PL-15-2375 Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-243703 Permit Number: PL-9-15-2375
Scheduled Inspection Date: December 16,2015 Permit Type: Plumbing - Residential
Inspector: Diaz, Osvaldo Inspection Type: Final
Owner: KANTOR,SEYMOUR&JILL Work Classification: Drainfield
Job Address:1094 NE 91 Terrace
Miami Shores, FL 33138- Phone Number (305)336-7100
Parcel Number 1132050010380
Project: <NONE>
Contractor: MR C'S PLUMBING&SEPTIC INC Phone: (305)651-7859
Building Department Comments
DRAINFIELD INSTALLATION. Infractio Passed comments
INSPECTOR COMMENTS False
Inspector Comments
Passed HRS IN FILE
Failed
Correction �-
Needed
Re-Inspection ❑
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid
December 15,2015 For Inspections please call: (305)762-4949 Page 15 of 51
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Miami Shores Village
Building Department SEP 2015
10050 N.E.2nd Avenue,Miami Shores, Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 20L(+
BUILDING Master Permit No. Fu is, 2_�-15
PERMIT APPLICATION Sub Permit No.
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
LUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
,,ll(,�f CONTRACTOR DRAWINGS
V
JOB ADDRESS: I 4 UE 4I lett
Com: Miami Shores County: Miami Dade Zip: S 3 1 3 r
Folio/Parcel#: 3x05 -001- D 360 Is the Building Historically Designated:Yes NO —
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name(Fee Simple Titleholder): S&Amhur �A6or Phone#: R7e7 L-t-
Address: 10% we '��ql-rajHr
City: WGu.t IJ W" State: :EL Zip: 33 8(
Tenant/Lessee Name: Phone#:
Email: / r �l
CONTRACTOR:Company Name: �� �1 S va.��L1j Phone#:- 651 lM
Address: ���137 NW r
City: d°�� State: Zip: x310 !,
Qualifier Name: Phone#: 0
State Certification or Registration#: � Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: r� City: State: Zip:
Value of Work for this Permit:$ Square/Linear Footage of Work: lot
Type of Work: ❑ Addition p❑cAlteratio-�n�� \\ ❑ New Repair/Replace ❑ Demolition
Description of Work: �lc�,a, �e
Specify color of color thru tile:
Submittal Fee$ `p Permit Fee$ f'� 0P ?`y CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
�—r1
TOTAL FEE NOW DUE$ 0
I `
(Revised02/24/2014) 6 rj 3 0
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 einspection fee will be charged.
Signature Signature
WNER or AGENT CONTRACTOR
The foregoing instrume t was acknowledged before me this The foregoing instrument was acknowledged before me this
(1 day of�oo r.KL,�•f ---120 l 5 by 1-7 day of �W� 'a 20 ) 5 , by
-%4uvP l�.�t�� ,who is personally known to !!,pd"AE �TiC K who is personally known to
Ji
me or who has produced - 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: I A. �
Print: Print: If -M WNWIN
1 R�'p KEMBLE ETTRICK •""""'
�PµY P
Seal: 'o`P �b�;•-, Seal: ,o ��-,, Notary Public-State of
r. .o: Notary Public-State of Florida ;_
=•: :• My Comm.Expires Sep 19,2017 •„ ,•?My Comm.Expires Oct Florida23,2018
Commission#FF 136597
Commission #FF "re p Bowed bNatl�alNotaryAm.
�,OF fl�• ''�. 1111\O•�
Bonded Through National Not Assn.
APPROVED BY `� Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
PERMIT #: 13-SC-1629655
APPLICATION #:AP1203971
STATE OF FLORIDA
` DATE PAID:
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM FEE PAID:
` CONSTRUCTION PERMIT RECEIPT #:
DOCUMENT #: PR987609
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: Seymour Kantor
PROPERTY ADDRESS: 1094 NE 91 Ter Miami, FL 33138
LOT: 12 BLOCK: 2 SUBDIVISION: Watersedge
PROPERTY ID #: 11-3205-001-0380 [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 [ 900 1 GALLONS / GPD Exist.septic tank to remain CAPACITY
A [ 0 ] GALLONS / GPD CAPACITY
N [ 0 l 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 Bed confiquration drainfiel SYSTEM
R [ 0 ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [x] STANDARD [ ] FILLED [ ] MOUND [ ]
I CONFIGURATION: [ ] TRENCH [xl BED [ ]
N
F LOCATION OF BENCHMARK: FFE: 11.3'NGVD
I ELEVATION OF PROPOSED SYSTEM SITE [ 36.00 ] [ INCHES FT ] [ABOVE BELOW BENCHMARK/REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 76.081 [ INCHES FT ] [ABOVE BELOW BENCHMARK/REFERENCE POINT
L
D FILL REQUIRED: [ 0.001 INCHES EXCAVATION REQUIRED: [ 52.001 INCHES
1.-Existing 900 gal.septic tank,certified by"Mr.C's Plumbing and Septic"on 9/9/2015 to remain.
O 2.-Install 300 sf of drainfield in bed configuration.
T 3.-Install 12"of slightly limited soil at the bottom of the drainfield.
H 4.-Perimeter of excavation area shall be at least 2 ft wider and longer than the proposed absorption bed or drain trench.
E --------------------------------_----------------- -- ---_
5.- (Comments Continued on Page 2.)
R
SPECIFICATIONS BY: 14rCl Is TITLE:
APPROVED BY: TITLE: Engineering Specialist II Dade CHD
Betsy Lange-Olmino
DATE ISSUED: 09/15/2015 EXPIRATION DATE: 12/14/2015
DH 4016, 08/09 (Obsoletes all previous editions which may not be )I n F"—`` 7�
Incorporated: 64E-6.003, FAC PSA
- Page 1 of 3
v 1.1.4 AP1203971 _ SE971384
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