PL-16-256 a �
Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores,FIL
Phone: (305)795.2204 Fax:(305)756.8972
Inspection Number. I14SP-251928 Permit Number: PL-1-16-256
Scheduled Inspection Date:April 2%2016 Permit Type: Plumbing -Residential
Inspector. Hernandez,Rafael Inspection Type: Final
Dmer. RODRIGUEZ,DANIEL Work Classification: Drainfield
Job Address:150 NE 102 Street
Miami Shores,FL 33138 Phone Number
Parcel Number 1132060131870
'roject: <NONE>
,ontractor. STATEWIDE SEPTIC CONNECTIONS Phone: (954)9630082
Building Department Comments
REPLACE DRAINFIELD Infractio, PassedComments
INSPECTOR COMMENTS False
Inspector Comments
Passed HRS IN FILE
Failed
Correction
Needed ❑
Re-Inspection a
Fee
No Additional inspections can be scheduled until
re-inspection fee is paid
Miami Shores Village
Building Department JAN 2 9 2015
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972 1Y:
INSPECTION UNE PHONE NUMBER:(305)762-4949
FBC 20114
BUILDING Master Permit No. �
PIMMIT APPLICATION Sub Permit No.
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION RENEWAL
$dPLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 1 ,50 NE 102 S-T
City: Miami Shores County Miami Dade Zig):
Folio/Parcel#: t 1—320(0 1 e70 Is the Building Historically Designated:Yes NO ')C _
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder):_D Q rN4-f- 1 Pod r1 Q cep- Phone#: '756 SCS-- 8-25.7
Address: t s 0 II��(� r 0 z 5T
City: �®Ngofu State: Zip: 331-6
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: cSti kAft lft A ti 'f i C Phone#: 3oS bro I 3-3--
Address:
Address: tM690 WNN 11 A-je- 4(C)
City: L-10-CUA
State: EL Zip: 3305 4-
Qualifier Name: ISS �� S®f®rl-cw) Phone#:
State Certification or Registration#:_ &f-A-001 7 IICZ6 Certificate of Competency#:
DESIGNER:Architect/Engineer. Phone#:
Address: City: State: Zip:
Value of Work for this Permit: Ito4 Square/Linear Footage of Work:
Type of Work: ❑ Addition Alteration ❑ New E2 Repair/Replace ❑ Demolition
Description of Work:
n I ace Dyair-)
t - -
Specify color of color thru tile:
Submittal Fee$ Permit Fee$ 4<0.. CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$ il ? C
(Revised02/24/2014)
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 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.
Signatur Signature �
OWNER or AGEM CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of J Qn .2016 ,by l day of cJ+�-'�'�-' 20 ,�--.#by
D CAV)' I o�S!i�ho is personally known to �(L-SN S%3Lk—y'`-'w�io is personally known to
me or who has produced (� as me or who has produced as
�dentificatlon and who did take an oath. identification and who did take an oath.
.� RY PUBLIC: NOTARY PUBLIC:
lign: rZ� e��'�� Sign:
Print: _ 1efid UVAN
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a: 90/x'
I Seal: �
`°✓'sa�rdx?�
883
rani
APPROVED BY Plans/6 Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
9 „ , PERT #:13-SC-1656301
APPLICATION #:AP 1221701
STATE OF FLORIDA
DATE PAID.
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM FEE PAID:
CONSTRUCTION PERMIT RECEIPT #:
DOCUMENT #:PR1002542
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: Daniel Rodriguez
PROPERTY ADDRESS: 150 NE 102 St Miami,FL 33138
LOT: 8 9 BLOCK: 14 SUBDIVISION:
PROPERTY ID #: 11-3206-013-1870 [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 [ 900 I GALLONS / GPD new septic tank CAPACITY
A I 0 I GALLONS / GPD CAPACITY
N [ 0 l GALLONS GREASE INTERCEPTOR CAPACITY E)CUMSUM CAPACITY SINGLE TANK:1250 GALLONS]
K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ ]
D [ 200 I SQUARE FEET Bed confiquration drainfiel SYSTEM
R [ 0 I SQUARE FEET SYSTEM
A TYPE SYSTEM: [x] STANDARD [ ] FILLED [ ] MOUND I I
I CONFIGURATION: [ ] TRENCH [xI BED [ I
N
F LOCATION OF BENCHMARK: FFE: 11.9'NGVD
I ELEVATION OF PROPOSED SYSTEM SITE [ 13.207[ INCHES FT ] [ABOVE JBELOW BENCHMARK/REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 56.16 ] [ INCHES FT I[ABOVE JBELOW BENCHMARK/REFERENCE POINT
L
D FILL REQUIRED: [ 0.00] INCHES EXCAVATION REQUIRED: [ 43.001 INCHES
1.-Install a 900 gal min.septic tank with an approved filter.
0 2.-The licensed contractor installing the system is responsible for installing the minimum category of tank in accordance
T with s.64E-6.013(3)(f),FAC.
3:Install 200 sf of drainfield in bed configuration. ""THIS PERMIT IS NOT FOR ANY ADDITIONS.
H 4.Bottom of drainfield and invert elevations to be no less than 7.22'and 7.72'NGVD.
E 5.-This permit includes the abandonment of the existing septic tank.
R System sized for 2 bed with a maximum occupancy of 4 persons(2 per bedroom),for a total estimated flow of 300 gpd.
SPECIFICATIONS BY: Teresa J Solomon TITLE: Master Septic Tank Contractor
APPROVED BY: TITLE: Engineering Specialist II Dade CHD
Betsy Lange-olmino
DATE ISSUED: 01/27/2016 EXPIRATION DATE: 04/26/2016
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 AP1221701 SE983309
}
STATE OF FLORIDA
DEPARTMENT OF HEALTH
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT ,WE .
Permit Application Number
-----• PART 11 =SITE PLAN----- '`_-----
Scale: Each block represents 5 feet and 1 inch=50 feet.
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Site Plan submitted b : 1 +(� �,� '� r(
nature -rte
Plan Approved Not Approved Date
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BY A/1 County Health Department
ALL CHANGES MUST BE APPROVED BY THE CGUNTY�HEALTH DEPARTMENT
?H 4015,10M(Replaces HRS-H Form 4015 which may be useM
StoeR Numbw:57"-=-4015.6) Page 2 of 3
r
Miami Shores Villages x`
10050 N.E.2nd Avenue NE
Miami Shores,FL 33138-0000
N9Phone: (305)795-2204
w � Expiration: 07/31/2016
Project Address Parcel Number Applicant
150 NE 102 Street 1132060131870
DANIEL RODRIGUEZ
Miami Shores FL 33138- Block: Lot:
Owner information Address Phone Cell
DANIEL RODRIGUEZ
150 NE 102 Street
MIAMI SHORES FL 33138-2325
Contractor(s) Phone Cell Phone Valuation: $ 3,400.00
STATEWIDE SEPTIC CONNECTIONS (954)963-0082 Total Sq Feet: 200
Type of Work:REPLACE DRAINFIELD Available Inspections:
Type of Piping: YP
Inspection Type:
P
Additional Info: HRS Approval
Bond Retum: Final
Classification:Residential Scanning:1 Review Plumbing
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $2•`w Invoice# PL-1-16-58504
DBPR Fee $2.25 02/02/2016 Check#:5028 $113.90 $50.00
DCA Fee $2.25
Education Surcharge $0.80 01/292016 Credit Card $50.00 $0.00
Permit Fee $150.00
Scanning Fee $3.00
Technology Fee $3.20
Total: $163.90
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 oning. Futhemto ,I auttVoirize the above-named contractor to do the work stated.
February 02,2016
A orized Si nature:Owner / Applicant / Contractor / Agent ate
Building epartment Copy
February 02,2016 1
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