PL-15-704 Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-231214 Permit Number: PL-3-15-704
Scheduled Inspection Date: July 16, 2015 Permit Type: Plumbing - Residential
Inspector: Diaz, Osvaldo
Inspection Type: Final
Owner: LOWMAN, MARCI Work Classification: Septic
Job Address:75 NE 101 Street
Miami Shores, FL 33138-
Phone Number (305)981-4477
Parcel Number 1132060131550
Project: <NONE>
Contractor: MR C'S PLUMBING &SEPTIC INC Phone: (305)651-7859
Building Department Comments
SEPTIC TANK AND DRAINFIELD INSTALLATION. Infractio Passed Comments
INSPECTOR COMMENTS False
I ector Comments
Passed HRS ON FILE
Failed
Correction ❑
Needed
Re-Inspection ❑
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid.
July 15,2015 For Inspections please call: (305)762-4949 Page 3 of 37
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Incaaparatad: 6612-6.003, FAC Pape 2 Of 3
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Miami Shores Village �t7ft e P, r" � �id
10050 N.E.2nd Avenue NE "
Miami Shores, FL 33138-0000 " l 'I � � � R�
ws
APP
Phone: (305)795-2204 ",_••
FLORIDA .St . . . . ._..�::. ... ...
I�aueat�� /2� Expiration: 09/27/2015
Project Address Parcel Number Applicant
75 NE 101 Street 1132060131550
Miami Shores, FL 33138- Block: Lot: MARCI COWMAN
Owner Information Address Phone Cell
MARCI LOW 75 NE 101 Street (305)981-4477
MIAMI SHORES FL 33138-
75 NE 101 Street
MIAMI SHORES FL 33138-
Contractor(s) Phone Cell Phone Valuation: $ 8,500.00
MR C'S PLUMBING&SEPTIC INC (305)651-7859
Total Sq Feet: 200
Type of Work:SEPTIC TANK AND DRAINFIELD INSTALLA 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-Owners Bond $500.00
CCF Invoice# PL-3-15-54972
$5.40 03/30/2015 Check#:2716 $50.00 $782.40
DBPR Fee $4.50
DCA Fee $4.50 03/31/2015 Check#: 1174 $500.00 $282.40
Education Surcharge $1.80 03/31/2015 Check#:2722 $282.40 $0.00
Permit Fee $300.00 Bond#:2655
Scanning Fee $9.00
Technology Fee $7.20
Total: $832.40
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 c�rtify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zoni ermore].authorize the above-named contractor to do the work stated.
March 31, 2015
Authorized Signature:Owner / Applicant / Contractor / Agent Date
Building Department Copy
March 31,2015 1
Miami Shores Village RECR
1
Building Department Baas n15
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 (O
BUILDING Master Permit No.TL
PERMIT APPLICATION Sub Permit No.
BUILDING ❑ ELECTRIC ROOFING REVISION EXTENSION RENEWAL
FE-]PLUMBING ❑ MECHANICAL PUBLIC WORKS ❑ CHANGE OF CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: -70 �rL
City' Miami Shores County: Miami Dade3�
Folio/Parcel#: (- o�d� d(- Il'i;S0 Is the Building Historically Designated:Yes NO
Occupancy Type: Load: ^Construction T�ypee:�r Flood Zone: BFE: F/FE:
OWNER:Name(Fee Simple Titleholder): �(~✓'Ld 1�""" Phone#: -3Q� IV µ`",7
Address: 7 5 kf' 0 r t _
City:_141- ,�1119_Ieo State: i�zi Zip: 3 31 '5 y
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:$ d Square/Linear Footage of Work: Dr
Type of Work: ❑ Addition ❑ Alteration ❑ New 0 Repair/Replace ❑ Demolition
Description of Work:
Specify color of color thru tile:
Submittal Fee$ Permit Fee$ vQ ' CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Bond$ E5� , (-�)
Structural Reviews$
TOTAL FEE NOW DUE$ —I
(Revised02/24/2014)
erg 2 . e-JrO
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
he work and installations as indicated. I certify Application is hereby made to obtain a permit to dot Y 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$2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of suc ost notice, the
inspection will not be a p and reinspection fee will be charged.
Signature _ Signature
OWNER or AGENT 0 CTO
The foregoing instrument was acknowledged before me this The foregoing ins r ent as acknowledged before me this
l l day of fAaXZk 20 f by y, day of 20 1;�' , by
who is personally known to Mm&C who is personally known to
me or who has produced as me or who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
g EM LE E
S n: Sign: Pda
;? Notary u
Pri C/ / Print: _ �'�' _ t i ` ' 2017 SHERYL A MENDES
ommi 2 0 Y Public-State of Florid
Seal: a°`,.A'p6�% CINDY KIM Seal: mm.Expires Oct 23,2C
Bon ed rnro t miction 8 FF 136597
* * MY COMMISSION d FF 1422!3 n - f)otbed nmo National Notary W
EXPIRES:July 15,2013 SI,F�(L /Y1
A
+.E(OMWF de��e Bonded Thru Budget Noluy$mia9
APPROVED BY /� .►/_3.—awl.55 Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
PERMIT #: 13-SC-1 595437
APPLICATION #:AP1181685
STATE OF FLORIDA
DATE PAID:
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM FEE PAID:
CONSTRUCTION PERMIT RECEIPT #:
DOCUMENT #: PR969078
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: Marci Lowman
PROPERTY ADDRESS: 75 NE 101 St Miami, FL 33138
LOT: 21 22 BLOCK: 11 SUBDIVISION:
[SECTION, TOWNSHIP, RANGE, PARCEL NUMBER]
PROPERTY ID #: 11-3206-013-1550
[OR TAX ZD 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 [ 900 ] GALLONS / GPD New septic tank CAPACITY
A [ 0 1 GALLONS / GPD CAPACITY
N [ 0 ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ 1
D [ 200 SQUARE FEET Bed confiquration SYSTEM
R [ 0 ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [x] STANDARD [ ] FILLED [ ] FUND [ ]
I CONFIGURATION: [ ] TRENCH [x] BED [ 1
N
F LOCATION OF BENCHMARK: F.F.E., 12.90'NGVD
I ELEVATION OF PROPOSED SYSTEM SITE [ 24.0011 INCHES FT ] [ ABOVE BELOW BENCHMARK/REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 74.04 ] [ INCHES FT ] [ABOVE BELOW BENCHMARK/REFERENCE POINT
L
D FILL REQUIRED: [ 0.00] INCHES EXCAVATION REQUIRED: [ 62.001 INCHES
*Invert elevation of drainfield to be no less than 7.23' NGVD.
O "Bottom of drainfield elevation to be no less than 6.73' NGVD.
T *Install 42"of slightly limited soil under the bottom of drainfield.
-Perimeter of excavation area shall be at least 2 ft.wider and longer than the proposed absorption bed or drain trench.
H 'THIS PERMIT IS NOT FOR"ADDITION(s)".
E 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.
R
SPECIFICATIONS BY: Kemble trick TITLE:
APPROVED BY: TITLE: Dade CHD
Carloi7 Icaza
DATE ISSUED: 03/27/2015 EXPIRATION DATE: 06/25/2015
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E-6.003, FAC �'` w[!Ftt" ' "`' `' *'` `"�' c Page 1 of 3
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