PL-14-170r
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 206372 Permit Number: PL -1 -14 -170
Scheduled Inspection Date: February 20, 2014 Permit Type: Plumbing - Residential
Inspector: Diaz, Osvaldo
Inspection Type: Final
Owner: VINCENT LEVROS, ARLETTE LEVROS Work Classification: Septic
Job Address: 117 NW 103 Street
Miami Shores, FL 33138-
Project: <NONE>
Phone Number
Parcel Number 1121360131570
Contractor: A AARON SUPER ROOTER Phone: 305 -944 -8886
Isunaing uepartment comments
REPLACE DRAIN FIELD
INSPECTOR COMMENTS False
Inspector Comments
Passed S �.
Failed
Correction
Needed ❑ 'C�
Re- Inspection ❑
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
February 19, 2014 For Inspections please call: (305)762 -4949 Page 15 of 31
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BUILDING
Miami Shores Village
Building Department -
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: 2 e.0 1-1 ii:
Tel: (305) 795.2204 Fax: (305) 756.8972 /� —'"'
INSPECTION'S PHONE NUMBER: (305) 762.4949 k
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Permit No.
PERMIT APPLICATION
Permit Type: PLUMBING
JOB ADDRESS: 4 11-1 N W 10'3 St
Master Permit No.FL I"I "- k-1 0
City: Miami Shores County: Miami Dade Zip: 3 3 s®
Folio/Parcel #: 0- 2.I'3 (0 _,)1 3 °' S -1,0
Is the Building Historically Designated: Yes NO Flood Zone:
OWNER: Name (Fee Simple Titleholder): Art C*G Q+ V 9,nCen-k L eyrrs Phone #: qS % 3 2-" "'5
Address: W "b S1
City: < VNO rf-S State: iZ Zip: 3 l O
Tenant/Lessee Name:
Email:
CONTRACTOR: Company Name: /k A ck ro-' Phone #:
Address: G ®22 Suj -65 c7r
City: W" dF ®` State: FL Zip: 3 3 o Z 3
Qualifier Name: c/ * " "1 T04 Phone #:`
State Certification or Registration #: Certificate of Competency #:
Contact Phone #: Email Address:
DESIGNER: Architect/Engineer: Phone #:
o°
Value of Work for this Permit: $ 3 ®® ® _ Square/Linear Footage of Work:
Type of Work: DAddress DAlteration
Description of Work:
1 1�ia
ONew )(Repair/Replace ODemolition
61CG Oe Qty
Submittal Fee $ Permit Fee $ g 0 CCF $ CO /CC $
Scanning Fee $
Notary
Radon Fee $
Training/Education Fee $
Double Fee $ Structural Review $
DBPR $ Bond
Technology Fee $
TOTAL FEE NOW DUE
Bonding Company's Name (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 comet ement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. I t e absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature 4".e "
Owner or Agent
The foregoing instrument was acknowledged before me this 2 °/
day of of r1 , 20 f 4, by Ay l e- k+?. L -e—VwJ ,
who is personally known to me or who has produced R)* Or iV
UN CeJW As identification and who did k oj--W 7
NOTARY PUBLIC:
Sign: `L
Print:
My Commission Expires:
Contractor
The foregoing instrument was acknowledged before me this
day of ocP\ , 20(�t b 0`1'\ Tv
who is personally known to me or who has produced
(jrtV bC&, as identification and who did take i o . ;
APPROVED BY
Structural Review
(Revised3 /12/2012)(Revised 07 /10 /07XRevised 06/10 /2009 )(Revised 3/15/09)
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Clerk
NOTARY PUBLIC:
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Sign:
Print:
My Commission Expires:
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APPROVED BY
Structural Review
(Revised3 /12/2012)(Revised 07 /10 /07XRevised 06/10 /2009 )(Revised 3/15/09)
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REPAIR
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STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION PERMIT
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: Arlette & Vincent Levros
PROPERTY ADDRESS: 117 NW 103 St Miami, FL 33150
LOT: 21. 22
BLOCK: 127 SUBDIVISION: Miami Shores Sec 5
PROPERTY ID #: 11- 2136 - 013 -1570
CI i A
PERMIT #:13 -SC- 1514084
APPLICATION #: AP1131350
DATE PAID:
FEE PAM:
RECEIPT #:
DOCUMENT #: PR926624
[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 [ 650 ] GALLONS / GPD existing septic tank CAPACITY
A [ ] GALLONS / GPD CAPACITY
N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [
D [ 150 ] SQUARE FEET trench configuration drainf SYSTEM
R [ ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [x] STANDARD [ ] FILLED [ ] MOUND [ ]
I CONFIGURATION: [x] TRENCH [ ] BED [ ]
N
F LOCATION OF BENCHMARK: FFE 12.9' NGVD
I ELEVATION OF PROPOSED SYSTEM SITE [ 30.00][ INCHES FT ][ ABOVE BELOW BENCHMARK /REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 68.00][ INCHES FT ][ABOVE BELOW BENCHMARK /REFERENCE POINT
L
D E
O
T
H
E
R
ILL REQUIRED: [ ] INCHES EXCAVATION REQUIRED: L 36= J INUliMb
1.- Existing 650 gal. septic tank, certified by A Aaron Super Rooter on 01/07/2014, to remain.
2.- Install 150 sf of drainfield in trench configuration.
3.- Perimeter of excavation area shall beat least 2 ft wider and longer than the proposed absorption bed or drain trench. , % y
4. -Invert elevation of drainfield to be no less than 7.73' NGVD.
5. -Bottom of drainfield elevation to be no less than 7.23' NGVD.
(Comments Continued on Page 2.)
SPECIFICATIONS BY: Teresa J Solomon TITLE: Master Septic Tank Contractor
APPROVED BY:
DATE ISSUED:
TITLE: Engineering Specialist II Dade CHD
8rlaade Omisca
0111042014 EXPIRATION DATE: 04 /1012014
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E - 6.003, PAC The contractor (or designee) is requireofgedoff $soil
v 1.1. t "1131350 boring ad)a%jq; ;fatf+e dralmfield excavation at the time of final
Inspection. Prior to Final Approval, the FOOH 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.
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"7,.WATE OF FLORIDA
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DEPARTMENT OF HEALTH
APP 1CATION FOR ONSITE SEWAGE DISPOSAL SYSTEf I COf�(STR'UCTION PERMIT
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Permit Applical on Nurn e P,
�.. — PART 11 - SITE PLAN -
Scale: Each.b lock. repreSE nts 5 feet and t inch.= 50 feet.
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Site Plan submitted by:
Signature Tit(e•a
Plant Approved Not Approved Date
By- — County Health Departm .r
ALL CHANGES MQST "BE.AAPPRQVED BY THE COUNTY HEALTH DEPARTMENT
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