PL-16-2310 (2) Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores,Fl-
Phone: (305)795-2204 Fax: (305)7564972 �V
Inspection Number. INSP-266688 Permit Number: PL-8-16-2310
Scheduled Inspection Date: September 20,2016 Permit Type: Plumbing - Residential
Inspector. Hernandez, Rafael Inspection Type: Final
Owner. FRUCIANO,DANIEL Work Classification: Drainfield
Job Address:236 NE 91 Street
Miami Shores, FL 33138- Phone Number
Parcel Number 1132060190440
Project <NONE>
Contractor. MR C'S PLUMBING&SEPTIC INC Phone: (305)151-7859
Building Department Comments
DRAIN FIELD INSTALLATION. n cdo Passed Comments
INSPECTOR COMMENTS False
Inspector Comments
Passed , HRS APPROVAL ON FILE
Failed
Correction
Needed
Re-inspection D
Fee
No Additlonal Inspections can be scheduled until
re-inspectlon fee Is paid.
P #N0 P - 46-2310
Miami Shores Village, � ` �� erynit T,)± a SIO ��r Rasidential
10050 N.E.2nd Avenue NE _ /t y Q
r1 � f1lf.�'.1cZSSlI{"FI�'It?t? If`aillfie��
Miami Shores,FL 33138 0000 P61mit St (S:APP ,
h Phone: (305)795-2204
Issue 8I ',� 1 Expiration: 0212V2017
Project Address Parcel Number Applicant
236 NE 91 Street 1132060190440
DANIEL FRUCIANO
Miami Shores, FL 33138- Block: Lot:
Owner Information Address Phone Cell
DANIEL FRUCIANO 236 NE 91 ST
MIAMI SHORES FL 33138-3128
Contractor(s) Phone Cell Phone Valuation: $ 3,000.00
MR C'S PLUMBING 8 SEPTIC INC (305)651-7859
........ _ Total Sq Feet: 200
Type of Work:DRAIN FIELD INSTALLATION. Available Inspections:
Type of Piping: Inspection Type:
Additional Info:
HRS Approval
Bond Return: Final
Classification:Residential Scanning:3 Review Plumbing
Fees Due AmountPay Date Pay Type Amt Paid Arnt Due
Bond Type-Owners Bond $500.00 Invoice# PL-8-16-61008
CCF $1.80 08/25/2016 Check#:721 $500.00 $168.30
DBPR Fee $2.25
DCA Fee $2.25 08/16/2016 Credit Card $50.00 $118.30
Education Surcharge $0.60 08/25/2016 Credit Card $ 118.30 $0.00
Permit Fee $150.00 Bond#:3202
Scanning Fee $9.00
Technology Fee $2.40
Total: $668.30
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 properuthorities of Miami Shores Village. In
accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I�inderstand 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 accLyste and that all work will be done in compliance with all applicable laws regulating
construction and zoning. Futhermore,I authorize the above-named co actor to do the work stated.
August 25,2016
Authorized Signature:Owner / Applicant / ontractor / Agent Date
Building Department Copy
August 25,2016 1
Miami Shores Village" '
Building Department UG 16 luI
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 13Y.14z�o
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION UNE PHONE NUMBER:(305)762-4949 1—V4
FBC 2014
BUILDING fluster Permit No.
PERMIT APPLICATION Sub Permit No.
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
UMBING [� MECHANICAL []PUBLIC WORKS ❑ CHANGE OF []CANCELLATION SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: a34 N6 s�
City: Miami Shores County: Miami Dade Zig):
Folio/Parcel#: -1264- oil- 040 is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: _Flood Zone: CB•FFE:»yO, — FFE:
OWNER:Name(Fee Simple Titleholder): j9ldilid rLIL/Ah.o _Phone#:
Address
oZ 36 IUE `I! St
SOS '� ( —� -
City: _ t`�vKl State: rL Zip:
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR.Company Name:
Mr C's Plumbing and Septic Phone#: 305 6517859
Address: 19932 NW 2 Ave 33169
City: Miami state: FL —zip:
Qualifier Name:
Kemble Ettrick Phone#. 305 6517859
State Certification or Registration#: SR061536 Certificate of Competency
Pho
DESIGNER:Architect/Engineer: :e#:
Address: City: —State: Zip:
Value of Work for this Permit:$ 3aCO. 00 Square/Linear Footage of Work:;
Type of Work: ❑ Addition ❑ Alteration ❑ New 0 Repair/Replace Demolition
Description of Work:
Specify color of color thru tile:
Submittal Fee$_
Aol�) Permit Fee$ 15 10 CCF$ / CO/CC$
Scanning Fee$ '. ic/D Radon Fee$ DBPR$ ? Notary$
Technology Fee$ T 0 Training/Education Fee$ 4�>Q Double Fee$ 0
Structural Reviews$ Bond$ � '
TOTAL FEE NOW DUE$ 11,
(Revised02/24/2014) 6( 3- 30
'-Otl Company's Flame(if applicable)
Bonding�ompany'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. l understand that a separate permit must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS,
FURNACES,BOILERS,HEATERS,TANKS,AIR CONDITIONERS,ETC.....
OWMER'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 on 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.
P
I
Signature Signature
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The fxing instrument was acknowledged before me this
day of 20 A G by day of)%a fir_� F 201�.by
who is personally known to n tcg a n
ta�eli who has produced
me or who has produced JIV as t N s
identification and who did take an oath. identification and who did take an oath. W o
NOTARY PUBLIC: NOTARY PUBLIC: .2 W y
o = E
y E
�a V U d
Sign: Sign: >1
1410eloo�'-AJ ,-.4Print: Print: bv,
..``►.. EP SIT Nuts
Sa0 •s °'ao.
Notary Public-State of Florida mal. �f�o Yj %�of Florida
Seal: ;.`My Comm.Expires Sep 19,2017
lBTpires Oct 23,2018
�= Commission#FF 055732 %�! 89 fission#FF 136597
Bonded Through National N t ry Assn. ��'' °;,;t°Q��� Bond Hugh National Nary Assn.
**********sss***ossa*ssa** *assasss**sss*ss•sssssss*ss*ssss:*s x**ass* * '*
APPROVED BY f �' Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
PERMIT #:13-SC-1701015
APPLICATION #:AP1251756
STATE OF FLORIDA
"
°- DEPARTMENT OF HEALTH DATE PAID:
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM FEE PAID:
CONSTRUCTION PERMIT RECEIPT #:
DOCUMENT #:PR1028958
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: Daniel Fruciano
PROPERTY ADDRESS: 236 NE 91 St Miami, FL 33138
LOT: 8 9 BLOCK: 3 SUBDIVISION:
PROPERTY ID #: 11-3206-019-0440 [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 l GALLONS / GPD EXISTING Septic TO REMAIN CAPACITY eat°Qo�a��ekN
p0�
A [ 0 ] GALLONS / GPD CAPACITY \SCeQ�\C�yGa�a�2\,��a�e��P
N [ 0 l GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1a2;re \Ppp�dG°C�d
K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES° �sl ,t1�c�"�` G�OC`]
D [ 200 ] SQUARE FEET DF BED CONFIGURATIO SYSTEM ire u°c��9 a\\�s .`��e5s •\�e era sea`�
R [ 0 1 SQUARE FEET SYSTEM fie
A TYPE SYSTEM: [X] STANDARD I' ] FILLED [ ] MOUND [ ] tlgpe�Gz�p�r keel aCCaC�a
I CONFIGURATION: [ ] TRENCH [sl BED I lk.
tCeseG`�e`ea
N
F LOCATION OF BENCHMARK: FFE..............13.00'NGVD a�
I ELEVATION OF PROPOSED SYSTEM SITE [ 34.801 [ INCHES FT ] [ABOVE BELOW BENCHMARK/REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 84.801 [ INCHES FT ] [ABOVE BELOW BENCHMARK/REFERENCE POINT
L
D FILL REQUIRED: [ 0.001 INCHES EXCAVATION REQUIRED: ( 62.001 INCHES
1.-EXISTING 900 gal.septic tank with and approved filter TO REMAIN.
0 2.- Install 200 sf.of drainfield in bed configuration.
T 3.-Install 12"of slightly limited soil at the bottom of the drainfield.
H 4.-Perimeter of excavation area shall be at least 2 ft wider and longer than the proposed absorption bed or trench.
(Comments Continued on Page 2.)
E
R
SPECIFICATIONS BY: Gerar Philiza're TITLE: Engineering Specialist II
APPROVED BY: L, TITLE: Engineer Supervisor III Dade CHD
As V Edwards
DATE ISSUED: /11/2016 EXPIRATION DATE: 11/09/2016
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E-6.003, FAC Page 1 of 3
v 1.1.4 AP1251756 sE1004677
r
STATE OF FLORIDA
DEPARTMENT OF HEALTH
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTIO��I'L�J �Y
Permit Application Number
--------------------------- PART II -SITEPLAN ---------------------------
Scale: Each block represents 10 feet and 1 inch =40 feet.
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There are no pertinent features on adjacent properties and or across the street that may affect the New Soptic system installation.
o es:
Z6 NO q1 Sf 671 AORTAL PG 3713f
e
Site Plan submitted C&J'r�
Plan Approved Not Approved Date i
By County Health Department
ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
DH 4015,10/96(Replaces HRS-H Form 4016 which may be used) Page 2 of 4
(Stock Number: 5744-002-4015-6)
^' .►�� DIVISION OF
• Environmental Health
Florida Health
Miami-Dade County �o
eQ� OSTDS/Well Division
11805 SW 26th Street•Miami,FL 33175
) :
Inspector Daae
Address 2310 �� �/ OSTDS# A0
Comments:
Signature ,