PL-14-2547Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-223610 Permit Number: PL -11-14-2547
Scheduled Inspection Date: January 06, 2015 Permit Type: Plumbing - Residential
Inspector: Diaz, Osvaldo
Inspection Type: Final
Owner: LONDON, RICKI Work Classification: Septic
Job Address: 9290 N BAYSHORE Drive
Miami Shores, FL 33138 -
Project: <NONE>
Contractor: MR C'S PLUMBING & SEPTIC INC
Phone Number
Parcel Number 1132050270240
Phone: (305)651-7859
Lsunaing uepartment comments
INSTALL NEW SEPTIC SYSTEM (TANK & DRAIN FIELD) Infractio Passed Comments
INSPECTOR COMMENTS False
January 05, 2015 For Inspections please call: (305)762-4949 Page 17 of 45
`
Inspector Comments
Passed
HRS ON FILE
Failed
Correction
Needed ❑
-'
Re -Inspection ❑
Fee
No Additional Inspections can be scheduled until
re -inspection fee is paid.
January 05, 2015 For Inspections please call: (305)762-4949 Page 17 of 45
[ fi � ��-\
PERMIT APPLICATION
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 N U 9 C1
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
FBC 20 j"
Master Permit No.
Sub Permit No.
e- - -- rs
❑ BUILDING
❑ ELECTRIC
❑ ROOFING
❑ REVISION
❑ EXTENSION
❑ RENEWAL
PLUMBING
❑ MECHANICAL
❑PUBLICWORKS
[-]CHANGE
CONTRACTOR
❑ CANCELLATION
❑ SHOP
DRAWINGS
JOB ADDRESS: ` o
City: Miami Shores �t ^ County: Miami Dade Zip:
ff/3f-
Folio/Parcel#: //- , 7�6 . f'J� 7 W_ Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type
OWNER: Name (Fee Simple Titleholder):
Address:�1�
Flood Zone: BFE: FFE:
one#: ��t'jX 0 J_012
City:/moi' State: Zip:
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: 6
Ar ��i ,s/�s f �1r Phone#:
Address: A%_,� .Ulr% �K /177l
City: State: AL Zip:331clo
Qualifier Name:lf1`NL� Phone#:
State Certification or Registration #: �j( �3Certificate of Competency #:
DESIGNER: Architect/Engineer: _ r _— Phone#:
Address: — City: State: Zip:
I J r^
Value of Work for this Permit: $_�C J Square/Linear Footage of Work:
Type of Work: ❑Addition F-1 Alteration 1-1 New [Repair/Replace ❑ Demolition
Submittal Fee $ Permit Fee $� 'r CCF $ CO/CC $
DBPR $ Bond $; U
Scanning Fee $ Radon Fee $
Notary $,
Training/Education Fee $
Technology Fee $
Double Fee $ Structural Review $ f}
TOTAL FEE NOW DUE $ t J !
121 0
0" -- —44
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
State
Zip
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 Bence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature(DA&Jk NRtL% J\ Signature �e vvvb�
Owner or Agent v
The foregoing instrument was acknowledged before me this U
day of 0 -4V 20 1�j by ��, 4VJ&Y\
who is personally known to me or who has produced
✓ As identification and who did take an oath.
Contractor IL
The foregoing instrument was acknowledged before me thisf
day of l! 20 T by
who is personally known to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC-
NOTARY PUBLIC:
9—v�Sign:
Sign:
Print:
Print:
L
��,.t ,a. KEMt�' ET I
PRY PGd{r
�i
My Commission E
L ..:. Notary Puolic - State of Florida
My Com
s '
res: gqn NOES
My Comm. Expires Sep 19, 2017
� C of F�
Commission # FF 055732
i7lF o?.,
-aF fl
Through National Notary Assn
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OMIII. E
$ � g xpNe; Oct 23 2011
Bonded
APPROVED BY //-/Y /Y Plans Examiner
Structural Review
(Revised02/24/2014)(Revised 5/2/2012)(Revised 3/12/2012) )(Revised 06/10/2009)(Revised 3/15/09)(Revised 7/10/2007)
Zoning
Clerk
n!4
7
STATE OF FLORIDA a
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT ANDD SPOSAL SYSTEM
rnucmurrrmTnN PERMIT
OSTDS Repair
CONSTRUCTION PERMIT FOR:
APPLICANT: Ricki London
PROPERTY ADDRESS: 9290 N Bayshore Dr Miami, FL 33138
LOT: 12 BLOCK: 2 SUBDIVISION:
PROPERTY ID #: 11-3205-027-0240
PERMIT #:13 -SC -1569228
APPLICATION #: AP1165148
DATE PAID:
FEE PAID:
RECEIPT #:
DOCUMENT #: PR955125
[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
T1,050 GALLONS / GPD New septic tank CAPACITY
A C' 01 GALLONS / GPD CAPACITY
N [ O --j- GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
K [ { 300 D GALLONS DOSING TANK CAPACITY 167.00 ]GALLONS @[ 6 ]DOSES PER 24 HRS #Pumps [ 1 l
D [ 300 l SQUARE FEET Bed confiquration SYSTEM
R [ 0 ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [x] STANDARD [ ] FILLED [] MOUND
I CONFIGURATION: [ ] TRENCH [xl BED [ ]
N
F LOCATION OF BENCHMARK: CL NE 93 st.,
I ELEVATION OF PROPOSED SYSTEM SITE
E BOTTOM OF DRAINFIELD TO BE
L
dr., 4.02' NGVD
8.76 1 [1 INCHES FT I [I ABOVE BELOW] BENCHMARK/REFERENCE POINT
6.24 l[ INCHES FT ][ABOVE BELOW BENCHMARK/REFERENCE POINT
D FILL REQUIRED: [ 3.001 INCHES EXCAVATION REQUIRED: [ 27.001 INCHES
Inspector to verify the existing septic tank is properly abandoned before final approval.
0 "Invert elevation of drainfield to be no less than 4.00' NGVD.
T "Bottom of drainfield elevation to be no less than 3.50' NGVD.
H "Install 12" of slightly limited soil under the bottom of drainfield.
-Perimeter of excavation area shall be at least 2 ft. wider and longer than the proposed absorption bed or drain trench.
E "THIS PERMIT IS NOT FOR " ADDITION(s) ".
R The system is sized for 3 bedrooms with a maximum occupancy of 6 persons (2 per bedroom), for a total estimated flow
SPECIFICATIONS BY: Kemble G
APPROVED BY:
DATE ISSUED:
TITLE:
TITLE: Dade CHD
EXPIRATION DATE
j no orrfr777 :7 ds s€once) �s r iii pd io perr5rrn a
DH 4016, 08/09 (Obsole A;i�,]afjui,j, s�O xr ;r�gk oma t t be used)
Incorporated: 64E-6.OQ g Mai insoectio . P'r } i Fwas rova,, the [)0H
inspector 9i AA 4'fA eCs ttie ` u,0- b0rii1q UMk15§ re the SE942646
results to the original site avalsaation submitted. A
reinspection fee w0l be assE; ss:jel if the contractor is not
at the jobrite at the arianao{S time.
02/05/2015
Page 1 of 3
DOCUMENT #: PR955125
Pumps must be certified as suitable for distributing sewage effluent.
Required drainfield area based on rule 64E -6.015(6)(c)2.
Install a new drainfield to achieve Drainfield size requirement.
The licensed contractor installing the system is responsible for installing the minimum category of tank in accordance with s.
64E-6.013(3)(0, FAC.
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.