PL-13-0628Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)766 -8972
nsoection Number: INSP- 186267 Permit Number: PL -3- 13-628
Inspection Date: September 24, 2013
Inspector I01Z I cf—
Owner: GARCIA, JOHN
Job Address: 169 NW 104 Street
Miami Shores, FL
Project: <NONE>
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Septic
Phone Number
Parcel Number 1121360131370
Contractor: A AMERICAN SEPTIC & PLUMBING Phone: (305)866 -5600
WU11UIII!d Wupulull—t.
TANK AND DRAINFIELD REPAIR
Infractio Passed
Comments
INSPECTOR COMMENTS False
Inspector Comments
Passed
EZ
HRS IN FILE
Failed
Correction
Needed
Re- inspection ❑
Fee
No Additional Inspections can be
scheduled until
re- inspection fee is paid.
For Inspections please call: (305)762 -4949
September 24, 2013 Page 1 of 1
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
111MI)ING
PERMIT APPLICATION
Permit Type: PLUMBING
FBC 20
Permit No.
H
BY-- --------- ......
Mader Permit No.-
JOB ADDRESS: - M WW iDtA &TPEET
City: hfitimi Shores County: M Miami Dade Zip: 3
Folio/Parcelt.
Is the Building Historically Designated: Yes NO jqood zone: 0 AcN
OWNER: Name (Fee Simple Titleholder)- J06-N Gac-CAA —Phonet_
Address: U q t3w t0q ST
City: n't a ry.) I %n 0-f C-S State: -F1 Ziv:..-3 3 qo
Tenant/1-essee Name: N Phone#:
Email:
CONTRACTOR: Company Name:
Address: Wj—& (-a
City: rymwrol
Qualifier Name: -, t t-, a cn
State Certification or Registration #:
Contact Phone#-.
DESIGNER: ArchitectlEnginew.
ri ca
Pi"'
state: t-
6 CA L4 " Phone* q-tU I ZZ (,K S OR
S-F- P ()DO C1 Certificate of Competency 0 0 t 3 %-L �
)0
Email Address:
101 f3 Phone*:
3
Value of Work for this Permit: $ , '? 00. _Square/Linear Footage of Work: kS0
Type of Work: ❑Address UAlteration QNew XRVairllkeplace LIDemolition
Description of Work:
+
Submittal Fee Permit Fee CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR$ _Boud$
Notary $' TrainhiWEducation Fee $. Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE -3c)
Dr
• Sondin'g Company's Name (if applicable) �j /1K
Bonding company's Address
City State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
M
Zip
City Stag 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 moet 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 OAR: YOUR FAILURE TO RECORD A NOTICE OF
CON MENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR
IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN
FINAN G, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECD G YOUR NOTICE OF COMMENCEMENT:'
Notice to lican • As a condition to the issuance of a building penvit with an estimated value exceeding $2500, the applicant must
promise in od f h that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose prope is s bject to attachment. Also, a cer i fled copy of the recorded notice of commencement must be posted at the job site
for the first i e n which occurs seven (7) days after the building permit is issued In the absence of s posted notice, the
inspection w' a ap inspection fee will be charged.,,, �^
NOTARY PLBLIC -STATE OF FLORIDA
Signaillre
O er ur Agent +�'•„� 1 8 4 Contractor
BONDED THRti C BOND Co.,)NC.
The foregoing instrument was acknowledged before me this The foregoing instrument vas acknowledged before me this
day of � � 2 1 3 . . �®�Y� GGS_ Cf to day of ZQ ti by `i d ( dn�
who is personally kno 0 n4 or who has produced E= who is me or who has produced
17'n lX ide cation and who did take an oath as identification and who did take an oath.
NOTARY LI NOTARY PUBLIC: NOTARY PUBLIC-STATE OF FLORIDA
Jazzmin Cruz
".Commission # BE030407
,,,,,,,s° Expires: SER 28, 2014
Sign: Sign: Ba ... MUAnAN'NC30h'D1NGc0.,1NC.
Print: Print: J a2, -Z.Arl t Lk
My Conunissio Aires: I My Commission Expires: L4
APPROVED BY y 3 -i'_7 Plans Examiner
Structural Review
(ReAse0 /12J2012)(Revised 07 /10/07)(Revised 06/10n2009)(Rev1sed 3/15/09)
Zoning
Clerk
STATE OF FLORIDA
DEPARTHMIT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM
CONSTRUCTION PERMIT
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: John Garcia
PROPERTY ADDRESS: 169 NW 104 St Miami, FL 33150
LOT: 15 16 BLOCK: 126 SUBDIVISION:
PROPERTY iD #: 11- 2136-013 -1370
PERMIT #:13 -SC- 1462$93
APPLICATION #: AP1101977
DATE PAID:
FEE PAID:
RECEIPT #•
DoCmaNe #: PR901417
{SECTION, TOWNSHIP, RANGE, PARCEL NUMBER]
[OR TAX ID NMOMI
SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF SECTION
381.0065, F.S., AND CHAPTER 64E -6, F.A.G. DEPARTMENT APPROVAL OF SYSTEMS DOES NOT GUARANTEE
SATISFACTORY PER1F0PMANCE FOR ANY SPECIFIC PERIOD OF TIDES. ANY CHANGE IN MATERIAL FACTS,
WHICH SERVED AS A BASIS FOR ISSUANCE OF THIS PERMIT, REQUIRE THE APPLICANT TO DDDIFY THE
PERMIT APPLICATION. SUCH MODIFICATIONS MAY RESULT IN THIS PERMIT BEING MADE NULL AND VOID.
ISSUANCE OF THIS PERMIT DOES NOT EXEMPT.` THE APPLICANT FROM COMPLIANCE WITH OTHER FEDERAL,
STATE, OR LOCAL PERMITTING REQUIRED FOR DEVELOPMENT OF THIS PROPERTY.
SYSTEM DESIGN AND SPECIFICATIONS
T [ 900 ] GALLONS ! GPD New septic tank CAPACITY
A [ 0 ] GALU)KS / GPD CAPACITY
N [ 0 ] GALums GREASE INTERCEPTOR CAPACITY [Mkxnm CAPACITY sn;= TANK:1250 GALLONS]
K E ] GAtXAM DOSING TANK CAPACITY I ]GALL0N$ @[ ]DOSES PER 24 HRS #Pumps [ ]
D [ 150 ] SQUARE FEET Trench pDnfiguration drain SYSTE'�S
R E 0 1 SQUARE FEET SYSTEM
A TYPE SYSTEM: Ex] STANDARD I ] FILLED I I HOUND [ ]
I CONFIGinWXCN: [xI TRENCH E ] S&D I I
N
F LOCATION OF BENCHM1M. F.F.E., 13.10'NGVD
I ELEVATION OF PROPOSED SYSTEM SITE 1 21.60][ INCHE3 FT ] E ABOVE BELOW BENCHM?M /REFERENCE POINT
E SOTTCM OF DRAINFIELD TO BE [ 53.603[ INCHES FT ]EABOVE BELOW BENcHmARK /REFERENCE POINT
L
D FILL REQUIRED: 1 0.00] INCHES EXCAVATION REQUIRED: [ ] INCHES
0
T
H
E
R
Inspector to verify the existing septic tank is properly abandon before final approval.
*Invert elevation of drainfield to be no less than 9.13 ft. NGVD.
*Bottom of drainfield elevation to be no less than 8.63 ft. NGVD.
-The system is sized for 2 bedrooms with a maximum occupancy of 4 persons (2 per bedroom), for a total estimated
sewage flow of 300 gpd.
-The licensed contractor installing the system is responsible for installing the minimum category of tank in accordance
with sec. 64E- 6.013(3)(0. F.A.C.
'THIS PERMIT IS NOT FOR " ADDITION(s) ".
SPECIFICATIONS BY: Carlos M Icaza TITLE:
APPROVED SY: TITLE: Dade CHD
DATE ISSUED: 03/27/2013
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E- 6.003, PAC
AP1101977 SE893977
v 1.1.4
EXPIRATIAN DATE: 06125/2013
Page 1 of 3
If NQTICg OF RIGHTS
A party 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 Cleric'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.