PL-11-906Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 159952 Permit Number: PL -5 -11 -906
Scheduled Inspection Date: August 10, 2011
Inspector: Hernandez, Rafael
Owner: RANCANO, RUEBEN
Job Address: 9413 NW 2 Court
Miami Shores, FL 33150-
Project: <NONE>
Contractor: SOUTHERN SEPTIC CONTRACTORS INC
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Septic
Phone Number
Parcel Number 1131010150350
Phone: (305)598 -8266
Building Department Comments
DRAINFIELD AND SEPTIC TANK REPLACEMENT
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
August 09, 2011
For Inspections please call: (305)762 -4949
Page 8 of 29
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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
Permit No. FL-1'
PERMIT APPLICATION
FBC 20
Permit Type: PLUMBING
Master Permit No.
OWNER: Name (Fee Simple Titleholder): C_ ABC' 8 S Cot 5 4" 11 0 Phone#: 3 °S S rt S SS 26 Co
Address: q 2j N N 2- c
City:; GG •State: (.. Zip: 316 50
Tenant/Lessee Name: Phone #:
Email:
JOB ADDRESS: C 03 N v) 2
City: Miami Shores
County: Miami Dade Zip: 1A
Folio/Parcel #:
Is the Building Historically Designated: Yes NO X Flood Zone:
CONTRACTOR: Company Name: Sra,A IN ei',A 5 ecT+ adt n 1'5 Phone #: 10 S1 '6' $ 7-1.
Address: 1 `J 7 / S. i X� t kA 51/4)
City: M-■ rw rte- State:
Qualifier Name: r a r �...c, .
State Certification or Registration #: Certificate of Competency #:
Contact Phone #: Email Address:
DESIGNER: Architect/Engineer:
Phone #:
Zip: -1 3 IS 7
Nto C.‘ .g7,go
Value of Work for this Permit: $
N .,A
Phone #:
O o c Square/Linear Footage of Work:
Type of Work: Address ❑Alteration New ARepair/Replace
Description of Work: 17r a. ∎ ✓� �r + a & �el� w �+^ • T ow∎l � 14 ce
❑Demolition
Submittal Fee $
Scanning Fee $
Notary $
Double Fee $
r r
Permit Fee $ 3 clC, _� ,_ CCK$ CO /CC $
Radon Fee $
DBPR $ Bond $
Training/Education Fee $ Technology 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 /1' I / -mom - Signature
* /
Pr
� Owne .� Agent �
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of Th j , 20 �, by /05 COSI % /() _ "'� day of f Ace , 20 t� , by `Z.t� �Z��` (ol d"
who is perso ally known to me or who has produced y iso Y2'//�' who is personally known to me or who has produced t "�
iiiii�
I� `1 As identification and who did take an oath. as identification and who d � e o
r
NOTARY P , I LIC: NOTARY PUBLIC: l ..�` " ~'
:0
e
�O
My Commission Expires:
APPROVED BY
1
���ITI GRISEL DIAZ
r. ,��4PRY PV9�i
s. u,
Notary Public - State of Florida
Nly Comm. ` eSATn' ss a nire� agi '�
Structural Review
(Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09)
Sign:
Print:
My Commission Expires:
• -
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11111m
Zoning
Clerk
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION PERMIT
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: Carlos Castillo
PERMIT #: 13-SC-1350342
APPLICATION #: API 035997
DATE PAID:
FEE PAID:
RECEIPT #:
DOCUMENT #: PR844898
PROPERTY ADDRESS: 9413 NW 2 Ct Miami, FL 33150
LOT: 11
BLOCK: 3 SUBDIVISION: Odell Manors
PROPERTY ID #: 11- 3101 - 015 -0350
[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
0 ] GALLONS / GPD
0 ] GALLONS GREASE INTERCEPTOR CAPACITY
] GALLONS DOSING TANK CAPACITY [
D [ 200 ] SQUARE FEET
CAPACITY
CAPACITY
[MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
]GALLONS @ [ ]DOSES PER 24 HRS #Pumps [ ]
SYSTEM
R [ 0 ] SQUARE FEET SYSTEM
[x] STANDARD [ ] FILLED [ ] MOUND [ ]
[ ] TRENCH [R] BED [ ]
A TYPE SYSTEM:
I CONFIGURATION:
F LOCATION OF BENCHMARK:
F.F.E.: 14.15' NGVD.
I ELEVATION OF PROPOSED SYSTEM SITE
E BOTTOM OF DRAINFIELD TO BE
L
D FILL REQUIRED: 1 0.00 ] INCHES
T
H
E
R
1 28.20 ] (1 INCHES If FT ] [ ABOVE /) BELOW II BENCHMARK /REFERENCE
[ 64.20 ] II INCHES r FT ] [ ABOVE 4 BELOW (I BENCHMARK /REFERENCE
EXCAVATION REQUIRED: [ 48.00] INCHES
POINT
POINT
1— Install 900 gal. category-3 septic tank equipped with an approved filter. 2 -The licensed contractor installing the system
is responsible for installing the minimum category of tank in accordance with sec. 64E- 6.013(3)(f). 3- Install 200 sf of
drainfield in bed configuration. 4- Install 12" of slightly limited soil under the bottom of drainfield. 5- Perimeter of
excavation area shall be at least 2 ft wider and longer than the proposed absorption bed. 6 -Invert elevation of drainfield
to be no less than 9.30' NGVD. 7. Bottom of drainfield elevation to be no less than 8.80' NGVD.
THIS PERMIT IS NOT FOR AD
SPECIFICATION: PEDRO N
APPROVED BY:
Pedro Ospina
DATE ISSUED: 05/16/2011
DH 4016, 08/09 (Obsoletes all previous editions which may not be
Incorporated: 64E- 6.003, FAC
v 1.1.4 AP1035997
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401
STATE OF FLORIDA
DEPARTMENT OF HEALTH
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERM Permit Application Number /( /i 07;
PART II:; SITEPLAN
Scale: Each block represents 10 feet and 1 inch = 40 feet.
1
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Notes: THERE ARE NO PERTINENT FEATURES ON ADJACENT PROPERTIES AND OR ACROSS
THE STREET THAT MAY AFFECT THE NEW SYSTEM INSTALLATION.
Site Plan submitted br
Plan Approved 11 wow
WirrIrs'
11111.11111""
By
roved
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Date
County Health Department
ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
DH 4015, 10/96 (Replaces HRS -H Form 4016 which may be used)
(Stock Plumber: 5744- 002 - 4015 -6)
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