PL-12-366Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 170653 Permit Number: PL -3 -12 -366
Scheduled Inspection Date: September 06, 2012
Inspector: Hernandez, Rafael
Owner: CAUCHI, PAUL & MAGDALENA
Job Address: 131 NE 96 Street
Miami Shores, FL
Project: <NONE>
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Septic
Phone Number
Parcel Number 1132060132590
Contractor: A AARON SUPER ROOTER Phone: 305 -944 -8886
Building Department Comments
REPLACE FRAINFIELD
AS PER APPROVAL FROM BO, OK TO EXTEND THE
PERMIT
Passed
Failed
)?/'...-Inspector Comme
HRS IN FILE
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
September 05, 2012
For Inspections please call: (305)762 -4949
Page 5 of 26
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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
Permit No.
HAR 0 L5■2 !)
ti�
'PI 1E-X69
Master Permit No.
Permit Type: PLUMBING
OWNER: Name (Fee Simple Titleholder): P J �• MQOdQI-en o. CA u c k i Phone #:
Address:
City: State: Zip:
(94 r%—e—)
Tenant/Lessee Name: Phone #:
Email:
JOB ADDRESS: v6‘ Co f ee t
City:
Folio/Parcel #:
Miami Shores County: Miami Dade
la- 3l 06 -0(3- `ZSco
Zip: - 3 i'3 8
Is the Building Historically Designated: Yes NO
CONTRACTOR: Company Name:��
Go 2,2_ 51-ti Cf,
Address:
City:
Qualifier Name: - = &1 1
State Certification or Registration #:
Contact Phone #:
State:
Flood Zone:
?SAS
Phone #: °I (.44 .4 --WC
Phone#:
Zip: 3 30 2-75
Certificate of Competency #:
Email Address:
DESIGNER: Architect/Engineer: Phone#:
Value of Work for this Permit: $ 9-3`m Square/Linear Footage of Work:
Type of Work: UAddress UAlteration
Description of Work:
ONew 2epair/Replace
ODemolition
k i ce v-et ■h
* *** x** *****m *****+ x********+x*********** Fees** ** * *** xx:* *a:+ 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
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, BOII.RRS, 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 commenc' !nt must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In t sence of such posted notice, the
inspection will not b approved and a reinspection ee will be charged.
Signatur Signature
Contractor
The foregoing instrument was acknowledged before me this The foregoin instrument was acknowledged before me this J
day of Fri& , 20 �, by rk tiS etc' CA°) - ", day of 20 _Itby 5347VN X
who is personally known to me or who has produced 0114 1...a"X who is personall
me or who has produced
As identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC:
Sig
Pri
My Commission Expires:
NOTARY PUBLIC:
ESA J SOLOM
oe $ION
.„ EXPIRES EE12015
398-01a3 November 08.2015
Fbridallota , "N com
N+ ****ih*+ k***ak*****Ks****sN*****+k*** sIuh*ikfltik******** * *** k h*********ak*****+k*** k***+ k*+ R* ********* *****Ns************
APPROVED BY Plans Examiner Zoning
Structural Review
(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09)
Clerk
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION PERMIT
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: Paul Cauchi
PERMIT #: 13-SC-1396146
APPLICATION #: API063763
DATE PAID:
FEE PAID:
RECEIPT #:
Doct NT #: PR868471
PROPERTY ADDRESS: 131 NE 96 St Miami, FL 33138
LOT: 19 20
BLOCK: 19 SUBDIVISION:
PROPERTY ID #: 11- 3206 - 013 -2590
[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
0 1 GALLONS / GPD
0 ] GALLONS GREASE INTERCEPTOR CAPACITY
] GALLONS DOSING TANK CAPACITY
D [ 150 ] SQUARE FEET
R [ 0 ] SQUARE FEET
A TYPE SYSTEM: [x] STANDARD
I CONFIGURATION: [x] TRENCH
N
F LOCATION OF BENCHMARK:
CAPACITY
CAPACITY
[MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ ]
SYSTEM
SYSTEM
[ ] FILLED [ ] MOUND [ ]
[ ] BED [ 1
F.F.E.: 13.30' NGVD.
I ELEVATION OF PROPOSED SYSTEM SITE
E BOTTOM OF DRAINFIELD TO BE
L
D FILL REQUIRED: [ 0.00 ] INCHES
O
T
H
E
R
[ 36.00 ] (I INCHES it FT ] ( ABOVE /I BELOW b BENCHMARK /REFERENCE POINT
[ 66.00 1 [I INCHES I' FT I [ ABOVE 4 BELOW b BENCHMARK /REFERENCE POINT
EXCAVATION REQUIRED: [ 30.00] INCHES
1— Existing 900 gal. septic tank certified by " A Aaron Super Rooter" on 02/20/2012 to remain. 2- Install 150 sf of drainfield
in bed configurationn 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 7.80' NGVD. 5. Bottom of drainfield elevation to be no less than
7.30' NGVD.
THIS PERMIT IS NOT FOR ADDITION(s).
. rPtP', +tor designee) is require•
SPECIFICATIONS BY Terms f'tf�' Adjacent to the drainfielr. .., vation h„
!13tlltfl.�tsr�..+.. -
+ pw pprova er DOH
APPROVED BY: ,,,erwrlCil i all borirn/ anrr �amAaro the er+-�
long site evaluation submitted. A
DATE ISSUED: 03 /01/ZOler pection fee will be assessed if the contractor is not RATION DATE:
the jobo;te at the arraangaed Vail
DH 4016, 08/09 (Obsoletes all previous editions wnch may not be used)
Incorporated: 64E- 6.003, FAC
v 1.1.4
AP1063763
SE864300
Dade cHD
05/30/2012
Page 1 of 3
FATE C. FLORIDA
DEPARTMENT OF HEALTH .
APPLICATION• FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permit Application Number \ V.)1/4
PART II - SITE PLAN
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Notes:
Q, - T' wJ r d v Q i r -C ( d
NO tr1C. -eck•
Site Plan submitted by:
Plan Approved
By
Signature
®- -~—`°- Not Approved
Date
County Health Department
ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
DH 4015, 10/96 (Replaces HRS-H Form 4015 which may be used)
(Stock Number: 5744 -002- 4015.6)
Page 2 of 3