PL-09-1578 Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-125384 Permit Number: PL-9-09-1578
Scheduled Inspection Date: October 26, 2009 Permit Type: Plumbing - Residential
Inspector: Levrock,James
Inspection Type: Final
Owner: PUEBLA/SOTTI, RAFAEL& MARIANA Work Classification: Drainfield
Job Address:526 NE 103 Street
Miami Shores, FL 33138- Phone Number (305)757-6967
Parcel Number 1132060170920
Project: <NONE>
Contractor: MR C'S PLUMBING SEPTIC INC Phone: (305)651-7859
Building Department Comments
Replace 300 drainfield.
s'
Inspector Ce#nments,• (�
Passed
Failed
Correction ❑
Needed
Re-Inspection ❑
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid.
October 23,2009 For Inspections please call: (305)762-4949 Page 7 of 17
19
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Miami Shores, FL 33138-0000 ...
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Project Address Parcel Number Applicant
526 103 Street 1132060170920
Miami Shores, FL 33138- Block: Lot: RAFAEL 8 MARIANA PUEBLA/:
Owner Information Address Phone Cell
...................................................................................................................................................................................................................................................................................................
RAFAEL&MARIANA PUEBLA/SOTTI 526 103 Street (305)757-6967
MIAMI SHORES FL 33138-
Contractor(s) Phone Cell Phone
MR C'S PLUMBING SEPTIC INC (305)651-7859 (305)651-5652Valuation: $ 1,800.00
__..........._............_._........................................................................................... .. ' Total Sq Feet: 300
Type of Work: For Inspections please call:
Type of Piping: (305)762-4949
Additional Info: Available Inspections:
Bond Return: Inspection Type:
Classification: Residential Final
Rough
Landscaping
Fees Due Amount Invoice# Total Amt Paid Amt Due
Bond Type-Owners Bond $300.00 PL-9-09-35972 $480.97 $50.00
CCF $1.20 �? �
Education Surcharge $0.40 PL-9-09-35972 $480.97 $180.97
...........::...........
Permit Fee-Additions/Alterations $175.00 PL-M9-35972 $480.97 $480*97 $ 0.00
Submittal Fee $50.00 Check#:1665 Bond#:192
Submittal Fee $50.00
Submittal Reversal Fee ($50.00)
Submittal Reversal Fee ($50.00)
Technology Fee $4.37
Total: $480.97
In consideration of the issuance to me of this permit,I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining
thereto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this
permit I assume responsibility for all work done by either myself,my agent,servants,or employes. I understand that separate permits are required for ELECTRICAL,
PLUMBING, MECHANICAL,WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zoning. Futhermore, I authorize the above-named contractor to do the work stated.
September 28, 2009
Authorized Signature:Owner / Applicant / Contractor / Agent Date
Building Department Copy
September 28,2009 1
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305)795.2204 Fax:(305)756.8972 -
jBUILDING S`S ko 15IPermit No.
PERMIT APPLICATION Q Mast Permit No.
FBC 2004 # a
Permit Type: Plumbing
Owner's Name(Fee Simple Titleh6lder)`� no-ha- (A-p—G-(9::'4 Phone#
Owner's Address N C (0 a 12�*
City H., CLH I State �- Zip
Tenant/Lessee Name Phone#
E-MAIL: �^�.�.
l
Job Address(where the work is being done) �017
a N�' ( 0 3
City Miami Shores Village County Miami-Dade Zip
FOLIO/PARCEL# ' k — -�)aC>C- - O( `7 - C-25 2,
Is Building Historically Designated YES NO if
Contractor's Company Nam�`•�l1- Sn�lnc Phone#_
Contractor's Address LA-.� a l�V-ty
City P laH I State f2L, Zip 3 3tC
Qualifier Name rk Phone#
State Certificate or Registration No.G'�I l.iI l.i- P(oI$( Certificate of Competency No.
E-MAIL:
Architect/Engineer's Name(if applicable) Phone#
Value of Work For this Permit$ gooc9b Square/Linear Footage Of Work: 50o
Type of Work: ❑Addition ❑Alteration ❑New Repair/Replace ❑ Demolition
Describe Work:
G`2. �6a ?fG-Ill -P.2
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Submittal Fee$, `� Permit Fee$ �� CCF$ L6 CO/CC
Notary$ �—Training/Education Fee$ S L o Technology Fee$.
Scanning$ Radon$---- DPBR$ Zoning
Bond$ Code Enforcement$ Double Fee$
Structural Review.$ Total Fee Now Due$
See Reverse 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$2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
n
Signature Signature
Ow gent Contractor
The fore oing instrument was acknowledged beforp�e is The fore oing in was acknowledged before me this
day of- ,20p ,byMQ�t cwc,�, rlll��oi day of 20'!nl,by Obkh Hail 1-e
who is personally known to me or who has produced who is personally known to me or who has produced
As identification and who did take an oath. as identifica' and who did take an oath. '
NOTARY PUB C: NOTARY PUBLIC-
Sign: 111.04Sign:
Print: ;.= MY COMMISSION#DO89134t� [ , M�
o; a Print: ,-:�a� eu?�;. KEN►BLE ICK
My COmmiSs BondedThruNotaryPublicUndenvriters �3 EXPIRES:September 14,2013
My Com 11 PKMThru Notary Public Underwriters
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APPLICATION APPROVED Y: Plans Examiner
Engineer
Zoning
(Revised 02/08/06)
PERMIT #' 13-SC-1092-410
STATE 4F FLOIRIIR►
ARnzm TxoN 9:AP.1936Q96
DEPARTFEW OF HFALT8 DATE PAID:
CUSIT$ SEWIM TREATMM AM DTSPOSAL FEE PAID:
SYSTM RE =PT 0;
4a" DocE #: PR785074
CONBMWCTIM IWOUT FOR: 0ST08 Raoalr
"MCANT: Rafael Puebla
YROPSRTY ADDRESS: 526 NE 103 St Miami,FL 33139
LOT: 9.10 BL=. 95 BMIVxsx(m: Mtarni shores
wnpERi'Y ID #: 113208.017.OM (aw-TION, T0W8>>i'LP, won, MR= EMMMI
[OR TAX XD IM S3ER]
sYSmw wn 8R GoSswavem = 31CCOBmAtwn wiTH simm aTxons AND XTANDAFNDS OV SECTMO11
Sel.am, r.S., mw cwjmR a4E-6, F.A.C. DEPART T APPROVAL OP SYSTEM 00" 4W QUAMUTER
SATISFACTORY ?ERBF FOR AM xFIC PERIOD of TIMI my cum= = MffiR:A:t:-AL FACTS,
WHILE SERVED 3fS A BASIS FOR 28200= Or THx3 PE UM O Rr OMM TER APPLICART TO WDIFY THE
PERLUT APMCATION. SUCH MMITIC11TIONS 3!ditY RESULT ZU TAX$ 7=CT bEx>n MhDR Nt3LL AM VOW.
ISSN OF. PAIS JUNUT DOES NOT WMM THE APnXCAM MK CMWLXMM WITS OT9W rJIDWAL,
STATE, OR WCAL ?ERt?E<==Q RMQUYR= FOR DEVELOWA=1T OF '1'Sie FROMMY.
SYSTEM DRex= AND sPzCIFICAT%CNB
T t 11050 ] daLLONS / GFD Seotla CAPACITY
A L 0 ] taEs.MS / GPD CAPACITY
N t 0 ) GALLW9 GRWLU xtiMCZPMR C"YLCxTR t[4 a CAPACITY BxNQ= TwW!%250 GAMM]
R t l GMI.ONS DOSING TAWS CAPACITY ( ]CALI .S @ t IDMS PER 24 RRS #Pwre [ ]
D t 400 ] SQuh= rzn SYR=
R L 0 ] SQUARE 3i'2w STST$S
A TYPE SYSTEM: EX) sTAMDUM t ] FILLED [ ] MOt7Nu [ 1
Y CONFIGURATION; t ] Taw= tY] BED t ]
D
F ZA=Tzm or F_F_E.:120 NGVD
X RLXVWT lQ OF FROPOUX0 SSST= SIT$ t 27.60 FT ][ABOVE PDX"
83 SOTTOM bF DRUM= TO BE t 55.80 FT l t ABOVE/ SERCOMMMA BFBRF.NCE POINT
L
0 FILL RRQVTF=; t 0.00) E1Fo z=vwzcw REou ww: t 26.00) nwms
0 1—Existing 1050 gal,septic tank certified by Mt G's Plumbing&Septic"to remain.2-install 571 s(of drainfleld in bed
configuration.3-PerimeWr of excevetlon area shall be at leag 2 ft wider and longer than the proposed aboorplon bed.
T 4-Invert elevation of drainfleld to be no less than 7.W NGVD S. Bottom of drainfreld elevation to be no less Than 7.36
9 NGVD
S
THIS PERMIT IS NOT FOR ADDITION(s)
R
SRXCIFiCATi4HS BY: P$DRO N OSPxNA TITLE: -Zog410p
APPROVED Sys TITLE- Dade CHD
BATE xSeUED: OSM&2009 Tom DATE: 12115/2009
DR 4016, 10/97 (PravipvLe a!.tons May Be Used) PA90 1 Of 3
V 1.I.4 AP 47GOg0
=7M-,772
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STATE OF FLORIDA
DEPARTMENT OF HEALTH
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permit Application Number
--------------------------- PARTII -SITEPLAN ---------------------------
Scale: Each block re resents 10 feet and 1 inch =40 feet.
91-1
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Notes: G I b C�-IrA Q -
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Site Plan submitted by:
Plan Approved Not Approved Date--!N'�-
Sy County Health Department
ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
DH 4015, 10/96(Replaces HRS-H Form 4016 which may be used) Page 2 of 4
(Stock Number: 5744-002-4015-6)