PL-14-112Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 207391
Scheduled Inspection Date: March 12, 2014
Inspector: Diaz, Osvaldo
Owner: LEZAMA, LOUIS
Job Address: 420 NE 92 Street
Miami Shores, FL
Project: <NONE>
Permit Number: PL -1 -14 -112
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Drainfield
Phone Number
Parcel Number 1132060140079
Contractor: MC INVESTMENT GROUP INC Phone: (786)294 -1987
sunaing Department comments
REPLACE DRAINFIELD
INSPECTOR COMMENTS False
Inspector Comments
Passed CREATED AS REINSPECTION FOR INSP- 206027. HRS IN FILE
no permit no one home
57(A` x/11 te_ "7
Failed
Correction ❑
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
March 11, 2014 For Inspections please call: (305)762 -4949 Page 18 of 34
•� DIVISION OR
Environmental Health
Florida Department of Health
Mimi -Dade County Health Department
OSTDS/Well Division �Q
11805 SW 26 St. • Mtalpi, !!L 33175
Inspector S
Date 7 ��
Address OSTDS It I
Comments:
Signature
T Miami Shores Village
L' �L\ 7, Tz 311
Building De artment ..
U
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972 IB_ Y.
INSPECTION'S PHONE NUMBER: (305) 762.4949
FBC 20 t 0
BUILDING Permit No.
PERMIT APPLICATION Master Permit No.
Permit Type: PLUMBING
JOB ADDRESS: L O u / S V11 °
City: Miami Shores County: Miami Dade
Folio/Parcel #: 0 7 6?
Is the Building Historically Designated: Yes NO ✓ Flood Zone: iV
OWNER: Name ((Fee Simple Titleholder): 11 0 e1 (' v (° Z.Cf 6"A - Phone #: 90 ��l 'C� �/e
Address: Ll A 0 /j L C4 � i
city: !R A L% f P S State: LL
Tenant/Lessee Name: Phone #:
Email:
3 3/,?V
CONTRACTOR: Company Name: '1 a�I y&&z _. w Phone #: 4&- - y ®Z - 6 82/
Address: —
City:
Qualifier Name: A
State Certification or
G/ Zip: :�?3 % y 3
Contact Phone #: 396 - 1/1�: -( 2 ? / Email Address:
DESIGNER: Architect/Engineer:
Value of Work for this Permit: $ of Square/Linear Footage of Work:
rp C-)
Type of Work: ❑Address DAlteration ,�// ONew Wepair/Replace ODemolition
Description of Work: Al -P t^1 1/ C9 i , 4 f r -t l G(
Submittal Fee $ Permit Fee $ CCF $ CO /CC $
Scanning Fee $
Radon Fee $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
DBPR $ Bond
Technology Fee $
TOTAL FEE NOW DUE $ 14 f
Soocb�o
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.
r
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
EWROVEMENTS 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 Signature
Owner or Agent
The fore g instrument was acknowledged before ime this 9
day oj 0Z�, by 114 t4, Z /�r,►�
P
who is ppersonaq y known to me or who has Z Fi
produlS ced G%
NOTARY
Sign:
Print:
My
and who did take an oath.
COMMISSION # FF000737
EXPIRES: NiAR. 25, 2017
d.AARONNOTARYMM
Contractor
The fore oing instrument was acknowled ed before me this
day o , 20 &, by �` C p
who is personally known to me or who has produced
APPROVED BY 1>2-3-7",- Plans Examiner
Structural Review
(Revised3 /12/2012XRevised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09)
as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My
J
COMMISION# FF000737
EXPIRES: SAAR. 25, 2017
1M1w.AARONNOTARymm
Zoning
Clerk
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION PERMIT
CONSTRUCTION PERMIT FOR:
APPLICANT: Louis Lezama
PROPERTY ADDRESS:
LQT: 10
PROPERTY ID #:
t
OSTDS Repair
420 NE 92 St Miami, FL 33138
BLOCK: 49 SUBDIVISION:
11- 3206 - 014-0079
PERMIT # :13 -SC- 1514659
APPLICATION #:AP1131711
DATE PAID:
FEE PAID:
RECEIPT #:
DocumENT #: PR926954
[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 [ 1,050 ] GALLONS / GPD Existing septic tank to remain. CAPACITY
A [ 0 ] GALLONS / GPD CAPACITY
N [ 0 ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps
D [ 500 ] SQUARE FEET
R [ 0 ] SQUARE FEET
A TYPE SYSTEM: [X]
I CONFIGURATION: [X]
N
Trench confiquration drain SYSTEM
SYSTEM
STANDARD [ ] FILLED [ ] MOUND [ ]
TRENCH [ ] BED [ ]
F LOCATION OF BENCHMARK: Crown of the rd, 9.00' NGVD
I ELEVATION OF PROPOSED SYSTEM SITE [ 7.20 ][INCHES FT It BELOW]BENCHMARK /REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 22.80][ INCHES FT ][ABOVE BELOW BENCHMARK /REFERENCE POINT
L
D FILL REQUIRED: [ 0.00] INCHES EXCAVATION REQUIRED: [ 66.001 INCHES
*Invert elevation of drainfield to be no less than 7.60' NGVD.
o "Bottom of drainfield elevation to be no less than 7.10' NGVD.
T *Install 36° of slightly limited soil under the bottom of drainfield.
- Perimeter of excavation area shall be at least 2 ft. wider and longer than the proposed absorption bed or drain trench.
H 'THIS PERMIT IS NOT FOR " ADDITION(s) ".
E The system is sized for 4 bedrooms with a maximum occupancy of 8 persons (2 per bedroom), for a total estimated flow
of 400 gpd.
R
BY:
APPROVED BY:
DATE ISSUED: 01/15/2014
TITLE:
TITLE:
Dade CHD
EXPIRATION DATE: 04 /15/2014
DH 4016, 08/09 (Obsoletes all p evious rditions which .may_ of b� used)
Incorporated: 64E- 6.003, FAC �he LC�It`�Ctu' J::'' }y '" r ` ' EyvG UO pe Orm a
soil boring ad} cent Lo the drainfield excavation at the
tfmt * i` final inspection. Prf'r'PH a Approval, the DOH S0917073
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.
Page 1 of 3
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