PL-12-230Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 169829 Permit Number: PL -2 -12 -230
Scheduled Inspection Date: March 02, 2012
Inspector: Hernandez, Rafael
Owner: KOHL, JOSEPH
Job Address: 80 NE 97 Street
Miami Shores, FL 33138-
Project: <NONE>
Contractor: STATEWIDE SEPTIC CONNECTIONS
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Drainfield
Phone Number
Parcel Number 1132060130740
Phone: (954)963 -0082
Building Department Comments
REPLACE 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
March 01, 2012
For Inspections please call: (305)762 -4949
Page 4 of 8
1 13
BUILDING
PERMIT APPLICATION
FBC 20
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 Type: PLUMBING
me OWNER: Name (Fee Simple Titleholder):
Address: ► M c ?7
City: \S /'.4)'t'C -S State:
Tenant/Lessee Name: Phone #:
Permit No. 'Pl
Master Permit No.
Phone #:
Email:
Zip: 33 13 S
JOB ADDRESS:
City:
•
we-97 S-t-
Miami Shores
Folio/Parcel #:
County:
R 32-01?4 09(3-074-0
Miami Dade
Zip: 13 2
Is the Building Historically Designated: Yes NO X
Flood Zone:
CONTRACTOR: Company Name:S `t'+'C.+,•ll', C C'ajhs' i k,ec Phone #:' (- k
Address: 17t PDX 36C5
City: (-110 ((,t y 0d
T i' 4 & (ate,.
State Certification or Registration #: is'l n -7 (2_ Certificate of Competency #:
Contact Phone #: Email Address:
DESIGNER: Architect/Engineer: Phone #:
Qualifier Name:
State: a-
Zip:
33°23
Phone #:
Z7_- `? Square/Linear Footage of Work: 2-2-5- 2-2-5- Value of Work for this Permit: $
Type of Work: ❑Address UAlteration
Description of Work:
❑New repair/Replace
ot CL f
❑Demolition
**** x**** ** *****+x******x:***** **** * * * *** Fees+ r****** ***+ x+ x* *** **** * *** **** **** ********x * **
Submittal Fee $ Permit Fee $
Scanning Fee $ Radon Fee $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
/rd
CCF $ CO /CC $
DBPR $ Bond $
Technology Fee $
r
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 $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs se (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be a roved and a r in pection fee will be charged.
4,1/4 Signature
Owner or Agent
The forego g instrument was acknowledged before me this 5
day of , 20 I?-, by J ®4‘ ICO
who is personally known to me or who has produced 0110.
As identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
- --e
My Commission Expires:
* * * * * * * ** * * * * * * * * * * * **
APPROVED BY
.
"'4," TERESA SA J SOLOMON
"c MY COMMISSION # EE131935
EXPIRES ov
FIaWallotary$ervice.com
V
i
Signature C
Contractor
The foregoing instrument was acknowledged before me this
day of , 20 _, 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 Expires:
******************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
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 Repair
APPLICANT: Joseph Kohl
PERMIT #: 13-SC-1391233
APPLICATION # : AP 1060722 •
DATE PAID:
FEE PAID:
RECEIPT #:
DOCUMENT #: PR865864
PROPERTY ADDRESS: 80 NE 97 St Miami, FL 33138
LOT: 1
BLOCK: 6
PROPERTY ID # : 11- 3206-013 -0740
SUBDIVISION:
[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 1 GALLONS / GPD
O 1 GALLONS / GPD
O 1 GALLONS GREASE INTERCEPTOR CAPACITY (MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
] GALLONS DOSING TANK CAPACITY [ 1AALLONS 8[ ]DOSES PER 24 BRS #Pumps ( 1
Septic
CAPACITY
CAPACITY
D ( 225 ) SQUARE FEET SYSTEM
R [ 0 ] SQUARE FEET SYSTEM
A TYPE SYSTEM: (x1 STANDARD [ ] FILLED ( 1 MOUND [ 1
I CONFIGURATION: [x] TRENCH ( ] BED [ ]
N
F LOCATION OF BENCHMARK: F.F.E.: 13.40' NGVD.
I ELEVATION OF PROPOSED SYSTEM SITE [ 25.20 (I INCHES ' FT 1( ABOVE A BELOWbBENCHMARK /REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 55.20 1 ( INCHES r FT 1 [ ABOVE 4 BELOW b BENCHMARK /REFERENCE POINT
D FILL REQUIRED:
T
H
E THIS PERMIT IS NOT FOR ADDITION(s). trAilir
(or Ro 5
cPOr
' `e�Siwe.v0� . et0 , _ TITLE: • ap pApfsw�..v
Ihe
Dade Cnn
,'Site iiiiill: f i ..rte
■ .1 t<'_ JG ", i lithe' 'm, ,are tn. EXPIRATION DATE:
[ 0.001 INCHES
EXCAVATION REQUIRED: [ 30.00] INCHES
1— Existing 750 gal. septic tank certified by " Statewide Septic Connections Inc." on 01/25/2012 to remain. 2- Install 225 sf
of drainfield in trench 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 Tess than 9.30' GVD, 5. Bottom of drainfield elevation
to be no Tess than 8.80' NGVD.
SPECIFICATION
res
APP [ :a
DATE ZSSUED A CO e� A
DE 4016, 08/09 (Obsoletes all prelious edfftbrigileich may not be used)
Incorporated: 64E - 6.003, FAC
v 1.1.4
AP1060722
S15861987
Page 1 of 3
DEPARTMENT OF HEALTH
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permit Application Numl4d
PART II - SITE PLAN-
Scale: Each block represents 5 feet and 1 inch = 50 feet.
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Site Plan submitted by:
Plan Approved
By
•
- --Signature
Not Approved
Tide
Date
County Health Department
ALL CHANGES .MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
0H 4015. 10/96 (Replaces HRS44 Form 4016 Witch may be used)
(Stock Number: 5744-002•4015-6)
Page 2 of 3