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PL-12-365Permit Number: PL -3 -12 -365 I Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 nspection Number: INSP - 171576 Inspection Date: March 28, 2012 Inspector: Hernandez, Rafael Owner: LAGUERRE, MARIE Job Address: 125 NE 105 Street Miami Shores, FL 33138 -2032 Project <NONE> Contractor: MIAMI DADE ENVIROMENTAL Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1121360050110 Phone: 786 -251 -4099 Building Department Comments DRAINFIELD REPAIR Passed Inspector Comments CREATED AS REINSPECTION FOR INSP- 170651. HRS IN FILE missing sod j Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled re- inspection fee is paid. until For Inspections please call: (305)762 -4949 March 28, 2012 Page 1 of 1 TANK INSTALLATION [01] TANK SIZE [1] 7.-rU [2] [02] TANK MATERIALC [03] OUTLET DEVICE -�-- [04] MULTI - CHAMBERED [Y(/ N [05] OUTLET FILTER 1°,/ -� [06] LEGEND ,A✓ � <` [07] WATERTIGHT [08] LEVEL [09] DEPTH `TO LID DRAINFIELD INSTALLATION [10] AREA [1]f ti JS [2] -2 SOFT [11] DISTRIBUTION BOX HEADER f°'° [12] NUMBER OFDRAINLINES ' '5- tget-ot [13] DRAINLINE SEPARATION / 2, [14] DRAINLINE SLOPE [15] DEPTH OF COVER/ [16] ELEVATION [ABOV EL017J BM [17] SYSTEM LOCATION �_ .A [18] DOSING PUMPS f [19] AGGREGATE SIZE , / [20] AGGREGATE EXCESSIVE FINES [21] AGGREGATE DEPTH "/ FILL / EXCAVATION MATERIAL [22] FILL AMOUNT -2 y [23] FILL TEXTURE - ----- - . [24] EXCAVATION DEPTH -'--'-- [25] AREA REPLACED [26] REPLACEMENT MATERIAL EXPLANATION OF VIOLATIONS / REMARKS: [ 1 I 1 I I [ 1 CONSTRU ON APPROV /DISAPPROVED]: FINAL SYST‘ PROI ED /DISAPPROVED] 0 °`'t e:1 t • [ [27] [28] [29] [30] [31] [32] [33] [34] [35] SURFACE WATER FT DITCHES FT PRIVATE WELLS FT PUBLIC WELLS FT IRRIGATION WELLS FT POTABLE WATER LINES � i— FT BUILDING FOUNDATION FT PROPERTY LINES OTHER FILLED / MOUND SYSTEM [36] .1[37] '[38}' [39] DRAINFIELD COVER SHOULDERS SLOPES STABILIZATION 1 ADDITIONAL INFORMATION [40] UNOBSTRUCTED AREA [41.] [42] ,[43j [441 [45] [46] [47] [48] STORMWATER RUNOFF ALARMS MAINTENANCE AGREEMENT BUILDING AREA LOCATION CONFORMS WITH SITE PLAN FINAL SITE GRADING CONTRACTOR OTHER ' ABANDONMENT [49] TANK PUMPED >' [50] TANK CRUSHED & FILLED / L DH 4016 (Page 2), 10/97 (Previous Editions May Be Used) Stock Number. 5744 - 002 - 4016 -4 '�./ CHD DATE. c�� CHD DATE / PT 1: Applicant` PT 2: Installer /Contractor PT 3: Buildng Department PT 4: Health Department Page 2 of 3 Ree7dd Ghp.. 1 Protect Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Parcel Number Applicant 125 NE 105 Street Miami Shores, FL 33138 -2032 1121360050110 Block: Lot: MARIE LAGUERRE Owner Information Address Phone Cell MARIE LAGUERRE 125 NE 105 Street MIAMI SHORES FL 33138 -2032 Contractor(s) MIAMI DADE ENVIROMENTAL Phone 786 -251 -4099 Cell Phone Valuation: Total Sq Feet: $ 2,400.00 0 1 Type of Work: DRAINFIELD Type of Piping: Additional Info: Bond Return : Classification: Residential Scanning: 2 Fees Due Bond Type - Owners Bond CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Total: Amount $500.00 $1.80 $2.25 $2.25 $0.60 $150.00 $6.00 $2.40 $665.30 Pay Date Pay Type Invoice # PL -3 -12 -43542 03/02/2012 Check #: 3088 03/05/2012 Check #: 3091 Bond #: 2116 Amt Paid Amt Due $ 50.00 $ 615.30 $ 615.30 $ 0.00 Available Inspections: Inspection Type: Top Out Final Underground 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. March 05, 2012 Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy Date March 05, 2012 1 BUILDING PE FBC 2 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 Permit No. P-( 2 ----r5C0S Master Permit No. PLICATION RECEIVED MAR 022012 Permit Type: PLUMBING ,g ll rr �c OWNER: Name (Fee Simple Titleholder): MAR. ( e T 1 ul 4 0. ft(LC. Phone#: _305 44.7 `� Address: J l U.) e..S e 1 r City: J eau T o fi < — A.D c% State: Ill ' Cr. Zip: /D Q a I( Tenant/Lessee Name: Email: Pik— s Q Phone #: S E g* JOB ADDRESS: 12 tV - 10 r City: Miami Shores County: Zip: � 3 1 Folio/Parcel #: / 1- (3 --00 Fj - ®i g 0 Is the Building Historically Designated: Yes NO Flood Zone: Miami Dade CONTRACTOR: Company Name: Hip be N O i tics 1M e ivTa 1 Phone #: 7 g6.4"/S/-1/0 Ci'9 Address: 99'0 L W,k e n S `"?..c-A,`F City: 1/4l I�t I l2 Qualifier Name: a fe, hAt f9'ai State Certification or Registration #: 7' 115, Email Address: State: [ri Contact Phone #: Itg-6 -S ( l{ LA/ Zip: S 3/4, Phone #: 78th ((O n/ j' Certificate of Competency #: jI AP-u Aa&t *JOrnoD kert fii( ffSb.COey DESIGNER: Architect/Engineer: Phone#: 0 Value of Work for this Permit: $ I ® Square/Linear Footage of Work: Type of Work: Address ❑Alteration ❑New ,Repair/Replace Description of Work: tik■-I44.143 ft eik RePblek... OoS -Pt ❑Demolition ************** * * ** ********************* Fees**m *a: *+ xu: *** ***** ***** ******:x***** *** * * *** ** Submittal Fee ° �° Permit Fee $ Scanning Fee $ Radon Fee $ ism CCF $ CO /CC $ 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) 'Siren n 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 iamination 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 w hich occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be A ' roved and reinspection fee will be charged. Ear Signatur , J, �.__.__ Signature Owner or A Contractor The foregoing instrument was acknowledged before me this 58 The fo egoing instrument was acknowledged before me this day of refit_ (11, 20 ft, by Pak!. ce • `450ef11Le.- , day of , 20 , b 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. NOTARY PUBLIC: C As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: * * * * * * * * * * * * * * * * * * * * * * * * * * ** APPROVED BY Print: = 'C'....' pSign: JOSE R. BOLANOS My Commission Expires; 0/kty Ouc Nosey Public, State of FiOrlda Commission sE�86B % •. CO 165 1. . My Ost> san Expires Oct Ob, EU '% • DD 90 •. • O` *************************************************4.414)0017:70Q, kov********* (Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09) Plans Examiner Zoning Structural Review Clerk PERMIT #:13 -SC- 1396019 APPLICATION #: AP1063680 STATE OF FLORIDA DEPARTMENT OF HEALTH DATE PAID: ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM FEE PAID: CONSTRUCTION PERMIT RECEIPT #. DOCUMENT #: PR868437 CONSTRUCTION PERMIT FOR: OSTDS Repair APPLICANT: Marie Laguerre PROPERTY ADDRESS: 125 NE 105 St Miami, FL 33138 LOT: 11 BLOCK: 201 SUBDIVISION: PROPERTY ID #: 11 -2136- 005 -0110 [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 [ N [ K [ 750 ] GALLONS / GPD Septic CAPACITY 0 ] GALLONS / GPD CAPACITY 0 ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS] ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ ] D [ 200 ] SQUARE FEET SYSTEM R [ 0 ] SQUARE FEET SYSTEM A TYPE SYSTEM: [x] STANDARD [ ] FILLED [ ] MOUND [ ] I CONFIGURATION: [ j TRENCH [x] BED [ ] N F LOCATION OF BENCHMARK: F.F.E.: 12.20' NGVD. I ELEVATION OF PROPOSED SYSTEM SITE E BOTTOM OF DRAINFIELD TO BE L D FILL REQUIRED: 0 T H E R SPECIFICATIONS BY: �..contraC6 t I v,var on at the - SO1 •b tektnt piked fia } Cq� r the t4ria of tlnal IfSUUG,iUl . Fi , % iL .�(1 DA• TE ISSUED: : time of Shall witn6 ir, so l b3ring and comRare a cHD Pew oNOSp'- Ott DATE ISSUED: .03/01/2012 results to the origins +sloe av��uati�� 3UCOnittactor gs not reinspeCtion tee �� b5/30/2012 DH 4016, 08/09 (Obsoletes all previous editions which may norm l6 at the arranged time. [ 0.00] INCHES [ 22.80 1 [I INCHES If FT ] [ ABOVE /I BELOW IJ BENCHMARK /REFERENCE POINT [ 42.80 ] [I INCHES I/ FT ] [ ABOVE 4 BELOW b BENCHMARK /REFERENCE POINT EXCAVATION REQUIRED: [ 20.001 INCHES 1- Existing 750 gal. septic tank certified by "Miami Dade Environmental" on 02/21/2012 to remain. 2- Install 200 sf of drainfield in bed configuration. 3- Perimeter of excavation area shall be at least 2 ft wider and longer than the proposed absorption bed. 4 -Invert elevation of drainfield to be no less than 9.13' NGVD. 5. Bottom of drainfield elevation to be no less than 8.63' NGVD. THIS PERMIT IS NOT FOR ADDITION(s). riPAIR Incorporated: 64E- 6.003, FAC v 1.1.4 AP1063680 SE864274 Page 1 of 3 oour t 1 STATE OF FLORIDA i z DEPARTMENT OF HEALTH 4 cob wt Ic°1 APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Permit Application Number Scale: Each block re PART II SITEPLAN sres- ts 10 feet and 1 inch = 40 feet. • mil mmummummammom Immammmmam um mom um momumwrimmumimmil MOMMENIMMUMWWWWIMMOMME COMNEM•IM•E oPegiiiiiiiiiNMIMMWM N11111111116161111111111 4 1111111111111=111111111111E 1111111111111111111111111111112111111111111111111 II SOMMEMEMEMMEMMOMMEM MN IEWILIMEMMINIMMIMMEMMEMOMMIN 111111NIMMENIIMEMININIMIMEMISPIE • • mommommammommumwas m immimmmommorm•menscum 111111111111•1111110111111111111111111110001111 arena= Jmoumaimerommoracilowillibli Wilitiriklifilimmucamm iiiimilnuillialiniMMINFV 111111111111111111111 ((TA,g. Notes: --r 44Ue E... I s (k) E /0s5-r 114/4,-11 Si-10/1.-S rm 3 NtA itfit e)1 00 on flOCUto5 Site Plan submitted b Plan Approved By 1,115( Signature --- Nor. • • - • ScPPri IC (4161 4 ( Date Title County Health Department ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT DH 4015, 10/96 (Replaces HRS-H Form 4016 which may be used) (Stock Number: 5744-002-4015-6) Page 2 of 4