PL-14-593Inspection Worksheet
Miami Shores Village
10060 N.E. 2nd Avenue MIMI Shores, FL
Phorte: (305)79S.2204 Fax: (305)766-8972
inspection Number INSP-209972 Permit Number: PL-3-14-693
Scheduled. Inspection Date: April 22, 2014 Permit Type: Plumbfitio - Residential
Inspector Diaz, Osvaldo
Inspection Type-
. Final
Owner. PENARANDA, JOSE Work Classification: $40C
Job Address: 777 NE 90
, Street
Mimi Shores, FL Phone Number
Parcel Number 1LI32MI423N
Projecti <NONE>
Contractor: MR CS PLUMBING & SEPTIC INC Phorw. (30$)$.$j-785$
Drain field Installation
FOe
inspector comments
Passed CREATED AS REINSPECTION FOR INSP-209686.
Failed
Q- LL
Correction
Needed
Re-inspection
Fee
NoA ' do"f*f Inspectims can be sdiediAled unit
re-Inspedon The is'paid.
April 21, 2044 For inspections please call.- (305 )782494q PaW flvf 33
�D IVISION OF
Environmental Health
orida Department of Health I°I�
D Miami Dade County Health Department ID
OSTDS/Weli DivisionO
11805 SW 26 St. • Miami, FL 33175
p � �'e" vim/ n/1� Date ��l
Insector�C 11 q
— x'11 W Q$ OSTDS #
Address
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
L=j
10
LU 14
RYA
Permit No. 22
Master Permit No.�� rS�J
OWNER: Name (Fee Simple Titleholder):.1 Cis a `1 m A ri_h, W L�A Phone#:I os - 5 2,1 " 3-15 b
Address: —1—In N r Ok Iq I-\& . S 'r
City: �A t COs ►.- k S\VN A �L State: _ Zip: 3
Tenant/I.essee Name:
Email:
JOB ADDRESS: 7 7 7 NE 9f '�-t
City: Miami Shores County: Miami Dade Zip: 351 3h
Folio/Parcel #:
Is the Building Historically Designated: Yes NO r Flood Zone:
CONTRACTOR: Company Name: Ar 615 �U ,s. Phone#:
Address: uj a
City: &lcwc State: Zip:c3' %�
Qualifier Name: Phone#:
State Certification or Registration #: sKW) 6 j6 Certificate of Competency #:
Contact Phone#: Email Address:
DESIGNER: Architect/Engineer: Phone#:
Value of Work for this Permit: $ i 9 6_._ Square/Linear Footage of Work:��
Type of Work: ❑Address []Alteration ❑New i2lkepair/Replace ❑Demolition
Description of Work: ,
Submittal Fee '9 C_'5Z) Permit Fee $
Scanning Fee $ Radon Fee $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
CCF $ CO /CC $
DBPR $ Bond $
Technology Fee $
TOTAL FEE NOW DUE $� 6 l J
M6
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 a of such posted notice, the
inspection will not be approved andddispection fee will be charged. _
Signature Signature
O er or gent Contractor
The foregoing instrument was acknowledged before me this '
day of , 20 �by J4. 3%a4-4 4 ,
who is personally known to me or who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
APPROVED BY
KEMPLE EMICK
Notary Public - State of Florida
My Comm. Expires Sep 19, 2017
_ _', Commission & FF M47A9
The foregoing instrument was acknowledged before me this
day of FM&AAS1 , 20 +, by I i'T'K
who is personally down to me or who has produced
5'."50 Plans Examiner
Structural Review
(Revised 07 /10 /07)(Revised 06 /1=009)(Revised 3/15/09)
identification and who did take an oath.
NOTARY PUBLIC:
Sign: ' ZI
Print:
Pubt�
My Co s: " .'eStteryl ft EE0 7613
'� g�irq 10/1312014
Zoning
Clerk
Rt *P
REPAIR
:11A s OFCFLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION PERMIT
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: Jose Penaranda
PERMIT #:13 -SC- 1528153
APPLICATION #: AP1140238
DATE PAID:
FEE PAID:
RECEIPT #:
DOCUMENT #: PR933842
PROPERTY ADDRESS: 777 NE 98 St Miami, Fl- 33138
LOT: 2, 3 BLOCK: 71 SUBDIVISION: Miami Shores Sec 3
PROPERTY ID #: 11- 3206 - 014 -2380 [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
T I 900 l GALLONS / GPD Septic CAPACITY
A I 0 ] GALLONS / GPD CAPACITY
N [ 0 l GALLONS GREASE INTERCEPTOR CAPACITY [MAXn4UM CAPACITY SINGLE TANK:1250 GALLONS]
K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ ]
D [ 300 ] SQUARE FEET Bed configuration drainfiel SYSTEM
R [ 0 ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [x] STANDARD [ ] FILLED [ ] MOUND I l
I CONFIGURATION: [ ] TRENCH [x] BED [ l
N
F LOCATION OF BENCHMARK: FFE 10.8' NGVD
I ELEVATION OF PROPOSED SYSTEM SITE 1 9.60 ][INCHES FT ][ ABOVE A BELOW1 BENCHMARK /REFERENCE POINT
E BOTTOM OF DRAINFIE14D TO BE [ 44.64 ][ INCHES FT ][ABOVE BELOW BENCHMARK /REFERENCE POINT
L
D E
O
T
H
E
R
J.A,b kV';WU.LkWjj: L U.UUJ IMUnsu EXUAVATIUN XzWU1ArW- L 41.UUJ JU49=50
1: Existing 900 gal. septic tank, certified by "Mr C's Plumbing and Septic" on 3/19/2014 to remain.
2.- Install 300 sf of drainfield in bed configuration.
3.- Install 12" of slightly limited soil at the bottom of the drainfield.
4.- Perimeter of excavation area shall be at least 2 ft wider and longer than the proposed absorption bed or drain trench.
5.- (Comments Continued on Page 2.)
SPECIFICATIONS BY: Kemble Ettrick TITLE:
APPROVED BY: TITLE: Engineering Specialist II Dade CHD
Betsy Lange- OJ,mino
DATE ISSUED: 03/21/2014 EXPIRATION DATE: 06119/2014
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E- 6.003, FAC The contracto Page 1 of 3
� i nee i q
v 1.1.4 AP1140238 boring adjacent to the d,ragnfield exca ationtatR he t time of final
inspection. Prior to Final Approval, the FDOH inspector shall
witness the soil boring and compare the results to the original
site evaluation submitted. A reinspection fee will be assessed
if the contraster ir. not at the jobtit.a at the arranged time.