PL-12-1943r
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 181614 Permit Number: PL -10 -12 -1943
Scheduled Inspection Date: March 06, 2013
Inspector: Hernandez, Rafael
Owner: MINSKI, JOEL & ANDREA
Job Address: 9969 NE 4 Avenue Road
Miami Shores, FL 33138-
Project: <NONE>
Contractor: SR0061536 MR C'S PLUMBING & SEPTIC INC
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Septic
Phone Number (305)510 -0916
Parcel Number 1132060171230
Phone: (305)651 -7859
Building Department Comments
INSTALL REPLACE NEW DRAINFIELD
Infractlo Passed Comments
INSPECTOR COMMENTS
False
Passed
Failed
Correction
Needed
Re- lnspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
CREATED AS REINSPECTION FOR INSP- 180103. HRS IN FILE
11/14/2012 - broken side walk.
ACCESS IS IN THE ALLEY
March 05, 2013
For Inspections please call: (305)762 -4949
Page 9 of 43
Miami Shores Village
Building Department
40050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
B DING
PERMIT APPLICATION
Permit No. R t 3
Master Permit No.
Permit Type: PLUMBING
JOB ADDRESS: get (0'i IOC itAvt,
City: Miami Shores County: Miami Dade Zip: 331 se
Folio/Parcel #: it- 3a o6 - b l7 -1a30
Is the Building Historically Designated: Yes NO r Flood Zone:
OWNER: Name (Fee Simple Titleholder): 'rVireA 1 tik.sk1 Phone#: 7116337:S67
Address: lqG °► 1.16 4 AveJ
City: iikieWl State: a. Zip: 3313r
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: fYlr L. s {l(oJo i nq 3 3iL Phone#: o5IT1 ?al
Address: Vici 3a. ►.) w 2." '' arc .1
City: K t State: L- Zip: 33 161
Qualifier Name: leetabk E1h Phone#: '78'SA
State Certification or Registration #: 5k."' 53C Certificate of Competency #:
Contact Phone#: Email Address:
DESIGNER: Architect/Engineer: Phone#:
Value of Work for this Permit: $ a1 . DO Square/Linear Footage of Work: etOD,
Type of Work OAddress OAlteration New ORepair/Replace ODemolition
Description of Work: ��t444(91/4 le
Submittal Fee $ Permit Fee $ X09 CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ - Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $
--So0. ok0
y
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
Owner or Agent L
The foregoing instrument was acknowledged before me this 1C2 The foregoing instrument was acknowledged before me this /6
day of * , 20 19; by Pt-'QGt. 9 n ,) , day of ,f e , 20 �..,by_/-i !�- Gk
who is personally Imo me or who has produced Nxbilsis kersonally known to me-or who-hag-produced ,_
As i, - cation and who did take an oath. as identifi ti i n and who did take an oath.
Signature
Contractor
* * * * * * * * * * * * * * * * * * * * * * * * **
APPROVED BY
NOTARY PUBLIC:
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/T-12-- Plans Examiner
Structural Review
(Revised3 /12/2012)(Revised 07 /10/07)(Revised 06 /10/2009)(Revised 3/15/09)
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Zoning
Clerk
2012 b�'T`IFICATE OF S E 2C
EXPi1RES S t a r 30, 2013.:'
UST. SE 'CI SPL+AYED AT`1 L1 CE OF BL I
E 1 SCRIPTIQN / RESTRICTION
AU GenrIBusiWhIsiRett Uses
sl n
ID= SEPTIC IN
19932 NW 2ND AVE.
11IAMt GARDENS, FL 33189
O r/Co rp. Name
M R CS PLUMBING AND SEPTIC INC.. MIC L CO ING
19932 NW 2ND AVE.
MIAMI GARDENS, FL 331.69 use as permitted within zone.
City a!`kliami Gardena. EnSuite 20if, i ilarr�t Gardens FL•33
Registered Septic Tank Contractor
SR0061536
KEMBLE G ETTRICK
19932 NW 2 AVENUE
MIAMI FL 33169-
MR. C'S PLUMBING & SEPTIC, INC.
Business Authorization: SA0121793
Registration Expires on September 30, 2013
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT PI1W D 5frfSL al t1
SYSTEM
CONSTRUCTION PERMIT
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT:
Andrea Minski
PERMIT #: 13 -SC- 1434359
APPLICATION #: API085501
DATE PAID:
FEE PAID:
RECEIPT #:
DOCUMENT #: PR887170
PROPERTY ADDRESS: 9969 NE 4 Ave 14 Miami, FL 33138
LOT: 12
BLOCK: 96 SUBDIVISION:
PROPERTY ID #: 11- 3206 -017 -1230
[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 [ 1,050 ] GALLONS / GPD Septic 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 HRH #Pumps [ l
D [ 400 ] SQUARE FEET bed configuration drainfile SYSTEM
R ( 0 ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [x] STANDARD [ ] FILLED [ ] MOUND [ ]
I CONFIGURATION: [ ] TRENCH [x] BED [ ]
N
F LOCATION OF BENCHMARK: F.F.E., 13.30' NGVD
I ELEVATION OF PROPOSED SYSTEM SITE [ 48.00 ] 1 INCHES I FT ] [ ABOVE A BELOW b BENCHMARK /REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 78.00][ INCHES I FT ][ ABOVE 4BELOWbBENCHMARK /REFERENCE POINT
D FILL REQUIRED:
0
T
H
E
R
[ 0.00 ] INCHES
EXCAVATION REQUIRED: [ 42.00] INCHES
*Invert elevation of drainfield to be no less than 7.30 ft. NGVD.
*Bottom of drainfield elevation to be no less than 6.80 ft. NGVD.
*Install 12" of slightly limited soil under the bottom of the drainfield.
- Perimeter of excavation area shall be at least 2 ft wider and longer than the proposed absorption bed or drain trench.
-The system is sized for 4 of bedrooms with a maximum occupancy of 8 of persons (2 per bedroom), for a total
estimated sewage flow of 500 gpd.
"THIS PERMIT IS NOT FOR " ADDITION(s) ".
SPECIFICATIONS BY:
APPROVED BY:
DATE ISSUED:
Carlos M Icaza
Carlos M Iaaza
10/12/2012
TITLE:
TITLE:
Dade CHD
EXPIRATION DATE: 01/10/2013
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E- 6.003, FAC
v 1.1.4 AP1085501 SE880855
Page 1 of 3
NOTICE OF RIGHTS
A party whose substantial interest is affected by this order may petition for an
administrative hearing pursuant to sections 120.569 and 120.57, Florida Statutes. Such
proceedings are governed by Rule 28 -106, Florida Administrative Code. A petition for
administrative hearing must be in writing and must be received by the Agency Clerk for the
Department, within twenty -one (21) days from the receipt of this order. The address of the
Agency Clerk is 4052 Bald Cypress Way, BIN # A02, Tallahassee, Florida 32399 -1703. The
Agency Clerk's facsimile number is 850 -410 -1448.
Mediation is not available as an altemative remedy.
Your failure to submit a petition for hearing within 21 days from receipt of this order
will constitute a waiver of your right to an administrative hearing, and this order shall become
a 'final order'.
Should this order become a final order, a party who is adversely affected by it is
entitled to judicial review pursuant to Section 120.68, Florida Statutes. Review proceedings
are governed by the Florida Rules of Appellate Procedure. Such proceedings may be
commenced by filing one copy of a Notice of Appeal with the Agency Clerk of the
Department of Health and a second copy, accompanied by the filing fees required by law,
with the Court of Appeal in the appropriate District Court. The notice must be filed within 30
days of rendition of the final order.