PL-13-836Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 189807 Permit Number: PL -4 -13 -836
Scheduled Inspection Date: May 08, 2013
Inspector: Hernandez, Rafael
Owner: MARQUEZ, ERNESTO
Job Address: 1421 NE 104 Street
Miami Shores, FL 33138 -2663
Project: <NONE>
Contractor: SR0061536 MR C'S PLUMBING & SEPTIC INC
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Drainfield
Phone Number
Parcel Number 1122320320060
Phone: (305)651 -7859
Building Department Comments
INSTALLATION OF 300 SQ FT DRAINFIELD 900 GALLON
EXISTING SEPTIC TANK TO REMAIN AND CERTIFIED BY
MR C'S.
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 18 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
AFR2-3 213 1IIJ
BY > >o�000e
FBC 20
Permit No. [ 3- 0
`P n
PERMIT APPLICATION Master Permit No.
Permit Type: BUILDING
14-at IJG 144 st
JOB ADDRESS:
ROOFING
City: Miami Shores County: Miami Dade
Folio/Parcel #: 1 I - aa3 a-- O 3 -fi'pki..)
Is the Building Historically Designated: Yes NO Flood Zone:
Zip: 13133
OWNER: Name (Fee Simple Titleholder): L� ( u t `W g_ U �2
Address: g A 14-at
L N,E_ (Ott
City: l"\t 3 State:
Phone#: --/Ca 4-7 �76
31 13r
Tenant/Lessee Name: Pone#-
Email:
CONTRACTOR: Company Name: Mr C's Plumbing & Septic
Address: 19932 NW 2 Ave
City: Miami State: FL
Qualifier Name: Kemble Ettrick
State Certification or Registration #: SR 061538
phone#: 305- 651 -7859
Zip: 33169
Phone#. 305 -651 -7859
Certificate of Competency #:
Contact Phone#: Email Address:
DESIGNER: Architee eer. Phone#:
Value of Work for this Permit: $ J O. To Square/Linear Footage of Work: f
Type of Work: Addition ❑Alteration
Description of Work: Dix �: o �0� . k
ONew epair/Replace
LIDeniolition
gttM E�Q�H� b9*19* ******** *** ******* ** 4.***i� *i�**.T *0**, * ******** *****•** o�i*****0***** ***** *** **
Submittal Fee $ W'M Permit Fee $ /5 �— CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
Color thru tile:
TOTAL FEE NOW DUE $
vtdecQ -,in in tuTuu Oufvt-r
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 is issued. In the absence of such posted notice, the
inspection will not be approved and a reins ection fee will be charged.
Signature
Owner or Agent
The fo / o' ng jnstrument was acknowledged before me thi r
day of t'T` � 1 , 20 , by - �'�' :k�.� >r s
who is personally known to me or who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
X,4N KEMBL ETTRICK
MY COMMISSION 4 0R 891340
<` EXPIRES: September 14, 2013
g.;:•'� Bonded Thru Notary Public Underwriters
1
* * * * * ** * * * * * * * * * * * * * * * * * **
APPROVED BY
Signature
The fo
day o
I1
Contractor
strument was ackno ledged
2013, by
wn to me or who has produced
+ as identification and who did take an oath.
PUBLIC: - •
S
Print
My Commission
*********** * * * * * * * * ** * * * * * * * * * * * * * * * * * * * **
Plans Examiner
Structural Review
(Revised 3 /12/2012XRevised 071I0107XRevised 06/10/2009XRevised 3/15/09)
* * * * * *** ****D* **
Zoning
Clerk
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION PERMIT
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT Ernesto Marquez
PROPERTY ADDRESS: 1421 NE 104 St Miami, FL 33138
LOT : 6
PROPERTY TD :
BLOCK: 3
R EPAIS
PERMIT # 13-SC-1466440
APPLICATION AP I 104163
DATE PAID:
FEB PAID:
RECEIPT it:
DOCUMENT it: PR903678
SUBDIVISION : River Bay Park
[SECTION, TOWNSHIP, RANGE, PARCEL NUMBER]
1OR TAX ID NUMBER]
SYSTEM :5JCT BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF SECTION
381.0063, 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 [ GALLONS / GPE Existing setic tank to remain. CAPACITY
A •? GALLONS I ,;,:=T) CAPACITY
N 0 ] CALLONE GREAS :":.:D1=RCE3TOR CAPACIIY SINGLE TANK:1250 GALLONS]
K E Dr!..LCNE DDSIND CAPLCIT1' 2 DOSES PER 24 HRS #Pumps E
D 1 3,00 3 SQUARE FEET 1:ticon5akii-:4and! SYE1:
R E 0 ] SQUARE FEET SYS:7:1
A TYPE SYSTEM: [xj ST;',NDARD [ 1 FILL:0 ( 1 M=FD
I CONFIGURATIC,N: [ ) TRID7CH !x] EED ( 1
N
P LOCAT: 311 CF ClARK F. F.,., 7,40 NGVD
I ELEVATION OF PROPOSED SITE 1 33.301 ifil.tos ET 3i 1-,i11E,,,1FELioW1BENCISaRK/REFERENCE POINT
E BOTTOm OF DRAINFIELD TC 1 45.e0 1 T.NE77ES FT 1 [ 7,..730VE 4 BELOW OHNNCOW/REFERFICE. POINT
L
D FILL 7,E(;Ul..:::.,;E: EXCAVATION PEQT.:7DFf...:
*invert
O *Bot:-i. NGVD.
T The is sized for 3 b,c;dre....7ros with a maximum txcl.:p.nr:cy t:f 3 pc:. sc.::; s (2 p,:r bedracm), far a tatai eStiMated
!3.00 3 INCHES
sew; ilo'd
• 'THIS PERMiT 3 NOT FOR " ADiDITION(s)".
SPECIPI CAT I CV S
APPROVE T.
ick
DATE IS': 04/1F,120-1,-,
DH 401C The (1,6A-irfiF.::::5,:f.f.o tied te-sar:f6iirt a
Woitboring aill to the drainfield excavation at the
time of final inspectiso. Friel tO FinalApprOval, the DOH
inspector shall witness the soil boring and compare the
results to the original site evaluation submitted. A
reinspection fee wiii be assessed it the contractor is not
at the iobsite at It-re arranged time.
EXPIRATION DATE:
Dade CND
07/17/2013
Page 1 of 3
)3-gue
DIVISION OF
Environmental Health
Florida Department of Health
mi-Dade County Reath Department
OSTDS/Well Division
, tt805 SW 26 St. • Mont, FL 33175
-2 4 -/
%.dy ' OSTDS# P 1CY /C5
I-
Signature