PL-15-1693 Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-247281 Permit Number: PL-7-15-1693
Scheduled Inspection Date: December 22,2015 Permit Type: Plumbing - Residential
Inspector: Diaz, Osvaldo Inspection Type: Final
Owner: DALRYMPLE, DORIS Work Classification: Septic
Job Address:107 NE 91 Street
Miami Shores, FL 33138- Phone Number
Parcel Number 1132060133300
Project: <NONE>
Contractor: A AARON SUPER ROOTER Phone: 305-944-8886
Building Department Comments
REPLACE BROKEN SEPTIC TANK AND DRAIN FIELD Infractio Passed comments
WITH NEW 1050 TANK NEW 300 D/F INSPECTOR COMMENTS False
nspector Comments
Passed CREATED AS REINSPECTION FOR INSP-247085. CREATED AS
REINSPECTION FOR INSP-238513. need sod
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 11 of 33
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Permit NO. PL-7-15-1693
$ Miami Shores Village Permit Type: Plumbing-Residential
n 10050 N.E.2nd Avenue NE Per m i Work Classification:Septic
•"' "'"`" Miami Shores,FL 33138-0000 Permit Status:APPROVED
Phone: (305)795-2204
Issue Date:7/9/201'S Expiration: 01/05/2016
Project Address Parcel Number Applicant
107 NE 91 Street 1132060133300 DORIS DALRYMPLE
Miami Shores, FL 33138- Block: Lot:
Owner Information Address Phone Cell
DORIS DALRYMPLE 107 NE 91 Street
MIAMI SHORES FL 33138-2809
Contractor(s) Phone Cell Phone Valuation: $ 8,500.00
A AARON SUPER ROOTER 305-944-8886
- ---- _- -------------- _-_ Total Sq Feet: 300
Type of Work:REPLACE BROKEN SEPTIC TANK AND DRAI 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 Invoice# PL-7-15-56257
CCF $5.40 07/07/2015 Check#:4804 $50.00 $782.40
DBPR Fee $4.50
DCA Fee $4.50 07/09/2015 Check#:4407 $782.40 $0.00
Education Surcharge $1.80 Bond#:2783
Permit Fee $300.00
Scanning Fee $9.00
Technology Fee $7.20
Total: $832.40
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 zoning. Futhermore,I authorize the above-named contractor to do the work stated.
'2 July 09, 2015
thorized Signature:Owner / Applicant / Contractor / Agent Date
Building Department Copy
July 09,2015 1
Miami Shores Village C-PTVFD
Building Department
10050 N.E.2nd Avenue,Miami Shores, Florida 33138 BY: JUL 0,7; 2015
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949 �' �A
EBC 20�
BUILDING Master Permit No) 93
PERMIT APPLICATION Sub Permit No.
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
1%PLUMBING ❑ MECHANICAL F-]PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
gg S-1
CONTRACTOR DRAWINGS
JOB ADDRESS: l ®sI � I J 1�
City: Miami Shores County: Miami Dade zip:
( �
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name(Fee Simple Titleholder):_ D®I ®i✓k5oaPtH h� �=y�el-e#:
Address: N e ( �(
City: "l,"( ,S State: - — -Zip: -
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: A Phone#:
Address: 10022 'Li a�3 OT
City: P-k( rp A{L State: Zip: ' 50)2-3
Qualifier Name: V 0*0 '[d nfi4 Phone#: 4 tf -C-ee6'
State Certification or Registration#:�� 0`� �� Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State:__—Zip:
Value of Work for this Permit: Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace ❑ Demolition
Description of Work: PC-PC 4:) C(:F YGCZ0 -G:N '
T6"� K-'- f (D kzA t ly F I Mf
Specify color of color thru tile:
Submittal Fee$ Z Permit Fee$ ✓`ter CCF$ CO/CC$
Scanning Fee$ Radon Fee$ _ DBPR$ _ Notary _—
Technology Fee$ Training/Education Fee$ _ _Double Fee$
Structural Reviews$ Bond
rOTAL FEE NOW DUE$6Q
(Revised02/24/2014)
Bonding Company's Name(if applicable) _
Bonding Company's Address _
City State tl 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$2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law chure will be delivered to the person
whose property is subject to attachment. Also,a certified copy of the tecoided notice of co m ncement rnust be posted ut the Deb site
for the first inspection which occurs seven (7) days after the building pet—nit .s issued ' th,� absence of such pasted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature id, ® Signature LO Lo
LO
OWNER or GENT CONTRACTOR Z M `n
�+ r O M N
O �, Ahe oregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me t is2 W o g
co o O W
O w (8 " day of JULY 20 I ; by � day of � 20 �S
J U A O
cnZo E 6„ (Tt°c2�}{� (� ''i w a is personally known to � �b�1� who is personally know te, z
rt0 n q (O 8e~i who has produced as me or who has produced n
o
u.
►� 2iication and who did take an oath. identification and who did take an oath. U X
f— �NbTA Y PUBLIC: NOTARY PUBLIC: ,
'M sc �� Sign — � -- %?a.s�!
Print: z—
Seal: Seal:
APPROVED BY '� /$ Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
PERMIT #: 13—SC-1615532
STATE OF FLORIDA APPLICATION #:AP1194825
DEPARTMENT OF HEALTH DATE PAID:
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION PERMIT €' FEE PAID:
aqg RECEIPT #:
d
DOCUMENT #: PR979952
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: Doris Dalrymple
PROPERTY ADDRESS: 107 NE 91 St Miami, FL 33138
LOT: 1516 BLOCK: 24 SUBDIVISION:
PROPERTY ID #: 11-3206-013-3300 [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.
WHICH SERVED AS A BASIS FOR ISSUANCE OF THIS PERMIT, REQUIRE THE APPLICANT TOCHANGE INERTSMODIFY IAL ACTHE
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 1 GALLONS / GPD New septic tank CAPACITY-
A [ 0 1 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 [ 300 1 SQUARE FEET Trench confiquration drain SYSTEM
R [ 0 ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [X] STANDARD'[ I FILLED [ ] MOUND [ ]
I CONFIGURATION: [xl TRENCH [ ] BED [ ]
N
F LOCATION OF BENCHMARK: F.F.E., 15.6'NGVD
I ELEVATION OF PROPOSED SYSTEM SITE [ 30.001 [ INCHES FT ] ( ABOVEBLOWEBENCHMARK/REFERENCE POINT
L INCHES BELOW
E BOTTOM OF DRAINFIELD TO BE [ 78.001 [ FT ] [ABOVE BENCHMARK/REFERENCE POINT
D FILL REQUIRED: [ 0.00] INCHES EXCAVATION REQUIRED: [ 48.001 INCHES
Inspector to verify the existing septic tank is properly abandoned before final approval.
0 'Invert elevation of drainfield to be no less than 9.60'NGVD.
T "Bottom of drainfield elevation to be no less than 9.10'NGVD.
H 'THIS PERMIT IS NOT FOR"ADDITION(s)".
The system is sized for 4 bedrooms with a maximum occupancy of 8 persons(2 per bedroom),for a total estimated flow
E of 400 gpd.
R Required drainfield area based on rule 64E-6.015(6)(c)2.
SPECIFICATIONS BY: John TITLE:
APPROVED BY: TITLE:
C los xoaza Dade cHD
DATE ISSUED: 07/ /201
EXPIRATION DATE: 09/30/2015
DH 4016, 08/09 (Obsoletes 1 previous editions which maynot be,used)
Incorporated: 64E-6.003, FAC
Page 1 of 3
V 1.1.4 "1194025 � li.r �SE965120
I
STATE OF FLORIDA
DEPARTMENT OF HEALTH
'� !r APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONST
RUCTION PERMIT
Permit Application Number
---------------------. PART II
SITE PLAN-- —
Scale: Each block represents 5 feet and 1 inch=50 feet.
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Site Plan submitted by: , 'P }
Signature
Plan Approved Title
Not Approved Date
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By
+ r County Health Department
ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
]H 4015,10/96(Replaces HRS-H Form 4015 which may be used)
Stock Number:5744-002-4015.6)
Page 2;of 3