PL-12-356Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 170589 Permit Number: PL -3 -12 -356
Scheduled Inspection Date: March 23, 2012
Inspector: Hernandez, Rafael
Owner: JIMENEZ, JESUS
Job Address: 41 NW 106 Street
Miami Shores, FL
Project: <NONE>
Contractor: MR C'S PLUMBING SEPTIC INC
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Septic
Phone Number
Parcel Number 1121360060210
Phone: (305)651 -7859
Building Department Comments
DRAINFIELD INSTALLATION
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
hrs in file
March 22, 2012
For Inspections please call: (305)762 -4949
Page 8 of 15
(t)11- Oadwo--
Miami Shores Village
Building Department
RECEIVED
MAR 01`2012
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
BUILD I► G Permit Nor. L) 2 -- 3s ro
PE PPLICATION Master Permit No.
FB
Permit Type: PLUMBING
OWNER: Name (Fee Simple Titleholder): <CS 0,S 5fez_ Phone#: 796 A/ Sys-‘ 7
Address: Lt "' to?. S i'
City: rt., ... 51.4,1-ev State: Zip: iS7)
Tenant/Lessee Name: Phone#: 'a
Email:
JOB ADDRESS: 4 l AEA) 10 6
City: Miami Shores County: Miami Dade Zip: S315-6
Folio/Parcel #: %a -,213c - Q oC - 0a Jo
Is the Building Historically Designated: Yes NO / Flood Zone:
CONTRACTOR: Company Name: /1r Ls f6,,...s;4 fi tZ T Phone#: Jas—t rI 78(
Address: i3d ,Vii) oZ '1‘,...„.1,
City: /'f (A-..f State: fL Zip: /1 /d
Qualifier Name: K &f ` Phone #: 3 6r 7 78'5 .1
State Certification or Registration #: 6 1 S3 6 Certificate of Competency #:
Contact Phone #: Email Address:
DESIGNER: Architect/Engineer: Phone #:
Value of Work for this Permit: $ c ?.v-o a Square/Linear Footage of Work: 't.o°
Type of Work: ❑Address ❑Alteraatiion UNew epair/Replace
Description of Work: <7(44,-4.Zry,
❑Demolition
* ****+ x********+x*************** **+ x****** Fees*******+x******** ****** * ********+x***** ** *****
Submittal Fee $_ �
Permit Fee $ �® 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 FT ECTRICAL 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 $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the inspection which occurs seven (7) days after the building permit is issued. In t ., ,sence of such posted notice, the
inspection be approved and a reinspection fee will be charged.
Signature��4''� ,
r or Agent
The foregoing instrument was acknowledged before me this
day of , 20 12-, by SeStA & 3- trtegUFZ.
who is personally known to me or who has produced
As identification and who did take an oath.
NOTARY PUBLIC.
Sign:
Print:
My Commissio
EXPIRES: Septeaan ^r 14, 2013
a.. Bonded Thu Notary r ubna Undenvdters
C
MY COP$Mt3SICr:'$ 00 891340
APPROVED BY
(Revised 07110 /07)(Revised 06 /10/2009)(Revised 3/15/09)
Signature
Contractor
The foregoing instrument was acknowledged before me thiss7
day of FE/ t , 20 /2_, by ICcMf6 4:rresrer
1 is personally o or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commiss
Wary PuIUc State of Florida
Shyl A Mend s
11111Copmi3sion EE
gIfirlo 10,23/20'4
113
Plans Examiner Zoning
Structural Review Clerk
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION PERMIT
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT:
Jesus Jimenez
PERMIT #: 13-SC-1393691
APPLICATION # : AP1062247
DATE PAID:
FEE PAID:
RECEIPT #:
DOCUMENT #: PR867260
PROPERTY ADDRESS: 41 NW 106 St Miami, FL 33150
LOT: 13 BLOCK: 206
PROPERTY ID #: 11- 2136- 006 -0210
SUBDIVISION: Dunnings 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 [
A [
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K [
D
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A
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N
F
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L
D
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SPECIFICATIONS BY:
APPROVED BY:
DATE ISSUED:
750 ] GALLONS / GPD Septic existing
0 ] GALLONS / GPD
0 ] GALLONS GREASE INTERCEPTOR CAPACITY
] GALLONS DOSING TANK CAPACITY
[ 200 ] SQUARE FEET
0 ] SQUARE FEET
TYPE SYSTEM: [x] STANDARD
CONFIGURATION: [ ] TRENCH
CAPACITY
CAPACITY
[MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ ]
SYSTEM
SYSTEM
[ ] FILLED [ ] MOUND
[x] BED [
LOCATION OF BENCHMARK: FFE : 12.2' NGVD
ELEVATION OF PROPOSED SYSTEM SITE
BOTTOM OF DRAINFIELD TO BE
FILL REQUIRED:
[ 0.00 ] INCHES
22.80 I ti INCHES I FT ] [ ABOVE /) BELOW h BENCHMARK /REFERENCE POINT
50.80 ] [I INCHES I FT ] [ ABOVE 4 BELOW b BENCHMARK /REFERENCE POINT
EXCAVATION REQUIRED: [ 40.00] INCHES
- Install 200 sq ft drainfield.
- Install 12" of slightly limited soil under bottom of drainfield.
- Elevation of bottom of drainfield to be no less than 7.97' NGVD.
- Existing 750g septic tank, to remain.
- Not for additions
t
E i ck
Kemble
The contractor (or designee) is required to perform a
soil boring adjacent to the drainfield excavation at the
time of final inspection. Prior 1J Final Approval, the DOH
inspector shall witness the soil boring and compare the
results to the original site evaluation submitted. A
relnspectlon tee will be assessed If the contractor is not
at the jobsite at the arranged time.
DH 4016, 08/09 (Obsol
Incorporated: 64E -6.
Jo
0 17/2012
es all previous editions which may not be used)
03, FAC
v 1.1.4 AP1062247
TITLE:
TITLE: Engineer Specialist II
Dade
EXPIRATION DATE: 05/17/2012
SE863244
CHD
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