PL-12-8241
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 173290 Permit Number: PL -5 -12 -824
Scheduled Inspection Date: June 01, 2012
Inspector. Hernandez, Rafael
Owner: MENDEZ, JUANA
Job Address: 167 NW 103 Street
Miami Shores, FL 33150 -1235
Project: <NONE>
Contractor: MR C'S PLUMBING SEPTIC INC
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Drainfiield
Phone Number
Parcel Number 1121360131530
Phone: (305)651 -7859
Building Department Comments
DAINFIELD INSTALLATION
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
HRS IN FILE
May 31, 2012
For Inspections please call: (305)762 -4949
Page 3of7
Miami Shores Village IMCMFTTET
Building Department AY Ot�9 Z°='
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
3 0 ® ( I `-p/A INSPECTION'S PHONE NUMBER: (305) 762.4949
BUILDIN Permit No. 4
PERMIT APPLICATION Master Permit No.
FBC20
Permit Type: PLUMBING
OWNER: Name (Fee Simple Titleholder):
Address: /6 7 Afi.4.1 to 3 Jf"
City:
Tenant/Lessee Name:
MeloiDea. Phone #: 7e' $33 9
State:
Phone #:
Zip: 33 /5-6
Email:
JOB ADDRESS: 7 Ai /a 3 "I
City: Miami Shores County: Miami Dade Zip: 5. 3 /5-0
Folio/Parcel #: I-- a / — 6 / 3 —4530
Is the Building Historically Designated: Yes NO Flood Zone:
CONTRACTOR: Company Name: % f G s % J 1 S9-1,& Phone #: (.7‘53,57. v 7tSl
Address: / yy .3.2 ,1/44} 2 f
City: State: Zip: /3149
Qualifier Name: Kext*.- � Phone #: ?I .224 Cc( ?�
State Certification or Registration #: . ' Certificate of Competency #:
Contact Phone #: Email Address:
DESIGNER: Architect/Engineer: Phone #:
Value of Work for this Permit: $ 2 3 Square/Linear Footage of Work: 3 ,,,cyfi
Type of Work: OAddress DAlteration ❑New cdRepair/Replace ODemolition
&Ai:tie( -Lit' `
Description of Work:
********** ***** *** ***** ** ************** Fees***** ************* * ** ***x***** **** **+x*******
Submittal Fee $ Permit Fee $ /--5 CCF $ CO /CC $
Scanning Fee $ Radon Fee $ . DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $
)
2 .3c"
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City tate 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 ab. ' e of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signatu
Owner or �--
The foregoing instrument was acknowledged before me this "1°r
day of ti tkl , 20 l 2-, by SVPV{U& 16
who is personally known to me or who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
* * * * * * * * * * * * * **
Signature
Contractor
The foregoing instrument was acknowledged before me this 4
day of
o is personally known to me
20 L2 by - K6fY&f F -ac
r who has produced
KEMBLE E?TRiCK
MY CCMM4SS10N # 00 891340
EVIFIES ;13eptem berur er0rnets
Bonded TIn
APPROVED BY / 1 5-1-1 Z Plans Examiner
Structural Review
(Revised 07 /10/07)(Revised 06 /10/2009)(Revised 3/15/09)
as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission E 'ires:
*
/ %Des
* * * * * * * * **
Zoning
Clerk
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION PERMIT
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: Juan Rodriguez
PROPERTY ADDRESS: 167 NW 103 St Miami, FL 33150
LOT: 16
PERMIT #:13 -SC- 1407899
APPLICATION #:API070914
DATE PAID:
FEE PAID:
RECEIPT #:
DOCUMENT #: PR874656
BLOCK: 127 SUBDIVISION: Miami Shores Sec 5
PROPERTY ID #: 11- 2136- 013 -1530
[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 [
A [
N [
K [
900 ]
0 ]
0 ] GALLONS GREASE INTERCEPTOR CAPACITY
] GALLONS DOSING TANK CAPACITY
GALLONS / GPD Septic existing CAPACITY
CAPACITY
[MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ ]
GALLONS / GPD
D [ 300 ] SQUARE
R [ 0 ] SQUARE
A TYPE SYSTEM:
I CONFIGURATION:
N
FEET
FEET
[x] STANDARD
[ ] TRENCH
SYSTEM
SYSTEM
[ ] FILLED [ ] MOUND [ ]
[x] BED [ ]
F LOCATION OF BENCHMARK: FFE : 12.3'NGVD
I ELEVATION OF PROPOSED SYSTEM SITE
E BOTTOM OF DRAINFIELD TO BE
L
D FILL REQUIRED: L 0.00 ] INCHES
T
E
[ 16.80 ] [I INCHES I/ FT ] [ ABOVE /) BELOW b BENCHMARK /REFERENCE POINT
[ 46.80 3 [I INCHES f FT ] [ ABOVE A BELOW 11 BENCHMARK /REFERENCE POINT
EXCAVATION REQUIRED: [ 42.00] INCHES
- Install 300 sq ft drainfield.
- Install 12" of slightly limited soil under bottom of drainfield.
- Elevation of bottom of drainfield to be no less than 8.40' NGVD.
- Existing 900 g septic tank, to remain.
- Not for additions
SPECIFICATIONS BY:
APPROVED BY:
Jo
DATE ISSUED: 052012
DH 4016, 08/09 (Obso
Incorporated: 64E-
TITLE:
The contractor (or designee) is required to perform a
soil boring adjacent to the drainfield excavation at the
time of final inspection. Prior to Final Approval, the DOH
inspector shall witness the soil boring and compare the
results to the original site evaluation submitted. A
reinspection fee will be assessed if the contractor is not
at the jobsite at the arranged time.
TITLE: E der Specialist II
s all previous editions which may not be used)
3, FAC
v 1.1.4 AP1070914
Dade CHD
EXPIRATION DATE: 08/01/2012
58869685
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