PL-13-2193Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number. INSP- 199999 Permit Number. PL -9-13 -2193
Inspection Date: January 21, 2014 Permit Type: Plumbing - Residential
Inspector. Diaz, Osvaldo
Inspection Type: Final
Owner. FROHBOSE, JACQUELINE Work Classification: Drainfield
Job Address: 667 NE 105 Street
Miami Shores, FL 33138 -2053 Phone Number
Parcel Number 1122310120090
Project <NONE>
Contractor. STATEWIDE SEPTIC CONNECTIONS Phone: (954)963 -0082
Ruildinn nanartment Comments
REPLACE DRIAN FIELD
Infractlo Passed Comments
INSPECTOR COMMENTS False
'Inspector Comments
Passed
Failed El
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
For Inspections please call: (305)762 -4949
January 17, 2014 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
BUILDING
PERMIT APPLICATION
FBC 20
Permit Type: PLUMBING
OWNER: Name (Fee Simple
Permit No. 1 e3
Master Permit No.
h b o SIC
"�.
�. 1
Address: fl �� .... ... • ..Y: �}�
City: lea r t-m .S -C-v State: - -Zip:,
TenandLessee Name: Phone#: ; .ti � `0'
Email:; E
,. L-
JOB ADDRESS: ..r.�
City: Miami Shores County: Miami Dade Zip: � 13&
Folio/Pazcel #: �4 P- 7,�i_� � �� � 2- °tea-' � ��
Is the Building Historically Designated: Yes NO Flood Zone:
CONTRACTOR: Company Name: ��� i Kfl c ar\r VC' t1 —� 'Phone #: ;c 'V C61' C 6 3
Address: 6 Q2)2- �--,3 2 --� -�+
City: %Y'z State: - Zip: �
Qualifier Name: Phone #:
State Certification or Registration #: ;S- ' `I r Z Certificate of Competency #:
Contact Phone #: Email Address:
DESIGNER: Architect/Engineer: Phone #:
Value of Work for this Permit: $ s Square/Linear Footage of Work:
Type of Work: ❑Address ❑Alteration ❑New *epair/Replace ❑Demolition
Description of Work:
&V I�� 9 -- A may(
Submittal Fee $ Permit Fee $ 0 ISO CCF $ CO /CC $
Scanning Fee $ UW .' Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
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 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 and a reinspection fee will be charged.
Signature a q V
Owner or Agent
The foregoing instrument was acknowledged before me this
day of , 2�, by r►ccr"y'4
who is personally known to me or who has produced
!aKI'y , U%C.Pr3 As identification and who did take an oath.
NOTARY PUBLIC:
r--.
Sign: �,_ tJ2&2:__
Print: Z." -r-
My Commission Expires:
APPROVED BY
Signatu ��Contractor
The foregoing instrument was acknowledged before me this &.1
day of SCI C- , 20 Q, by 1W___-'54
who is personally known to me or who has produced
TERESA J SOLOMON
MY COMMISSION # EE131935
EXPIRES November 08, 2015
(Revised 07 /10 /07)(Revised 06 /1=009)(Revised 3/15/09)
Plans Examiner
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
0,
,4V0
Print;
I
_ �d u7
My Commission Expires:
m :�a:1��`�p /�'�
Zoning
Structural Review Clerk
STATE OF F:LORII' M COtMN HM1W t9Ep�
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION PERMIT
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: Jacqueline Frohbose
PROPERTY ADDRESS: 667 NE •105 St Miami, FL 33138
LOT: 10 BLACK: na SUBDIVISION:
PERMIT #:13 -SC- 1496466
APPLICATION #: AP1121103
DATE PAID:
FEE PAID:
RECEIPT #:
DOCUMENT #: PR917796
PROPERTY ID #: 11- 2231 -012• -0090 [SECTION, TOWNSHIP, RANGE, PARCEL NUMBER]
[OR TAX ID NUMBER]
SYSTEM MIDST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF SECTION
381.0065, F.S., AND CHAI:'TER 64E -6, E.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 [ 900 ] GALLONS / GPD Septic CAPACITY
A [ 0 ] GALLONS / GPD CAPACITY
N [ 0 ] GALLONS GREAS:u INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
K [ ] GALLONS DOSING. TANK CAPACITY I ]GALLONS 01 ]DOSES PER 24 HRS #Pumps
D I 225 ] SQUARE FEET Trench configuration drain SYSTEM
R [ 0 ] SQUARE FEET SYSTEM
A TYPE SYSTEM: IX] STANDARD [ ] FILLED [ ] MOUND I ]
I CONFIGURATION: [X] TRENCH ( ] BED ( ]
N
F LOCATION OF BENCHMARK: FFE 12.7'NGVD
I ELEVATION OF PROPOSED SY::•TEM SITE [ 18.00][ INCHES FT ][ABOVE BELOW BENCBMARK/REFERENCE POINT
E BOTTOM OF DRAINFIELD TO :31F, [ 60.00 ] [INCHES FT ] [ ABOVE BELOW BENCHMARK /REFERENCE POINT
L
D E
O
T
H
E
R
ILL REQUIRED: ( 0.00 1 INCHES EXCAVATION RE9U1MW :. I 4L.UU J iarL.nzlc
1.- Existing 900 gal. septic tank certified by "Statewide Septic Connection Inc." on 9/23/2013 to remain.
2.- Install 225 sf of drainfield in trench configuration.
3.- Perimeter of excavation area shall be at least 2 ft wider and longer than the proposed absorption bed or drain trench.
elevation of drainfleld to be no less than 8.20' NGVD.
SPECIFICATIONS BY: ;, %La a TITLE: Engineering Specialist II
APPROVED BY: TITLE: Dade CHD
09/261:2013
(Obsoletes all previous editions which may not be used)
64E- 6.003, PAC
v 1.1.4 AR1121103
DATE ISSUED:
DH 4016, 08/09
Incorporated:
EXPIRATION DATE: 12/25/2013
The contractor (or Tes$ne� is�required to perform
SE908e62 soil boring adjacent to the drainfield exca,+ation a.1 i
time of final inspection. Prior to Final Approval, the
insoectof shall witness. the soil hpring ant compar
results to the original site evaluation submitted. A
reinspection let wilt pe assessed 0 the cc ntractot`i.
at the jobsite at the tnaiiged time.
Fax Server 9/27/2013 6:01 :37 AM PAGE 1/005 Fax Server
Fax redplent information
To: Teres Solomon
Fax #: 1- 954963 -M
Number of pages faxed: 5
4UREU MF
ORMPInsualree
PoGry Number: 75899297 -7
Underwritten by:
Progressive American Insurance Co
Policyholder:
Teres F Solomon
September 27, 2013
Page 1 of 1
1-95&980-9324
989.9324
Malmo i Tyson Inc
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Declarations pages, and r :ie.
DOCUMM4T #: PR917795
Dttom of drainfield elevation to be! no less than 7.70' NGVD.
system is sized for 3 bedrooms ve ith a maximum occupancy of 6 persons (2 per bedroom), for a total estimated flow of
91d•
,p
FLOF
Z;tATE (5�- -11 DA
DEPARTMENT OF HEALTH
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTPUC,1'Iq\0PENNt,1I'I*
awn �ilA
Applic,
PARI'll -SITE PLAN-
Scare: Each block represents 5 feet and I inch = 50 feet.
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Not,.-s:— (0(01 0, _s: S 5Go 33
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Sitc Plan submitted by: 2 Q .r►4-r- e.1c �7,1_
Signature Title
Plan Approved Not Approved Date
By County Health Departal-If
ALL CHANGES MUST BE APPROVED BY.TRE COUNTY HEALTH DEPARTMENT
M( 40'5, IONS(Roplaces H8S-H Farm 40j$whi0 may bo used) n n I
(Siva luatm 574A.M.4015-6)