PL-15-2295 Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-243155 Permit Number: PL-9-15-2295
Scheduled Inspection Date: September 29, 2015 Permit Type: Plumbing - Residential
Inspector: Diaz, Osvaldo Inspection Type: Final
Owner: SEDMAKOV, KRASSIMIR Work Classification: Septic
Job Address: 17 NW 107 Street
Miami Shores, FL 33168-4306 Phone Number
Parcel Number 1121360070470
Project: <NONE>
Contractor: MR C'S PLUMBING&SEPTIC INC Phone: (305)651-7859
Building Department Comments
SEPTIC AND DRAIN FIELD Infractio Passed Comments
INSPECTOR COMMENTS False
Inspector Comments
Passed [ZOO,/ HRS IN FILE
Failed
L✓�
Correction �2iZ p� ``s`jtA `/-\ &
Needed
Re-Inspection ❑ �, 2�,� S
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid.
For Inspections lease call: (306)762-4949 September 28, 2015 p p ( ) Page 21 of 44
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,SHORES y Miami Shores Village A :
4 10050 N.E.2nd Avenue NW
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Miami Shores,FL 33138-0000 i `3 ,
Lq'Qry Bim` Phone: (305)795-2204 �\ '\ 3; , � •i'...�•..
dORiPp` 0
Y Expiration: 03/1312016
Project Address Parcel Number Applicant
17 NW 107 Street 1121360070470
Miami Shores, FL 33168-4306 Block: Lot: KRASSIMIR SEDMAKOV
Owner Information Address Phone Cell
KRASSIMIR SEDMAKOV 17 NW 107 Street
MIAMI SHORES FL 33168-4306
17 NW 107 Street
MIAMI SHORES FL 33168-4306
Contractor(s) Phone Cell Phone Valuation: $ 5,800.00
MR C'S PLUMBING&SEPTIC INC (305)651-7859
Total Sq Feet: 400
Type of Work:SEPTIC AND DRAIN FIELD 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
CCF Invoice# PL-9-15-57027
$3.60 09/15/2015 Check#:2983 $277.60 $550.00
DBPR Fee $4.50
DCA Fee $4.50 09/15/2015 Check#:2981 $500.00 $50.00
Education Surcharge $1.20 09/10/2015 Credit Card $50.00 $0.00
Permit Fee $300.00 Bond#:2837
Scanning Fee $9.00
Technology Fee $4.80
Total: $827.60
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 authorize the above-named contractor to do th rk stated.
September 15, 2015
Authorized Signature:Owner / Appli Contractor / Agent Date
Building Department Copy
September 15,2015 1
Miami Shores Village
Building Department SEP ° 9 2015
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 By: =r—
Tel: (305)795.2204 Fax: (305)756.8972
INSPECTION'S PHONE NUMBER: (305)762.4949
BUILDING Permit No.P01- I
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PERMIT APPLICATION Master Permit No.
FBC 20
Permit Type: PLUMBING // [ y /
OWNER:Name(Fee Simple Titleholder): 1 R�S J I M I K S ED M A Koy Phone#: T"g� 2(D 6 to
Address: 24-5- RACt e L y\e 0�
City: yjA L--r44A-M State: M A Zip: y z g 5 2
Tenant/Lessee Name: Phone#:
Email: K SS Z (4� `1LtffiQ.l P. (.rim
JOB ADDRESS: 17 I V W C O C 'q f a i
City: Miami Shores County: Miami Dade Zip: S 1 t 6 9
Folio/Parcel#: WAIA O& [KW 54 F5^P 0 B q Z-3 LDT 115� B LK 2l
Is the Building Historically Designated:Yes NO I Flood Zone:X
CONTRACTOR:Company Name: M1�1�• C t5 N U YA-iV�q Phone#:
Address: 19 Q �)Z UW ),n N VE 1 2
City: MIA-til ((-�II-- I r State: � Zip: 3 2 6
Qualifier Name:�,Y A J l- F-1'1-Yl w Phone#:
State Certification or Registration#: Certificate of Competency#:
Contact Phone#: Email Address:
DESIGNER:Architect/Engineer: Phone#:
Value of Work for this Permit: $_ �OV, OD Square/Linear Footage of Work:
Type of Work: ❑Address ❑Alteration ❑New ®Repair/Re lace ❑Demolition
Descri tion of Work: ;,t I4 0 ykq � - Q
3D -St o
S „~ .,.:�: Y• til
Submitta4Fee$ = a ~ Permit Fee$ CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Bond$ '
Notary$ Training/Education Fee$ Technology Fee$
Double Fee$ Structural Review$
TOTAL FEE NOW DUE$
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
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 issu ce of a building permit with an estimated value exc4eding $2500, the applicant must
promise in good faith that a copy of the notic of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Als , a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspectiwhich occurs seve (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not b a proved and a r in e ion fee will be charged.
Signature Signature w
V�—Awner or Agent Contractor The foregoingOL instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of Vl ,20 E KRA5ffilf— 5FQAAKA1 day of 996FAM 20 Lr "LC 4
who is personally known to me or who has produced who is personally known to me qr who has produced
As identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: Sign:
Print: KQM'l IKEMBLE ETTRICK Pri
oar
My Commission Ex ; �;^_My Comm. Expires Sep 19,2017 M Co sentExpires
p fres:
Commission # FF 055732 sSHERYI A MENDES
NOWY Public-State of Florida
OF Bonded Through National Notary Assn.
y •'°My Comm
Co .Expires Oct 23,2018
.—/4-1-5National Notary assn.
APPROVED BY Plans Examiner oning
Structural Review Clerk
l (Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)
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PERMIT #: 13-SC-1626920
STATE OF FLORIDA t, A DEPARTMENT OF HEALTH APPLICATION #: AP 1202206
ONSITE SEWAGE TREATMENT AND DISPOSAL DATE PAID:
SYSTEM
FEE PAID:
CONSTRUCTION PERMIT
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RECEIPT #:
W"s DOCUMENT #: PR986982
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: Krassimir Sedmakov
PROPERTY ADDRESS: 17 NW 107 St Miami, FL 33168
LOT: 15 BLOCK: 211 SUBDIVISION:
PROPERTY ID #: 11-2136-007-0470 [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 [ 900 ] GALLONS / GPD existinq septic tank to remain CAPACITY
A [ 0 ] 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 ] SQUARE FEET new bed confiq.drainfield SYSTEM
R [ 0 ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [x] STANDARD [ ] FILLED [ ] MOUND [ ]
I CONFIGURATION: [ ] TRENCH [x] BED [ ]
N
F LOCATION OF BENCHMARK: FFE 12.3'NGVD
I ELEVATION OF PROPOSED SYSTEM SITE [ 21.60 ] [ INCHES FT ] [ ABOVE BELOW BENCHMARK/REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 71.60 ] [ INCHES FT ] [ ABOVE BELOW BENCHMARK/REFERENCE POINT
L
D FILL REQUIRED: [ 0.00] INCHES EXCAVATION REQUIRED: [ 62.001 INCHES
O 1.-Existing 900 gal. septic tank,certified by"Mr.C's Plumbing"on 8/25/2015 to remain.
2.-Install 300 sf of drainfield in bed configuration.
T 3.-Install 12"of slightly limited soil at the bottom of the drainfield.
H 4.-Perimeter of excavation area shall be at least 2 ft wider and longer than the proposed absorption bed or drain trench.
E (Comments Continued on Page 2.)
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SPECIFICATIONS BY: Mt C's Plb Sept TITLE:
�LAFAPPROVED BY: TITLE: Engineering Specialist II Dade CHD
uar in
DATE ISSUED: 09/09/ 015 EXPIRATION DATE: 12/08/2015
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E-6.003, FAC Page 1 of 3
�, = - 4 . . AE'12�r22(35 569'708;1
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STATE OF FLORIDA
DEPARTMENT OF HEALTH
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permit Application Number
------- --- --- --- - --- - --- --- PART II -SITEPLAN - --- -- --- - -- ----- -- - --- --- -
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Scale: Each block re resents 10 feet and 1 inch =40 feet.
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There are no pertinent features on adjacent properties and or across the street that may affect the New Septic system installation.
o es: _
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Site P1 ubmitte�by: +br
Plan p ved. ' Not Approved Date s )
By j County Health Department
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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)