PL-14-1425 (2)Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
inspection Number: INSP-215282 Permit Number: PL -7-14-1425
Inspection Date: August 13, 2014 Permit Type: Plumbing - Residential
Inspector: Diaz, Osvaldo
Inspection Type: Final
Owner: BOURNE, ROBERT Work Classification: Septic
Job Address: 490 NE 101 Street
Miami Shores, FL 33138-2449 Phone Number
Parcel Number 1132060170430
Project: <NONE>
Contractor: ALLSTATE DIVERSIFIED ENGINEERING INC Phone: (305)256-0306
Buildinia Department Comments
SEPTIC TANK AND DRAIN FIELD
Infractio Passed Comments
INSPECTOR COMMENTS False
Inspector Comments
Passed
Ef
HRS IN FILE
Failed
Correction
Needed
e0
Re -Inspection
�i r ----.I.
Fee
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r
I� �
No Additional Inspections can
be scheduled until
re -inspection fee is paid.
For Inspections please call: (305)762-4949
August 13, 2014 Page 1 of 1
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BUILDING
PERMIT APPLICATION
Mid1111 JI IUI CJ V IIIdgC .K !;Ch;1 `I--
Building Department JUL 022814
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY:
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION UNE PHONE NUMBER: (30S) 762-4949
FBC 200
Master Permit No.RL / �/ , /dq �—
Sub Permit No.
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION [:]SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: -4qO AIE /0/ ..%$
City: Miami Shores County: Miami Dade Zip: 33138
Folio/Parcel#: I l - 3oZt3Gc - Q 17 - DIs the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder):. ab rfi 80 -aa) Phone#:
Address:_ 4gi) lJ f Ol
City: 0�,Cnl State: i— i s Zip: 33 i bxg
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: `C Phone#: .3Cl57 QG87r1a1`7
Address: aS C -U3 1 A h&2 -
City: 6\&M SAO -A S�. State••to Zip: 43[ 3 2
Qualifier Name: clUt 1 lQ i Mb !r l 14 �(' Phone#: 30S` a t 3
State Certification or Registration M
of Competency M
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ /. 02. Square/Unear Footage of Work:
Type of Work: Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work:
Specify color of color thru tile:
Submittal Fee $ Permit Fee $ /� �'`i CCF $ CO/CC $
Scanning Fee $
Radon Fee $ DBPR $ Notary $
Technology Fee $ Training/Education Fee $
Structural Reviews $ _
Double Fee $
Bond $ sem®
TOTAL FEE NOW DUE S
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
Zip
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 ELECTRIC, PLUMBING, SIGNS, POOLS,
FURNACES, BOILERS, HEATERS, TANKS, 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 elivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement my4t bV posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absen �Ach posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature
OWNER r AGENT
The foregoing instrument was acknowledged before me this
n�� day of �.J O r . 20 1 � . by
1� 0t- JbU ('(\I? . who is personally known to
me or who has produced
as
The foregoing instrument was acknowledged before me this
2 day of :S"q 20 I , by
C wh rsae� c n to
me or who has produced as
identification and who did take an oath. identification andwh djd take an oath.
NOTARY PUBLIC: NOTARY PUBLIC: I
Print:
• ' : OSCAR RESW
Seal: .. IN COMMISSION # EE 012830
EXPIRES: July 28, 2014
barn Thru Nobipr Public Ummran
Print:
Seal: 'fir" SARIMABA113TA
g MY COMMISSION # EE 873354
2017
BorAw Thm i Pufc Uwmbrs
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APPROVED BY Z.r/ 31' Z'/`'rPlans Examiner
Zoning
Structural Review Clerk
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION PERMIT
CONSTRUCTION PERMIT FOR: OSTDS New
APPLICANT: Robert Boume
PERMIT #:13 -SC -1535730
APPLICATION #: AP 1145065
DATE PAID:
PEE PAID
RECEIPT #•
DocumNr #: PR942207
PROPERTY ADDRESS: 490 NE 101 St Miami, FL 33138
LOT' i= 1 BLOCK: 90 SUBDIVISION:
PROPERTY ID: 11-3206-017-0430 (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 TIMM. 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 I 900 1 GALLONS / GPD Septic CAPACITY
A [ I GALLONS / GPD N/A CAPACITY
N I ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
X t ] GALLONS DOSING TANK CAPACITY [ ]GALLONS 0 ]DOSES PER 24 HRS #Pumps [:
D I 375 ] SQUARE FEET Trench configuration drain SYSTEM
R t ] SQUARE FEET N/A SYSTEM
A TYPE SYSTEM: (x] STANDARD [ ] FILLED [ j MOUND
I CONFIGURATION: (x] TRENCH ( ] BED I 1
N
F LOCATION OF BENCHMARK: CL NE 101 St., 10.22 NGVD
I ELEVATION OF PROPOSED SYSTEM SITE 14.80 1
E BOTTOM! OF DRAINFIELD To BE ( 34.80 1
L
D F
0
T
H
E
R
FT 1[ABOVE BELOWBEMICHMARK/REFERENCE POINT
FT ] [ ABOVE fBELOW .BENCHM1ARK/REFERENCE POINT
1,.,. 1fZWVjF.=: [ 0.00 ] INCHES EXCAVATION REQUIRED: [ 72.00 ] INCHES
'Invert elevation of drainfield to be no less than 7.82' NGVD.
'Bottom of drainfield elevation to be no less than 7.32' NGVD.
The system is sized for 2 bedrooms with a maximum occupancy of 4 persons (2 per bedroom), for a total estimated flow
of 300 gpd.
The licensed contractor installing the system is responsible for installing the minimum category of tank in accordance with
s. 84E-6.013(3)(0, FAC:
SPECIFICATIONS BY: GUILD' SUAREZ TITLE:
APPROVED BY: TITLE: Dade CHD
oe xoaz
DATE ISSUED: 06/1 01 EXPIRATION DATE: 12/12/2015.
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E-6.003, FACPage 1
„Tp.elcpntractor (or designoy4j Wed to perform a SE931074:
soil boring adjacent to the drainfield excavation at the
time of final Inspection. prior to Final Approval, the DOH
Inspector shall witness the soil boring and compare the
results to the original site evaluation submittedA
reinspection fee will be assessed if the contrarfinr fc n„a
ONE
i� M15,
AF
kYz
ISSUED: OaM2014 DISPLAY AS REQUIRED BY LAW SEQ# L1406250000905
ISSUED: 06/25/2014 DISPLAY AS REQUIRED BY LAW SEQ # L1406260000756
RICK SCOTT, GOVERNOR
KEN LAWSON. SECRETARY
ISSUED: 06/25/2014 DISPLAYAS REQUIRED BY LAW SEQ# L1406250000960