PL-16-1131 Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores,FL
Phone:(305)795-2204 Fax: (305)756-8972
Inspection Number. INSP-257669 Permit Number. PL-4-16-1131
Scheduled Inspection Date:June 13,2016 Permit Type: Plumbing-Residential
Inspector. Hernandez,Rafael
Inspection Type: Final
Owner BOONE-SAENZ ORTA,ELIZABETH Work Classification: Septic
A
Job Address:61 NE 102 Street
Miami Shores,FL 33138- Phone Number
Parcel Number 1132060131670
Project <NONE>
Contractor. MR C'S PLUMBING A SEPTIC INC Phone:(305)651-7859
Building Department Comments
NEW SEPTIC TANK Inbactio Passed menta DRAINFIELD INSPECTOR COMMENTS False
Inspector Comments
Passed HRS APPROVAL ON FILE
Failed
Correction ❑
Needed
Re-inspection
Fee
No AddItional inspections can be scheduled until
re-inspection The is paid.
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�� DIVISION 9E
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Issued: 04/29/2016
BUILDERS BOND Amount: $ 500.00
Bond#: 3068
Permit#: PL-4-16-1131
ELIZABETH&YRAK BOONE-SAENZ ORTA owner of property, in consideration of the issuance to me of a permit or permits to construct or repair a building or buildings
at the following address:
61 NE 102 Street Miami Shores FL 33138-
do hereby deposit the sum of: $500.00
and I agree that when such construction has been completed by me, within the meaning of the ordinances of this district, I will clear all premises and repair any
property damaged by me, used for the deposit of material or equipment in the construction or repair and that, if I do not so clear and repair such premises immediately
upon the completion of construction within the meaning of the ordinances, the district may clear and repair the same and pay the cost of such clearance and repairs
out of the Builder's Bond, and return the remainder to and that, if I shall clear and repair the property immediately, then the Builder's Bond shall be returned to me.
WITNESS AND DATE: 04/29/2016 N110 BE
J%A*
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Fit;
Signature
INSTRUCTIONS TO BUILDER:When the above mentioned construction is completed and the premises are cleared and repaired,take this bond to the District
Building Department for a refund of your money in accordance with the above agreement.
BUILDING INSPECTOR'S APPROVAL
I hereby certify that the construction contemplated under this Bond, has been completed and that the builder thereof has caused the surrounding premises to be
cleared and repaired in as good condition as they were before commencing said construction.
WHEN CLEARED AND REPAIRED BY THE DISTRICT:
Amount of Bond: $
Cost of clearing and repairs done by District $ Building Official
Balance due Builder: $ Cancelled:
Date
By:
Bond refund payable to applicant only.
($10.00 CHARGE IF BOND IS LOST OR DAMAGED)
rmjt nro. pL-446-1131
s�`O1 Miami Shores Village Permit Type.Plumbing Resldorltw
10050 N.E.2nd Avenue NE
Miami Shores,FL 33138-0000 f J w E18SStfiirtlQ�J:$e01t
Phone: (305)795-2204 "s f, Peri tws:APPROVED
�tonmp ° cr
Expiration: 10/26/2016
issue ire M2912r116
Project Address Parcel Number Applicant
61 NE 102 Street 1132060131670
ELIZABETH&YRAK BOONE-SAE
Miami Shores, FL 33138- Block: Lot:
Owner information Address Phone Cell
ELIZABETH&YRAK BOONE-SAENZ 61 NE 102 Street
--- MIAMI SHORES FL 33138-
61 NE 102 Street
MIAMI SHORES FL 33138-
Contractor(s) Phone Cell Phone Valuation: $ 6,000.00
MR C'S PLUMBING&SEPTIC INC (305)651-7859 Total Sq Feet: 200
Type of Work:NEW SEPTIC TANK&DRAINFIELD 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-4-16-59555
CCF $3.60 04/29/2016 Check#:130 $500.00 $327.60
DBPR Fee $4.50
DCA Fee $4.50 04/27/2016 Credit Card $50.00 $277.60
Education Surcharge $1.20 04/29/2016 Check*1087 $277.60 $0.00
Permit Fee $300.00 Bond#:3068
- ..Scanning Fee $9.00
'fwechnology Fee $4.80
Total: $827.60
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 tpereto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In
acceptinofis permit I assyme responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required fb E L LUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work.
OWNERS. IDA c��lfythat ll the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction a n' Tauthorize the above-named contractor to do the work stated.
April 29,2016
Authorized Signature:Owner / Applicant / Contractor / Agent Date
Building Department Copy
April X,2016 1
Miami Shores Village ,
ail
N. Building Department 2.7 2016
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 [APR
Tel:(305)795-2204 Fax:(305)756-8972 --
INSPECTION LINE PHONE NUMBER:(30S)762-4949
FBC 20 iL�
BUILDING Master Permit No. �L C(rJ- 11,31
PERMIT APPLICATION Sub Permit No.
BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION EXTENSION RENEWAL
1pLUMBING ❑ MECHANICAL r-1 PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP
�V CC CCCONTRACTOR DRAWINGS
JOB ADDRESS: 6 N6 j oa� ''
City: Miami Shores County: Miami Dade Zip: 33t3
Folio/Parcel#: It—3Q% 0(3" 1470 Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): Phone#: 305 170 356r
—' hd.
Address 1
City: State Zip:
Tenant/Lessee Name: Phone#:
Email: / &46"
& � l '03
l tr 4
CONTRACTOR:Company Name: �{' 1.S 46 �T 5 •L Phone#: l3J 45 t?p S r
N w �
Address:��L�3c� e�.
City: At&-,� State: Zip: 331 L�
Qualifier Name: K VMI k Phone#: .
State Certification or Registration#: JtZb6($36 Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: / City: State: Zip:
Value of Work for this Permit:$ Square/linear Footage of Work: aoo
Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace ❑ Demolition
Description of Work: A/Pi 50WA- ;nk f
Specify color of color thru tile:
by
Submittal Fee$ Permit Fee'$ �� CCF$ � CO/CC$
Scanning Fee$9 • CO Radon Fee$ 4, SO DBPR$ y Notary$_
Technology Fee$--q • Training/Education Fee$ 1 . 20 Double Fee$
Structural Reviews$ Bond$ S O
TOTAL FEE NOW DUE$
(Revised02/24/2014) ::j
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.
r
Signature QSignature
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
0.4 day ofr'i ,20 (6 ,by 6 day of .20 16 ,by
EY�it&A &Ke who is personally known to who is personally known to
me or who has produced V i l.d 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:
Sign: �1J� Sign:
Print: Print:
°+ ` 1Notary Public-State of Florida
Seal: Claude#te Phillips Seal: 3�' c, My Comm.Expires Oct 23,2018
�. •• ��,,� �. ��, Commission#FF 138597
= = COMMISSION FF222451 Thnx NatiaialNotaryAs�i
ssssssss= ' �,�s�'61isl�ls� �ssssssssssssssssssssssssssssssssssssssssssssssssss s s ssssssssssss
www.AAR O[[TrrARY.CONI
APPROVED BY 7' l 7— o Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
PST #:13410-1676544
O
NO
APPLICATION #:AP1235775
STATE OF FLORIDA,DEPARTH' OF HEALTHPAIDONSITE SEvV= TRIUMMIENT AMID DISPOSAL SYSTEM FEE PAID:
CONSTRUCTION PERMITRECEIPT- - L.":,' tt" Documnm #:PRI 016198
CONSTRUCTION PERMIT FOR: OSTDS RBpair
APPLICANT: Elizabeth Boone
PROPERTY ADDRESS: 61 NE 102 St Miami,FL 33138
LOT: 19 BLOCK: 12 sUSDxvislON: Muni Shores Section 1
PROPERTY ID #: 11-320"13-1670 [SECTION, TOWNSHIP, RAUGE, PARCEL NUMBER]
[OR TAX ID NUMBER]
SYSTEM MUST BE CONSTRIICTRD IN ACCORDANCE WITH sPBcIFICATIONS Am 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- Alit CHANGE IN MATERIAL FACTS,
WHICH SERVED AS A BASIS FOR ISSUANCE OF THIS PERMIT, RETIRE THE APPLICANT TO MODIFY THE
PERMIT APPLICATION. SUCH MODIFICATIONS MAY RESULT IN THIS PERMIT BRING 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 1 SNS ! GPD Septic(New Tank) CAPACITY
A [ 0 ] GILIANB / GPD CAPACITY
N [ 0 1 GALLONS GREASE INTERCEPTOR CAPACITY DfXXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
K [ ] GALLONS DO8n;a TANK CAPACITY [ Ids 6E ]DOSES PER 24 =8 #Pumps [ }
D [ 200 I SQUARE FEET Bed Drainfield SYSTEM
R [ 0 I SQUARE FEET SYSTEM
A TYPE SYSTEM: [sI STANDARD [ 1 num [ I MOUND [ ]
I CONFIGURATION: [ ] TRENCH 18I BED [ I
N
F LOCATION OF BENCHMARK: FFE 13.8'NGVD
I ELEVATION OF PROPOSED SYSTEM SITE [ 36.00]If ncus FT ][ABOVE POINT
E BOTTOM OF DPAMCF33M TO BE [ 86.00 1IITCHEs FT I[ABOVE POINT
L
D FILL REQUIRED: [ 0.001 INCHES EXCAVATION REQUIRED: [ 62.001 INCHES
**THIS PERMIT IS NOT FOR ADDITIONS"
0 :Install 12"of slightly limited soll at the bottom of the drainfieW.
T •Perimeter of excavation area sh al be at least 2 ft wider and longer than the proposed absorption bed
*Invert elevation of drainfield to be no less than 7.1V NGVD.
H *Bolton of drainfleid elevation to be no less than 6.64'NGVD.
E *The licensed cx nbvzW installing the system 1S reSponsilge for installing the nAnkrnsn category of tank hn accordance
with s.64E-6.013(3xf),FAC. •• ••• • • • •.
R • •
SPECIFICATIONS BY: TITLE: •• •°• •• • • • ••
APPROVED BY: TLE: Engineering Specialist II _ _ Dade CHD
43
• • • °
DATE ISSUED: 04/2=16 EXBIRATxd4 : 4 • • • •
• .•07j21f2Q1a•° • •
• • • • . •
DH 4016, 08/09 (Obsoletes all previous editions which may not be used) °• • ••• • • •
incorporated: 64E-6.003, FAC Page 1 of 3
V 1.1.8 AP1235775 SS993276
• •• •• • • • •• ••
••• • • • ••• • •
NOTICE OF COMMENCEMENT 111111111111111111111111111111111111111111111
A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION C-FN 211-316RC-1229264.
OR BK 30043 Pg 737 (lPss)
PERMIT NO. FOLIO NO RECORDED 14;`Ic"201,c 14071-1.
-TAX " " 4 ' :1
�-!'iRVEY R.VIN,- Ct.ERK OF COt R*T
STATE OF FLORIDA:
COUNTY OF MIAMI-DADE: WPM OF TY OF
I Hawff ilebwowofft
THE UNDERSIGNED hereby gives notice that Improvements will bwoWdW, of
property;and in accordance with Chapter 713,Florida Statutes,th .20"""'-"'
is provided In this Notice of Commencement. nWhod
HARRY R",
jo
Space above reserved for use of recording office
1.Legal description of proaerty and streettaddress: Rq&I 6k*e5 $6-c1 AAD 4-til"r 91-9 12
,61/W 1bc2_Tf AW-P**l sle4ce".11' 010re- -T i3&
2.Description of Improvement: /17171k 1-111W AZ;9 S/&
3.Owner(s)name and address: 4Z672A toem 9.040t e 4Y 416F ZDA St AMIMI Aftjeej- PC
Interest In property.
Name and address of fee simple titleholder:
4.Contractors name,address and phone umber: fsj0Z&&AijV1.- g
S.Surety:(Payment bond required by owner from contractor,If any)
Name,address and phone number
Amount of bond
6. Lender's name and address:
7.Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided by
Section 713.13(l)(47.,Florida Statutes,
Name,address and phone number
8.In addition to himself,Owners designates the following person(s)to receive a copy of the Uenor's Notice as provided in Section
713.13(1)(b),Florida Statutes.
Name,address and phone number
9. Expiration date of this Notice of Commencement:
(the expiration to fall year from the date of recording unless a dtffemrd date Is specified)
WARNING TO OWNER:ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED
IMPROPER PAYMENTS UNDER CHAPTER 713,PART 1,SECTION 713.13. FLORIDA STATUTES,AND CAN RESULT IN YOUR PAYING TWICE FOR
IMPROVEMENTS TO YOUR PROPERTY.A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE
FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING,CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK
OR RECORDING YOUR NOTICE OF COMMENCEMENT.
Signature(s)op��A�Owns orized Officer/Director/Partner/Manager
Prepared By Prepared By
Print Name Print Name
Me/Office Title/Office
STATE OF FLORIDA
COUNTY OF MIAMI-DADE
The foregoing Instrument was acknowledged before me this /2 day ofAqqj_. golf.
By e1i Le-A 9-oa#L-r_
R Individually,or U as - for
Ll Personally known,or &produced the following type of Identification: f- 0
MRIFF FW
Signature of Notary Public: TRICK
Print Name: Notary Public-State of Florida
0
(SEAL) my Comm. Expires Sep 19,2017
Commission#FF 0557312]
VERIFICATION PURSUANT TO SECTION 92 625 FLORIDA S Ron Through National Assn.
Under penalties of perjury, I declare that I have read the foregoing and
that the facts stated in It are true,to the best of my knowledge and belief.
s
Signa eq)or Ow ner(s)'s Authorized Offleer/Director/Partner/Manager who signed above:
By .4 By
12301-52 PA3E3 3M2