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PL-15-907lk- Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-232760 Scheduled Inspection Date: April 29, 2015 Inspector: Diaz, Osvaldo Owner: OREJANA, FERNANDO MONEDERO Job Address: 101 NE 105 Street Miami Shores, FL 33138 - Project: <NONE> Contractor: STATEWIDE SEPTIC CONNECTIONS :sunamg uepartment comments INSTALL NEW TANK AND DRAINFIELD TO CLOSE PERMIT# PL -13-2818 Permit Number: PL -4-15-907 Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Drainfield Phone Number (786)329-0222 Parcel Number 1121360050090 INSPECTOR COMMENTS False Inspector Comments Passed HRS ON FILE Failed Correction ❑ Needed Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. Phone: (954)963-0082 April 28, 2015 For Inspections please call: (305)762-4949 Page 10 of 33 Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Parcel Number Applicant 101 NE 105 Street 1121360050090 FERNANDO MONEDERO OREJA Miami Shores, FL 33138- Block: Lot: Owner Information Address Phone Cell FERNANDO MONEDERO OREJANA 101 NE 105 Street (786)329-0222 MIAMI SHORES FL 33138-2032 Contractor(s) Phone Cell Phone STATEWIDE SEPTIC CONNECTIONS (954)963-0082 Type of Work: INSTALL NEW TANK AND DRAINFIELD Type of Piping: Additional Info: Bond Retum : Classification: Residential Scanning: 3 Fees Due Amount CCF $4.80 DBPR Fee $4.50 DCA Fee $4.50 Education Surcharge $1.60 Permit Fee $300.00 Scanning Fee $9.00 Technology Fee $6.40 Total: $330.80 Valuation: $ 7,200.00 Total Sq Feet: 0 Pay Date Pay Type Amt Paid Amt Due Invoice # PL -4-15-55235 04/27/2015 Credit Card $ 330.80 $ 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. Futhermora I authorize the above-named contractor to do the work stated. April 27, 2015 Building Department Copy April 27, 2015 Miami Shores Village Building Department 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 APPLICATION Permit Type: PLUMBING REED CRI`�V ®E6 2013 BY FBC 20 tO Permit No. Master Permit No. 1? U'3— JOB ADDRESS:. i 01 N E I o 5 ")q a City: Miami Shores County: Miami Dade Zip: 33) 3 8 Foho/Parcel#: I' -2- 1 ?) 6 - 00 5- ®'®q 0 Is the Building Historically Designated: Yes NO ✓ Flood Zone: OWNER: Name (Fee Simple Titleholder): F 1ZN A-wQ0 ®(ZC S"A Phone#: `7e6 329 - OzZZ. Address: 10 I N e- 10 S ST City: mk prfAt S 40 n_&& State: 1=L Zip: "%3 13 8 Tenant/Ussee Name: Phone#: Email: CONTRACTOR: Company Name: S"tp-%� toeC &Om/ C0Q o fV0ff�9( h ne#: ® � 33 Address: k0 ))' SUl ')_2S ST City: 1`11 Q Pcl_�A& State: ' Zip: 53023 i Qualifier Name: ��,�aS A !'d Lo Ko A Phone#:1 S4- 2-a w S 6 Lf - State Certification or Registration #: S K® Oki k Z 6 `Z zZ�,<> Certificate of Competency #: Contact Phone#: Email DESIGNER: Architect/Engineer: Value of Work for this Permit: $ ^1, zoo Sq of Work: G`z Type of Work: ❑Address ❑Alteration ❑New ❑Repair/Replace ❑Demolition Description of Work: Pt NA A -F.` N i ACE S'CVTIG Tot j live y07 6 k -t10 &1 -CA•SEc, sr- NuAv 661 13ir�_ ®(LA LgE utp Submittal Fee $ Permit Fee $ .3 00 • Tao- CCF $ CO/CC $ Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural AMew $ DBPR $ Bond Technology Fee $ TOTAL FEE NOW DUE 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 Owner or Agent The foregoing instrument was acknowledged before me this day of C, , 201 A , by -g A t po 1OWJ P , who is personally known to me or who has producedl`> �,y - ucEas►&—' As identification and wjkq* take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: Wil Signature &0—� Contractor The foregoing instrument was acknowledged before me this ( -7 day of fJ—, 20 0, by �Q INA Q LQ),� who is personally known to me or who has produced' as identification and who did take an oath. NOTARY PUBLIC: Sign: .TERES,► � SOLOMON riot: MY COMMISSION # EE131935J 4y Commission Expires: P EXPIRES November 08, 2015 !9"153 T P idallotarySer tce.com �Y4t:E•�:?•�k:r•& Y�Y�Y�&�'e�roY�Y>'c Y9::?• YoY�tktk4:>F�Y4c9c4e:09: ��:t k k9e�Y� k�Y9c�oY9:4eoY4e�� Y ka4:F Y Y�9: k ks4:?; k�� kakoYtk k9: �:Y k k&�9etk4:9F k:F k��k�Y4e:>• k4e�4e•Ic4toY4e k4t&9toF4t4: APPROVED BY /L / 3 Plans Examiner Zoning Structural Review Clerk (Revised3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) Address: City: State: Zip: Value of Work for this Permit: $ r ';L® 0 Square/linear Footage of Work: & 67 Type of Work: ;9j Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: n a" N e.-ju7 +i n K 4 - Specify color of color thru Me: Submittal Fee $ Perrrii F S„. .° CCF $ Scanning Fee $ Technology Fee Structural Reviews $ (Revised02/24/2014) Radon Fee $ Training/Education Fee $ CO/CC $ DBPR $ Notary $ Double Femme $ Bond $ iR - () TOTAL FEE NOW DUE $ 33 Miami Shores.Village P"'FIC: Building Department artment AP1'"' 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 �y INSPECTION LINE PHONE NUMBER: (305) 762-4949 0jr BUILDING AFB Master Permit No.1 PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION RENEWAL PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS I ►�6' -6 4 ®S St JOB ADDRESS: 404 N-6 City: Miami Shores County: Miami Dade Zip: 3a 13a Folio/Parcel#: (3 6 " ®®' OOt-) 0 Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): �� 6 S�®Phone#: Address: 4 c7.1 N tv A 0 a s" City: M 1 AAA I "ORCS State: �� Zip: Tenant/LeName: Phone#: tssee Email:_ (-V\CAA&0 C�j CONTRACTOR: Company Name: __hVt j e1A)1 ®Lei i C JS e s I nC Phone#: 3 , 661- 6633 Address: tb640 N W I" A,je_ fJ C1� V I S City: G State: FL Zip: 3`3®S Lf Qualifier Name: � I•= rL'on Phone#: State Certification or Registration M TM 0 011 (Z l& 2 Certificate of Competency M DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ r ';L® 0 Square/linear Footage of Work: & 67 Type of Work: ;9j Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: n a" N e.-ju7 +i n K 4 - Specify color of color thru Me: Submittal Fee $ Perrrii F S„. .° CCF $ Scanning Fee $ Technology Fee Structural Reviews $ (Revised02/24/2014) Radon Fee $ Training/Education Fee $ CO/CC $ DBPR $ Notary $ Double Femme $ Bond $ iR - () TOTAL FEE NOW DUE $ 33 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 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. Signature OWNER or AGENT Signature - AAvW . CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day �ofA P'\?W �— 20 G . by 0 r day of " e' , 20 IS , by 1vlU� . who is personally known to`� ®i0`� who is personally known to me or who has produced Fl. -'DD.) NSA as me or who has produced PyV L—t C" as identification and who did take an oath. identification and who did take an oath. NOTARY PU IC: NOTARY PUBLIC: Sign: Sign:- n&- GL.- G' - Print: Print: Opp Notary Public State of Florida Seal: Sindla Alvarez Seal: My Commission FF 156750 NwAry ftbu stab of FbMa pFp� Expires 09/03/2018 •pv if lla 60YYla My 4WRMIU n FF 19830F.x�f83 oy08d2019 APPROVED BYPlans Examiner Zoning Structural Review Clerk (Revised02/24/2014) STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT CONSTRUCTION PERMIT FOR: OSTDS New APPLICANT: Fernando Monedero PROPERTY ADDRESS: 101 NE 105 St Miami, FL 33138 LOT: 9 BLOCK: 201 SUBDIVISION: PROPERTY ID #: 11-2136-005-0090 PERMIT #: 13 -SC -1492780 APPLICATION #: AP1119005 DATE PAID: . FEE PAID: RECEIPT #: DOCUMENT #: PR919891 [SECTION, TOWNSHIP, RANGE, PARCEL NUMBER] [OR TAX 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 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 [ 1,050 ] GALLONS / GPD Septic 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 [ 334 ] SQUARE FEET bed confiquration drainfiel SYSTEM R [ 334 ] SQUARE FEET bed confiquration drainfiel SYSTEM A TYPE SYSTEM: [X] STANDARD [ ] FILLED [ ] MOUND [ ] I CONFIGURATION: [ ] TRENCH [x] BED [ ] N F LOCATION OF BENCHMARK: F.F.E., 11.66' NGVD I ELEVATION OF PROPOSED SYSTEM SITE [ 19.90][ INCHES FT ][ABOVE BELOW BENCHMARK/REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ 49.90][ INCHES FT ][ABOVE BELOW BENCHMARK/REFERENCE POINT L D FILL REQUIRED: [ 0.00] INCHES EXCAVATION REQUIRED: [ 30.001 INCHES 0 Inspector to verify the existing septic tank is properly abandoned before final approval. *Invert elevation of drainfield to be no less than 8.00' NGVD. T "Bottom of drainfield elevation to be no less than 7.50' NGVD. H The system is sized for 3 bedrooms with a maximum occupancy of 6 persons (2 per bedroom), for a total esti flow of 400 gpd. E The licensed contractor installing the system is responsible for installing the minimum category of tank in a ordan R with s. 64E -6.013(3)(f), FAC. JJ�� SPECIFICATIONS BY: Barry G Teixeira TITLE: Master Septic O APPROVED BY: TITLE: ea�tir V- CHD Carlos M loaza _ DATE ISSUED: 10/21/2013 EXPIRATION 04/21/2015 DH 4016, OB/09 (Obsoletes all previous editions which may not be used) Incorporated: 64E-6.003, FAC Page 1 of 3 v 1.1.4 AP1119005 SE910752 DIVISION OF ' Environmental Health 0 Florida Department of Health Miami-Dade County Health Department OSTDS/Well Division tl'� 11805 SW 26 St. • Miami, FL 33175 Date 43 Address 0�3 Inspector Address`! I ce 0 S T D S #R_I t 1 L9O S� Comments: i v I 114 k. nwortmentai ktalith Florida Dcj',)Artl-vlulltr "if 1-441th oont*v livilth Orpattillent