PL-12-1441Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 176552 Permit Number: PL -7 -12 -1441
Scheduled Inspection Date: August 08, 2012
Inspector: Hernandez, Rafael
Owner: APARICIO, LILY
Job Address: 1242 NE 104 Street
Miami Shores, FL 33138 -2660
Project: <NONE>
Contractor: JOE LEWIS SPECIALTY SEPTIC
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Drainfield
Phone Number
Parcel Number 1122320300070
Phone: (305)662 -7979
Building Department Comments
DRAINFIELD 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
August 07, 2012
For Inspections please call: (305)762 -4949
Page 17 of 33
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
Imcmgw:
iii JUL 3 O 2 t2
BY: omoeOe
Permit No.P 12- 441
Master Permit No.
Permit Type: PLUMBING p
OWNER: Name (Fee Simple Titleholder): ` Li/ 4-par r C-/ 0 Phone#: 3o� -,7S61-4 ! ! `
Address: l , 7'0Z N �' l l� t( S'l r �r e• - aOS' - 7/0 " 0 0 0 V
City: M i C!lt l� i a rZ -� State: 1 L Zip: 3. 32
Tenant/Lessee Name: .- Phone #:
Email: &.p&.r a--to 4.1-4. a t ne
JOB ADDRESS: 6 g �A. Aire- (( 4 S 2"F
2.° o- o O
City: Miami Shores County: Miami Dade
FoliolParcel #: 1 ` Zip: 23 � /cd
°' �, 2.3
Is the Building Historically Designated: Yes NO s' Flood Zone:
CONTRACTOR: Company Name: L e G./ i15 `J - f 7t/'e._. Phone #: 7 y‘- Z 6 3 -4
Address: 3 0 7S 5 As/ (/ A UL
City: fr? it n A jr► /3-/C., State: if Zip: 3L46 2.3
Qualifier Name: J O C /. G L✓ / S J A Phone #:
State Certification or Registration #: S L605 ' /S 9 / Q Certificate of Competency #:
Contact Phone #: 7 y‘ -Z `3- J 7 Email Address:
DESIGNER: Architect/Engineer: Phone#:
Value of Work for this Permit: $ ) Square/Linear Footage of Work:
Type of Work: Address ❑Alteration ®New ORepair/Replace ODemolition
Description of Work: `YI (�' vl� RI
***************************************Fees************ ***Fees** * ******* * ** **+x*+r**** **** **** **** *
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 $
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 appro d and a reinspection fee will be charged.
The foregoing instrument was acknowledged before me this
day of ; �� F., , 20 F - by CSI r y Apr, c, a ,
who is personally known to me or who has produced d N 9
As identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission Expir
Signature
Contractor
The foregoing instrument was acknowledged before me this
day of TJ , 20 2, by e.
vho is personally known to me or who has produced D I J V
F A as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
TERESA J SOLOMON My Commission
MY COMMISSION # EE131935
% ' o EXPIRES November 08, 2015
***+k=k*****sp**%aN:*** (,07)_3p¢91b3 *************ok h*******+h=ksksk*****
irm TERESA SOLOMON
- ` ''= MY COMMISSION # EE131935
4:?,1,8. EXPIRES November 08, 2015
(407) 398 -0153
p....:N�:,,; -.. ... ***fie
APPROVED BY
Plans Examiner
Structural Review
(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09)
Zoning
Clerk
Registered Septic Tank Contractor
JOE LEWIS
3075 NW 61 AVENUE
MIRAMAR FL 33023-
SR0081599
OE LEWIS SPECIALTY SEPTIC
Business Authorization: SE0081499
Registration Expires on September 30. 2012
ALEX SINK
CHIEF FINANCIAL OFFICER
STATE OF FLORIDA
DEPARTMENT OF FINANCIAL SERVICES
DIVISION OF WORKERS' COMPENSATION
03 -27 -2012
* * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW
CONSTRUCTION INDUSTRY EXEMPTION
This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law.
EFFECTIVE DATE: 03/27/2012 EXPIRATION DATE: 03/27/2014
PERSON: LEWIS JOE JR
FEIN: 262847579
BUSINESS NAME AND ADDRESS:
LEWIS SEPTIC SERVICE LLC
3078 SW 61 AVE NORTH APT.
MIRAMAR FL 33023
SCOPES OF BUSINESS OR TRADE:
1- DRAINAGE
2- SEPTIC TANKS
IMPORTANT: Pursuant to Chapter 440. 06(14), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this
section may not recover benefits or compensation under this chapter. Pursuant to Chapter 440.06(12), F.S., Certificates of election to be exempt... apply only within the
scope of the business or trade listed on the notice of election to be exempt. Pursuant to Chapter 440.05(13), F.S., Notices of election to be exempt and certificates of
election to be exempt shall be subject to revocation If, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or
certificate no longer meets the requirements of this section for Issuance of a certificate. The department shall revoke a certificate at any time for failure of the person
named on the certificate to meet the requirements of this section. QUESTIONS (850) 413 -1609
DWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09 -06
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION PERMIT
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT:
Lily Aparicio
PERMIT #:13 -SC- 1422218
APPLICATION #:API078661
DATE PAID:
FEE PAID:
RECEIPT #:
DOCUMENT #:PR881255
PROPERTY ADDRESS: 1242 NE 104 St Miami, FL 33138
LOT: 2
BLOCK: 2 SUBDIVISION: River Bay Park
PROPERTY ID #: 11- 2232 -030 -0070
[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 ] GALLONS / GPD Septic existing
0 ] GALLONS / GPD
0 ] GALLONS GREASE INTERCEPTOR CAPACITY
] GALLONS DOSING TANK CAPACITY
D [ 150 ] SQUARE FEET
R [ 0 ] SQUARE FEET
CAPACITY
CAPACITY
[MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
]GALLONS 81 ]DOSES PER 24 HRS #Pumps [ ]
in trench configuration SYSTEM
SYSTEM
[ ] FILLED [ ] MOUND
[ ] BED [ ]
A TYPE SYSTEM: [x] STANDARD
I CONFIGURATION: [x] TRENCH
N
F LOCATION OF BENCHMARK: FFE : 13.38' NGVD
I ELEVATION OF PROPOSED SYSTEM SITE [ 25.70 I [I INCHES I FT ] [ ABOVE A BELOW b BENCHMARK /REFERENCE
E BOTTOM OF DRAINFIELD TO BE [ 55.68 ] [I INCHES If FT ] [ ABOVE 4 BELOW b BENCHMARK /REFERENCE
L
D FILL REQUIRED: [ 0.00] INCHES EXCAVATION REQUIRED: [ 30.00] INCHES
O
T
H
E
R
SPECIFICATIONS BY:
APPROVED BY:
DATE ISSUED:
POINT
POINT
- Install 150 sq ft drainfield in trench configuration.
- Elevation of bottom of drainfield to be no Tess than 8.74' NGVD.
- Existing 900 g septic tank, to remain.
- The system is sized for 2 bedrooms with a maximum occupancy of 4 persons,
for a total estimated sewage flow of 200 g /d.
- Not for additions
The contractor (or designee) is p'e ed to perform a
soil boring ac tces ihe drainfield excavation at the
time of 1, icispeon. Milt. r tJ Hnai App fo1'ai, Me OH
inspector sna1! witness: Ira soil boring anO compare the
reuits to the origined site e,waioatien suorrlitled. U
reinsppection tee rrii( be a sewed if the contractor is riot
at the jobsite at the arranged time.
Joe Lewis
TITLE:
TITLE: Engineer Specialist II Dade CHD
Joseph P G"aiw
07/27,12
DH 4016, 08/09 (Obsole all previous editions which may not be
Incorporated: 64E- 6.003, FAC
v 1.1.4
AP1078661
used)
EXPIRATION DATE: 10/25/2012
6E875536
Page 1 of 3
STATE OF FLORIDA
DEPARTMENT OF HEALTH
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permit Application Number
PART II - SITE PLAN
Scale: Each block represents 5 feet and 1 inch = 50 feet.
Notes: I L NZ N C /a4 s 33138
R e . are o v - . -F , W . r Q 1,1'g-etc/ New )So l
Cc `r re' A1G1 a
Date
County Health Department
ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
DH 4015, 1W96 (Replaces HRS-H Form 4015-which may be used)
(Stock Number. 5744-002-4015-6)
A N OF
ronmental H+ afth
Florida Department of Health
ami -Dade County ieait b Department
OSTDS!Well Division
21805 SW 26 Si. • Miami, FL 33175
A.ddrCSS