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PL-16-667 f '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-254672 PermitNumber: PL-3-16-667 Scheduled Inspection Date: March 29,2016 Permit Type: Plumbing - Residential Inspector: Hernandez, Rafael Inspection Type: Final Owner: SOUZA,HENRIQUE Work Classification: Septic Job Address:479 NE 102 Street Miami Shores,FL Phone Number (646)320-4171 Parcel Number 1132060170840 Project: <NONE> Contractor: STATEWIDE SEPTIC CONNECTIONS Phone: (954)963-0082 Building Department Comments INSTALL ONE 1050 GAL TANK AND DRAINFIELD REPAIR Infractio Passed Comments 300 TRENCH 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 12 of 27 TL F-I mw Li _ � r b� . t ` r r Ith VC 161TO-IM '010 44 a i, mss,-s'E A ffi 44 �`y 'DAY � 4-74 �� -*£ Scanned by CarnScanner Miami Shores Village 10050 N.E.2nd Avenue NE Miami Shores,FL 33138-0000 Phone: (305)795-2204 Expiration: 09/14/2016 Project Address Parcel Number Applicant 479 NE 102 Street 1132060170840 HENRIQUE SOUZA Miami Shores, FL Block: Lot: Owner Information Address Phone Cell HENRIQUE SOUZA 479 NE 102 Street (646)320-4171 MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone Valuation: $7,000.00 STATEWIDE SEPTIC CONNECTIONS (954)963-0082 Total Sq Feet: 300 Type of Work:INSTALL ONE 1050 GAL TANK AND DRAIN 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-3-16-59008 CCF $4'20 03/15/2016 Check#:6041 $50.00 $629.70 DBPR Fee $2.25 DCA Fee $2.25 03/15/2016 Check#:1218 $500.00 $129.70 Education Surcharge $1.40 03/18/2016 Credit Card $129.70 $0.00 Notary Fee $5.00 Bond#:3014 Permit Fee $150.00 Scanning Fee $9.00 Technology Fee $5.60 Total: $679.70 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 cert' that aM the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhe orize the above-named contractor to do the work stated. March 18,2016 Authorized Signature:Owner / Applicant / Contractor / Agent Date Building Department Copy March 18,2016 1 `3 Miami Shores Village 3 14 Building Department artment MAR1A; 2018 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 _BY:— Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 541\ FBC 2014 BUILDING Master Permit No. PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL PLUMBING ❑MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF CANCELLATION ❑ SHOP pi CONTRACTOR DRAWINGS JOB ADDRESS: 1 Off+ `0?' ST City: Miami Shores /y� t� Coun : Miami Dad Z711): 33138 Folio/Parcel#: ��(0Oil- %L o Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): ff"H&ILAZ D�C LAZA Phone#: &L00— 320- t? Address: `tea tz 10Z k City: M•Jn-om s State: R Zip: 1371,38 Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: C GVlH l h G Phone#: Address: 136ft N\AJ City: �+ �e �q State: Zip: rs Qualifier Name: Tees Phone#: State Certification or Registration#: Certificate of Competency#: DESIGNER:Architect/Engineer. O/4� Phone#: Address: City: State: Zip: Value of Work for this Permit:$ r 00 Square/Linear Footage of Work: 300 Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace ❑ Demolition Description ofork: 1WK W loco 4tun1G + tr 300 ,ca Specify color of color thru tile: Submittal Fee$ w`� Permit Fee$ 6�� CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$, Technology Fee$ Tmining/Education Fee$ p ' Y 0 Double Fee$ J Structural Reviews$ 0 Bond$ �1) • (D TOTAL FEE NOW DUE$ (Revised02/24/2014) _ k r Bonding Company's Name(if applicable) !' Bonding Company's Address City State Zip Mortgage lender's Name(if applicable) tA/Pf 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 a reinspection fee will be charged. Signature Signature OWNER AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of 20 it, by 'S day of 6VW-C*I .20 by -,a is personally known ��CLi4-S p` $�Ly+��''who is Qsona ly n to me or who has produced s me or who has produced as identification and who did take an oath. Identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: �,L�o3Ld�1S Fal tj!/IN0r 0 �� •:gib o� 09[448 '.Qy Sign: Sign: — s Print• Print: • ;d o �r• Seal: QUIDA JACOBS HOISs��:•'; MY COMMISSION N FF43855 Seal:.. /// L��•••••..•• WIRES:August 14,2017 �rrr N "fill S AAAA APPROVED BY eLh, > / — Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) PERMIT #: 13-SC-1666349 STATE OF FLORIDA APPLICATION #:14PI22$7$$ DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL DATE PAID: 0. 0 SYSTEM FEE PAID: CONSTRUCTION PERMIT RECEIPT #: DOCUMENT #: PR1008736 CONSTRUCTION PERMIT FOR: OSTDS Repair APPLICANT: Henrique Souza PROPERTY ADDRESS: 479 NE 102 St Miami, FL 33138 LOT: 22 BLOCK: 92 SUBDIVISION: Miami Shores Sec 4 Amd Plat PROPERTY ID #: 11-3206-017-0840 [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 septic tank CAPACITY A [ ] GALLONS / GPD CAPACITY N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS] K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ ] D [ 225 ] SQUARE FEET Trench configuration drain SYSTEM R [ ] SQUARE FEET SYSTEM A TYPE SYSTEM: [x] STANDARD [ 7 FILLED [ ] MOUND [ ] I CONFIGURATION: [x] TRENCH [ ] BED [ ] N F LOCATION OF BENCHMARK: FFE 11.6'NGVD I ELEVATION OF PROPOSED SYSTEM SITE [ 22.80][ INCHE3 FT ][ABOVE BELOW BENCHMARK/REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ 74.80 ] [ INCHES FT ] [ABOVE BELOW BENCHMARK/REFERENCE POINT L D FILL REQUIRED: [ ] INCHES EXCAVATION REQUIRED: [ 52.001 INCHES O —THIS REPAIR PERMIT IS NOT FOR ANY ADDITIONS- 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 225 sf of drainfield in trench configuration. E 4.-Perimeter of excavation area shall be at least 2 ft wider and longer than the proposed absorption bed or drain trench. R (Comments Continued on Page 2.) SPECIFICATIONS BY: William Woodard TITLE: APPROVED BY: TITLE: Engineering Specialist II Dade CHD Eraca DATE ISSUED: 03/10/2016 EXPIRATION DATE: 06/08/2016 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 AP1229788 SE988251 DocublM #; PRIO08736 5.-Invert elevation of drainfield to be no less than 5.87'NGVD. 6.-Bottom of drainfleld elevation to be no less than 5.37'NGVD. 7.-This permit includes the abandonment of the existing septic tank. The system is sized for 3 bedrooms with a maximum occupancy of 6 persons(2 per bedroom),for a total estimated flow of 400 gpd. 14 KENN !!!lam �?NE�ONlN�El3i!! MON "Mm ■!!lN��!!lNONO �L ■i ■CL& lf�ME ■!!!!!!!!!!!! ■ �f , u a OMEN MEMMUMMININ mjm /■gymilrlmINIMMISSIMEAMMMUS- an �N ■!!N'��lrN!l�ENNE�E�i O! MAMMONISM !l is • r '!! r�a�0"RWIT43lNilN!ESEEM EM ■ENEEEME■ �USINSIMME!!!N!N!N! ■IN ■OMEN REM 1: 73-3y, / M 4-1 • R M• R ' I: Y