PLC-11-370f
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 170143
Permit Number: PLC -3 -11 -370
Inspection Date: March 30, 2012
Inspector: Hernandez, Rafael
Owner: MCHALE, EDWARD
Job Address: 9500 NE 12 Avenue
Miami Shores, FL 33138-
Project: <NONE>
Contractor: A AARON SUPER ROOTER
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Septic
Phone Number
Parcel Number 1132060143640
Phone: 305 -944 -8886
Building Department Comments
REPLACE DRAINFIELD
Passed
Inspector Comments
CREATED AS REINSPECTION
sod
FOR INSP- 156696. HRS IN FILE pending
PA I
Failed
Correction
Needed
Re- Inspection
Fee
No Additional. Inspections can be scheduled
re- inspection fee is paid.
until
March 30, 2012
For Inspections please call: (305)762 -4949
Page 1 of 1
(o-Kv. tv6-4-41Q
BUILDING
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.
tt MAR 032011
BY:
PERMIT APPLICATION Master Permit No.
FBC 20
Permit Type: PLUMBING
Owner's Name (Fee Simple Titleholder) ' V.J t ( Phone #
Owner's Address ' IC"/ (L.- t , c " 12 '1
City t 'S‘ V--2A •_' State V L..- Zip 3 ' 1 ''..)
Tenant/Lessee Name
Email
Job Address (where the work is being done)
Phone #
City Miami Shores Village County Miami- Dade Zip
FOLIO / PARCEL # t( - C : h, } _
0
Is Building Historically Designated YES
NO
Contractor's Company Name A ' AGro ri �e
Contractor's Address .4 Q 'Z ,Z 5., I .3 5 C---
I 12,—v v
Flood Zone
3° S 9'LHE 6'
City 1%-A1 " 1.-.k G,,-
Qualifier Name b kr't Tv
State Certificate or Registration No.
Contact Phone
State 1
Zip "3 30 Z 3
Phone #
E -mail
Certificate of Competency No.
Architect /Engineer's Name (if applicable) Phone #
Value of Work For this Permit $ 23 00
Square / Linear Footage Of Work:
Type of Work: ['Addition ❑Alteration ❑New 21. ace /Re lr
Re ai
�^ p p ❑Demolition
'�.
Describe Work: e'�t C,;t, p s I �l d
* ** * * * * * *: * * * * * * * * * * * * * * * ** *** * ** * * * * ** Fees ************ * * * * * * * * * * * *** * * * * * * * * * * * * * * * **
Submittal Fee $ %�_
.,_ • Permit Fee $ / 5-'° CCF $ CO /CC $
Notary $ Training /Education Fee $ Technology Fee $
Scanning $ Radon $ DPBR $ Bond $
Double Fee $ Violation date:
Structural Review. $ Total Fee Now Due $
See Reverse side -+
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
FINAN ' , CON ULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
REC h 1 ING YO R N ICE OF COMMENCEMENT."
Notic to.Applican . As a
promise in good faith\,
whose property is su
for the first inspect
in a tion will not
of a building permit with an estimated value exceeding $2500, the applicant must
mmencement and construction lien law brochur will be delivered to the person
zed copy of the recorded notice of comment' ent must be posted at the job site
after the building permit is issued. In th absence of such posted notice, the
will be charged.
The foregoing instrument was acknowledged before me this,, z G(e')
day of d , 2011 , by E � , << Y�c aat
who is personally known to me or who has produced
ification and who did take an oath.
NOTARY P
Sign:
Print:
Signature
Contractor
The foregoing instrument was acknowledged before me this
day of M(){(-1".' , 20 (r , by J t-, k
who is personally known to me or who has produced 0 1 v
z (..x..i as identification and who did take an oath.
NOTARY PUBLIC:
A N. GERSTEMEIER
My Commission Expires:
03
;_: = EXPIRES: August 2, 2011
Via
"• . °, ^^ Bonded Thru Notary Public Underwriters
Sign:, s \�-{^f 1%` 12. -Tr'
Print 1 +�,tf'�.:��:. ® .. ............
My Commission Ex iresy.ERESA J. SOLQMON
y p xn, "�� Comm# ID '
D0733346
Expfres 11/8/2011
' $
n.n.nnnsr, * * **
** * *icdc9:9c9:isic**** **** * ** * **** **** *ic* k:F** *i: ** * *iF:P:t :F :tkk*9:*i:9F: ** *iekaF9:9::r*** *iP: ***
APPROVED BY
Plans Examiner
(Revised 07 /10 /07)(Revised 06/10/2009)
Engineer
Zoning
Clerk checked
PLC- (5-- ‘1.-- 310
61i
STATE OF FLORIDA
DEPARTMENT OF HEALTH DATE PAID:
ONSITE SEWAGE TREATMENT AND DISPOSAL FEE PAID:
SYSTEM
RECEIPT #:
DOCUMENT #: PR836778
PERMIT #: 13-S C - 1304384
APPLICATION #: AP995996
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: Edward & Evelyn Mchale
PROPERTY ADDRESS: 9500 NE 12 Ave Miami, FL 33138
LOT: 32
BLOCK: 81 SUBDIVISION: Miami Shores
PROPERTY ID # : 11- 3206 -014-3640
[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 ] GALLONS / GPD Septic CAPACITY
A [ 0 ] GALLONS / GPD CAPACITY
N [ 0 ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ ]
D [ 300 ] SQUARE FEET SYSTEM
R [ 0 ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [x] STANDARD [ ] FILLED [ ] MOUND [ ]
I CONFIGURATION: [X] TRENCH [ ] BED [ ]
N
F LOCATION OF BENCHMARK: F.F.E.: 10.8' NGVD.
I ELEVATION OF PROPOSED SYSTEM SITE [ 6.00 ][I=CBEs FT 3 [ABOVE /1 BELOW BENCEARK/Rb'ERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 48.00 II INCHES FT ]I ABOVE 'BELOW IBENCHMARK/REFERENCE POINT
L
D FILL REQUIRED:
0
T
H
E
R
[ 0.001 INCHES EXCAVATION REWIRED: [ 54.00] INCHES
1— Existing 1050 gal. septic tank certified by " A Aaron Super Rooter" on 02/25/2011 to remain 2- Install 300 sf of drainfield
in trewnch configuration. 3- Install 12° of slightly limited soil under the bottom of drainfield. 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 Tess they
7.60' NGVD. 6. Bottom of drainfield elevation to be no Tess than 7.10' NGVD. r_
' trip4 it
Hexcr" '3°41 1141
THIS PERMIT IS NOT FOR ADDITION(s).
SPECIFICATIONS B
APPROVED BY:
DATE ISSUED:
PEDRO OSPINA
Pedro Ospina
03/02/2011
TITLE:
Dade CHD
DH 4016, 08/09 (Obaoletes all previous editions which may not be used)
Incorporated: 64E - 6.003, FAC
v 1.1.4
AP995996
EXPIRATION DATE:
6E837639
05/31/2011
Page 1 of 3
STATE OF FLORIDA
DEPARTMENT OF HEALTH
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT ,
-/
Permit Application Number ;
PART II SITEPLAN
Scale: Each block represents 10 feet and 1 inch = 40 feet.
Notes: NI C
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Site Plan submitted, by: ,
Signature
Plan Approved
By
t-Approve_d
JfL ‘f
0.4
(^)ce'l . -
Title
Date
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
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Site Plan submitted, by: ,
Signature
Plan Approved
By
t-Approve_d
JfL ‘f
0.4
(^)ce'l . -
Title
Date
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