]
I CONFIGURATION: [ ] TRENCH [x] BED [ 1
N
F LOCATION OF BENCHMARK: F.F.E.: 12.70' NGVD.
I ELEVATION OF PROPOSED SYSTEM SITE [ 21.60 ] [I INCHES I/ FT 1 ( ABOVE 4 BELOW j BENCHMARK /REFERENCE POINT
[ 49.60 ] [I INCHES r FT ] [ ABOVE 4 BELOW ] BENCHMARK /REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE
L
D FILL REQUIRED:
O
H
E
R
SPECIFICATIONS BY: Pedro N Ospina
APPROVED BY:
[ 0.00 ] INCHES
EXCAVATION REQUIRED: [ 40.00] INCHES
1— Existing 900 gal. septic tank certified by " Mr C's Plumbung & Septic" on 11/10/2011 to remain. 2- Install 300 sf of
drainfield in bed configuration. 3- Install 12" of slightly limited soil under the bottom of drainfield. 4- Perimeter of
excavation area shall be at least 2 ft wider and longer than the proposed absorption bed. 5 -Invert elevation of drainfield
to be no Tess than 9.06' NGVD. 6. Bottom of drainfield elevation to be no Tess than 8.56' NGVD.
THIS PERMIT IS NOT FOR ADDITION(s).
Pedro N Ospina
DATE ISSUED: 11/30/2011
TITLE:
TITLE:
Dade CHD
EXPIRATION DATE: 02/28/2012
DE 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E - 6.003, FAC
v 1.1.4 AP1053953 3E856980
Page 1 of 3
NOTICE OF RIGHTS
A party whose substantial interest is affected by this order may petition for an
administrative hearing pursuant to sections 120.569 and 120.57, Florida Statutes. Such
proceedings are govemed by Rule 28 -106, 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 govemed 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 filing 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.