PL-13-206Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 185109
Scheduled Inspection Date: February 21, 2013
Inspector: Hernandez, Rafael
Owner: BAPTISITE, CILOTTE
Permit Number: PL -2 -13 -206
Job Address: 534 NW 113 Street
Miami Shores, FL 33138 -0000
Project: <NONE>
Contractor: STATEWIDE SEPTIC CONNECTIONS
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Septic
Phone Number
Parcel Number 3021360210850
Phone: (954)963 -0082
Building Department Comments
REPLACE BROKEN SEPTIC TANK
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
frx
February 20, 2013
For Inspections please call: (305)762 -4949
Page 14 of 23
`oL'1.:-1 ,)- Lob
DIVISION OF
nvironmental Health
Otil0
Florida Department of Health
Miami -Dam County Health Department
OSTDS/Well Division
11 SW 26 St.'. Miami, FL 33175
1 iiQr'
Date 1-
osms'
<. rrDIVISION F
i
Florida Department of Health
MIamf Dade County Health Department
OSTD'ell Division
11iOSSW24 St. +Aetna, FL 3317S
BUIL*13-- if)
DING
PERMIT APPLICATION
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
sOov4_,,D k-tPM LXo -(0
141)3
13°613111 FBC 20 \O
Permit No. t _
Master Permit No. - i'�
Permit Type: MEtifiZai P corrkb Y13
JOB ADDRESS: 534 M J �—�-
City: Miami Shores County: Miami Dade Zip: 3 \G8
Folio/Parcel #: 1 - Z 1 36 - 6 21- 0 6 SO
Is the Building Historically Designated: Yes NO
Flood Zone:
OWNER: Name (Fee Simple Titleholder): C 'e I0 P d e it rf Phone #: '3-0S- Z.:0 9-99 S3
Address:
City: d i' Gt a r lO r-S State: ? L Zip: 331G8
Tenant/Lessee Name: Phone #:
Email:
i0.
CONTRACTOR: Company Name: 0t+ a C,, I� ( Phone #: GG f
Address: k
City:
fJ r o,,K
Qualifier Name: (,ees
5 ri o cri
Email Address:
State Certification or Registration #:
Contact Phone #:
DESIGNER: Architect/Engineer:
State: - Zip: '33G9 ma
Phone #:
Certificate of Competency #:
Value of Work for this Permit: $ 5C 0
Type of Work: ❑Address DAlteration
Description of Work:
Phone #:
Square/Linear Footage of Work: -3 O
ONew *tepair/Replace UDemolition
• �� io c - lz
6134,41) f 1100 pk riC
d
******** ** * * * * * * * * * * * ** * * * * * * * * * * * * * *** Fees************** ** **,r * * * * ** * * ** * * * ** * * * * ** * ***
Submittal Fee $ Permit Fee $ 30 0
Scanning Fee $ Radon Fee $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
CCF $ CO /CC $
DBPR $ Bond $
Technology Fee $
TOTAL FEE NOW DUE $
3
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 afier 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.
Cam;
Contractor
The foregoing instrument was acknowledged beforree me this it The foregoing instrument was acknowledged before me this
day of fb , 20 ( , by C.i 110 t' Z tpre, , day of , 20 P, by a9-11-21-4-
who is personally known to me or who has produced 1 Liter-4 who is personally known to me or who has produced CA--
as identification and who did take an oath.
9
As identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires
*** * *** * * * * * * * * ****
APPROVED BY
w TERESA J SOLOMON
MY COMMISSION # EE131935
407) 396-0
Raid BtOWYService.Dom
/3 Plans Examiner
Structural Review
(Revised 3 /12 /2012XRevised 07 /10 /07)(Revised 06 /10 /2009XRevised 3/15/09)
NOTARY PUBLIC:
�\\‘` Arlo
E. j
Sign: is O
r iri��
•
Print: -. • l'a ‹, �a 1 -
...a • c6' ./.
My Commission Expires: '..4.,0:e. a a ,. : • ``
O .
Zoning
Clerk
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM
CONSTRUCTION PERMIT
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: Cilotte Pierre
PROPERTY ADDRESS: 534 NW 113 St Miami, FL 33168
LOT: 7
PERMIT #: 13-SC- 1453141
APPLICATION #: API 096015
DATE PAID:
FEE PAID:
RECEIPT #:
DOCUMENT #: PR896128
BLOCK: 5 SUBDIVISION: West Shores
PROPERTY ID #: 11- 2136 -021 -0850
[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 [ 1,200 ] GALLONS / GPD New Septic Tank 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 [ 300 ] SQUARE FEET Trench configuration drain SYSTEM
R [ 0 ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [x] STANDARD [ ] FILLED [ ] MOUND [ ]
I CONFIGURATION: [x] TRENCH [ ] BED [ ]
N
F LOCATION OF BENCHMARK: F.F.E., 13.20' NGVD
I
E
L
D
0
T
H
E
R
ELEVATION OF PROPOSED SYSTEM SITE
BOTTOM OF DRAINFIELD TO BE
FILL REQUIRED:
[ 0.00 ] INCHES
[ 20.40 ] [1 INCHES / FT ] [ABOVE 4 BELOW p BENCHMARK /REFERENCE POINT
[ 56.40 ] [I INCHES I FT ] [ ABOVE 4 BELOW b BENCHMARK /REFERENCE POINT
EXCAVATION REQUIRED: [ 36.00] INCHES
Required utility easement shall be submitted before final approval.
Inspector to verify the existing septic tank is properly abandon before final approval.
*Invert elevation of drainfield to be no Tess than 9.00 ft. NGVD.
*Bottom of drainfield elevation to be no less than 8.50 ft. NGVD.
-The system is sized for 4 of bedrooms duplex with a maximum occupancy of 8 of persons (2 per bedroom), for a total
estimated sewage flow of 400 gpd.
-The licensed contractor installing the system is responsible for installing the minimum category of tan : = 0r�
with sec. 64E- 6.013(3)(f). F.A.C. 1/_ Qep
SPECIFICATIONS BY: Carlos M Icaza
APPROVED BY: TITLE:
DATE ISSUED: 02/01/2013 \I‘ ` EXPIIRATION
TITLE:
tir
G°
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E- 6.003, FAC
v 1.1.4 a.P1096015 SE8 89053,
Page 1 of 3
0•
APPLICATION.. FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT ,
. Permit Application Numtar /
• MrATE .C5,P' FLORIDA
DEPARTMENT OF HEALTH •
PART II SITE PLAN-'
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SOS-IcoNev- coy\ N-c dray
Site Plan submitte by:
j
Plan Ap roved
By
Signature
Not Approved
I 3 13
le
Date
County Health Departmer
ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
0144015. 10/96 (Replaces HRS-li Form 4015 which may he used)
(Stock Numbec 5744-002-4015-64
Page 2 of