PL-16-1448 !/
Inspection Worksheet 1
Miami Shores Village 0i
10050 N.E.2nd Avenue Miami Shores,FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-261832 Permit Number. PL-5-16-1448
Scheduled Inspection Date:June 27,2018 Permit Type: Plumbing- Residential
Inspector: Hernandez, Rafael
Inspection Type: Final
Owner: FRANCESCA RINONAPOLI TRS, Work Classification: Septic
=QIMOAM /`111 _MVA TD
Job Address:9915 NE 4 Avenue Road
Miami Shores,FL Phone Number
Parcel Number 1132060171300
Project: <NONE>
Contractor: STATEWIDE SEPTIC CONNECTIONS Phone: (954)963-0082
Building Department Comments
INSTALL NEW 1050 TANK AND BED DRAIN FIELD I Wo Passed Comments
INSPECTOR COMMENTS False
Inspector Comments
Passed Side walks will be taken care off prior to building final under the master
E4 permit.
Failed
Correction
Needed
Re-Inspection D
Fee
No Additional Inspections can be scheduled until
re-Inspection fee is paid
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10050 N.E.2nd Avenue NE �
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Miami Shores,FL 33138-0000
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Phone: (305)795-2204 AIM
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Ex iration: 11t 3/2016
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Project Address Parcel Number Applicant
9915 NE 4 Avenue Road 1132060171300
Miami Shores, FL Block: Lot: ESTEBAN GIUGOVAZ TRS FRAl'
Owner Information Address Phone Celt
ESTEBAN GIUGOVAZ TRS FRANCESCA 9915 NE 4 Avenue Road
- - -- --- MIAMI SHORES FL 33138-
9915 NE 4 Avenue Road
MIAMI SHORES FL 33138-
Contractor(s) Phone Cell Phone Valuation: $ 7,225.00
STATEWIDE SEPTIC CONNECTIONS (954)963-0082
. .. ....•.•... ._. ,.. _.x ..... _. Total Sq Feet: 667
Type of Work: Available Inspections:
Type of Piping: Inspection Type:
Additional Info:
HRS Approval
Bond Return: Final
Classification:Residential Scanning:3
Review Plumbing
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $4.80
DBPR Fee Invoke# PL-5-16-59929
$4.50 05/27/2016 Check*6105 $280.80 $50.00
DCA Fee $4.50
Education Surcharge $1.60 05/25/2016 Check#:5079 $50.00 $0.00
Permit Fee $300.00
Scanning Fee $9.00
Technology Fee $6.40
Total: $330.80
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 zoning. Futhermore,I authorize t above-named contractor to do the work stated.
G May 27,2016
Authorized Si ature: wrier / Applicant / Contractor / Agent Date
Building Department Copy
May 27,2016 1
Miami Shores Village �o,s
Building Department MAY 2 5
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972 1-1
INSPECTION LINE PHONE NUMBER:(305)762-4949 PC.sz— I/ ^-3 S
7
FBC.20�O J
BUILDING Master Permit No.
PERMIT APPLICATION Sub Permit No.
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS [] CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 9915 NE A Ay`- k(1
City: Miami Shores County Miami Dade Zip )�J
Folio/Parcel#: h— 3Z6— ®1"1— 13>0o Is the Building Historically Designated:Yes NO V
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
S"�4 of,n G o �a r'1 Cel COi t'Z►r)0 r% of i +�S
OWNER: Name(Fee Simple Titleholder): U �®4q"z Phone#: S®S—301— X4.68
Address: 90I, s NtG_ '. A�. Rd
City: M1,1q rel) ' 1�.J FCS State:. Zip: 8
Tenant/Lessee Name: Phone#:
Email: '
CONTRACTOR:
/Company �Name: S�'�-� gide ,C "S 'C Phone#:
Address:_�`�G8 rV NW 19 Ak t a
L
City: opq _QCKAI State: rL Zip:
Qualifier Name: fDc-f'SCr �t1V� ® p n Phone#:
State Certification or Registration#: ��� {���✓ Certificate of Competency M
DESIGNER:Architect/Engineer: Phone#: °
Address: City: State: Zip:
Value of Work for this Permit:$ 22�j Square/Linear Footage of Work: 6 ,;
Type of Work: X Addition El Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: q— — a,fi q �1 NLeA
N fie ICF
Specify color of colorathru tile:
Submittal Fee$ • (0 Permit Fee$ CCF$ ey. ® 'CO/CC$
Scanning Fee$ 47,z> Radon Fee$ DBPR$ e Notary$
Technology Fee$ ®- /4CI Training/Education Fee$ �� ®' Double Fee$
Structural Reviews$ Bond$ I6"'
TOTAL FEE NOW DUE$2A U
(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.
Signature
Signature
OW ER or AGENT —k
"CONTRACTOR °
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of
� �..� 20 16
o 1 — by _daY of d�G� 20 ,by
��cc SCS Ro loft T1�tsi personally known to T -S-° y,.� who is personally known to
me or who has produced 1�7 as me or who has produced a(A- ft)
as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC:
NOTARY PUBLIC: `
Sign: � f
:a Sign:
Print: /
I Print: .ems
Seal: lfiNotary Publec state of F;.(ba
Trencelle Lewis Seal: I- Zig
State of Florida
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APPROVED BY 6 e �3�`� Plans Examiner
Zoning
Structural Review Clerk
Fcv sed02/24/2014)
CI W4 IC4:o iraC-Tar
PERMIT #:13-SC-1654905
STATE OF FLORIDA APPLIC
DEPARTMNT OF HEALTH ATION #:AP1220769
ONSITE SEWAGE TDATE PAID:
CONSTRUCTION PERMIT AND DISPOSAL SYSTEM
FEE PAID:
RECEIPT 1:
DOCUMENT 1:PR1002166
CONSTRUCTION PELT FOR: OSTDS New
APPLICANT: Francesca Rktonapoli
PROPERTY ADDRESS: 9915 NE 4 Avenue Rd
Miami,Ft.33138
LOT: 15, 16 BLOCK: 96
BUBDIV•ISION: Miami Shores SOC 4
PROPERTY ID #: 11-3206-017-1300 (SECTION, TOWNSHIP, RANGE, PARCEL NUMBER)
(OR TAX ID NUMBER)
SYSTEM MUST BE CONSTRUCTED INACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF SECTION
381.0065, F.S., AND CHAPTER 54E-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 I 1,050 I GALLONS / GPD septic tank CAPACITY
A I I GALLONS / GPD CAPACITY
N I l GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS)
K ( I GALLONS DOSING TANK CAPACITY [ IGALLONS Q[ ]DOSES PER 24 HRS #Pumps I I
D ( 667 I SQUARE FEET bed confiquration drainfiel SYSTEM
R ( I SQUARE FEET SYSTEM
A TYPE SYSTEM: [XI STANDARD 11 FILLED I I MOUND I ]
I CONFIGURATION: ( I TRENCH (XI BED [ I
N
F LOCATION OF BENCHMARK: center line of 4 Avenue Road.10.10'NGVD
I ELEVATION OF PROPOSED SYSTEM SITE [ 3.00 11 INCHES FT I[ BELOW I BENCHMARK/REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE 127.001[ INCHES FT I(ABOVE BELOW BENCHMARK/REFERENCE POINT
L
D FILL REQUIRED: ( I INCHES EXCAVATION REQUIRED: ( 30.00) INCHES
1.4ristall a 1050 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)(0,FAC.
3.-Install 667 sf of drainfield in bed configuration.
H 4 Perimeter of excavation area shall be at least 2 ft wider and longer than the proposed absorption bed or drain trench.
E (Cornntents Continued on Page 2.)
R
SPECIFICATIONs BY: ereea a Soloman TITLE: Master Septic Tank Contractor
TITLE: Engineering specialist II Dade CND
APPROVED BY: aslands Oati�ca
01/25/2016 EXPIRATION DATE: 07/28/2017
DATE ISSUED;
06109 6dE-6.003, FAC(ibsoletes all previous editions which may not be used] �g �p
DH 4016, Avi22o�so COATRIACTQ ... SV ry► NG
Incorporated:
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DOCUMZNT 1: PR1002166
5.-Invert elevation of drainfield to be no less than 8.35'NGVD.
6.-Bottom of drainfield elevation to be no less than 7.85'NGVD.
T-Water line within 10 ft of septic system to be Sch 40 PVC or sleeved in accordance with FAC Ch 64E-6.005(2)(b).
8.-This permit includes the abandonment of the existing septic tank.
The system is sized for 4 bedrooms with a maximum occupancy of 8 persons(2 per bedroom),for a total estimated flow of
400 god.
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