PL-13-738Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 189125 Permit Number: PL -4 -13 -738
Scheduled Inspection Date: May 08, 2013
Inspector: Hernandez, Rafael
Owner: , SLP RESIDENTIAL INVESTORS LLC
Job Address: 1172 NE 103 Street
Miami Shores, FL 33138 -2652
Project: <NONE>
Contractor: DIAZ & RUSSELL CORP
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Septic
Phone Number
Parcel Number 1132050190040
Building Department Comments
UPDATED EXISTING SEPTIC TANK AND DRAINFIELD
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
HRS IN FILE
May 07, 2013
For Inspections please call: (305)762 -4949
Page 15 of 35
BUILDING
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
"MEV
AFR 1 I) 2013
FBC 201 I3 ��
Permit No. !!
PERMIT APPLICATION Master Permit No.
Permit Type: PLUMBING
JOB ADDRESS:
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel #:
Is the Building Historically Designated: Yes
NO
Flood Zone:
OWNER: Name (Fee Simple Titleholder): Phone #: ACS t 7,m3 P} i °G-
Address:
City:
v�C (vsD •
Tenant/Lessee Name: Lr�
State: Zip:
Phone #:
Email: % _-1-NC� •
Phone #: 30 -. (39'2 5 a
CONTRACTOR: Company Name: DP- -V SSe LC C OPP.
Address: \2S-S® CScSe ®yp..se. 6cs,O Lf e 24(
City: ' 4--z f1 rt ( 8-'i ( State: l L
Zip: 3 '5 LB
Phone #: 30 5- `i 39 S 2 S
Qualifier Name: N ‘-So ALd Q -LCb0 O0 t ht
State Certification or Registration #: F C_ k i Z `1 6 0 2- Certificate of Competency #:
Contact Phone #: Email Address: f \C---QQ-VCt b e 74 H-o 0 Cori ,
DESIGNER: Architect/Engineer: Phone #:
Value of Work for this Permit: $ (01 (93 Square/Linear Footage of Work:
Type of Work: ❑Address °Alteration
°New °Repair/Replace
Description of Work: LRDIS.-t LXIS `C 10-J S & P'C t C
❑Demolition
Dam N `PAL L.O N
******** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Fees************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Submittal Fee $ Permit Fee $ 3 6 0 CCF $ CO /CC $
Scanning Fee $ Radon Fee $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
DBPR $ Bond $
TOTAL FEE NOW DUE $ -'fl' (
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 aloe exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien l ►, broch . will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of . mmenc ' t must be posted at the job site
for the first inspection w h even (7) days after the building permit is issued In the '• ► nce ofSuch posted notice, the
inspecti a reinspection fee will be charged.
Signature/
Signature
Owner or Agent
The fore oin_ instrument was a
day of r 1 , 201
Al led -• before
The for
day of
�
ho is
)11
known to me or who has produced
identification and who did take an oath.
1
C i ntractor
oin instrument was , kno
,20 1
ed before
11
personally known to me or who has produced
NOT
Sign:
Print:
My Commission Expir
.ti
OTARY PUBLIC:
Sign:
Print:
My Commis ion
* * * * * * * * * * * ** * * * * * * **
APPROVED BY
********************************************************************************
4 V' ( t3 Plans Examiner Zoning
Structural Review
(Revised3 /12/2012XRevised 07 /10 /07XRevised 06 /10 /2009XRevised 3/15/09)
Clerk
Page 1 of 1
MIAMI -DADE COUNTY
OFFICE OF THE PROPERTY APPRAISER
PROPERTY SEARCH SUMMARY REPORT
Carlos Lopez - Cantera
Property Appraiser
Property Information:
Folio
11-3205-019-0040
Property Address
1172 NE 103 ST
Owner Name(s)
SLP RESIDENTIAL INVESTORS LLC
Mailing Address
4120 W SPRING CREEK PK #100
PLANO TX
75024 -
Primary Zone
1100 SGL FAMILY - 2301 -2500 SQ
Use Code
0001 RESIDENTIAL - SINGLE FAMILY
Beds /Baths/Half
2/2/0
Floors
1
Living Units
1
Adj. Sq. Footage
1,681
Lot Size
10,531.25 SQ FT
Year Built
1949
Legal Description
MIAMI SHORES SEC 8 REV PB 43 -67
LOT 4 LESS W2OFT BLK 175
LOT SIZE IRREGULAR
OR 18267 -1104 08981
OR 28410 - 4956 1112 01
Assessment Information:
Current Previous
Year
2012
2011
Land Value
$181,980
$151,650
Building Value
$126,124
$126,124
Market Value
$308,104
$277,774
Assessed Value
$305,551
$277,774
Exemption Information:
Current Previous
Year
2012
2011
Homestead
$0
$0
2nd Homestead
$0
$0
Senior
$0
$0
Veteran Disability
$0
$0
Civilian Disability
$0
$0
Widower)
$0
$0
Disclaimer:
Aerial Photography 2012
Taxable Value Information:
Current Previous
Year
2012
2011
Exemption/Taxable
Exemption/Taxable
County
$0/$305,551
$0/$277,774
School Board
$0 /$308,104
$0/$277,774
City
$0/$305,551
$0/$277,774
Regional
$0/$305,551
$0/$277,774
Sale Information:
Date
Amount
OR Book -Page
Qualification Code
11/2012
$275,000
28410 -4956
Sales qualified as a result of
examination of the deed
8/1998
$125,000
18267 -1104
Sales which are qualified
8/1993
$0
16137 -2244
Sales which are disqualified as a
result of examination of the deed
The Office of the Property Appraiser and Miami -Dade County are continually editing and updating the tax roll and GIS data to reflect the latest property information
and GIS positional accuracy. No warranties, expressed or implied, are provided for data and the positional or thematic accuracy of the data herein, Its use, or Its
interpretation. Although this website is periodically updated, this information may not reflect the data currently on file at Miami -Dade County's systems of record. The
Property Appraiser and Miami -Dade County assumes no liability either for any errors, omissions, or inaccuracies In the Information provided regardless of the cause
of such or for any decision made, action taken, or action not taken by the user in reliance upon any information provided herein. See Miami -Dade County full
disclaimer and User Agreement at http:// www. miamidade .govilnfo /disclaimer.asp.
Property information Inquiries, comments, and suggestions email: pawebmall @miamidade.gov
GIS Inquiries, comments, and suggestions email: gis@miamidade.gov
Generated on: Thu Apr 11 2013
http: / /gisweb.miamidade .gov/PropertySearch /printMap.htm 4/11/2013
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION PERMIT
CONSTRUCTION PERMIT FOR: OSTDS New
APPLICANT:
(SLP Residential Investors LLC)
PERMIT #: 13-SC-1459872
APPLICATION #:AP1100106
DATE PAID:
FEE PAID:
RECEIPT #'
DOCUMENT #: PR902925
PROPERTY ADDRESS: 1172 NE 103 St Miami, FL 33138
LOT: 4
BLOCK: 175 SUBDIVISION:
PROPERTY ID #: 11- 3705 - 019 -0040
[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 l
GALLONS / GPD Septic
GALLONS / GPD N/A
GALLONS GREASE INTERCEPTOR CAPACITY
GALLONS DOSING TANK CAPACITY [
CAPACITY
CAPACITY
[MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ ]
D [ 375 ] SQUARE FEET in trench configuration SYSTEM
R [ ] SQUARE FEET
N/A SYSTEM
A TYPE SYSTEM: [x] STANDARD [ ] FILLED
I CONFIGURATION: [x] TRENCH [ ] BED [ ]
N
F LOCATION OF BENCHMARK: C/L NE 103rd St 10.81'ngvd
[ ] MOUND
I ELEVATION OF PROPOSED SYSTEM SITE
E BOTTOM OF DRAINFIELD TO BE
L
D
O
T
H
E
R
SPECIFICATIONS BY:
APPROVED BY:
DATE ISSUED:
FILL REQUIRED:
[ 0.00] INCHES
[ 33.70 ] [I INCHES I FT ] [ ABOVE /) BELOW I BENCHMARK /REFERENCE
[ 63.72 ] [I INCHES I FT ] 1 ABOVE 4 BELOW b BENCHMARK /REFERENCE
EXCAVATION REQUIRED: [ 30.00] INCHES
POINT
POINT
- Install 900 g septic tank.
- Install 375 sq ft drainfield in trench configuration-
- Elevation of bottom of drainfield to be no less than 5.50' NGVD.
- The system is sized for 3 bedrooms with a maximum occupancy of 6 persons,
for a total estimated sewage flow of 300 g /d.
The Contractor (or designee) is requirerf to perform a
soil boring adjacent To the Firainfie;ri excavnon the of final inspection. Prior to Final ? pro l tOe DOH
inspector shall cviti F ;t1' i CAM and i:ompare the
results to trio origi Div r7r,) 7 'i ") ^tkec /
reinspectiorl fee will be asr:r;� ed it tale, contractor is not
at the jobsite at the arranrree; tiree.
Joseph R Pi
TITLE: Engineer Specialist II
TITLE: Engineer Specialist II
0 3
Dade CHD
DH 4016, 08/09 (Obsf etas all previous editions which may not be
Incorporated: 64E- 6.003, FAC
v I. %.4 AP11007.06
used)
EXPIRATION DATE: 10/11/2014
SE895287
Page 1 of 3
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION PERMIT
CONSTRUCTION PERMIT FOR: OSTDS New
APPLICANT: (SLP Residential Investors LLC)
PERMIT #:13 -SC- 1459872
APPLICATION #:API100106
DATE PAID:
FEE PAID:
RECEIPT #:
DOCUMENT #: PR902925
PROPERTY ADDRESS: 1172 NE 103 St Miami, FL 33138
LOT: 4
BLOCK: 175 SUBDIVISION:
PROPERTY ID #: 11- 3705 -019 -0040
[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
] GALLONS / GPD N/A
] GALLONS GREASE INTERCEPTOR CAPACITY
] GALLONS DOSING TANK CAPACITY
D [ 375 ] SQUARE
R [ ] SQUARE
A TYPE SYSTEM:
I CONFIGURATION:
N
F LOCATION OF BENCHMARK:
FEET in trench confiquration
FEET
[x] STANDARD
[x] TRENCH
CAPACITY
CAPACITY
[MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
]GALLONS 8( ]DOSES PER 24 HRS #Pumps [
SYSTEM
N/A SYSTEM
[ ] FILLED [ ]
[ ] BED [ ]
C/L NE 103rd St: 10.81'ngvd
MOUND
I ELEVATION OF PROPOSED SYSTEM SITE
E BOTTOM OF DRAINFIELD TO BE
L
D
0
T
R
SPECIFICATIONS BY:
APPROVED BY:
DATE ISSUED:
FILL REQUIRED:
[ 0.00] INCHES
[ 33.70 ] [I INCHES I/ FT ] [ ABOVE A BELOW b BENCHMARK /REFERENCE POINT
[ 63.72 ] [I INCHES Y FT ] [ ABOVE 4 BELOW F BENCHMARK /REFERENCE POINT
EXCAVATION REQUIRED: [ 30.00] INCHES
- Install 900 g septic tank.
- Install 375 sq ft drainfield in trench configuration-
- Elevation of bottom of drainfield to be no less than 5.50' NGVD.
- The system is sized for 3 bedrooms with a maximum occupancy of 6 persons, .
for a total estimated sewage flow of 300 g /d.
The contractor (or designee;) is required to perform a
soil boring adjacent to the Grainfield excavation at the
time 01 final in4fieciion. Prior to anal Approv 1, the DOE
inspector sha!1 witr!!' t3 ihe, so ! brr;r ;i ;nit compare the
results to to O k t i lit ?! ia.t t r! d , rrttted. r`i
reinspection tea a s'n.,- , d it th . contractor is no
at the jobsite at the arranflwii tilde.
Jos =•h R P'
DH 4016, 08/09 (Ob
Incorporated: 64
TITLE: Engineer Specialist II
ngineer Specialist II
tes all previous editions which may not be used)
.003, FAC
v 1.1.4 AP110010s
Dade cHD
EXPIRATION DATE: 10/11/2014
SE89S287
Page 1 of 3
i
Protect Address
Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138 -0000
Phone: (305)795 -2204
Parcel Number
1172 NE 103 Street
Miami Shores, FL 33138 -2652
1132050190040
Block: Lot:
Owner Information
Address
Phone
Applicant
SLP RESIDENTIAL INVESTORS!
Cell
SLP RESIDENTIAL INVESTORS LLC
1172 NE 103 Street
MIAMI SHORES FL 33138-
Contractor(s)
DIAZ & RUSSELL CORP
Phone
CeII Phone
Valuation:
Total Sq Feet:
$ 6,000.00
0
1
Type of Work: SEPTIC & DRAINFIELD
Type of Piping:
Additional Info:
Bond Retum :
Classification: Residential
Fees Due
Bond Type - Owners Bond
Bond Type - Owners Bond
CCF
DBPR Fee
DCA Fee
Education Surcharge
Permit Fee
Scanning Fee
Technology Fee
Total:
Amount
$0.00
$500.00
$3.60
$4.50
$4.50
$1.20
$300.00
$9.00
$4.80
$827.60
Pay Date
Invoice #
04/11/2013
04/17/2013
04/1112013
Pay Type
PL -4-13 -47323
Check #: 1381
Check #: 1389
Check #: 1380
Bond #: 2227
Amt Paid Amt Due
$ 50.00
$ 277.60
$ 500.00
$ 777.60
$ 500.00
$ 0.00
Available Inspections:
Inspection Type:
HRS Approval
Final
Review Plumbing
Applicant Copy
For Inspections, Cali (305) 762 -4949 or Log on at https:// bldg .miamishoresvillage.com /cap/.
Requests must be received by 3 pm for following day inspections.
NOTICE: In addition to the requirements of this permit, there may be AND THERE MAY BE ADDITIONAL PERMITS REQUIRED FROM OTHER
additional restrictions applicable to this property that may be found in GOVERNMENTAL ENTITIES SUCH AS WATER MANAGEMENT
the public records of this county. DISTRICTS, STATE AGENCIES, OR FEDERAL AGENCIES.
April 17, 2013 2
iwko
1. or. v/Z4 T1(Z
[01] TANK SIZE [1I0$' [2] t
(02] TANK MATERIAI, _ _ [
[03] OUTLET DEVICE I
[04] MULTI - CHAMBERED_ 1 1 [
[051 OUTLET FILTER ,/.........i4.:6 t / -1/ [
[0'61 LEGEND 2O '' ii / -- / O ✓..V C3 [
[07] WATERTIGHT [
[08] LEVEL Z V [
(09] DEPTH TO LID 3 p e ! / i [
DRAINFIELD INSTALLATION ee,,/
[ 1 [10] AREA E13/3"4316[23 /�dtQFT / r
[ ] [11] DISTRIBUTION BOX- HEADER [
I ] [12] NUMBER OF DRAINLINES�in,�, t,
[ 1 [13] DRAINLINE SEPARATION .,e y [
I ] [14] DRAINI,INE SLOPE
I ] [15] DEPTH OF COVER it V '1
[ ] [16] ELEVATION [ABOVE BM [
[ ] [17] SYSTEM LOCATION [
I ] [18] DOSING PUMPS / �Q
[ ] [19] AGGREGATE SIZE // f 2[ •
[ ] [20] AGGREGATE EXCESSIVE FINES
[ ] (21] AGGREGATE DEPTH A/ J 74
1
1
1 FILL
(22]
[23]
[24]
[25]
1
[26]
/ EXCAVATION MATERIAL •
FILL AMOUNT 7
FILL TEXTURE
EXCAVATION DEPTH.
AREA REPLALSD
REPLACEMENT MATERIAL
EXPLANATION OF VIOLATIONS /'REMARKS:
I ]
'1 3
I
[ ]
1
3
3
1
1
1
[27]
[28]
[29]
[30]
[31]
[32]
[33]
[34]
(35] O riii R
SURFACE WATER
DITCHES-
PRIVATE WELLS
PUBLIC WELLS
IRRIGATION WELLS
POTABLE WATER LINES S'" FT
BUILDING FOUNDATION 1 6 FT
PROPERTY LINES / FT
FT
FT
FT
FT
FT -
FT
FILLED / MOUND SYSTEM
[36] DRAINFIELD COVER
[37] SHOULDERS - d�L
[38] SLOPES
(39] STABILIZATION
ADDITIONAL INFORMATION
�7 [40] UNOBSTRUCTED AREA
✓T [41] STORMWATER RUNOFF
[ 1 ] [421
.[ 4 ] [43]
[ [44]
[-21"' [45]
[ sj [46]
[ /1 [47]
[.
J. [48]
ALARMS
MAINTENANCE AGREEMENT
BUILDING AREA
LOCATION CONFORMS WITH
FINAL SITE GRADIN
CONTRACTOR
OTHER
SITE
7v ..
ABANDONMENT'
(49] • •TANK PUMPED `24 4r/1.3 �i
•[50.] TANK CRUSHED & FILLED �/� >/ •
%3
CONSTRUCTI (APPROVED ISAPPROVED1
CHD • DATES _ .Z .57-^ % . •
'INAL SYSTEM„ [APPROjD /DISAPPROVED] : �� ! C.�s...�P C"'�'�` c DATE: 9/•-e-2-5"."— /3
`16, 08/09 (Obsoletes. all previous editions which•may not be used)
rated•: 64E- 6.003, FAC'
Page 2 of 3