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PL-11-2279Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 167522 Permit Number: PL -12 -11 -2279 Scheduled Inspection Date: January 06, 2012 Inspector: Hernandez, Rafael Owner: BILLMAN, JAMES Job Address: 55 NW 100 Street Miami Shores, FL 33150- Project: <NONE> Contractor: SOUTHERN SEPTIC CONTRACTORS INC Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Septic Phone Number Parcel Number 1131010180390 Phone: (305)598 -8266 Building Department Comments SEPTIC Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments HRS IN FILE January 05, 2012 For Inspections please call: (305)762 -4949 Page 5 of 19 i • 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 RECEIVED DEC 07 011 BY: BUILDING Permit No d' l A I —9;09 PERMIT APPLICATION Master Permit No. FBC 20 Permit Type: PLUMBING OWNER: Name (Fee Simple Titleholder): T- Phone #: 3 '�`�S ' g )Z� Address: s (Ns 100 S r City: y.-% Si oeLtZ -3 State: 'FL Zip: 3-3 1 go Tenant/Lessee Name: Phone#: Email: 7 \ • • JOB ADDRESS: SC 6 City: Miami Shores County: Miami Dade Folio/Parcel #: d d - 31 cW 1 -01%- r 3Ci o So Is the Building Historically Designated: Yes NO . Flood Zone: N o CONTRACTOR: Company Name: 4 0Iii`h er!i 5e, & . Phone#: 305 Sy Yz(-,b Address: /5. 7 if S 'A :1 /4v11.5-14 ,�� ,�r0 City: r` \ i fi-w+ % State: F r- _ Zip: 33 z 5 Qualifier Name: Phone #: State Certification or Registration #: Certificate of Competency #: • Contact Phone #: Email Address: DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ 'ti 50 ° Square/Linear Footage of Work: Type of Work: ❑Address °Alteration °New 11 Repair/Replace °Demolition Description of Work: !'t n-e-ii Ex. S rv4 1 : �_ .> ) ** ******* ***** ****+x*** **** ****.n******** Res**** ** **+ n******* ***+ x***+x****************+ *** 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) rz_ A_(.. e )po i Mortgage Lender's Address e . c o t b 33 City �tiS F--oi as zS State -t-0 h. Zip 50-306 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 iss, %. 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•3 )0 t� day of ti , , 20 I I , by SY � - 6,1 t rpt , day of 1 i 2-- , 20 bl , by who is personally known to me or who has produced ".0fW Li As identification and who did take an oath. The foregoing instrument was ackn = : ', before me this / ao9Zc (awl- who is personally known to me or who has produced NOTARY PUBLIC: My Commission Expires APPROVED BY as identification and who did take an oath. NOTARY PUBLIC: \\��```\gn 5 Agov Sign: � 0 11 7 l ®'( Plans Examiner Structural Review (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) Print: My Commission Expires: s cn j D1 1g0 13' Zoning Clerk STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT CONSTRUCTION PERMIT FOR: OSTDS Repair APPLICANT: James Billman PROPERTY ADDRESS: 55 NW 100 St Miami, FL 33150 LOT: 14 PERMIT #: 13-SC- 1381753 APPLICATION #: API054662 DATE PAID: FEE PAID: RECEIPT #: DOCUMENT #: PR860795 BLOCK: 4 SUBDIVISION: PROPERTY ID #: 11- 3101 -018 -0390 [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 [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS] K [ ] GALLONS DOSING TANK CAPACITY 1 1GALLONS @[ ]DOSES PER 24 HRS #Pumps [ ] D R A I N F I E L D 0 T H E R SPECIFICATIONS BY: APPROVED BY: 1 300 ] SQUARE FEET SYSTEM [ 0 ] SQUARE FEET SYSTEM TYPE SYSTEM: [u] STANDARD [ ] FILLED [ ] MOUND [ ] CONFIGURATION: [ ] TRENCH [x] BED [ ] LOCATION OF BENCHMARK: F.F.E.: 11.53' NGVD. ELEVATION OF PROPOSED SYSTEM SITE [ 13.30 ] [I INCHES r FT ] I ABOVE A BELOW 1' BENCHMARK /REFERENCE POINT BOTTOM OF DRAINFIELD TO BE [ 43.30 ] 11 INCHES f FT ] [ ABOVE 4 BELOW b BENCHMARK /REFERENCE POINT FILL REQUIRED: 1 0.00 ] INCHES EXCAVATION REQUIRED: [ 42.00] INCHES 1- Existing 900 gal. septic tank certified by " Busy Bee Septic" on 11/18/2011 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 8.42' NGVD. 6. Bottom of drainfield elevation to be no less than 7.92' NGVD.. THIS PERMIT IS NOPT FOR ADDITION(s) DATE ISSUED: PEDRO N OSPINA Pedro N Ospina 12/07/2011 TITLE: TITLE: Dade CHD EXPIRATION DATE: 03/06/2012 DH 4016, 08/09 (Obsoletes all previous editions which may not be used) Incorporated: 64E- 6.003, FAC v 1.1.4 AP1054662 6E857545 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 altemative 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 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. 1 1 Protect Address Miami Shores Village 10050 N.E. 2nd Avenue NW Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Parcel Number Applicant 55 NW 100 Street Miami Shores, FL 33150- 1131010180390 Block: Lot: JAMES BILLMAN Owner Information Address Phone Cell JAMES BILLMAN 55 NW 100 Street MIAMI SHORES FL 33150 -1268 Contractor(s) Phone Cell Phone SOUTHERN SEPTIC CONTRACTORS I (305)598 -8266 Valuation: Total Sq Feet: $ 4,500.00 0 1 Type of Work: DRAINFIELD ONLY Type of Piping: Additional Info: Bond Retum : Classification: Residential Scanning: 1 Fees Due Bond Type - Owners Bond CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Total: Amount $500.00 $3.00 $2.25 $2.25 $1.00 $150.00 $3.00 $4.00 $665.50 Pay Date Pay Type Invoice # PL-12-11-42777 12/08/2011 Check #: 1052 12/08/2011 Check #: 1277 Bond #: 2086 Amt Paid Amt Due $ 500.00 $ 165.50 $ 165.50 $ 0.00 Available Inspections: Inspection Type: HRS Approval Final 1 In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS 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. Futhermore, I authorize the above -named contractor to do the work stated. December 08, 2011 Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy Date December 08, 2011