PL-15-191Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-227259 Permit Number: PL -1-15-191
Scheduled Inspection Date: February 24, 2015 Permit Type: Plumbing - Residential
Inspector: Diaz, Osvaldo
Inspection Type: Final
Owner: SELZER, ALEXANDRA Work Classification: Drainfeld
Job Address: 271 NE 101 Street
Miami Shores, FL 33138- Phone Number 305/446-0500
Parcel Number 1132060134810
Project: <NONE>
Contractor: MR C'S PLUMBING & SEPTIC INC Phone: (305)651-7859
tswiaing uepanment comments
DRAIN FIELD INSTALL.
INSPECTOR COMMENTS False
Inspector Comments
HRS ON FILE
Passed F
Failed
Correction
Needed
Re -Inspection ❑ j
Fee
No Additional Inspections can be scheduled until
re -inspection fee is paid
February 23, 2016 For Inspections please call: (305)762-4949 Page 16 of 51
Miami Shores Village
�""�z�r� • BuildingDepartment
p �
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 JAN 2 7 2010
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (30S) 762-4949 IBY:j� )
FBCr�20110
BUILDING Master Permit No � t ✓" 191
PERMIT APPLICATION Sub Permit No.
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING [:]MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
II��
1 CONTRACTOR DRAWINGS
JOB ADDRESS: 2/�7 I h)f �d I S 1
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: II -W6- 0(3" 4410 Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): A64AAq .J IZG— Phone#: ,3o!�--60071
Address: oL 1( II m .i r �t
City: Q II,. �] State: (lr. Zip:
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: '"� l 5 r IOwb i�4 3 �Z Phone#: 3K411 S-5 S
Address: —J�hT�_ NO aO Aqt.
City: Uhl i &_. State: ISL Zip
Qualifier Name: I/Nf1y^ !� 6 Phone#:
State Certification or Registration #: 54 (� 4 ( 5X Certificate of Competency #: _
DESIGNER: Architect/Engineer: Phone#:
-37(0
Address: City: State: Zip:
Value of Work for this Permit: $ ' . Square/Linear Footage of Work:
Type of Work: ❑ Addition 0 Alteration ❑ New Repair/Replace ❑ Demolition
Description of Work: I n vt
n
Specify C04vi
Submittal Feel.. Permit Fee $ k6
. CCF $ y CO/CC $
Scanning Fee Radon Fee $ DBPR $ Notary $
Technology Fee $ Training/Education Fee $
Structural Reviews
(Revised02/24/2014)
Double Fee $
Bond it - 930 - W
TOTAL FEE NOW DUE $ S
•'50
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
State
i"
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 occursse (7) days after the building permit is issued. in the absence of such posted notice, the
inspection will not be approved and a reinsp ion fee will be charged.
J//4. 4_,
OWNER or AGENT
The foregoing instrument was acknowledged before me this
-Z day of Q 20 by
Ay, lD6LF . who is personally known to
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Signature
CONTRACTOR
The foregoing instrument was acknowledged before me this
27 day of /lStt . 20 15 , by
K-AWKE 912:9�& ,Wko-J-s personally known to
as me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print: now Print:
Seal: r is state of Florida Seal:
11 My Comm. Expires Sep 19, 2017
Commission # FF055732
p\ ` Bonded Throe* National Notary Assn.
APPROVED BY 7 Plans Examiner
Structural Review
(Revisedo2/24/2014)
SHERYL A MEN DES
NOWY PUblic - Sta>je Of FWWa
MY Caron. Expires Oct 23, 2018
Commission # FF 1387
as
Zoning
Clerk
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION PERMIT
CONSTRUCTION PERMIT FOR:
APPLICANT: Alexander Selzer
OSTDS Repair
PROPERTY ADDRESS: 271 NE 101 St Miami, FL33138
IAT: 19-20 BLOCK: 35 SUBDIVISION
PROPERTY ID #: 11-3206-013-4810
PERMIT *: 13 -SC -1 501325
APPLICATION # : AP 1 1 72420
DATE PAID:
FEE PAID:
RECEIPT #:
DOCUMENT #: PR961359
Miami Shores ,.
[SECTION, TOWNSHIP, RANGE, PARCEL NUMBER]
[OR TAX ID NUMBER]
SYSTEM MAST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF SECTION
381.0065, F.S., AND CHAPTER 649-6, F.A.C. DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE
SATISFACTORY PEF.FORMANCE FOR ANY SPECIFIC PERIOD OF TIME. ANY CHANGE IN MATERIAL FACTS,
WHICH SERVED A:; 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 FRCM COMPLIANCE WITH OTHER FEDERAL,
STATE, OR LOCAL PERMITTING REQUIRED FOR DEVELOPMENT OF THIS PROPERTY -
SYSTEM DESIGN ANL? SPECIFICATIONS
T [ 750 -1 GALLONS / GPD Exist. septic tank to remain CAPACITY
A [ 0 J GALLONS / GPD CAPACITY
N [ 0 ? GALLONS GREASE INTERCEPTOR CAPACITY IM Xn4UM CAPACITY SINGLE TANK: 1250 GALLONS]
K [ 1 GALLONS DOSING TANK CAPACITY I ]GALLONS @I ]DOSES PER 24 HRS #Pumps
D [ 200 J SQUARE FEET Bed confiauration dam_ra-mfH i SYSTEM
R { 0 ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [Xl STANDARD I ] FIT -1 I ] MOUND
I CONFIGURATION: [ 7 TRENCH [X] BED I l
N
F LOCATION OF BENCHMARK: FFE 12.5' NGVD
I ELEVATION OF PROPOSED SYSTEM SITE 128.801 INCHES FT ][ABOVE BELOW BENCHMARK/REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE 1 78.84]I INCHES FT ] [ ABOVE �RENCHMARK/SCE POINT
�1 ]
L
D E
O
T
H
E
R
ILL REQUIRED: 1 0.001 INCHES EXCAVATION REQUIRED: L tiL.UU 1 -` Mm
1. -Existing 750 gal. septic tank, certified by "Mr. C's Plumbing and Septic" on 1/16/2015 to remain.
2. -Install 200 sf of drainfield in bed configuration.
3. -Install 12" of slightly limited soil at the bottom of the drainfield.
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.)
SPECIFICATIONS BY: Kemble Ettrick
TITLE'
TITLE: Engineering Specialist II
Dade CHD
APPROVED BY:
Bet Lange-o7minn
EXPIRATION DATE:
04/21/2015
DATE ISSUED:
01/2112015
DH 4016, 08/09
(obsoletes all previous
editions which may not be used)
of 3
Incorporated:
64E-6.003, FAC
if the 1oltrac r