PL-12-500Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: I NSP- 171416
Permit Number: PL -3 -12 -500
Scheduled Inspection Date: April 11, 2012
Inspector: Hernandez, Rafael
Owner: ARENAS, JORGE & TINA
Job Address: 889 NE 97 Street
Miami Shores, FL 33138-
Project: <NONE>
Contractor: A AMERICAN SEPTIC & PLUMBING
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Septic
Phone Number
Parcel Number 1132060142650
Phone: (305)866 -5600
Building Department Comments
DRAINFIELD REPAIR AND TANK INSTALLATION
Passed
al.
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
April 10, 2012
For Inspections please call: (305)762 -4949
Page 14 of 25
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
PE ' =' PPLICATION
FBC 2
RECEIVED
MAR 2 2 2p12
BY
Permit No. L1 ® -SC C
Master Permit No.
Permit Type: PLUMBING �g,.�.
OWNER: Name (Fee Simple Titleholder): A01-9e- 1 �S. Phone#:
Address: MCI ct 4
City: rnr nt1 ,S-Vvr State: Zip: .331
Tenant/Lessee Name: N I D-
Email:
Phone#:
JOB ADDRESS: (E C1- S ee
City: Miami Shores County:
Folio/Parcel #: (°- 3 "OIL -- 70-50
Is the Building Historically Designated: Yes
Miami Dade
Zip: 3313
NO Flood Zone: N % R
CONTRACTOR: Company Name: A fl meriza i1 , 6 - 4 WYl 1, onS:
Address: �'S5 � �Y;� L�► 7a '�
City: 0° 1- 0-iYlt
State: FL'
Zip: 331(2S1
Qualifier Name: Wilt willmnq vo-O 1i - u Phone#:
State Certification or Registration #: 6e C( Certificate of Competency #: „SP Oi)D 1 -ta.
Contact Phone#: `*WO 43 i0 SSCI-q Email Address: 'moo -t-() ,rilei"1��4LA Lana tl&(. Long
DESIGNER: Architect/Engineer: Eat p1" Phone#:
Value of Work for this Permit: $ P '61 Square/Linear Footage of Work: 1
Type of Work: ❑Address DAlteration ❑New air/Replace ❑Demolition
Description of Work:
Dmt i=e Lra Q elQ Lr t 4-ark a-b VI'
*** * **ea*a°° *** aye**** * * ***** *****aa * ** ** *Fees*** *******4.* ** ** ****** * * *********** * *** * * **
Submittal Fee $ Permit Fee $ 7c-30-- CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $ (1){
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
3� 1
Mortgage Lender's Name (if applicable) N I }
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.F,CTRICAL 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 copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose prope is subject t �� attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection whi h occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection w not b appro ed and a reinspection fee will be charged.
Signature
Owner or Agent
The foregoing instrument was acknowledged before me this a)
day of Maredh , 20 l ;.by S , day of _ TM 20 1 by WiVMM V Od
Signaturelr} 1
tractor
The foregoing instrument was acknowledged before me thisDO
who is personally known to me or who has produced FL- who
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print
NOTARY PUBLIC -STATE OF FLORIDA
Jazzmin Cruz
Commission # EE030407
�xplres. 3L' Y. 1N, cvix
BONDED THRD ATLANTIC BONDING CO.,INC.
My Commission Expires:
or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
NOTARY PUBLIC -STATE • F FLORID
Jaz\
Sign: '
T. o
Print ` .••°` Expires \ '. 28,' ii►
'BON'DED TERG ATIANTICaoNnING CO,II44
My Commission Expires:
***************************;:;,;****** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
APPROVED BY
7---Plans Examiner
Structural Review
(Revised 07 /10/07)(Revised 06/10/2009)(Revised 3/15/09)
********* * * * *** * * * * * * * * * * * * ** **** * * ** * **
Zoning
Clerk
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION PERMIT
CONSTRUCTION PERMIT FOR: OSTDS New
APPLICANT: Jorge Arenas
PROPERTY ADDRESS: 889 NE 97 St Miami, FL 33138
LOT: 23 24
PERMIT # :13 -SC- 1397225
APPLICATION 41: API 064459
DATE PAID:
FEE PAID:
RECEIPT #:
DOCUMENT #: PR869200
BLOCK: 73 SUBDIVISION:
PROPERTY ID #: 11- 3206- 014 -2650
[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 [ 1,050 1 GALLONS / GPD Septic CAPACITY
A [ ] GALLONS / GPD N/A CAPACITY
N ( ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS #[ ]DOSES PER 24 HES #Pumps [ ]
D [ 667 3 SQUARE FEET bed configuration drainfile SYSTEM
R [ ] SQUARE FEET N/A SYSTEM
A TYPE SYSTEM: [x] STANDARD ( ] FILLED [] MOUND [ ]
I CONFIGURATION: [ ] TRENCH [xl BED [ ]
N
F LOCATION OF BENCHMARK: F.F.E., 10.49' NGVD.
I ELEVATION OF PROPOSED SYSTEM SITE
E BOTTOM OF DRAINFIELD TO BE
L
D
0
T
H
E
R
FILL REQUIRED:
[ 0.00 ) INCHES
[ 11.80) [J INCHES I FT ] [ABOVE 4 BELOW II BENCHMARK /REFERENCE POINT
[ 41.80 3 [FINCHES (' FT ] [ ABOVE /, RELOW b BENCHMARK /REFERENCE POINT
EXCAVATION REQUIRED: 1 72.00] INCHES
Inspector to verify the existing septic tank is properly abandon before final approval.
*Invert elevation of drainfield to be no less than 7.50 ft. NGVD.
*Bottom of drainfield elevation to be no less than 7.00 ft. NGVD.
*Install 42" of slightly limited soil under the bottom of the drainfield.
- Perimeter of excavation area shall be at least 2 ft wider and longer than the proposed absorption bed or drain trench.
-The licensed contractor installing the system is responsible for installing the minimum category of tank in accordance
with sec. 64E- 6.013(3)(f). F.A.C.
SPECIFICATIONS BY:
APPROVED BY:
Carl
law
c ...
DATE ISSUED: 03/0
a
TITLE:
TITLE:
Dade CHD
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E - 6.003, FAC
>r 1.1.4
kP19 6c,154
EXPIRATION DATE: 09/08/2013
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