PL-15-849 Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-234605 Permit Number: PL-4-15-849
Scheduled Inspection Date: July 02, 2015 Permit Type: Plumbing - Residential
Inspector: Diaz, Osvaldo Inspection Type: Final
Owner: PALMATIER, SUSAN Work Classification: Drainfield
Job Address:341 NE 104 Street
Miami Shores, FL 33138-2017 Phone Number
Parcel Number 1121360130110
Project: <NONE>
Contractor: A AARON SUPER ROOTER Phone: 305-944-8886
Building Department Comments
REPLACE DRAINFIELD Infractio Passed Comments
INSPECTOR COMMENTS False
nspector Comments
Passed CREATED AS REINSPECTION FOR INSP-232278. HRS ON FILE
E21
sod needs to be put back
Failed
Correction ❑
Needed I
Re-Inspection ❑
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid.
July 01,2015 For Inspections please call: (305)762-4949 Page 18 of 47
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ANON,
5µors t� Miami Shores Village
10050 N.E.2nd Avenue NE
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Miami Shores,FL 33138-0000 f E
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Phone: (305)795-2204 `"" ` f
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' 1 ' Expiration: 10/13/2015
Project Address Parcel Number Applicant
341 NE 104 Street 1121360130110
Miami Shores, FL 33138-2017 Block: Lot: SUSAN PALMATIER
Owner Information Address Phone Cell
SUSAN PALMATIER 341 NE 104 Street m
MIAMI SHORES FL 33138-
341 N E 104 Street
MIAMI SHORES FL 33138-
Contractor(s) Phone Cell Phone Valuation: $ 2,250.00
A AARON SUPER ROOTER 305-944-8886 Total Sq Feet: 150
Type of Work:REPLACE 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-4-15-55169
CCF $1.80 04/16/2015 Check#:4300 $618.30 $50.00
DBPR Fee $2.25
DCA Fee $2.25 04/13/2015 Check#:4715 $50.00 $0.00
Education Surcharge $0.60 Bond#:2677
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. Futhermore,I au hon bove-named contractor to do the work stated.
--T_,�4 kx,�� April 16, 2015
Authorized Signature:Owner / Applicant / Contractor / Agent Date
Building Department Copy
April 16, 2015 1
Miami Shores Villages
Building Department
APR' 1`8 2015
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel:(305)795-2204Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 20 (0
BUILDING Master Permit No. � —Ccj
PERMIT APPLICATION Sub Permit No.
❑BUIL.DING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING ❑ MECHANICAL F—]PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
PP CONTRACTOR DRAWINGS
!OB ADDRESS:_ —"�)' Py t �c�
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: ( � 3�+ �%(; i�O Is the Building Historically Designated: Yes NO _
Occupancy Type: Load: cConstruction Type:: Flood Zone:_ BFE: FFE:
OWNER: Name(Fee Simple Titleholder): ° ,J .SCt,) CC, ,:h Qom' Phone#:
Address:_Ad NJ E ( oLt ST B�
City: m t a m-% Rho (-e5 State:_ Zip: tl �
Tenant/Lessee Name: Phone#:
Email
CONTRACTOR:Company Name: r'®r) " ��-0��- Phone#:
Address: �� �Z S -6s t _
City: 1am State:. " Zip: �>�®Q 3
Qualifier Name: ��^ �a7 i ` _Phone#: _
fi fid{}"."tion#:�� zQ tzB- c)�1l Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: _State: Zip:
Value of Work for this Permit:$ �a l Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace ❑ Demolition
Description of Work:
Specify color of color thru tile:
Submittal Fee$ Permit Fee$ -- Di CCF$__ CO/CC$_
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee--$
Structural Reviews$ — Bond$ Soo , M
TOTAL FEE NOW DUE$ \'
(Fevited02/24/2074)
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 on 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. ,/I`
1
i
Sig atur Signature
k —
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
1
day of 'VntV 1 20 _, by _day of 20 —, by
S'y SC PG�e-4'+�-Oho is personally known to h>z. � ,who erson known to
me or who has produced �r w ' , as me or who has produced lUC� as
identifiidentification and who did take an oath.
;►k� TER�SA 9 OMON
NOTAR Cs;_ t,1Y(-(,&OMISSION#EE131935 NOTARY PUBLIC:
EXPIRESNovember 08,2015
7)398-0153 F"allotaryservice.com
Sign:
Print: Print:
Seal: Teo--esk A,0-� Seal:
J SOLOMON
I •,ION#EE13193��
,�•...�; � �- ., .: , ;tuber 08.201.5
7)398-0153 F,...,daMdtaryService.com
APPROVED BY '13 '7 S Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
JOIIN J TUH-y
A-AARON SUPER ROOTER, INC.
6022 S W 35TH COURT
MIRAMAR, FL 33023-
OxFLORIDA DEPARTMENT OF HEALTH
CERTIFICATE OF AUTHORIZATION FOR SEPTIC TANK CONTRACTING
H E.AL.TH'
The No-ida Department ol'%lealth herebY certifies the business or entity named belotiv ha.� .suti,gied the rcq/trircmcrlr. ol /'art
lll. C'l:aptcr 4,5<J. l7uridu Statutes, for septic lank coruractimu and has been dtdv authorized hi, the Lkpuroncrnt/(pro I Oc
septic tank contruc ting.seri ices urtdcr the Hume uJ.
A-AARON SUPER ROOTER, INC.
Qualifying( omractor: JOHNJJJJ FFY
S.A0920648 April 6, 2015 Mari h 31 , 2017
Authorization Numher Date Issued [:xpir.ation Date
ri #: 13-SC-1596136
PERMIT
APPLICATION #:AP 1182159
STATE OF FLORIDA
� DATE PAID:
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM FEE PAID:
CONSTRUCTION PERMIT RECEIPT #:
DOCUMENT #: PR969625
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: Susanl, Palmatier
PROPERTY ADDRESS: 341 NE 104 St Miami, FL 33138
LOT: 1718 BLOCK: 117 - SUBDIVISION:
[SECTION, TOWNSHIP, RANGE, PARCEL NUMBER]
PROPERTY ID #: 11-2136-013-0110
[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 [ 750 ] GALLONS / GPD existinq septic tank to remain CAPACITY
A ( 0 J GALLONS / GPD CAPACITY
N [ 0 ] GALLONS GREASE INTERCEPTOR CAPACITY (MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
K [ ] G S DOSING TANK CAPACITY [ ]GALLONS C[ ]DOSES PER 24 HRS #Pumps [ ]
D [ 150 SQU IA�IE FEET new trench confiq. drainfie SYSTEM
R [ 0 ] SQUAi2E FEET SYSTEM
A TYPE SYSTEM: [x] STANDARD ( J- FILLED [ ] MOUND [ ]
I CONFIGURATION: [x] TRENCH [ ] 'BED [ ]
N
F LOCATION OF BENCHMARK: FFE 12.2' NGVD
I ELEVATION OF PROPOSED SYSTEM SITE [ 25.20 ] [ INCHES FT ] [ ABOVE BELOW BENCHMARK/REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 65.16 ] [ INCHES FT ] [ ABOVE BELOW BENCHMARK/REFERENCE POINT
L
D FILL REQUIRED: ( 0.00] INCHES EXCAVATION REQUIRED: ( 40.00 ] INCHES
1.-Existing 750 gal.!septic tank,certified by"A Aaron"on 3/23/2015 to remain.
0 2.-Install 150 sf of grainfield in trench configuration.
T 3.-Perimeter of excavation area shall be at least 2 ft wider and longer than the proposed absorption bed or drain trench.
4.-Invert elevation of drainfield to be no less than 7.27' NGVD.
H 5.-Bottom of drainfijeld elevation to be no less than 6.77' NGVD.
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:' `A ron S.Roote TITLE:
APPROVED BY: TITLE: Engineering Specialist II Dade CHD
U i Martin
DATE ISSUED: i0 1 2015 EXPIRATION DATE: 06/30/2015
DH 4016, 08/09 (08soletes all previous editions which may not be used)
Incorporated: 64E-6.003, FAC Page 1 of 3
v 1 .1.4' 52
i
STATE OF FLORIDA
DEPARTMENT OF HEALTH
APPL`CATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permit Application Number
--------- ----- PART II - SITE PLAN------------.-------
Scale: Each block represel is 5 feet and 1 inch= 50 feet.
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Site Plan submitted by:
,.t Signature Title
Plan 4prbved Not Approved Date
By .h
County Health Department
ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
DH 4015.10/96(Replaces HRS"H Form 4015 which maybe used)
;Stock Numbw:5744-002-4015-6) Page 2 of 3