PL-13-2716r
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 203914 Permit Number: PL -12 -13 -2716
Scheduled Inspection Date: January 08, 2014 Permit Type: Plumbing - Residential
Inspector: Diaz, Osvaldo
Inspection Type: Final
Owner: GURNEY, EDWARD Work Classification: Drainfeld
Job Address: 130 NW 111 Street
Miami Shores, FL Phone Number (305)757 -9804
Parcel Number 1121360030430
Project: <NONE>
Contractor: MR C'S PLUMBING & SEPTIC INC Phone: (305)651 -7859
suuamg ueparmtent comments
REPLACE 300 SF DRAINFIELD
INSPECTOR COMMENTS False
Inspector Comments
Passed 12 HRS IN FILE
Failed
Correction
Needed ❑
Re- Inspection ❑
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
January 07, 2014 For Inspections please call: (305)762 -4949 Page 14 of 27
444N� DIVISION OF
Environmental Health
ad�o Florida Department of Health '�
b* County Health Department ��
�Q OSTDS/Well Division MS
11805 SW 26 St. • Miami, FL 33175 %0
Inspector 7>S e t e. r Date _ 12 Z f 1 /1-3
Address 13 N 6 I c 3,-4Z OSTDS # I l 2-44 7 C
-2�I�
f %
Miami Shores Village
Building Department
900$0 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
Permit Type: PLUMBING
FBC 20
DEC 0 3 200
Permit No.
Master Permit Nn. R1 `J — 2 % l 6
JOB ADDRESS: 130 NW 111 Street
City: _ Miami Shores County: Miami Dade Zip; 33168
Folio/Parcel #: 11- 2136- 003 -0430
Is the Building Historically Designated: Yes
NO x Flood Zone:
OWNER: Name (Fee Simple Titleholder): Edward Gumey phone#.: 305 - 331 -8946
Address: 130 NW 111 St.
City: Miami State. Fl. Zip: 33168
Tenant/Lessee Name: Phone #:
Email:
CONTRACTOR: Company Name: Mr. Cs Plumbing & Septic Inc Phone #: 305 - 651 -7859
Address. 19932 NW 2 Ave.
City: Miami State. Fl. Zip: 33169
Qualifier Name: Kemble Ettrick phone#: 305- 651 -7859
State Certification or Registration #: SR061536 Certificate of Competency #:
Contact Phone# Email Address:
DESIGNER: Architect/Engineer.. Phone#:
Value of Work for this permit: $ 2000.00 Square/Linear Footage of Work: 300
Type of Work: ®Address ®Alteration ®New ®Repair /Replace ®Demolition
Description of Work. Replace 300sf Drainfield
Submittal Fee $ , Permit Fee $ CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
Technology Fee $
TOTAL FEE NOW DUE $ '�
4- OP-0 -
Bonding Company's Naive (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
State
Zip
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 $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered'to the person
whose property is subject to attachment Also, a certified copy of the recorded notice of commencement must be pasted at the job site
'for the first inspection which occurs .seven (7) days after the building permit is issued In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signatuee dti�" i�«
Owner or Agent
The foregoing instrument was ac ledged befo me this
day of ��� , 201 9� by�� 4
who is personally known to me or who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
Contractor
The foregoiinng instrument was acknowle ged before me this
day of
J�C� . 20 �, by JZ Ca �° 1 fiyL
who is personally known to me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
MY 014'wn WA RES May 18, 2015
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised3/12/2012)(Revised 07 /10107)(Revised 06110t2009)(Revised 3/15/()9)
APPLICANT: Edward Gurney
PROPERTY ADDRESS: 130 NW 111 St Miami, FL 33168
LOT: 11 RLOCK: 220
StaWxw$ION: Hami Shores Ext
PERMIT #:13- SC4507 576
APPLICATION #: AN 127476
16� !km
PER PAID:
PROPERTY XD t: 1121364X)3-0430 [SECTION, TOWNSHIP, RANCH, PARCEL WMERRI
[OR TAX ID ]
SYSTEM MUST BE CONSTRUCT=
IN ACC WITH SPECIFICATIONS
AND STANDBIMS
OF SECTION
381.0065, F.S., AND CHAPTER
64E -6, F.A.C. DEPARTMENT APPROVAL OF
SYSTlW DOES
NOT GUARANTEE
SATISFACTORY PERFORMANCE FOR ANY SPECIFIC PERIOD OF TIME. ANY
CHANGE IN MATERIAL FACTS,
=XCH SERM AS A BASIS
FOR ISSUANCE OF THIS PERMIT, REQUIRE THE APPLICANT
TO UDDIFY THE
PERMIT APPLICATION- SUCH
MWIFICATIONS key RESULT IN TRIS VERMIT
EWING M!!DE
NULL AM VOID.
ISSUANCE. OF THIS PERMIT
DOES NOT ERMPT THE APPLICANT F04K COMPLIANCE:
WITS
OTAER rM)ERAL,
STATE, OR LOCAL PENUTTM MQUIRM FOR DZYMPMW OF THIS Pte, PERTY.
SYSTEM DESIGN AND SPECIFICATIONS
T t
1,050 ]
GALLONS ! GM §Nfic
CAPACITY
A t
0 l
GALLONS / GPD –
CAPACITY
N [
0 I
GALLONS GREASE INTERCEPT= CAPACITY
[M infix CAPACITY SINN TANK:1250 GA1J S1
K [
I
QALLAiS DOSING TANK CAPACITY [
IGAFILONS e[ ]DOSES PER 24 HRS #Pumps [
D [ 300 I SQmm FEET Bed oonfiOUrsfion drainfiel SYSTEM
R [ 0 ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [x] STaxuARb [ I Fix.T.>;!b [ I MOMW [ l
I CONFIGURATION: [ I TRENCH Ex] BED I
N
F LOCATION OF . FFE 12.5' NGVD
I ELEVATION OF PROPOSED SYSTEM SITE 116.801[ FT I I ABOVE
OF DRAINFIELD TO BE 66.841 � FT I c ABOVE
L
M �j;.
O
T
H
7;
R
.L" mw.0 aw.- [ U.UU } 319:EzS EXCAVATION REQUIRED: [ } iNCtiNS
I. g 1050 gal. septa tank, certified by "Mr. C's Plumbing and Septic" on 11/23/2013 to remain.
2 4ristall 300 sf of drainfield in bed oonfigurafion.
3. -Irk 12" of sfightiy limited soil at the bottom of the drainfleld.
4.- Perimeter of excavation area shall be at least 2 ft wider and longer than the proposed absorption bed or drain trench.
(Comments Continued on Page 2.)
�
SPECIFICATIONS BY: Kemb+le Ettrick TITLE:
APPROVED BY -kY 1 Qil f. sL, TITLE: Engineering Specialist II Dade CHD
— metay la9e
DATE ISSUED: 11/2712013 EXPIRATION DATE: 0212512014
DR 4016, 08!09 (Obsoletes all previous editions which may not be used)
Incorporated.: 64E- 6.008, PAC The contractor for deslgnee} Is reolred to Off" rf KIP
V 1.1.4 AP112747s baring adjacent%W%ainfield excavation at the time Of final
inspection. Prior to Final Approval, the FDOH Inspector shall
witness the soil borin$ and Compare the results to the original
site evaluation submitted.-A reinspection fee will be assessed
if the contractor is net at tits jobsise at the arranged time.