PL-13-2820i*
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 208253 Permit Number: PL -12 -13 -2820
Scheduled Inspection Date: May 07, 2014
Inspector: Diaz, Osvaldo
Owner: GORMAN, SEAN CHELSEA
Job Address: 372 NE 98 Street
Miami Shores, FL 33138-
Project: <NONE>
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Septic
Phone Number
Parcel Number 1132060135680
Contractor: SOUTHERN SEPTIC CONTRACTORS INC Phone: (305)598 -8266
comments
septic tank and drain
INSPECTOR COMMENTS False
Inspector Comments
Passed �/� CREATED AS REINSPECTION FOR INSP - 206648. SIDE WALK
EV REQUIRES REPAIR AT FqWSIDE FRONT OF PROPERTY
Failed
Correction ❑ �;
Needed
Re- Inspection ❑
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
May 06, 2014 For Inspections please call: (305)762 -4949 Page 8 of 34
Q �
\5-)j
Miami Shores village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
I Tel: (305) 795.2204 Fax: (305) 756.8972
V
INSPECTION'S PHONE NUMBER: (305) 762.4949
BUILDING
PERMIT APPLICATION
Permit Type: PLUMBING
JOB ADDRESS: 372 NE 98 ST
pry �
tcrr 12 pia
FBC 201
Permit No.
Master Permit N
City: Miami Shores County: Miami Dade gip; 33138
Folio/Parcel #: 11- 3206 - 013 -5680
Is the Building Historically Designated: Yes
NO X Flood Zone: N/A
OWNER: Name (Fee Simple Titleholder): CHELSEA GORMAN Phone#:
Address: 372 NE 98 ST
City: MIAMI SHORES State: FL Zip; 33138
Tenant/Lessee Name: N/A Phone #:
Email:
CONTRACTOR: Company Name: SOUTHERN SEPTIC Phone #: 305 598 -8266
Address: 1421 SW 153 PATH
City-
MIAMI State: FL zip; 33194
Qualifier Name: ROBERTO RODRIGUEZ Phone#: 305 598 -8266
State Certification or Registration #: SR 0021421 Certificate of Competency #:
Contact Phone#: 305 598 -8266 Email Address: robett rod @bellsouth.net
DESIGNER: Architect/Engineer: N/A Phone #:
Value of Work for this Permit: $ 2'0'01- O 0 Square/Linear Footage of Work:
Type of Work: ❑Address ❑Alteration ❑New ❑Repair/Replace
Description of Work: SEPTIC TANK AND DRAIN FIELD REPLACEMENT
Submittal Fee $ Permit Fee CCF $ CO /CC $
Scanning Fee $
Radon Fee $
DBPR $ Bond
❑Demolition
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE JY dU
Bonding Company's Name (if applicable) N/A
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable) N/A
Mortgage Lender's Address
city
State
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 t sense of such posted notice, the
inspection wil be rove a a reinspection fee will be charged.
Signature Signature
Owner or Aaent Con for
The foregoing instrument was acknowledged before me this
day of Ja W _, 20 a, by C�Aas °a cool 1d-y\,
who is personally known to me or who has produced
Z L F p L. As identification and who did take an oath.
NOTARY PUBBL
Si
Print:
$.34� p° Notery Public, State of Florida
Commission # EE 849817
APPROVED BY
The foregoing in ment w ackno ged b ore me this t t
day of C , 20 �, by �.
who is personally known to me or who has producedl f='
as identification and who did take an oath.
'� �• /7 Plans Examiner
Structural Review
(Revised3 /12/2012)(Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09)
NOTARY
Sign:
Print:
My Commission Expires:
r tuunrir /,
Zoning
W
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION PERMIT
Y. r
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: Chelsea Gorman
PROPERTY ADDRESS: 372 NE 98 St Miami, FL 33138
LOT: 4 BLOCK: 42 SUBDIVISION:
PROPERTY ID #: 11- 3206- 013 -5680
PERMIT #:13 -SC- 1510024
APPLICATION #: AP1129011
DATE PAID:
FEE PAID:
RECEIPT #:
DOCUMENT #: PR924492
[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 L 900 ] GALLONS / GPD New Septic Tank CAPACITY
A I 0 ] GALLONS / GPD CAPACITY
N I 0 ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [
D [ 300 ] SQUARE FEET
R [ 0 ] SQUARE FEET
A TYPE SYSTEM: [x]
I CONFIGURATION: [ ]
N
bed configuration drainfiel SYSTEM
SYSTEM
STANDARD [ ] FILLED [ ] MOUND [ ]
TRENCH [x] BED [ ]
F LOCATION OF BENCHMARK: F.F.E., 12.29' NGVD
I ELEVATION OF PROPOSED SYSTEM SITE [ 25.00][ INCHES FT ]( ABOVE BELOW BENCHMARK /REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 61.08 1 [FINCHEsT FT ][ABOVE BELOW BENCHMARK /REFERENCE POINT
L
D FILL REQUIRED: [ 0.00] INCHES EXCAVATION REQUIRED: [ 48.001 INCHES
New sewer line shall be permitted and inspected by the pertinent plumbing dept.
0 Inspector to verify the existing septic tank is properly abandoned before final approval.
T 'Invert elevation of drainfield to be no less than 7.70' NGVD.
H *Bottom of drainfield elevation to be no less than 7.20' NGVD.
*Install 12" of slightly limited soil under the bottom of drainfield.
E - Perimeter of excavation area shall be at least 2 ft. wider and longer than the proposed absorption bed or drain trench
R' ?HIS PERMIT IS NOT FOR "ADDITION(s) ".
SPECIFICATIONS BY:
TITLE:
APPROVED BY: ^ -_, -- J% TITLE: Dade CHD
DATE :ISSUED:. 12/13/2013 EXPIRATION DATE:
fl' i ?'Sr!ir. ! 'r.' - ' -�:.r, . •!�i r -.ti? •;�l•:�ti,�fTi rd
DH 4016, 08/09 (Obsoletes all previouWi6d!K -* t tt whiari .tG�.-i'%' ; bA,,,°u* "at the
Incorporated: 64E- 6.003, PAC ii67t3 rx ,i;;�i ii".i!)ti;'%i':n. ;'i[G+ w I inal f llroval, i"IC 00h
V 1.1.4 insPeE ;M ; i "! !! !,t ?ikkijj4uj1i0 1!onriq m-;' corll tA863
revults to the iziuinrii ..:t° tx`vtil;i:,elRrn - ubmifted. A
rein,:i:,acti;iq ¢eN t,. il? ilt' it the 01)ntractor IS iil:i
9t%IlE JUit; Ctti vl the
03/13/2014
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