PL-16-1410 Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores,FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-259472 Permit Number. PL-5-16-1410
Scheduled Inspection Date: May 31,2016 Permit Type: Plumbing - Residential
Inspector: Hernandez, Rafael
Inspection Type: Final
Owner: OHLSSON,KNUT Work Classification: Drainfield
Job Address:118 NW 111 Street
Miami Shores,FL Phone Number
Parcel Number 1121360030420
Project: <NONE>
Contractor: MR C'S PLUMBING&SEPTIC INC Phone: (305)651-7859
Building Department Comments
Infraction Passed Comments
DRAINFIELD INSTALLATION INSPECTOR COMMENTS False
TO REPLACE PERMIT#PL-10-15-2506
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
May 27,2016 For Inspections please call: (305)762-4949 Page 15 of 27
EL
.� Miami Shores Village
10050 N.E.2nd Avenue NW
Miami Shores,FL 33138.0000
Phone: (305)795-2204 2E
u Expiration: 11/2212016
Project Address Parcel Number Applicant
118 NW 111 Street 1121360030420
Miami Shores, FL Block: Lot: KNUT OHLSSON
Owner Information Address Phone cell
KNUT OHLSSON 118 NW 111 ST
MIAMI SHORES FL 33168-4323
Contractor(s) Phone Cell Phone Valuation: $ 3,200.00
MR C'S PLUMBING&SEPTIC INC (305)651-7859
Total Sq Feet: 300
Type of Work:PLA 0-15-2506 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
CCF $2.40 Invoice Al PL-5-16-59887
DBPR Fee $2.25 05/26/2016 Check#:1098 $119.90 $50.00
DCA Fee $2.25
Education Surcharge $0.80 05/23/2016 Credit Card $50.00 $0.00
Permit Fee $150.00
Scanning Fee $9.00
Technology Fee $3.20
Total: $169.90
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 zoning. Futhermore,I authorize the above-named eo or to do the work stated.
May 26,2016
Authorized Signature:Owner / Applicant Contractor / Agent Date
Building Department Copy
May 26,2016 1
Miami Shores Village -E� E
Building Department MAY 2320i6
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 �Y:
Tel:(305)795-2204 Fax:(305)756-8972
:t
INSPECTION LINE PHONE NUMBER:(30S)762-4949 0.
.�
FBC 20 tq`
BUILDING Master Permit No. l-��'- 1 "
PERMIT APPLICATION Sub Permit No.
BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION EXTENSION ❑RENEWAL
PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: I M St-
City: Miami Shores County: Miami Dade Zip: 153 C 6'Sl
Folio/Parcel#: 1 a l T 4660 3 a'C+I in is the Building Historically Designated:Yes NO 70
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): KAL& OLI ssow Phone#:�7��3,;3�
Address: lit k1u) I LI 3T 1
City: IGM+f State: ft zip: 3 3
Tenant/Lessee Name: Phone#:
Email: / / 7
CONTRACTOR:Company Name: D
S !LK4/4Phone#: ✓ � Z>f'�f
Address: 111"Ig uW o2 w �1
City: A 4,/ C.
. u r State: IQ Zip: 531
Qualifier Name: 4.j ke Phone#:. r 65t?rs-4f
State Certification or Registration#: _596411 5-34C Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ 3*?db Square/Linear Footage of Work: 300
Type of Work: ❑ Addition ❑ Alteration [:1 New [�epair/Replace ❑ Demolition
Description of Work: �c�A' %e(A. C83-6 I
Specify color of color thru tile:
Submittal Fee$ Permit Fee$ CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$ l J
(ReAsedo2/24/2014)
Bonding Company's Name(if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name(if applicable)
Mortgage tender'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' 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$2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
k (2
Signature Signature
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
-91 day of 20 ,by day of 20 lb .by
5 'h who is personally known to K ..� .who is personally known to
me or who has produced JT as ��r who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: L Sign:
Print: C"-'-%grr6 Lztf Print.
""""•, SHERYL A MENCES
Seal: - Chudefte Phillips Seal: i°;'�Y pie C'% Notary Public-State of Florida
=$ ON COMMISSION#FF222451 *• My Comm.Expires Oct 2 2016
=+i p�plp�; Apt 20, 2019 i 9 °P',V Commission #FF 136597
�'� �``� Bonder'Through Natwal Notary Asp.
e•sa•rwrss*'iii*stlT �'�����***asss***e**a*ssssa ssaasa*wsssss*
APPROVED BY Idog-%C'4f-1C Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
APPLICATION #:AP1205737
STATE OF FLORIDA PERMIT #:13-SC-1632376
DEPARTMENT OF HEALTH DOCUMENT #:FI1021627
w F ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM DATE P�D:09/23/2015
CONSTRUCTION INSPECTION AND FINAL APPROVAL
FEE PAID:200.00
RECEIPT #:13-PID-2805420
APPLICANT: Knut Ohlsson
AGENT: MrC"s Plumbing
PROPERTY ADDRESS: 118 NW 111 St Miami, FL 33168
LOT: 10 BLOCK: 220
SUBDIVISION: 3m#: 11-2136-003-0420
CHECKED [X] ITEMS ARE NOT IN COMPLIANCE WITH STATUTE OR RULE AND MUST BE CORRECTED.
TANK INSTALLATION SETBACKS
[ I [011 TANK SIZE [1] 900.00 [2] [ ] [271 SURFACE WATER FT
[ ] [02] TANK MATERIAL [ I [281 DITCHES FT
[ 1 [031 OUTLET DEVICE [ I [29] PRIVATE WELLS FT
[ ] [04] MULTI-CHAMBERED [ Y / N ] [ ] [30] PUBLIC WELLS FT
[ 1 [05] OUTLET FILTER [ ] [31] IRRIGATION WELLS FT
[ I [061 LEGEND 1. 2. [ ] [321 POTABLE WATER 29.1 FT
[ 1 [071 WATERTIGHT [ ] [33] BUILDING FOUNDATIONS 6.1 FT
[ 1 [081 LEVEL [ 1 [34] PROPERTY LINES 4 FT
[ 1 [09] DEPTH TO Lm [ 1 [35] OTHER FT
DRAINFIELD INSTALLATION FILLED / MOUND SYSTEM
[ 1 [10] AREA [11 300 [2I SQFT [ ] [36] DRAINFIELD COVER
[ 1 [111 DISTRIBUTION BOX HEADER X [ ] [37] SHOULDERS
[ 1 [121 NUMBER OF DRAINLINES 1. 5.000 2. [ ] [38] SLOPES
[ 1 [131 DRAINLINE SEPARATION [ 1 [39] STABILIZATION
[ 1 [141 DRAINLINE SLOPE
[ 1 [151 DEPTH OF COVER ADDITIONAL INFORMATION
[ I [161 ELEVATION [ ABOVE / ]BM 63.72 [ ] [40] UNOBSTRUCTED AREA
I l [171 SYSTEM LOCATION [ ] [41] STORMNATER RUNOFF
[ I [181 DOSING PUMPS [ 1 [42] ALARMS
[ 1 [191 AGGREGATE SIZE [ 1 [431 MAINTENANCE AGREEMENT
[ 1 [201 AGGREGATE EXCESSIVE FINES [ 1 [441 BUILDING AREA
I l [21] AGGREGATE DEPTH [ I [45] LOCATION CONFORMS WITH SITE PLAN
FILL / EXCAVATION MATERIAL [ l [461 FINAL SITE GRADING
[ ] [22] FILL AMOUNT [ ] 1471 CONTRACTOR Mr.C"s(Mr.C"S)
[ ] [23] FILL TEXTURE [ ] [48] OTHER PTI MPRDS(9 pipes-2 tier)
[ ] [24] EXCAVATION DEPTH ABANDONMENT
[ ] [25] AREA REPLACED [ l [491 TANK PUMPED
[ ] [26] REPLACEMENT MATERIAL [ ] [50] TANK CRUSHED 6 F
Comments: Comments are on page 2.
co"rty
CONSTRUCTION I APPROVED / DISAPPROVED 1: Dade CHD
Environmental Specialist n Heber Moro(Department of HeM Da \�h
FINAL SYSTEM [ ABPROVED DISAPPROVED ]: Dade
FEnvIronmental Spec1allsta o ro par men oHsaM in de
(Explanation of violations on following page)
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E-6.003, FAC ge 2 of 3
EH Database v 1.0.1 AP1205737 EID1632376
APPLICATION #:AP1206737
STATE OF FLORIDA PERMIT #:13-SC-1632376
40 DEPARTMENT OF HEALTH DoCT #:F 11021627
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM DATE PAID,09/23/2015
CONSTRUCTION INSPECTION AND FINAL APPROVAL
FEE BAm:200.00
RECEIPT #:13-PID-2805420
Violation Number Comment
Comments
The system is sized for 3 bedrooms with a maximum occupancy of 6 persons(2 per bedroom),for a total estimated flow of 400
9pd•
-900 gal existing
-10 bundles 9 pipe each,5 drainlines(20 feet in length)
-bed configuration,12 inches of sand
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E-6.003, FAC Page 2 of 3
EH Database v 1.0.1 AP1206737 EID1632376
•� DIVISION� OF'•� °' Environmental Health
Florida Health .�
eQ�O Miami-Dade County
OSTDS/Well Division
U805 SW 26th Street•Miami,FL 33175
Inspector ' %y� /✓Io,,fT' 'U Date
Address l! ` r OSTDS#
Comments:
Signature
l
OCT 0 2015 APPLICATION PERMIT #:13-SC-1632376
CATION #:AP1205737
STATE OF FLORIDA
DEPARTMENT OF DATE PAID:
ONSITE SEWAGE TREA SYSTEM FEE PAID:
CONSTRUCTION PERMITTow RECEIPT #:
GO '� ? DoCUMENT #:PR989044
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: Knut Ohlsson
PROPERTY ADDRESS: 118 NW 111 St Miami, FL 33168
LOT: 10 BLOCK: 220 SUBDIVISION:
PROPERTY ID #: 11-2136-003-0420 [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 Septic(EXIStInQ) CAPACITY • • •
A [ 0 1 GALLONS / GPD CAPACITY •••••• •••••• ••••i•
N [ 0 I GALLONS GREASE INTERCEPTOR CAPACITY [MAXIlKUM CAPACITY SINGLE TANKijjj$•GALLONS]• • •
K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS OE ]DOSES PEI;gl•HRS •j1"imps [ •••]•i
•••• •••• s••••
D [ 300 ] SQUARE FEET Bed Drainfield SYSTEM •••••c • • ••i••°
R [ 0 1 SQUARE FEET , SYSTEM •••••• �••••• ••••••
•
A TYPE SYSTEM: [XI STANDARD [ da D [ ] MOUND [ ] •••••• • •
I CONFIGURATION: [ ] TRENCH [XI > I I • • • • ••••••
N r ` #�� • • • • •
F LOCATION OF BENCHMARK: FFE 13.0'NGVD ° • •• • • •••
I ELEVATION OF PROPOSED SYSTEM SITE [ 22,8 g FT ] [ABOVE BELOW BENCHMARK/REFLNCL POINT
E BOTTOM OF DRAINFIELD TO BE [ TSAW FT ] [ABOVE BELOW BENCHMARK/REFERENCE POINT
L
D FILL REQUIRED: [ 0.00] INCHES EXCAVATION REQUIRED: [ 62.001 INCHES
***THIS PERMIT IS NOT FOR ADDITIONS***
0 *Install 12"of slightly limited soil at the bottom of the drainfield.
T *Perimeter of excavation area shall be at least 2 ft wider and longer than the proposed absorption bed.
*Invert elevation of drainfield to be no less than 7.43'NGVD.
H *Bottom of drainfield elevation to be no less than 6.93'NGVD.
E *The system is sized for 3 bedroo th a maximum occupancy of 6 persons(2 per bedroom),for a total estimated flow
of 400 gpd.
R
SPECIFICATIONS BY: E TITLE:
APPROVED BY; T Engineering Specialist II Dade CHO
N e P EE
DATE ISSUED: 09 8/2 T�' ! r) XP RaA ION DATE: 12/27/2015
Ormsoll
DH 4016, 08/09 (Obsoletes all previou " `incl
�r` = Page 1 of 3
Incorporated: 64E-6.003, FAC -, n
� 597'
v 1.1.4 witness8E9
'api' i^ . . 2 � 1
Site eva;L;2t�
if the cantractor is .tL iie