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PL-15-2310 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores,FL Phone:(305)795-2204 Fax:(305)766-8972 Inspection dumber. I S -243279 Permit Number PL-9-15-2310 Scheduled Inspection Date: September 22,2016 Permit Type: Plumbing Residential Inspector:Diaz,Osvaldo Inspection 'Type: Final Owner: SOTO,DAISY Work Classification: Drainfield Job Address:567 NE 92 Street Miami Shores,FIL 33138- Phone Number Parcel Number 1132060141160 Project: <NONE> Contractor: STATEWIDE SEPTIC CONNECTIONS Phone:(964)963-00$2 Building Department Comments REPLACE DRAIN FIELD Infractio Passed Co nments INSPECTOR COMMENTS False Inspector Comments Passed Id HRS IN FILE p Failed Correction Needed Re-inspection Fee No Additional Inspections can be scheduled until re-inspection fee is paid. September 21,2015 For Inspections please call: (306)762449 page 29 of I ` DIVISION OF Environmentall 'sf_ Florida H.ea,jth 201AP 1 14 j- ade C os FDS/Weld Mvisioll 91-805 SSW 25 1)Streets i�laan;q 1T t31 _. _ Date . .`' kdols-1 Ds 5'b9�sy o can _Aw x -- Sign a tu re IRE pOW I i3 tom £ Miami Shores Village f�8 � 4c 10050 N.E.2nd Avenue NE � n � y Miami Shores,FL 33138-0000 ` Phone: (305)795-2204 � ► l5r8iAiOVE3 -` _£. �, � �1$� Expiration: 03/16/2016 Project Address Parcel Number Applicant 557 NE 92 Street 1132060141160 DAISY SOTO Miami Shores, FL 33138- Block: Lot: Owner information Address Phone Cell DAISY SOTO 557 NE 92 Street MIAMI SHORES FL 33138-3156 Contractor(s) Phone Cell Phone Valuation: $ 2,300.00 STATEWIDE SEPTIC CONNECTIONS (954)963-0082 Total Sq Feet: 300 Type of Work: Available Inspections: Type of Piping: Inspection Type: Additional Info:REPLACE DRAIN FIELD HRS Approval Bond Retum: Final Classification:Residential Scanning:3 Review Plumbing Fees Due Amount Pay Date Pay Type Amt Paid Amt Due Bond Type-Contractors Bond $500.00 CCF Invoice# PL-9-15-57044 $1.80 09/18/2015 Check#:4897 $623.30 $50.00 DBPR Fee $2.25 DCA Fee $2.25 09/11/2015 Check#:4888 $50.00 $0.00 Education Surcharge $0.60 Bond#:2844 Notary Fee $5.00 Permit Fee $150.00 Scanning Fee $9.00 Technology Fee $2.40 Total: $673.30 In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. F hermore,I author' the a o e-named contractor to do the work stated. C September 18,2015 Authorized e:Owner / Applicant / ontracto / Agent - Date Building Department Copy September 18,2015 1 Miami Shores Village SEr 112015 Building Department B��: 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER: FBC 207'/, BUILDING PERMIT APPLICATION Sub Permit No. 7BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION RENEWAL PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: S;-) 92 S-� City: Miami Shores County: Miami Dade Zip: 3 3 ,-]5,' Folio/Parcel#: 1 -3 ZO 6' C)1 (6 ri Is the Building Historically Designated:Yes NO 'o Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: 6 ^p OWNER:Name(Fee Simple Titleholder): �� Phone#:-]? Address: e'5-� Njo 9 z P,t City: State: Zip: 3 r J� Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: � 'ol� g- `� ► 1 Phone#: Address: ,Y—\� NjvQ 15 , City: I)q KA, State: Zip: Qualifier Name: ��'�f-C-L ' Phone#: State Certification or Registration#: S I Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ Z-';oo` 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$ �J�, CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ 2,3 ° zD® (Revised02/24/2014) e 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 0 N R or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this ( day of .20 `5 by day of aS ` %`' 20 by ' c bL, o who is personally known to /�. - 1:4L C4 AnzcAv-who is personally known to ® w mem who has produced as me or who has produced i�' as ® Z ie fication and who did take an oath. identification and who did take an oath. n 11) RY PUBLIC: NOTARY NOTARY PUBLIC: o �`�®�� Ul >-Sin: Sign: .; rjng Print: _ Seal: ,� Notary Public State of Florida %'�►.,;;�,,- Joanna M Feliciano My Commisabn FF 082753 pd Expires 01/12/2018 APPROVED BY Cy" Plans Examiner Zoning . Structural Review Clerk (Revised02/24/2014) l PERMIT #: 13-SC-1628855 pFLIP � hill �? � r, APPLICATION #:AP1203485 STATE OF FLORIDA DATE PAID: DEPARTMENT OF HEALTH f��O�4.a?.�73,�°Nrk.. =#.)8Jl�d� ,'s, ,t;.k r].s a- ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM FEE PAID: CONSTRUCTION PERMIT RECEIPT #: DOCUMENT #: PR987201 CONSTRUCTION PERMIT FOR: OSTDS Repair APPLICANT: Daisy Soto PROPERTY ADDRESS: 557 NE 92 St Miami, FL 33138 LOT: 1617 BLOCK: 57 SUBDIVISION: PROPERTY ID #: 11-3206-014-1160 [SECTION, TOWNSHIP, RANGE, PARCEL NUMBER] [OR TAX 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 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 l 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 [ ] D [ 300 l SQUARE FEET new bed confiq.drainfield SYSTEM R [ 0 l SQUARE FEET SYSTEM A TYPE SYSTEM: [x] STANDARD [ ] FILLED [ ] MOUND [ ] I CONFIGURATION: [ ] TRENCH [X] BED [ ] N F LOCATION OF BENCHMARK: FIFE 10.9'NGVD I ELEVATION OF PROPOSED SYSTEM SITE [ 12.001 [ INCHES FT ] [ABOVE BELOW BENCHMARK/REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ 57.001 [ INCHES FT ] [ABOVE BELOW L BENCHMARK/REFERENCE POINT D FILL REQUIRED: [ 0.001 INCHES EXCAVATION REQUIRED: [ 45.00 ] INCHES 1.-Existing 750 gal.septic tank, certified by"Statewide Septic"on 9/4/2015 to remain. O 2.-Install 300 sf of drainfield in bed configuration. T 3.-Invert elevation of drainfield to be no less than 6.65'NGVD. H 4.-Bottom of drainfield elevation to be no less than 6.15'NGVD. THIS PERMIT IS NOT FOR ANY ADDITIONS. E The system is sized for 3 bedrooms with a maximum occupancy of 6 persons(2 per bedroom),for a total estimated flow R of 400 gpd. SPECIFICATIONS ABY: Ter J Solomon TITLE: Master Septic Tank Contractor APPROVED BY: TITLE: Engineering Specialist II rt3n Dade cxn DATE ISSUED: EXPIRATION DATE: 12/09/2015 DH 4016, 08/09 (Obsoletes all previous editioi> sr 'may not bQ used] Incorporated: 64E-6.003, FAC T� «r1. " ' Page 1 of 3 v 1.1.4 h atP1 69485 SE9?1019 STATE OF FLORIDA DEPARTMENT OF HEALTH APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT .�COb iVR tr*' :. Permit Application Number ` ------------------ PART 11 =SITE PLAN----------------- Scam: Each block represents 5 feet and 1 inch=50 feet. , _ , : - , _i _ t , _. .. _ - , i' Y.' - _ , , t� - - i . ,• S r - 7 t - I , r r Tttielre are no p ertinent.features.aemss` - - - ! - the street of adjacent to ahe�roperty that irtayaffect septics9 s -, tem. , ! # L cj site Plan submitted by: Off�1 --Signature Ian Appr vo- / Not Approved Title A11.. Date lt b. County Health Department ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT 4015,10196(Replaces HRS-H Form 4015 wMch may be used) ick Number:5744-002-4015-b') _ . Page 2of3