PL-12-572Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 171878 Permit Number: PL -4 -12 -572
Scheduled Inspection Date: April 16, 2012
Inspector: Hernandez, Rafael
Owner: COLLARD, MILAGROS
Job Address: 10070 N MIAMI Avenue
Miami Shores, FL
Project: <NONE>
Contractor: MR C'S PLUMBING SEPTIC INC
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Septic
Phone Number (305)220 -6990
Parcel Number 1131010210100
Phone: (305)651 -7859
Building Department Comments
INSTALL SEPTIC TANK AND 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
April 13, 2012
For Inspections please call: (305)762 -4949
Page 23 of 36
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 vp
Permit Type: PLUMBING
OWNER: Name (Fee Simple Titleholder):
Address: 3C- / '3
City: eCA1A
Pv Er/
APR 0 3 2012
Permit No ?L.I — S 1
Master Permit No.
it € -co.Ii
c V H"‘ sf' Phone #: � � ) C L 9 9 Ci •
State:
Zip: : :3)
Tenant/Lessee Name: Phone #:
Email:
JOB ADDRESS: r 00 7 CF /V. s
City: Miami Shores County: Zip: 3 3 A = a)
Folio/Parcel #: // — 3 to / - 6 A. I — Of
Is the Building Historically Designated: Yes NO Flood Zone:
Miami Dade
CONTRACTOR: Company Name: I�r S f ✓, 6, f S / i c Phone #: 305- 65 t 7
Address: // 5 3 aL 11/01-) °" G-4/"(.
City: State: Zip: Ci
Qualifier Name: /c. 6 7 4 Phone #:
State Certification or Registration #: 54. " D6 I S- 3 6 Certificate of Competency #:
Contact Phone#: Email Address:
DESIGNER: Architect/Engineer: Phone #:
7f 9 2
Value of Work for this Permit: $ 2 4,41-' ° �o Square/Linear Footage of Work:
Type of Work: ❑Address ❑Alteration ONew2,epair/Replace
Description of Work: // sl t l Serif e %.L s of ra,.., . ,h'e a
Z &015-
ODemolition
* ****+ x**** ** *****+ x*** **** **•x******•x****Fees *+x**** ********** *** *• s********************* **
Submittal Fee $ Permit Fee $ 3 6 6) 1– CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training duration Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $
•
s 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.FCTRICAL 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) s after the building permit is issued. In th absence of such posted notice, the
inspection will not be approved and a einspecti,y ill be charged.
Signatur
0 '` er or Age
w
The fore oing instrument was acknowledged before me this 6
day of 1 , 201 .a, by
who is personally known to me or who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission Exp
MY COMMISSION ;# DO 89124,1
EXPIRES: September 14, 20 `-
'qr mod°. Bonded Thru Nota ry Public Underwriters
Signature
Contractor /�
The foregoing instrument was acknowledged before me this 40 r�
day of /9I L , 20 a byk 0, g'rre ('
who is personally known to
or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commis
** ******+A********* *******MM* ********* ****** ** *********4 ** ************ ** a , ***
Zoning
APPROVED BY
(Revised 07 /10 /07)(Revised 06/10/2009)(Revised 3/15/09)
Plans Examiner
Structural Review Clerk
•
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM
CONSTRUCTION PERMIT
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT:
(Emerald Title Group)
PERMIT #: 13-SC- 1401664
APPLICATION #: API067278
DATE PAID:
FEE PAID:
RECEIPT #:
DOCUMENT #: PR871623
PROPERTY ADDRESS: 10070 N miami Ave Miami, FL 33150
LOT: 3
BLOCK: 2 SUBDIVISION:
PROPERTY ID #: 11- 3101 -021 -0100
[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 [
900 ] 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: [ ] TRENCH [x] BED [ ]
N
F LOCATION OF BENCHMARK: FFE: 12.7' NGVD
I ELEVATION OF PROPOSED SYSTEM SITE
E BOTTOM OF DRAINFIELD TO BE
L
D FILL REQUIRED:
O
T
H
E
R
] INCHES
[ 26.40 ] [I INCHES Y FT ] [ ABOVE A BELOW Ii BENCHMARK /REFERENCE POINT
[ 56.40 ] [I INCHES r FT ] [ ABOVE /f BELOW I BENCHMARK /REFERENCE POINT
EXCAVATION REQUIRED: ( 42.00] INCHES
- Install 900 g septic tank.
- 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 8.0' NGVD.
- Not for additions
The licensed contractor installing the system is responsible for installing
the minimum category of tank in accordance with s. 64E- 6.013(3)(f), FAC.
SPECIFICATIONS BY: Kemble Ettrick
APPROVED BY:
DATE ISSUED:
Joseph R Piverger
03/30/2012
TITLE:
TITLE.: Engineer Specialist II
Dade CHD
EXPIRATION DATE: 07/01/2012
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E- 6.003, FAC
v 1.1.4 AP1067278 8E867074
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 governed 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.