PL-13-1672 Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-195926 Permit Number: PL-7-13-1672
Scheduled Inspection Date: August 29,2013 Permit Type: Plumbing - Residential
Inspector: Diaz,Osvaldo
Inspection Type: Final
Owner: CUSTIN, RUBY Work Classification: Septic
Job Address: 1451 NE 102 Street
Miami Shores, FL Phone Number
Parcel Number 1132050240160
Project: <NONE>
Contractor: A AARON SUPER ROOTER Phone:-305-944-8886
Building Department Comments
REPLACE SEPTIC TANK AND DRAINFIELD Infractio Passed Comments
INSPECTOR COMMENTS False
Inspector Comments
Passed HRS IN FILE
Failed
Correction ❑
Needed
Re-Inspection ❑
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid.
August 28,2013 For Inspections please call: (305)762-4949 Page 5 of 26
Miami Shores e
Villa ,p$
Village
L
Building Department _
90050 N.E.2nd Avenue,Miami Shores,Florida 33138
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.ez/ — 7
Permit Type: PLUMBING
JOB ADDRESS: IL"G 1 ME (®a S- r e e-f"
City: Miami Shores County: Miami Dade Zip. 3 312W
Folio/Parcel#: I t > 3 20 S 2-q-- 0 160
Is the Building Historically Designated:Yes NO X Flood Zone:
OWNER:Name(Fee Simple Titleholder): W ,k t` 0 rn Moo rt Phone#:
Address: 1451 fl�1Na 1 02 St
City: Miami s h o d'e s State: F L Zip: 38
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: AQ ron ho-e#: 3.0 51 Lf Lf 086
Address: _ ®�� s
City: lY Gt r+\o, State: Zip;
Qualifier Name: k n Phone#:
State Certification or Registration#: Certificate of Competency#:
Contact Phone#: Email Address:
DESIGNER:Architect/Engineer: Phone#:
Value of Work for this Permit:$ 2� t Square/Linear gF��ootage of Work: S�)
Type of Work: ❑Address OAlteration gg ONew ARepair/Replace. ODemolition
Description of Work: 1 C h o c;
Submittal Fee$ Permit Fee$ CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Bond$
Notary$ Training/Education Fee$ Technology Fee$
Double Fee$ Structural Review$
r
TOTAL FEE NOW DUE$
a
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$2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law hure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of co a cement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. n t e absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
d`/ Q
s 4
AS ignature Signature
Owner or Agent Contractor
The foregoing instrument was acknowledged before me this-1--� The foregoin instrument was acknowledged before me this
day of y >20 105,by W I I iA M®ore day of 3V Li 20 L`3,by 5011N-V
who is personally known to me or who has produced �Y t� who is personally known tome or who has produced ®Yt
U1 CV_d'e' As identification and who did take an oath. L_`CJe-\k'- as identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: Sign: r _ .
(`
Print: (lea-Psc �o ro-r X.0s Print: C��SG� �J ���''�.0`1
My Commission Expires: My "' lon 1 A
SOLOMON
'= MY COMMISSION#EE131035
M,, EXPIRES Novemtwr 0
* MY COMMISSION#EE13
teiY9ervks.con,
APPROVE EXPIRES NOvemb$r 0"' Plans Examiner Zoning
3""153 Flcidamote
Structural Review Clerk
(Revised3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)
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Address:
This Instrument Prepared by:
Wayne H.Rassner,Esquire
7700 North Kendall Drive,Suite 509
Miami,Florida 33156
Folio Number. 11-3205-024-0160 ------
~~~� SPACE ABOVE THIS LINE FOR PROCESSING DATA
This Warranty Deed made the
day of June, A.D. 2013, by RUBY 1. CUSTIN, a single woman,'
hereinafter called the grantor,to WILLIAM MOORE,a married man,whose postoffice address is: 1451 NE 102 Street,
Miami Shores, FL 33138-2621, hereinafter called the grantee:
(Wherever used herein the terms"grantor"and"grantee"include all the parties to this instrument and the
heirs,legal representatives and assigns of individuals,and the successors and assigns of corporation)
Witne$Seth: That the grantor,for and inconsideration of the sum of$10.00 and other valuable consideration
receipt whereof is hereby acknowledged,hereby grants,bargains,sells,aliens,remises,releases,conveys and confirms
unto the grantee, all that certain land situate in Miami-[lade County, Florida,viz:
Lot 20,Block 1,Replat of Tract A,Miami Shares Bay Park Estates,according to the plat thereof
as recorded in Plat Book 56, Page(s) 86,Public Records of Miami-Dade County,Florida.
SUBJECT TO: Conditions;restrictions,easements and limitations of records, if any,and not meant to reimpose same.
SUBJECT TO: faxes for the year 2013 and subsequent years.
Together with all the tenements,hereditaments and appurtenances thereto belonging or in anywise appertaining.
To Have and to Hold, the same in fee simple forever.
And the grantor hereby covenants with said grantee that the grantor is{awfully seized of said land in fee simple;that
the grantor has good right and lawful authority to sell and convey said land;that the grantor hereby fully warrants the title
to said land and will defend the same against the lawful claims of all persons whomsoever, and that said land is free of
all encumbrances,except taxes accruing subsequent to December 31,2012.
In Witness Whereof, the said grantor has signed and sealed .h a presents the day and year first above
written.
Signed, sealed and delivered in our presence:
0
UBY I.. TIN
(Print): Addre
Avemuya PL, 331W
(Print)
STATE OF FLORIDA
COUNTY OF MIAMI-DADE
I HEREBY CERTIFY that on this day, before rile;an officer duly authorized in the State aforesaid.and
in the County afores 'd, to take acknowledgments, personally appeared RUBY I CUSTIN, identified by
}�3d V10 and is to me known to be the person described in and who executed the
fortgoing instrAlment and she acknowledged before me that she executed the same and that she did take an
oath.
WITNESS my hand and seal in the County and State last aforesaid this day of June, A.D.2013.
Ply n` I
'F®� th�'.1'with all the tenements, hereditatnents and a
To Have and to -Hold, the same in fee sim'- I appurtenances thereto belonging or in anywise appertaining,
p e forever.
And the grantor hereby covenants with said grantee that the grantor is la
the grantor has good right and lawful authority to sell and convey said l
to said land and will defend the same against the lawful wfully seized of said land in fee simple;that
Y and;that the grantor hereby fully warrants the title
all encumbrances, except taxes accruing subsequent to December 31 201
claims of all persons whomsoever;and that said land is.free of
I°� Witness VI/here®f, the said grantor has signed a 2
written. g and sealed a presents the day and year first above
Signed sealed and delivered in our presence:
(print): UBY I. TIN
Addres , z'�5 ®1/�
ieq 5V,; 4Vl.;i 09
(Print) Avbwura, n,. 3 ttoz�
:
0
STATE OF FLORIDA
COUNTY OF MIAMI-DADE
I HEREBY CERTIFY that on this day, before me, an officer
in the County afores °d, to take acknowledgments, duly authorized in the State aforesaid and
rtv 9 , personal) a °
and is to me known to be the person eared bed)in and who a identified d e
fo going instrt nt and she acknowledged before m
oath. a that she executed the same and that she did take an
WITNESS my hand and seal in the County and State last
Notary Stamp: aforesaid thi day of June, A.D.2013.
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heft. aF e�+ NOTA LI TATE OF FLORIDA
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1WATE a FLORI
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DEPARTMENT OF. HEALTH
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTPUCTION PERMIT
PenTift Applicat',on Nunes e
--————————————————I PART 11 -SITE PLAN--——————
VP block represents 5 feet and I inch 50 feet.
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Site Plan submitted by: 41 ) C.
Signature TUa___
Plao Approved V/ Not Approved Date. '
By---- —7 117 40 County Health Deparnt
ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
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TMENT OF HEALTH
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Scaie: Each block . ' h 50 feet:
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Sett Plan submitted by
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t d Not Approved Date
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Gaunt/ Heafth Departme
ALL CHA GES,:MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
ikt 4 0-5,'tXdr95.'r ewaima HAS-i4.1:w F 4o i a which rtaay ba usad)
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PERMIT #: 13-SC-1484511
APPLICATION #':AP1114214
STATE OF FLORIDA
DEPARTMENT OF HEALTH DATE PAID
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM FEE PAID:
CONSTRUCTION PERMIT
RECEIPT #•
�l
DOCUMENT #T R911937
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: Ruby Custin
PROPERTY ADDRESS: 1451 NE 102 St Miami, FL 33138
LOT: 20 BLOCK: 1 SUBDIVISION: Miami Shores Day Park Estates
PROPERTY ID #: 11-3205-024-0160 [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 HRS #Pumps [ ]
D [ 300 ] SQUARE FEET in trench configuration SYSTEM
R [ 0 ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [X] STANDARD [ ] FILLED [ ] MOUND [ ]
I CONFIGURATION: [X] TRENCH [ ] BED [ ]
N
F LOCATION OF BENCHMARK: FFE:8.60'ngyd
I ELEVATION OF PROPOSED SYSTEM SITE [ 26.40 ] [ INCHE3 FT I ABOVE BELOW BENCHMhRK/REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 60.40 ] [FINCHES FT ] [ABOVE BELOW BENCHE�,RIC/REFERENCE POINT
L
D FILL REQUIRED: [ 0.00] INCHES EXCAVATION REQUIRED: [ 34.00 ] INCHES
The system is sized for 4 bedrooms with a maximum occupancy of 8 persons(2 per bedroom),for a total estimated flow
0 of 400 gpd.
The contractor(or drs''gre;;) is, gpir.-d to paiform a
T -Install 1050 g septic tank. sail t)oring adjacent;.o ate�-' ,ainfiald exravation at the
-Install 300 sq ft drainfield in trench configuration. time 0 final insreraion.Prior to Final Pppraval,the DOt
H -Elevation of bottom of drainfield to be no less than 3.56'NGVD. inspector vnritj,�a tb�soil boring and compare the
E -Not for additions resa!t8 A
reinspeF More tt.r m6 b,� c set li rite contractor is not
R at the jobsite at liis arranoau` time.
SPECIFICATIONS BY: JO J TITLE:
APPROVED BY: ITLE: Engineer Specialist II Dade CHD
h R Plv--
DATE ISSUED: 7/ EXPIRATION DATE: 10/15/2013
DH 4016, 08/09 (ObiVetes all previous editions which may not be used)
Incorporated: 64E-6.003, FAC Page 1 of 3
V 1.1.4 AP1114214 SE9036i5