PL-13-435Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 186771
Permit Number: PL- 3- 13-435
Scheduled Inspection Date: March 21, 2013
Inspector: Hernandez, Rafael
Owner: THOROGOOD, DANIEL
Job Address: 635 NE 105 Street
Miami Shores, FL
Project <NONE>
Contractor: CHAPMAN SEPTIC SERVICE, INC.
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Septic
Phone Number
Parcel Number 1122310120070
Phone: (305)815 -9901
Building Department Comments
SEPTIC TANK INSTALL
Infractlo 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
March 21, 2013
For Inspections please call: (305)762 -4949
Page 17 of 40
3�c�Im � Yn
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
FBC 20 \0
Permit No. L-13 o9 3 5
Master Permit No.
BUILDING
PERMIT APPLICATION
Permit Type: PLUMBING
JOB ADDRESS: (� / t/ € ` �� bt-
City: Miami Shores County: Miami Dade Zip: `331 3 E
Folio/Parcel #: `l - 01:901 0-0 -0670
Is the Building Historically Designated: Yes NO Flood Zone:
OWNER: Name (Fee Simple Titleholder): 13 14vvt, Phone #:
Address: WS'
City: fit to.«n)
Tenant/Lessee Name: Phone #:
Email:
State: Zip: '33 i 3 V
CONTRACTOR: Company Name: Lt.� Phone #: LC $3• ( cS `�-"i 91
Address: `Pig ` yl i p
City: State: Zip: 33.2
Phone #:.,2 /& 94I
Qualifier Name: ('w t .
State Certification or Registration #: _S WOO 4I -G t W7 Certificate of Competency #:
Contact Phone #:38g' -C (fb-0 Email Address:
DESIGNER: Architect/Engineer: Phone #:
Value of Work for this Permit: $ P1/51) Square/Linear Foota e of Work:
Type of Work: ❑Address ❑Alteration ❑New epair/Replace
❑Demolition
* * * * * * * * * * * * * * * * * * * * * * ** ** * * * * * * * * * * ** Fees************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Submittal Fee — Permit Fee $ 06 ce— 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
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 reinspection fee will be charged.
Signature X. l/--T
.4
Owner r Agent
The foregoing instrument was acknowledged before me this 3
day ofh ,20 3 by CzWilJJ 1740 KO6r0
who is personally known to me or ho has produced
As identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
.4
'Orr,"
ANFF ^ANTRELL
°: Notary public - State of Florida
s ` "' rau - My Comm. Expires Jun 15, 2013
L Commission # DD 897782
.FOF F;os.
Bonded Through National Notary Assn.
My Commiss
APPROVED BY
* * * * * * * * * **
3 13
Contractor
The foregomg instrum- st was acknowledged before me this 3
day of , 20 /3 by 611444-/pg
who is personally known to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
Sign: !i
Print: U t
_
: 1,S, , o ary • u is - tate of Florida
My Co $ y Comm. Expires Jun 15, 2013
srr��a�c Commission # 00 897782
'44);,&% ''' Bonded Through National Notary Assn.
******************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Plans Examiner
Structural Review
(Revised3 /12 /2012)(Revised 07 /10 /07)(Revised 06 /10 /2009XRevised 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:
Daniel Thorogood
PERMIT #: 13-SC-1456828
APPLICATION #:API098215
DATE PAID:
FEE PAID:
RECEIPT #:
DOCUMENT #: PR898188
PROPERTY ADDRESS: 635 NE 105 St Miami, FL 33138
LOT: 8
BLOCK: SUBDIVISION: Golf View Estates
PROPERTY ID #: 11- 2231 -012 -0070
[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
WHICH SERVED AS A BASIS FOR ISSUANCE OF THIS PERMIT, REQUIRE THE APPLICANT
PERMIT APPLICATION. SUCH MODIFICATIONS MAY RESULT IN THIS PERMIT BEING MADE
ISSUANCE OF THIS PERMIT DOES NOT EXEMPT THE APPLICANT FROM COMPLIANCE WITH
STATE, OR LOCAL PERMITTING REQUIRED FOR DEVELOPMENT OF THIS PROPERTY.
MATERIAL FACTS,
TO MODIFY THE
NULL AND VOID.
OTHER FEDERAL,
SYSTEM DESIGN AND SPECIFICATIONS
T [
A [
N [
K [
1,050 ] GALLONS /GPD Septic
0 ] GALLONS / GPD
0 ] GALLONS GREASE INTERCEPTOR CAPACITY
] GALLONS DOSING TANK CAPACITY [
D [ 300 ] SQUARE
R [ 0 ] SQUARE
A TYPE SYSTEM:
I CONFIGURATION:
N
F LOCATION OF BENCHMARK:
FEET
FEET
[x] STANDARD
[ ] TRENCH
CAPACITY
CAPACITY
[MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ ]
SYSTEM
SYSTEM
[ ] FILLED [ ] MOUND [ ]
[x] BED [ ]
FFE: 16.0'ngvd
I ELEVATION OF PROPOSED SYSTEM SITE
E BOTTOM OF DRAINFIELD TO BE
L
D FILL REQUIRED: [ ] INCHES
0
T
H
E
R
[ 19.20 ] [) INCHES 1 FT ] [ ABOVE /) BELOWII BENCHMARK /REFERENCE POINT
[ 49.20 3 [) INCHES I FT 3 [ ABOVE 4 BELOW I] BENCHMARK /REFERENCE POINT
EXCAVATION REQUIRED: [ 42.00] INCHES
- Install 1050 g septic tank.
- .Install 300 sq ft drainfield.
- Install 12" of slightly limited soil under bottom of drainfield.
- Elevation of bottom of drainfield to be no Tess than 11.90' NGVD.
- The system is sized for 3 bedrooms with a maximum occupancy of 6 persons,
for a total estimated sewage flow of 400
- Not for additions
SPECIFICATIONS BY:
APPROVED BY:
Charles man
h
DATE ISSUED: ! 22/2013
The contractor 1'3r r1osignarl i^ as ;pit ;t ,r orm a
soil boring adlaccnt ' rl the drain? It d Y tcasfi 8.e i =,q
time of final it :2sc ion; Prior tti i a "z,hio.4, LYE
inspector shall w;tn'rc.s9Ins soia t ,��,; 3r0 tiomrJsre tipe
results to the oOinar ,P.? is 4z � pe
reinspection tee vv ill biz as 4 :', , .`to =MCY 'a.",otor is no'
at the jobsite at the a +r„ rig tank.
TITLE: Master Septic Tank Contractor
TITLE: Engineer Specialist II
DH 4016, 08/09 (Obso / =tes all previous editions
Incorporated: 64E- 6.003, FAC
v 1.1.4
which may not be used)
AP1098215
Dade cHD
EXPIRATION DATE: 05/23/2013
SE890945
Page 1 of 3
STATE OF FLORIDA
DEPARTMENT OF HEALTH
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permit' Application Number
PART 1I - SITEPLAN
Scale: Each block represents 10 feet and 1 inch = 40 feet. /00 e
1..„.6 IA
Notes:
o
4 s
4te Plan submittJ-41/(444,9
Plan Approved_
By
0
/)
X(C Q ✓k dto+ 53flLd U S 9-- k) l) no /IIIaaA/lcimId ✓ ,, .4b,,
Signature
Not Approved
Title
Date
County Health Dep rtment
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; 5744002 - 4015=6)
Page 2 of 4