PL-15-1658 Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-239575 Permit Number: PL-7-15-1658
Scheduled Inspection Date: July 23, 2015 Permit Type: Plumbing - Residential
Inspector: Diaz, Osvaldo Inspection Type: Final
Owner: MIQUELLI JTRS,ALEXANDER Work Classification: Septic
Ra'"ICI 1 1 1700
Job Address:53 NW 99 Street
Miami Shores, FL Phone Number (305)753-8874
Parcel Number 1131010180500
Project: <NONE>
Contractor: JASON'S SEPTIC INC Phone: 305-252-1080
Building Department Comments
INSTALL NEW TANK/DRAINFIELD Infractio Passed Comments
INSPECTOR COMMENTS False
pector Comments
Passed CREATED AS REINSPECTION FOR INSP-238251. HRS IN FILE
EV NO SIDEWALKS
SOD OK
COULD NOT SIGN PERMIT
Failed
dc-
Correction ❑ Gv
Needed
Re-Inspection ❑ �'-� V r r�,}��
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid.
July 22,2015 For Inspections please call: (305)762-4949 Page 25 of 39
APPLICATION #:AN 185013
STATE OF FLORIDA PERMIT #:13-$C-1600611
DEPARTMENT OF HEALTH DocummT #:F11000950
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION INSPECTION AND FINAL APPROVAL DATE PAID:05/13/2015
FEE PAID:100.00
RECEIPT #:13-PID-2657547
APPLICANT: Alexander Miguelli
AGENT: Jason"s Septic
PROPERTY ADDRESS: 53 NW 99 St Miami, FL 33175
LOT: " BLOCK: 6
SUBDIVISION: 3:D#: 11-3101-018-0500
CHECKED [X] ITEMS ARE NOT IN COMPLIANCE WITH STATUTE OR RULE AND MUST BE CORRECTED.
TANK INSTALLATION SETBACKS
[ I [011 TANK SIZE [1] 1050.00 [2] [ 1 [273 SURFACE WATER FT
[ l [02] TANK MATERIAL Polyethylene [ ] [eel DITCHES FT
[ ] [03] OUTLET DEVICE [ ] 1293 PRIVATE WELLS FT
[ ] [04] MULTI-CHAMBERED ELIJ ELIN ] [ l (301 PUBLIC WELLS FT
[ 1 [05] OUTLET FILTER Tuf-Tite EF-4 [ ] [31] IRRIGATION WELLS FT
I l 1063 LEGEND 1. 70-109-21DC3 2. [ ] [32] POTABLE WATER 25 FT
I I [071 WATERTIGHT [ 1 [33] BUILDING FOUNDATIONS 5 FT
[ l [Oe] LEVEL [ l [34] PROPERTY LINES 9.5 FT
I I [091 DEPTH TO LID [ ] (35] OTHER FT
DRAINFIELD INSTALLATION FILLED / MOUND SYSTEM
I 1 [101 AREA [ll 300 [2] SQFT [ 1 [361 DRAINFIELD COVER
[ 1 [11] DISTRIBUTION BOX HEADER X [ ] [371 SHOULDERS
I 1 1123 NUMBER OF DRAINLINES 1. �,Q2 2. [ ] 1361 SLOPES
[ ] [131 DRAINLINE SEPARATION [ 3 [391 STABILIZATION
[ ] [141 DRAINLINE SLOPE
[ ] [151 DEPTH OF COVER ADDITIONAL INFORMATION
[ ] [161 ELEVATION I ABOVE / BELOW ]BM 32.76 [ l 1401 UNOBSTRUCTED AREA
[ ] 1173 SYSTEM LOCATION 1 ] [413 STONER RUNOFF
I I [16] DOSING PUMPS [ 1 [421 ALARMS
I 1 [19] AGGREGATE SIZE [ ] [43] MAINTENANCE AGREEMENT
I l 1203 AGGREGATE EXCESSIVE FINES [ 1 [44] BUILDING AREA
I 1 1211 AGGREGATE DEPTH 1 1 [451 LOCATION CONFORMS WITH SITE PLAN
FILL / EXCAVATION MATERIAL [ ] [461 FINAL SITE GRADING
1 1 [22] FILL AMOUNT [ 1 [47] CONTRACTOR Jason Nesenman(Jason"s S
1 l [231 FILL TEXTURE [ 1 [483 OTHER ADS ARC 24
I ] [241 EXCAVATION DEPTH ABANDONMENT
I ] [25] AREA REPLACED [ ] [49] TANK PUMPED 05/01/2015
[ ] [261 REPLACEMENT MATERIAL 1 ] [50] TANK CRUSHED & FILLED 05/05/2015
Comments: Conmenta are on page 2.
CONSTRUCTION L APPROVED / DISAPPROVED 1: Dade CEO DATE. 05/14/2015
Engineering Specialist II Erlande Ombcs(Department of Health In Delle Co
FINAL SYSTEM L APPROVED / DISAPPROVED ]; Dade CED, DATE: 05/14/2015
Engineering specialist N Ertandeca(Dipa—Ment of HealffiIn C
(tsplanation of Violations on following page)
DH 4016, 06/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E-6.003, FAC Page 2 of 3
EH Detabose v 1.0.1 APIIBS013 EID1600611
APPLICATIoN #:AP1185013
STATE OF FLORIDA PENT'#:13-SC-1600611
lip DEPARTMENT OF HEALTH Docmaw #-F11000950
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION INSPECTION AND FINAL APPROVAL DATE PAID:05/13/2015
FEE PAID:100.00
RECEIPT #:13-PID-2657547
Violation Number Comme
Commnents
-Setbacks,septic tank information and tank elevations taken during initial inspection by previous inspector.
-Total of 6 drainlines with 4 chambers each.
-Total of 20 ARC24 chambers for 300 sq ft bed drainfield.
-12"Inches of sand provided below drainfield.
The system is sized for 2 bedrooms with a maximum occupancy of 4 persons(2 per bedroom),for a total estimated flow of 300
gid•
DR 4016, 08/09 (Obsoletes all previous editions which may not be used)
incorporated: 64E-6.003, FAC Page 2 of 3
EH Database v 1.0.1 AP1186013 EID1600611
1 gxortes y�! Miami Shores Village P8#TtII Tj/j�e P11111113t1) -Ride �I�
10050 N.E.2nd Avenue NW
!r �o wo Cid i CBtibri:s ig
Miami Shores,FL 33138-0000
`mea` Phone: (305)795-2204
�`CORIDA s,
issue oate:71161201 6 = Expiration: OV1212016
Project Address Parcel Number Applicant
53 NW 99 Street 1131010180500
ALEXANDER MIQUELLI JTRS P
LMmi Shores, FL Block: Lot:
Owner Information Address Phone Cell
- � ..... .W_
ALEXANDER_MIQUELLI JTRS 53 NW 99 Street (305)753-8874
MIAMI SHORES FL 33150-1740
53 NW 99 Street
MIAMI SHORES FL 33150-1740
.
Contractor(s) Phone Cell Phone Valuation: $ 7,200.00
JASON'S SEPTIC INC 305-252-1080 I
Total Sq Feet: 500
Type of Work: INSTALL NEW TANK/DRAINFIELD 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-7-15-56201
CCF $4.80
DBPR Fee $4.50 07/16/2015 Check#:3157 $280.80 $50.00
DCA Fee $4.50 07/02/2015 Check#:3129 $ 50" $0.00
Education Surcharge $1.60 Bond#:2793
Permit Fee $300.00 Invoice# PL-7-15-56371
Scanning Fee $9.00 07/16/2015 Check#:3157 $500.00 $0.00
Technology Fee $6.40
Total: $830.80 Bond#:2793
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 conf with the plans,drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this p it I assume espon ibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELEWFuth
ICA BIN MECHANICAL,WINDOWS, DOORS,ROOFING and SWIMMING POOL work.
OWNERS AFFIl the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction andauthorize the above-named contractor to do the work stated.
July 16, 2015
Autho ed SZp-aa- rtment
ure:Owner / Applicant / Contractor / Agent Date
Buildin D Copy
July 16, 2015 1
Miami Shores Village _
Building Department Jugo1
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
FBC 20�1-( S=�
BUILDING Master Permit No..-FL k - f6S'c�?
PERMIT APPLICATION Sub Permit No.
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING ❑ MECHANICAL F]PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
cc�� 11 \�(r , \ G� CONTRACTOR DRAWINGS
J
JOB ADDRESS: ` : > J )w �
City:U�Ml 1Miami Shores County: Miami Dade zip:
Folio/Parcel#: 1'' �' _0[?)_05M Is the Building Historically Designated:Yes NO
Occupancy Type: �_Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple
�Ti�tleh�older): 1AW1Ruo, Phone#:
Address�6 >� �W �1c � -'1
City: "�ft U (� 1 �State: � Zip: '3I l
Tenant/Lessee Name: f:Y Phone#:
Email:
CONTRACTOR:Company Name. `S C Phone#:
Address: �l�'' �
City: ff iA I ,State:_ Zip: E�a'7
Qualifier Name: °m�ii ff� Phone#:"'
State Certification or Registration#: Certificate of Competency#:
DESIGNER:Architect/Engineer: +,!4 Phone#:
Address: City: State: _ Zip: _
Value of Work for this Permit:$ 7, 100 - 00 Square/Linear Footage of Work: C;00
Type of Work: ❑ Addition ❑ Alteration ❑ New t�epair/Replace ❑ Demolition
Description of Work: ( ekk 4eAj l i� _ C r l R ' CQ
Specify color of color thru tile:
Submittal Fee$ �- bo Permit Fee$ 3�> y CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$ S � rn(�W _
TOTAL FEE NOW DUE$ `J
(Revised02/24/2014) y�
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 --.. Signature
OWNER or AGENT ,, CONTRACTOR
The foregoing instru n wa ac nowledged oin before me this The foregstru en was ac nowledged befor is
`
I
day of '� / 20 �by day of 20 by
( is personallyknown to
w rsonally known to
me or who has produce ✓�L�1 se as me or who has produced-_moi �` ( �C ") as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: Sign:
Print: ck,k-(pl
r, Print: Y 1
�p a o orida _ fly rY Public State of Florid
Seal: Catherine E Nylund Seal: c'�/ Catherine E Nylund
�oF ExpC s 07/15/201sion 6 OMMi3216211 OF FU My Expires s 07/15/20OMMission 16 216211
************************************************************************************************************
APPROVED BY �% "Z S Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)