PL-11-337Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 156490 Permit Number: PL -2 -11 -337
Scheduled Inspection Date: February 24, 2012
Inspector: Hernandez, Rafael
Owner: PORTNER, TINA
Job Address: 870 NE 92 Street
Miami Shores, FL 33138-
Project <NONE>
Contractor: G&L PLUMBING SERVICE
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Drainfield
Phone Number
Parcel Number 1132060050140
Phone: 305 - 551 -5090
Building Department Comments
DRAIN FIELD ONLY
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
hrs in file
February 23, 2012
For Inspections please call: (305)762 -4949
Page 1 of 12
,' i2-Mf1
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 Type: PLUMBING D 67f; 4 ` t2 f at
.ice Fa.
FED
Permit No.? L
Master Permit No.
OWNER: Name (Fee Simple Titleholder)): —1r �(d-i1 e d' Phone#:
Address: (3 7 0 4/ F `�' 2- 7
City: rde✓l e i, cofaS state: f zip: g
Tenant/Lessee Name: Phone#:
Email:
JOB ADDRESS: 7 d 1V F cr
City: Miami Shores County: Miami Dade Zip: `53 132
Folio/Parcel #:
Is the Building Historically Designated: Yes NO 7C Flood Zone:
CONTRACTOR: Company Name: Get- 1- rVV P i ii3 �e()/: ` I n C Phone#:
Address: ? c f (( 5L/ 67 t1' v I
City: 5 M : vvi a State: T.( Zip: 33 / (1 3
Qualifier Name: Orr; Prof Cloy Phone#: 305 3 1 4, TOO' O
State Certification or Registration #: C F C -0567 SS Certificate of Competency #:
Contact Phone#: Email Address:
DESIGNER: Architect/Engineer: Phone#:
�P
Value of Work for this Permit: $ ®• Square/Linear Footage of Work:
Type of Work: °Address °Alteration °New gRepair/Replace
Description of Work: ) at; 4 -i ,e `r.�
°Demolition
Submittal Fee A ID 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 $ 1411 �
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 FLF.CTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDTTIONERS, 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
Owfer or ent
The foregoing instrument was acknowledged before me this I
day of __/h, 20 LL, , by
who is personally known to me or who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
Signatur
Contractor
The foregoing instrument was acknowledged before me this
day of rei ,20LL,by
who is personally known to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
Structural Review
(Revised 07 /10 /07)(Revised 06 /10i2009)(Revised 3/15/09)
Zoning
Clerk
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM
CONSTRUCTION PERMIT
CONSTRUCTION PERMIT FOR:
APPLICANT: Tina Portner
PROPERTY ADDRESS: 870 NE 92 St Miami FL 33138
LOT: 3 BLOCK: 2
OSTDS Existin Modification
PROPERTY ID (t: 11- 3205 -005 -0140
SUBDIVISION:
PERMIT fi : 13.,SC- 1275787
APPLICATION #: AP977180
DATE PAID:
FEE PAID:
RECEIPT B:
Doc' #: PR822100
[SECTION, TOWNSHIP, RANGE, PARCEL NUMBER]
[OR TAX ID NUMBER]
SYSTEM MUST SE CONSTRUCTED
381.0065, F,S,, AND C ACCORDANCE WITH BPECIFICATIONB AND STANDARDS OF
381.0065, ., ANMAN RAFTER 64E -6, F.A,C. DEPARTMENT APPROVAL OF SYSTEM SECTION
WHICH TIS SERVED FOR ANY SPECIFIC PERIOD OF DOES NOT Gt7ARACTS,
A NASIS FOR ISSUANCE OF THIS TIME. ANY CHANGE IN MATERIAL FACTS,
PERMIT APPLICATION. SUCH FOR ISSUANCE PERMIT, REQUIRE THE APPLICANT
ISSUANCE OF MAY RESULT IN THI8 MOD/FY THE
THIS PERMIT DOES NOT EXEMPT THE APPLICANT FROM BEING MADE NULL AND ERIL,
STATE, OR LOCAL PERMITTING REQUIRED FOR DEVELOPMENT YOM COMPLIANCE
PMENT OF THIS PROPERTY. �� OTHER FEDERAL,
SYSTEM DESIGN AND SPECIFICATIONS
T
A
N
K[
900 ] GALLONS / GPD
] GALLONS / GPD CAPACITY
] GALLONS GREASE NIA CAPACITY
] GALLONS DOSING TANK INTERCEPTOR CAPACITY (MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
CAPACITY [ ]GALLONS @[
D [ 500 ] SQUARE FEET o f a rati
R [ ] SQUARE FEET SYSTEM
A TYPE SYSTEM: h/A SYBTEM
[R] STANDARD
I CONFIGURATION: [ ] TRENCH (X] LLED[ } [ ] MOUND [ ]
F LOCATION OF BENCHMARK: FFE: 15.21' NGVD
I ELEVATION OF PROPOSED SYSTEM SITE
E BOTTOM OF DRAINFIELD TO BE
L
D FILL
O
T
H
E
R
REQUIRED:
[ 0.00 ] INCHES
FT ] [ ABOVE BENCHMARK /REFERENCE POINT
FT ][ABOVE BENCHM#1RK /REFERENCE POINT
EXCAVATION REQUIRED: [ 72.00 INCHES
1 .-Existing 900 gal. septic tank, certified by "Statue Septic Contractors on 08/27/2010" to remain.
2.- Install 500 sf of drainfield in bed configuration.
3.- Install 42" of slightly limited soil at the bottom of the drainfield.
4.- Perimeter of excavation area shall be at least 2 ft wider and longer than the proposed absorption bed.
5. -Invert elevation of drainfield to be no less than 10.20' NGVD.
S.- Bottom of drainfield elevation to be no less than 9.80' NGVD.
]DOSES PER 24 HRS #Pumps [ ]
SPECIFICATIONS BY: Astrid V Edwards
APPROVED 8Y:
rar
TITLE: Engineer Specialist II
TITLE: Engineer Specialist II
DATE ISSUED: 09/16/2010
EXPIRATION DATE:
DE 4016, 08/09 (Obsoletes all
previous editions which may not be used)
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