PL-15-982 Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-233291 Permit Number: PL-4-15-982
Scheduled Inspection Date: July 30, 2015 Permit Type: Plumbing - Residential
Inspector: Diaz, Osvaldo
Inspection Type: Final
Owner: MENDEZ, BENIGNO Work Classification: Septic
Job Address:551 NE 105 Street
Miami Shores, FL 33138-2044 Phone Number
Parcel Number 1122310140280
Project: <NONE>
Contractor: CHAPMAN SEPTIC SERVICE, INC. Phone: (305)815-9901
Building Department Comments
ABANDON SEPTIC TANK 900 GAL AND 300 DRAINFIELD infractio Passed Comments
INSPECTOR COMMENTS False
TO REPLACE PERMIT PL14-513
Inspector Comments
Passed rough ok
HRS PICKED UP
SOD REQUIRED
SIDE WALK REPAIR REQUIRED
Failed
Correction
Needed
Re-Inspection ❑
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid.
July 29, 2015 For Inspections please call: (305)762-4949 Page 12 of 40
Permit 1U3. �"�- -'I - �
Miami Shores Village Psl3hit Type. P1tlmbin0,,-
10050 N.E.2nd Avenue NE � WO!%<`Eja55tCc�f1Dt8:S@1t(C
Miami Shores, FL 33138-00001
'V= Phone: (305)795-2204
Pelt`$1a11JS_ 'PRO W
'��oRioA
tss Date:F�-22/111115 Expiration: 01/1812016
Project Address Parcel Number Applicant
551 NE 105 Street 1122310140280
Miami Shores, FL 33138-2044 Block: Lot: BENIGNO MENDEZ
Owner Information Address
Phone Cell
BENIGNO MENDEZ � 551 NE 105 Street � ..
MIAMI SHORES FL 33138-2044
551 NE 105 Street
MIAMI SHORES FL 33138-2044
Contractor(s) Phone Cell Phone Valuation: $ 3,450.00
CHAPMAN SEPTIC SERVICE, INC. (305)815-9901
Total Sq Feet: 300
Type of Work:ABANDON SEPTIC TANK 900 GAL AND 300 Available Inspections:
Type of Piping: Inspection Type:
Additional Info:
HRS Approval
Bond Return : Final
Classification:Residential Scanning: 1
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $2.40 Invoice# PL-4-15-55319
DBPR Fee
DCA Fee $4.50 07/22/2015
$4.50 Credit Card $318.40 $0.00
Education Surcharge $0.80
Permit Fee $300.00
Scanning Fee $3.00
Technology Fee $3.20
Total: $318.40
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:11 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 authorize the above-named contractor to do the work stated.
July 22, 2015
Authorized Sig a ure:Owner / Applicant / Contractor / Agent Date
Building De ar Ment Copy
July 22, 2015 1
Miami Shores Village
Building Department APR 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 to
BUILDING Master Permit No. � �"— 98 2
PERMIT APPLICATION Sub Permit No.
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING MECHANICAL PUBLIC WORKS ❑ CHANGE OF CANCELLATION SHOP
❑ ❑ CONTRACTOR ❑ ❑ DRAWINGS
JOB ADDRESS: / (�►1- I O s S�
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: l ° 2 2-3 i 0) OZf O Is the Building Historically Designated:Yes NO �
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name(Fee Simple Titleholder): VA'k a Q Me ) Phone#: C-
Address: �C-5 [ c)C
1"�
City: S' f�rVp_� State: � � Zip: 3 3
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: C"[�-fy yj ' ► I C Phone#:
Address: �0 O JC �� �►
City: 7 Y�1(A Vyl k _ State: L— Zip: 5
Qualifier Name: C�� HA(v Phone#: � �j� _ O 1
State Certification or Registration#: �� 1 Certificate of Competency#: >
DESIGNER:Architect/Engineer: Phone#: S rl Ci
Address: City: State: Zip:
Value of Work for this Permit:$ Square/Linear Footage of Work: 3�x="
Type of Work: ❑ Addition ❑ Alteration ❑ lyew ] Repair/Replace ❑ Demolition
Description of Work: kk
Ct v` SPpC h k" C c Ct� ✓�CCS G4 q �� l
Specify color of color thru tile:
Submittal Fee$ "5-v CU Permit Fee$ ' � U CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$ U• ` _�J
(Revised02/24/2014)
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 &/a,
WNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
_day of F(920 --'?0I5, by -3 day of FC 6 , 20 �)e)I',>, by
Bi Y)i)to fY\1;'ri A if Z_ ,who is personally known to 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.
ADA1N'r'u
NOT4PUBL P..•.'�' MY COMMSPSIEONt�FRFO165583NOTARY PUBLI ro`"•••:��% AIDAPEGUERO
EXPIRES:October 5,2018 ,� * MY COMMISSIONt FF 1855&4
°A �Oe Bonded Thru Budget Notary Senka ` EXPIRES:October 5,2018
rFpFFly RdBonded Thru Budget Notary Smim
Sign: Sign:
PrintPrint:
Seal: Seal:
APPROVED BY (C ���"�S Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
i
s Miami Shores e
Villa
g
C Building Departmentc�
f 10050 N.E.2nd Avenue,Miami Shores,Florida 33138S20
AR 172014
3` Tel:(305)795.2204 Far.(305)756.8972 INSPECTION'S PHONE NUMBER:(3o5)762.494
BUILDING Permit No.
PERMIT APPLICATION Master Permit No.P/
i
Permit Type: PLUMBING
aoB ADDREss: S�1 12e, /95
city: Miami Shores County: Miami Dade Zip: 3 13 0
Folio/Parce*.
Is the Building Historically Designated:Yes NO Flood Zone:
OWNER:Name(Fee Simple Titleholder): ;Bsa,A N O_Mir. phone#•
Address SS'1 n - 1®�6fi �_
City• m1a lk) State: ivy
zip:
Tenant/Lessec Name: Phone#:
Email:
CONTRACTOR:Company Name: qmuwL���� Phone#;
Address: h
city: State: zip:-3 32gs
Qualifier Name: Phone#:c3
State Certification or Registration#: (07 Certificate of Competency#: S A 6 all B S
Contact Phone#:13 96A 1 Email Address: 06quaA f4j4
DESIGNER:Architect/Engineer: Phone#:
Value of Work-for.this Permit:$ SquatWUnear F'Oobvaf Work: c3
of brk: O,A ONew 44air/Roplace UDemolition
Type: �Y ddrees DAltcration
Description of Work: ,?
i
,r*,kap►w�e�t*ttww*«,rwwt� +*maw«�,k�wwF��r*,r�rsir,r«w*ew,rwaa+nrrr+�►�rw�**+rwwir*,err
Submittal Fee S,312100 Permit Fee$ �. �+ CCF$ CO/CC$
i
Scanning Fee$ Radon Fee$ DBPR$ Bond$
Notary$ Tralaing/Education Fee$ Technology Fee$
Double Fee$ Structural Review$ _pyo
TOTAL FEE NOW DUE$,�� •CY
i
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 ELECTRICAL WORK,PLUMBING,SIGNS,
WELLS,POOLS,FURNACES,BOILERS,HEATERS,TANKS and 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
EMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN
FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORDING YOUR NOTICE OF COMNVIENCEMENT."
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
O
or Agent Contractor
The foregoing instrument was acknowledged before me this L7— The foregoing iastrament was aclmowl ged before me this]
day of ll�,20 A by Y Alm.&—eAiAAyL , day of P110rek J 20 W,by
who is personally known to me or who has*duced who is personally known to me or who has produced
As identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
g111ulilyty,�
xs, .
Sign: f/ .•••.. /.••.• Ste: S ••.....:K
Print 7 r� a:'• 90.PD •'•.
• � • Print-
•
My Commission Expires: •• *s My Commission Expires:
iOFFOUe� •SOslo ?e
• Prwtlee
•04 � ti�rmas •• O�
*«** *eye ka rya*«**,e,ae, ,t*,rw**nr*yew �,r,raw«w r,k,k�r*w**,►,k,r,rw�e,►w*rww w. w,r+r w*w+r+r* ql •'91,'' ,►«,eew
��ptlHu�p����
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Rmi9ed3/12t2012XRrAsed 07/10/07)(1trAsod 06/10/=9XRrA9ed 3/15/09)
r
Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores,FL
Phone:(305)795-2204 Fax:(305)756-8972
Inspection Number: INSP-209089 Permit Number: PL-3-14513
Scheduled Inspection Date:March 25,2014 Permit Type: Plumbing - Residential
Inspector: Diaz,Osvaldo Inspection Type: Final
Owner: MENDEZ, BENIGNO Work Classification: Drainfield
Job Address:551 NEI 05 Street
Miami Shores,FL 33138- Phone Number
Parcel Number 1122310140280
Project <NONE>
Contractor: CHAPMAN SEPTIC SERVICE,INC. Phone: (305)815-9901
Building Department Comments
ABANDON EXISTING TANK INSTALL 900 GALLON AND Infractio Passed Comments
300SQ. FT DRAIN FIELD INSPECTOR COMMENTS False
Inspector Comments
Passed
Failed
kA
Correction
Needed
Re-Inspection
Fee �-
' e
No Additional Inspections can be scheduled until /
re-inspection fee is paid
March 24,2014 For Inspections please call: (305)762-4949 Page 19 of 35
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Master Septic Tank Contractor
CHAMES J CHAPMAN
471 BIG PINE ROAD
KEY LARGO FL 33037-
CHAPMAN SEPTIC SERVICE,INC.
Business Authoritatbn. SA0910574
SM0941167
Registration Expires on September 30,2014
i
i
PERMIT #:13-SC-1520382
STATE OF FLORIDA APPLICATION tl:AN 135308
DEPARTMENT OF HEALTH DATE PAID
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM FEE PAID:
CONSTRUCTION PERMIT RECEIPT (I:
},
DOCUMENT a:PR929687
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: Benign Mendez
PROPERTY ADDRESS: 551 NE 105 St Miami,FL 33138
LOT: 19 BLOCK: 10 SUBDIVISION: amd pl miiami shores
PROPERTY ID 9: 11-2231-0140280 [SECTION, TONNSHIP, RANGE, PARCEL NUMBER]
[OR TAX ID NUMBER]
SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF SECTION
361.0065, P.O., 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 ] GALLONS / GPD CAPACITY
N [ 0 ] GALLONS GREASE INTERCEPTOR CAPACITY I A)MW K CAPACITY SINGLE TANK:1250 GALLONS]
K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS II ]DOSES PER 24 HRS $Pumps [ ]
D [ 300 ] SQUARE FEET bed configuration drainflel SYSTEM
R [ 0 ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [xl STANDARD [ ] FILLED [ ] MOUND [ ]
I CONFIGURATION: [ ] TRENCH [x] BED [ ]
N
F LOCATION OF BENCHMARK: Top of bottom floor,12.30'NGVD
I ELEVATION OF PROPOSED SYSTEM SITE [ 18.00] INCHES FT IIABOVE BELOOP BENCHMARK/REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 58.00] niaHEs FT ][ABOVE BSNcHMARK/REFERENCE POINT
L
D FILL REQUIRED: [ 0.00] ITCHES EXCAVATION REQUIRED: [ 52.00] INCHES
This repair permit was wranted based on building information provided in the application by the contractor of 3 bedroom
O SFR with 1,542 sq.ft.of building area.
T New sewer line shall be permitted and inspected by the pertinent plumbing dept.
H Inspector to verify the existing septic tank is properly abandoned before final approval.
*Invert elevation of dreinfield to be no less than 7.96'NGVD.
E 'Bottom of drainfield elevation to be no less than 7.48'NGVD.
"Install 12'of slightly limited soil under the bottom of dreinfeld.
R
SPECIFICATIONS BY: Charles J Chapman TITLE: Master Septic Tank Contractor
APPROVED BY: TITLE: Dade CHD
Carlos M Ioasa
DATE ISSUED: 02/122014 EXPIRATION DATE: 05/132014
DH 4016, 08/09 (&fi(M ISI ��;,� fi r { ��erQr z �y not be used)
Incorporated: 6�0�r9�p+' j ad"F1 c�"rain9ielTexcava;%
Incorporated: �t�
time ui iulY inspectico.',ior t.,Final Approval,title-DOFI Page 1 of 3
inspector shall wi[es '�ia°soil borina ans±Corr"*woe 58919610
results to the original siie evaluation submitted.A
reinspection tee will be assessA if the contractor is no`
at the jrjlosite ai ttie arranged:+me
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