PL-13-667Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 188566 Permit Number: PL -4 -13 -667
Scheduled Inspection Date: April 15, 2013
Inspector: Hernandez, Rafael
Owner: NEWBAUER, JEFFREY
Job Address: 70 NE 92 Street
Miami Shores, FL
Project: <NONE>
Contractor: SR0061536 MR C'S PLUMBING & SEPTIC INC
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Septic
Phone Number (305)799 -0885
Parcel Number 1132060130020
Phone: (305)651 -7859
Building Department Comments
INSTALL DRAINFIELD
Passed
Infractio Passed Comments
INSPECTOR COMMENTS
False
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
HRS IN FILE
April 12, 2013
For Inspections please call: (305)762 -4949
Page 16 of 38
'ZAMA INSTALLATION
[01] TANK $IZE [11.
1021 TAM MATERIAIJ
t ""7/ [03] OMIT DEVICE
t 1 041 1 T-
[ 1 1 (053 OUTLET mg=ER V
[ 1 [061 ILIDEND .ref f
[ , (071 WATENTI
t:::),0' ` :1081. LEVEL
[ . 033 Mimi T0 LID
MELD INSTALLATION
c /i [103 AREA [.13 121 1 sf
[ '1, 1117 DISTRIBUTION DOS .— HEADER
[ /. 1121 RIMER DR MAINLINES
t d , [131 DRAB SEPARATION a . %'
E,...4 [143 DRAINLINE SLOPE
14 [151 NTH DP COVE if ' if
[ 1163 =MIXON [A$r
[ - [171 SYSTEN LOCATXON =:...
[ 1 1181. DOSS G PUMPS
[ 1 [191 A, TE SIZE ,4/
[ 1 WI AOMEGATE EX SSIVZ VMS
[ ' 1 [21:1 AGGATN Domes ,%1!
F / EKCANATIOM NAZ
Lee 1221 FIB A M O U N T / f )
[' 1231 . FILL TTxruka
.r1`' 1241 EXCAVATION DEPTI
1 1251 AREA =RDA=
1 1 1261 EIMAMEENT KATEEXAL
KEPIANATION of VIOLATIONS / REM.
1 1
[
1
SETBACKS
t 1 1271 SURFACE WAT1gR
t 1 1261 DXT:m0 FT
[ 3 1291 PRIVATE WELLS IT
t 3 [30] PTBEaIC mr4iLs WELLS
t 1 . [311: IRRI ATION limajWt
[ 1321. POTABLE HATER. LINES
t - '" (3.31 3UILDINS FOUNDATION
t .•o 1341 PROPERTY LINES'
I [351 OTHER
FT
FILLED ./ MOW SI T=
t. 1 061 DRAINFIELD DOVER R
[371 HEOuLDEED ,77
[ 1 0381 g. vas
.3 E191 temaximarow
ADD c ONAL TNFOR`NATION
[ .% [461 UNQBSTRU A
[ .° [44 STDRMRA'R moo
1 [421 ALARMS:
[ 1 1431 MAINTENANCE A' _ .
[443' 3UIWTNG AREA
04_,051.
(451. LDCATI�1', WITH SITE PL?
- r [461 � SITE GRAD3C140
[ x [471 CommCTQR
i 3 [481 OTHE
A O NT
1 [491 TANK PUMPED
1 1501 Tax€. so' & FILLED J.,
1
CONSTRUCT
SAPPROVEDj
OBD DATE: ° O -j3
DATES
"mull SYSTYE LT-0 /Die:APPRO ) a
08/O$. (01)s- elates all previous edii
ra1eth 64E- 6.003, FAG .
on which may not be use}
Page 2 of 3
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
BUILDING
PERMIT APPLICATION
FBC 20 'O
Permit Type: PLUMBING
APR 0 fl13
Permit No. 3
Master Permit No.
OWNER: Name (Fee Simple Titleholder): k.Tocr RJP�.0 c)eJ' Phone #: %tazzar54
Address: 70 108 Ca 3•
City: filieutt. State: Z(. Zip: 33 13V
Tenant/Lessee Name: Phone #:
Email:
JOB ADDRESS: 10 a as 5�
City: Miami Shores
Folio/Parcel #: - saa, ,0(1 -(x)2O
County:
Miami Dade
Is the Building Historically Designated: Yes
NO Flood Zone:
CONTRACTOR: Company Name: i' LAS I I U w.� (N 5 S �t k � / Phone#: ; �5 ` 7� cf
Address: i ��3 a` fid �.� QW'� e P
City: t.ilw,,,i State: f1...- Zip: 33 (.f
Qualifier Name: 4j(,e. 614-,'a
State Certification or Registration #: Certificate of Competency #:
Contact Phone #: Email Address:
DESIGNER: Architect/Engineer: Phone#:
Phone#: 505 LS/ 7erf
Value of Work for this Permit: $ 2Ji IN • (N Square/Linear Footage of Work: 3 c
Type of Work: °Address °Altera``ti``on °New 0Repair/Replace °Demolition
Description of Work: �' 5 � Ne .i) OVAJA,i,,u9SK
*************+ x****+x*********+x**** ** **** Fees* **+x****+x**** ******** ** ********+x****+x*******
Submittal Fee e..) . Permit Fee $ /-3 C) • 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 S 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 FT.FCTRICAL 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 = e of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Owner or Agent
The foregoing instrument was acknowledged before me this 4
day of 49f; ( , 20 /3 , by
who is personally known to me or who has produced
As identification and who did take an oath.
My Commission E
* * * * * * * * * * * * * **
APPROVED BY ( 17614-13 Plans Examiner
KEMBLE ETTRICK
' MY COMMISSION # 00 891340 14, 2013
EXPIRES:
7' op BondedThu Notary Public Underwriters
Signature
Contractor
The foregoing instrument was acknowledged before me this
day of 4 /)./ , 20 13 by v
or Who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
My C
* * * * * * * * * * * * * * * * * * * * * * * * * * * **
Structural Review
(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09)
St."ofFla
Shheer'
orn mP1 EED116"
MY1G11311014
Zoning
Clerk
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION PERMIT
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: Jeffrey Newbaner
PERMIT #: 13-SC-1463973
APPLICATION #: AP1102638
DATE PAID:
FEE PAID:
RECEIPT #:
DOCUMENT #: PR901982
PROPERTY ADDRESS: 70 NE 92 St Miami, FL 33138
LOT: 4 5
BLOCK: 1 SUBDIVISION:
PROPERTY ID #: 11- 3206 -013 -0020
[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 Existing septic tank to remain CAPACITY
0 ] GALLONS / GPD CAPACITY
0 ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [
[
D [ 300 ] SQUARE FEET bed configuration drainfile SYSTEM
R [ 0 ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [x] STANDARD [ ] FILLED [ ] MOUND [ ]
I CONFIGURATION: [ ] TRENCH [g] BED [ 1
N
F LOCATION OF BENCHMARK: F.F.E., 12.80' NGVD
I ELEVATION OF PROPOSED SYSTEM SITE
E BOTTOM OF DRAINFIELD TO BE
L
D FILL REQUIRED:
0
T
H
E
R
0.00] INCHES
[ 31.20 ] tJ INCHES i FT ] [ ABOVE a BELOW l] BENCHMARK /REFERENCE POINT
[ 59.20 1 [I INCHES I FT ] [ ABOVE 4 BELOW b BENCHMARK /REFERENCE POINT
EXCAVATION REQUIRED: [ 40.00] INCHES
*Invert elevation of drainfield to be no less than 8.36 ft. NGVD.
*Bottom of drainfield elevation to be no less than 7.86 ft. NGVD.
*Install 12" of slightly limited soil under the bottom of the drainfield. TIM EMIT 73 NOT FOR i 5r1 s5(2)
- 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 XX bedrooms with a maximum occupancy of XX persons (2 per bedroom), for a total estimated
sewage flow of XX gpd.
-The licensed contractor installing the system is responsible for installing the minimum category of tank in accordance
SPECIFICATIONS BY:
APPROVED BY:
Carlos
car 'a°)' -- aaza
DATE ISSUED: 04/02/201
TITLE:
DH 4016, 08/09 (ObsQle e e Gnee}1$ i � Y r % 9 e p Mine
Incorpora 0[1fti4 - e�
oring djec,e tt Ih ' ainfleld n�fexcavtiont at DOH
time of final inspection. Prior 15FFAPP a
inspector shall witness the soil boring and compare the
results to the original site evaluation submitted. A
reinspection fee will be assessed if the contractor is not
at the jobsite at the arranged time.
TITLE:
which may not be used)
Dade CHD
EXPIRATION DATE: 07/01/2013
A21102630 S &894519
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 alternative 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.
� inmiumomiminnuuniiainoun
iicgionlittiogieltEn.kr
Stephan L. Cohen
Attorney at Law
Old Flaaisha. Tide Campos,
20801 Biscayne Boaieward Suite 400
AveNurs, FL 33180
305 - 7921717
Mile Rumba: 134115
Will Call No.:
CFH 20138021.8829
OR 8k 28541 Pss 4067 - 4068; (lass)
RECORDED 03/21/2013 11s38;19
DEED DOC TAX 2,520.00
HARVEY RUUIH, CLERK OF COURT
MIAMI -DADE COUNTY, FLORIDA
Parcel Identification No. 11-3206413-N20
Poore AboK'fU Line FarrRamWksDafai
Warranty Deed
tsrATu[UatYFORM -S i689.o2jSj
This Indentaaare made this I day of March, 2013 between Lain Adam. Frederica t&1a Labs A. De Mega
Frederica, a siaaale a sea whose past office address is do Omar Rey CPA, 1400 Lisa ek Reed, 0594, Miami Beach, FL
33139 of the County of Miami -Dole, State of Florida, eta*, and Jeffrey Adams Newhaner and Wen BNta
New6aaaer, husband and wife whose post office address is 70 NE Mad Street, Mead Shores, FL 33130 ofthe County of
All, -Dade, State of Florida, grantee *,
RliDestieth that said grantor, for and in consideration of sum of TEN AND NO/100 DOLLARS (510.00) and other
good and valuable cam to said grantor in hand paid by said grantee, the receipt wheaeof is hereby
has Scanted, barged, and sold to the said grantee, and grantee's heirs and assigns forever, the fallowing desaaibed land,
lying and bring in Miand -Dade County, Merida, to-wk
Lot 4 and the East 112 of Let 5, Block 1, AMENDED PLAT OF MIAMI SHORES, SECTION No.1,
according to the saran ar pint thereof as recorded in Plait Book 10, Page 70, Pie Records of Miami -
Dade County, Fleriiia.
Subject to taxes for 2013 and subsequent young cam, conditions, restrictions, easrsnents,
reservations and Radtedons of record, if any
and said grants does hereby fully warrant the title to said land, and will defend the samm against lawful claims of all
pasons
*Ilmthemdllmmbemmusaiwaq0brarplundomminitanquins.
OmrWrTimes
Book28541/Page4067 CFN #20130218829 Page 1 of 2