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PL-16-296 P Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores,FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-252128 Permit Number: PL-2-16-296 Scheduled Inspection Date: February 23,2016 Permit Type: Plumbing-Residential Inspector: Hernandez,Rafael Inspection Type: Final Owner: BREEN,JAMES&MAR Work Classification: Septic Job Address:1481 NE 104 Street Miami Shores, FL 33138-2663 Phone Number (786)617-3500 Parcel Number 1122320320090 Project: <NONE> Contractor. STATEWIDE SEPTIC CONNECTIONS Phone: (954)963-0082 Building Department Comments INSTALL ONE NEW 1050 GALLON SEPTIC INSTALL infracuo Passed Comments DRAIN FIELD REPAIR 300 SQ FEET INSPECTOR COMMENTS False Inspector Comments Passed I V IHRS APPROVAL IN FILEIon Failed Correction ❑ Needed Re-Inspection Fee No Additional Inspections can be scheduled until re-inspection fee is paid 3 3 � r ! �f 4 'I 32 d E I . F I fi � � p 'RAT" L V 3 ; +xlz k� 4 i Ig t z T� 3 � 3 5' Scanned by CmScanner ' V Miami Shores Village �\� Building Department 7F�EB ® 22016 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 — — ' INSPECTION LINE PHONE NUMBER:(30S)762-4949 FBC 201 BUILDING Master Permit No.;2/ %6 PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION [-]RENEWAL PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP `} �y CONTRACTOR DRAWINGS JOB ADDRESS: I4% -1 ST City: Miami Shores County: Miami Dade Zia: 31139 Folio/Parcel#: 11 - 22 232-0 72- 0010 Is the Building Historically Designated:Yes NO X Occupancy Type: Mth Load: NSA' Construction Type: N/Pf- Flood Zone: VIA- BFE: 0/A FFE: NIR OWNER:Name(Fee Simple Titleholder): J&Wj fPhone#: lQ6' (0( i' 3SOO Address 'ist PIE�. IO-q ST- City: TCity: M • S State: FL Zip: Tenant/Lessee Name: om Phone#: Email: �,� CONTRACTOR:Company Name:��'�'4 Crlt�C'r �i�&I C' ��S, IV) C Phone#: J��' 6653 "� Address: l 68O N°VJ' (5 A-,-,�'e tkl O City: Lo 'xq State: f Zip: � 2 5' " Qualifier Name: fi Lc' e3 f'Dx'1' Phone#: State Certification or Registration#: a]-_M 0g-717X Z- Certificate of Competency M DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: Square/Linear Footage of Work: No 94 Ft Type of Work: ❑ Addition ❑ Alteration ❑ New ® Repair/Replace ❑ Demolition Description of Work: 10So ctot droc' +00-k • Specify color of color thru tile: Submittal Fee$ Permit Fee$ CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ �� Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ cJ ` TOTAL FEE NOW DUE$ (Revised02/24/2014) 90 cJ Bonding Company's Name(if applicable) Bonding Lampany's Address City state Zip Mortgage lender's Name(if applicable) Mortgage lender's Address — city state Application is hereby made to obtain a permit to do the work and Installations as Indicated. 1 certify that no work or Installation has commenced prior to the Issuance of a pemdt 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.... OWtsM AFFIDAVIT: 1 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 Applimili As a condition to the issuance of a budding permit with an estimated value exceeding$Z=,the applicant most promise In good faith that a copy of the notice of commencement and constructdon lien haw 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 whkh occurs seven(7)days after the budding permit Is Issued In the absence of such posted notice, the Inspection wig not be approved and a reinspectionfee wfil be charged. Signature —`lSignature OWNER or AGENT CONTRACTOR The foregoing Instrument was acknowledged before me this The foregoing Instrument was acknowledged before me this day of L a it%,li Q .20- by Z day of 21 .by m es tr .who Is personally(mown to to me or who has produced 19W Cr-n-r~ -Qs me or who has produced as identification and who did take an oath. Identification and who did take an oath. NOTARY PUBLIC NOTARY PUSUC: Sign: Print: Print: Seal: ►jDf Notary Putruc State of Florida Seek Denise Carrier • K My COttflnlsslon EE 187532 roe► ��o�� Notary Public State of Florida �l�µo Eires 071�i2016 ,e��q Joanna M Feliciano '� Q�of KMy Commission FF 082753 •t***,• / i •t*i**i*I********** * ** '�+Lt�ti W6 %0******* APPROVED BY ,,._.� Plans Examiner Zoning Structural Review Clerk PERMIT #:13-SC-1651934 STATE OF FLORIDA APPLICATION #:AP1218744 DEPARTMENT OF HEALTH DATE PAID: ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM FEE PAID: •� CONSTRUCTION PERMIT RECEIPT #: WE DOCUMENT #: PR999965 CONSTRUCTION PERMIT FOR: OSTDS Repair APPLICANT: James Breen PROPERTY ADDRESS: 1481 NE 104 St Miami, FL 33138 LOT: 1011 BLOCK: 3 SUBDIVISION: PROPERTY ID #: 11-2232-032-0090 [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 [ 1,050 ] GALLONS / GPD new septic tank ®oo" CAPACITY A [ 0 ] GALLONS / GPD CAPACITY N [ 0 ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS] K [ 300 ] GALLONS DOSING TANK CAPACITY [67•0Q ]GALLONS @[ 6 ]DOSES PER 24 HRS #pumps [ q ] D [ 300 ] SQUARE FEET Trench confiquration drain SYSTEM R [ 0 ] SQUARE FEET SYSTEM A TYPE SYSTEM: [x] STANDARD [ ] FILLED [ ] MOUND [ J I CONFIGURATION: [x] TRENCH [ ] BED [ ] N F LOCATION OF BENCHMARK: FFE:8.3'NGVD I ELEVATION OF PROPOSED SYSTEM SITE [ 20.40] [ INCHES FT ] [ABOVE BELOW BENCHMARK/REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ 51.60 ][ INCHES FT ] [ABOVE BELOW BENCHMARK/REFERENCE POINT L D FILL REQUIRED: [ 0.00] INCHES EXCAVATION REQUIRED: [ 37.001 INCHES Amended on 1/26/2016 by B.Olmino to add a new dosing tank to meet bottom of drainfield elevation. 0 1.-Install a 1050 gal min.septic tank with an approved filter. T 2.-The licensed contractor installing the system is responsible for installing the minimum category of tank in accordance H with s.64E-6.013(3)(f),FAC. 3.-Install 300 sf of drainfield in trench configuration. THIS PERMIT IS NOT FOR ANY ADDITIONS. E 4.-Bottom of drainfield and Invert elevation to be no les 4.00'and 4.50'NGVD. R 5.-This permit includes the abandonment of the existing septic tank. SPECIFICATIONS BY: A American Sept TITLE: APPROVED BY: ff� TITLE: Engineering Specialist II Dade CHD Betsy Lange-olmtno DATE ISSUED: 01/06/2016 EXPIRATION DATE: 04/05/2016 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 AP1218744 SE981319 1'` r L ""� .. `yrio „s g� Miami Shores Village 'VIM PL� jrIIq,II Ilo 10050 N.E.2nd Avenue NE Wrrtk' tassrcetfn170 ; c * Miami Shores,FL 33138-0000 ' a •yr s Phone: (305)795-2204 Petit'$0W�:APl�� , FCORiDp' re a z �, X201 Expiration: 011201 z> Project Address Parcel Number Applicant 1481 NE 104 Street 1122320320090 Miami Shores, FL 33138-2663 Block: Lot: JAMES&MAR BREEN , Owner Information Address Phone Cell JAMES&MAR BREEN 1481 NE 104 Street (786)617-3500 I. MIAMI SHORES FL 33138- 1481 NE 104 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone Valuation: $ 8,500.00 STATEWIDE SEPTIC CONNECTIONS (954)963-0082 Total Sq Feet: 300 Type of Work:INSTALL ONE NEW 1050 GALLON SEPTIC 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-2-16-58546 CCF $5.40 DBPR Fee $4.50 02/03/2016 Credit Card $787.40 $50.00 DCA Fee $4.50 02/02/2016 Check#:5028 $50.00 $0.00 Education Surcharge $1.80 Bond#:2972 Notary Fee $5.00 Permit Fee $300.00 Scanning Fee $9.00 Technology Fee $7.20 Total: $837.40 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. Futhe or ,I authorize the above-named contractor to do the work stated. February 03,2016 Authorized Signatur : wner / Applicant / Contractor / Agent Date Building Department Copy February 03,2016 1