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PL-10-416Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 nspection Number: INSP - 137974 Permit Number: PL -3 -10 -416 Inspection Date: March 24, 2011 Inspector: Bruhn, Norman Owner: PAZ, EMMANUEL Job Address: 1291 NE 102 Street Miami Shores, FL 33138- Project: <NONE> Contractor: MIAMI DADE ENVIROMENTAL Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Drainfield Phone Number (239)565 -3103 Parcel Number 1132050200050 Phone: 786 -251 -4099 Building Department Comments INSTALL NEW 1050 SEPTIC TANK AND 667 SQ OF DRAINFIELD Passed Inspector Comments � t Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled re- inspection fee is paid. until For Inspections please call: (305)762 -4949 March 23, 2011 Page 1 of 1 STATE OF FLORIDA PERMIT NO DEPARTMENT OF HEALTH DATE PAID: ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM FEE PAID. CONSTRUCTION INSPECTION AND FINAL APPROVAL RECEIPT #: °ov vt APPLICANT: AGENT: PROPERTY ADDRESS: LOT: BLOCK: SUBDIVISION: PROPERTY ID #: ` CHECKED [X] ITEMS ARE NOT IN COMPLIANCE WITH STATUTE OR RULE AND MUST BE CORRECTED. TANK INSTALLATION SETBACKS [01] [02) [03] [04) [05] OUTLET FILTER TANK SIZE [1]; [2] [ ] [27] SURFACE WATER TANK MATERIAL [ ] [28] DITCHES OUTLET DEVICE [ 1 PRIVATE WELLS MULTI- CHAMBERED [Y / N ] [ 1 PUBLIC WELLS IRRIGATION WELLS [06) LEGEND [07] WATERTIGHT [08] LEVEL [09] DEPTH TO LID DRAINFIELD INSTALLATION [ 10] AREA [1] - 12] SOFT [11] DISTRIBUTION BOX HEADER_ [12] NUMBER OF DRAINLINES [13] DRAINLINE SEPARATION [14] DRAINLINE SLOPE [15] DEPTH OF COVER [16] ELEVATION [ABOVE /BELOW] BM [17] SYSTEM LOCATION [18] DOSING PUMPS [19] AGGREGATE SIZE - [20] AGGREGATE EXCESSIVE FINES -]2-:] AGGREGATE DEPTH FILL / EXCAVATION MATERIAL [22] FILL AMOUNT [231 FILL TEXTURE [24] EXCAVATION DEPTH [25] AREA REPLACED [26) REPLACEMENT MATERIAL EXPLANATION OF VIOLATIONS / REMARKS: [ I ] [29] [30] [31] [32] [33] [34] [35] POTABLE WATER LINES BUILDING FOUNDATION PROPERTY LINES OTHER FT FT FT FT FT FT PT FT FT FILLED / MOUND SYSTEM [36] DRAINFIELD COVER [37] SHOULDERS [38] SLOPES [39] STABILIZATION ADDITIONAL INFORMATION [40] UNOBSTRUCTED AREA [41] STORMWA T ER RUNOFF [42] ALARMS [43] MAINTENANCE AGREEMENT [44] BUILDING AREA [45] LOCATION CONFORMS WITH SITE PLAN [46] FINAL SITE GRADING [47] CONTRACTOR - [48] OTHER ABANDONMENT [49] TANK PUMPED / I [50] TANK CRUSHED & FILLED___ / CONSTRUCTION [APPROVED /DISAPPROVED]:. FINN_ SYS'EM'[APPF# "FDJDISAPPROVED)- DH 4016 (Page 2), 10/97 (Previous Editions May Be Used) Stock Number: 5744- 002 - 4016 -4 CHD DATE: = - - CHD DATE: PT 1: Applicant PT 2: Installer /Contractor PT 3: Building Department PT 4: Health Department Page 2 of 3 1 Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Project Address 1291 102 Street Miami Shores, FL 33138- Owner Information EMMANUEL PAZ mostkvam Address Pear : Plumbing Parcel Number 1651 115 Street MIAMI FL 33181- 1132050200050 Block: Lot: Contractor(s) Phone CeII Phone F &F CONSTRUCTION SERVICES INC (954)454 -1948 (305)525 -1427 MIAMI DADE ENVIROMENTAL 786 - 251 -4099 Phone PROVED Expiration: /1 Applicant (239)565 -3103 Valuation: Total Sq Feet: Type of Work: PLUMBING Type of Piping: TANK & DRAINFIELD Additional Info: Bond Return : Classification: Residential Fees Due CCF Education Surcharge Permit Fee - Additions /Alterations Scanning Fee Technology Fee Total: Amount $3.00 $1.00 $300.00 $3.00 $4.00 $311.00 Pay Date Pay Type Amt Paid Amt Due Invoice # PL -3 -10 -37290 03/18/2010 Check #: 2498 $ 311.00 $ 0.00 Cell Available Inspections: Inspection Type: Final Rough i Landscaping In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS 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. Futhermore, I authorize the above -named contractor to do the work stated. March 18, 2010 Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy Date March 18, 2010 1 Miami Shores Village p0311W311 Building Department MAR 1 5 2010 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 BY: BUILDING PERMIT APPLICATION FBC 2004 Permit Type: Plumbing Owner's Name (Fee Simple Titlehdlder) F #'%(Q NOe_l BA-2_ Owner's Address 7�Q ( 1)& te22.G Permit No.11 10-1 l� Master Permit No. Phone # City (/411-4A StDfLe.S State Tenant/Lessee Name Flo zip 33I 3& Phone # E -MAIL: Job Address (where the work is being done) City Miami Shores Village /29/ iu r_; -102 sT County Miami -Dade FOLIO / PARCEL # /1- 3205- 020 -cc sO Zip 33138 Is Building Historically Designated YES NO p( Contractor's Company Name i(r ( Out 11.0 J -(e (NA Contractor's Address g210 L IAK e S City ((4 k State r (!& Qualifier Name d P ci \wwl S Phone # 786,•2 5/-L(0 -l! State Certificate or Registration No. (k OCt Z 1 '40 E -MAIL: Architect /Engineer's Name (if applicable) Zip '3•31(0(., Phone # 786 `). 0 -Cfcf Certificate of Competency No. Phone # Value of Work For this Permit $ C..S0O Square / Linear Footage Of Work: (' "7 , Type of Work: ❑Addition ['Alteration [New ❑ Repair /Replace ❑ Demolition Describe Work: I'N � l (A.1\ to se j e l t e I l 01A 66,7 * * * * * * * * * * * * * * * * * * * * * * * *x *x * * * ** Submittal Fee $ Permit Fee $ * *Feesx x** xx***** * * * *xxxxxxx * * * * * * * * ** * * * * * * * * ** Notary $ Training /Education Fee $ 1- GO Scanning $3• Radon $ DPBR $ Bond $ Code Enforcement $ Structural Review. $ CCF $ (O9 C /CC Technology Fee $ 4- Double Fee $ Zoning $ Total Fee Now Due $ 511 • n See Reverse side --* Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City Zip 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. l 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 seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Owner or Ag-nt Contractor The foregoing instrument was acknowledged before me this The regoing instrument was acknowledged befo e me this y of IS— �I fkt�> 20i 6 by who is personally known to me or who has produced Signati • / day of /14/ fit, ((,2010 ,by who is personally known to me or who has produced As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC!--- My Commission Expires: LAURA FARLEY MY COMMISSION a DD 646761 EXPIRES: March 16, 2011 Bonded Thru Budget Notary Services Xxr. XY. XY. XXW * W W *xxxxx *xx *x *x 1C Y. XXxxxxx *xxx APPLICATION APPROVED BY: (Revised 02/08/06) NOTARY PUBLIC: ,to t,Y 1"06.,, 4l IRA F LEY ^D 646761 Sign: ��a1b ,2011 "P"'rT �' tSOri u I uuget NO SeNICEs Print: L t,--,...... orF�`e �' My Commission Expires: :xx * *r. xxr. *xx * *x * * *x xr.x * *rx * * *r. rxrxxrxx* *,.xxxr. xxxr. **r* *r.r. * * *r. **4: - *': Plans Examiner Engineer Zoning STATE OF FLORIDA '4"Nit "t6 DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT FOR: APPLICANT: Emmanuel Paz OSTDS New PLPMIT:g,13-_Sc107785 APPLICATION AP942214 DATE PAID: FEE PAID: RECEIPT #: DOCUMENT #: PR795563 PROPERTY ADDRESS: 1291 NE 02 St arni, FL 33138 LOT: n/a BLOCK: N/a PROPERTY ID #: 11-3205-020-0050 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 [ 1,050 1 GALLONS / CPD Seotic CAPACITY A [ 1 GALLONS / GPD N/A CAPACITY N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS] K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS (II ]DOSES PER 24 HRS #Pumps [ D R A N [ 667 ] SQUARE FEET SYSTEM ] SQUARE FEET N/A SYSTEM TYPE SYSTEM: [x] STANDARD [ ] FILLED [ ] MOUND [ CONFIGURATION: ] TRENCH [x] BED [ F LOCATION OF BENCHMARK: 7.64' NGVD C/L NE 102 St ELEVATION OF PROPOSED SYSTEM SITE [ 13.70 1 E BCTTOM OF DRAINFIELD TO BE [ 31.70 i I D FILL REQUIRED: [ 0.00 ] INCHES 11 E R INCHES [ ADC / BELOW 1] BENCHMARK/REFERENCE POINT INCITES [ ABOVE 4 BELOW 11BENCHMARK/REFERENCE POINT EXCAVATION REQUIRED [ 60.00] INCHES 1.-Install a 1050 gal min. category 3 septic tank with an approved filter. 2.-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. 3.-Install 667 sf of drainfield in bed configuration. 4,-Install 42" of slightly limited soil at the bottom of the drainfield. 5.-Perimeter of excavation area shall be at least 2 ft wider and longer than the proposed absorption bed. 6.-Invert el. of drainfield to be no less than 5.50 NGVD. 7.-Bottom of drainfield el. to be no less than 5.00' NGVD. SPECIFICATIONS BY: APPROVED BY: DATE ISSUED: s rid V Edwards 7/ str Ld V Edwards 01/12/2010 TITLE: Engineer Specialist II TITLE: Engineer Specialist II DH 4015 10/97 (Previous Editions May Be Used) Dade CHD EXPIRATION DATE: 07/12/2011 Page 1 of 3