PL-15-2889 Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores,FL
Phone: (305)795-2204 Fax:(305)756-8972
Inspection Number. INSP-247871 Permit Number. PL-11-15-2889
Scheduled Inspection Date: December 08,2015 Permit Type: Plumbing -Residential
Inspector. Diaz,Osvaldo Inspection Type: Final
Owner. WEISMANTLE,LOIS Work Classification: Septic
Job Address:640 NE 101 Street
Miami Shores,FL 33138-2468 Phone Number (305)467-5342
Parcel Number 1132060172090
Project cNONE>
Contractor. STATEWIDE SEPTIC CONNECTIONS Phone:(954)963-0082
Building Department Comments
REPLACE BROKEN TANK DRAIN FIELD Infractic Passed Comments
INSPECTOR COMMENTS Fad
TO REPLACED PERMIT PL15-155
nspector Comments
Passed `
Failed
�s
Correction
Needed
Re-Inspection
Fee
No Additional Inspections can be scheduled until
re-inspection fee Is paid.
December 07,2015 For Inspections please call: (305)762.4949
Page 22 of 44
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10050 N.E.2nd Avenue NE �'
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Miami Shores,FL 33138 0000
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Project Address Parcel Number Applicant
640 NE 101 Street 1132060172090
Miami Shores, FL 33138-2468 Block: Lot: LOIS WEISMANTLE
Owner Information Address Phone Cell
LOIS WEISMANTLE 640 NE 101 Street (305)467-5342
MIAMI SHORES FL 33138-
640 NE 101 Street
MIAMI SHORES FL 33138-
Contractor(s) Phone Cell Phone Valuation: $ 8,500.00
STATEWIDE SEPTIC CONNECTIONS (954)963-0082
�.---- W ._-------- --- Total Sq Feet: 225
Type of Work:REPLACE BROKEN TANK DRAIN FIELD Available Inspections:
Type of Piping:
Inspection Type:
Additional Info:
HRS Approval
Bond Retum: Final
Classification:Residential Scanning:3 Review Plumbing
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $5.40Invoice# PL-11-15-57773
DBPR Fee $4.50 11/18/2015 Check#:4940 $287.40 $50.00
DCA Fee $4.50
Education Surcharge $1.80 11/16/2015 Check* 1038 $50.00 $0.00
Notary Fee $5.00
Permit Fee $300.00
Scanning Fee $8.00
Technology Fee $7.20
Total: $337.40
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 zon' Futhermore,I auth 'ze th bove named contractor to do the work stated.
November 18, 2015
Tu-thod S ature:Owner / Applicant / Contractor / Agent Date
Building Department Copy
November 18,2015 1
Miami Shores Village .
Building Department 11, 11111,
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 '.
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(30S)762-4949 5�K
FBC 201q
BUILDING Master Permit No. TL. `S— Z
PERMIT APPLICATION Sub Permit No.
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING ❑ MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
,, ''11`V CONTRACTOR DRAWINGS
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JOB ADDRESS: TO F, I 0 C� 1
City: Mia�mi Shores County: Miami Dade zip: 136
Folio/Parcel#:l tt1- r2-0 -01-1 '-'2-09 0 Is the Building Historically Designated:Yes NO V
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): ®16 we) Phone#: 70 L?SI - 2-90Z
Address: (0 40 kk-: 1.0 1
City: A&&(noo vr-5 State: 11- Zip: 1��
Tenant/Lessee Name: Phone#:
Email:
r
CONTRACTOR:Company Name: ®�f�Ca.D1 phone#:
Address: I,(,"
City: -, State: l`� Zip:
tT
Qualifier Name: � SoLeine n Phone#:
State Certification or Registration#: OCl'I I '� Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ 01 S Square/Linear Footage of Work: Z2.1'
T W
Type of Work:
F-1Addition [-IAlteration ❑ New [�Repair/Replace ❑ Demolition
Description of Work: 2L, 4m
Specify color of color thru tile:
Submittal Fee$ Permit Fee$ �a �`7' 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 A
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.
�
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Signatur Signature
1 10 OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
i® day of 20 1 S by day of4�&E�' ,20 15 by
_
In i S We rSmQ,A k-who is personally known to who is personally knowno
me or who has produced as me or who has produced F M UCk K--`as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUB
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Seal: +►ag4 Se
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EXPIRES November 8,2019 •Q np�y GRe e6e0
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APPROVED BY ��'/���Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
I
yPERMIT #:13-SC-1580560
�
STATE OF FLORIDA �
Lti mRTYHATH PAP'S cATION #:AP1171899
DEPARTMENT OF HEALTH DATE PAID:
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM FEE PAID:
CONSTRUCTION PERMIT RECEIPT #:
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DOCUMENT #:PR961013
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: John Grndhauser
PROPERTY ADDRESS: 640 NE 101 St Miami, FL 33138
LOT: 3 5 BLOCK: 103 SUBDIVISION:
PROPERTY ID #: 11-3206-017-2090 [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 [ 1,200 ] GALLONS / GPD new septic tankn 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 [ 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 14.5'NGVD
I ELEVATION OF PROPOSED SYSTEM SITE [ 69.60 ] [ iNCHEs FT ] [ABOVE BELOW BENCHMARK/REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 117.601 [ INCHES FT ] [ABOVE BELOW BENCHMARK/REFERENCE POINT
L
D FILL REQUIRED: [ 0.00] INCHES EXCAVATION REQUIRED: [ 48.00 ] INCHES
1.-Install a 1200 gal min.septic tank with an approved filter.
0 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)(0, FAC.
H 3.-Install 225 sf of drainfield in trench configuration.
4.-Perimeter of excavation area shall be at least 2 ft wider and longer than the proposed absorption bed or drain trench.
E 5.-Invert elevation of drainfield to be no less than 5.20'NGVD.
6.-Bottom of drainfield elevation to be no less than 4.70'NGVD.
R
SPECIFICATIONS BY: er�,sa Solomon TITLE: Master Septic Tank Contractor
APPROVED BY: Imux TITLE: Engineering Specialist II Dade CHD
d Martin
DATE ISSUED: 16/ 015 EXPIRATION DATE: 04/16/2015
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 AP1171899 SE948068
DOCUMENT #: PR961013
7.-This permit includes the abandonment of the existing septic tank.
THIS PERMIT IS NOT FOR ANY ADDITIONS.
The system is sized for 3 bedrooms with a maximum occupancy of 6 persons(2 per bedroom),for a total estimated flow of
460 gpd.
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DEPARTMENT OF HEALTH
{` = APPLiCATI�i`d FOR ONSITESEWAGE DISPOSAL SYSTEM CONSTP JGI fOP! PERMIT
Permit Applicat`ort E`lur�#� 'r'' yrAl
— _— — — PART II -SITE PLAN!--
Scz;e: Each block represents 5 feet and 1 inch =50 feet.
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Site Plan submitted by: A � It OT, -4a?
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Plao Ap r F och; Not Approved Date
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County Health Departm-
ALL CHANGES MUST BE APPROVED BY T14E COUNTY.HEALT14 DEPARTMENT
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