PL-15-2888 Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores,FL
Phone:(305)795-2204 Fax: (305)7554972
Inspection Number. INSP-247869 Permit Number. PL-11-15-2888
Scheduled Inspection Date: December 08,2015 Permit Type: Plumbing - Residential
Inspector. Diaz,Osvaldo
Inspection Type: Final
Owner. MUSTAD,KRISTEN Work Classification: Septic
Job Address:1260 NE 94 Street
Miami Shores,FL 33138-
. Phone Number (305)661-6633
Parcel Number 1132050100180
Project <NONE>
Contractor STATEWIDE SEPTIC CONNECTIONS Phone: (954)9634082
Building Department Comments
REPLACE SEPTIC TANK+ DRAINFIELD Uwactio Passed Comments
INSPECTOR COMMENTS False
TO CLOSE PERMIT PL-142162
HRS APPROVAL
Inspectors Comments \\
Passed
Failed
Correction
Needed
Re-Inspection
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid
December 07,2016 For Inspections please call.(305)762-4949 Page 21 of 44
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Expiration: 06/14/2016
Project Address Parcel Number Applicant
1260 NE 94 Street 1132050100180
KRISTEN MUSTAD
Miami Shores, FL 33138- Block: Lot:
Owner Information Address Phone Cell
KRISTEN MUSTAD 1260 NE 94 Street (305)661-6633
MIAMI SHORES FL 33138-
1260 NE 94 Street
MIAMI SHORES FL 33138-
Contractor(s) Phone Cell Phone Valuation: $ 5,800.00
STATEWIDE SEPTIC CONNECTIONS (954)96350082 Total Sq Feet: 225
Type of Work:REPLACE SEPTIC TANK+DRAINFIELD Available Inspections:
Type of Piping: Inspection Type:
Additional Info:
HRS Approval
Bond Return: Final
Classification:Residential Scanning:3 Review Plumbing
Fees Due AmountPay Date Pay Type Amt Paid Amt Due
CCF $3.60 Invoice# PL-11-15-57772
DBPR Fee $4.50 11/16/2015 Check#:1038 $50.00 $277.60
DCA Fee $4.50
Education Surcharge $1.20 11/18/2015 Check#:4940 $277.60 $0.00
Permit Fee $300.00
Scanning Fee $9.00
Technology Fee $4.80
Total: $327.60
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zoni uthermore,I autho a the bove-named contractor to do the work stated.
C November 18, 2015
Authoriz Sign re:Owner / Applicant / Contractor / Agent Date
Building Department Copy
November 18,2015 1
.. Miami Shores Village
Building Department NOV
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel: (305)795.2204 Fax: (305)756.8972 7.Zy
INSPECTION'S PHONE NUMBER:(305)762.4949
FBC 20 It/
BUILDING Permit No.
PERMIT APPLICATION Master Permit NoTu S—2s W4
Permit Type: PLUMBING
JOB ADDRESS: 1`160 N5- 0(+ STR-E eT
City: Miami Shores County: Miami Dade Zip: L3 31'L72
Folio/Parcel#: a-- ®1
Is the Building Historically Designated:Yes NO Flood Zone:
OWNER:Name(Fee Simple Titleholder): t<rI M +ct Phone#:_ �Sq —146
Address: t e?- 6® J'e 0
City:_ m-Syo res State: Zi� -53
p
Tenant/I,essee Name: Phone#:
Email:
CONTRACTOR:Company Name: g t" \Ck. &XICI &4NIS PhoneO.:
Address: 24 �� t9
P AV-P— 4-- is
City: ORG LOCAI?—A State: C� Zip:
Qualifier Name: ex-ra �'�o 1 Pe--"0-.-. Phone#:
State Certification or Registration#: 1�(��'�k? Certificate of Competency#:
Contact Phone#: Email Address:
DESIGNER:Architect/Engineer: Phone#:
Value of Work for this Permit:$_ -5e(pa Square/Linear Footage of Work:
Type of Work: ❑Address ❑Alteration- ONew Iepe
' /Replace ODemolition
Description of Work: �`E RT�
T.
Submittal Fee$ Permit Fee$ ®. ;Y CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Bond$
Notary$ Training/Education Fee$ Technology Fee$
Double Fee$ Structural Review$
TOTAL FEE NOW DUE ro 0
Bonding Company's Name(if applicable) r
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 alfthe.foregoing information is accurate and that all work will be done it compliance with all
applicable laws regulating construction and zoning.
"WARNINGTO 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
k4afier or Agent Contractor q
The foregoing instrument was acknowledged before me this_LO The foregoing instrument was acknowledged before me this t 0
day of Q ,20 %y Kr t SPr� u�C4 day of I-0 U ,20��,by 1(X�i�
who is personally known to me or who has produced who is personally known to me or who has produced '
Cly As iden � as identification and who did take an oath.
NOTARY PUBLIC: re�Qe L StaW a NOTARY PUBLI
MY Commission FF 188307 Notary na Lewis of FbNda
OF Expir"o2/OSJZ01a Trema LeNds
FF 188307
Sign. Sign: w 02A5J2018
Print: per G_ ��.0 rJ r Print: ! s
My Commission Expires: J' 1 Ej My Commission Expires: �' q
APPROVED BY /®(/S Plans Examiner Zoning
Structural Review Clerk
(Revised3/12/2012)(Revised 07/10/07XRevised 06/10/2009)(Revised 3/15/09)
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Division Or
Envimnmentat Heatth
Florida Health
®� Miami-Dade County
I OSTDS/Well Division o�
11805 SW 261"Street•Miami,FL 33175
Inspector 7_cl .e � �t`t/e% P Date
Address 12,C N E 9 k Ss� OSTDS #
Comments:
Signature
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R iii V1 A � R PERMIT #: 13-SC-1560396
STATE OF FLORIDA MRAIRM-DADE COUNTY HEAP Ti I P/=1a ;.`-
DEPARTMENT OF HEALTH APPLICATION #: gP1159956
ONSITE SEWAGE TREATMENT AND DISPOSAL DATE PAID:
SYSTEM FEE PAID:
t CONSTRUCTION PERMIT RECEIPT #:
DOCUMENT #: PR950791
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: (Kristen Mustard&Maria Martinez)
PROPERTY ADDRESS: 1260 NE 94 St Miami, FL 33138
LOT: 20,21 BLOCK: SUBDIVISION: Miami Shores Bay View
PROPERTY ID #: 11-3205-010-0180 [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 [ 1,050 ] GALLONS / GPD new septic tank 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 I l
D [ 225 ) SQUARE FEET new trench confiq.drainfie SYSTEM
R [ 0 ) SQUARE FEET SYSTEM
A TYPE SYSTEM: [x] STANDARD [ ] FILLED [ ] MOUND [ ]
I CONFIGURATION: [x] TRENCH [ ] BED [ ]
N
F LOCATION OF BENCHMARK: FFE 8.3'NGVD
I ELEVATION OF PROPOSED SYSTEM SITE [ 31.20 ] [ INCHE3 FT ] [ ABOVE BELOW BENCHMARK/REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 57.24 ] [ INCHES FT ] [ABOVE BELOW BENCHMARK/REFERENCE POINT
L
D FILL REQUIRED: [ 0.00] INCHES EXCAVATION REQUIRED: [ 38.00 ] INCHES
O 1.-Install a 1050 gal min.septic tank with an approved filter.
2.-The licensed contractor installing the system is responsible for installing the minimum category of tank in accordance
T with s.64E-6.013(3)(f), FAC.
H 3.-Install 225 sf of drainfield in trench configuration.
4.-Install 12"of slightly limited soil at the bottom of the drainfield.
E 5.-Perimeter of excavation area shall be at least 2 ft ider and longer than the proposed absorption bed or drain trench.
R (Comments Continued on Page 2.)
SPECIFICATIONS BY: Yude'sy Martin TITLE:
APPROVED BY: LE:
Dade CHD
DATE ISSUED: 09/18/2014 EXPIRATION DATE: 12/17/2014
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E-6.003, FACPage 1 of 3
v 1,1.4 AF11S9956 SE930727
DOCUMENT #: PR950791
6.-Invert elevation of drainfield to be no less than 4.03'NGVD.
7.-Bottom of drainfield elevation to be no less than 3.53'NGVD.
9.-This permit includes the abandonment of the existing septic tank.
The system is sized for 3 bedrooms with a maximum occupancy of 6 persons(2 per bedroom),for a total estimated flow of
400 gpd.
THIS PERMIT IS NOT FOR ANY ADDITIONS.
` �rATi= 0I✓ I=LURr0A -
DEPARTMENT OF HEALTH
- � 4 APPLICATION FOR ONSITE SEWAGE.DISPOSAL SYSTEM CO�iSTF JGl"IOM PER�ftl f
Permit Apnlicat on Nurs)ber
PART"II SITE PLAN ----- -- - -- -� r --- -
Scare: Each block represents 5 feet and inch = 50 feet. "
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Not s: - r"o-s a �12Ga Ng C1 (k ST 3-3{.3d' ---
Sits Plan submitted by: [; /10 A
Signature —
Plao Approv6d'"', Not Approved _ Date
�s
bounty Health Departm ;
t
ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
114 40'5.101%(RcrytaWs,HiiS-H-nrm 4015 which My bo used)
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