PL-14-2678Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-224794 Permit Number: PL -12-14-2678
Scheduled Inspection Date: January 27, 2015 Permit Type: Plumbing - Residential
Inspector: Diaz, Osvaldo
Inspection Type: Final
Owner: GODOY, OCTAVIO Work Classification: Septic
Job Address: 123 NW 102 Street
Miami Shores, FL 33150 -
Project: <NONE>
Phone Number (786)493-7296
Parcel Number 1131010220070
Contractor: A AMERICAN SEPTIC & PLUMBING Phone: (305)866-5600
liunamg Department comments
INSTALL ONE 900 GAL TANK. INSTALL 375 DRAIN FIELDI Infractio Passed Comments
REPAIR. INSPECTOR COMMENTS False
January 26, 2015 For Inspections please call: (305)762-4949 Page 7 of 29
Inspector Comments
Passed
EE
HRS IN FILE
Failed
V" .,
Correction
Needed
Re -Inspection
❑
Fee
No Additional Inspections can
be scheduled until
re -inspection fee is paid.
January 26, 2015 For Inspections please call: (305)762-4949 Page 7 of 29
ORES ,�
Miani Shr Villagg s
10050 N E 2° VeiiJe NW
Miami Shor .`63138-0000
Phone =Tr 795-2204
Project Address
123 NW 102
Miami Sh
Owner Informati
OCTAVIO G
A AM
of \A
DofP
itional
Fees
Bond T'
CCF
DBPRI
DCA F4
T
Expiration: 0611312015
ne Valuation: _ ~ $ 6,000.00
5599 Total Sq Feet: 375
Available Inspections:
Inspection Type:
HRS Approval
y Type
Amt Paid
Amt Due
•12-14-53846
dit Card
$ 50.00
$ 787.04
9dit Card
$ 287.04
$ 500.00
eck #: 1831
$ 500.00
$ 0.00
Applicant Copy
For Inspections, Call (305) 762-4949 or Log on at https://bldg.miamishoresvillage.com/cap/.
Requests must be received by 3 pm for following day inspections.
NOTICE: In addition to the requirements of this permit, there may be AND THERE MAY BE ADDITIONAL PERMITS REQUIRED FROM OTHER
additional restrictions applicable to this property that may be found in GOVERNMENTAL ENTITIES SUCH AS WAGER MANAGEMENT
the public records of this county. DISTRICTS, STATE AGENCIES, OR FEDERAL AGENCIES.
December 15, 2014 ,,
+, r
BUILDING
PERMIT APPLICATION
Miami Shores Village
Building Department DEC 9°14
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 ;'.
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
FBC 20 i
Master Permit NoT� ' a _ -2
Sub Permit No.
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
■❑PLUMBING F -I MECHANICAL PUBLIC WORKS ❑ CHANGE OF n CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: N Vj W 11 -
City: Miami Shores County: Miami Dade Zi :
Folio/Parcel#: i 7 ( L)(— 02,1— O U it'd Is the Building Historically Designated: Yes NO �
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): U L VLV t U /'"v Phone#:
Address: 1 ),3 � w (D,)- Ar r _
City: t� . jly' � State. Iry Zip: J �1 � l 4� D
Tenant/Lessee Name: is 1 k Phone#:
Email:
CONTRACTOR: Company Name: ki "e'(1 Ui�� J `� F' ` G fi �ym� P glee#:
Address: 4'ws- P15C"Oe_ ��`icl
3ti i�(oW_i;b0d
City: M 1frh iM�,{ State: t zip: 33 "B) I
Qualifier Name: V`� I� t o-ry) Phone#: 3w 6-14(0 S-1000
r�2, DZ " 1 � � ?' Certificate of Competency #: DOD A �,
State Certification or Registration M. .. p Y
DESIGNER: Architect/Engineer: Phone#:
iH
Address: City: State: Zip:
Value of Work for this Permit: $ G' Gw/ � >'' Square/Linear Footage of Work:
Type of Work: 11Addition 6 Alteration ❑ New Repair/Replace
❑ Demolition
Description of Work:
j itis 04t 11 S Sa f�x PY141 t U- (-e00__ fv
Specify color of color thru tile:
NCI}
�" Permit Fee $ _ 3�S '"CCF S
Submittal Fee $CO/CC $ �,._.
q
Scanning Fee $ Radon Fee $, DBPR $ Nota(-� - � r1► $
Technology Fee $ Training/Education Fee $ ) Double Fees $$
Structural Reviews $ Bond $
TOTAL FEE NOW DUE $ a-&—1 . %9
(Revised02/24/2014)
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
Zip
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. 1 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 charge
Signature
OWNER or AGENT
The foregoing instrument was acknowledged before me this
B day of f% 20 /y , by
who is ersonally know to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
1-7
Print: - /eat14 ael / _
Seal. _,`� 01�YAN M HOLLANDER
'` MY COMMIOSM 1f EE188113
EXPIRES Felmory 00.2016
>warass .aan
*s*r*****s**s**•
d.
Signature
_ A�A:�
CONTRACTOR
The foregoing instrument was acknowledged before] me this
day of DCIV WO V' , 20 f 'fby
W + I ``11 t -�-fo (V\- 0 00 , w o is personally known to
me or who has produced it- b r l jTtlfas
identification and who did take an oath.
„141, NANCY GOLDRM G
NOTARY PUBLIC: '� MY COMMISSION # EE 860M
* EXPIRES: February 15, 2017
Bonded Thru Budge Notary 8orvirM
Sign:,
Print:
Seal:
****r**�s**r*************•****�e��s*s*******r;s*:***s*s**r�***
_= Y
APPROVED BY Plans Examiner
Structural Review
(Revised02/24/2014)
Zoning
Clerk
REGISTERED SEPTIC TANK CONTRACTOR
WILLIAM M. WOODARD
12555 BISCAYNE BLVD, *970
NORTH MIAMI, FL 33481-
A AMERICAN SEPTIC & PLUMBING,
INC.
Business Author¢ation: SA0000947
SR0001342
000737
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM
CONSTRUCTION PERMIT
CONSTRUCTION PERMIT FOR:
OSTDS New
APPLICANT: Octavio Godoy
PROPERTY ADDRESS: 123 NW 102 St Miami, FL 33150
LOT: 16 BLOCK: 1 SUBDIVISION:
PROPERTY ID #: 11-3101-022-0070
PERMIT #:13 -SC -1556386
APPLICATION #: AP1157588
DATE PAID:
FEE PAID:
RECEIPT #'
DOCUMENT #: PR956615
Gold Crest
[SECTION, TOWNSHIP, RANGE, PARCEL NUMBER]
[OR TAX ID NUMBER]
SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIO14S 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 DE_�SIGN'iIND SPECIFICATIONS
T I ; 6 900L, -J' //GALLONS I GPD Septic CAPACITY
A [ C l GALLONS / GPD N/A CAPACITY
N [ 1 GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
K r ] GALLONS DOSING TANK CAPACITY I ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ 1
D [ / 375 SQUARE FEET trench configuration drainf SYSTEM
R [ 111 ] SQUARE FEET N/A SYSTEM
A TYPE SYSTEM: [x] STANDARD I ] FILLED [ ] MOUND [ ]
I CONFIGURATION: [xl TRENCH [ ] BED [ ]
N
F LOCATION OF BENCHMARK: CL NW 102 ST: 10.30' NGVD
I ELEVATION OF PROPOSED SYSTEM SITE [ 3.60 ][ INCHE3 FT ][ABOVE BELOW BENCHMARK/REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE 1 33.60 111 INCHES FT ][ABOVE BELOW BENCHMARK/REFERENCE POINT
L
D FILL REQUIRED
O
T
H
E
R
F O 00 1 INCHES EXCAVATION REQUIRED: [ 72.001 INCHES
1. -Install a 900 gal min. septic tank with an approved filter.
2. -The licensed contractor installing the system is responsible for installing the minimum category of tank in accordance
with s. 64E -6.013(3)(f), FAC.
3. -Install 375 sf of drainfield in bed configuration.
4. -Install 42" of slightly limited soil at the bottom -of the drainfield.
5. -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.)
SPECIFICATIONS BY: Betsy Lange-Olmino
APPROVED BY:TITLE: Engineering Specialist II
u. easy in
DATE ISSUED: 11/24/2014
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)(�'
8,�
O
Incorporated: 64E-6.003, FAC��;���
v IA- R41115;566
CHD
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