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PL-15-859Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-232312 Permit Number: PL -4-15-859 Scheduled Inspection Date: May 06, 2015 Inspector: Diaz, Osvaldo Owner: GUGUEN, ALICE Job Address: 10601 NE 6 Avenue Miami Shores, FL 33138 - Project: <NONE> Contractor: SOUTHERN SEPTIC CONTRACTORS INC tiunamg uepartment comments INSTALLATION OF SEPTIC TANK AND DAINFIELD Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Septic I,tTTtT-3ZMi� _s7M Parcel Number 1122310120020 Phone: (305)598-8266 INSPECTOR COMMENTS False / / May 05, 2015 For Inspections please call: (305)7624949 Page 17 of 50 Inspector Comments Passed Ef 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)7624949 Page 17 of 50 �ryYm Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 VJWJ .L UUIVOM Parcel Number Applicant 10601 NE 6 Avenue 1122310120020 ALICE GUGUEN Miami Shores, FL 33138- Block: Lot: Owner Information Address Phone Cell ALICE GUGUEN 10601 NE 6 Avenue MIAMI SHORES FL 33138- 10601 NE 6 Avenue MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone SOUTHERN SEPTIC CONTRACTORS 1 (305)598-8266 Type of Work: INSTALLATION OF SEPTIC TANK AND DAI Type of Piping: Additional Info: Bond Retum : Classification: Residential Scanning: 3 Fees Due Amount CCF $1.20 DBPR Fee $2.25 DCA Fee $2,25 Education Surcharge $0.00 Permit Fee $150.00 Scanning Fee $9.00 Technology Fee $1.60 Total: $166.70 Valuation: $ 2,000.00 Total Sq Feet: 500 Pav Date Pav Tvoe Amt Paid Amt Due I Invoice # PL -4-15.55179 04/13/2015 Credit Card 05/05/2015 Check #: 1241 $ 50.00 $ 116.70 $ 116.70 $ 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 in Is a urate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore, I authorize the ab ve-n m d co tractor to do the work stated. May 05, 2015 Authorized Signature: Building Department Copy ` May 05, 2015 1 BUILDING PERMIT APPLICATION Miami Shores Village C, ED Building Department APR, 8 2815 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY: Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC 20(0 Master Permit No. S Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: _ ®(say©I bl1 _ A o(^, City: Miami Shores County: Miami Dade zip: Folio/Parcel#: Ik- Z2.:3 1 — of 2- J 0 7-3 Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): LLL ( Ci= (�,, 1 H , l R �� L� Q Phone#::196 ( 5_j: 1 Address: (06n t h!�C c6 city: A Z -g S vtoQLS State: zip: Tenant/Lessee Name: Email: CONTRACTOR: Company Name: �C'j+�o"d `n'' Phone#: �-6 -(tl � -16 Address: 1 x-121 15 -3 --?A TJ City: M; State: ��-- Zip: 9 'I Qualifier Name: �' r ®� 2a° �J Phone#: r os State Certification or Registration #: ��21 �`L Certificate of Competency #: DESIGNER: Architect/Engineer:� Phone#: Address: City: State: Zip: Value of Work for this Permit: $ �-o®® Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: 1:11'1f_' S`� O�1\ V�k�1 o'er QA t LID Specify= v af'coldrthh, tile: Submitt4. Fee $ ® '` Permit Fee $ Scanninee$ Radon Fee $ Technology Fee $ Training/Education Fee $ Structural Reviews $ (Revised02/24/2014) CCF $_ DBPR $ CO/CC $: h Notary-$ Double Fee $ Bond $ 14- 20zq TOTAL FEE NOW DUE $ � I _). ;� c) 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 P 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 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. n _ Signatu Ce OWNER or AGENT The foregoing instrument was acknowledged before me this -s day of i i 20 0° , by A I i Ce. G Q GZ e N , who is personally known to me or who has produced identification and who did take an oath. NOTARY PUBLIC: Sign. Print: e C.) as The foregoing instrument vVa5 acknow ed before me this 13_ day of 12 20 , by u who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: _� Seal: Seal: humdkh "Os.•po��`� °°e%;.�' JANET VALLECILLO i-Aps- ° ' JANET VALLECILLO jos+ v . __ Notary Public - State of FI r Va*N t Py�ill<t�1�d6 gf, 2016 's;�9 gf y omm. Expires Mar 27, 2016 '•.;�;„�•• Commission # EE 183586 '•.;`;P+�a•' Commission # EE 183586 ,.. APPROVED_ Plans Examiner Zoning to Bim_ Structural Review Clerk (Revised02/24/2014) STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SERAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT CONSTRUCTION PERMIT FOR: OSTDS New APPLICANT: Alice Guguen PROPERTY ADDRESS: 10601 NE 6 Ave Miami, FL 33138 PERMIT #:.13 -SC -1562786 APPLICATION #: AP 1161448 DATE PAID: FEE PAID: RECEIPT #: DOCUMENT #: PR965675 LOT: 3 BLOCK: na SUBDIVISION: PROPERTY ID #• 11-2231-012-0020 [SECTION, TOWNSHIP, RANGE, PARCEL NUMBER] [OR TAX ID NUMBER] SYSTEM MIDST 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 IIQ 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 [ 1,050 I GALLONS / GPD new septic tank CAPACITY A [ ] GALLONS / GPD N/A CAPACITY N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS] K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ D [ 500 I SQUARE FEET new trench config. drainfie SYSTEM R [ I SQUARE FEET N/A SYSTEM A TYPE SYSTEM: [s] STANDARD [ ] FILLED [ ] MOUND [ ] I CONFIGURATION: [S] TRENCH [ ] BED [ ] N F LOCATION OF BENCHMARK: Rear Door Elevation: 14.59' NGVD I ELEVATION OF PROPOSED SYSTEM SITE [ 73.00 3 15 -4c -HEST FT I I ABOVE BELOW BMCM-EUWREFERENCE POINT E BOTTOM OF DRAINFIELD TO BE 1103.081[ INCHES FT ][ABOVE JBELOW BENCHMARK/REFERENCE POINT L D FILL REQUIRED: [ 0.00] INCHES EXCAVATION REQUIRED: [ 72.001 INCHES O T H E R 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 500 sf of drainfield in trench 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: Roberto Rodriguez TITLE: APPROVED BY: TITLE: Engineering Specialist II Dade CHD Yude&sy Mrtln- DATE ISSUED: 11/14/2014 DH 4016, 08/09 (Obsoletes all previous editions which may not be used) Incorporated: 64E-6.003, FAC EXPIRATION DATE: 05/14/2016 v 1.1.4 AP1161448 SE943089 Page 1 of 3 DOCUMENT #: PR955575 Invert elevation of drainfield to be no less than 6.5' NGVD. Bottom of drainfield elevation to be no less than 6.0' NGVD. be system is sized for 3 bedrooms with a maximum occupancy of 6 persons (2 per bedroom), for a total estimated flow of 00 gpd. 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.