PL-12-116544
6
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 175139
Permit Number: PL -6 -12 -1165
Scheduled Inspection Date: July 20, 2012
Inspector: Hernandez, Rafael
Owner: LORENZO - LUACES, ENRIQUE
Job Address: 334 NE 100 Street
Miami Shores, FL 33138-
Project: <NONE>
Contractor: STATEWIDE SEPTIC CONNECTIONS
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Drainfield
Phone Number 786/942 -9475
Parcel Number 1132060135450
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
July 19, 2012
For Inspections please call: (305)762 -4949
Page 3 of 5
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
p . , INSPECTION'S PHONE NUMBER: (305) 762.4949
BUILDING
PERMIT APPLICATION
Fsc zo
JU 2 5 2612 !
BY:
Permit No. P 1 V-145
Master Permit No.
Permit Type: PLUMBING
OWNER: Name (Fee Simple Titleholder): Lk/ el Les) r i 0 Phone #:
Address: ( SLr, r )
City: State: Zip:
Tenant/Lessee Name: Phone #:
Email:
JOB ADDRESS: 33 } N
City: .
Folio/Parcel #:
too 5-r
Miami Shores County:
132_06 013 °Slf-So
Miami Dade
Zip: `�v /
Is the Building Historically Designated: Yes
CONTRACTOR: Company Name:
« ' t
NO 1~A
Address:
City: ,' 11,r'i
Qualifier Name: r'S
Al ri
Contact Phone #: Email Address:
Flood Zone:
Phone #:
State:
State Certification or Registration #:
Zip:
Phone #:
Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone #:
Value of Work for this Permit: $ ° ' Square/Linear Footage of Work:
Type of Work: ❑Address DAlteration
Description of Work:
CINew epair/Replace
r a rt
ODemolition
*************************** x: *** *+ x****** Fees**x: ********+x**+xx:+x****** ** : *******+x+x *********
Submittal Fee $
Scanning Fee $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
Permit Fee $
Radon Fee $
CCF $ CO /CC $
DBPR $ Bond $
Technology Fee $
TOTAL FEE NOW DUE $ ( g
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.
Signature
cet or Agen
The foregoing instrument was acknowledged before me this 2.7--
Signature ' � � 40
Contractor
The for instrument was ackn■ wledg; d befo, e thi
day of c -Q , 20 kZ , by 9 ve- d'
' - , day of ► 01 c2-, by I.4.rf <i
who ' personally known to me or who has produced PA J OCetist who ' �ersonall known e or who has produced
As identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
It/ e/2o15
Sign:
Print:
My Co
i
it &h t._
CL
Publie - State of Florida
Expires
ires
Comm. P 128819
;' Commission # EE
o`q° Bonded Through National Notary Assn.
APPROVED BY 7 1 Mans Examiner Zoning
(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09)
Structural Review Clerk
STATE OF FLORIDA
DEPARTMENT OF HEALTH DATE PAID
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM FEE PAID:
CONSTRUCTION PERMIT RECEIPT #:
DOCUMENT #: PR878548
PERMIT # :13 -SC- 1416707
APPLICATION #:API075615
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: Enrique Luaces
PROPERTY ADDRESS: 334 NE 100 St Miami, FL 33138
LOT: 78
BLOCK: 40 SUBDIVISION:
PROPERTY ID #: 11 -3206- 013 -5450
[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 [ 750 ] GALLONS / GPD Septic CAPACITY
A [ 0 ] GALLONS / GPD CAPACITY
N [ 0 ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pump$ [ ]
D
R
A
I
N
I
L
0
T
H
[ 150 ] SQUARE FEET SYSTEM
[ 0 ] SQUARE FEET SYSTEM
TYPE SYSTEM: [x] STANDARD [ ] FIT.T.FD [ ] MOUND [ ]
CONFIGURATION: [x] TRENCH [ ] BED [ ]
LOCATION OF BENCHMARK: F.F.E.: 11.90' NGVD.
ELEVATION OF PROPOSED SYSTEM SITE [ 27.60][l INCHES I/ FT ](ABOVE4 BELOW`IBENCHMARK /REFERENCE
BOTTOM OF DRAINFIELD TO BE [ 57.60 ] [) INCHES r FT ] [ ABOVE 4 BELOW BENCHMARK /REFERENCE
FILL REQUIRED:
[ 0.00 3 INCHES EXCAVATION REQUIRED: [ 30.00 ] INCHES
POINT
POINT
1— Existing 750 gal. septic tank certified by "Statewide Septic Connections Inc." on 06/17/2012 to remain. 2- Install 150 sf
of drainfield in trench configuration 3- Perimeter of excavation area shall be at least 2 ft wider and longer than the
proposed absorption trench. 4 -Invert elevation of drainfield to be no Tess than 7.60' NGVD. 5. Bottom of drainfield
elevation to be no Tess than 7.10' NGVD.
THIS PERMIT IS NOT FOR ADDITION(s).
frNigf.$xq ,.;, C.QUeTY NEAL114 DEPARTMENT
SPECIFICATIO = Teresa J Solomon TITLE: Master Septic Tank Contractor
APPR• •. _ ,,,.,ii�� TITLE: - -- Dade CHD
P, o N ospina the contractor (or desiV ATE: 09!20/2012
DATE ISSUED: 06/22/2012 soil boring adjacent to the drainfield excavation at t a
DH 4016, 08/09 (Obsoletes all previous editions which matrmr�o�t i� lo.
p viispector s Zion. Prior to Fina/ A at t e 1 of 3
hall witness the soil boring and co i, the
Incorporated: 64E- 6.003, FAC results to the prig J and compare the
1.1.4 AP107561y4e1fults to jt o iin�i¢ 6n,:c,7. uatior� submitted: /�
at the jobsite at tile rarra assessed
ge arranged imelf the contractor is not
, 'VW
" ':14.NPTTATE.Oir .FLOR4DA
DEPARTMENT OF HEALM •
APPLICATION; FOR ONSITE SEWAGE DISPOSAL SYSTEM QONSTRUGTION pEFiwin-
. Permit Application Num rx)
"Ni:■91'
•
PART 11 SITE PLAN-
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Notes:
Ke loo 331'3
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Site Plan submitted by:
Plan ApprOved
By
d
Title
Date
County Health Department
ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
014 4015, 10196 (Replaces HRS-H Form 4015 Mitch may be used)
(Stock Numbec 5744-002-4015-6)
Page 2 of 3