PL-15-861Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
FnNumber: INSP-232324 Permit Number: PL -4-15-861
F
Inspection Date: April 15, 2015 Permit Type: Plumbing - Residential
Inspector: Diaz, Osvaldo Inspection Type: Final
Owner: JULIANA MIRANDA, PAUL ADAN Work Classification: Septic
Job Address: 500 NE 97 Street
Miami Shores, FL 33138- Phone Number
Parcel Number 1132060171540
Project: <NONE>
Contractor: MR C'S PLUMBING & SEPTIC INC Phone: (305)651-7859
Buildina Deoartment Comments
SEPTIC AND DRAIN FIELD
Infractio Passed Comments
INSPECTOR COMMENTS False
Inspector Comments
Passed
Ef
l-l�
Failed El
Correction
Needed
Re -Inspection ❑
Fee
-
No Additional Inspections can be scheduled until
re -inspection fee is paid.
For Inspections please call: (305)762-4949
April 15, 2015 Page 1 of 1
�to;r�rt�
Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
—j—UU1u a Parcel Number Applicant
500 NE 97 Street 1132060171540
Miami Shores, FL 33138- Block: Lot: PAUL ADAN JULIANA MIRANDA
Owner Information Address Phone Cell
PAUL ADAN JULIANA MIRANDA 500 NE 97 Street
MIAMI SHORES FL 33138-
Contractor(s) Phone Cell Phone
MR C'S PLUMBING 8 SEPTIC INC (305)651-7859
Type of Work:
Type of Piping:
Additional Info:
Bond Retum :
Classification: Residential Scanning: 3
Fees Due
Amount
CCF
$3.00
DBPR Fee
$2.25
DCA Fee
$2.25
Education Surcharge
$1.00
Permit Fee
$150.00
Scanning Fee
$9.00
Technology Fee
$4.00
Total:
$171.50
Valuation: $ 5,000.00
Total Sq Feet: 625
Pay Date Pay Type Amt Paid Amt Due
Invoice # PL -4-15-55181
04/13/2015 Credit Card $ 50.00 $ 121.50
04/15/2015 Credit Card $ 121.50 $ 0.00
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. Futhermore, I au prize the above-named contractor to do the work stated.
April 15, 2015
AdMorized Signature: Owner / Applicant / Contractor / Agent Date
Building Department Copy
April 15, 2015 1
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
BUILDING
PERMIT APPLICATION
❑BUILDING ❑ ELECTRIC ❑ ROOFING
APR 13 2015
FBC 20 16
Master Permit No. �
Sub Permit No.
❑ REVISION
FE-] PLUMBING ❑ MECHANICAL F-1 PUBLIC WORKS ❑ CHANGE OF
CONTRACTOR
❑ EXTENSION ❑ RENEWAL
❑ CANCELLATION ❑ SHOP
DRAWINGS
JOB ADDRESS: 1�2 Q 0 '� 1, c r \ Soo 06 T7 LST"
City Miami Shores County Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder):.
Address: �5(oc N
U �iayi(" vNi, 1`G( P16 C'\
S� 1 Ca e ^�11 l S �� Zip: �/ 4
a '
City: State:
Tenant/Lessee Name: Phone#:
Email;
CONTRACTOR: Company Name: Mr C's Plumbing and Septic Phone#: 305-651-7859
Address: 19932 NW 2 Ave
City:
Miami State: FL Zip: 33169
Qualifier Name: Kemble Ettrick Phone#: 305-651-7859
State Certification or Registration #: SR061536 Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State Zip:
Value of Work for this Permit: $_ S, 000.6a Square/Linear Footage of Work: 6a_477
Type of Work: El Addition ❑ Altera*inn New Q Repair/Replace ❑ Demolition
Description of Work: n L 0
Specify color of color thru tile:
Submittal Fee $� n `iV Permit Fee $ CCF $ CO/CC $
Scanning Fee $ Radon Fee $ BPR $
Technology Fee $ Training/Ed cation Fee $
Structural Reviews $
(Revised02/24/2014)
Notary $
Double Fee $
Bond $ Z)
TOTAL FEE NOW DUE $ (2-1-5
S
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. 1 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.
4 Signature Signature
OW N ER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this
19 day of , 20 by
ff
,who i ersonally know to
me or who has produced iU lr'�� C1 (r r c; r1c as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
KEMBLE ETTRICK
Seal: Notary Public - State of Florida
�a My Comm. Expires Sep 19, 2017
CC@odm�m[iis�siihonN�j#(](F�aF� 101�5�5�7ry3�2
'•��j/OFG��•� >�lT�F �R3R'�R Nt"1killfk�fkfltflf=k=7kfR=i1Wi
+N+k
The foregoing instrument was acknowledged before me this
day of APte- , 20 19 , by
,whoispersQpallyJLnowJ0
_e or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign:_
Print:
Seal: =�r�• : Notary Public - State of Florida
. •= My Comm. Expires Oct 23, 2018
''z�,',P�;� Commission # FF 138597
Bonded Through National Notary Assn.
APPROVED BY ®�'� Plans Examiner
Structural Review
(Revised02/24/2014)
as
Zoning
Clerk
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION PERMIT
CONSTRUCTION PFAWT FOR:
APPLICANT:
Pail Aelan
OSTDS New
PROPERTY ADDRESS- 500 NE 97 St Miami, FL 33138
LOT: 910 BLACK: 99 SUBDIVISION:
PROPERTY ID #: 11-3206-017-1540
PST #:13 -SC -1479226
APPLICATION #: AP 1111120
DATE PAID:
FEE PAID:
RECEIPT #•
DOCUMENT #: PR911920
[SECTION, TOWNSHIP, RANGE, PARCEL 7
[OR TAX ID NUMBERI
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 C 1,200 7 GALLONS / GPD Septic CAPACITSi
A [ ] GALLONS / GPD N/A CAPACITY
N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK -.1250 GALLONS]
K [ l DOSING TANK CAPACITY I Ing @I IDOSES PER 24 HRS #PUMPS I
7
D [ 625 SQUARE FEET in trench configuration SYSTEM
R [ ] SQUARE FEET N/A SYSTEM
A TYPE SYSTEM: IXI STANDARD 1 7 FILLED I I MOUNDE 3
I CONFIGURATION: IxI TRENCH I I BED [ 1
N
F LOCATION OF BENCHMARK: FF:9.06'ngvd
I ELEVATION OF PROPOSED SYSTEM SITE C 0.72 I INCHES FT I[ ABOVE�BENCHMARE6/REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE 1 30.727 q INCHES FT IIABOVE BELOW BENCHMARK/REFERENCE POINT
L
D FILL REQUIRED: 10.007 INCHES EXCAVATION REQUIRED: [ 72.007 INCHES
The system is sized for 3 bedrooms with a maximum occupancy of 6 persons (2 per bedroom), for
rsartotal estimated flow
b is roequired to p®asor i a
O of 500 gpd. S0 i v:ing to dile tre n wai excavaticun 2t the
T - Install 1200 g septic tank. time czt lir; ' :;,sr . °rr:.e;w t' A-raval, thi CION
- Install 625 sq It drainfield in trench configuration. :,I7.' VI) r&� +"--0 rz�{i
H - Install 42" of slightly limited soil under bottom of drainfield. re. uqs tc� 9 r ;;rt, , ;,a n ora ouba fitted, A
E - Elevation of bottom of drainfield to be no less than 6.. ' VD. reinspeectiori 4tc r<d ; r, a. . s 1 th? contractor s not
- The ends of the drain lines shall be connectproducd a continuous circuit recycling ! srrari 00-'e.
R
SPECIFICATIONS BY: TTRICK ,,�
R TITLE:
APPROVED BY:
TITLE: Engineer Specialist II CHD
a R S=
DATE ISSUED: 7/17(2{. EXPIRATION DATE: 01/1712015
DH 4016, 08/09 (Oblvietes all previous editions which may not be used) Page 1 of 3
Incorporated: 64E-6.003, FAC
.;c12i2220 SV043597
I