PL-13-167Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 184868 Permit Number: PL -1 -13 -167
Scheduled Inspection Date: April 24, 2013
Inspector: Hernandez, Rafael
Owner: ANDREOPOULOS, FOTIOS
Job Address: 118 NW 101 Street
Miami Shores, FL
Project <NONE>
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Septic
Phone Number (305)301 -7828
Parcel Number 1131010220200
Contractor: STATEWIDE SEPTIC CONNECTIONS Phone: (954)963 -0082
Building Department Comments
REPLACE DRIANFIELD
Infractio Passed Comments
INSPECTOR COMMENTS
False
Passed
Failed
7
Correction
Needed.
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
HRS IN FILE
AprII 23, 2013
For Inspections please call: (305)762 -4949
Page 5 of 43
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: (05). 762.4949
FBC 20 lD
BUILDING Permit No. FL-► 3 (01-
PERMIT APPLICATION Master Permit No
_AN 2 9 zo1
Permit Type: PLUMBING
JOB ADDRESS: 1 t g A.hjJ
(Ot NA 4
City: Miami ghores: County: Miami Dade
Folio/Parcel#: 5 (C. [ -- OZtro
Is the Building Historically Designated: Yes
Thkfoc
rp 53(.5-C)
NO Find Zone:
ZiP . 33
Phone#:
OWNER: Name (Fee Simple Titleholder): YL P`
Address:
City:
Tenant/i
Email:
t t � NUJ ` 0
N
State:
Op Uo fr
CONTRACTOR Company Name: 44e 01' (Lei t c Crx ] n c I Y' C Phone#: 31 `6p- C 6'3
Address: 32 S14) 7:6 Sf-
city:t
Qualifier Name: 1 $Ot. ,
State Certification or Registration #: JK O fl Q 2C�2
Contact Phone#: RmAO Address:
DESIGNER: Architect/Engineer. Phone#:
Phone#: 30s— 3: >r2'�
state: rz-
4p: 2,
Phone#:
Certificate of Competency #:
Value of Work for this Permit: $ o
Type of Work: ClAddress
Description of Work:
Square/Linear Footage of Work: 1
OAlteration ONew
Ct c�
i R ,��po
Go 9!3 +ruir.ch g+eir-
ODemolition
************
******** ****** ss ******* Foss s*** s**** ***** ** * ******************* **sssa
Submittal Fee $ Permit Fee $ 75-- CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
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, 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 Ls issued In the absence of such posted notice, the
inspection will not be approved and a rernspection fee will be charged
Owner or Agent
Signature
h
o4 `jam tl
-r—
V
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of 10s1 l 1 C, 20 3 by o S P r1ChK iTcaa 4-9 day of , 20 _, by
who is personally known to me or who has produced PY° 4' who is personally known to the or who has produced
tS:' As identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign:
Print
My Commission Expires:
Structural Review Clerk
(Revised3 /1212012)(Re wised 07 /10/07)(Revised 06t10 XRevised 3/15/09)
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION PERMIT
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: (Fotios & Jessica Andreopoulos)
PERMIT #: 13-SC-1451515
APPLICATION # :API095063
DATE PAID:
FEE PAID:
RECEIPT #:
DOCUMENT #: PR895423
PROPERTY ADDRESS: 118 NW 101 St Miami, FL 33150
LOT: 4 & 5
BLOCK: 3 SUBDIVISION: Gold Crest
PROPERTY ID #: 11- 3101 -022 -0200
[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 [ 150 ] SQUARE FEET in trench configuration SYSTEM
R [ 0 ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [x] STANDARD [ ] FILLED [ ] MOUND [ ]
I CONFIGURATION: [x] TRENCH [ ] BED [ ]
N
F LOCATION OF BENCHMARK: FFE: 13.4'ngvd
I ELEVATION OF PROPOSED SYSTEM SITE [ 28.80 [I INCHES I/ FT ][ABOVE/+BELOWI]BENCHMARK /REFERENCE POINT
[ 64.80 ] [I INCHES I/ FT ] [ ABOVE 4 BELOW I] BENCHMARK /REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE
L
D
0
T
E
R
SPECIFICATIONS BY:
APPROVED BY:
DATE ISSUED:
FILL REQUIRED:
1 0.00 ] INCHES
EXCAVATION REQUIRED: [ 36.00] INCHES
- Install 900 g septic tank.
- Install 150 sq ft drainfield (minimum) in trench configuration.
- Elevation of bottom of drainfield to be no less than 8.00' NGVD.
- The system is sized for 2 bedrooms with a maximum occupancy of 4 persons,
for a total estimated sewage flow of 200 g /d.
- Not for additions
Teresa Ji''o_omon
TITLE: Master Septic Tank Contractor
The contractor (or dec rye.-) is repir?d to perform pa5
soil Ui-ing 1 p ont to «o o.a.�Y i CX.cavnon at the
time of fir ^ it ,ec. d_o. Prior to Final Approval, the DOH
iosp ctor Shall Witri8SF, the So i boring and compare the
re spits to the OnOin t a'a +eq - 'iion? ;u bniitted. A
reinspeciipri t c a_,tes5ed if the contractor is not
at the iobsite at the arraia o time.
DH 4016, 08/09 (Obs/ ' /etes all previous editions which may not be used)
Incorporated: 64E / -.003, FAC
v 1.1.4
AP1095063
EXPIRATION DATE:
SE888381
Page 1 of 3
, •'
EPARTMENT. OFi4EALTH..
APPL.ICATION'E•OR` ONSITE SEWAGE DISPOSAL SYSTEM COINISTRUCTION,PERMIT
Permit Application
4 ,
, -
"'" • PART 11:-- SITE PLAN - —
$
Scale: Each blookrepresents 5 feet and,1 inch 50 feet. ,
•-•
1, t. - t
: t " 414 4
1fov 1 431 t *12.
•
..;
1_4t,j 1- 1 1 U.. I 1 "
1-i
= ;_t
4 1,t 444,14..
• 1 .1141
•
.4 • -..
L-=-2 4 1 14.7f
. ,
-f
.1 'a ,
Iftif fi? —p r is
I itr.,1
f T 1 f
.
1-- --•-----**-1—'•-"••"--•*-1----i---t--"--- — -; 1, . ---1-*
4,----.4Li -:J ,--i-• ';-i- .1-: -4 -4-4.-,-4.-,.-- -
1 ; 4 I r t - —I I : : • , ; • . - • '''' i
-11---
- _ :
,
_....
i----1"1--1-1*-1-1-1-:1-1* ' . i 1...J... 4. '....L.1....!...1.-.. 3 .1_1_, ...4...t....:-4._4_. t-4...t_t....4_.4._1_44......J.
,--;-,--------i-r..--,-,-:----; --;-!Iii-ii-1:.;,if .itL I 4.) +.2........4..L
• ........__L.,.,...„----, ---,--- --:- -
_ c_ _
I-
---:---1•17111.- 1-77iffi2i •
-1 • 4. I t *t I : 1--1-1 i-
i_t.....,.........„,....;....,......,..-...
, ..
_ • _,_ 1
C. -__r-r
,f
ri
-I_ t
- ' fi'
,
1-..-
.,,...„........ -I • --s, ,-, t-:-,-; , I-1 1 , • t ' t I 4 __I - i I I : f 1 1
..1_,......t.,. ...1....1-•....:_.:-..-2--:-.-:-.:.---.. _,.....„„4„,-,, ..,_•,__ ...4„—.4....„...i ...,.....,t_..
t t Err .i_, . t._----, i i t - :ci : t_,...1 ; I . , -..i. ...:__-._,...--_-____I i......1...i.._i...,.............. I =A_
-1 ."f
tts
.-: *f_-___I...
'-'""
f ?
r 1
._,.
> l , f f-i '1"-• -1- (""" t f f f
— .1-;*- -*------;-- 4— .- *t-1- 4-711-i ,,.1:- f r: i
i c 1 , • • : 1 j , , - •
:." • 1 !* :
1-------1-•-
4
I p 7. I • ' 7 I
1-4- -1-1••-• '-'"-
4 I , , 1 t
, i !
ri.....=
_1
l ri 1. i ; i , #1. --T-11 1 t 1-1 4 t t /
=
'
4- ...-- ----4.--4.- t-t .-. --. ..-- • i st; •
LI 1 ......i. f
-,-1-1-1--r --,-,-r-i• j..-- Li_LL.,
r'^f / • i :
i 3 . .,...•...L.....,
1 1
- f 1 -
y i
.,;__
3 , 3 • f. ; , ;
I . ;
1+
„ .
..t.....
ci !-T-1-1".`1-:. IP t
4.....4-.3.....„....
.
.
1 i
,
, ,-1,11111,t-i-!IttiltliLL4.2:
i -1-:";.=iti' .ti I t i ;
.
...lt
,t, z t 1
• ....,--„,-Li ,
I t , ' I I -
,.----.
,-f i f
. 4.,,,_ ,......
A.,1
4.,;
.
- .
„--
, 1-; L'i'l !
r , 1
' '''''' •i ' i
r r £ rs
,f11 ft, . , ,
- . I 3
"..' .•
' (3
3
. , -•.
'nal
.
1--
3 r
'
3 i . i , ,
-
,
' • t : ! 1-1____,f T ;
3
,
•333.3
V.:4k
'''S
• ,3 - t 4 4 int,
:
1---.
f
• ,
*41
•"_ •--1•1 ' 1L. i .
- 1, •..
k
•
/; . .„; .
1
Mk.
•
--1
,
i
.
-i • 1i _, • ,- i..._, i1 • i
•
‘ .
i i
-. .• .•.4•4 .•, „
1 I ,, „i ,
-
, i i .
1
t,
i t !
: • ,
T= T
1
-t . —
- -t
4••,•■i _- I
I r -t1 4
4
• :
1
4 ' 0 iiAiL.,.
,
1iIiI
CO.,..9
'
•,-,
p , ,
1
1. I
,
te.i .•
v# 4 -
_.
,
.
411ttit ,r,:-.,_
-1I
rt-1 i
4
t',"r, LI ;
• 1 I 1 ' ' '
0 i
1 X
t l_t_i• 1 I 1
; f L ...,..-
1. ' I - . •
1 t• I
,
. •
.i
. f • ■
1r
i- k
li
f
Wi• W.1it r11
.t : 1 ......L• 1 i 1
4
I till.,
1,-1 ifi-,111-- --._.
, 1--- 1 . . -
,,
..
• I
;., - ., 0
-
r-
.
-1
4
i *
4,-
,
_ 5
• , - .
I t
,..4.......4._
I A_
i. -
1
U_______i_..
•
i 1, -
Yee.
..iik'
LC,
- ----
,
-110,11),,
),ttriw--
KAI;
I .
e
'NW
,
cd: - '
' ''
f, :
; ,
,
p
-1. 1-ima
,
I -
_..t....
,
i _ -III
-
, • i 1
-
, .
-
„,-..-
i • i :
t i. , i
f
t i
-
-1-T-
I- tisk
1
•
..
.
, t ; ill
I
f
lgt
1
41,01 9.'11
i
at
11111,
,,f/
;,
” Iiiiiriktilln
III
,44
i
1 ''• ,.._, ri
4'
i 1 ••-'
4
WM
'
'
111111411
L
1
1 LI
i .
.
is ,'
•
,'
•
i
,„ -
' ‘7,i,r
— , i i ;
1 , t
t
I * * t
1
cr
I i
,...
,
v 6
--
- -
1
likirrt
- -
,-- ,
, 1 , ,
, 1 ....
, 1,_
.., .
,,
1 f
'‘i• zi*-1‘'' -Orr-
Ps '
:
;
412 Ilf
a
,
NOWS: ri 4 iNeCii) at.)
Ct ''K°'
0. 0” 1 I 0 NW 101 .
do 2
14.9A-6 co
Site Plan submitted by:
Plan Approved
co-- five V„Rel *tof-it,
rot, Dc kryse t •
c
Signature
Not Approved
By 1- 3
,
ALL CHANGES MUST BE APPROVED I3Y THE COUNTY HEALTH DEPARTMENT
DH 4015, 10196 (Replaces 1-1139-14 Faun 4015 which may be used) • (Stock Number:5744-002-4015-6) Page 2 of 3 •
N
'fp
-ntio
Date
County Health Department