PL-12-923v
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 173915 Permit Number: PL -5 -12 -923
Scheduled Inspection Date: September 19, 2012
Inspector: Hernandez, Rafael
Owner: RAMON, GUILLERMO
Job Address: 157 NW 98 Street
Miami Shores, FL 33138-
Project: <NONE>
Contractor: SOUTHERN SEPTIC CONTRACTORS INC
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Septic
Phone Number (786)395 -9473
Parcel Number 1131010240110
Phone: (305)598 -8266
Building Department Comments
INSTALLATION OF 1050 GALLONS SEPTIC TANK AND
400 SQ DRAINFIELD. THE SYSTEM IS SIZED FOR 4
ROOMS AND OCCUPANCY OF 8 PERSONS
bounce check
09/18/2012 -HOME OWNER PAID BALANCE (BOUNCE
CHECK AND BANK) WITH CREDIT CARD.
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
�I
September 18, 2012
For Inspections please call: (305)762 -4949
Page 3 of 27
I �k-
ILIMNG
PERMIT APPLICATION
• Miami Shores Village MAY 2. 2 2612 lili ,ffl
„ Building Department BY:
6' e 10050 N.E.2nd Avenue, Miami Shores, Florida 33138
'�I'Z Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
Permit No. Plic9,—T-b
Master Permit No.
FBC 20
Permit Type: PLUMBING
OWNER: Name (Fee Simple Titleholder): i t I 1 *er c vi' /7 Phone #: o
1-
Address: / J 7 q q St_
City: 51 v f -e , State: L
Zip: 331 S 0
Tenant/Lessee Name: Phone #:
Email:
JOB ADDRESS: / S -7 J ci
City: Miami Shores County:
Folio/Parcel #: j, — 31 ®1 — 0 2.`t 0 1 IQ
Is the Building Historically Designated: Yes NO
Miami Dade
Zip: 331 S-0
Flood Zone:
CONTRACTOR: Company Name: ° qk".11‘ 6' "-1' 4%.(--- Phone #: `IDS SA it 1 1 (7
Address: / S---I d 5 = D x i Q e. vv..) Sv i
: 4.--....: ,,� --�- �” Zip: '' 1 `� 1
Ci State:
Qualifier Name: a g E R i 0 R 0 0 l i 6.k ( • Phone #:
State Certification or Registration #: C n a 07- i 4 `._ 1 Certificate of Competency #:
Contact Phone #: 61 %- i2 b N. Email Address:
1.10 `Z
DESIGNER: Architect/Engineer: tv 1'.'
Phone #:
Value of Work for this Permit: $ '6 00 '0 • °" Square/Linear Footage of Work:
Type of Work: DAddress
Description of Work:
❑Alteration New ❑Repair/Replace
r, S k.
❑Demolition
* * * * * * ** * ** * * * * * * * * * * * * * * * * * * *** * * * ** Fees**** ***** *** **** * * * * * * ** * * * * * * * * * ** * * * * * * **
Submittal Fee $ Permit Fee $ 360 `'— CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $ 3 9 d t SL'
Bonding Company's Name (if applicable)
Bonding Company's Address
City State J 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 pe ram *�� -. ed. In the absence of such posted notice, the
inspection will not be a' 'roved and a reinsp, tto'' fee will be charged.
Signature g
e forego'n
day of
who is
.4 A
Owner or Agent
i strument as ac _owl- ed before me
J ,20I ,by .;1
Signature
The forego'
Contract
ment a cknowl
, 201 by
own to me or who has produc
NOT R
Sign:
Print:
My Commission Expires:
s identification and who did take an oath.
day of
hoisp:
UBLIC:
sonall
TAR
L
s identification and who did take an oath.
PUBLIC:
nt:
My Commissio
CLAUDIA '_ state of Flotlpl5
No a ExPlces
MY Commission # EE 12881 Assn.
Bonded Through National Nota{Y
* * * * * * * * * * * * * * * * * * * * * * * * * * ** , ;gam .::.***** ** ***+ x*********** *************
APPROVED BY f - 2-3°- ('1""—Plans Examiner
Structural Review
(Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09)
* * * * * * * * * * * * * * * * * * * * * **
Zoning
Clerk
This instrument was prepared by and return to:
Name: Judith J. Lon'redo, Esq.
Address: 9999 N.E. 2nd Avenue, Suite 216
Miami Shores, FL 33138
Parcel Identification No. 11- 3101- 024 -0110
WARRANTY DEED
11111111111111111111111111111111111111111111
C N 2012R0172915
OR Bk 2802E F's 2521; (fps)
RECORDED 03/09/2012 15:25W2
DEED DOC TAX 1,368.00
HARVEY RIJVIN, CLERK OF COURT
MIAMI-DADE C:OUNTYv FLORIDA
LAST PAGE
This Indenture, made this 0 V day of March, 2012, Between
HEROLD ALOUIDOR, a married man,
joined by his wife Chantal Alouidor
whose post office address is: 198 N.W. 30 Avenue, Miami Gardens, Florida
of the County of Miami -Dade, State of Florida , grantor *, and
GUILLERMO J. RAMON, a married man
whose post office address is 157 N.W. 98 Street, Miami Shores, Florida, 33150
•of the County of Miami- Dade, State of Florida , grantee *,
Witnesseth that said grantor, for and in consideration of the sum of
Ten and 00 /100
Dollars
and other good and valuable considerations to said grantor in hand paid by said grantee, the receipt whereof is hereby
acknowledged, has granted, bargained and sold to the said grantee, and grantee's heirs and assigns forever, the following
described land, situate, lying and being in Miami -Dade County, Florida, to-wit:
•
Lot 24, and the West Y2 of Lot 23, Block 1, BORMAR PARK, according to the Plat thereof,
as recorded in Plat Book 17, Page 11, of the Public Records of Miami -Dade County, Florida.
SUBJECT TO:
1.- Conditions, restrictions, limitations and easements of the Public Record however this
reference shall not act to reimpose the same.
2.- Governmental zoning ordinances affecting the property.
3.- Taxes for the year 2012 and all subsequent years.
and said grantor does hereby fully warrant the title to said land, and will defend the same against lawful claims of all persons
whomsoever.
* "Grantor" and "grantee" are used for singular or plural, as context requires.
In Witness Whereof, grantor has hereunto set grantor's hand and seal the day and year first above written.
S' ed, sealed, and delivered in our presence:
Witness t b
i ess as to both
Print name: David tim yt4 ,'
STATE OF FLORIDA
COUNTY OF MIAMI -DADE
(Seal)
HEROLD ALOUIDOR
�•u' (Seal)
CHANTAL ALOUIDOR
1 HEREBY CERTIFY that on this day before me, an officer duly qualified to take acknowledgments, personally appeared,
HEROLD ALOUIDOR and CHANTAL ALOUIDOR, HIS WIFE
to me known to be the persons described in and executed the foregoing instrument and > gwledp�$before me fiat the a uted the same,
They are ( ) personally known to notary or produced the following as identification: a_
4--1. -.non
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION PERMIT
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: Guillermo Ramon
PERMIT # :13 -SC- 1411031
APPLICATION #: AP 1072601
DATE PAID:
FEE PAID:
RECEIPT #:
DocuMNT 1: PR876167
PROPERTY ADDRESS: 157 NW 98 St Miami, FL 33150
LOT: 24
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 [ 1,050 ] GALLONS / GPD Septic CAPACITY
A [ 0 1 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
R
A
I
N
I
E
L
D
0
T
H
E
R
[ 480 l SQUARE FEET SYSTEM
[ 0 ] SQUARE FEET SYSTEM
TYPE SYSTEM: [x] STANDARD [ ] FILLED [ ] MOUND [ ]
CONFIGURATION: [ ] TRENCH [x] BED [ ]
LOCATION OF BENCHMARK: FFE: 13.82'NGVD
ELEVATION OF PROPOSED SYSTEM SITE [ 25.40 l (1 INCHES ( FT ] [ ABOVE /' BELOW b BENCHMARK /REFERENCE POINT
BOTTOM OF DRAINFIELD TO BE [ 61.44 INCHES I FT ] [ ABOVE A BELOW b BENCHMARK /REFERENCE POINT
FILL REQUIRED:
[ ] INCHES EXCAVATION REQUIRED: [ 36.00] INCHES
- Install 1050 g septic tank.
- Install 400 sq ft drainfield.
- Elevation of bottom of drainfield to be no less than 8.70' NGVD.
- The system is sized for 4 bedrooms with a maximum occupancy of 8 persons,
for a total estimated sewage flow of 400 g /d.
- Not for additions
SPECIFICATIONS BY:
APPROVED BY:
DATE ISSUED:
Roberto •ague
Jos
0 -%
.s all previous editions which may not be used)
3, FAC
v 1.1.4
DH 4016, 08/09 (Obsol
Incorporated: 64E -6.
2012
TITLE:
Engineer Specialist II
Dade ci
EXPIRATION DATE: 08/20/2012
AP1072601 SE871006
Page 1 of 3
Sca
STATE OF FLORIDA
DEPARTMENT OF HEALTH
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permit Application Number
PART II - SITEPLAN
e: Each block represents 10 feet and 1 inch = 40 feet. 73
Notes:
THERE ARE NO PERTINENT FEATURES ON ADJACENT PROPERTIES AND OR ACROSS
THE STREET THAT MAY AFFECT THE NEW SYSTEM INSTALLATION.
Site Plan submitted by:
Plan Approved N�pproved Date
By County Health Department
ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
DH 4015, 10/96 (Replaces HRS -H Form 4016 which may be used)
(Stock Number: 5744 - 002 - 4015 -6)
Page 2 of 4
PI 12-01z