PL-15-2246 4Fi C:'3 E, -k-u i'-q x-'\
Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores,FL
Phone: (305)795-2204 Fax: (305)75&8972
Inspection Number: INSP-242765 Permit Number: PL-9-15-2246
Scheduled Inspection Date: November 23,2015 Permit Type: Plumbing - Residential
Inspector: Diaz,Osvaldo
Inspection Type: Final
Owner: WHITMER,KEELY Work Classification: Drainfield
Job Address:69 NE 103 Street
Miami Shores,FL 33138-
Phone Number (407)739-8820
Parcel Number 1121360130970
Project: <NONE>
Contractor: MR CS PLUMBING&SEPTIC INC Phone: (305)651-7859
Building Department Comments
REPLACE DRAIN FIELD Infractio Passed Comments
INSPECTOR COMMENTS False
Inspector Comments
Passed 1Z
HRS GREEN TAG ON FILE f )-,3(1
Failed
Correction
Needed
Re-inspection ( �
Fee t
No Additional Inspections can be scheduled until
re-inspection fee is paid.
November 20,2015 For Inspections please call: (305)762.4949 Page 7 of 411
Miami Shores Village
10050 N.E.2nd Avenue NE
•„' ”'"�` Miami Shores,FL 33138-0000
Phone: (305)795-2204
an Expiration: 03/21/2016
Project Address Parcel Number Applicant
69 NE 103 Street 1121360130970 KEELY WHITHER
Miami Shores, FL 33138- Block: Lot:
Owner Information Address Phone Cell
KEELY WHITMER 69 NE 103 Street (407)739-8820
MIAMI SHORES FL 33138-
69 NE 103 Street
MIAMI SHORES FL 33138-
Contractors 200.00
MR C'S P
Type of tions:
Type of
e:
Addition
Bond R
Classifi
r
Fees Du
Bond Type-Owne $500.00
CCF Invoice# PL-9-15-56935
$1.80 09/23/2015 Check#: 171 $ 500.00 $ 168.30 ?
DBPR Fee $2.25 n
DCA Fee $2.25 09/02/2015 Credit Card $50.00 $118.30 =W=4 nomwIll-lt'
Education Surcharge $0.60 09/23/2015 Credit Card $ 118.30 $0.00
Permit Fee
$150.00 Bond#:2850 �q
Scanning Fee $9.00
Technology Fee $2.40 r4m
q
Total: $668.30
Applicant Copy
For Inspections, Call (305) 762-4949 or Log on at https://bidg.miamishoresvillage.com/cap/.
Requests must be received by 3 pm for following day inspections.
NOTICE: In addition to the requirements of this permit, there may be AND THERE MAY BE ADDITIONAL PERMITS REQUIRED FROM OTHER
additional restrictions applicable to this property that may be found in GOVERNMENTAL ENTITIES SUCH AS WATER MANAGEMENT
the public records of this county. DISTRICTS,STATE AGENCIES,OR FEDERAL AGENCIES.
September 23,2015 2
Miami Shores Village,
} - Building Department s 201
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 ? r.
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 20/�/_
BUILDING Master Permit No 2Z / 22
PERMIT APPLICATION Sub Permit No.
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING ❑ MECHANICAL [JPUBLIC WORKS ❑ CHANGE OF E]CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS:
City: Miami Shores County: Miami Dade Zia: I O
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: '_es °Icu1'Load: Construction Type: Flood Zone: N O BFE: FFE:
1� �Yt+�/Y� d 1 S 9 e� 2-o
OWNER: Name(Fee Simple Titleholder): �� "�'7„`e°+' c_
e� Phone#:
Address: �eA Ill ) p 3 Y� {-
City: M -14,VV6 S h OY2S` State: I' (_ Zip: ��J
Tenant/Lessee Na,/me: Phone#: I'fo "13`1 $Fs Z o
Email: k{ e I hq k r'i L
CONTRACTOR:Company Name: Me-, CIS S'ep,)L 'c Phone#: 3o56 Sl 78-Sl
Address: �� �J o� Aj vu 00<1- A-yz
City: M 1 Gt M ) State: F Zip: 19 3 G/
Qualifier Name: t!!�"1e ewee_k Phone#: 365
State Certification or Registration M.L ;G 1ZF-2 f 7,A i Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ Square/Linear Footage of Work: 7--1 7 � _
Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace ❑ Demolition
Description of Work: relol a C e cot k I►'1 -6'e /a
Specify color of color thru tile: LL
Submittal Fee$ Permit Fee$ J0 CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$
(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
NER or AGENT CONTRACTOR
The foregoing instrumeentY was acknowledged before me this The foregoing instrument was acknowledged before me this
1 a day
1 of ',V C 20 1 J ,by day of . *Ors ice- ,20 1 by
Keel, Wnj�MCr who is personally known to ��J�^ ��/ z��,who is personally known to
me or who has r_p odu_^ed 2522: 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:
Print: KPMR1 r rTTAWK Print:
Seal: , Notary PubMN
:•. . ;My Comm. E ,o,F111/ e;'-,,
Seal: .ter SHERYL A MENDE]2018 Notary Public-State of
Commiss
'F OF F�o•�. 2N �• My Comm.Expires Oct 2
�� , d rou _ 6 r-
�' ' Commission#FF 13
'� iF OF F��P,,
**********ss******s***ss s****ssssssss*ssss*ss*s*sssssss s*****s*****
APPROVED BY "L'fs Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
A a • 1
• , PERMIT #: 13-SC-1626931
APPLICATION #:AP1202217
STATE OF FLORIDA
DEPARTMENT OF HEALTH DATE PAID:
t ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM FEE PAID:
CONSTRUCTION PERMIT RECEIPT #
DOCUMENT #• PR986024
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: Peter Merritt
PROPERTY ADDRESS: 69 NE 103 St Miami, FL 33138
LOT: 19 20 BLOCK: 123 SUBDIVISION:
PROPERTY ID #: 11-2136-013-0970 [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 Septic#1 (To Remain) ° S.KrACITY
A [ 900 ] GALLONS / GPD Septic#2(To Remain) 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 [ 200 ] SQUARE FEET Bed Drainfield(#1 -To Re SYSTEM e/
R [ 300 ] SQUARE FEET Bed Drainfield(#2-To Re SYSTEM
A TYPE SYSTEM: [x] STANDARD [ ] FILLED [ ] MOUND [ ]
I CONFIGURATION: [ ] TRENCH [x] BED [ ]
N
F LOCATION OF BENCHMARK: FFE 13.3'NGVD
I ELEVATION OF PROPOSED SYSTEM SITE [ 30.00 ] [ INCHES FT ] [ ABOVE BELOW BENCHMARK/REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 80.00 ] [ INCHES FT ] [ ABOVE BELOW BENCHMARK/REFERENCE POINT
L
D FILL REQUIRED: [ 0.00 ] INCHES EXCAVATION REQUIRED: [ 62.00 ] INCHES
*Install 12"of slightly limited soil at the bottom of the drainfield.
o *Perimeter of excavation area shall be at least 2 ft wider and longer than the proposed absorption bed.
T *Invert elevation of drainfield to be no less than 7.13' NGVD.
*Bottom of drainfield elevation to be no less than 6.63' NGVD.
H *Water line within 10 ft of septic system to be Sch 40 PVC or sleeved in accordance with FAC Ch 64E-6.005(2)(b).
E The system is sized for 3 bedrooms with a maximum occupancy of 6 persons(2 per bedroom),for a total estimated flow
of 300 gpd.
R
SPECIFICATIONS BY: K 1 t i k TITLE:
APPROVED BY: TITLE: Engineering Specialist II Dade CHD
Ni P
DATE ISSUED: 08/28124f5 EXPIRATION DATE: 11/26/2015
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E-6.003, FAC Page 1 of 3
V 1.1.4 AP1202217 SE970072
QW
Miami Shores Village
� 10050 N.E.2nd Avenue NE
Miami Shores,FL 33138-0000
FR - Phone: (305)795-2204 ` f
Expiration: 312.,
Project Address Parcel Number Applicant
69 NE 103 Street 1121360130970
KEELY WHITMER
Miami Shores, FL 33138- Block: Lot:
Owner Information Address Phone Cell
KEELY WHITMER 69 NE 103 Street (407)739-8820
MIAMI SHORES FL 33138-
69 NE 103 Street
MIAMI SHORES FL 33138-
_....___.
Contractor(s) Phone Cell Phone Valuation: $ 2,200.00
MRCS PLUMBING&SEPTIC INC (305)651-7859 Total Sq Feet: 300
Type of Work: REPLACE 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-Owners Bond $500.00 Invoice# PL-9-15-56935
CCF $1.80 09/23/2015 Check* 171 $500.00 $ 168.30
DBPR Fee $2.25
DCA Fee $2.25 09/02/2015 Credit Card $50.00 $ 118.30
Education Surcharge $0.60 09/23/2015 Credit Card $ 118.30 $0.00
Permit Fee $150.00 Bond#:2850
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 thfs.regearig information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zoning. Fu erer 1'auth above-named contractor to do the work stated.
September 23, 2015
orized Signature:Owner / Applicant / Contractor / Agent Date
Building Department Copy
September 23,2015 1