PL-14-2207Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number. INSP-222088
Scheduled Inspection Date: November 18, 2014
Inspector. Diaz, Osvaldo
Owner: FISHER, DIANNE
Job Address: 1250 NE 95 Street
Miami Shores, FL
Project <NONE>
Permit Number. PL -10-14-2207
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Drainfield
Phone Number
Parcel Number 1132060144070
Contractor: MR C'S PLUMBING & SEPTIC INC Phone: (305)651-7869
Comments
DRAIN FIELD INSTALL
INSPECTOR COMMENTS False
spector Comments
Passed CREATED AS REINSPECTION FOR INSP-221222. need hrs card
need sod
HRS IN FILE
Failed
Correction
Needed
Re -inspection ❑
Fee
No Addftional Inspections can be scheduled until
re -inspection fee is paid
November 17, 2014 For Inspections please call: (305)762-4949 Page 14 of 46
mB :
114206-014-4070
ADDITIONAL INFORMATION
67.20 [
S 0LIAXCE WITH STAIVTE OR RULE AND hWST BE CORRECTED.
1401
fl
[
1
[41]
STOIRMSTER RUNOFF
i`
1
1421
SETBACKS
1
1
L
1
[27] SURFACE WATER
FT
to
[
I
1281 DITCHES
FT
LOCATION CONFORMS WITH SITE PLAN
[
I
[29] PRIVATE WELLS
FT
1
1
]
[301 PUBLIC WELLS
FT
]
1
I
1311 IRRIGATION WELLS
FT
[
1
1321 POTABLE WATER 20
FT
1
I
[33] BUILDING FOUNDATIONS 12
FT
[
I
1341 PROPERTY LINES 3
FT
[
1
[351 OTHER
IPP
FILLED / HOUNO, SYSTEM
SOFT [
1
[361 DRAINT'XELD COVER
ODER
X L
1
[371 SHOULDERS
Q 2.
1
1
1381 SLOPES
L
]
1391 STABILIZATION
Comments: Comments are on page 2.
CONSTRUCTION �
DISAPPROVED I - ;Ehglm3sr
FrNAL SYSTM I APpRO{ISD DISAPPROVED ]
(Faplanation of violations on 'ollowing page)
DB 4016, 08/09 (Obsolete$ all previous editt4o
Incorporated: 64E-6.003, FAC
EH Detabm v 10.1
ABANDMOSM
1 1 1491 TANK PUIMED
L 1 1501 TANK CRUSHED S FILLED
ADDITIONAL INFORMATION
67.20 [
1
1401
UNOBSTRUCTED AREA
[
1
[41]
STOIRMSTER RUNOFF
1
1
1421
ALARMS
1
1
1431
KhT*1'NANCE AGRMOdENT
L
1
[441
BUILDING AREA
L
1
[451
LOCATION CONFORMS WITH SITE PLAN
1
1
1461
FINAL SITE GRADING
1
1
[471
CONTRACTOR KEMBLE ETTRICK {MR C'S
1
]
1483
OTHER PTI MPRDS (9 pipes - 2 tier)
Comments: Comments are on page 2.
CONSTRUCTION �
DISAPPROVED I - ;Ehglm3sr
FrNAL SYSTM I APpRO{ISD DISAPPROVED ]
(Faplanation of violations on 'ollowing page)
DB 4016, 08/09 (Obsolete$ all previous editt4o
Incorporated: 64E-6.003, FAC
EH Detabm v 10.1
ABANDMOSM
1 1 1491 TANK PUIMED
L 1 1501 TANK CRUSHED S FILLED
Miami Shores VillageFj
� W�P11 LD)
Building Department ®cT® 2014
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972 pny;
INSPECTION LINE PHONE NUMBER: (305) 762-4949
FBC 20 p O
BUILDING master Permit NoF�-` 14 ` 'z
PERMIT APPLICATION
Sub Permit No.
❑BUILDING
❑ ELECTRIC
ROOFING
❑ REVISION ❑ EXTENSION
❑RENEWAL
❑ MECHANICAL
E] PUBLIC WORKS
[:]CHANGE OF ❑ CANCELLATION
❑ SHOP
epLUMBING
DRAWINGS
Al -0 /JCONTRACTOR
9CL52-4
JOB ADDRESS:
/(��
City:
Miami Shores
County:
Miami Dade Zia:3�/I
Folio/Parcel#:
1/^-9:0®6 `,OX
""!9,d7e0
Is the Building Historically Designated: Yes
NO r -
Occupancy Type:
Load:
Construction Type:
® Flood Zone: BFE:
FFE:
OWNER: Name (Fee Simple Titleholder): lJ 4.v1 n e �1 S c � e ✓ Phone#: 13 .'19 s3
Address: (2 �' V KI E 9 s'F`' S+
City: tiA i a vi% State: r L- zip: 3 1 3 8
Tenant/Lessee Name: t1 Phone#:
Email: t1{eQ1e-e.-P%'SC(ne✓' gF-jCA1-r✓11Rh .ecar-O-N
CONTRACTOR: Company Name: A11r t,,-3 14 4z. Z,&4Phone#:
Address: o -o /w
City: ,,//JState: Zip: 41
����
Qualifier Name: e�l�A Z� �r1 Phone#:
State Certification or Registration #: 115< 6 Certificate of Competency #:
DESIGNER: Architect/Engineer:
Address: C State: Zip:
Value of Work for this Permit: $ 0 e�) Square/Linear Footage of Work: A.00
Type of Work: ❑ Addition ❑ Alteration ❑ New �epair/Replace ❑ Demolition
�
Description of Work: 1 /i�Jl1 A Lo � I �AZSLt
Specify color of -..color
rtthru tile:
Submittal Fee $-1 W Permit Fee $� ° ` CCF $ ® CO/CC $
Scanning Fee $ < . Radon Fee $ 6 DBPR $ X—'? Notary $
Technology Fee $ 1 • (:>® Training/Education Fee $C)��) Double Fee $ -0
Structural Reviews $ Bond $ -
TOTAL FEE NOW DUE $ (I co, 0
(Revised02/24/2014)
Bonding Company's Name (if applicable)
Bonding Company's Address
City z< State Zip
Mortgage Lender's Nada (if applicable)
Mortgage Lender's Address
City ,/ State I-,- Zi
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 approved and a reinspection fee will be charged.
.m-
Signature Signature
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
Z`(-tL
'�`day of sc p �p w.-b-Lv" 20 Iq by day of i��'�f� {��R- 20�J by
�itr.►r►•e� c s c �� who is personally known to K��'1/J��, who is personally known to
me or who has produced as me or who has produced as
.r.
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
gn• Sign:
Print: Print: L ES
Seal Seal:
ftft - Ift a film 00 Notary Public State at Florida
• » 4P 0Sheryl A Mendes
My Commission EE017513
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
REGISTERED SEPTIC TANK CONTRACTOR
MIAMI, F L 33169-
MR.
Business Authorization: SA01 1793
4
006310
Im
REPAIR
Vi!-fly"%) �:Clllvery . te.ALIld
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION PERMIT
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: Dianne Fisher
PROPERTY ADDRESS: 1250 NE 95 St Miami, FL 33138
LOT: 7, 8, 9 BLOCK: 85 sUBDIVIsxoN: Miami Shores Sec 3
PERMIT #:13 -SC -1561903
APPLICATION # : AN 160910
DATE PAID:
FEE PAID:
RECEIPT #:
DOCUMENT #: PR951632
PROPERTY ID #: 11-3206-014-4070 [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 [ 1,050 ] GALLONS / GPA existing septic tank to remain CAPACITY
A 1 0 ] GALLONS / GPD CAPACITY
N [ 0 ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS U ]DOSES PER 24 HRS #Pumps [
D [ 400 1 SQUARE FEET new bed confin. drainfield SYSTEM
R [ 0 I SQUARE FEET SYSTEM
A TYPE SYSTEM: [X] STANDARD [ ] PILLED [ ] MOUND [ ]
I CONFIGURATION: I ] TRENCH Ix] BED I I
N
F LOCATION OF BENCHMARK: FFE 10.1'
I ELEVATION OF PROPOSED SYSTEM SITE [ 22.80][ INCHES FT ][ABOVE JBELOW BENCHMARK/REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE 162.80][ INCHES FT ]I ABOVE BELOW BENCHMARK/REFERENCE POINT
L
D FILL REQUIRED: 1 0.001 INCHES EXCAVATION REQUIRED: [ 52.001 INCHES
1.-Exlsiin gal, septic tank, certified by "MrC's Plumbing & Septic" on 8/27/2013 to remain.
0 2: Ins 11400 f drainfleld in bed configuration.
T 3: Insta# 12" of slightly limited soil at the bottom of the drainfield.
H 4. -Perimeter of excavation area shall be at least 2 ft wider and longer than the proposed absorption bed or drain trench.
(Comments Continued on Page 2.)
E t
R
SPECIFICATIONS BY. Yudeisy Martin l!
APPROVED BY:
TITLE:
DATE ISSUED: 09/3012014
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E-6.003, FAC
v 1.1.4 AP1160910
Dade CHD
EXPIRATION.DATE: 12/29//2014
sz939411
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