PL-11-274Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 156132 Permit Number: PL -2 -11 -274
Scheduled Inspection Date: January 27, 2012
Inspector: Hernandez, Rafael
Owner: GUILLERMO CASTRO, JOSE
Job Address: 9701 BISCAYNE Boulevard
Miami Shores, FL 33138-
Project: <NONE>
Contractor: JOE LEWIS SPECIALTY SEPTIC
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Septic
Phone Number
Parcel Number 1132060143320
Phone: (305)662 -7979
Building Department Comments
INSTALL 1050 GAL SEPTIC TANK AND 225 DRAINFIELD
IN TRENCH CONFIGURATION
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
HRS FINAL IN FILE.
January 26, 2012
For Inspections please call: (305)762 -4949
Page 2 of 17
Miami Shores Village REcEIVEI)
Building Department JAN 2 5 012
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY:
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. P.,
Master Permit No.
OWNER: Name (Fee Simple Titleholder): ��p, d' �� hone #:
Address: �� ere-)
City: State: Zip:
Tenant/Lessee Name: Phone#: 2 r2. - ( ) 17
Email:
JOB ADDRESS: 1-1 0 6 bl sccu -jt (-J (' J GI
City: Miami Shores 'J County: Miami Dade Zip: 3 ➢ r3Es-
Folio/Parcel#: 1 t •-- 3O 2
2- 6 - 01 4 - J0j'_-
Is the Building Historically Designated: Yes _ NO Flood Zone:
CONTRACTOR: Company Name: 3b( Le cry 1 S 6 0 141 7 Phone #: "1 RI G 2') 1 Z3
Address: /O1 S ��-vJ G, 1 Ave.
City: M 1''r a ark a., State: Zip: -3,,t22--1
Qualifier Name: V--eke., Le)..11 S Phone #:
State Certification or Registration #: Certificate of Competency #:
Contact Phone #: Email Address:
DESIGNER: Architect/Engineer: Phone #:
Value of Work for this Permit: $ 2 o ' Square/Linear Footage of Work: 22- S
Type of Work: Address ❑Alteration ❑New epair/Replace ❑Demolition
D rat` r - l Of
Description of Work:
****1 x�x�a�x�x�a�xx��x* ***a��x+x�x*****�n+x***wax * **** Fees** �xx�*************+ x�x* �x+�x� **** *�x�x****�•�x **** ****
Submittal Fee ' Permit Fee $ . L , 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 t ich occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not b ' appru ved and a reinsp ion fee will be charged.
Signature
Owner or A
The foregoing instrument was ackn
Signature
Contractor
ed before me this Z3 The foregoing instrument was acknowledged before me thi;2-3
day of 3 1 , 20 12 , by NM o. 6'4 to 9rl e(4l Ale arttflay of ro , 20 It-, by 3'o 1,-.60.11 S' ,
who is personally known to me or who has produced pin t' who is personally known to me or who has produced ®ra V.
Uwe (PA.-) As identification and who did take an oath. LNenk C as identification and who did take an oath.
NOTARY PUBLIC:
NOTARY PUBLIC:
Sign: / r, Sign:
Print: l y�@ ®pp A Print: `_ " N
� 4' ! ERESA J SOLOMOAI
My Commission Expires: ,,;_ My Commission Exp : !'. ':• MY COMMISSION # EE131935
, . MY COMMISSION # EE131935
1.•V' EXPIRES November 08, 2015
:f o, EXPIRES November 08, 2015 8f,,,`` F a ervme.eom
(407) 398-0153 FladdaNataryServiee.cam (407) 398 0153 ����.
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09)
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
_Permit Type: PLUMBING ,�/ ? /� p
OWNER: Name (Fee Simple Titleholder): 36 Li; 1 � (YID Phone#: JV O 01 -3951
Address: 9-* 0 `g/ sec,i 0-42 TR 1 vi%)
City: 14-1 1 iron) State: Zip: l
Tenant/Lessee Name: ,a ,� Phone #:
Email: CPS4I 0 7, P"-' E T) a ILA). ®►Y`�il - Eb U
Permit No.
FEB 182011
- ii-e•-•""?
Master Permit No.
CaSi- f0 DA1a5
JOB ADDRESS: •c1 1l?
City: Miami Shores
County: Miami Dade
Zip.
Folio/Parcel #:
I Building Historically Designated: Yes NO
Flood Zone:
/'e
CONTRACTOR: Company Name: jC _ L v r S . St e C/4 �5 -r-if
Phone #:
Address: 30 7S sP• 6 ( /- P4-
City: Al r`!L.AM4qq IC State: F f•
Qualifier Name: c 1 Q (. C %/ LS c 1 i _..
State Certification or Registration #: .5/e 0 047 /S 9 /- Certificate of Competency #:
Contact Phone #:
7�I6 -243 /7Z3
zip: 33o23
Phone #:
7y(- Z `) Email Address: krkj /✓ _k776-/10 // Ai 4,7
• `Ce, ,*�
DESIGNER: Architect/Engineer: ° Phone#:
Value of Work for this Permit: $ lat3oo Square/Linear Foo f Work:
Type of Work: ❑Address DAlteration New /Replace ❑Demolition
■
Description of Work:
+ u+ x***+ x*** ************ **** ** *** * ******** Fees********************** ***********+x+•**** *****
0 vJ
Submittal Fee $ Permit Fee $ 36 6 ° CCF $ tO/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 o npany'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 $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspgction fee will be charged.
,Signature .
wner or Agent
The foregoing instrument was acknowledged before me this The f
day of Fe. b , 20 l 1 , by-31:6€ G. aC1 rD bQn 6 S , day of
who is personally known to me or who has produced b' L• who is ersonally kno
C 2 ° 4t1- (o 1` ' L entification and who did take an oath. LAC
NOTAItM PUBLIC:
Signaturee� --
Contractor I
instrument was ackn• !edged be ,jre me tlyds
,_
0 11 , by 4' i
to me or who has producej d l 0-41Wiil- '
as identification and who did take an oath.
Sign:
Print: q us Lit RIDA
Yusmila Alen
My Commission Ex , Commission #DD686772
mr
,,.„,,,$ Expires: AUG. 06, 2011
BONDED MEW ATLANTIC BONDING CO, INC.
NOT
Sign:
Print:
PUBLIC:
My Commission Expires:
Nal 00V
4a
** ** * * ** *,k,k******* BNB+k*,A**** ***+k**+ ANA **** * * * ********+k*ga** kph***** ******+ k*****+ k* *+ k******+ K*********k,knk*skHaeN,kHb***
APPROVED BY
07--(P-//
(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09)
Plans Examiner
Structural Review
Zoning
Clerk
h
JoLoQ� er ! tr--•I V S420. Z-'
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM!
C0 NSTRuCTION PERMIT FOR: OSTDS Repair
APPLICANT: Jose Guillermo (Castro)
PERMIT 1:13 -SC- 1300963
APPLICATION # :AP993763
DATE PAID:
FEB PAID:
RECEIPT #:
DOCUMENT #: PR835320
PROPERTY ADDRESS: 9701 Biscayne Blvd Miami, FL 33138
LOT: 1-4
BLOCK: 79 SUBDIVISION: Miami Shores
PROPERTY ID #: 11 -3208- 0143320
(SECTION, TOWNSHIP, RANGE, PARCEL NUMBER]
[OR TAX ID NUMBER]
SYSTEM )JUST BE CONSTRUCTED XS ACCORDANCE MITE SPECIFICATIONS AND SAS 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,
ERICH SERVED AS A BASIS FOR ISSUANCE OF THIS PERMIT, REQUIRE THE APPLICANT TO MODIFY THE
PERMIT APPLICATION. SUCH MODIFICATIONS MAY RESULT III THIS PERMIT HEING mama NULL AND VOID.
ISSUANCE OF THIS PERMIT DOES NOT EXEMPT THE APPLICANT FROM COIIPL?ANCE NITS OTHER FEDERAL,
STATE, OR LOCAL PERICCEEDSG REQUIRED FOR DEVELOPMENT OF THIS PROPERTY.
SYSTEM DESIGN AND SPECIFICATIONS
T [ 1.050 ] GALLONS / GPD Septic CAPACITY
A [ 0 ] GALLONS / GPD CAPACITY
N [ 0 ] GALLOWS SEBASE INTERCEPTOR CAPACITY [MAXI) CAPACITY SINGLE TANK:1250 GALLONS]
K [ ] GALLONS DOSIMG TANK CAPACITY [ WALLOW @[ ]DOSES PER 24 SRS #Pumps [ ]
D [ 225 ] SQUARE FEET SYSTEM
R [ 0 ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [X] STANDARD [ ] =LED [ ] MOUND [ ]
I CONFIGORAtION: [u] TRENCH 1 1 BED [ ]
N
F LOCATION OF BENCHMARK: F.F.E.: 12.127' NGVD.
I =RATION OF PROPOSED SYSTEM SITE
E BOTT034 OF DRAZNFXELD TO BE
L
[ 18.30 ]
t 46.30]
INCHES
FT II ABOVE A BELOW haigNanamovinmEncE POINT
FT ] [ ABOVE n BK/1►CE POINT
D FILL REQUIRED: [ 0.00] INCHES EXCAVATION REQUIRED: 1 28.00 ] INCHES
1- Install 1050 gal. category-3 septic tank equipped with an approved filter. 2-The licence contractor install ng the system
• is responsible for installing the minimum seemly of tank in accordance with sec. 64E -6.013(3)(f). 3- Install 225 sf of
T drainfield in trench configuration. 4- Perimeter of excavation area shall be at least 2 ft wider and longer than the proposed
• absorption trench. 5 -Invert elevation of drainfield to be no less than 8.80' NGVD. 6. Bottom of drainfield elevation to be no
less than 8.30' NGVD..
THIS PERMIT IS NOT FOR EPA1R
SPECIFICATI
DATE
W Oer4 a
02/17/2011
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E- 6.003, FAC
v1.1.4
AP993763
EXPIRATION DATE:
SE836353
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
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.