PL-16-278 Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores,FL
Phone: (305)795-2204 Fax: (305)7564972
Inspection Number: INSP-252049 Permit Number: PL-2-16-278
Scheduled Inspection Date: March 29,2016 Permit Type: Plumbing - Residential
Inspector. Hernandez,Rafael
Inspection Type: Final
Owner. DOS SANTOS, MALON Work Classification: Drainfield
Job Address:801 NE 91 Terrace
Miami Shores,FL 33138- Phone Number
Parcel Number 1132060050220
Project: <NONE>
Contractor: MR C'S PLUMBING&SEPTIC INC Phone: (305)651-7859
Building Department Comments
DRAIN FIELD INSTALLATION. Infractlo Passed Comments
INSPECTOR COMMENTS False
Inspector Comments
Passed
HRS APPROVAL IN FILE
Failed
Correction
Needed
Re-Inspection ❑
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid
March 28,2016 For Inspections please call: (305)762.4949 Page 10 of 27
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DIVISION OF
•� Environmental Health
Florida Health
Q�1 Miami-Dade County
eQ� OSTDS/Well Division 0�
11805 SW 26th Street•Miami,FL 33175 �o
Inspector C,WGU Date ® 3l1 I g�0 1 6
Address Njl�' a + �P�f�GCC°Q, OSTDS#
Comments:
AA
Signature
1
Miami Shores Village
10050 N.E.2nd Avenue NE
Miami Shores,FL 33138-0000
Phone: (305)795-2204
Expiration: 08/0112016
Project Address Parcel Number Applicant
801 NE 91 Terrace 1132060050220
Miami Shores, FL 33138- Block: Lot: MALON DOS SANTOS
Owner Information Address Phone cell
MALON DOS SANTOS 801 NE 91 TERR
MIAMI SHORES FL 33138-3217
Contractor(s) Phone Cell Phone Valuation: $ 4,300.00
MR C'S PLUMBING&SEPTIC INC (305)651-7859
Total Sq Feet: 200
Type of Work:DRAIN FIELD INSTALLATION. Available Inspections:
Type of Piping: Inspection Type:
Additional Info: HRS Approval
Bond Retum: Final
Classification:Residential Scanning:3 Review Plumbing
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
Bond Type-Owners Bond $500.00 Invoice# PL-2-16-58526
CCF $3.00 02/03/2016 Credit Card $500.00 $171.50
DBPR Fee $2.25
DCA Fee $2.25 02/02/2016 Credit Card $50.00 $121.50
Education Surcharge $1.00 02/03/2016 Check#:3007 $ 121.50 $0.00
Permit Fee $150.00 Bond#:2977
Scanning Fee $9.00
Technology Fee $4.00
Total: $671.50
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 informali n is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zoning. Futhermore,I authorize the abo ed contractor to do the work stated.
February 03,2016
Authorized Signature:Owner Applicant / Contractor / Agent Date
Building Department Copy
February 03,2016 1
Miami Shores Village �c
b
f
wilding Department FEB 02 2016
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 20
BUILDING Master Permit NOTL-16-2_ 8
PERMIT APPLICATION Sub Permit No.
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION EXTENSION RENEWAL
PLUMBING ❑ MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP
Q c CONTRACTOR DRAWINGS
JOB ADDRESS: t/ )jL' !/
City: /71CA-t Miami Shores County: Miami Dade Zip: 37/34?
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: �+ �tFFE:
OWNER:Name(Fee Simple Titlehold r}: �jp�,t ��) c�Et t��o Phone# TQ 1� Z 26
Address: —re!'/'6+-C.�
City: State: Zip:{,
Tenant/Lessee Name://�� �> Phone#:_
Email: OVg- I4'f b r p-m-C& ,i,A,C a
CONTRACTOR:Company Name: /�!! L Phone#: 3ds67Lw� �7
Address: 1140 4�" Atel
City' State: Zip:
Qualifier Name: &"/VP7211C Phone#:
State Certification or Registration#: Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ W Square/Linear Footage of Work: ZUO
Type of Work: ❑ Addition Iterati n ❑ New Repair/Replace ❑ Demolition
Description of Work:
Specify color of color thru tile: _
Submittal Fee$ vay d Permit Fee$ /50' CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$ 5W .
TOTAL FEE NOW DUE$ Y� ,60
(Revisedo2/24/2014) n 1 rO
ro
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. 1 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 a relnspection feg will be charged.
D�r..Lzc: 2S-3 04-0
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SignatureL Signature
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
7 day of 20_IG ,by day of ,20�_,by
MAI�?M DSS .S �S ,who is personally known to Kn�B(.L` G1 ,who is per�lly known to
me or who has produced SO 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:
Q6Sign Sign
Print: 1,C MWETTRICK Print: g
Notary Pub:c State of Florida �. SHERYL A N
Seal: •, »•e My Comm. E ptres Sep 19,2017 Seal •°�
_• NMy POIc-State of Florida
%sem, P Commission#FF 055732 WCOmExPhIsOct23,20118
%-° Bonded Through National NotaryAssn
Cofuf#FF 136597
n Beniltd lk**NftW Notary A-,
APPROVED BY ����^f Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
PERMIT #:13-SC4 664144
ASPLIcmacs #:AP1220244 -
STATE OF FLORIDA
DEPARTMENT OF HEALTH DATE PAW:
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM FEE PAID:
CONSTRUCTION PERMIT RECEIPT #•
DOCUM11NT #:PRI 001692
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: Malorn Dos Santos
PROPERTY ADDRESS: 801 NE 91 Ter Miami,FL 33138
LOT: 14 BLOCK: 2 SUBDIVISION:
PROPERTY ID #: 11-3206-005-0220 [SacTION, TOWNSHIP, RANGE, PARCEL NUMBER]
[OR TAX ID NONBBR]
SYSTEM MST BE CONSTRUCTED IN ACCOR[HU E WITH SPECIFICATIONS AND STANDARDS OF SECTION
391.0065, F.S., AND CHAPTER 649-6, P.A.C. DEPART29NT 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 EXIT THE APPLICANT FROM COMPLIANCE WITH OTHER FEDERAL,
STATE, OR LOCAL PERMITTING REQUIRED FOR DEVELOPMENT OF THIS PROPERTY.
SYSTEM DESIGN AND SPECIFICATIONS
T [ 750 ] GALLONS / GM Exisft Septic tank to remain r- CAPACITY
A [ 0 l GALLONS ! GPD CAPACITY
N [ 0 ] GAUCKS GREASE INTERCEPTOR CAPACITY EMAXIMOM CAPACITY SINGLE TANK:1250 GALLONS]
7 K [ DOSING TANK CAPACITY [ ]GAUMS 6I ]DOSES PER 24 SRS #Pumps [ l
D [ 200 ] SOUARE FEET bed duration drame, W
R [ 0 I SQUARE FEET SYSTEM
A TYPE SYSTEM: [x) STANDARD [ I FILLED [ I MOUND [ I
I CONFIGURATION: [ I TRENCH [s] BED t ]
N
F LOCATION OF BENCHMARK: F.F.E.,9.70 NGVD
I ELEVATION OF PROPOSED SYSTEM SITS [ 19.201 INCHES FT ][ABOVE BELOW B$NCHDfARK/REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE 1 61.20 1 INCHES FT I[ABOVE/ BENCHMhRK/REFERENCE POINT
L
D FILL REQUIRED: [ 0.00I INCHES EXCAVATION REQUIRED: [ 54.001 INCHES
Invert elevation of dmkftid to be no less than 5.1 V NGVD.
0 'Bottom of draMeld elevation to be no less than 4.60'NGVD.
T 'Install 12°of slightly limited sod under the bottom of drainfieid.
-Perimeter of excavation area shall be at least 2 ft.wider and loiW than the proposed absorption bed or drain trench.
H THIS PERMIT IS NOT FOR"ADDITION(s)".
E The system is sized for 2 bedrooms with a maximum occupancy of 4 persons(2 per bedroom),for a total estimated flow
R of 300 9Pd
SPECIFICATIONS BY: Kemble trick TITLE:
APPROVED BY: ! TLz: Dade CHD
Carlos Daze
DATE ISSUED: 01/21/201 ;:. :,,_c,. EXPIRATION DATE: 04/20/2016
DR 4016, 08/09 (Obsoletes all previous e¢ "tion psi rsTs mart sot used),`
Incorporated: 64E-6.003, FAC Hage 1 of 3
1.1.4 ; tii� bzaa ��ss�82G7o
STATE OF FLORIDA
DEPARTMENT OF HEALTH
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permit Application Number
-------------------------- PART II-SITEPLAN---------------------------
A-Scale: Each brepresents 10 feet and 1 inch=40 feet.
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There are no per0nertt features on a4acent property and or across the street that may affect the Now Septic system'nstailatTon
Notes:
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Site Plan submitted by: c C;- o Y
Plan Approved Not Approved Date
BY County Health Department
ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
DH 4015,10M(Replaces HRS-H Form 4018 which maybe used) Page 2 of 4
(Stock Number. 5744-002-40154M