PL-12-1508Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 177975 Permit Number: PL -8 -12 -1508
Scheduled Inspection Date: August 31, 2012
Inspector: Hernandez, Rafael
Owner: GREEN, PENNY SUE
Job Address: 73 NE 99 Street
Miami Shores, FL
Project: <NONE>
Contractor: STATEWIDE SEPTIC CONNECTIONS
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Septic
Phone Number
Parcel Number 1132060131310
Phone: (954)963 -0082
Building Department Comments
REPLACE DRAINFIELD ONLY
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
CREATED AS REINSPECT ON FOR INSP- 177136. HRS IN FILE broken
side walk
August 30, 2012
For Inspections please call: (305)762 -4949
Page 4 of 6
*1)- .L11--01
Miami Shores Village ' ECEIVED 1
Building Department AUG 0 8 0:02 w
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 No.
PERMIT APPLICATION
FBC 20 Lt,
Permit Type: PLUMBING Pen y Svg,
OWNER: Name (Fee Simple Titleholder): (E4 rcl f re -eP-) Phone#: � 58 , 553
Master Permit No.
Address: i ►a1 Pi 9 9 St
City: . I on i S r'1 ,-e J State: F C
Tenant/Lessee Name: CS qi
Zip: 33)38
Phone#:
Email:
JOB ADDRESS: 1
City: Miami Shores County: Miami Dade Zip: rrJ i l) g
Folio/Parcel#: I k - .3 O `/ � -Ot - 1 31 0
Is the Building Historically Designated: Yes NO V Flood Zone:
CONTRACTOR: Company Name: ° ' \ 4 -4-it.AA) k de, SCI G Cfrd,n S `.->c Phone#: 30.5—(0 aj- 33
Address: 6o '2.. Sui 2.-- a S -tree f
City: 1%°--q Int1 ct State: Zip: 53023
Qualifier Name: T&tS4 cO I-0 rel- -. Phone#:
State Certification or Registration #: C ikft °9-7 126 2, Certificate of Competency #:
Contact Phone#: Email Address:
DESIGNER: Architect/Engineer: Phone#:
Value of Work for this Permit: $ '2 Square/Linear Footage of Work: --iZ
Type of Work: OAddress UAlteration UNew lepair/Replace ODemolition
fp(lice. 01-ctin -e(Cii Onij
; 60100(014.74 6 /44169,11"1
Walt 371 A 41 ': 6a k °IN
Att.0 Ve411EACIA SiFOGOLI
********* *** *************** ************ YGY K R R me *3 4=3* *************
Submittal Fee $ 0 ] Permit Fee $ /Y -- CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $)'• I
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
Description of Work:
TOTAL II hE NOW DUE $ D a
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,
WELT 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.
r y,�
afore
Signature' " "" ° u Signature
weer or Agent
Contractor
The foregoing instrument was acknowledged before me this % The foregoing instrument was acknowledged before me this
day of F u 5 , 20 J Z , by Pto v►^-( G' eei , day of 201V, by ..P'%/4-.14 cent-
who is 5
s p e r s o n a ll y known to m e or w h o has p r o d u c e d D''" Lice e.who is pe own me or who has produced
(FL t) As identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
4 CS(210.01/1—.
NOTARY PUBLIC:
\ a\\``'� ua i urrrrttt .,'
•
Sign:
�'°C a- Print: $ Q ��� �� o �? - • 7�A J QOM My Commission Expires: 1:76../:11. � oF��� 'c��c r�� MY OCMM�110N 0 W �� G �4 . O* \\ RIPON. Novenew 09.!0!5 S T Al o`
esa. mk, h*�b�k�k& �k�kk�Rtl�da*agda+ k�NnAA��k4+ d�sp�kK�tl��k�Ftl�+ 9��k�k�hN+ k +N &tic9e************
*** *********** * ** ******
APPROVED BY RW - r -I 1,
(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09)
Plans Examiner Zoning
Structural Review Clerk
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEA TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION PERMIT
CONSTRUCTION PEUT FOR: OSTZDS Repair
APPLICANT: Edward Green
PERMIT 1:13 -SC- 1423034
APPLICATION 4: AP 1079127
DATE PAID:
FEB PAID:
RECEIPT 8:
DOCUMENT #: PR881734
PROPERTY ADDRESS: 73 NE 99 St Miami, FL 33138
LOT: 2223 BLOCK: 9
PROPERTY ID 8: 11 -3206- 013 -1310
SUBDIVISION:
{SECTION, TOWNSHIP, RANGE, PARCEL RARER]
[OR TAX ID NOMBER3
SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE NITS SPECIFICATIONS AND =mum OF SECTION
381.0065, F.S., AND CHAPTER 64E -6, F.A.C. DEPARTMENT APPROVAL 08 SYSTEM DOES NOT
SATISFACTORY PERFOPNANCE FOR ANY SPECIFIC PERIOD OF TIME. ANY CHANGE IN
WHICH SERVED AS A BASIS FOR ISSUANCE OF THIS PERMIT, REQUIRE THE APPLICANT
PERMIT APPLICATION. SUCH MODIFICATIONS MAY RESULT IN THIS PERMIT BEING MADE
ISSUANCE OF THIS PERMIT DOES NOT EXEMPT THE APPLICANT FROM COMPLIANCE WITH
STATE, OR LOCAL PERMITTING RED FOR DEVELOPMENT OF THIS PROPERTY.
MATERIAL FACTS,
TO MODIFY THE
NULL AND VOID.
OTHER FEDERAL,
SYSTEM DESIGN AND SPECIFICATIONS
T E
A t
N E
K t
900 3 GALLONS / GPD
3 GALLONS / GPD
3 GALLONS GREASE INTERCEPTOR CAPACITY
3 GALLONS DOSING TANK CAPACITY
D { 225 3 8 ARr FEST
R E I SQUARE FEET
A TYPE SYSTEM: 14 STANDARD
I CONFIGURATION: Eu) TRENCH
K
CAPACITY
CAPACITY
[MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS)
3GALLONS 9{ )DOSES PER 24 HRS *Pumps 1 3
SYSTEM
SYSTEM
{ 3 FILLED { 3 M
E 3 BED E 1
F LOCATION OF BENCHMARK: F.F.E.: 12.5' NGVD.
1 16.80 INC
7 HES FT 3{ ABOVE 4 x o P BENCSMtARICIREFERENCE
d 48.8014 3Mi1:HES� FT 1 A80VE BELOW 3
I ELEVATION OF PROPOSED SYSTEM SITE
E BOTTOM OF DRAINFIELD TO BE
L
D FILL : { 0.00 3 INCHES EXCAVATION : { 30.00 3 moms
1 3
POINT
POINT
THIS PERMIT IS FOR SYSTEM* 3 ((7 F.U.) ONLY. 1- Existing 900 gal. septic tank certified by " Statewide Septic
Inc.) on 07/3012012 to remain. 2-Install 225 sf of drainfield in trenchconfiguration.3-Perimeter of excavation
T -,,,,,1 _ at feast 2 ft wider and longer than the proposed absorption trench. 4- Invert elevation of drainfield to be no
^lacer t ry ,,•f�,� t3 drarr d eteva6on do be rro teas man 6.6tf' NGVD.
fl 0061' ` tide 6Fd r: i i perlonp a
In cr r,'
uits to me v, ,rrrr, '4 t a tt,y„ i' a gtthe
DOk
Pecr/an f� " ` °��" av , compare fire MIAMI Y.ti t Nf IV NOAL7N CERs1A�TI !NF
REPAIR
APPROVED BY:
DATE ISSUED:
DE 4016, 08/09
Incorporated:
Master Septic Tank Contractor
Dade CHD
08/07' + 2 EXPIRATION DATE: 10)31/2012
{Obsoletes all previous editions which may not be used)
64E- 6.003, FAC
V 1.1.4 AP1D79127 &8875913
Pagel of3
• % w
ATE 41 FLORIDA
DEPARTMENT OF HEALTH •
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION,PERMIT
Permit Application t)ti
PART 1.1 SITE PLAN
Scale: Each bbak represents 5 feet and 1 inch =50 feet.
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Notes:
Site Plan submitted by:
Plan Approved
By
GoK 6441
Tide
Date
• County Health Departmen
ALL CHANGES MUST BE APPROVED BYTHE COUNTY-HEALTH DEPARTMENT
OR 4015. 10(96 (Reigases Farm 4015 votkda may be used)
pock Number:5744-002-40154
Page 2 of .1