PL-15-2438 Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-244190 Permit Number: PL-9-15-2438
Scheduled Inspection Date: October 29, 2015 Permit Type: Plumbing - Residential
Inspector: Diaz, Osvaldo
Inspection Type: Final
Owner: ZAVERTNIK,JOHN Work Classification: Drainfield
Job Address: 155 NE 92 Street
Miami Shores, FL 33138- Phone Number
Parcel Number 1132060133180
Project: <NONE>
Contractor: MR C'S PLUMBING & SEPTIC INC Phone: (305)651-7859
Building Department Comments
DRAINFIELD INSTALLATION Infractio Passed Comments
INSPECTOR COMMENTS False
Inspector Comments
Passed HRS APPROVED 10/8/2015 IS ON FILE
a l-z
Failed F e
Correction CA
Needed ,r ;
Re-Inspection ❑
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid.
October 28,2015 For Inspections please call: (305)762-4949 Page 12 of 33
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`5µur�Es y Miami Shores Villageidt )K.
10050 N.E.2nd Avenue NE
Ill
' Miami Shores,FL 33138-0000
„r �PROYEi
t� Phone: (305)795-2204
ni
�y Expiration: 04/02/2016
Project Address Parcel Number Applicant
155 NE 92 Street 1132060133180 JOHN ZAVERTNIK
I Miami Shores, FL 33138- Block: Lot:
Owner Information Address Phone Cell
JOHN ZAVERTNIK 155 NE 92 ST
MIAMI SHORES FL 33138-2813
Contractor(s) Phone Cell Phone Valuation: $ 2,200.00
MR C'S PLUMBING&SEPTIC INC (305)651-7859
.. Total Sq Feet: 300
Type of Work:DRAINFIELD INSTALLATION 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-Owners Bond $500.00 Invoice# PL-9-15-57203
CCF $1.80 10/05/2015 Check#:832 $500.00 $ 168.30
DBPR Fee $2.25
DCA Fee $2.25 09/24/2015 Credit Card $50.00 $ 118.30
Education Surcharge $0.60 10/05/2015 Credit Card $ 118.30 $0.00
Permit Fee $150.00 Bond#:2858
Scanning Fee $9.00
Technology Fee $2.40
Total: $668.30
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zoning. Futhermore, I authorize the above-named con r to do the work stated.
October 05, 2015
Authorized Signature:Owner / Applicant Contractor / Agent Date
Building Department Copy
October 05, 2015 1
w
Miami Shores Village
Building Department
SEP 2015
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795.2204 Fax:(305)756.8972
INSPECTION'S PHONE NUMBER:(305)762.4949
BUILDING Permit No.
PERMIT APPLICATION Master Permit No.
FBC 20
Permit Type: PLUMBING
OWNER:Name(Fee Simple Titleholder): Salo" z1ler+iIik Phone#:
Address: 159" PC q 1 S-t-
City: State: ft- zip: 3313
Tenant/Lessee Name: Phone#:
Email:
JOB ADDRESS:
City: Miami Shores County: Miami Dade —zip: l 3 y
Folio/Parcel#: It^ 3.206 " b c 3— 31 b'O
Is the Building Historically Designated:Yes NO — Flood Zone: —
CONTRACTOR:Company Name: 0+' L5 f LwLiM Z Phone#: [3) 671 W91
Address: lq 13a, ow r Aims
City: jAz k.z State: Zip: I6 9
Qualifier Name: KP.J. te_ 'kric, Phone#:
State Certification or Registration#: Certificate of Competency#:
Contact Phone#: Email Address:
DESIGNER:Architect/Engineer: Phone#:
Value of Work for this Permit:$ oZ2,oD.Oy Square/Linear Footage of Work: 3�
Type of Work: ❑Address ❑Alteration ❑New �kepair/Replace ❑Demolition
Description of Work: / %t Lv
Submittal Fee$ C Permit Fee$ Jr�/ —CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Bond$_ C;N3.1 C-1
Notary$ Training/Education Fee$ Technology Fee$
Double Fee$ Structural Review$
TOTAL FEE NOW DUE$
� � w
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 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.
7
Signature Signature
Owner oirXgent Contractor
The foregoing instrument was acknowledged before me this y-- The foregoing instrument was acknowledged before me this
day o�20K,bykday of0 X,by
who is personally known to me or who has produced 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:
Sign: Sign:
Print: Pri
ENOES
My Commission ExpS:"""",b, KEMBLE ETTRICK M Cglnmis Toh Riffoublic-State of Florida
NotaryPublic-State of Florida 1y `-omm.Expires Oct 23,2018
My Comm. Expires Sep 19,2017 Commission#FF 136597
Commission #FF 055732 Bonded Through National
APPROVED BY /s Plans Examiner Zoning
Structural Review Clerk
(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)
PERMIT #:13-SC-1631186
STATE OF FLORIDA APPLICATION #:AP12O5O15
DEPARTMENT OF
HEALTH DATE PAID:
'1+ ONSITE SEWAGE TREATI4CNT AND DISPOSAL SYSTEM
CONSTRUCTION PERMIT FEE PAID:
RECEIPT #:
DOC #:PR988362
' :o*rsTRUCTION PERMIT FOR: 0 Repair
Ar2LICANT: John Zavertnik
PROPERTY ADDRESS: 155 NE 92 St Miami,FL 33138
zc='- 20,21 BLOCK: 23
SUBDIVISION: Miami Shores No. 1
PROPERTY ID #= 11-3206-013-3180
[SECTION, TOWNSHIP, RANGE P
[OR TAR ID NUMBER]
a►RCEL NOMBER]
MUST BE CONSTRUCTED IN
381-Ce
8 vC65, F.S., AND WITH SPECIFICATIONS AND STANDARDS
iSt'7iCTORY CHAPTER 64E-6, F.A.C. DEPARTMENT Ap OF SECTION
RCE FOR ANY SPECIFIC P `�' OF SYSTEM DOES NOT GUARANTEE
SERVED AS A BASIS FOR ISS SP Cg OF PERIOD OF TIME. ANY CHANGE
IN FACTS
PPS"` APPLICATION. THIS PERMIT, REQUIRE THE ����
SUCH PERMIT APPLICANT TO MODIFY THE
MODIFICATIONS MAY RESULT IN THIS
OF THIS PERMIT DOES NOT BEING MADE NULL AND ��
S.A_"Y, OR LOCAL PERMITTING REQUIRED
FOR D THE
APPLICANT FROM COMPLIANCE
EVELOPMBNT OF THIS TH OTHER FEDERAL,
PRO
DESIGN AND SPECIFICATIONS
Y 900 i GALLONS / GPD Exist.septic tank to remain
t) I GALLONS / GPD CAPACITY
0 1 GALLONS CAPACITY SINGLE TA
GREASE CAPACITY
CAP CAPACITY
l GALLONS DOSING ACITY [ S NK:1250 GALLCKS]
TANK CAPACITY [ ]GALLONS
LI IDOSES PER 24 HRS #pimps [ ]
' l SQUARE FEET _Bed*nfiauration drainfiel
F G SYSTEM I SQUARE FEET VVVV
A = SYSTEM: [xl�?tSTANDARp SYSTEM
ATION: [ ) TRENCH [ l FILLED [ ] MOUND [ ]
R [zl BED [ I
Z--V--A-7T-CN OF BENCH: FFE:1i.8'NGVD
'; xLYd OF PROPOSED SYSTEM SITE
[ 26.40] I ABOVE INCHES FTI
r � OF DRAINgrgLD TO BE 166.407 INCHES FT BELOW � 'RE :NCE POINT
][ABOVE BENCHMARK/REFERENCE POINT
" r---Z REQUIRED: [ 0.00] INCHES
EXCAVATION REQUIRED; [ 52.001 INCHES
9W gal.septic tank,certified by"Mr.C's Plumbing
—'300 sf of drainfold in bed Configuration. and Septic 9/14/2015 to remain.
'� sk 12"of slightly limited soil at the bottom of the drainfield.
�£-'--eri-eter of excavation area shall be at least 2 ft wider and kmger than the
Proposed absorption bed or drain trench.
F(Comments Continued on Page 2.)
------------
S CATIONS BY:
Mr C's Plb Sept TITLE:
A "Tr BY; -------------
TITLE: Engineering specialist II
Betsy �� Dade
09/17/2015 CHD
-'= 41 ` OS/09 (Obsoletes all EXPIRATION DATE: 12/21/2015
Previous editions which may not be used)
r�=te+d: 64E-6.003, FAC
AP12G5G1S sE972e1e Page 1 of 3