PL-12-919Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: I NSP- 173884
Permit Number: PL -5 -12 -919
Scheduled Inspection Date: June 13, 2012
Inspector: Hernandez, Rafael
Owner: CRAVELLO, LOURDES & ERIC
Job Address: 761 NE 95 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 1132060142150
Phone: (954)963 -0082
Building Department Comments
REPLACE DRAINFIELD
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
HRS IN FILE
June 13, 2012
For Inspections please call: (305)762 -4949
Page 6 of 19
DIVISION OF
Environmental Health
Florida Department of Health
Miami -Dade County Health Department
OSTDS/Well Divjsion
11805 SW 26 St. t- VItyl0 PL 33175
Inspector
Address ; 1 ,
Comments.
Date -1 °2
Q.S`TDS #O4P'C 7.2.4-7/
Signature
J(/N 1` 1 X012
BUILD
PERMIT APPLICATION
Fsc zo
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
,
MAY 2 2 26i2 ►
Permit No. I
Master Permit No.
Permit Type: PLUMBING f
OWNER: Name JL ��((/Fee Simple Titleholder): l Q0'Trd l 11 C Cyc �K 11 C Phone #:
Address: 46 ME ¶� Sfree- f
City: 141 too' j Stores State: Zip: 3313
Tenant/Lessee Name: Phone #:
Email:
JOB ADDRESS: q S Srt
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel #:
y � - 2- G 014--
Is the Building Historically Designated: Yes
CONTRACTOR: Company Name: &C. +t' 05\ Cke,
Address: C 2-70 51 , - t
City: Ir a IV c
Qualifier Name: Tejo
State Certification or Registration #: M c l
Contact Phone #:
o3
NO
Flood Zone:
/he
3�S
Phone#: G6 (- ,.
State: FL
Zip: '" L i
Phone #:
Certificate of Competency #:
Email Address:
DESIGNER: Architect/Engineer: Phone #:
Value of Work for this Permit: $ LOO 0 Square/Linear Footage of Work:
Type of Work: Address
Description of Work:
°Alteration °New
4'
epair/Replace
°Demolition
******** * ** ***** ******* ********** ****** Fees************* * ****** ** * * * * * *** * *** ** ******a*
Submittal Fee $ Permit Fee $ %5
Scanning Fee $
Notary $
Double Fee $
Radon Fee $
Training/Education Fee $
Structural Review $
CCF $ CO /CC $
DBPR $ Bond $
Technology Fee $
TOTAL FEE NOW DUE $ 1 ?..e 3 D
soo
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 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 $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Ct
Owner or Agent
The foregoing instrument was acknowledged before me this i The forego'
day of , 20 ., by _$ day of
who is personally known to me or who has product° who is pers
d
NOTARY PUBLIC:
Print: [kf-s
My Commission Expires:
********* *********+a *** ** ***** * *********
APPROVED BY
g T7m2oae , 20 .1±, MY
4
own to
as identi
NOTARY
Sign:
Print:
My C
.0
LIC:
or who has produced
tion and who did take an oath.
I
I l 1 f':i
Air4•; rs Notary Public - State of Florida
My Comm. Expires ep
Pirgemmission # EE 128810
of vcit' Bonded Through National Notary Assn.
******* ****+ x******** ***+ xH< *****, x* u :******** ** * * ************
Plans Examiner
Structural Review
(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09)
Zoning
Clerk
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION PERMIT
CUNI:MMULT OS PERMIT' FOR:
APPLICANT: Lourdes Cravello
PROPERTY amuse 761 NE 95 St Miami, 'FL 33138
PERMIT 8:13-SC-1410396
APPLICATION W:AP1072291
DATE PAID:
FEE PAID:,
RECEIPT 8:
DOCUMENT 0: PR875867
LOT: 15 16 BLOCK: 66
PROPERTY ID 0: 11-3206-014-2150
SUBDIVISION:
ISECTION, TOWNSHIP, RANGE, PARCEL NUMBER]
[OR TAX ID NOMBER1
SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF SECTION
301.0065, F.S., AND CHAPTER 64E-6, F.A.C. DEPAIMENT APPROVAL OF SYS'DIN 'DOES NOT GUARANTEE
SATISFACTORY PERFORMANCE FOR ANY SPECIFIC' PERIOD OF TIME. ANY CRIME 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 CCAIPIGANCE WITH 'OTHER FEDERAL,
STATE, OR LOCAL PEIEFITTING REQUIRED FOR DEVELOPMENT OF THIS PROPERTY.
SYSTEM DESIGN AND SPECIFICATIONS
T [ 750 1. GALLONS / GPD Exiatingt.sentic tank.to remain. CAPACITY
A [ 0 GALLONS / GPD CAPACITY
N L 0 1 GALLONS GREASE INTERCEPTOR CAPACITY [MAX32401. CAPACITY SINGLE. UNX4.1250 GALLONS].
K 1 GALLONS DOSING TANK CAPACITY 1GALLONS 111 IDOSES PER .24 MRS *Pumps
D 150 SQUARE FEET Trench configuration drain SYSTEM
E L 0 1 SQUARE PEET
A TYPE SYSTEM: la) STANDARD [ .1 FILLED MX=
I CONFIGURATION: (a]' TRENCH BED
SYSTEM
N
F LOCATION or BENCHMARK: F.F.E., 10.5U NGVD
1 3
• ELEVATION OF PROPOSED SYSTEM SITE
• BOTTOM OF DRAINFIELD TO BE
L
D FILL REQUIRED:
0
T
E
N • -
[ 0.001 INCHES
1 16.00 INCHES FY / ABOVE BENCHMARK/REFERENCE POINT
148.001 1.1 mous I/ FT j (ABOVE fiiirogliBENCHMARK/RZPERENOS POINT
EXCAVATION REQUIRED: [ 30.00 INCHES
*Invert elevation of drainfield to be no less than 7.00 ft. NGVD.
*Bottom of drainfiekl elevation to be no less than 6.50 ft NGVD.
1141S PERMIT IS NOT FOR " ADDMON(s) ".
SPECIFICATIONS BY:
APPROVED BY:
Carlos le
Carlos Rd I
DATE ISSUED: 05/17/2012
=LE:
DR 4016, 08/09 -(0bsoletes all previous editions •which nay not be mood)
IrtoorPoraWb011trIVWX0M911/a, IS required to perform a
soil boring adjacent U, &Le dfantikeli.thccavaborrat the
time of final inspecburt Prior t Final Approval.; the DOH
inspector shall witness the sue oaring and compare the
Jesuits to the angina: ubmitted. A
letnspection fee MI e asses:Itio it trie contractor is not
trit: jobsite at the afratigeo',3:i*
Dade CHD
EXPIRATION DATE: 08/15/2012
Ap3.072291 =810753
Page 1 of 3.
ATE ... FLORIDA
DEPARTMENT OF HEALTH
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM 'CONSTRUCTION - ERMtT
Permit Applic n Number
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Site Plan submitted
Signature
Plan te " Net Approved.
• By
ce-
Too
Date q5 /1y1
County Health. Departrner
ALL CHANGES MUST BE APPROVED BY THE COUNTY - HEALTH DEPARTMENT •
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(Stock .:5744.- 401s4)
Page 2 of