PL-13-22644
t
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795.2204 Fax: (305)7864972
Inspection Number: INSP- 209287 Permit Number: PL40 -13 -2264
Scheduled. Inspection Date: April 01, 2014 Permit Type Plumbing - Re tdentlal
Inspector: Diaz, Osvaldo
Inspection Type: Final
Owner: SIERRA; DELFINA Work Classification: Drainfield
Job Address: 130 NE 97 Street
Miami Shores, FL, Phone Number
Project:, <NONE> Parcel Number 1132060132530
Contractor: STATEWIDE SEPTIC CONNECTIONS Phone: (9$4)963-0082
Suildina Department Comments
REPALCE DRAIN FIELD
False
Inspector Comments
Passed HRS IN FILE ,\
Failed El a S L CA
Correction
Needed �� cL
Re-Inspection
Fee ii II
No Additional Inspections can be scheduled until
re- inspection tee is paid.
Wreh 31, 2014 For inspections please call: (305)762.4949
Pace 22 *1-50
5
V
r
c--
Rooms . . . . . . . . . . . .
DIIIISION OF
Environmental Heallth
►�
florIO—I)II-epartment of g
1% Miami -Dade °nntY ealth
Health Department
OSTDS /Well Division
118111 SW 26,1;t. �ilt, ..
and, F1, 33171.5
Inslret;tor•
0/
Address_ Date � � "�-
)STDS #
COMMents:_
Signature
e�
Miami Shores Village
Building Department�`�
^e J 7 206
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 ��*
Tel: (305) 795.2204 Fag: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949 ' - _- - ---
FBC 20 t
BUILDING
PERMIT APPLICATION
Permit Type: PLUMBING
Permit No.
Master Permit No-R13
�, ��
JOB ADDRESS: �1 -�
City: Miami Shores County: Miami Dade Zip:
Foho/Parcel #: t( 3 2-0 6 " 013- z ' u
Is the Building Historically Designated: Yes NO Flood Zone:
OWNER: Name (Fee Simple Titleholder): r� au �"0 � ' "� "-'C- 60 Phone #: 130 `d e
Address: \ 17DI& 0 �__ C-1 -1
City:
Tenant lessee Name:
Email: o e-"�, F
State:`'
CE, LL
-7, `°fie V ;
CONTRACTOR: Company Name: S *A-k--ew%de, JPL-&, c (�O'^S jyi (L Phone #: '3o J' 6 /' 66 33
Address: G® 32- S*,-J Z3 r1"
City: M I { State: F L Zip: 30 '-3
Qualifier Name: ( z1fA d� Phone #:
State Certification or Registration #: S�A-1 Certificate of Competency #:
Contact Phone #: Email Address:
DESIGNER: Architect/Engineer: Phone #:
Value of Work for this Permit: $ 2- S ®,-:; Square/Linear Footage of Work: ) 5 O
Type of Work: ❑Address ❑Alteration ONew *epair/Replace ❑Demolition
Description of Work:
Submittal Fee
Scanning Fee $
Notary
Permit Fee $ 1st"" CCF
Radon Fee $
Training/Education Fee $
Double Fee $ Structural Review $
CO /CC $
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 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 affJ Inspectionfee will be charged.
A � t, ignature Signature
OLeVor Agent Contractor
The foregoing instrument was acknowledged before me this
day7f , 20 :,�, by
who is personally known to me or who has produced t" `"e l
G R rYocko As identification and who did take an oath.
NOTARY PUBLIC:
Sign:
ra A
Print:
My Commission Expires:
TERESA J SOLOMON
MY COMMISSION # EE131936
EXPIRES November 08, 2015
The foregoing instrument was acknowledged before me this
day of ® , 20 , by
wh or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
tau ►cn++ ryes
Sign:
to
Prmt: •
4 a> ;UJ
"..:... to �. ��; � _
My Commission Expires:
APPROVED BY Plans Examiner
Structural Review
(Revised3 /12/2012XRevised 07/10/07 )(Revised 06 /10 /2009XRevised 3/15/09)
Zoning
Clerk
STATE OF M..ORIDA 6 37�> AIR
DEPARTMENT OF HEALTH CL3"N ""-A �n�.
ONSITE SEWII,GE TREATMENT AND DISPOSAI;'Tb'zrTi�EM
CONSTRUCTIOM PERMIT
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT:
PROPERTY ADDRESS: 130 NE U St Miami, FL 33138
PERMIT #:13- SC- 1497543
APPLICATION #: AP1121698
DATE PAID:
FEE PAM:
RECEIPT #:
DOCUMENT #: PR918242
LOT: 8-9 BLOCK: 19 SUBDIVISION: Miami Shores Section 1
[SECTION, TOWNSHIP, RANGE, PARCEL -Al
[OR TAX ID NUMBER]
PROPERTY ID #:
11- 3206 - 013 -2530
MUST BE CONSTRICTED IN ACCORDANCE
WITH SPECIFICATIONS AND STANDARDS OF SECTION
SYSTEM
AND CHAPTER 64E -6, F.A.C.
DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE
381.0065, F.S.,
FOR ANY SPECIFIC PERIOD OF TIME. ANY CHANGE IN MATERIAL FACTS,
SATISFACTORY PERFORMANCE
OF
THIS PERMIT, REQUIRE THE APPLICANT TO MODIFY THE
WHICH SERVED AS A BASI:: FOR ISSUANCE
SUCH MODIFICATIONS MAY
RESULT IN THIS PERMIT BEING MADE NULL AND VOID.
PERMIT APPLICATION.
NOT EXEMPT
THE APPLICANT FROM COMPLIANCE WITH OTHER E'EDERAL,
ISSUANCE OF THIS PERMIT DOES
PERMITTING REQUIRED FOR DEVELOPMENT OF THIS PROPERTY.
STATE, OR LOCAL
SYSTEM DESIGN AND SPECIFICATIONS
T [ 750 ] GALLONS /GPI) Septic
CAPACITY
A [ 0 ] GALLONS / GPI)
CAPACITY
CAPACITY SINGLE TANK:1250 GALLONS]
N [ 0 ] GALLONS GREAS•:: INTERCEPTOR CAPACITY
[MAXIMUM
]DOSES PER 24 HRS #Pumps [ )
K [ ] GALLONS DOSING: TANK CAPACITY [
]GALLONS @[
D [ 150 ] SQUARE FEET Trench configuration drain SYSTEM
R [ 0 ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [x] STANDARD [ l FILLED L ] MOUND 17
I CONFIGURATION: [x] TPENCH [ l BED [ ]
N
F LOCATION of BENCHMARK: F.F.E. 12.7' NGVD
[[INCHES FT l[p,BOVE BELOW BENCHMARK /REFERENCE POINT
I ELEVATION OF PROPOSED SY :;TEM SITE [ 25.201
E BOTTOM OF DRAINFIELD TO 13E [ 63.20 ] [ INCHES FT ] [ ABOVE BELOW BENCHMARK /REFERENCE POINT
L
D BILL REQUIRED: [ 0.007 INCHES EXCAVATION REQUIRED: [ 38.00] INCHES
Fhe 750 gal. septic tanic, certified by "Statewide Septic Connection INC" on 9/18/2013 to remain.
O 50 sf of drainfield in trench configuration.
T er of excavation areia shall be at least 2 ft wider and longer than the proposed absorption bed or drain trench.
__.._ . �_
elevation -- ofdraln lelffio G� rio less than 7:93' NG
H of drainfield elevati�: n to be no less than 7.43 NGVD.ed for 2 bedrooms -Kith a max occupancy of 4 persons (2 per bedroom), for a total est flow of 300 gpd.
R I
TITLE! Engineering Specialist II
SPECIFICATIONS BY: ;; L ge
• Dade CHD
i._...
TITLE:
APPROVED BY:
EXPIRATION DATE: 12/30/2013
DATE ISSUED: 10/012013
DH 4016, 08/09 (Obsoletea all previous editions which may
not be used) Page 1 of 3
Incorporated: 64E- 6.003, PAC 1.1.6 AP1121698 SE909269
v
Fl-.ORlf)A
DEPARTMENT OF HEALTH
T RiM
ION PEI•
APPLICATION FOR ONSITE SEWAGE DISPOSAL SyS'FD�I`CONISTP
Permit Applical:on Nuirni)
PART II - SITE P LAN -
Scare: Each block represents 5 feet and I inch = 5 0 fe'et. T.
A J
Pg
e
ry
Px*�
7;
A.
. ....... ...... .
. ...............
72!
. .............
4:;1
0
rt
Not Is:
Site Plan submitted by:
'Plan Approved
lc.,
Not Approved ___
Co
County Health Departrnf,
By
ALL CHAW31ES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
-ty be u5w
46 (Repjacr
DH 40-5, , HjfS.�jFq(Mj0j5,jjhich.Tk dl
(S,,txk IwW: 5744-002-4016-61