PL-12-1043Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 174530
Permit Number: PL -6 -12 -1043
Scheduled Inspection Date: September 26, 2012
Inspector: Hernandez, Rafael
Owner: MAYER, JEFFREY
Job Address: 1255 NE 93 Street
Miami Shores, FL 33138-
Project: <NONE>
Contractor: STATEWIDE SEPTIC CONNECTIONS
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Drainfield
Phone Number (954)547 -3357
Parcel Number 1132050270090
Phone: (954)963 -0082
Building Department Comments
REPLACE DRAINFIELD AND INSTALL DOSING TANK.
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
hrs approval in file
September 25, 2012
For Inspections please call: (305)762 -4949
Page 8 of 41
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 �% 1
Permit No. `�— b 2— IC°4
Master Permit No.
BUILDING
PERMIT APPLICATION
FBC 20
Permit Type: PLUMBING OWNER: Name (Fee Simple Titleholder): 1.'• 1[k `' � ' , / Phone#: QS Y 5 33 S7
EIVED
JUN 06an
Address:
125-C A ?3 S 1
City: 4 (4 A ( 51411 f State: f t
Tenant/Lessee Name: Phone #:
Email:
gyp. ?7/
JOB ADDRESS:
City:
Folio/Parcel #:
izcSAk 13 57-
Miami Shores
County: Miami Dade
0 � -
9,2_0 a- 027- 0090
NO Flood Zone:
Is the Building Historically Designated: Yes
Zip: •33f
CONTRACTOR: Company Name: 5 +'u) ■ de Cr4 S Inc Phone#: 'C'S-6G 1 64,33
Address: (aQ 3 2. S') 2'7) ST,r t' N
C
City: M 1 Tare \ a r (^ State: Zip: 3 2-3
Qualifier Name: - St f o,v0in Phone #:
State Certification or Registration #: S M O C! 1( ZG 2 Certificate of Competency #:
Contact Phone #:
DESIGNER: Architect/Engineer: Phone #:
Email Address:
Value of Work for this Permit: $
Type of Work: °Address °Alteration
Description of Work:
Square/Linear Footage of Work: 500
°New ` tepair/Replace
RnF(4�. D -a(v (d a' (rift-a ( I
b�s� tQn�
°Demolition
******** * * * *+ * * * * * * * * * * * * * * * * * * * * * * * * ** Fees * * * * * * * * * * * * * * * * * ** * * * * * * * * * * * * * * * **
* * * * **
Submittal Fee $ 50 • co Permit Fee $ Fe::' ®,_. CCF $ CO /CC $
Scanning Fee $ PA Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $ lip
Bonding Company's Name (if applicable)
Bonding Company's Address
City • ` _.w. _..,.. 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 FT FCTRICAL WORK, PLUMBING, SIGNS,
WFT d .S, 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
er or Agent
The foregoing instrument was acknowledged before me this 29
day of 44G , 20 rby o-efrj ,
who is personally known to me or who has produced
Li- As identification and who di, take an oath.
NOTARY PUBLIC:
Signature
e cSaecg-r-
Contractor
The foregoing instrument was acknowledged before me this e97
day of kej , 20 (2 , by ( -&red`‹ So(o,
who is personally known to me or who has produced DIV •
Li 0211W as identification and o did take an oath.
NOTARY PUBLIC:
Print:
My Commission Expires:
APPROVED BY
2-el `i
* ** * * * * * * * * * * * * * * * * * * * * * * * * **
r1"-- Plans Examiner
Structural Review
(Revised 07 /10:07)(Revised 06 /10/2009)(Revised 3/15/09)
Clerk
w
-11711/ED
JUN 0 6 20t Ap
STAVE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION PERMIT
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: Jeffrey Mayer
PERMIT #:13 -SC- 1412351
ICATION #:AP1073255
DATE PAID:
FEE PAID:
RECEIPT #:
DOCUMENT #: PR877140
PROPERTY ADDRESS: 1255 NE 93 St Miami, FL 33138
LOT: 7 8
BLOCK: 1 SUBDIVISION:
PROPERTY ID #: 11- 3205 -027 -0090
[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 [
1,050 1 GALLONS / GPD Existing septic tank to remain CAPACITY
0 1 GALLONS / GPD CAPACITY
0 1 GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
300 ] GALLONS DOSING TANK CAPACITY [67.00 ]GALLONS @[ 6 ]DOSES PER 24 HRS #Pumps [
D [ 400 ] SQUARE FEET
R [ 0 ] SQUARE FEET
A TYPE SYSTEM:
I CONFIGURATION:
N
F LOCATION OF BENCHMARK:
bed configuration drainfile SYSTEM
SYSTEM
[ ] FILLED [ ] MOUND [ ]
[x] BED I
[x] STANDARD
[ ] TRENCH
F.F.E., 5.80' NGVD
I ELEVATION OF PROPOSED SYSTEM SITE
E BOTTOM OF DRAINFIELD TO BE
L
D FILL REQUIRED: 1 0.00 1 INCHES
0
T
H
E
R
7.20 ] II INCHES I FT ] [ ABOVE A BELOW 6 BENCHMARK /REFERENCE POINT
27.20 ] [I INCHES FT ] [ ABOVE /) BELOW b BENCHMARK /REFERENCE POINT
EXCAVATION REQUIRED: [ 32.001 INCHES
"Invert elevation of drainfield to be no less than 4.00 ft. NGVD.
"Bottom of drainfield elevation to be no less than 3.50 ft. NGVD. 9�
`Install 12° of slightly limited soil under the bottom of the drainfield. actin d a.
- Perimeter of excavation area shall be at least 2 ft wider and longer than the proposed absorption bed or drain trench.
-The system is sized for 4 of bedrooms with a maximum occupancy of 8 of persons (2 per bedroom), for a total estimated
sewage flow of 400 gpd.
-The licensed contractor installing the system is responsible for installing the minimum category of tank in accordance
SPECIFICATIONS BY:
APPROVED BY:
DATE ISSUED:
DH 4016, 08/09
Incorporated:
Carlos
TITLE:
TITLE:
chr= ;.cO,Q/ga(?Q ee) is required to perform a EXPIRATION DATE: 09/03/2012
c n e. drainfiel .excavation at the not be used)
tObo-fii�i't���`�a)?�IY
64�69hb1 u�C On. rf$tW Page 1 of 3
inspec aF s'na Hess the soil boring and compare the
results to the origiffallsrle :valuation submittednt.o132s5 $E371880
reinspection fee will be assessed if the contractor is not
at v;,: lo;,site at the arranged time
Dade cHD
nocumnrr #1: PR877140
"THIS PERMIT IS NOT FOR " ADDITION(s) ".
Performing Lift Dosing.Pumps must be certified as suitable for distributing sewage effluent.
NOTICE OF RIGHTS
A party whose substantial interest is affected by this order may petition for an
administrative hearing pursuant to sections 120.569 and 120.57, Florida Statutes. Such
proceedings are governed by Rule 28 -106, Florida Administrative Code. A petition for
administrative hearing must be in writing and must be received by the Agency Clerk for the
Department, within twenty -one (21) days from the receipt of this order. The address of the
Agency Clerk is 4052 Bald Cypress Way, BIN # A02, Tallahassee, Florida 32399 -1703. The
Agency Clerk's facsimile number is 850 -410 -1448.
Mediation is not available as an alternative remedy.
Your failure to submit a petition for hearing within 21 days from receipt of this order
will constitute a waiver of your right to an administrative hearing, and this order shall become
a 'final order'.
Should this order become a final order, a party who is adversely affected by it is
entitled to judicial review pursuant to Section 120.68, Florida Statutes. Review proceedings
are governed by the Florida Rules of Appellate Procedure. Such proceedings may be
commenced by filing one copy of a Notice of Appeal with the Agency Clerk of the
Department of Health and a second copy, accompanied by the filing fees required by law,
with the Court of Appeal in the appropriate District Court. The notice must be filed within 30
days of rendition of the final order.