PL-14-2172Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-220921
Scheduled Inspection Date: November 05, 2014
Inspector: Diaz, Osvaldo
Owner: ,
Job Address: 141 NE 104 Street
Miami Shores, FL 33138 -
Project: <NONE>
Contractor: STATEWIDE SEPTIC CONNECTIONS
Building Department Comments
Permit Number: PL -10-14-2172
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Septic
Phone Number
Parcel Number 1121360130730
Phone: (954)963-0082
REPLACE SEPTIC TANK AND DRAIN FIELD 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
HRS IN FILE
November 04, 2014 For Inspections please call: (305)762-4949 Page 14 of 31
N
Miami Shores Village 8
Building Department cp:-fV
10050 N.E.2nd Avenue, Miami Shores, Florida 3313E OCT 0 3 2014
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (30S) 762-4949
B
FBC 2016
6
BUILDING Master Permit No.
PERMIT APPLICATION Sub Permit No.
❑BUILDING
ELECTRIC
❑ ROOFING
❑ REVISION
❑ EXTENSION
❑RENEWAL
PLUMBING
MECHANICAL
❑PUBLICWORKS
[:]CHANGE
CONTRACTOR
❑ CANCELLATION
❑ SHOP
DRAWINGS
JOB ADDRESS: I T k N E 164 u'
City: �,Miami Shores County: Miami'Dade Zip: 331
Folio/Parcel#: 23 . A 1 J— CT 30 Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
LLC` 01
OWNER: Name (Fee Simple Titleholder): M O d lsOn ��a�l� PM.( Ox![ .S Phone#:
Address: 141 t�WE:7 104 -S -
City: M Svt0,-C S State: Fz, Zip. -'3S 12 �
Tenant/Lessee Name: Phone#:,
Email:
CONTRACTOR: Company Name: S_kCA W �� C �'� III a Phone#: �� 66';3
Addre4SCAO ow CC( Awe 4�,- t -S
City: (Dj?a CoCKci State: . Zip: 32MEL -
Qualifier Name: ����� �{'`� Phone#:
State Certification or Registration #: Certlificate of Competency #:
DESIGNER: Architect/Engineer:
Address City:
State: Zip:
Value of Work for this Permit: $_194�00 SP Square/Linear Footage of Work: 22-5
Type of Work: ❑ Addition ❑ Alteration ❑ New 91 Repair/Replace ❑ Demolition
Description of Work: R4219 Ce, Sr I C '%n ISO 1!0
Specific color of color thru tile:
Submittal Fee $ 1_�c r CR Permit Fee $ ` Y CCF $CO/CC $
Scanning Fee $ C'� _0� Radon Fee $
Notary $_ �5 Training/Education Fee $
Double Fee $ I/i t Structural Review $
DBPR $ c4, Bond $ aD -
k ` 2Z Technology Fee $ k4 ,
TOTAL FEE NOW DUE $
Bonding C mpany's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
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 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 absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature Signature Z V Vk
caner or Agent Contractor
The foregoing instrument was acknowledged before me this I
this 2— day of (00+ 20 _L+by A 11\d, MS %,—+vr!�j
who is personally known to me or who has produced
5YX-4 bc-CA C As identification and who did"I
NOTARY PUBLIC:
v 0
Sign: T fin
Print: r,�6P� �,r... _ z z 0
z o to
My Commission Expires:
Sew
ffi�k�h�kffiakak�kakNeak�k&�k�kektk�kKe&��k*�k�k�k�k�k�ki�8�k��k�k�k�k�k�k�N�k**�k �k+k ����F+R �
APPROVED BY L Plans Examiner
The foregoing instrument was acknowledged before me 'V
day of � 20 t , by
who is personally known to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
Sig
Print:
My C On
oA x tary Public State of Florida
Joanna M Feliciano
MY OF 61 E piC s 01/12/2018 OMMission FF 082753
Zoning
Structural Review Clerk
(Revised02/24/2014)(Revised 5/2/2012)(Revised 3/12/2012) )(Revised 06/10/2009)(Revised 3/15/09)(Revised 7/10/2007)
R � 3
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION PERMIT
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: (MAdison Bradley Moldings LLC)
PROPERTY ADDRESS: 141 NE 104 St Miami, FL 33138
LOT: 19 20 BLOCK: 121 SUBDIVISION:
PERMIT #:13 -SC -1561691
APPLICATION #:AP1160760
DATE PAID:
FEE PAID:
RECEIPT #:
DOCUMENT #: PR951596
PROPERTY ID #: 11-2136-013-0730 [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 [ 900 1 GALLONS / GPD new septic tank CAPACITY
A [ 0 l GALLONS / GPD CAPACITY
N [ 0 1 GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [
D [ 225 1 SQUARE FEET new trench confiq. drainfie SYSTEM
R [ 0 1 SQUARE FEET SYSTEM
A TYPE SYSTEM: [X] STANDARD [ ] FILLED [ ] MOUND [ 1
I CONFIGURATION: [X] TRENCH [ ] BED [ ]
N
F LOCATION OF BENCHMARK: FFE 11.6' NGVD'
I ELEVATION OF PROPOSED SYSTEM SITE [ 14.401[ INCHES FT ][ABOVE BELOW BENCHMARK/REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 50.401[ INCHES FT ][ABOVE BELOW BENCHMARK/REFERENCE POINT
L
D FILL REQ ED -"\ [ 0.001 INCHES EXCAVATION REQUIRED: [ 36.001 INCHES
1. -Instal a-9OQ alnf'n. septic tank with an approved filter.
0 2. -The licensed contractor installing the system is responsible for installing the minimum category of tank in accordance
T with s. 64E-6.013(3)(0, FAC. /
H 3. -Install 225 sf of drainfield in trench configuration✓
4. -Perimeter of excavation area shall be at least 2 ft wider and longer than the proposed absorption bed or drain trench.
E(Comments Continued on Page 2.)
R \ I,,,,
SPECIFICATIONS BY:
APPROVED BY:
DATE ISSUED: 09/29/2014
1-1 • /� wTITLE :
-�T�yLF • u b . I� Dade CHD
EXPIRATION DATET 0 12/2$/2014
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E-6.003, FAC
v 1.1.9 AP1160760 SE939995
Page 1 of 3
Docubam #: PR951596
.-Invert elevation of drainfield to be no less than 7.90' NGVD.
.-Bottom of drainfield elevation to be no less than 7.40' NGVD.
.-This permit includes the abandonment of the existing septic tank.
he system is sized for 3 bed with a max occupancy of 6 person(2 per bed), for a total est. flow of 300 gpd.
HIS PERMIT IS NOT. FOR ANY ADDITIONS.
�S8T'UTE.OFf FLORIDA
DE-PARTMENT OF HEALTH
APPLICATION FOR ONSITE SEVVAGE DISPOSAL SYSTEM CO�IISTF �r G 101`1 P RM1T
Permit Applicai on 1,i,r,:#�,�f
- — — —'— -- — PARI-11 -SITE PLAN---
Sca:e: Each block represents 5 feet and Minch = 50 feet.
44
k
i'
a_
- s * rare
:. 1
:
i
_ Ay - - - ..i." •_ -" >f 1. _. -_ __ _ - - � -_ _ -.�
NO t ' S .{�.` �'.',>,< •fb- ., ,I 4 '•.,.� w `,"C.'?d_. :8 9 t` L.4 ,S �' ,lam .. t s,.; ' " { 1' i.q t1i•' `i .. �".k-:` �*s'.: _.{
�'�•-'� ^�� ,s `�v k%'-e.-�,;,�,r:�rt � 4{ � �% F, r E}•'
J w. tt 5-.- 7aPk6 +—...—_'_q. L" RwF J "
S?tc Plan suers tted by:_ °. ", '. ., ...._ r � ,•, ° � ¢ `
Signature T'q
Plan App tovp, i ,y,. Blot Approve- d Date
ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
i� �: f 4�'S =CY"F.> ;Rz�ta�s3s !-iRS•Fi 6ctrnl d�? 5 •ahi^,n ; na/ F i :rs3:1J
1WN;(X: 574A GG9-40=5-6)