PL-12-861Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 180021 Permit Number: PL -5 -12 -861
Scheduled Inspection Date: October 17, 2012
Inspector: Hernandez, Rafael
Owner: MENDOZA, MARIEDY & WILMER
Job Address: 9826 NW 1 Avenue
Miami Shores, FL
Project: <NONE>
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Septic
Phone Number
Parcel Number 1131010240060
Contractor: SOUTHERN SEPTIC CONTRACTORS INC Phone: (305)598 -8266
Building Department Comments
SEPTIC REPAIR
Infractio Passed Comments
INSPECTOR COMMENTS
False
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
CREATED AS REINSPECTION, ' OR INSP- 173570. HRS IN FILE not reday
October 16, 2012
For Inspections please call: (305)762 -4949
Page 12 of 18
a-FG1 .
• Miami Shores Vitage
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
Permit Type: PLUMBING
JOB ADDRESS:
1 St b IN vJ ( la �J t,`
4..RT _r
MAY 14 2012 I
FBC 20 lb
Permit No. PLJ o t
Master Permit No.
City: Miami Shores County: Miami Dade Zip: 331 S D
Folio/Parcel #: I I •- 31 O I - 02-1 .. OD bO
Is the Building Historically Designated: Yes NO X. Flood Zone:
OWNER: Name (Fee Simple Titleholder)..'I'Gl t�f j &O r?, ldt � ►'181 , .111 El 0 Phone #: , u (a go(, '' S o
Address: 61g.2. (p Nvu 1-t.- Ave
City: 1M,1G1 yt.vi, L evrTh State: F.- Zip: ?r (SO
Tenant/Lessee Name: 0 W -g iJ/ Phone #:
Email: ' f�Vl �f't� • 1(14 Ok f� D
5tA Crry
CONTRACTOR: Company Name:
Cork 0C,I °o(5 Phone #:5OS -33,2 -eNgil
Address: '1 ci 1'5 '- 0 I)(I c,, S; W 0 1 Su ;srt 402._
City: P1 i ' INAA State: C t., Zip: 43 °a; r)
Qualifier Name: 12O (5 6R- ra RP 0 ft 606-Z_ Phone #: ‘, 69S` t
State" Certifidatit n of egistration #: j 2 / `i 2,1 Certificate of Competency #:
` #lontacft Phone #: S er kg ` 4 ALL Email Address:
DESIGNER: Architect/Engineer: y J ) 14 Phone #:
Value of Work for•this Permit: $ 319°0 Square/Linear F i tage of Work:
Type of Worts:' DAddress- OA teteration ONew epair/Replace ODemolition
Description of Work: i 4 jibe of t f
* * * ** * ** * * * * * * ** ** * * * ** ** * * * * * * * * * * ** Fees * * ** * * * * * * * * * * * * * * * ** * * * * * * * * * * * * * * * * * * * * **
Submittal Fee $Sa' Permit Fee $ 26° 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
114N
City, ffi 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: 1 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 / einspection fee will be charged.
to.
Ir
wner or Agent
The foregoing instrument was acknowledged before ,re thi
day of i`v �K • ' 20 ( i, by
h• is rsonally known t' e or who has produced
Co; 1-01
NOT Y PUBLIC:
Sign:
Print:
My Commission Expire
tification and who did take an oath.
* * * * * * * * ************
APPROVED BY
My Comm. Expires Sep ,
s• iiii o, Commission # EE 128810ssn.
; oer Bonded Through National Notary
The foregoing instrument was ackn. ._et., d before me this
day of , 20 1-rby tZ 41011
who is personally known to me or who has produced ila-44:1
as identification and who did take an oath.
- .NOTARY PUBLIC: oututmolo���'''
et? .•• •• 4�
Sign:
Print:
CQ 41 .o",� ea.
• My Commission Expires: ` •° �v; ff;
/ / ///l i n nt1ot,
**************************************************** * * * * * * *** ** **** ******** *** * **** *k*
Plans Examiner
Structural Review
(Revised3 /12/2012XRevised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09)
Zoning
Clerk
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION PERMIT
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: Francisco Morillo
PERMIT # :13 -SC- 1409726
APPLICATION #: AP 1071920
DATE PAID:
FEE PAID:
RECEIPT 8.
DOCUMENT #: PR875462
PROPERTY ADDRESS: 9826 NW 1 Ave Miami, FL 33150
LOT: 16
BLOCK: 1 SUBDIVISION:
PROPERTY ID #: 11- 3101 -024 -0060
[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 [ 900 ] 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 #Pumps [ ]
D [ 300 ] SQUARE FEET SYSTEM
R [ 0 ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [x] STANDARD [ ] FILLED [ ] MOUND [ ]
I CONFIGURATION: [ ] TRENCH [x] BED [ 3
N
F LOCATION OF BENCHMARK: F.F.E.: 13.29' NGVD.
I ELEVATION OF PROPOSED SYSTEM SITE [ 14.001(1 INCHES Y FT ][ ABOVE A BELOWliBENCHMARK /REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 50.00 INCHES If FT 1(ABOVE4 BELOW JIBENCHMARK /REFERENCE POINT
D FILL REQUIRED: [ 0.00] INCHES EXCAVATION REQUIRED: [ 48.00] INCHES
0
T
H
E
1— Install 900 gal. septic tank equipped with an approved filter. 2 -The licensed contractor installing the system is
responsible for installing the minimum category of tank in accordance with sec. 64E- 6.013(3)(f). 3- Install 300 sf of
drainfield in bed configuration. 4- Install 12" of slightly limited soil under the bottom of drainfield. 5- Perimeter of
excavation area shall be at least 2 ft wider and longer than the proposed absorption bed. 6 -Invert elevation of drainfield
to be no less than 8.62' NGVD. 7. Bottom of drainfield elevation to be no Tess than 8.12' NGVD. 8. This permit includes
the Abandonment of existing septic tank.
THIS PERMIT IS NOT FOR ADDITI
• .. q•n►fN•T
SPECIFICAT
APPR• =i BY:
DATE ISSUED:
BY:
Roberto _..Rodr
Pedio N Ospina
05/14/2012
DH 4016, 08/09 (Obsoletes all previous
Incorporated: 64E- 6.003, FAC
v 1.1.4
n
i ils drsia ^ee) is rP.feirad to perform a
uonny acijacent to tree grainfieid excavation at the
TITLE: time of final inspection Prwnw ,, ginal P., proval, the-6O
inspector shall witness the s i
results to the original site 'ubm� °[ g3.the
vafU�ta ion submitted. A
reinsuect� ape {viii sessed if the contractor is not
editions whiafi
t r �'obsi e a { t Fi e arranged time.
coUNDI
AP1071920 5E870393
Dade CHD
08/12/2012
Page 1 of 3
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.