PL-12-2143Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 181493 Permit Number: PL -11 -12 -2143
Scheduled Inspection Date: April 15, 2013
Inspector: Hernandez, Rafael
Owner: ALBERTSON, KATHLEEN
Job Address: 730 NE 94 Street
Miami Shores, FL
Project: <NONE>
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Septic
Phone Number
Parcel Number 1132060141690
Contractor: SR0061536 MR C'S PLUMBING & SEPTIC INC Phone: (305)651 -7859
Building Department Comments
DRAINFIELD ONLY
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
HRS IN FILE
April 12, 2013
For Inspections please call: (305)7624949
Page 5 of 38
APR. 11.2013 :10, 29A 'TERN()) (Obl """+, i{
BTATR CTS FWRXDA
DE] NT OF HEALTH .
ONSXT]E 9zwAas =AMMO AND DTsPo$AL .> TETEM
CoNOat1CTYoN IN$P3CTzoN AND J?TNAL .5211 OW L
A LLcatT: Kothiesn Albertson
Amax Mr O"8
nom= A505555:
Win an
31
S_BD szoi a 1 1—# 413.:6 q'
730 Nt; 94 St Miami. FL 331313
Uraaat
NO.+�
P.
..r
ApsTaCATzoi * :, Pf087171,
5551dTT 5:13 -SC- 1437443
a:F1892321 ��...
razz mum :11/20/2012
mAm :05.00
=Er 4.13 -P 1 D- 206184 1
3
3
}
1
3
J
3
1
3
1 1
1 3
1 3
1 7
1 3
TARN INSTULDDICH
[013 OM s (1) 900,00 123
1021. TAM 3047213324 Cpqefete
;[081 OUTLET DEvics
1041 MTx ...
1053 aT x IL
Mel Warm t 04011.04
1073 114mAtaget
1063 Trot,
10:01 MU TO LTD
DWAx55=10 atsuskiaTrOtt
[
[103
1341
1121
1143
[151:
[x.61
[17]
tie)
1193
1203.
[213
° (13 240 131.._._,_ ss
020525.0,220N 50x 500ER X.
Matta OPDRAZIttrta$
D14314412.48 83.23100103
radittunt5 SLOP2
DEP1H O PNATIt
ELEVAMICAt [ QVE
lxsT2ts
1EG MOS
1- AZ a
1>8K 31.92
VeREGAtt =nem Mrs.
ADORE= DZIPTEl
lf']k'iCil.. / Exekv323Q
[22] 533T, AT'
1231 24233.
t243 82=03DIDIT 03
12251 ARIA EOM=
1251 A T
Co ola9? Catableithl aro ,on page 2.
tort t"
NIVIAZ
SEMM
[273
1281
[291
1303
(31)
[32]
[331"
1243
[3433
i* 1i
PM= ms's
SRRIVAIICON s
IPODynE WADED
311m0IND Eot738232zONs
PROMS! Tams
01IDER
FT
8T
10 >�'r
12 VD
MUSD / SUM
[361 08338313870 DOYDR
[371 ETIOULIVA$
.13:8] SUMS
1392 stava xaxx tar
ZOODZIONAZ,
Vt03 taValS A
[411 sToraciA SR.:RD 7
(421 ALARMS
[431tT
1441 3vasas5 A
[451 LOCI-2703r =FM= WITH MS MOT
14e =Was sip
[47]. CoNizaaairOR $ (Mr. C"a Pitnwing &Sept
Re/ 012
A
E 1 1461 !. .
1 1301 max cat,
DISAPPROVED ]'
Y 8619 ixYnlv isni{roNlf9lftel
D23NPPROVED j
CsIgannatiaa at natal:Law on tellaaian ,ma)
DR 4016; 08/09 [Dbaaletes all proy10 as Editions which may mot be used)
iacezparated,; 642- 6.003, >l
t Datr atse v 1.0.1 Afte$ 47T Rldi
11 •` 012
Pagel 2 at 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
PERMIT APPLICATION
VED
NOV 13 2012
FBC 20 t°
Permit No. R--I 2 —2.1
Master Permit No.
Permit Type: PLUMBING
JOB ADDRESS: '730 AJ,M(141
City: Miami Shores County: Miami Dade Zip: 3 3/ 3e
Folio/Parcel #:
Is the Building Historically Designated: Yes NO Flood Zone:
OWNER: Name (Fee Simple Titleholder): 1(L' Ill /eeit )f e.f't ort Phone #: 7a 7 �'S3 7
Address: -730 i\)& eic� c+""
City: 1 Gl..•.. -t State: -t---7-- Zip: '3 g 13 Fr
Tenant/Lessee Name: Phone #:
Email:
CONTRACTOR: Company Name: 1/1r C 13 -P -�`j ) r� . Phone#: T t' r6 5? 7.oi ss"
Address: f4{ , n / `?3 a. Il '() 02l'°' a e
City: CIt 4—i State: fa-- Zip: 33/61
��//
Qualifier Name: T\ k E f Gk._ Phone #: q S'/ 7.�'
State Certification or Registration #: 512 N 1 5,3) Certificate of Competency #:
Contact Phone #: Email Address:
DESIGNER: Architect/Engineer: Phone #:
Value of Work for this Permit: $ 00 Square/Linear Footage of Work: 3 06
Type of Work: DAddress /nt DAlteration DNew eiRepair/Replace ❑Demolition
Description of Work: V rkk �Zo S!"
***************************************Fees* *********** * * * * * * * * *** * * **** * * * * * * * * * * * + **
Submittal Fee $ Permit Fee $ `r° 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 Ali IUAVIT: 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 com ' 'nce t must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. n the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature
4::/rA.-.,.....-
Owner or Agent
The foregoing instrument was acknowledged before me this 1
(� K P6
day of V , 20 �%by
3
Signature
Contractor
The foregoing instrument was acknowledged before me this 13
2�'i� 5 , day of t) t t i6 L , 20 Li, by
,tln.,
who is personallyown to me or who has produced Gho is personally known to me r who has produced
As identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC:
NOTARY PUBL
•
Sign: ')
Print:
My Commission Expire
::01°�Y Wit,. KEMBLE ETTRIC
MY COMMISSION # D0 891340
_= EXPIRES: September 14, 2013
Bonded Thru Notary Public Underwriters
****************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
APPROVED BY
Plans Examiner
Structural Review
(Revised3 /12/2012)(Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09)
Sign:
Print:
*
fit
• pP's:
N Public Stated Floes
Sheryl A Menders
My Canmtwater+ EE017513
a 10,23ia014
* * * * * * * * * * **
Zoning
Clerk
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION PERMIT
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: Kethleen Albertson
PERMIT # :13 -SC- 1437443
APPLICATION #:AP1087171
DATE PAID:
FEE PAID:
RECEIPT #:
DOCUMENT #: PR888518
PROPERTY ADDRESS: 730 NE 94 St Miami, FL 33138
LOT: 1213
BLOCK: 65 SUBDIVISION:
PROPERTY ID #: 11- 3206 - 014 -1690
[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 [ 900 3 GALLONS / GPD Septic eXiStinq CAPACITY
A[ 0 3 GALLONS / GPD CAPACITY
N [ 0 l GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS 81 ]DOSES PER 24 HRS #Pumps [ ]
D [ 300 ] SQUARE FEET SYSTEM
R [ 0 ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [x] STANDARD [ ] FILLED [ ] MOUND [ ]
I CONFIGURATION: [ ] TRENCH [x] BED [ 3
N
F LOCATION OF BENCHMARK: FFE: 10.10'NGVD
I ELEVATION OF PROPOSED SYSTEM SITE [ 9.60 ] [1 INCHES I FT ] [ABOVE/) BELOW I BENCHMARK /REFERENCE POINT
[ 39.60 ] [) INCHES f FT ] [ ABOVE 4 BELOW b BENCHMARK /REFERENCE POINT
[
E BOTTOM OF DRAINFIELD TO BE
L
D FILL REQUIRED:
0
T
H
E
0.00] INCHES EXCAVATION REQUIRED: [ 42.00] INCHES
- Install 300 sq ft drainfield.
- Install 12" of slightly limited soil under bottom of drainfield.
- Elevation of bottom of drainfield to be no less than 6.80' NGVD.
- Existing 900 g septic tank, to remain.
- The system is sized for 3 bedrooms with a maximum occupancy of 6 persons,
for a total estimated sewage flow of 300 g /d.
- Not for additions
R
SPECIFICATIONS BY:
APPROVED BY:
DATE ISSUED:
Kemb ick
TITLE:
Engineer Specialist II
DH 4016, 08/09 (Ob -`; ' etes all previous editions which may not be used)
Incorporated: 64 .f 6.003, FAC
v 1.1.4
Dade cND
EXPIRATION DATE: 01/28/2013
AP1087171 sE882054
Page 1 of 3
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION PERMIT
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: Kethleen Albertson
PERMIT #:13 -SC- 1437443
APPLICATION # : AP 1087171
DATE PAID:
FEE PAID:
RECEIPT #:
DoctmeNT #: PR888518
PROPERTY ADDRESS: 730 NE 94 St Miami, FL 33138
LOT: 1213
BLOCK: 65 SUBDIVISION:
PROPERTY ID #: 11- 3206 - 014 -1690
[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 [ 900 ] GALLONS / GPD Septic existinq 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
R
A
I
N
F
I
E
L
D
0
T
H
E
R
SPECIFICATIONS BY:
APPROVED BY:
DATE ISSUED:
[ 300 ] SQUARE FEET SYSTEM
[ 0 ] SQUARE FEET SYSTEM
TYPE SYSTEM: [x] STANDARD [ ] FILLED [ ] MOUND [ ]
CONFIGURATION: [ ] TRENCH [x] BED [ 1
LOCATION OF BENCHMARK: FFE: 10.10'NGVD
ELEVATION OF PROPOSED SYSTEM SITE
BOTTOM OF DRAINFIELD TO BE
FILL REQUIRED:
[ 9.60 ] [l INCHES I FT ] [ ABOVE A BELOW Ji BENCHMARK /REFERENCE POINT
[ 39.60 ] 11 INCHES FT ] [ ABOVE 4 BELOW b BENCHMARK /REFERENCE POINT
[ 0.00] INCHES EXCAVATION REQUIRED: [ 42.003 INCHES
- 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 6.80' NGVD.
- Existing 900 g septic tank, to remain.
- The system is sized for 3 bedrooms with a maximum occupancy of 6 persons,
for a total estimated sewage flow of 300 g /d.
- Not for additions
TITLE:
TITLE: Engineer Specialist II
DH 4016, 08/09 (s soletes all previous editions which may not be used)
Incorporated: 64E- 6.003, FAC
v 1.1.4 AP1087171
Dade CHn
EXPIRATION DATE: 01/28/2013
SE882054
Page 1 of 3