PLC-13-2164 Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-199822 Permit Number: PLC-9-13-2164
Scheduled Inspection Date: October 16, 2013 Permit Type: Plumbing - Commercial
Inspector: Diaz, Osvaldo
Inspection Type: Final
Owner: , BARRY UNIVERSITY Work Classification: Drainfield
Job Address:64 NW 111 Street
Miami Shores, FL 33168- Phone Number
Parcel Number 1121360030380
Project: <NONE>
Contractor: SR0061536 MR C'S PLUMBING&SEPTIC INC Phone: (305)651-7859
Building Department Comments
INSTALLATION OF DRIANFIELD Infractio Passed Comments
INSPECTOR COMMENTS False
09/30/2013- BOND WAS POSTED BY CONTRACTOR
MR.C'S AND SHOULD BE RETURN TO SUCH.
Inspector Comments
Passed S 0 3 -1 ri-W
Failed
Correction ❑
Needed
Re-Inspection ❑
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid.
October 15,2013 For Inspections please call: (305)7624949 Page 23 of 48
1 Miami Shores Village
Building Department
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 ;EP 2 4 2013
Tel:(305)795.2204 Fax:(305)756.8972
INSPECTION'S PHONE NUMBER:(305)762.4949
FBC 20
BUILDING Permit No.
PERMIT APPLICATION Master Permit No. ^ ,
Permit Type:PLUMBING
JOB ADDRESS: 64- JjW 1 `1 5+
City: Miami Shores County: Miami Dade Zip: 9 3 1.6 1
Folio/Parcel#: 11 - qt U. C013-- ®3go
Is the Building Historically Designated:Yes NO d-- Flood Zone:
OWNER:Name(Fee Simple Titleholder): rs'y n;wec-Se` -i T1C. Phone#: W6 red a-t cf-
Address: It 160 W: a 1
City: Nei c-,- S *ee State: T:�t - Zip: 23 141
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name:�I�!r- L't, Plu.6,,,. 5 Sr Phone#: 36(-19.57 7�5
Address: 1'iI a 00 a,..k &VC-
City: State: f -- Zip: 33 6 Pi
Qualifier Name: <P.—b1f_ °FAe-�CL Phone#:
State Certification or Registration#: 51Z 661!9-36 Certificate of Competency#:
Contact Phone#: Email Address:
DESIGNER:Architect/Engineer: Phone#:
Value of Work for this Permit:$ Sa a 0 . ®d Square/Linear Footage of Work: ®�
Type of Work: ❑Address ❑Alteration ONew #(Repair/Replace ODemolition
Description of Work:._
Submittal Fee$ Permit Fee$ �� CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Bond$
Notary$ Training/Education Fee$ Technology Fee$
Double Fee$ Structural Review$
TOTAL FEE NOW DUE$
0® •OJ)
l
-0 • f u
Bonding Company's Name(if applicable)
Bonding Company's Address
City I 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 jurisdictiotL I understand that a separate permit must be secured for ELECTRICAL WORK,PLUMBING,SIGNS,
WELLS,POOLS,FURNACE$„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 taw 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 reinspection fee will be charged.
Signature Signature
Owner or Agent Contractor
The foregoing instrument was acknowledged before me this i3 The foregoing instrument was acknowledged before me this.
day of ._,2013,by Wt-M-6 day of S TlW& ,204? by � T
who is personally known o�me or who has produced �w o is personally known tom or who has produced
As identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: Sign:
Print: Print: L, iq
M E d �� My Commis es:No*#V pubk State of Fbfide
Namobv 1%x014 Shauyrl A Mend88
E12�raD " a MY C"n*410n EE017513
ar EXO"10/2312014
oaaaaaa�aa�xx�aaaxaaaa���aa�*aa�m�w�x�����*�a�aa�����a���ao�a�aaaa��a�aa �,� o �*o
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised3/1=012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)
R E P A I R PIC.,
PERMIT #:13-SC-1493516
WAWOADE COUNTY HEWH DE AP�iICATI :AP1119441
STATE OF FLORIDA DATE PAID:
DEPARTMENT OF HEALTH
ONSITE SEWAG TREATMENT AND DISPOSAL SYSTEM FEE PAID:
CONSTRUCTION PERMIT RECEIPT #:
DOCUMENT #:PR916368
CONSTRUCTION PERMIT FOR: OST DS Repair j E P 2 4 2013
APPLICANT: (Bang Universidy)
PROPERTY ADDRESS: 64 NW 111 St Miami,FL 33161 -
LOT: 6 BLOCK: 220 sUBDIVIsION: Miami Shores Ext
ISECTION, TOWSHIP, RANGE, PARCEL NUMBER)
PROPERTY ID #: 11-2186-003-0380 IOR TAX ID NUMBER]
SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF SECTION
381.0065, F.S., AMID CHAPTER 699-6, F.A.C. DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE
SATISFACTORY PERV0j0q= 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 =20T THE APPLICANT FROM C06PLIAMM WITH OTHER FEDERAL,
STATE, OR LOCAL PERMITTING REQUIRED FOR DEVELOPMENT OF THIS PROPERTY.
SYSTEM DESIGN AND SPECIFICATIONS
T [ g00 I GALLONS / GPD existinA septic tank CAPACITY
A [ 0 1 GALLONS / GPb CAPACITY
N C 0 ] GALLONS GREASE INTERCEPTOR CAPACITY IMAXIMUK CAPACITY SINGLE TAM-1250 GALLONS]
K [ 1 GALLONS DOSING TANK CAPACITY E ]GALLONS SI ]DOSES PER 29 HRS #Pumps E ]
D [ 300 ) SQUARE FEET BW configuration drainfiel SYSTEM
R I 0 1 SQUARE FEET SYSTEM
A TYPE SYSTEM: Ex] STANDARD E I FILLED E i MOUND E 1
I CONFIGURATION: E I TRENCH Ix] BED I I
N
F LOCATION OF BENCHMARK: FFE 12.8*NGV[D
I ELEVATY�1 OF PROPOSED SYSTEM SITE E 26.80] IATCH9$ FT ]C ABOVE BEL{?W BENCHMARK/REFERBNGE POINT
E BOTTOM OF DUAINFIELD TO BE E 68.80]f INCHES FT I E ABOVE BENCHMARK/REFEREDiCE POINT
L
D FILL REQUIRED: E 0.001 INCHES EXCAVATION REQUIRED: E 52.001 INCHES
1.-Existing 900 gal.septic tank,certified by Mr.as PLumbing&Septic on 09/0412013,to remain.
O 2.4nstall 300 sf of drainfield in bed configuration.
T 3.-Install 12"of slightly limited soil at the bottom of the drainfield.
4.-Perimeter of excavation area shall be at least 2 ft wider and longer than the proposed absorption bed or drain trench.
H 5.-Invert elevation of drainfield to be no less than 7.5T NGVID.
E
6.-Bottom of drainfi+sld elevation to be no less than TOT NGVED.
System sized for 3 bedrooms with a max occupancy of 6 persons(2 per bedroom),for a total est.flow of 300gpd.
R
SPECIFICATIONS BY: Betsy Lange TIC Engineering Specialist: II
APPROVED BY: TITLE: ��''v�3 1 i` � IQ1I� Dade cm
DATE ISSUED: 09/10/2013 EXPIRATION DATE: 12/09/2013
DH 9016, 08/09 (Obsoletes all previous editions which may not be used) page 1 of 3
Incorporated.: 699-6.003, FAC gg
v AP1119441 srs� U?iV"�. l:%df yd}§'S "€'�F1' ) ;�reUbrl YUr#l�rfCi
swI boring 06i'x ent tt
t31 1:t`f r Rt.^? Eran. 7i(}r�Ci 41':�I 4'D" 'dal,the0ti
Sdlali 3t u 2P�8 .i boo, 'i dhd Compare the
r ausi5 to ter: ra t oil - Tt,G;Oi! :lbrritted,.A{
.43fi'tPuttof 15 n
iii''.'j"•'arlilll ..�
NOTICE OF RIGHTS
A'patty 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.