PL-16-528 Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores,FL
Phone:(305)795-2204 Fax:(305)756-8872
Inspection Number: INSP-253649 Permit Number. PL-2-16-528
Scheduled Inspection Date:May 04,2016 Permit Type: Plumbing- Residential
Inspector. Hernandez,Rafael
Inspection Type: Final
Owner: NEUIWEILER,DONNA Work Classification: Drainfield
Job Address:275 NE 94 Street
Miami Shores,FL 33138- Phone Number
Parcel Number 1132060133830
Project <NONE>
Contractor. MR C'S PLUMBING S SEPTIC INC Phone:(305)651-7859
Building Department Comments
Ininictlo, Passed Connnents
DRAIN FIELD
INSPECTOR COMMENTS FaL%
Inspector Comments
Passed HRS ON FILE
Failed El
Correction ❑
Needed
Re-inspection
Fee
No Additional Inspedions can be scheduled unto
re-Inspection tee is pati.
Miami Shores Village1@1�[ 7E
A : D
Building Department i FEB 26 2016
1WS0 N.E.2nd Avenue,Miami Shores,Florida 33138f,
Tel:(30S)795-2204 Fax(305)755-8972 113
INSPECTION UNE PHONE NUMBER.(30S)762-4949
FBC 20 �1 1-----r--
BUILDING P aoS� L 16 a ��
PERMIT APPLICATION Sub Perink No.
nBUILDiNG ❑ELECTRIC n ROOFING ❑ REVISION ❑EXTENSION nRENEWAL
I
®PLUMBING n MECHANICAL nPUSUC WORKS n CHANGE OF []CANCELLATION n SHOP
N L G(, CONTRACTOR DRAWINGS
M ADDRESS• a7S N G r�r S t
Miami Shores QMMY: Miami Dade Zip: �t J 3 138
Follo/Parcel#: l l n 20� —013— 3 r'3 D Is the Building Historkallr Designated:Yes NO —
Occupancy Type; Load: Construction Type: _Flood Zone' 8FE: FFE•
OWNER:Name(fee Simple Titleholder): n n �eU W'e!�6-r Phone#: '70o g�7 63 8�
Address: 9797126A q4 S+
City: Mt�Gm..i5hac" State: FL
Tenant/Lewee Name: Phoneri
Email:
CONTRACTOR:Company Name
Mr as Plumbing and SepticPhone#: 305 6517859
Address: 19932 NW 2 Ave
CRY. Miami state: FL gyp: 33169
Kemble Ettrk* Phone#: 3056517859
Qualifier Name:
State Certification or Registration#: SR061536 certificate of Competency#:
DESIGNER:Architect/Engineer:
Phone#•
Address• 3 2 City. State: Zip:
Value of Work for this Permit:$ _C'60. 0 Q SquarelLhw r Footage of Wo seep
Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace ❑ Demolition
Descrh7don of Work:
i
9
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Specify color of color thm tile:
'� Permit Fee$ CCF S co/cc$
NotSubmittal fee$
�Fee$ Radon Fee$ � _$ $
? Tech Fee$ � Training/Education Fee$ X Double Fee$
ABY `
Structural Revlews$ Bond$
TOTAL FEE NOW DUE$
� � .
(Revbed02/24/=4) ��
i
Bondinj Company's Name(if applicable)
Bonding Company's Address
t
City State Zip
Mortgage Lender's Name(If applicable)
Mortgage Lender's Address
qty state Zip
jApplication is hereby made to obtain a permit to do the work and'installation 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.....
I
i
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
l 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$25M 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.
1
Signature '�� Signature
OWNER or AGENT CONTRACTOR
I
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
�� day of 20 1 b ,by c4'7 day of 20 by
AbYJL& N Wt,Je4 ,who is personally known to who is personally known to
me or who has produced 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:
I
I
Ste: Sign4_ t'
Print: KEMBLE ETTRICK PrinL ' SHERYL A MENDES
„„��,,,,
#`�•:
No FOR + Pub9C-State Of Florida
Seal: E My Comm.Expires Sep 19.2017 �I. i r My Comm.Expires Oct 23,2018
y.W
s. Commission#FF 055732 Commission#E FF 136597
Bonded Through Nadu Notarlr Asst I�'" ��•�� BarlQed llsdrgh Natlor�al Notary Assn
sssssss*sss*ss**ss*sass**saes*sssssss***s**sss**ssssss**s*sasssssssss*essss*ssssss***ss+e+e*e*sssssessssssss**
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APPROVED BY $-�"` p' ' Plans Examiner Zoning
1
Structural Review Clerk
{RevbeM2/24/20241
PST #:13-SC4662142
APPLIcAnou ti:AP1225849
STATS OF F'�LaORIM
DSPC OB HSALTS DATE PAID:
MSITB SIM0111 ==OEM 1W DISPOSILL SYSTEM FEE PAID:
CONSTRUCTION PST RECEIPT 9:
DOCoMICNT #:PR1006197
ISM K r
CaSsxxO� PERMIT FOR.: OSTDS Repair ri L
APPLICANT: Donna Neuwiler
PROPERTY ADDRESS: 275 NE 94 St Miarrd,FL 33138
LOT: no BLOCK: no SUBDIVISION:
PROPERTY ID 4: 11-3206-013-38M [ACTION, TowwaRIP, RANGE, PAFJMM NUMBER]
[OR TAX ID NUMBER]
SYSTEM MUST SE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF SECTION
381.0065, F.S., AND CHAP'T'ER 645-6, F.A.C. DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE
SATISFACTORY P21tFORMANCZ FOR ANY SPECIFIC PERIOD OF Tnds. ANY CHANGE IN MATERIAL FACTS,
i WHICH SERVED AS A BASIS FOR ISSUANCE OF THIS PERMIT, REQUIRE THE APPLICANT TO MODIFY THE
PERMIT APPLICATICN. SUCH MODIFICATIONS MAY RESULT IN THIS PERMIT BEING MADS NULL AND VOID.
ISSUANCE OF THIS PERMIT DOES NOT 57MWT THE APPLICANT FROM COI4pLIANCE WITH OTHER FEDERAL,
STATE, OR LOCAL PERMITTING REQUIRED FOR DEVELOBMMIT OF THIS PROPERTY.
SYSTEM DESIGN AND SPECIFICATIONS
T [ 900 I GALLONS / GPD Existin a Septic tonic to remain CAPACITY
A [ 0 ] GALLONS ! GPD CAPACITY
N e 0 ] CALLOUS GREASE INTERCEPTOR CAPACITY DOLICOM CAPACITY SINGLE TANK:1250 GALLONS]
K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS ti[ ]DOSES PER 24 HRS #Pumps [ ]
D [ 300 ] SQUARE FEET Bed configuration dnainfiel SYSTEM
R [ 0 ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [s] STANDARD [ ] FILLED { ] MOUND e ] �
I CONFIGURATION: [ ] TRENCH [X] RED [ ]
N
F LOCATION OF BENCHMARK: F.F.E.,9.40 NGVD
I ELEVATION OF PROPOSED SYSTEM SITE a 13.20 1 xNCHES FT 1[ABOVE) BELOW BENcttMS=1wwERENCE POINT
E BOTTOM OF DRAB TO BE [ 53.281 INCH88 FT ][ABOVE POINT
L
D FILL REQUIRED: [ 0.00] INCHES EXCAVATION REQUIRED: a 72.001 xNCHES
*Invert elevation of drainfolcl to be no Ness than 5.46'NGVD.
O •Bottarn of drainfield elevation to be no less than 4.96'NGVD.
T `Install 12-of slightly limbi soil under the bottom of do field.
-Perimeter of excavation area shall be at Net 2 ft.wider and Niger than the proposed absorption bed or drain trench.
H 'THIS PERMIT IS NOT FOR-ADDITION(s)-.
E The system is sof for 3 bedrooms wtih a maximum icy of 6 persons(2 per bedroom),far a total estimated flow
of 300 gpd.
R
SPECIFICATIONS BY: Kamb a St ok TITLE:
APBODM BY: TITLE: Dade CHO
l-
DATE ISSUED: 6 EXPIRATION DATE: 05/23/2016
DH 4016, 08/09 (Obsolete* all previous � (�"w2liii���rr " `ate;�, Vrrt0 du fform a
xn�rporated: 645-6.003, FAC yoiD Dung ad;acenratsft(&c �t at the i of 3
time o,final inspection.r'fiof to f=inal Approval,the DOH Pag®
inspector shall v W"Rsoii boring and ronf§F@
rest to the original*sty avatuatrun Submitted.A
einspection tee'aii o6 awssed it the(;cintractor is PCS
Athe jobsite at the arr..rryeri.erne
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•• • -• • •• • -• -
y Miami Shores Village
10050 N.E.2nd Avenue NES n �_
Miami Shores,FL 33138-0000 �`�
Phone: (305)795-2204
Project Address Parcel Number Applicant
276 NE 94 Street 1132060133830 DONNA NEUWEILER
Miami Shores, FL 33138- Block: Lot:
Owner Information Address Phone Cell
DONNA NEUWEILER 275 NE 94 ST
MIAMI FL 33138-2829
Contractor(s) Phone Cell Phone Valuation: $ 3,500.00
MR C'S PLUMBING&SEPTIC INC (305)651-7859
~--� --� Total Sq Feet: 300
Type of Work: 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-2-16-58831
CCF $2.40 03/07/2016 Credit Card $500.00 $169.90
DBPR Fee $2.25
DCA Fee $2,25 0226/2016 Credit Card $50.00 $119.90
Education Surcharge $0.80 03/082016 Credit Card $119.90 $0.00
Permit Fee $150.00 Bond#:3003
Scanning Fee $9.00
Technology Fee $3.20
Total: $669.90
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 foregging information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zoning. Futhermore,I e bove-named contractor to do the work stated.
March 08,2016
Authoriz gnature:Omer / Applicant / Contractor / Agent Date
Building Department Copy
March 08,2016 1
d DIVISION OF
Em t'Oitl?1entat Heaf1
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01FloridaHealth
O Miami-Dade bounty
Q QSTDS/Well J)"ion
1I805 SW 26th Street•M nd FL 33175
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Address r ° JCUL C*i-
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