PL-14-191Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number. I NSP- 210303
Permit Number: PL -1 -14 -191
Scheduled Inspection Date: July 02, 2014
Inspector: Diaz, Osvaldo
Owner: TELESCO, THOMAS AND REBECCA
Job Address: 86 NE 109 Street
Miami Shores, FL 33161-
Project: <NONE>
Contractor A AMERICAN SEPTIC & PLUMBING
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Septic
Phone Number (305)751 -1786
Parcel Number 1121360110330
Phone: (305)866 -5600
Building Department Comments
SEPTIC TANK REPLACEMENT EXISTING Collapsed
Infractio
Passed Comments
INSPECTOR COMMENTS
False
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
CREATED AS REINSPECTION FOR INSP - 206495. HRS REQUIRED
07/01/2014 - HRS IN FILE
July 01, 2014
For Inspections please call: (305)762 -4949
Page 6 of 31
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION INSPECTION AND FINAL APPROVAL
APPLICANT: Thomas Telesco
AGENT: A American Septic
PROPERTY ADDRESS:
LOT: 1
APPLICATION ;i : P1 -a 32038
PERM # : 1 3 wC- 1515234
DOCUMENT # :FI943912:_ .
DATE PAID: 02/18/2014 -
nrt
86 NE 109 St Miami, FL 33161
BLOCK: 215
SUBDIVISION: Dunnings Miami Shores Ext No 7 ID #: 11- 2136- 011 -0330
CHECKED [X] ITEMS ARE NOT IN COMPLIANCE WITH STATUTE OP``''
TANK
[01]
[02]
[03]
[04]
[05] OUTLET FILTER Tuf-Tite
INSTALLATION
TANK SIZE [1]
TANK MATERIAL
OUTLET DEVICE
MULTI - CHAMBERED
1350.00 [2]
Concrete
[I Y
[06] LEGEND 1. 28- 015 -05DC3
(07]
[08]
[09]
WATERTIGHT
LEVEL
DEPTH TO LID
N
DRAINFIELD INSTALLATION
[10] AREA [1] 435 [2]
(11] DISTRIBUTION BOX
[12] NUMBER OF DRAINLINES
[13] DRAINLINE SEPARATION
[14] DRAINLINE SLOPE
[15] DEPTH OF COVER
[16] ELEVATION [ ABOVE / BELOW
[17] SYSTEM LOCATION
[18] DOSING PUMPS
[19] AGGREGATE SIZE
[20] AGGREGATE EXCESSIVE FINES
[21] AGGREGATE DEPTH
2.
SOFT
HEADER X
1. 4.00 2.
FILL
[22]
[23]
[24]
125]
[26]
Comments:
/ EXCAVATION MATERIAL
FILL AMOUNT
FILL TEXTURE
EXCAVATION DEPTH
AREA REPLACED
REPLACEMENT MATERIAL
Comments are on page 2.
] BM 60.36
SET'
[27
[2€
I
CONSTRUCTION
FINAL SYSTEM [ /
DISAPPROVED
(Explanation of Violations on following page)
APPROVED
DISAPPROVED I:
APPROVED
Engineer S
fat
[47] cOUTRACTCA William i;s Vioodard (h AMER
[48] OTHER ADS ARC 24
ABANDONMENT
[49] TANK PUMPED 02/2F/2014
[50] TANK CRUSHED & FILIW:D
02/25/2014
JOa >ph R Piverger (Department of Health in Dade Cou
9n PLO. I /"
r.—
Dade CHD DATE: 02/25/2014
DH 4016, 08/09 (Obsoletes all previous editions
Incorporated: 64E- 6.003, FAC
EH Database v 1.0.1
z
Dade
)7,7,i;;40:4-77,7 en • 'ea
o be used)
EID1616234
CHD - • DATE : 02/25/2014
ade Co
Page 2 of 3
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 No. /�
Master Permit No. P ! 1 L/ /9/
Permit Type: PLUMBING
JOB ADDRESS: (J(/ WE tog CT * A De Miami L
City: Miami Shores County: V N DeMiami Dade Zip: 33 6 (
Folio/Parcel #: IS 2131— 011'. 0330
Is the Building Historically Designated: Yes NO 36 Flood Zone: 1"/ /A
OWNER: Name (Fee Simple Titleholder): DIY �S I �i1(,S co t W Phone#: j t c.f.- �
1
Address: $� t04ST
City: VI • %WS State: Zip: 3ik tp
Tenant/Lessee Name:
Phone #:
Email:
CONTRACTOR: Company Name: " l ( teln t' t Phone#: 3 l J
Address: % orcwpete 014A .0 ell,'
City: IN tl £ A MM h State: ft. Zi`p: 1 [p�g� .�t�
Qualifier Name: f l 1 t t il� Alb b . Phone 3 D1O —O
State Certification or Registration #: S MOO 44 Certificate of Competency #: 5 00013 yZ
Contact Phone#: QQ Email Address:
DESIGNER: Architect/Engineer: 0 I l' Phone#:
Value of Work for this Permit: $ Z M Square/Linear Footage of Work: r % A
Type of Work: ❑Address ❑Alteration UNew \Repair/Replace ODemolition
Description of Work:
c % iVrotP1" rglxce m f maul to UaSp.
0 n v1 0 5 ? .ev1.
********** * *** * * * * * * * * * * * * * * * * * * * * * * * ** Fees************* * * * * * * * * * * * * * * * ** * * * * * * * * * * ** **
Submittal Fee $ SC) 'DU II Permit Fee $ #fcCA" CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $ ._,
Double Fee $ Structural Review $
TOTAL FEE NOW DUES.,
Bonding Company's Naine (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 cif 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 AI'i'IDAVIT: 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.
Signa
Owner or Agent 0 , Contractor
The foregoing instrument was acknowledged before me this 0 The foregoing instrument was acknowledged before me mee thiss ��
day of 6i1(� , 20 , by 1A P.�D�P —C� C� �� &5 C of !r • ! 20 ' by T. al wed hMOOk
y � L4.. y
e or who has produced who is personally known to me or who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission - pires:
as identification and who did take an oath.
J NNIFER MORALES
4 Commission # FF 77775
�garmr4 My Commission Expires
December 18, 2017
•
APPROVED BY Ca. °
Plans Examiner
Structural Review
(Revised3 /12/2012)(Revised 07 /10/07)(Revised 06 /10 /2009)(Revised 3/15/09)
NANCY GOLORIN0
MY COMMISSION # EE 860780
EXPIRES: February 15, 2017
Zoning
Clerk
REPAI
M'.a,Ml -DADE COUNTY HEALTH DEPARTS '
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION PERMIT
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: Thomas Telesco
PERMIT # :13 -SC- 1515234
APPLICATION #: API 132038
DATE PAID:
FEE PAID:
RECEIPT #:
DOCUMENT #: PR927871
PROPERTY ADDRESS: 86 NE 109 St Miami, FL 33161
LOT: 1 BLOCK: 215
PROPERTY ID #: 11- 2136-011 -0330
SUBDIVISION: Dunnings Miami Shores Ext No 7
[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 [ 1,200 ] GALLONS / GPD septic tank CAPACITY
A [ ] GALLONS / GPD CAPACITY
N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ l
D [ 400 ] SQUARE FEET existing bed drainfield SYSTEM
R [ ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [x] STANDARD [ ] FILLED [ ] MOUND
I CONFIGURATION: [ ] TRENCH [x] BED [ l
N
F LOCATION OF BENCHMARK: FFE 12.9' NGVD
I
E
L
D
O
T
H
E
R
SPECIFICATIONS BY:
APPROVED BY:
DATE ISSUED:
ELEVATION OF PROPOSED SYSTEM SITE
BOTTOM OF DRAINFIELD TO BE
FILL REQUIRED:
[ 2.10 ] [ INCHES 4I r 1 P [ ABOVE /) BELOW b BENCHMARK /REFERENCE POINT
[ 6.10 ] [ INCHES 4 FT l [ ABOVE 4 BELOW b BENCHMARK /REFERENCE POINT
] INCHES EXCAVATION REQUIRED: [ 0.00 ] INCHES
"" Inspector to verify that sidewalk over existing drainfield to be permanently removed and not replaced.
1.- Install a 1200 gal min. septic tank with an approved filter.
2. -The licensed contractor installing the system is responsible for installing the minimum category of tank in accordance
with s. 64E- 6.013(3)(f), FAC.
3. -The existing drainfield may remain if the system was previously permitted and approved, and not currently in failure,
and meets the setback requirements of Table V Ch 64E-6 FAC. (Comments Continued on Page 2.)
William Woodard
Erlaade Omisoa
01/24/2014
TITLE:
TITLE: Engineering Specialist II
Dade CID
EXPIRATION DATE: 04/24/2014
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
a
Incorporated: 64E - 6.003, FAC The contractor (or designee) is require to e per l orm f3 a soil
v 1.1.4 AP7132038 boring adlniAtit the drainfield excavation at the 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 relnspection fee will be assessed
if the contractor is not at the Jobsite at the arranged time.
STATE OF FLORIDA
DEPARTMENT OF HEALTH
APPLICATION FOR CONSTRUCTION PERMIT
Permit Application Number
PART II SITEPLAN
Each block re resents 10 feet and 1 inch = 40 feet.
.:',*1■111•10"1"• log issommiommoons.
411111111MMONIMMIIIIIIIIMMIIIIPIIIMINIImemmilla111111PNIS ammommummi
jammiammuramagiaasuiseirammumnimasill11111111111111111111111
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.1111r.211111C. MIME 111111111r1larlitIPM.T. r R1N44,4''''
liEliagaillIMIIIIMEMONEMEM211160-
1111.1111111111111111111111116111111N11111111111111111111101111111111111111
lull. III! 3EE II muhuului
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likiN1111111111111111110110.13Z21111111111V111111.111111111111111111111111
11111111111111111111SEMPRIZCZEMI111111mat1mosamm.
1111111141111111==111111ETECEEIE1rienimminmi
11111111111111111111111111111111111111111111111111111M111611111111111111111111
11111111111M1111111111111111111111111111111111111111.E111511111111111111111111111
1111111111111111111111/FM1110111111111111111111111111MMIIIIIIIIIIIIIIIIII
•u. ,up PIlUUNlUll IlillUlli
11111iiiiiiiillIMA1IMIIIIIIIIIIMII13111111111111111111111111111111
.11111111111111111:111111111041111111111111111111111111111111111:111111111111111111111111
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11111111111111111111110,1111111111111111111111111111111111111102111111111111111111111111111
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WOK
• • •- • Ae. --,..1191 • Io
otes:
.6--atfi-N-AetA •3
ite Plan submitted by:
Ian Approved
47,3 + %L.C.Or f>ra16-114
Not Appro
Date
County Health Department
ALL CHANGESMUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
I 400.48109 (Obsaletes previous editions letdcb may not be used) lacomerated: 8464.001, FAC
Page 2 of 4
FLORIDA DEPARTMENT OF HEALTH
CERTIFICATE OF AUTHORIZATION
HEALTH SEPTIC TANK CONTRACTING
The Florida Department of Health hereby certifies the business or entity named below has satisfied the
requirements of Part III, Chapter 489, Florida Statutes, for septic tank contracting and has been duly authorized
by the Department to provide septic tank contracting services under the name of:
March 29, 2013
Authorization Number
Registered Septic Tank Contractor
SR0001342
WILLIAM M WOODARD
12555 BISCAYNE BLVD. #970
NORTH MIAMI FL 33181-
A AMERICAN SEPTIC & PLUMBING.
INC.
Business Authorization: SA0000947
Registration Expires on September 30, 2014
2014 details - Business Tax Account A AMERICAN SEPTIC & PLUMBING INC - Tax... Page 1 of 1
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When entering your name and address on the payment form, please do not enter any special characters such as
#,or &.
2014 Details — Business Tax Account A AMERICAN SEPTIC & PLUMBING INC
Business Tax Account #4231718 0 Account details rri Account history
2014 I 2013 I 2012
2011 f 2010
Paid
Paid
Paid
Account number: 4231718
Business start date: 02/01/2000
Business address: A AMERICAN SEPTIC &
PLUMBING INC
1990 NE 163 ST 104
NORTH MIAMI BEACH, FL 33160
Physical business location: NORTH MIAMI BEACH
Receipts And Occupations
Paid
Paid
Owner(s): A AMERICAN SEPTIC &
PLUMBING INC
C/O WILLIAM M WOODARD
PRES
12555 BISCAYNE BLVD 970
NORTH MIAMI, FL 33181
Mailing address: A AMERICAN SEPTIC &
PLUMBING INC
C/O WILLIAM M WOODARD
PRES
12555 BISCAYNE BLVD 970
NORTH MIAMI, FL 33181
Flags: 7 NSF hold
lir Print account application
(PDF)
Receipt 4418836
Paid 2013 -10 -25 $45.00
Effective 2013 -09 -30
Contracting 10/01/2013— NAICS code: Receipt #TXHS1 -14- 002851 Print
SPECIALTY PLUMBING 09/30/2014 238220 this bill
CONTRACTOR Units: 1
Additional documentation required: SEP000947 State /County License or Certificate
,f
https: / /www.miamidade.county- taxes. cone /public/business_tax/accounts /4231718 1/31/2014
02/12/2014 1:18 PM
.o' � .:'R ,1415 .r*.'
Fax Services
13057568972
®1
AAMER•1 OP €D: MW
CERTIFICATE OF LIABILITY INSURANCE P`h? t64( e1 trYf
02112/201=4
THIS CERTIFICATE IS ISSUED AS A NIATTFR OF INFORMATIMi ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. TIN
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED SY THE POumES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: if the certificate holder is an ADDITIONM.. INSURED, the yattlietlr;•srsl rnitst �xr entiorserl It SUBROGATION IS WAIVED, subject to
irse Pewits and rsettlitioras of the p Ecy. ccrtein ptIticIea snag require an ers forsentent. A statement on this eettiffiesste (1cu. not confer rights to the
sonlifisastet holder in flees of such endsors:ernentls3.
PROCg3t:sn
Insistence Motet PIatr n Lie
2401 SW College Rd Suite 3
Ocala, FL 344
BARTOW
tusur 8T3 A American Septic and Plumbing
126E5 Si cayne Bud Ste BM
North Mierssi, FL 33181
BARTOW
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COVERAGES CERTIFICATE NUMBER; REVISION NUMBER:
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L. M5E:AUE • ^cY iCY3.Irs9£i I 800,00
RTIFICATE HOLDER
•• CANCEL TIGIII
MIAMISH
1i11i>IMI Shores Village
Building Department
10050 NE 2nd Ave
SP£OU*.Q ANY CW Tit 3I MOVE DESCRIBED POLICIES SE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF. NOME PALL, se DE£.EXEREI) IN
1', s.C:ORDAP3cE WITH THE POLICY PRiovISIOue.
AVYMPrZatIREPRPSSAFFAVE
Miami Shores Village, FL. 33135 ...T./4.00,4(144X `4%Aria& eeaeer.
Cy 10854010 ACORD CORPORATION. All rights reserved,
The ACORD name and logo are rsgistemd sharks of ACORD
AC`ORD 28 am up
Total Due: $122.70 II
Invoice
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138 -0000
Phone: (305)795 -2204 Fax: (305)756 -8972
For Inspections please call: (305)762 -4949
Pteturn to:
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138 -0000
Bill To 1
THOMAS AND REBECCA TELESCO
86 NE 109 Street
MIAMI SHORES, FL 33161 -7040
Date
01/31/2014
01/31/2014
01/31/2014
01/31/2014
01/31/2014
01/31/2014
01/31/2014
01/31/2014
Fee Name
Bond Type - Owners Bond
Technology Fee
DCA Fee
Scanning Fee
CCF
Permit Fee
Education Surcharge
DBPR Fee
Invoice Number: I1+4.6
Invoice Date: J -
Permit Numbe
Bond Number:
Comments:
Fee Type
Fixed
Calculated
Calculated
Calculated
Calculated
Percentage
Calculated
Calculated
Fee Amount
$500.00
$1.60
$2.25
$15.00
$1.20
$150.00
$0.40
$2.25
Total Fees Due:
$672.70
Payments
Date Pay Type Check Number Amount Paid Change
01/31/2014 Check 1018 $50.00 $0.00
01/31/2014 Check 1151 $500.00 $0.00
Total Paid: $550.00
Friday :January 31, 2014