PL-05-309 >SHahi Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores, FL
es
�ioatoA Phone: (305)795-2204 Fax: (305)756-8972
Perrr 11 I`Ittiriber.: P '2005
Inspection Date: 12/05/2005 Permit Type: Imported Permit
Inspector: Levrack,James Inspection Type: Rough
Owner: SHINABERRY, DIANA Work Classification: Drainfeld
Job Address: 9312 MIAMI Avenue N
Miami Shores Village, FL 33138- Phone Number (Z05)-7SI-'7 6-16
Parcel Number 1131010340160
Project: <NONE>
Block: Lot:
Contractor: LLOYD NORTH DADE SEPTIC TANK SERVICE INC Phone: 305-754-3375
Building Department Comments
9312 N MIAMI AVE
Insp ctor Comments
Passed
Failed
Correction
Needed
Re-Inspection
Fee
($75)
No Additional Inspections can be scheduled until
re-inspection fee is paid.
Friday, December 2, 2006 Page 2 of 2
FLORIDA
DEPARTMENT
OF HEALTH
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APPR'OVED
(305) 5133459
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STATE OF FLORIDA pzmxT
DEPARTNEW OF MALTZ DA= PD E
ON5ITE SEWAGE TREATXMT AIM DXPOSAL BYSTEN FM PAID2
CON TRUCTI®U XNSPECTION AND FINAL IPPROVALI 2
APPLICANTS
AGENTS
PROPERTY DRESS2
CHECKEDLOT BLOCK: MMIVISIONS PROPERTr ZD
[X) ITEMS An NOT IN COWLIMCRWITSgTATMM ®& ST39 CORRECIM.
TANK INSTALLATION S
[®1] TAM SIZE [i➢ � [27] SURpACZ NAT=128] DITiMES
[02] TANK MATERIAL rz
[03) OUTLET DEVICE [ ➢ I29) !RI rt}J
C,al [04I MULTI-CHAMBERED ➢ I I FT
[30) PumLIc vmm= AIA FT
[051 otmmT
[061 LEGEND [321 POTANA WAT= LXNZ-S FT
[ <a) [071 WATERTIGHT !) [33) ZU ATS ,,.
FT
1081 LEVEL [341 PROPERTY LIMB FT
[ J 1091 DEPTH TO LID 3: .('} 1 1351 OTHER FT
DRAXNFIELD INSTALLATION ATI l!. FI
[ l Tm
[101 [b) 4� [2) SQAKIBM COVER
11 :1,3 ���
C �) [ g➢ DIS C I Boz ; [ I 137[12] ®F DRAT S '$ 1 l [3C �.�l [13] DRAM S TI®Fd ) 9I
I VI [14➢ DRAIRLINE SLOPE
[ ✓) [15] DEPTH OF COVER ADDITIONAL IDN
,[X l 1171 SYS LOCATION I 1411 STORMNATER =OFF
I ) [181 DOSING PUMPS
[1,/] [191 AGGREGATE SIZE I ) 143) IRTZMANCE= § ,
[ L/) [20) AGG*EGATN EXCESSIVE FIMS ) [44) �IIIIDI
[ �:) 1211 AGGREGATZ DEPTE A-) 1431 I WITH SITE PLAN
146] FINAL SITE I
FILL / EXCAVATION MATERIAL [ A 147] CONTRACTOR 4
I •.s) [221 FILL AMOUNT [ ) [48) OTHER
;
C �'] [23) FILL TEXTURE -
[ ) [24) EXCAVATION
[ [251 AREA REPLACED0/'/1 1491mm r[26] REPLAcm=T MATERIAL
EXPLANATION OF VIOLATIONS / a
CONSTRUCTIONCm DATEa ! ' c-
FINAL SYSA APPR®VzDCm DATEst�
DE 4016, 10/97 (Previous Rdiiians may an Used) Page 2 ®f 3
Miami Shores Village
Building Department
10050 N.E.2nd Avenue,Nfiami Shores,Florida 33138
Tel:(305)7.5204
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BUILDING OCT Coe Permit No. C - _
PERMIT APPLICATION _ _..�.,erste; Permit No.
FBC 2001
Permit Type(circle): Building Electrical Plumbing Mechanical / -7Roofing
Owner's Name(Fee Simple Titleholder) -D✓�Q 16k Phone# ' 3/0 -79-7/
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Owner's Address `�.31J, AJ• 44 AM/ AVC°
City / /YI/ �l-/ State ,LQR1ZV9 Zip
Tenant/Lessee Name Phone#
Job Address(where the work is being done)
City Nfiami Shores Village County Miami-Dade Zip
Is Building Historically Designated YES NO
Contractor's Company Name J_1_D'1t> A,10;�T/-/ Phone#
Contractor's Address q,ffV
AJ. /0 7W-)
City State ZJ_0�l Zip
Qualifier L L��2 �- G�yCkG�"T
Architect/Engineer's Name(if applicable) Phone#
$Value of Work For this Permit Square Footage Of Work:
Work: Addition Alteration ❑New Re air/R lace ❑Demolition
Type of Wo ❑ ❑ P eP
Describe Work: R,nPLACC
Submittal Fee$ Permit Fee$ CCF$ -2-0
Notary$ S ffj Training/Education Fee$ i Ll CD Technology Fees 3-7 5
Scanning$ 0 Radon$ Bond$ /I, (Y&Y,
Code Enforcement$ Structural Plan Review.$
Total Fee Now Due$ N6"754 Y " • �, �� �J` �S
(Continued on opposite side) ��� `
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 ELECTRICAL WORK,PLUMBING, SIGNS,
WELLS,POOLS,FURNACES,BOILERS,HEATERS,TANKS and 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 In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged �/ )
J
Signature WCAAfflt, Signature
Owner or Agent Contractor
The foregoing instrument was acknowledged before me this uhf The foregoing instrument was acknowledged before me this � Ty
day of 6?a T ,20 C by 'IMA) 0�®AiRWARy, day of % ,20�by L L� f---�i?1���-i f
who is personall known to me who has produced who is personally known to me or who has produced
As ide do and who did take an oath. as identification and who did take an oath.
NOT Y NOTARY PUBLIC:
Sign: Sign:
Print: �- '�ftz- e`en Print:
or a� ixpiro_s •012009 M Commission Expires:
My Commission Expires: __a. � y •
(Certificate of Competency Holder)
State Certificate or Registration No. Certificate of Competency No.
APPLICATION APPROVED BY: Plans Examiner
Engineer
Zoning
chc 10/14/03
STATE OF FLORIDA
CENTRAX #: 13-SG-26741
DEPARTMENT OF HEALTH DATE PAID:
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM FEE PAID $
we CONSTRUCTION PERMIT RECEIPT
OSTDSNBR :-05-3312- -R
CONSTRUCTION PERMIT FOR:
[ ] New System [ ]Existing System [ ] Holding Tank [ ] Innovative Other
[ X ] Repair [ ]Abandonment [ ] Temporary [ NA ]
APPLICANT: Shinaberry, Diana AGENT: SR0001343, Crockett Lester
PROPERTY STREET ADDRESS: 9312 N Miami Ave Miami Shores FL 33150
LOT: 2 BLOCK: 168 SUBDIVISION: Miami Shores
[Section/Township/Range/Parcel No. ]
PROPERTY ID #: 11-3101-034-0160 [OR TAX ID NUMBER]
SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF CHAPTER 64E-6,FAC
DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE SATISFACTORY PERFORMANCE FOR ANY SPECIFIC TIME
PERIOD. 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 PROPERTY DEVELOPMENT.
SYSTEM DESIGN AND SPECIFICATIONS
T [ 900 ] Gallons SEPTIC TANK MULTI-CHAMBERED/IN SERIES: [ Y ]
A [ 0 ] Gallons MULTI-CHAMBERED/IN SERIES: [ Y ]
N [ 0 ] GALLONS GREASE INTERCEPTOR CAPACITY
K [ 0 ] GALLONS DOSING TANK CAPACITY [ 0 ] GALLONS @ [ 0 ] DOSES PER 24 HRS # PUMPS [ 0 ]
D [ 200 ] SQUARE FEET PRIMARY DRAINFIELD SYSTEM
R [ 0 ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [ N ] STANDARD [ N ] FILLED [ N ]MOUND [ N ]
I CONFIGURATION: [ N ] TRENCH [ N ] BED [ N ]
N
F LOCATION TO BENCHMARK: Existing Finished Floor E1. :13.10'NGVD
I ELEVATION OF PROPOSED SYSTEM SITE [ 2.0 ] [ FEET ] [ BELOW ] BENCHMARK/REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 3.5 ] [ FEET ] [ BELOW ] BENCHMARK/REFERENCE POINT
L
D FILL REQUIRED: [ 0.0 ] INCHES EXCAVATION REQUIRED: [ 18.0 ] INCHES
OTHER REMARKS:
1.-Install 900 gal. category-3 septic tank equipped with an approved filter.
2.-The licensed contractor installing the system is responsible for installing the minimum
category of tank in accordance with sec. 64E-6.013(3) (f) , FAC.
3.-Install 200 sf of drainfield in bed configuration.
4.-Invert elevation of drainfield to be no less than 10.10' NGVD.
5.-Bottom of drainfield elevation to be no less than 9.60' NGVD.
THIS PERMIT IS NOT FOR " ADDITION "
SPECIFICATIONS BY: Andre, Pau TITLE:
APPROVED BY: Andre, TITLE: Professional Engin Dade CHD
DATE ISSUED: 10/11/05 EXPIRATION DATE: 1/9/06
DH 4016, 03/97 (Obsoletes previous editions which may not be used)
(Stock Number: 5744-001-4016-0) [ostds_cons_4016-1] Page 1 of 2
STATE OF FLORIDA PERMIT #
DEPARTMENT OF HEALTH
ONSITE SEWAGE DISPOSAL SYSTEM
SITE EVALUATION AND SYSTEM SPECIFICATIONS
APPLICANT: a AGENT:
LOT: BLOCK: �- SUBDIVISION:
PROPERTY ID #: [Section/Township/Range/Parcel No. or Tax ID Number]
TO BE COMPLETED BY ENGINEER, HEALTH UNIT EMPLOYEE, OR OTHER QUALIFIED PERSON. ENGINEER'S MUST
PROVIDE REGISTRATION NUMBER AND SIGN AND SEAL EACH PAGE OF SUBMITTAL. COMPLETE ALL ITEMS.
PROPERTY SIZE CONFORMS TO SITE PLAN:
[>-] YES [ ] NO NET USABLE AREA AVAILABLE: -< "�` ACRES
TOTAL ESTIMATED SEWAGE FLOW: GALLONS PER DAY [RESIDENCES-TABLE 1 / OTHER-TABLE 2]
AUTHORIZED SEWAGE FLOW: -' GALLONS PER DAY (1500 GPD/ACRE OR 2500 GPD/ACRE)
UNOBSTRUCTED AREA AVAILABLE: SQFT UNOBSTRUCTED AREA REQUIRED: "< SQFT
BENCHMARK/REFERENCE POINT LOCATION:
ELEVATION OF PROPOSED SYSTEM SITE IS �L-(INCHES/FT] (ABOVE/BELOWj `BENCHMARK/REFERENCE POINT
THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES:
SURFACE WATER: FT DITCHES/SWALES: FT NORMALLY WET? [ ) YES [ ] NO
WELLS: PUBLIC: FT LIMITED USE: FT PRIVATE: FT NON-POTABLE: FT
BUILDING FOUNDATIONS: FT PROPERTY LINES: FT POTABLE WATER LINES: FT
SITE SUBJECT TO FREQUENT FLOODING: ( ] YES [ ] NO 10 YEAR FLOODING? [ j YES [ ] NO
10 YEAR FLOOD ELEVATION FOR SITE: FT MSL/NGVD SITE ELEVATION: FT MSL/NGVD
SOIL PROFILE INFORMATION SITE 1 SOIL PROFILE INFORMATION SITE 2
Munsell #/Color Texture Depth Munsell #/Color Texture Depth
to L r 3 'i.1` _ to
`t t0 t0
to to
y a t.
to to
t0 -to
-
to t0
to to
to to
USDA SOIL SERIES: ; •` , ,''r. USDA SOIL SERIES:
OBSERVED WATER TABLE: INCHES [ABOVE / BELOW] EXISTING GRADE. TYPE: [PERCHED / APPARENT]
ESTIMATED WET SEASON WATER TABLE ELEVATION: J. .-- INCHES ,[ ABOVE' / ,BELOW_.j EXISTING GRADE.
[ ] ( ] NO MOTTLING--f- YES [ jNO DEPTH: s INCHES
HIGH WATER TABLE VEGETATION: YES
f
SOIL TEXTURE/LOADING RATE FOR SYSTEM SIZING: DEPTH OF EXCAVATION: INCHES
DRAINFIELD CONFIGURATION: [ ) TRENCH BED [ ] OTHER (SPECIFY)
REMARKS/ADDITIONAL CRITERIA:
SITE EVALUATED BY: DATE:
DH 4015, 10/96(Replaces HRS-H Form 4015(Page 31 which may be used) Page 3 of 3
(Stock Number: 5744-003-4015-1)
STATE OF FLORIDA
z DEPARTMENT OF HEALTH
a
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permit Application Number
------------------ PART II -SITE PLAN-------------------
Scale: Each block represents 5 feet and 1 inch=50 feet.
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Notes: -
Site Plan submitted by:
= Signature Title
Plan Approved�� Not Approved Date
By County Health Department
ALL CHANG MTBE APPROVED BY THE COUNTY HEALTH DEPARTMENT
DH 4015,10M(Replaces HWH Foam 4015 which may be used)
(Stock Number:5744-002-4015-8) Page 2 of 3
ORS
Miami Shores Village Plumbing Permit -�
10050 NE 2nd Avenue �*••• T
Phone: 305-795-2204 Permit Number: PL2005-309dam`
�toaiv�'
Printed: 10/17/2005 Page 1 of 1
Applicant: DIANA SHINABERRY
Owner: SHINABERRY DIANA
JOB ADDRESS: 9312 N MIAMI AVE
Contractor LLOYD NORTH DADE SEPTIC TANK SERVIONdMactor's Address: 750 NW 107 ST
Local Phone: 305-754-3375
Parcel# 1131010340160 Legal Description: MIAMI SHORES SEC 6A PB 12-54 LOT 3 &S1/2 LOT 2 BLK 168 LOT SIZE
Fees: Description Amount
FEE2005-13573 Building Fee $175.00
FEE2005-13574 Notary Fee $5.00 Total Fees: $488.35
FEE2005-13575 CCF $1.20 Total Receipts:$4$$.35
FEE2005-13576 Training and Education Fee $0.40
FEE2005-13577 Technology Fee $3.75
FEE2005-13578 Scanning Fee $3.00
FEE2005-13579 Builders Bond $300.00
Total Fees: $488.35
Permit Status: APPROVED Permit Expiration: 4/12/2006 Construction Value: $1,800.00
Work: REPAIR DRAINFIELD
SOV 15 PAID
Signed: (INSPECTOR)
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 responisibility for all work
done by either myself,my agent,servants or employes.
Signed: (Contractor or Builder) BY: