PL-14-1242S,1L®,viz(Ldp.j�.EM
Miami Shores Village,,fj
Building Department M1-22014
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (M) 70_4
BUILDING
PERMIT APPLICATION
❑BUILDING ❑ ELECTRIC ❑ ROOFING
FBC 20i®
Master Permit No. Z2 Z / �� f
Sub Permit No.
❑ REVISION ❑ EXTENSION MRENEWAL
®PLUMBING ❑ MECHANICAL OPUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
T CONTRACTOR DRAWINGS
JOB ADDRESS: / 106 /0;( 5f
Occupancy Type: load:
OWNER: Name (Fee Simple
1 d U Is the Building Hist ft meted: Yes
Construction Type: Flood Zone: BFE: _
NO .-
FFE:
Y- X67 3375
City: 04 -Am. , f' State: 14rG Zip: 33
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: 40i C/1 �Gt/ /` Phone#:
Address: l#17!2 AIAV Jr
'j
City: A41 State: L Zip: 3✓?/ ` f
Qualifier Name: /`i �J�IlY2Phone#:
State Certification or Registration #: & �G1'� �� Certificate of Competency #:
DESIGNER: Architect/Engiieer: Phone#:
Address: city: State: Zip:
Value of Work for this Permit $ A h2- GCS Square/Linear Footage of Work:
Type of Work: ❑,�d, on ❑ AIVration ❑ New RI Repair/Replace ❑ Demolition
Description of Work:
Specify color of color thru tile:
Submittal Fee $ Pem*. Fee $ 0�7 � 02, CCF $ to/CC $
Scanning Fee $ Radon Fee $ DSPR $
Notary $
Technology Fee $ TrainhWEducation Fee $ Double Fee $
Structural Revlews $ Bond $
TOTAL FEE NOW DUE $
(Renised02/24/2m4)
r
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name Jif applicable)
Mortgage Lender's Address
City / State
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.
NWARNING 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 budding permit with an estimated value exceeding $25tr11, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be dernrered 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)after the budding permit Is sued. In the absence of such posted notice, the
inspection will not be rove nd a rei fee will be charged
Signature Signature
AGENT
The foregoing instrument was acknowled#d before me this The foregoing instrument was acknowledged before me this
day of 501V (7 20 14 • by 1_ day of A) C— . 20 1 by
who is personally known to v-" who is personally known to
me or who has produced
identification and who did take an oath.
NOTARY PUBS:
77
as me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
APPROVED BY Pians Examiner Zoning
(R tla2/24/2M4)
Structural Review Clerk
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM
CONSTRUCTION PERMIT
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: Dark Rushing
PROPERTY ADDRESS: 1351 NE 102 St Miami, FL 33138
PERMIT #:13 -SC -1541398
APPLICATION #: API 148573
DATE PAID:
FEE PAID:
RECEIPT #:
DOCUMENT #: PR941243
LOT: 3 BLOCK: 4 SUBDIVISION: Miami Shores Bay Park Estates
PROPERTY ID #: 11-3205-023-0170 [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 [ 750 I GALLONS / GPD existinq septic tank CAPACITY
A [ ] GALLONS / GPD CAPACITY
N I ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [
D [ 200 I SQUARE FEE'
R [ ] SQUARE FEE'
A TYPE SYSTEM: [X]
I CONFIGURATION: [ ]
N
bed configuration drainfiel SYSTEM
SYSTEM
STANDARD [ ] FILLED [ ] MOUND [ ]
TRENCH IX] BED [ I
F LOCATION OF BENCHMARK: crown of road NE 102 St. 5.6' NGVD
I ELEVATION OF PROPOSED SYSTEM SITE [ 8.40 ][INCHES FT ][ABOVE BELOW]BENCHMARK/REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 24.60][ INCHES FT IIABOVE /L BENCHMARK/REFERENCE POINT
L
D FILL REQUIRED: [ ] INCHES EXCAVATION REQUIRED: [ 45.001 INCHES
O
T
H
E
R
1. -Existing 750 gal. septic tank, certified by Mr. C's Plumbing & Septic on 05/29/2014, to remain.
2. -Install 200 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. -Invert elevation of drainfield to be no less than 4.05' NGVD.
6. -Bottom of drainfield elevation to be no less than 3.55' NGVD.
(Comments Continued on Page 2.)
SPECIFICATIONS BY: KEMBLE ETTRICK
APPROVED BY:
Erlande Cmisca
TITLE:
TITLE: Engineering Specialist II
Dade CHD
DATE ISSUED: 06/03/2014 EXPIRATION DATE: 09/01/2014
DE 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E-6.003, FAC Page 1 of 3
v 1.1.4 AP1148573 SE930175
DOCMff.NT #: PR941243
The system is sized for 2 bedrooms with a maximum occupancy of 4 persons (2 per bedroom), for a total estimated flow of
400 gpd.
"THIS REPAIR PERMIT IS NOT FOR ANY ADDITIONS`
NOTICE OF RIGHTS
A party whose substantial interest is affected by this order may petition for an
administrative hearing pursuant to sections 120.569 and 120.57, Florida Statutes. Such
proceedings are governed by Rule 28-106, Florida Administrative Code. A petition for
administrative hearing must be in writing and must be received by the Agency Clerk for the
Department, within twenty-one (21) days from the receipt of this order. The address of the
Agency Clerk is 4052 Bald Cypress Way, BIN # A02, Tallahassee, Florida 32399-1703. The
Agency Clerk's facsimile number is 850-410-1448.
Mediation is not available as an alternative remedy.
Your failure to submit a petition for hearing within 21 days from receipt of this order
will constitute a waiver of your right to an administrative hearing, and this order shall become
a 'final order'.
Should this order become a final order, a party who is adversely affected by it is
entitled to judicial review pursuant to Section 120.68, Florida Statutes. Review proceedings
are governed by the Florida Rules of Appellate Procedure. Such proceedings may be
commenced by filing one copy of a Notice of Appeal with the Agency Clerk of the
Department of Health and a second copy, accompanied by the filing fees required by law,
with the Court of Appeal in the appropriate District Court. The notice must be filed -within 30
days of rendition of the final order.
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-214138 Permit Number: PL -6-14-1242
Scheduled Inspection Date: August 19, 2014 Permit Type: Plumbing - Residential
Inspector: Diaz, Osvaldo
Inspection Type: Final
Owner: RUSHING, DERK Work Classification: Septic
Job Address: 1351 NE 102 Street
Miami Shores, FL 33138- Phone Number (305)607-3375
Parcel Number 1132050230170
Project: <NONE>
Contractor: MR C'S PLUMBING & SEPTIC INC Phone: (305)651-7859
dunding uepartment comments
SEPTIC TANK AND DRAIN FIELD INSTALLATION Infractio Passi
INSPECTOR COMMENTS False
Inspector Comments
Passed
Failed
Correction ❑
Needed
Re -Inspection ❑
Fee
No Additional Inspections can be scheduled until
re -inspection fee is paid.
August 18, 2014 For Inspections please call: (305)762-4949 Page 8 of 27
«� DIVISION OF
Environmental Heatth
``�O Florida Health A
`� Miami -Dade County �O
QQ�0 OSTDS/Well Division G
11805 SW 26'" Street • Miami, FL 33175 IO
I�
Inspector (`� Mil 1 Date-b
Address , 1 1 (� OSTDS #
Comments:
v
Signature