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
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