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PL-11-1925Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 172845 Permit Number: PL -10 -11 -1925 Scheduled Inspection Date: April 30, 2012 Inspector: Hernandez, Rafael Owner: REESE, SIDNEY Job Address: 960 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 1132060143160 Phone: (954)963 -0082 Building Department Comments REPLACE OVER FLOWING DRAINFIELD Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments CREATED AS REINSPECTION FOR INSP- 165652. HRS IN FILE missing sod April 27, 2012 For Inspections please call: (305)762 -4949 Page 27 of 38 Sidney W Reese 111 960 NE 97th Street a6-151--4303 Dear Norm ErVIEC APR 2 0 C ;; April 19, 2012 1 am writing this note to you humbly requesting an extension of 30 days for my final inspection of sod and cracked sidewalk, after the warranty work done on my drain field. P_ t 1T FL } _ 925 Thank you for your consideration. Respectfully DIVISION OF Erwirotuestid Health Ftoritlartmeut of Health M1arI -Dade County Health Department OSTDSIWeft Division 11505 SW 26 St. • 341ami, FL 33175 Date,r* `©SIDS #1g1/7v W Y PL 10- H- 1°(23 Inspector `- Address Comments-, f 6' I Signature Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 �� l C' �'` 'ij INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING Permit No. 16 11 1 PERMIT APPLICATION FBC 20 Master Permit No. s - o it ci ct-6 R Permit Type: PLUMBING ^, -7S� OWNER: Name (Fee Simple Titleholder): G i f R e Se Phone #: � 1 ,7 4-3 0 3 Address: ct Go NS en !i- City: M B C4 rell &VI®reS State: FL Zip: C (38 Tenant/Lessee Name: Phone#: Email: JOB ADDRESS: CI GC q- St-re�. City: Miami Shores County: L < Miami Dade Zip: 3( Folio/Parcel #: � �' 320 G — 1$"3 (� Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: c C- h ((" 2 Phone #: G C- Address: 5,e kS City: HXD (i Ci State: ��, Zip: 3)t)8 3 Qualifier Name: T -V, d/ 0-6:Ar") Phone #: State Certification or Registration #: X1.6191 t Z Certificate of Competency #: Contact Phone #: Email Address: DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ tza Square/Linear Footage of Work: 5 O pe of Work: Address Description of Work: OAlteration ONewRepair/Replace ODemolition CtVrbk Re0 ** * ** :a:**6*:= : +x *:**** ****** ** ****** ees******************************************** Submittal Fee $ Permit Fee $ / CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ t 13 0 Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) irVj 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature LiA'lekk Owner or Agent Signature e c 4v-C-oftli--- Contractor The foregoing instrument was acknowledged before me this le The fore�ng instrument was ackno ledge • before day of 0C1 , 20 V 1 , by tt €-I �e i. �° , day of C) , 201 , by who is personally known to me or who has produced D 14 i who is personally known to me or who has produced as identification and who did take an oath. ll. St; As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: 040 ,b itNESA 7- SOLOMON CbMMISSION # EE131935 ,e; EXPIRES November 08, 2015 (407) 398-0153 fLidallotary$ervt e.om NOTARY PUBLIC: L 1 / Ji he* Sign: Print: My Commission * * * * *x ******** *: x* ***u :***=k****=r:+x **** * * ** ******* * **** x ************ *** *** * *** ** APPROVED BY Plans Examiner Structural Review (Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09) CLAUDIA V C te of Florida B <'• c•Notar _ tidy Comm. Expires Sep 23, Commission #� EE 128810 ,, Comm � Notary Assn. '' o' — Bonded Tftro :atM * * * * * * * * * * * * * * * * * * * * * * * ** Zoning Clerk STATE : . EWRIDA IMF .... ..... I) T OR D& Rat 304 4 .:. APPLICATVAI 0: EATS PAID: WE PAM: Doc*. it; PRI35080.44 irocsor 31-critmlde Sc PFXI ,Sxs g, eI. , IN ACCORDANCE W1011 SPECIFIcATI SPCTION SAIPSFACTOSZ PERFOIESSICS FOR ANS stem= rainoo or TrIEL. ANT cENEIN IN L WHICH SEWED AS A RASPS FON ESSU,MiCE OP THIS PERDUE! PEL41112 Sttil :rxrzwarctis Isur RAWLY IN CEPS HARTY GING DADD NOLL An SOT. ISSUANCE OF THIS PERMIT EXEMPT ziatnz Oki 11; PINUR 114:01W124* STATE, CA . ISTING szotano DEVELOTNIZT or nits PROPERTY. TY. SYSTEM DESIGN AND SP A [ N E sco ] wow= /' 6`ro eitiat rsA Sect t • 1 . • 1 rataoss mamas zsrrstmes GALEona cosmic "rti CAPACITY amain E 1 I .r1 ots [ S T SYSTEM O 1 S: WPM or Simms= =Ems s E SoTIM o ORAL*ApIELE TO . RI L D STILL ONTAZDt Ir STATE OF FLORIDA DEPARTMENT OF HEALTH � ►VON FQR .:: rf€ ,S.411,ytaE DISPOSAL .s ONSTR CTJON PE ;. PO' Aliatteafforiltiiiintisi: .FART li - :;.... Scat*: Each -; pemsepts feet and inch 50 igut.