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PL-15-705Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-231217 Permit Number: PL -3-15-705 Scheduled Inspection Date: May 06, 2015 Permit Type: Plumbing - Residential Inspector: Diaz, Osvaldo Inspection Type: Final Owner: GROSSMAN, LEAH Work Classification: Septic Job Address: 320 NE 100 Street Miami Shores, FL Phone Number (786)342-8921 Parcel Number 1132060135460 Project: <NONE> Contractor: MR C'S PLUMBING & SEPTIC INC Phone: (305)651-7859 Building Department Comments SEPTIC TANK & DRAINFIELD INSTALLATION. Infractio Passed Comments INSPE TOR COMMENTS False Inspector Comments Passed 05/04/2015 HRS APPROVAL ON FILE Failed Correction Needed ❑ Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. May 05, 2015 For Inspections please call: (305)762-4949 Page 15 of 60 Project Address Parcel Number Applicant 320 NE 100 Street 1132060135460 Miami Shores, FL Block: Lot: LEAH GROSSMAN LEAH GROSSMAN 320 NE 100 Street (786)342-8921 MIAMI SHORES FL 33138- 320 NE 100 Street MIAMI SHORES FL 33138 - Contractors) Phone Cell Phone MR C'S PLUMBING & SEPTIC INC (305)651-7859 Type of Work: SEPTIC TANK & DRAINFIELD INSTALLATI Type of Piping: Additional Info: Bond Retum : Classification: Residential Scanning: 3 Fees Due Miami Shores Village 10050 N.E. 2nd Avenue NE Bond Type - Owners Bond Miami Shores, FL 33138-0000 CCF Phone: (305)795-2204 Project Address Parcel Number Applicant 320 NE 100 Street 1132060135460 Miami Shores, FL Block: Lot: LEAH GROSSMAN LEAH GROSSMAN 320 NE 100 Street (786)342-8921 MIAMI SHORES FL 33138- 320 NE 100 Street MIAMI SHORES FL 33138 - Contractors) Phone Cell Phone MR C'S PLUMBING & SEPTIC INC (305)651-7859 Type of Work: SEPTIC TANK & DRAINFIELD INSTALLATI Type of Piping: Additional Info: Bond Retum : Classification: Residential Scanning: 3 Fees Due Amount Bond Type - Owners Bond $500.00 CCF $5.40 DBPR Fee $4.50 DCA Fee $4.50 Education Surcharge $1.80 Permit Fee $300.00 Scanning Fee $9.00 Technology Fee $7.20 Total: $832.40 Valuation: $ 8,500.00 Total Sq Feet: 400 Pay Date Pay Type Amt Paid Amt Due Invoice # PL -3-15-54973 03/31/2015 Check #: 1237 $ 500.00 $ 332.40 03/30/2015 Check #: 2716 $ 50.00 $ 282.40 03/31/2015 Check #: 2722 $ 282.40 $ 0.00 Bond #: 2654 Available Inspections: Inspection Type: HRS Approval Final Review Plumbing In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS 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. M5gut0oxieff, I authorize t above-named contractor to do the work stated. March 31, 2015 Signature: Owner / Applicant / Contractor / Agent Wilding Department Copy March 31, 2015 Miami ShoresVillage g 7MMAR �aBuilding Department 2015 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING Permit NoT L I PERMIT APPLICATION Master Permit No. FBC 20 Permit Type: PLUMBING I / OWNER: Name (Fee Simple Titleholder):Phone#:/ Address : P-0 W 9 tob 54 - City: Mi(A�• State: Zip: 13 5- Tenant/Lessee Name: Email: JOB ADDRESS: 3 V� G 10 City: Miami Shores County: Miami Dade Zip: 3313-1' Folio/Parcel#• i i - 3am Q13— �-4 bd Is the Building Historically Designated: Yes CONTRACTOR: Company Name: Address: /�� AV 011 City: Qualifier Name: NO Flood Zone: jGU Phone#: 56 Aa State Certification or Registration #: Certificate of Competency #: Contact Phone#: Email Address: DESIGNER: Architect/Engineer: Phone#: zip: 13 M 9 36 5'/ 7 S -4f I Value of Work for this Permit: $� Square/Linear Footage of Work: `z Type of Work: ❑Address L3 Alteration ❑New ORepair/Replace ❑Demolition Description of Work: Submittal Fee $.S() Permit Fee $ ;�y CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ �iq 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 absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature YUL Signature Owner or Agent The foregoing instrument was acknowledged before me this day of gnk _, 20 � 5, by , who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: C� Sign: Sign: -" Print: „--_—„__MIN Print: My Co of Florida Qct 23, 2018 17 11,E Plans Examiner Zoning Contractor The foregoing instrument was acknowledged before me this.PO day of 20 �, by . who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: .KEMBLE ETTRICK My Commission , _ r p`��c; Notary Public - State of Florid • : : My Comm. Expires Sep 19, 20 aa:� Commission # FF 055732 APPROVED BY (Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) �c+s �arY PuDNe - gee sem. er � Comm. Exptrea Commission # FF 138391 Structural Review Clerk STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTVW CONSTRUCTION PERMIT CONSTRUCTION PERMIT FOR: APPLICANT: Ethan Grossman OSTDS Repair PROPERTY ADDRESS: 320 NE 100 St Miami, FL 33138 LOT: 910 BLOCK. 40 SUBDIVISION: PROPERTY ID #: 11-3206-013-5460 PEST #:13-SC4563650 APPLICATION #: AP1180514 DATE PAID: FEE PAM RECEIPT #: DOCUMENT #: PR968720 [SECTION, TOWNSHIP, RANGE, PARCEL NU[BER] (OR TAY. 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 TIE. 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. a SYSTEM DESIGN AND SPECIFICATIONS T [ 1,050 1 GALLONS ! GPD new septic tank CAPAYITY A 1 0 ] GALLONS / GPD CAPACITY N I 0 l GALLONS GREASE INTERCEPTOR CAPACITY IMAXIMUM CAPACITY SINGLE TANK:1250 GALLONS] K [ ] GALLONS DOSING TANK CAPACITY i ]GALLONS ]DOSES PER 24 HRS #Pumps I ] D [ 400 1 SQUARE FEST Bed confinuration drainfiei SYSTEM R [ 0 1 SQUARE FEET SYSTEM A TYPE SYSTEM: ix] STANDARD [ ] FILLED [] MOUND I CONFIGURATION: i ] TRENCH inl BED I ] N F LOCATION OF BENCHMARK: FFE 11.7 NGVD I ELEVATION OF PROPOSED SYSTEM SITE 110.80 1 [FINCHEsl [FINCHESFT ] [ ABOVE A BELOW SENCHGARIC/REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE 160.84][ INCHES FT ][ABOVE BELS BENCHMARK/REFERENCE POINT L D E 0 T H E R ILL REQUIRED: 10.001 INCHES EXCAVATION REQUIRED: %_62.001 INCHES 1. -Install a 1050 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 400 sf of_drainfield in bed configuration. 4. -install 12" 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 proaosed absorption bed or drain trench. (Comments Continued on Page 2.) SPECIFICATIONS BY" MROUX ETTRICK TITLE: APPROVED BY: ,_TITLE: Engineering Specialist II Dade CHD 0lmiao DATE ISSUED: 03/24/2015 EXPIRATION DATE: 06/22%2015 DH 4016, 08/09 (Obsoletes all previous editions which may not be used) Page 1 of 3 incorporated: 649-6.003, FAC v 1.1.4 AF1180514 P.M rPn,1a,sn A b @ F� 9q r iY/ ` FsJ- Cs.� nisi o 01 .� The contractor (or designee; ,s re ure, adjacent to the dre�neld 4 a exG3v„tcSF Inspection, prior to F,nal Acoro�, I witness the soil bonng ann Site evaluation subm+rev q N the cDntfvCt,) F--7= LAA DIV! s 1 OR AP11805 -sc-IE 04,13/20 ----------- H 00 13-PlD-2e SETBACKS TANK INSTALLATION 1050 (271 SURFACE 'WATER [01] TANK SIZE .Polyethy00 [21 lene 1281 DITCHES [02] TANK MATERIAL 1A.9 I PRIVATE WELLS (03 ] OUTLET DEVICE 1301 PUBLIC: WELLS (041 MULTI-CHAMBERED [T�N [311 JR111GATION WELLS Tuf-Tite EF -4 WATER 5 [ (05] OUTLET FILTER 321 POTABLE DC3 2. FOUNDATIONS [06] LEGEND 1. 70-109-21 [33) BUILDING PROPERTY LINES 4 (071 WATERTIGHT [341 THER (081 LEVEL O (351 1 sAnIND sys-mS