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PL-16-1421 Inspection Worksheet L 6,1Miami Shores Village �i 10050 N.E.2nd Avenue Miami Shores,FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-259560 Permit Number: PL-5-16-1421 Scheduled Inspection Date: June 27,2016 Permit Type: Plumbing- Residential Inspector: Hernandez, Rafael Inspection Type: Final Owner: LESCOT,GEORGES Work Classification: Septic Job Address:9125 NE 4 Avenue Miami Shores, FL 33138-3118 Phone Number (305)915-6037 Parcel Number 1132060140090 Project: <NONE> Contractor: STATEWIDE SEPTIC CONNECTIONS Phone: (954)963-0082 Building Department Comments REPLACE SEPTIC TANK AND DRAINFIELD Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed HRS APPROVAL IN FILE Failed Correction a Needed Re-Inspection Fee No Additional Inspections can be scheduled until re-inspection fee is paid TOR , f 3- ��,• ,. am , Y ... 4 4 ... I' limit x aVA07 Odom OR r e- �" �s a' � _� _ "• � � � ��Ys Zai f "t ,-. o .. .. rs u r , N - i ROO- ,rte. a��v\ cu >._..PA, ..fag. �. .., MCA 1 3 CE 2 'Owl EE cc - , - :h^,s. a: .. �' :�` r��., .:ter,+' „< -•.,yrs .'q.'. a:.�a .. . C it '�■ Miami Shores Village � �lu� fi� IRF °mss 9 10050 N.E.2nd Avenue NE I/ ►t3d5S �i �� , Miami Shores,FL 33138-0000, Phone: (305)795-2204 � tsu 126 , Expiration: 11123/ �tpRtPp` iJ 1 Project Address Parcel Number Applicant 9125 NE 4 Avenue 1132060140090 Miami Shores, FL 33138-3118 Block: Lot: GEORGES LESCOT Owner Information Address Phone Cell GEORGES LESCOT 9125 NE 4 Avenue (305)915-6037 MIAMI SHORES FL 33138- 9125 NE 4 Avenue MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone Valuation: $ 7,500.00 STATEWIDE SEPTIC CONNECTIONS (954)963-0082 Total Sq Feet: 667 Type of Work:REPLACE SEPTIC TANK AND DRAINFIELD Available Inspections: Type of Piping: Inspection Type: Additional Info: HRS Approval Bond Return: I Final Classification:Residential Scanning:3 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due Bond Type-Contractors Bond $500.00 Invoice# PL-5-16-59898 CCF $4.80 05/27/2016 Check*6105 $780.80 $50.00 DBPR Fee $4.50 DCA Fee $4.50 05/23/2016 Check#:5076 $50.00 $0.00 Education Surcharge $1.60 Bond#:3097 Permit Fee $300.00 Scanning Fee $9.00 Technology Fee $6.40 Total: $830.80 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 zonin Futhermore,I aut ize the above-named contractor to do the work stated. May 27, 2016 Autho'zed Sig ature:Owner / Applicant / Contractor / Agent Date Building Department Copy May 27,2016 1 • Miami Shores Village EB7Y: ET Building Department 3 016 10050 N.E.2nd Avenue, Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 201'1 BUILDING Master Permit No. ' PERMIT APPLICATION Sub Permit No. I)(— ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL LUMBING DoffCHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: / S City: Miami Shores County: Miami Dade Zip: ':N` Folio/Parcel#: � �`�;w '—�� jL� Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name(Fee Simple Titleholder): C77[-70ef_�. �C e=;5e-0'i Phone#:_- t -9,* Address: City: State: Zip: Tenant/Lessee Name: Phone#: Email: e CONTRACTOR:Company Name: cj i ScPflcnc Phone#: IG6t665' Address: f3c t4vi l t -W-(® City: ® a WC State: FZ Zip. Qualifier Name: eA_N4 � ��1<31 Phone#: State Certification or Registration#: &,, u C,,-1116 1, Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ Square/Linear Footage of Work: (4-1 Type of Work:. ❑ Addition Alteration ❑ New ❑ Repair/Replace ❑ Demo ition Description of Work: ce C a ►-,K. t -cq o'-) -e- Specify color of color thru tile: Submittal Fee$ Permit Fee$ CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ 4 Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ 500 TOTAL FEE NOW DUE$ (Revised02/24/2014) -W 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. Si Signature nature g g OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged beforemethis 19- day of P 120 IG by o1� day of M1206-0 , by Gkzv!5�p L�Uccqt --"who is personally known to -Tke .3A Yo L-o,,Lo ,who is p onalTy�c owi me or who has produced HCt.lfi as me or who has produced as identification and who did take an oath. identification and who did take an NOTARY PUBLIC: NOTARY PUBLIC: `mom c„ °•a°••• •°••of/ice :y+ Sign: Sign: Print: Print: ;b-'-off. •_�� Seal MARSHA A.PIERRE Seal: �PQN fjA 4A es �dot0ry Public,94040 01 Florida �/111111111111O Commission 0 FF 17632 my comm.expires May 13,2017 APPROVED BY i Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) PERMIT #: 13-SC-1662921 STATE OF FLORIDA APPLICATION #: AP1226382 DEPARTMENT OF HEALTH 4 :; ONSITE SEWAGE TREATMENT AND DISPOSAL DATE PAID: SYSTEM FEE PAID: CONSTRUCTION PERMIT RECEIPT #: DOCUMENT #: PR1018436 CONSTRUCTION PERMIT FOR: OSTDS New APPLICANT: Georges Lescot PROPERTY ADDRESS: 9125 NE 4 Ave Miami Shores, FL 33138 LOT: 13&14 BLOCK: 49 SUBDIVISION: Miami Shores Sec 2 PROPERTY ID #: 11-3206-014-0090 [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 CAPACITY A [ ] GALLONS / GPD N/A CAPACITY N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS] K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ ] D [ 667 ] SQUARE FEET Bed confiquratiion drainflel SYSTEM R [ ] SQUARE FEET N/A SYSTEM A TYPE SYSTEM: [x] STANDARD [ ] FILLED [ ] MOUND [ ] I CONFIGURATION: [ ] TRENCH [x] BED [ ] N F LOCATION OF BENCHMARK: F.F.E., 10.75'NGVD I ELEVATION OF PROPOSED SYSTEM SITE [ 29.10] [ INCHES FT ] [ABOVE BELOW BENCHMARK/REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ 57.00 ] [ INCHES FT ] [ABOVE BELOW BENCHMARK/REFERENCE POINT L D FILL REQUIRED: [ 0.00] INCHES EXCAVATION REQUIRED: [ 69.80 ] INCHES 0 Inspector to verify the existing septic tank is properly abandoned before final approval. *Invert elevation of drainfield to be no less than 6.50'NGVD. T *Bottom of drainfield elevation to be no less than 6.00'NGVD. H *Install 42°of slightly limited soil under the bottom of drainfield. -Perimeter of excavation area shall be at least 2 ft.wider and longer than the proposed absorption bed or drain trench. E The system is sized for 3 bedrooms with a maximum occupancy of 6 persons(2 per bedroom),for a total estimated flow R of 400 gpd. The licensed contractor installing the system is responsible for installing the minimum category of tank in accordance SPECIFICATIONS BY: Teresa J Solomon TITLE: Master tic Contractor art Go APPROVED BY: TITLE: de Dade CHD Carlos M Icaza DATE ISSUED: 05/17/2016 iiIIATE: 11/17/2017 oda DH 4016, 08/09 (Obsoletes all previous editions which may not be u Incorporated: 64E-6.003, FACO. ge 1 of 3 v 1.1.4 AP1226382 SE99589