PL-11-2299Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 167697 Permit Number: PL -12 -11 -2299
Scheduled Inspection Date: February 03, 2012
Inspector: Hernandez, Rafael
Owner: FARAH, JOSEPH
Job Address: 137 NW 93 Street
Miami Shores, FL
Project: <NONE>
Contractor: STATEWIDE SEPTIC CONNECTIONS
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Drainfield
Phone Number
Parcel Number 1131010330860
Phone: (954)963 -0082
Building Department Comments
REPLACE 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
February 02, 2012
For Inspections please call: (305)762 -4949
Page 2 of 8
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Miami Shores Village DEC DE 3
Building Department B' ampoeomo
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
Permit Type: PLUMBING
Permit No. PI x2-951
Master Permit No.
OWNER: Name (Fee Simple Titleholder): Jo - T h rG (o lV1 4 048( L C. r" r On Phone#:''Stir +29 -1 % G 3
Address: 137 N vN q 3 S't'
City: Mtarri ,S 1-es state: a Zip: 3-51S%
Tenant/Lessee Name: Phone#:
Email:
JOB ADDRESS: [ 37 N W "I 3 St re e
City: Miami Shores County: Miami Dade Zip: 3311 CO
Folio/Parcel #: Q - 310(-4:13.5° O F4, o
Is the Building Historically Designated: Yes NO Flood Zone:
CONTRACTOR: Company Name: St C r C'h hone #: S-661 -6653
Address: PQ bX 38 CS
City: Nc(I'+w��c�)
Qualifier Name: ¶Qc; du [ cx el
State: Zip: 33 ®8 3
Phone#:
State Certification or Registration #: Certificate of Competency #:
Contact Phone #: Email Address:
DESIGNER: Architect/Engineer: Phone#:
Value of Work for this Permit: $ 22 So Square/Linear Footage of Work:
2Z S
Type of Work: ❑Address ❑Alteration ❑New '- epair/Replace
Description of Work: Rev f t- dl ,r6f1 rl - d
❑Demolition
******** ************ ***************x *** Fees **** u** ********** ******* * * ********+x+x ********
Submittal Fee $ Permit Fee $ i CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEFAVOW DUE $ IQ ' 4)
jCt
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 Signature
Owner or Agent Contractor
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of , 20 _, by , day of , 20 _, by
who is personally known to me or who has produced who is personally known to me or who has produced
As identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: Sign:
Print: Print:
My Commission Expires: My Commission Expires:
****** * * *** ** ****x ******** *m********** *+ x+ x** **************** **** ******** *******+ x**** *+ x******* *********m******
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09)
nnnis,i
*sett**
Bonding Company's Name Of applicable)
Bending Comp:uty's Address
City State Zip
Mortgage I .ender's Name Of applicable) —
Murtgage Lenders Address
City State Zip
Application ik hereby made to obtain a permit to do the work and installations as indicated. i ccnify 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 ELIC1'RICAL.WORK. PLUMBING. SIGNS.
WELLS. POOLS. PL'RNACES. BOILERS. HEATERS. TANKS and AIR CONDITIONERS. ETC
OWNER'S AFFIDAVIT: I ccnife 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 Applicata: .4s a condition to the issuance e of a building p'nnit with an estimated value eace•eding S250). the applicant must
promise in god faith that a rain of the notice of commencement and c•unsuut1iun lien lag' brochure will be delivered to the pe+rcon
n•Iwse properly is subject to attachment. .•ilm u c'e•rtifttd ropy of the recorded notice cf commencement mutt he posted at the jab site
lot the just inspection e+hich occurs seven (7J day after the building permit k issued. in the absence of such posted ntim the
inspection will Shit he approted and a rein cpi t 1ian fee will be c•Itaryed.
Signature •'` —�`-ii i�2�i'
Owner or Agent
The foregoing inctntment was acknowled_ed before ms this r 3 The foregoing instrument was ackr,: fledged before ` to th'� I3
dad of __. _ . ` ) e C 20 _. M• et-1-4, S-'4 r re . day of 'Dec- . 20 11 b
who is personally known to tine or who has produced ` ' ": e8i a' who . iy ice,. r ma or who has produced
CPc CO As identification and who did take an oath. as identification and who did take an oath.
Signature
Contractor
NOTARY PUBLIC: NOTARY PUBLIC:
1�6
Sign: _.. --
Print: � , 5 r 4 3,, or.'
Yt
My Commission Expires:
*t+9f *9R *$ *99#9 *49##999* *999 **
APPROVED BY
Sign:
Prins
t `h.lt„ TERESA J SOLOMdk
''' ' 'eQ MY COMMISSION # EE131935
J-y4+
-41 ::?r,, EXPIRES November 08, 2015
41saraanil M* * *Mgalroer°y`eensr�ersasmsesss
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Plans Examiner
Structural Review
•
4
,d00 ;;;;;; ;i; Public - State of Plot a
My Comm %
9 4:11 Commission • F NoSB10
..,e o� ;o Boned Itimugh M a tary As
n. �
Zoning
Clerk
•
D2VI$ION OP
Environmental Health`
Florida Department of Health
Miami -Dade County Health Department
OSTtS/Well Division
11SAS SW 26 St. • Miami. FL 33175
inspector Date .! - 1. Jl
Address 13 7 # /. (6 ► ,'-•
ts.
QSTDS #A f'os`s ?6 y 0
Signature
STATE OF FLORIDA
DEPAR T OE' HEALTH
ON$X B SEWAGE TREATMENT Ate DISPOSAL
ccompacmal PEEWIT - -
.,13 *1380518
AP PLICATIMA t Amoi3e64 ..._.
DATE FAZO:
PAID:
PNCEIPT O.
O. PR
PROPER= IIk f:
137 1W 93 St !literal. FL 33150
BLOCK: 133
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IRMO : Shares Seca
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RE OCNSTRUVIED IN ACCORDANCE NIDE SPECIFICATIORS AND ETINDARDS OF SEMI=
3SZ:.O06E, F . ASO CRAPTP.R 642 -f, P.A.C. t3'ts2 Al+ ti OF SYSTEM NOES NOT COMM=
SAVE SEACIM PE CE F4a A" !t SPE= FIC PERIOD 07 `1 CFA IN NATER1AL PACTS,
._...s As A =SIR FOR MOM= or vas PE r, iRIMUIRE TEE APPLICANT
�. .�.��..._ . EDDIFICATIME PAT RESULT IN MS PERMIT IIFfl G 4 ' E NOLL AND
MIME 43i THIS T NOT 216& MUM= ,u"° C IANCE 'arm ,
STATE, CR DOCAL peammanse REWIRED FORD CF THIS Rummy.
STEM DESIGN AND SPECIFICATIONS
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