PL-16-1884 (2) 9
Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-262692 Permit N mber: PL-7-16-1884
Scheduled Inspection Date: September 27,2016 Permit Type: Plumbing - Residential
Inspector: Hernandez,Refeet 1.1191kil /lip
Inspection Type: Final
Owner: LANCE, KATHLEEN Work Classification: Septic
Job Address:246 NE 102 Street
Miami Shores, FL Phone Number
Parcel Number 1132060134740
Project: <NONE>
Contractor: A AARON SUPER ROOTER Phone: 305-944-8886
Building Department Comments
REPLACE BROKEN FIBERGLASS SEPTIC TANK WITH n c o ass@ ommen
NEW 1060 GALLON TANK 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 fee is paid
September 26,2016 For Inspections please call: (305)762-4949 Page 7 of 18
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Miami Shores Village
Pefm ffType-Plutttbifig-Residential
10050 N.E.2nd Avenue NE tt t €SS t [??1" 8Of
Miami Shores,FL 33138-0000
Status: PPRIWEf
ems` Phone: (305)795-2204
FOR1D4'
� 18/2t `f Expiration: 01/04/2017
Project Address Parcel Number Applicant
246 NE 102 Street 1132060134740
Miami Shores, FL Block: Lot: KATHLEEN LANCE
Owner Information Address Phone Cell
KATHLEEN LANCE 246 NE 102 ST
MIAMI FL 33138-2427
Contractor(s) Phone Cell Phone Valuation: $ 3,800.00
A AARON SUPER ROOTER 305-944-8886
Total Sq Feet: 0
Type of Work:REPLACE BROKEN FIBERGLASS SEPTIC TA Available Inspections:
Type of Piping: Inspection Type:
Additional Info:
HRS Approval
Bond Return
Final
Classification:Residential Scanning:3
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
Bond Type-Contractors Bond $500.00
Invoice# PL-7-16-60470
CCF $2.40 07/07/2016 Check#:6121 $50.00 $619.90
DBPR Fee $2.25
DCA Fee $2.25 07/08/2016 Check#:4726 $619.90 $0.00
Education Surcharge $0.80 Bond#:3135
Permit Fee $150.00
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 compli nce 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 a d that ork will be done in compliance with all applicable laws regulating
construction and zoning. Futhermore,I authorize the above-name ontract do th 5-k stated.
July 08,2016
Authorized Signature:Owner / Applicant actor / TXg6t Date
Building Department Copy
July 08,2016 1
Miami Shores Village _ r i,
Building Department JUL o,s
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 ;?
Tel:(305)795-2204 Fax:(305)756-8972 �— --- --
INSPECTION LINE PHONE NUMBER:(305)762-4949 !nthFBC 201 9
BUILDING Master Permit Nq.V L �b
PERMIT APPLICATION Sub Permit NO.
BUILDING ❑ ELECTRIC ❑ ROOFING REVISION ❑ EXTENSION DRENEWAL
M PLUMBING [:] MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: V'e-r r`-( L-cih Ce- J. kQ A fee-e, Ne� L02- S-f-
City: Miami Shores County: Miami Dade Zip: 33 1 3A
Folio/Parcel#: I I " �SZ6- C") (.3- y',Lto Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: __Flood Zone: BFE: FFE:
't'i
OWNER: Name(Fee Simple Titleholder le(ru �Lt w�CP. �� (eeh Phone#:
Address: 241G l4l-r it-, "f
City: MI S OrcJ State:_ Ft, Zip:3.3 3�
Tenant/Lessee Name: Phone#:
Email: O_ kL CONTRACTOR:Company Name: A A-G r-\or\ (S�� a�P.✓ Phone#? 1
Address:6 O 7-12. ��LL) as C+
City: IY G.ry\.ay //�� State: �,. Zip: 3�z
Qualifier Name: ���r T\5-& Phone#:
State Certification or Registration#:.)( Certificate of Competency#:1
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$�300 Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New [A Repair/Replace ❑ Demolition
Description of Work: Rt (G ce br'OKM
Specify color of color thru tile:
Submittal Fee$ So .
��0-3 Permit Fee$ CCF$ Y0 CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ ° 2-0 Training/Education Fee$ 4:0 Double Fee$ S�
Structural Reviews$ _ Bona!$ --T
TOTAL FEE NOW DUE$ U
(Revised02/24/2014) r I
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 th absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
t"X Signature �AASignature
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
3 day of J,-)(� ,20 ,by day of J 20 16 , by
e-Cn I_a n,Gido is personal kgown to e I,.
, V,n 'Tu who is personally known to
"tea
me or who has produced r--L-A-r--L-A- I I� ��� - as me or who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: a NOTARY PUBLIC:
Sign: / z a Sign: a
°
Print: � 1�� `�'s Print: in
Seal: " Seal:
APPROVED BY l�b Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
REPAIR C1 W�)n+
PERMIT #:13-SC-1692244
t%kj�a-DADS;:ours rY limeyi�+ "pyo �� APPLICATION.#:AP1246261
t ; ^ STATE OF FLORIDA DATE PAID:
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM FEE PAID:
CONSTRUCTION PERMIT RECEIPT #:
DOCUMENT #:PR1024293
� p 2016
CONSTRUCTION PERMIT FOR: OSTDS Repair {
APPLICANT: Jerry Lance
PROPERTY ADDRESS: 246 NE 102 St Miami,FL 33138
LOT: 6,7 BLOCK: 35 SUBDIVISION: Miami Shores Sec 1 Amd
[SECTION, TOWNSHIP, RANGE, PARCEL NUMBER]
PROPERTY ID #: 11-3206-013-4740 [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 tank CAPACITY
A L ] GALLONS / GPD CAPACITY
N L ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ I
D [ 225 l SQUARE FEET trench configuration drainf_SYSTEM
R [ ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [x] STANDARD [ ] FILLED [ ] MOUND [ ]
I CONFIGURATION: [x] TRENCH L ] BED [ ]
N
F LOCATION OF BENCHMARK: FFE 12.15'NGVD
I ELEVATION OF PROPOSED SYSTEM SITE [ 33.00] [ INCHES FT ] [ABOVE BELOW BZNCHMARK/REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 78.00 ] [ INCHES FT ] [ABOVE BELOW BIENCI•>MARK/REFERENCE POINT
L
D FILL REQUIRED: [ ] INCHES EXCAVATION REQUIRED: [ 45.00 ] INCHES
-THIS REPAIR PERMIT IS NOT FOR ANY ADDITIONS-
0 1.-Install a 1050 gal min.septic tank with an approved filter.
T 2.-The licensed contractor installing the system is responsible for installing the minimum category of tank in accordance
with s.64E-6.013(3)(f),FAC.
H 3.-Install 225 sf of drainfield in trench configuration.
E 4.-Perimeter of excavation area shall be at least 2 ft wider and longer than the proposed absorption bed or drain trench.
(Comments Continued on Page 2.)
R
SPECIFICATIONS BY: John Tuffy TITLE:
�r �� TITLE: Engineering Specialist II Dade CHD
APPROVED BY:
Erlande Omi.sca
EXPIRATION DATE: � 09_128/2016
DATE ISSUED: 06/30/2016
DH 4016, 08/09 (Obsoletes all previous editions which may not be used) CONTRACTOR.,,. 1L IN
Incorporated: 64E-6.003, FACv 1 1 4 i raEz6i a as stor 57 to �W c e y.e d) e req ,;red to p�et Qrm'a sil born
i'-p-E- ti'n1 .^ F�rai Approval, the FOOH i _cr spa
votness tie soi'� and compare the resjl,s !o the orgin
se evalua;"c� s�:bTitted t,rei�sr�c;ian ie� ;,u be asa�sse
if •ne MniraCtor is ^o' at the jobs%e at T..a aua.,g ct time
DoCUNENT #: PR1024293
5.-Invert elevation of drainfield to be no less than 6.15'NGVD.
6.-Bottom of drainfield elevation to be no less than 5.65'NGVD.
T-This permit includes the abandonment of the existing septic tank.
The system is sized for 3 bedrooms with a maximum occupancy of 6 persons(2 per bedroom),for a total estimated flow of
400 gpd.
d _ STATE OF FLORIDA
DEPARTMENT OF HEALTH
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT
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Permit Application Number _� y
------------------ PART II -SITE PLAN----.-------',t-'�;—.�----
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kale: Each block represents 5 feet and 1 inch=50 feet.
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. �,�'`• - There are no pertinent features across
thetre+et or adjacent to_the{property
that may affectseptic sysfem.
t _
otes:
i
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to Plan submitted by:
Signature I Title
an Approved Not Approved ° Date
t County Health Department
ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
t015,10/96(Replaces HRS-H Form 4015 which may be used)
x Number:57aa-002-Ql5-6) Paoe 2 of 3