PL-15-1145 ` Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores,FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-248997 Permit Number: PL-5-15-1145
Scheduled Inspection Date: December 22,2015 Permit Type: Plumbing - Residential
Inspector: Diaz, Osvaldo Inspection Type: Final
Owner: MARIA ANAYA, GABRIEL TORRES Work Classification: Drainfield
Job Address:142 NW 98 Street
Miami Shores, FL 33150- Phone Number
Parcel Number 1131010260060
Project: <NONE>
Contractor: STATEWIDE SEPTIC CONNECTIONS Phone: (954)963-0082
Building Department Comments
REPLACE DRAIN FIELD Infractio Passed Comments
INSPECTOR COMMENTS False
Inspector Comments
Passed CREATED AS REINSPECTION FOR INSP-234717. NO PERMIT
Failed
Correction
Needed
Re-Inspection ❑
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid.
December 21,2015 For Inspections please call: (305)762-4949 Page 19 of 33
l
DIVISION OF
Environmental Health
O��Q Florida Health •��
Miami-Dade County
Q� OSTDS/Well Division
11805 SW 6th Street•Miami,FL 33175 10401
/�
Inspector i��1 :�Djp,-h Date 41,` ! y
Address S S i OST DS#AP 'ItL � 4`
Comments: �. 44 I t MA4-, ~ ' v
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Scanned by CamScanner
A, . Permit NO1 : �- 1446
Miami Shores Village mumbwii-It iij►tiAl
10050 N.E.2nd Avenue NW IM0*CfaSMICaftol? Df'aInfleld
... . .
Miami Shores,FL 33138-0000 Pem to 5 A1P1P ��
he@e Phone: (305)795-2204
Moat '
3' Expiration: 0412682016
Issue DOC 10
p-
Project Address Parcel Number Applicant
142 NW 98 Street 1131010260060
Miami Shores, FL 33150- Block: Lot: GABRIEL TORRES MARIA ANAII
Owner Information Address Phone Cell
GABRIEL TORRES MARIA ANAYA 142 NW 98 Street
MIAMI SHORES FL 33150-
Contractor(s) Phone Cell Phone Valuation: $ 2,400.00
STATEWIDE SEPTIC CONNECTIONS (954)963-0082
Total Sq Feet: 225
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-Contractors Bond $500.00
CCF $�6o Invoice# PL-5-15-55556
DBPR Fee $2.25 05/14/2015 Check#:4699 $50.00 $618.30
DCA Fee $2.25 10/29/2015 Credit Card $618.30 $0.00
Education Surcharge $0.60 Bond#:2899
Permit Fee $150.00
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 nd in strict conformity with the plans,drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this p it I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for EL TRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work.
OWNERS AYa
D VI I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction i g. Futhermore,I authorize the above-named contractor to do the work stated.
October 29, 2015
Auth riteSignature:Owner / Applicant / Contractor / Agent Date
Building � epartment Copy
October 29,2015 1
\�S Miami Shores Village �-
\� Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 MAY- 14 2815
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949
BC 200 ®
BUILDING Master Permit No. 212S-
4Z�
PERMIT APPLICATION Sub Permit No.
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
E�IPLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: .1's( -T
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: 3 to ) a 2 6>00 0 Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name(Fee Simple Titleholder):q (z�^ / a��iz�e Pe PrL(5'9' Phone#:
Address: 142- IV W I
City: PIS e44(zle% State: P�_ Zip: S-SI r®
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: Phone#:
Address: 13C 4Lzi Nv,,j tR A_ir:� P
City: tpAl 4 c t A State: f:;L Zip
Qualifier Name: ��I�L� 910Phone#:
State Certification or Registration#: Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ '2L�%3C) Square/Linear Footage of Work: 9-2-5
Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace ❑ Demolition
Description of Work:
' [ N
Specify color of color thru tile:
Submittal Fee$ Permit Fee$ B 50•Ck--:) CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$ X314-3
,A-3
Structural Reviews$ Bond$ - ®� '
TOTAL FEE NOW DUE$ QI( s
(Revised02/24/2014) & r '�O
P 1
4 �}
Bonding Cpmparby'ts 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." r�
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 notbpproved and a re' spection fee will be charged.
7 Signat a Signature
OWNER o AGENT i ( ! �� /� CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
da of 7 AIDC c ,20
y 201- bv_�� day-of �y� 1 � �J by
,who is personally known to TeK, ,who is personally known to
me or who has produced � L- as me or who has produced ff(D-- as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: Sign:
Print: Print: ��1L'�� - Le C,-) r
,,�A Notary Public.State o
Seal: $ Commission aY EE 188163 Seal
My comm.expifes May 14,2016 Notary Public State of Fbrida
;F i Trencelle Lewis
+� My Commission FF 196307
'I Expires 02/05/2019
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
� s
z
SNo I
N Miami shores V
fte� Building Department
1pRIDA 10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
Notice to Owner — Workers' Compensation Insurance Exemption
Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05
allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to
obtaining a building permit. Pursuant to the Florida Division of Workers'Compensation Employer Facts Brochure:
An employer in the construction industry who employs one or more part-time or full-time
employees,including the owner,must obtain workers'compensation coverage. Corporate officers
or members of a limited liability company (LLC) in the construction industry may elect to be
exempt if:
1. The officer owns at least 10 percent of the stock of the corporation,or in the case of
an LLC,a statement attesting to the minimum 10 percent ownership;
2. The officer is listed as an officer of the corporation in the records of the Florida
Department of State,Division of Corporations;and
3. The corporation is registered and listed as active with the Florida Department of
State,Division of Corporations.
No more than three corporate officers per corporation or limited liability company members are
allowed to be exempt. Construction exemptions are valid for a period of two years or until a
voluntary revocation is filed or the exemption is revoked by the Division.
Your contractor is requesting a permit under this workers'compensation exemption and has acknowledge that he or she will not use
day labor,part-time employees or subcontractors for your project.The contractor has provided an affidavit stating that he or she will
be the only person allowed to work on your project.In these circumstances,Miami Shores Village does not require verification of
workers'compensation insurance coverage from the contractor's company for day labor,part-time employees or subcontractors.
BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS
CONTENTS.
Signature:
Owner
State of Florida
County of Miami-Dade
The foregoing was acknowledge before me this day of r( ,20A S .
B 7-y" Del who is personally known to me or has produced
as identification.
Notary:
�,�n Notary Public State of Florida
SEAL: 14r.)
Trencel�e�eWs
My Commission FF 198307Expiros 02!06/2019
D
STATE OF FLORIDA PERMIT #: 13-SC-1593261
DEPARTMENT OF HEALTH APPLICATION #: AP 1180256
ONSITE SEWAGE TREATMENT AND DISPOSAL DATE PAID:
SYSTEM _.
CONSTRUCTION PERMIT FEE PAID:
iy RECEIPT #: `
+o ova.
DOCUMENT #: PR968011
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: Gabriel Torre De Alba
PROPERTY ADDRESS: 142 NW 98 St Miami, FL 33150
T. 5 BLOCK: 2 SUBDIVISION:
PROPERTY ID #: 11-3101-026-0060 [SECTION, TOWNSHIP, RANGE, PARCEL NUMBERI
[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 1 GALLONS / GPD Septic(Existinq) CAPACITY
A I 0 1 GALLONS / GPD CAPACITY
O ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
[ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ ;
D [ 225 1 SQUARE FEET Trench Configuration SYSTEM
R [ O 1 SQUARE FEET SYSTEM
A TYPE SYSTEM: [x] STANDARD [ ] FILLED [ ] MOUND [ ]
1 CONFIGURATION: [XJ TRENCH [ ] BED [ ]
N
F LOCATION OF BENCHMARK: FIFE 13.4'NGVD
I ELEVATION OF PROPOSED SYSTEM SITE [ 25.20 ] [ INCHES FT
J [ ABOVE BELOW BENCHMARK/REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 70.20 1 [ INCHES FT ] [ c;g;�yF BELOW BENCHMARK/REFERENCE PONT
L
D FILL REQUIRED: [ 0.001 INCHES EXCAVATION REQUIRED: [ 45 001 INCHES
{ "'7HIS PERMIT IS NOT FOR ADDITIONS—
�' Existing 750 gal septic tank, certified by"Statewide Septic on 03/23/15"to remain.
--�
T 2 -Install 225 sf of drainfield in trench configuration.
H 3 -Perimeter of excavation area shall be at least 2 ft wider and longer than the proposed absorption bed
E
4 -Invert elevation of drainfield to be no less than 8.05'NGVD.
5 -Bottom of drainfield elevation to be no less than 7.55'NGVD
R 6-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)
The system is sized for 3 bedrooms with a maximum occupancy of 6 persons(2 per bedroom), for a total estimated flow
SPECIFICATIONS BY: Teresa J Solomon
TITLE: Master Septic Tank Contractor
APPROVED BY TITLE: Engineering Specialist II
Nico e P Gu s Dade CHD
DATE ISSUED: 03/18/2015
EXPIRATION DATE: 06/16/2015
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E-6.003, FAC
Page 1 of 3
e
12646 Polk Lake Deeson Park,LLC, The Colinas Group,Inc.,Agent
STATUTE/RULE CITATION:
381 OC65A(eiB FS Setback to swale or normally dry retention area(0 feet requested. 15 feet required)
64F-6 005(1 uf) FAC Same as 381 00651411e)B FS
381 OC65,4)(g)2 FS Setback to surface water body)40 ft requested 5C ft required,
64E-6 005)4))a) FAC-Inadequate unobstructed area available
381 OC65(4))g)2 a FS-Estimated sewage flow exceeds 2500 gpd/acre
RECOMMENDATIONS: Variance Committee:A (SHO-N CHD- DEP-Y STI-2 HBI-Y REI-1 ENG-Y) Health Officer: A
cpa,ed
12647 Dade Glines,Applicant Morisette,Agent
STATUTE/RULE CITATION:
64E-6 005t2,FAC Setback to bu,)d)ng,3 ft requested 5 it regwretl)
RECOMMENDATIONS: Variance Committee:A (SHO-N CHD- DEP-Y STI-1 HBI-2 REI-Y ENG-Y) Health Officer: A
.approved
12648 Dade Glines,Applicant Morisette,Agent
STATUTE/RULE CITATION:
54E-6 005)21.FAC Setback to building)3 ft requested 5 ft required)
RECOMMENDATIONS: Variance Committee:A (SHO-N CHD- DEP-Y STI-1 HBI-2 REI-Y ENG-Y) Health Officer: A
o,ed
-. ' STATE OF FLORIDA
DEPARTMENT OF HEALTH
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permit Application Number
-------------- PART II -SITE PLAN----------------
Each block represents 5 feet and 1 inch=50 feet.
-------------------
An
7.
t� .
, t
.�,
N
ii
Notes: 1 ��
>ite Pian submitted by: /�c 03
Approved
Signature
" ruE Not Approved Date
Nt tt �.Uv�hs IBIS
County Health Department
ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
Q'S£i(Replaces HRS-H Form 4015 which may be usai)
'%ibm:5744.002 4015-6)
y J Page 2 of 3
s
NOTICE OF RIGHTS
A party whose substantial interest is affected by this order may petition for an
administrative hearing pursuant to sections 120.569 and 120.57, Florida Statutes. Such
proceedings are governed by Rule 28-106, Florida Administrative Code. A petition for
administrative hearing must be in writing and must be received by the Agency Clerk for the
Department, within twenty-one (21) days from the receipt of this order. The address of the
Agency Clerk is 4052 Bald Cypress Way, BIN#A02, Tallahassee, Florida 32399-1703. The
Agency Clerk's facsimile number is 850-410-1448.
Mediation is not available as an alternative remedy.
Your failure to submit a petition for hearing within 21 days from receipt of this order
will constitute a waiver of your right to an administrative hearing, and this order shall become
a 'final order'.
Should this order become a final order, a party who is adversely affected by it is
entitled to judicial review pursuant to Section 120.68, Florida Statutes. Review proceedings
are governed by the Florida Rules of Appellate Procedure. Such proceedings may be
commenced by filing one copy of a Notice of Appeal with the Agency Clerk of the
Department of Health and a second copy, accompanied by the filing fees required by law,
with the Court of Appeal in the appropriate District Court. The notice must be filed within 30
days of rendition of the final order.