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PL-15-1464 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-236843 Permit Number: PL-6-15-1464 Scheduled Inspection Date: July 28, 2015 Permit Type: Plumbing - Residential Inspector: Diaz,Osvaldo Inspection Type: Final Owner: PEREZ,JUAN HUMBERTO Work Classification: Septic Job Address:230 NE 104 Street Miami Shores, FL 33138- Phone Number Parcel Number 1121360130350 Project: <NONE> Contractor: MR C'S PLUMBING&SEPTIC INC Phone: (305)651-7859 Building Department Comments DRAINFIELD Infractio Passed Comments INSPECTOR COMMENTS False 00, Inspector Comments Passed E7r HRS IN FIL L Failed Correction L / Needed ' Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. July 27,2015 For Inspections please call: (305)762-4949 Page 13 of 44 DIVISION OF Environmental Health Florida Health �10Miami-Dade An� County OSTDS/Well Division hQ Q `�`� 11805 SW 26th Street•Miami,FL 33175 InspectorAlCoilf, Q0bS �n Date 2 i Address rj '0j, �T —1 OSTDS# Comments: Signature ��� �� � � v � � � �: R t • M i er Nd:'! ► ' - r ` REs L� Miami Shores Village Pe�TYPE � � R� �t oS 10050 N.E.2nd Avenue NE it /vtt � i Miami Shores,FL 33138-0000 a ,i urDyE© Phone: (305)795-2204 R20RiDp' � ,$ ,�1 2Expiration: 12116/2015 Project Address Parcel Number Applicant 230 NE 104 Street 1121360130350 JUAN HUMBERTO PEREZ Miami Shores, FL 33138- Block: Lot: Owner Information Address Phone Cell JUAN HUMBERTO PEREZ 230 NE 104 Street MIAMI SHORES FL 33138-2016 Contractor(s) Phone Cell Phone $ 2,300.00 MR C'S PLUMBING&SEPTIC INC (305)651-7859 on Total Scl Feet: 300 4 Type of Work:DRAINFIELD Available Inspections: Type of Piping: Inspection Type.- Additional ype: Additional Info: HRS Approval Bond Return : Final Classification:Residential Scanning: 1 Review Plumbing Fees Due Amount Pay Date Pay Type Amt Paid Amt Due Bond Type-Owners Bond $500.00 Invoice# PL-6-15-55976 CCF $1.80 DBPR Fee $2 25 06/15/2015 Credit Card $50.00 $612.30 DCA Fee $2.25 06/19/2015 Credit Card $ 112.30 $500.00 Education Surcharge $0.60 06/19/2015 Check#:3050 $500.00 $0.00 Permit Fee $150.00 Bond#:2755 Scanning Fee $3.00 Technology Fee $2.40 Total: $662.30 In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans,drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. F re, I authorize a above-named contractor to do the work stated. June 19, 2015 -Agt—horized Signature:Owner / Applicant / Contractor / Agent Date Building Department Copy June 19, 2015 1 a rob, Miami Shores Village Building Department JUN 15 2015 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305)795-2204 Fax: (305)756-8972 -- - INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20 l" BUILDING Master Permit No. 0 PERMIT APPLICATION sub Permit No. BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION EXTENSION RENEWAL PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP `�C f CONTRACTOR DRAWINGS JOB ADDRESS: City: Miami Shores County: Miami Dade Zip: J �U Folio/Parcel#: l l %34— On 635-0 Is t Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: `��t` Flood Zone: BFE: FFE: OWNER: Name(Fee Simple Titleholder): J(f$TI Phone#: �eS 7A6111^ 3Y_'Y Address: a 3o City: f 'l\ate dr'-� State: Zip: S 3 7 p Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: `�t Phone#: Address: City: I,fin Y`h-kk 1! State: rL 9 Zip: 35, K Qualifier Name: 0,4t Phone#: 3OY65( A5 i State Certification or Registration#: SR®6 ( ,f36 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ �'0 Z' Square/Linear Footage of Work: -30-V Type of Work: ❑ Addition ❑ 'A'.ltle�ra1tiorrn.. ❑ New Repair/Replace El Demolition Description of Work: �rV11A .�Wi� Specify col .,of)color thruVie: �y Submittal Fee$ _PermItTge$ /SQA CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ 00 •43Q0 TOTAL FEE NOW DUE$1 LV (Revised02/24/2014) &1,2 -3o Bonding Company's Name(if applicable) Bonding Company's Address City State F11V 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 Si nature D, g OWNS or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of ��� �e 20 by 12�'day of ,7u hlfv 20 1,'5by who is personally known to ,m61 E_ 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: BLE t of Florida Print: State l7 Print: =�+ar °;��'� 140 m.Expires 732 ." y "• SHERYL A MENOES �.atM Seal: *._MY Commission#F� �pin. Seal. _ Notuy Public-State of Florida =sr o Wide Commission My Comm.Expires Oct 23,2018 ,9Tf OF F . Bon •,,� Commission # BMW FF 136 ,.,.,,, ` •����„Y. 597 Bonded Through National Not aryAW APPROVED BY / _ �G �S/S Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) R ""� PERMIT #:13-SC-1611330 � R A n :�.:sg AP 1192042 s . '" i';?T r eli✓� APPLICATION # tsaw ,.•...��... STATE OF FLORIDA DATE PAID: DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM FEE PAID: CONSTRUCTION PERMIT RECEIPT #: �''�o,►� DOCUMENT #:PR977708 CONSTRUCTION PERMIT FOR: OSTDS Repair APPLICANT: Juan Perez PROPERTY ADDRESS: 230 NE 104 St Miami, EL 33138 LOT: 8 g BLOCK: 119 SUBDIVISION: Miami Shores Sec 5 [SECTION, TOWNSHIP, RANGE, PARCEL NUMBER] PROPERTY ID #: 11-2136-013-0350 (OR TAY 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 TIh1L. 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 exestmg septic tank CAPACITY A [ ) GALLONS / GPD CAPACITY N [ J GALLONS GREASE INTERCEPTOR CAPACITY (MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS) K ( ] GALLONS DOSING TANK CAPACITY [ )GALLONS @I ]DOSES PER 24 HRS #Pumps [ ] D [ 300 ) SQUARE FEET bed configuration drainfiel SYSTEM - R [ } SQUARE FEET SYSTEM A TYPE SYSTEM: [X) STANDARD [ ),FILLED [ ] MOUND [ ) I CONFIGURATION: [ } TRENCH [x) BED [ ) N F LOCATION OF BENCHMARK: Crown of road NE-104 St. 10.4'NGVD I ELEVATION OF PROPOSED SYSTEM SITE [ 6.00 ] [FINCHES FT }[ A4OSvE BELOW BENCHMARK/REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE f 56.00 ) [ INCHES FT }[ ADOVE BELOW BENCHMARK/REFERENCE POINT L D FILL REQUIRED: [ } INCHES EXCAVATION REQUIRED: f 62.00 ) INCHES 1.-Existing 900 gal septic tank,certified by Mr.C's,PLumbing&Septic on 06109/2015,to remain. 0 2.-Install 300 sf of drainfield in bed configuration. T 3.-Install 12"of slightly limited soil at the bottom of the drainfield. 4.-Perimeter of excavation area shall be at least 2 f widet and longer than the proposed absorption bed or drain trench. H 5.-Invert elevation of drainfield no less than 6.23'Nt7VD. 6-Bottom of drainfield elevation no less than 5.73'NGVO. E The system is sized for 3 bedrooms with a maxiniurn occupancy of 6 persons(2 per bedroom),for a total estimated flow of 400 gpd "THIS REPAIR PERMIT IS NOT FOR ANY ADDITIONS" R SPECIFICATIONS BY: Kemble Ettrick TITLE' APPROVED BY: 7j' n TITLE: Engineering Spec.:alist II Dade CHD Erlande Omisca DATE ISSUED: 06/11/2015 EXPIRATION DATE: 09/09/2015 DH 4016, 08/09 (Obsoletes all previous editions which may not be eased) '?4'1='j b 'te I1� ztti Incorporated: 64E-6.003, FAC Tho � ;�, , v.. _ s {..'rte_, .�c_ c rig he o:-y.rai r c•io fee w t 2ssrssed iS not nt the jor"Slle at the arminy— tt r(le. r 6/12/15 CCF06092015_00000Jpg STATE OF FLORIDA DEPARTMENT OF HEALTH APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Permit Application Number 0 ----------- PART Ii-SITEPLAN--------------------------- Scale: Each block represents 10 feet and 1 inch= 40 feet. nR l Li t 1 1Y1 0 T There are no pertinent features on adjacent properties and or across the street that may affect the New Septic system installation. o es: Site Plan submitted by: d- ar Plan Approved Not Approved Date to r By County Health Department ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT DH 4015,10/96(Replaces HRS-H Form 4016 which may be used) Page 2 of 4 (Stock Number: 5744-002-4015-6) https://drive.googie.com/drive/u/0/folders/OB3SYVJuZW i RfVnJ lTl lhaTdD NTg/OB3SYVJLLZW i RfazA2RzJPU H coaEO 1/1