PL-15-1455 Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-240236 Permit Number: PL-6-15-1455
Scheduled Inspection Date: August 04, 2015 Permit Type: Plumbing - Residential
Inspector: Diaz, Osvaldo Inspection Type: Final
Owner: MARIA G. GUERRA,ALLESSANDRA Work Classification: Drainfield
Job Address:249 NE 97 Street
Miami Shores, FL 33138- Phone Number 305/759-8943
Parcel Number 1132060134260
Project: <NONE>
Contractor: STATEWIDE SEPTIC CONNECTIONS Phone: (954)963-0082
Building Department Comments
REPLACE DRAIN FIELD Infractio Passed Comments
INSPECTOR COMMENTS False
Inspector Comments
Passed CREATED AS REINSPECTION FOR INSP-236769. HRS IN FILE
NO PERMIT ONSITE
SIDE WALK REPAIR REQUIRED
Failed i . 01-J s , b� �✓,�ru`
Correction
Needed
V" r/S
Re-Inspection ❑
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid.
August 03,2015 For Inspections please call: (305)762-4949 Page 26 of 37
® o: DIVISION OF
Q� Environmental Health
V� Florida Health
Mi
O ami-Dade County �O
Q� OSTDS/Well Division
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h Street•Miami,FL 33175 O
Inspectors Date • �i.y r
1 Address Is r OSTDS#
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Comments:`
Signature ,,J 4'L
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Miami Shores Village
P€r� iPi Re ttllt1
10050 N.E.2nd Avenue NE f� Die" 1i
Miami Shores,FL 33138-0000 y
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Phone: (305)795-2204
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Expiration: 12/16/2015
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Project Address Parcel Number Applicant
249 NE 97 Street 1132060134260
ALLESSANDRA FRANCHINI MAI
Miami Shores, FL 33138- Block: Lot:
Owner Information Address Phone Cell
ALLESSANDRA FRANCHINI MARIA G. 249 NE 97 Street 305/759-8943
— --- MIAMI SHORES FL 33138
Contractor(s) Phone Cell Phone Valuation: $ 2,800.00
STATEWIDE SEPTIC CONNECTIONS (954)963-0082 Total Sq Feet: 150
Type of Work:REPLACE DRAIN FIELD Available Inspections:
Type of Piping: Inspection Type:
Additional Info:
HRS Approval
Bond Return: Final
Classification:Residential Scanning:3 Review Plumbing
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
Bond Type-Contractors Bond $500.00 Invoice# PL-6-15-55965
CCF $1.80
DBPR Fee $225 06/15/2015 Check#:4771 $50.00 $618.30
DCA Fee $2.25 06/19/2015 Check#:4789 $618.30 $0.00
Education Surcharge $0.60 Bond#:2756
Permit Fee $150.00
Scanning Fee $9.00
Technology Fee $2.40
Total: $668.30
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. Fut ore,I autho the bove-named contractor to do the work stated.
r' June 19, 2015
Authorized Signaka--9v6ner / Applicant / Contractor / Agent Date
Building Department Copy
June 19,2015 1
Property Search Application - Miami-Dade County Page 2 of 2
version: 4
Miami Shores VillageRE�uN � � io1�CEz ..
6
Building Department
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 200
BUILDING Master Permit No.Rz/ — /y
'�- z V
PERMIT APPLICATION Sub Permit No.
F-1 BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION F-]RENEWAL
]PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: y rNj G q� S
City: Miami Shores County: Miami Dade Zip: 3 31
Folio/Parcel#:_ (( _3zr06`_ of 3-42-CQ Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): MCin G L rtlZi of Gc•C l Phone#: -3 7S r' - S`1 -"3
Address: 21 NC C1
City: Sv)"O i' j State: Zip: -)2,1 5&
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: a �Wr� L. '< 5 I iPhone#: 3'�5_6, . k� 3
'r
Address: 1 (c, N'" A-"J * IS
City: DC. Loc
-Kzi _ ` State: L Zip:
Qualifier Name: `e mss'1 J' S"3 :�,��., Phone#:
State Certification or Registration#: &M L 2' Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ 2 t'JC%C' Square/Linear Footage of Work: �So
Type of Work: ❑ Addition ❑ Alteration ❑ New [� /Re lace
Re air
p p ❑ Demolition
Description of Work:
Specify color of color thru tile:
Submittal Fee$ � �0 Permii Fee$ /�• �r CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$
(Revised02/24/2014) � � �
http://www.miamidade.gov/propertvsearch/ 6/2/2015
► r
Bonding Company's Name(if applicable)
Bonding Company's Address /
City State / Zip
Mortgage Lender's Name(if applicable)
Mortgage Lender's Address
City State 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 �I ��Rx, Signature c
O ER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregtg instrument was acknowledged before me this
____� day of 120 , by day of Uy'y 20�J by
Mt✓.n 2 Q-'e-'r'e, who is personally known to '7 2f'10,S J4S4 fie— who is personally known to
me or who has produced as me or who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: / Sign:
Print::!� r_C'_��� G ��Oti S Print:
Seal: yr Notary Puaic state of Florida Seal: " Notary Public Stats of Florida
Trencella Leans . ly Trence►la Lewis
iV d` My
My Cwnm+►sion FF 196907 Commission FF 196907
• d�
n"-'0512019 or n. Expires 02i0512019
############ # ##############################################################
APPROVED BY /f/> Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
OO
SNoItES GY
Miami shores Village
Building Department
ORiDA 10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
Notice to Owner — Workers' Compensation Insurance Exemption
t
Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05
allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to
obtaining a building permit. Pursuant to the Florida Division of Workers' Compensation Employer Facts Brochure:
An employer in the construction industry who employs one or more part-time or full-time
employees, including the owner,must obtain workers' compensation coverage. Corporate officers
or members of a limited liability company (LLC) in the construction industry may elect to be
exempt if:
1. The officer owns at least 10 percent of the stock of the corporation, or in the case of
an LLC,a statement attesting to the minimum 10 percent ownership;
2. The officer is listed as an officer of the corporation in the records of the Florida
Department of State,Division of Corporations;and
3. The corporation is registered and listed as active with the Florida Department of
State,Division of Corporations.
No more than three corporate officers per corporation or limited liability company members are
allowed to be exempt. Construction exemptions are valid for a period of two years or until a
voluntary revocation is filed or the exemption is revoked by the Division.
Your contractor is requesting a permit under this workers' compensation exemption and has acknowledge that he or she will not use
day labor,part-time employees or subcontractors for your project.The contractor has provided an affidavit stating that he or she will
be the only person allowed to work on your project.In these circumstances,Miami Shores Village does not require verification of
workers' compensation insurance coverage from the contractor's company for day labor,part-time employees or subcontractors.
BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS
CONTENTS.
Signature:
caner �
State of Florida
County of Miami-Dade
The foregoing was acknowledge before me this day of JLJ n e.. 20 �.
By m ay-`ct G rte`r-, G L),e sY 4, who is personally known to me or has produced
as identification.
Notary:
SEAL: Notary Public State of Florida
Trencelle Lewis
y� My Commission FF 196307
�i Expires 02MI2019
PERMIT #: 13-SC-1610385
x,
APPLICATION
STATE OF FLORIDA T7,ir!.rT #:AP1191487
DEPARTMENT OF HEALTH DATE PAID:
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM FEE PAID:
CONSTRUCTION PERMIT
C06 W RECEIPT #:
DOCUMENT #: PR977228
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: Alessandra Freanchini
PROPERTY ADDRESS: 249 NE 97 St Miami, FL 33138
LOT: 1718 BLOCK: 31 SUBDIVISION; .
PROPERTY ID #: 11-3206-013-4260 [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 TIA's.. ANY CHANGE IN MATERIAL FACTS,
WHICH SERVED AS A BASIS FOR ISSUANCE OF THIS PERMIT, _ZEQUIRE 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 [ 750 ] GALLONS / GPD Exist. septic tank to remain CAPACITY
A [ 0 ] GALLONS / GPD
N
CAPACITY
[ 0 1 GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
K [ ] GALLONS DOSING TANK CAPACITY [ GALLONS @[
]DOSES PER 24 HRS #Pumps [ ]
D [ 150 ] SQUARE FEET Trench confiquration drain SYSTEM
R [ 0 ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [X] STANDARD [ ] FILLED [ ] MOUND [ ]
I CONFIGURATION: [x] TRENCH [ ] BED [ ]
N
F LOCATION OF BENCHMARK: FFE: 12.2'NGVD
I ELEVATION OF PROPOSED SYSTEM SITE [ 26.40 ] [ INCHES FT j"[ F�BOVE BELOW BENCHMARK/REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 74.40 ] [ INCHES FT
L ABOVE BELOW BENCHMARK/REFERENCE POINT
D FILL REQUIRED: [ 0.00] INCHES C EXCAVATION REQUIRED: [ 48.001 INCHES
1.-Existing 750 gal. septic tank, certified by"Statewide Septic Connections Inc."on 6/2/2015 to remain.
2.-Install 150 sf of drainfield in trench configuration.
T 3.-Install 12"of slightly limited soil at the bottom of the drainfieid.
H 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.)
E
R
SPECIFICATIONS BY:
TerAsa J Solomon _,__TITLE.
Master Septic Tank Contractor
1
APPROVED BY: C7:T :' Eng Y]'eerkng Specialist II
-
DATE ISSUED: 06/08/2015e O Dade CHD
DH 4016, 08/09 (Obsoletes all previous editions which may not be used) EXPIRATION DATE: 09/06/2015
Incorporated: 64E-6.003, FAC
o -1..4Page,. ,. of_3
rG.xx9Xas�� ``�+ sr9o28aa ,
The
Cts
i DOCUMENT #: PR977228
--------------------------------------------------------------------------------------------
-----------------------------------
---------------------------------------
5.-Invert elevation of drainfield to be no less than 6.50'NGVD.
6.-Bottom of drainfield elevation to be no less than 6.00' NGVD.
The system is sized for 2 bedrooms with a maximum occupancy of 4 persons(2 per bedroom),for a total estimated flow of
300 gpd.
THIS PERMIT IS NOT FOR ANY ADDITIONS.
qjFj,-
STATE OF FLORIDA
'+APARTMENT OF HEALTH
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT
.
Permit Application Number
--- --------- PART II - SITE PLAN-----------
Scale: Each block represents 5 feet and 1 inch=50 feet. {4
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Site Pian submitted by:
w. 1t '•t F �'.- -^'^'"v.,. r :. � � -.r � J.P.- r l(4/` � f_ ��
Signature
'Ian Approved me
Not Approved '
- Date ,-
County Health Department
ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
114015,10/96(Replaces HRS-H Form 4015 which may be used)
tack Number:5744-002-4015-6)
Page 2 of 3