PL-12-275Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 170072 Permit Number: PL -2 -12 -275
Scheduled Inspection Date: March 14, 2012
Inspector: Hernandez, Rafael
Owner: SAFDIE, CHARLES
Job Address: 126 NW 108 Street
Miami Shores, FL 33168 -4313
Project: <NONE>
Contractor: A AARON SUPER ROOTER
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Drainfield
Phone Number
Parcel Number 1121360100030
Phone: 305 - 944 -8886
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 13, 2012
For Inspections please call: (305)762 -4949
Page 14 of 27
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
Permit No' V h 2 21
Master Permit No.
Permit Type: PLUMBING
OWNER: Name Ch c ri S- `idgme #:
(Fee Simple Titleholder): � � �i � �1 C��+� -ci S1
Address: 12.G 4."J is 8 ST-
City: t''n S 6 re S State: a- Zip: 3 368
Tenant/Lessee Name: Phone #:
Email:
JOB ADDRESS: Z 1 0
City:
Folio/Parcel #:
r
Miami Shores
County:
1k ° Z 13 C , 10° 00"70
Is the Building Historically Designated: Yes
Miami Dade Zip: 3-3 16 s
NO Flood Zone:
CONTRACTOR: Company Name: A N.. r' St., 0.-4/ to-, Phone#: I ci t4-4'° ec
Address: co 0 ZZ. Ste% 3 S Ct.
City: iYd1 on ct r State: Zip: 3 3
Qualifier Name: 3ar -To Phone #:
State Certification or Registration #: Certificate of Competency #:
Contact Phone #:
DESIGNER: Architect/Engineer: Phone #:
Email Address:
�� Square/Linear Footage of Work: ISO
Value of Work for this Permit: $
Type of Work: Address ❑Alteration ❑New epair/Replace ❑Demolition
Description of Work: 1 c Ca 1 n (6
* * * * * * * * * * * * *** * * * * * ** * * * **** ********* Fees********+ x* *a: a:** ***>k *************** *** * **** *
Submittal Fee $ Permit Fee $ /,) �4 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 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 f` eeding $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law bra . ure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of com ement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. 1 ,`e absence of such posted notice, the
inspection will not re ' # p r c e' ' pfd reinspection fee will be charged.
Signature Signature
r Agent
The foregoing instrument was acknowledged before me this 13
day of , 20V1 by U- c,a-ies- Sr •A e
who is personally known to me or who has produced ]5
aC As identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
.--(124-,,ut.
My Commission Expires:
TERESA � ��!nERESA J SOLOMON
;-
1 *. *: MY COMMISSION # EE132
EXPIRES November 08• 015
• 6-0153
Contractor
The foregoing instrument was acknowledged before me this 1,3
day of , 20 la, by j''o I. T1
who is personally known to me or who has produced 0 rl i,
L' 2''' i° as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission Exp.
******* **************** Ha^ H�N+jk=k�k�k +ij �3 y.. 6 ***ik+k*sRgs**sk*d **dk******
APPROVED BY 2-- Plans Examiner
Structural Review
(Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09)
ek>K,e, TERESA J SOLOMON
1*. ,,, MY COMMISSION # EE131935
• + -b 2015
EXPIRES November 08,
- -� " �ce.com
407) 396.01
Zoning
Clerk
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION PERMIT
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: Vickie Richardson
PROPERTY ADDRESS: 126 NW 108 St Miami, FL 33168
LOT: 3
PERMIT 4 :13 -SC- 1393098
APPLICATION 8: AP1061891
DATE PAID:
FEE PAID:
RECEIPT 8:
DOCUMENT #: PR866872
BLOCK: 212 SUBDIVISION:
PROPERTY ID 4: 11- 2136 - 010-0030
[SECTION, TOWNSHIP, RANGE, PARCEL NUMBER]
(OR TAX ID NOMBERI
SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF SECTION
381.0065, F.B., 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 *A'E'RIAL 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 [ 750 1 GALLONS / GPD Septic CAPACITY
A [ 0 1 GALLONS / GPD CAPACITY
N [ 0 1 GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS ®[ ]DOSES PER 24 BPS #Pumps [ 1
D [ 150 1 SQUARE FEET SYSTEM
R [ 0 ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [u] STANDARD [ ] FILLED [] MOUND
I CONFIGURATION: [u] TRENCH ( ] BED [ ]
N
F LOCATION OF BENCHMARK: F.F.E.: 12.60' NGVD.
I ELEVATION OF PROPOSED SYSTEM SITE [ 24.00 ] INCHES FT ] ( ABOVE
1 54.00 ] (l INCHES I' FT ] [ ABOVE
5 BOTTOM OF DRAINFIELD TO BE
L
D FILL REQUIRED:
O
T
E
R
1 0.00 1 INCBBS
BENCHMARK /REFERENCE POINT
BENCHMARK /REFERENCE POINT
EXCAVATION REQUIRED: ( 30.001 INCHES
1— Existing 750 gal. septic tank certified by ° A Aaron Super Rooter' on 02/09/2012 to remain. 2- Install 150 sf of drainfield
in trends configuration. 4- Perimeter of excavation area shall be at least 2 ft wider and longer than the proposed
absorption trench.. 5- Invert elevation of drainfield to be no less than 8.60' NGVD. 6. Bottom of drainfield elevation to be
no less than 8.10' NGVD.
THIS PERMIT IS NOT FOR ADDITION(s).
REPAIR.
(tiltAt ► CO ill1
APPROVED BY: TITLE:
SPECIFICATI
cap
Badso N °� Il Morin r (or designee) is required to perform
DATE ISSUED: 02/1512012 time g adjacent to the drag sell excavation at the EXPIRATION DATE: 05/15/2012
e of final inspection
DH 4016, 08/09 (C�solefies all P 91� � �
DE 4016, 08/09 (Obeo ete a .1 results to the original site ftteM evaiu boring and t compare j A the
a i�cpection fee will be submitted. A sse62913
1liee jobsite at the arranged timehe contractor is not
Page 1 of 3
9'W t < %d w " '441,74 , Stw..
DEPARTMENT OF HEALTH
APPLICATION" FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permit Application Number
PART 11- SITE PLAN-
4'$ 2�TgS'=4a,7'
Scale: Each block represents 5 feet and 1 inch = 50 feet.
•
1 . 1 ! ! i
I , g{ i I • - !�
r
...' 1;..i _4
t -!
1 • ' i -. : 1 11
1_..f`e.
__.: • i _ II 1-- - ...: i
•
r i- _._.I_ ') _1- -_i--r i. -i --1-
'�`i -,• {• - -• - f---,-- t -1
{- -! .4.---t-...,- -_°
j f i ' a � , �
_ -._ .. ._
•1- ' 1- _
{.-..
-..
2 x !�
. -...._
- _
}-
_. S._......i
_
i i
r•-
�.._<
�
_ {.
a -- ;j
• .-._.�.{
� s_
I-4,404-1-'1H . !_.....k
{ 4,._
-' ! Iry
.
t t • . ,
_ - 1-j • { -� ^ . j -. ••
S �,._ � _ , • t 1 }._. - • •
• i i_(• !~ • •_ • ._ 1 :��i -{ !
-_ i_ 1-
i !
-1,i' �
��ff
-{ ' °
•
i - ..}...
t
��
jf (`
j,
-7.
._.1
_�...'_.,
•
_ !tom' ` _ _t Z•
,_
1
-, + �1{ it ��
;
#
c
t
r �!
1 �
t----
-
{
r
r
'
�-
•_--1-
1 '?-
(- 4
- I._-i.- j-
4-- 1_.-t'. -•-L_.
1 j F iii ••,
`,(
-'t [
4 -I-
'
�f11f�i
T
�'l>�S`._!''..
lain
M ...
_•-•�
{_f"_�l`J__.._J [� ....
1 , }-
{}
f�
._L
- ■
�
,
+t
f r:r►i`
!
i 1 1 = 1 r
. 1_, 1 1•
{ f 1 -r
,
t
}
1�t
..
�%'-
• { 1 i 1 •1
.
it
-j- � ' .
171
r
11
■
_L'=1
itt
wtf
t '�i" '
}
't
j
` y�'�
l
1 4
l
_
! (
t i
�� 1
r {_! J
."1
iT
a
--1
1_
` f �~- i
iTj4 -'I -�_ -; --i i
t
44
■
I
l�0l�l�i
_
...1
; 1 _ • r
1
1
Jt
` ....._4____• '
i
i '��'
J
1
-
Ail-TT 1
rjr-t
--
ti
!if
`-1
1
u-1--
t
i
a
t'>
I i
i i
!
r
at
s
■�'
!r
All
it
SI
_�:.�`
s# T
t
N
{ f �, l
1 1
I
II
■
III
■
■
!
4.-
i
-Milt
X41117)'
l
■
■
•
;
1
11
� !
� �
q
t
!
■
III
f
ii.
It
/°
i
■
1 1 f 1-'
•
J
ill.
•
1►
--t-
' 1
1
■
■■■i
i
m
1 U
is
t
{ f s
Al
Amman
t . ■ ■t
■
t-�-
■■
IN
WM■II■
■
• J_t
4
-
"�
r
!
!
'i
1
a
..
At
U ',.. X. 11.91..,;:r"..;,Follard111,111
ir_II s'. s04 C°1ra C a G ®e->l • A
l -• t ifY 1% C-4-. `- '2 Le- ti-
r�vaas. �v�i \"!' d^e 9 v • ds� v 1 viv I - ' - 1�s J + J .J % (
cir'cIR-e*N-f•Ve CI 1G) y
Site Plan submitted by: �, r
Plan Approved
By
Tide
Date
County Health Department
ALL CHANGES.MUST BE APPROVED BYTHE COUNTY HEALTH DEPARTMENT
OH 4015. IONS (Replaces HRS•H Farm 4015 wh lch may be used
(Stack Number: 5744-002-4015-6)
Page 2 of 3