PL-14-1223Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number. INSP-222953 Permit Number: PL -6-14-1223
Scheduled Inspection Date: November 18, 2014 Permit Type: Plumbing - Residential
Inspector. Diaz, Osvaldo
Inspection Type: Final
Owner: JENNINGS, LORRAINE Work Classification: Drainfield
Job Address: 149 NW 107 Street
Miami Shores, FL 33150 -
Phone Number
Project: <NONE> Parcel Number 1121360100120
Contractor: STATEWIDE SEPTIC CONNECTIONS Phone: (954)963-0082
Building Department Comments
REPLACE DRAIN FIELD
INSPECTOR COMMENTS False
Inspector Comments
Passed CREATED AS REINSPECTION FOR INSP-213961. HRS IN FILE
no plans no permit
Failed
Correction
Needed
Re -Inspection ❑
Fee
No Additional Inspections can be scheduled until
re -inspection fee is paid.
November 17, 2014 For Inspections please call: (305)762-4949 Page 23 of 46
Y� .
BUILDING
PERMIT APPLICATION
Miami Shores Village
k.:.
Building Department JUIN 112014
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY '14
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (30S) 762-4949
FBC ioio
Master Permit No.
Sub Permit No.
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
APLUMBING ❑ MECHANICAL F-1 PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: d 7? ti� ZG i S 7
Citv.#KMiami Shores Countv: Miami Dade lin: -33169
Folio/Parcel#: I (' 2.�,�f� " 1® ®I Is the Building Historically Designated: Yes NO
Occupancy Type: Load:
* OWA
Addr
City:
Construction Type: Flood Zone: BFE: FFE:
Tenant/Lessee Name: Phone#:
Email
CONTRACTOR: Company Name: 3'i -I rw i de,Srptc Cosi ei e C"i ' ria Ph 1— 3
Address: 13640 NDN A
City: CSC State: Zip:
Qualifier Name: ,,r4' ® ) Phone#:
State Certification or Registration M
of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
ry
Value of Work for this Permit: $ aG 16 d Square/Linear Footage of Work: -300
Type of Work: ❑ Addition ❑ Alteration ❑ New [KRepair/Replace ❑ Demolition
Description of Work:
Specify color of color thru tile;
Submittal Fee $,
Scanning Fee $
Permit Fee $ _
Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $
(Revised02/24/2014)
CCF $ CO/CC $
DBPR $
Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $ l I q .
NO
Bonding Company'' Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
Zip
City State zip
R
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 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,Rpproved andlWeinspection fee will be charged.
Signat �Vz���Signature - _ _
OW or AGENT CONTRACTOR
ri
The foregoing instrument was acknowledged before me this The foregoira instrument was acknowledged before me this
J day of L X12 2014" , by --� day of ,� C,4 —� , ZO % by
who is personally known to le/r, ,-_ personall k wn to
me or who has produced '11`j �v l i��' as me or who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign:
Print:
_.•TERESA J SOLOMON
Seal: -�• *_ MY COMMISSION # EE131935
EXPIRES November 08, 2015
(407)1"-015a FWftNorery8erv1ae.00m
Print:
,r'tirYT
�1rt I%%
Notary Public State of Horde
Joanna M FeIIClanO
My Commission FF 082753
01f1212018
_ �xpites
APPROVED BY Plans Examiner
Structural Review
(Revised02/24/2014)
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Zoning
Clerk
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION PERMIT
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: Anthony Way
PROPERTY ADDRESS: 149 MPV 107 St Miami, FL 33168
LOT: 12 BLOCK: 212 SUBDIVISION:
PROPERTY ID #: 11-2136-010-0120
PERMIT #:13 -SC -1542549
APPLICATION #: AP1149292
DATE PAID:
FEE PAID:
RECEIPT #•
DOCUMENT #: PR941656
[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 [ 750 ] GALLONS / GPD Existing septic tank to remain. CAPACITY
A [ 0 ] GALLONS / GPD CAPACITY
N [ 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 bed configuration SYSTEM
R [ 0 ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [x] STANDARD [ ] FILLED [ ] MOUND [ ]
I CONFIGURATION: [ ] TRENCH [x] BED [ ]
N
F LOCATION OF BENCHMARK: F.F.E., 12.50' NGVD
I ELEVATION OF PROPOSED SYSTEM SITE [ 25.00][ INCHES FT ][ABOVE BELOW BENCHMARK/REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 65.2$][ INCHES FT ][ABOVE BELOW BENCHMARK/REFERENCE POINT
L
D FILL REQUIRED: [ 0.00] INCHES EXCAVATION REQUIRED: [ 40.00] INCHES
*Invert elevation of drainfield to be no less than 7.56' NGVD.
O *Bottom of drainfield elevation to be no less than 7.06' NGVD.anr��•
T *Install 42" of slightly limited soil under the bottom of drainfield.
H -Perimeter of excavation area shall be at least 2 ft. wider and longer than the proposed absorption bed or drain trench.
E The system is sized for 3 bedrooms with a maximum occupancy of 6 persons (2 per bedroom), for a total estimated flow
R of 300 gpd.
SPECIFICATIONS BY: Teresa J S om TITLE:
Master Septic Tank Contractor
APPROVED BY: _f J�,J �/ TITLE: Dade CHD
DATE ISSUED: 06/06/2014 i
aH ao16, 08/09Ttt;0891�5 > 0 esi ne r required W perform a
Incorporated S�h$a !�aCE to DIY +R{F de +fittl, the may not be used)
time of fina I �pn Prior t0 Final Approval. the
inspector shall witneottle W, bonng and compar 1 49,92
results to the orfeeiginal site �Naivation submitted. <>.
re.Inspectionthe jobs to at illar
�era mess mFf the Contractor is no,
EXPIRATION DATE: 09/04/2014
SE930564
Page 1 of 3
e---
DOCUMENT #: PRO41656
licensed contractor installing the system is responsible for installing the minimum category of tank in accordance with s.
46.013(3)(0, FAC.
Sca.-e
t* A,
S"IrATE OF FLC)f-tll-)A
DEPARTMENT OF HEALTH
SEWAGE DISPOSAL SYSTEM CONSTP UG I'-TlON PE I
v
APPLICATION FOR ONSITE Yff�
Permit Applicator, Nur-noet
X"!
PART 11 - SITE PLAN---
Each block represents 5 feet and "I inch = 50 feet. N
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A"
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7
7
S�77'
7, 4.
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7-10
7
H
Notts: I �n Y,-\ V-\ N �.o�J t, 1 C"t �1 L?
SitE Plan submitted by:
Plan Approvyd
By -
signature
Not Approved
T -'l
Date z /
Count/ Health Depafttrnt)
ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
P -w- ') of
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