PL-16-1657 Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores,FL
Phone: (305)795-2204 Fax: (305)7564972
Inspection Number. INSP-260958 PermitNumber: PL-6-16-1657
Scheduled Inspection Date: November 29,2016 Permit Type: Plumbing - Residential
Inspector. Hernandez, Rafael Inspection Type: Final
Owner: GRIMBERT, DAVID AND MEGHAN Work Classification: Drainfield
Job Address:824 NE 100 Street
Miami Shores, FL
Phone Number (305)323-7700
Parcel Number 1132060340050
Project: <NONE>
Contractor: MR C'S PLUMBING&SEPTIC INC Phone: (305)651-7859
Building Department Comments
Infractlo Passed Comments
DRAINFIELD INSTALLATION. INSPECTOR COMMENTS False
Inspector Comments
Passed
Failed
Correction
Needed
Re-Inspection ❑
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid
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Miami Shores Villager @m T,y Plumbing 11"Id Sil't"tlel
10050 N.E.2nd Avenue NE
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Miami Shores,FL 3313&0000 3
Phone: (305)795-2204
Expiration: 1211 /201
Project Address Parcel Number Applicant
824 NE 100 Street 1132060340050
Miami Shores, FL Block: Lot: DAVID AND MEGHAN GRIMBER'
Owner Information Address Phone Cell
DAVID AND MEGHAN GRIMBERT 253 NE 92 Street
MIAMI SHORES FL 33138-
253 NE 92 Street
MIAMI SHORES FL 33138-
Contractor(s) Phone Cell Phone Valuation: $ 6,000.00
MR C'S PLUMBING S SEPTIC INC (305)651-7859
Total Sq Feet: 300
Type of Work:DRAINFIELD INSTALLATION. 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 $3.60
DBPR Fee Invoice# PL-6-16-60192
$2.70 06/17/2016 Credit Card $ 154.00 $50.00
DCA Fee $2.70
Education Surcharge $1.20 06/14/2016 Credit Card $50.00 $0.00
Permit Fee $180.00
Scanning Fee $9.00
Technology Fee $4.80
Total: $204.00
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zoning. Futhermore,I authorize the above-named contractor to do the work stated.
4r___ June 17,2016
Authorized Signature:Owner / Applicant / Contractor / Agent Date
Building Department Copy
June 17,2016 1
Miami Shores Village RFICET
Building Department J N 1 2016
10050 N.E.2nd Avenue,Miami Shores,Florida 3313$
Tel:(305)795-2204 Fax:(305)756-8972 BY.
No AA I
INSPECTION UNE PHONE NUMBER:(305)762-4949
FBC 2®J'q
BUILDING (waster Permit No.Tu�
PERMIT APPLICATION Sub Permit No.
F-1 BUILDING ❑ELECTRIC ® ROOFING ® REVISION ❑ EXTENSION ®RENEWAL
®PLUMBING D MECHANICAL ❑PUBLIC WORKS n CHANGE OF ❑CANCELLATION ® SHOP
Q' tic—
y e CONTRACTOR DRAWINGS
!OB ADDRESS: l)a Lf ti Cl, 0v
Miami Shores C n Miami Dade zip: 3 3
Fono/Parcel#: — ~ 0 J Is the Building Historically ted:Yes NO
Occupancy Type. Load: Construction Type: Cl—, _Flood Zone: BFE: FFE:
j OWNER:Name(Fee Simple Titleholder):
,Ik10 Phone#:
Address: o�� UW 5�
city: _state:_. �'L zip: 3 3 3 Y
ssee Name: Phone#:
Tenant/Le
Email:
I
CONTRACTOR:Company Name: Mr C'S dumbing and Septic Phone#: 305 6517859
Address: 19932 NW 2 Ave
City:
State: FL zip: 33169
Qualifier Name: Kemble Ethic k Phone#. 305 6517859
State Certification or Registration#: SR061536 Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: // City: State: Zi
Value of Work for this Permit:$ b 4aoQ• Square/linear Footage of Work: 3
Type of Work: F-1AdditionAlteration New Q Repair/Replace ❑ Demolition
Description of Work:
Specify color of color thru tile:
Submittal Fee$ Permit Fee$ � ® CCF$
co/cc s
Scanning Fee 5 C . C7 Radon Fee$ 0 DBPR$ ® Notary$
Technology Fee$ . g3 Training/Education Fee$ — ® Double Fee$
FL
Structural Reviews$ � Bond$ 101
_` r
TOTAL FEE NOW DUE$ 1�J "�
(Revisedv2/24/2014) ��
4ig ompany'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 perrmit 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.
i
"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 o attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection ich occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be a ved and a pection fee will be charged.
i
Signature Signature
OW R or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of "ktV l� .20 ,by +,�, day of .20 by
��fiVk, �prca+� who is personal known to KAGMI" �1MIdS who Is personally known to
me or who has produced as mjp,or who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC. NOTARY PUBLIC:
Sign: Sign•
Print• Z[- PS Print
P au e e Phillips Seal: Claudette Phillips
Seat: _ = COMMISSION#FF222451 COMMISSION#FF222451
EXPIRES:
a� April 20, 2019 :Q EXPIRES: April 20, 2019
WWW.AARONNOTARY.COM °'% p"�'rw� `�� WWW.AmomNOTARY.COM
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APPROVED BY �-f, ��` Plans Examiner Zoning
Structural Review Clerk
(RevMW2/24/2014)
CFM:20160282148 BOOK 30074 PAGE 4615
DATE:05/13/2016 08:46:03 AM
DEED DOC 3,450.00
HARVEY RUVIN,CLERK OF COURT,MIA-DADE CTY
THIS INSTRUMENT PREPARED BY:
Melvyn Trute,Esq.
1090 Kane Concourse
Bay Harbor Islands,FL 33154
Property Appraiser's Parcel I.D.Number:
11-3206-034-0050
Warran , Deed
For Clerk's Use
THIS INDENTURE made this day of May, 2016, between SUSANNE WILBY
RAUP,a single woman, by JOHN W. RAUP,her attorney-in-fact, of the State of Illinois,whose
address is 1212 North Lake Shore Drive,Apt. 13 CN,Chicago,IL 60610,party of the first part,and
DAVID GRIMBERT and MEGHAN GRIMBERT, his wife, parties of the second part, of the
County of Miami-Dade,State of Florida,whose address is 253 NE 92 St, Miami Shores, FL 33138
WITNESSETH,that the said party of the first part,for and in consideration of the sum of
TEN ($10.00) DOLLARS, to her in hand paid by the said parties of the second part, the receipt
whereof is hereby acknowledged,has granted,bargained,and sold to the said parties of the second
part, and their assigns forever, the following described land, situate, and being in the County of
Miami-Dade,State of Florida,to wit:
Lot 8 and the West half of Lot 7, Block 169, MIAMI SHORES,
Section No.8,according to the plat thereof as recorded in Plat Book
14,Pages(s)33,Public Records of Miami-Dade County,Florida.
SUBJECT TO THE FOLLOWING:
1. Taxes for the year 2016 and subsequent years;
2. Conditions,restrictions,limitations,and easements of record,if any;and
3. Zoning ordinances of applicable governmental authorities;
And the said party of the first part does hereby fully warrant the title to said land,and will
defend the same against the lawful claims of all persons whomsoever.
Trate&Robbins
ATTORNEYS AND COUNSELORS AT LAW,SUITE 202,1090 KANE CONCOURSE, BAY HARBOR ISLANDS,FLORIDA 33154• (305)885-8738
CFN:20160282148 BOOK 30074 PAGE 4616
IN WITNESS WHEREOF,the said party of the first part has hereunto set her hand and seal
the day and year first above-written.
SIGNED,SEALED,AND DELIVERED
IN THE PRESENCE OF:
First Witrti�ss as to Grantor SUSANNE WILBYRAIfP, by J HN W.
RAUP,her attorney-in-fact
(Print Name of Witness)
Second]Witness as to Grantor' I
(Print risme of Witness)
STATE OF ILLINOIS
COUNTY OF COOK
The foregoing instrument was acknowledged before me this 0 day of May, 2016, by
SUSANNE WILBY RAUP, a single woman, by JOHN W. RAUP, her attorney-in-fact, who is
personally known to me and who did/did not take an oath.
NQTARY PUBLIC
sign:
My Commission Expires: print:
State of Illinois at Large
=State
L
OYO
of Illinois Oct 2,2018
Trute&Robbins
ATTORNEYS AND COUNSELORS AT LAW,SUITE 202.1090 KANE CONCOURSE, BAY HARBOR ISLANDS,FLORIDA 33154 t (305)865.8736
CFN:20160282148 BOOK 30074 PAGE 4617
MIAMI SHORES VILLAGE
Building Department
10050 NE 2 Ave, Miami Shores Fl, 33138
Tel: 305-795-2204- Fax: 305-756-8972
Permit No. REOC-5-16-1180
Certificate of !fie-Occupancy
Address: 824 NE 100 Street
City: Miami Shores
State: FL
Zip:
This certificate verifies that the reference property has been inspected by Miami Shores
Village and has been determined to presently comply with schedule of regulations of
Miami Shores Land and Development Code pertaining solely to the requirement that each
one-family dwelling is used and intended to be used for a one-family dwelling purpose
only; however, this certificate does not constitute any representation or warranty as to the
condition of the dwelling or other structures on the premises described herein, or any
aspect of such condition, and interested persons are advised and encouraged to make
their own inspections of the premises in order to determine the condition thereof.
Building Approval:
c<<�1c�enC�-C;k--
r C3 PERMIT #:13-SC-1684487
REPAIR ��al� �±�.,.
i
STATE OF FLORIDA v91.- �'�'A7�COUtIV HEAL APPLICATION #:AP 1241141
DEPARTMENT OF HEALTH DATE PAID:
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM FEE PAID:
CONSTRUCTION PERMIT RECEIPT #:
f "wrr. DOCUMENT #: PR1019770
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: Susanne Raup
PROPERTY ADDRESS: 824 NE 100 St Miami, FL 33138
LOT: 8 BLOCK: 169 SUBDIVISION: Miami Shores Sec. 8
PROPERTY ID #: 11-3206-034-0050 [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 existinq septic tank CAPACITY
A [ ] GALLONS / GPD CAPACITY
N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ ]
D [ 300 ] SQUARE FEET bed confquration drainflel SYSTEM
R [ ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [x] STANDARD [ ] FILLED [ ] MOUND [ ]
I CONFIGURATION: [ ] TRENCH [xl BED [ ]
N
F LOCATION OF BENCHMARK: FFE 13.5'NGVD
I ELEVATION OF PROPOSED SYSTEM SITE [ 25.20 ] [ INCHES FT ] [ABOVE BELOW BENCHMARK/REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 75.201 [ INCHES FT ] [ABOVE BELOW BENCHMARK/REFERENCE POINT
L
D FILL REQUIRED: [ l INCHES EXCAVATION REQUIRED: [ 62.00 ] INCHES
1.-Existing 900 gal.septic tank,certified by Mr.C's Plumbing&Septic Inc on 05/24/2016,to remain.
O 2.-Install 300 sf of drainfield in bed configuration.
T 3.-Install 12"of slightly limited soil at the bottom of the drainfield.
4.-Perimeter of excavation area shall be at least 2 ft wider and longer than the proposed absorption bed or drain trench.
H 5.-Invert elevation of drainfield no less than 7.73'NGVD. 6.-Bottom of drainfield elevation no less than 7.23'NGVD.
E 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. "THIS REPAIR PERMIT IS NOT FOR ANY ADDITIONS•"
R
SPECIFICATIONS BY: Kemble Ettrick TITLE:
APPROVED BY: Ir TITLE: Engineering Specialist II Dade CHD
Erlande omisca
DATE ISSUED: 05/26/2016 EXPIRATION DATE: 08/24/2016
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E-6.003, FAC �4g,, fi/�- SM �{ �
v 1.1.4 AP1241141 S@�r3 � ��ld����d CPOG �P
The contractor(or des cin )is required to perform a soil boring
ao'acent to d�irP•eld excavation at the time of final
r -miction. F „r ; cinaipm`�al, tt e FpOH inspector shall
`, t�,z the so; ker ng and compare the resu'ts to the or glnal
=`•e evzlua!on s.:bmit?ed. ti reinspection `ee v-'lk be assessea
t,,e n.trecior is not at the jobsrte at the array wd !'n e•
NOTICE OF RIGHTS
A party whose substantial interest is affected by this order may petition for an
administrative hearing pursuant to sections 120.569 and 120.57, Florida Statutes. Such
proceedings are governed by Rule 28-106, Florida Administrative Code. A petition for
administrative hearing must be in writing and must be received by the Agency Clerk for the
Department,within twenty-one (21) days from the receipt of this order. The address of the
Agency Clerk is 4052 Bald Cypress Way, BIN#A02, Tallahassee, Florida 32399-1703. The
Agency Clerk's facsimile number is 850-410-1448.
Mediation is not available as an alternative remedy.
Your failure to submit a petition for hearing within 21 days from receipt of this order
will constitute a waiver of your right to an administrative hearing, and this order shall become
a'final order'.
Should this order become a final order, a party who is adversely affected by it is
entitled to judicial review pursuant to Section 120.68, Florida Statutes. Review proceedings
are governed by the Florida Rules of Appellate Procedure. Such proceedings may be
commenced by filing one copy of a Notice of Appeal with the Agency Clerk of the
Department of Health and a second copy, accompanied by the filing fees required by law,
with the Court of Appeal in the appropriate District Court. The notice must be filed within 30
days of rendition of the final order.
r
STATE OF FLORIDA APPLICATION # AP1241141
-' DEPARTMENT OF HEALTH PERMIT # 13-SC-1684487
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM DOCUMENT # SE996979
SITE EVALUATION AND SYSTEM SPECIFICATION
APPLICANT: Susanne Raup
CONTRACTOR / AGENT: Mr C"s Plumbing&Septic Inc
LOT: 8 BLOCK: 169
SUBDIVISION: Miami Shores Sec.8 ID#: 11-3206-034-0050
TO BE COMPLETED BY ENGINEER, HEALTH DEPARTMENT EMPLOYEE, OR OTHER QUALIFIED PERSON. ENGINEERS MUST
PROVIDE REGISTRATION NUMBER AND SIGN AND SEAL EACH PAGE OF SUBMITTAL. COMPLETE ALL ITEMS.
PROPERTY SIZE CONFORMS TO SITE PLAN: [X]YES [ ]NO NET USABLE AREA AVAILABLE: 0.20 ACRES
TOTAL ESTIMATED SEWAGE FLOW: 400 GALLONS PER DAY [ RESIDENCES-TABLET / OTHER-TABLE 2 ]
AUTHORIZED SEWAGE FLOW: 500.00 GALLONS PER DAY [ 1500 GPD/ACRE OR 1 2500 GPD/ACRE ]
UNOBSTRUCTED AREA AVAILABLE: 450.00 SQFT UNOBSTRUCTED AREA REQUIRED: 450.00 SQFT
BENCHMARK/REFERENCE POINT LOCATION: FFE 13.5'NGVD
ELEVATION OF PROPOSED SYSTEM SITE 25.20 [ INCH83 / FT ] [ ABOVE /FLOW]] BENCHMARK/REFERENCE POINT
THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES
SURFACE WATER: N/A FT DITCHES/SWALES: N/A FT NORMALLY WET: [ ]YES [ ]NO
WELLS: PUBLIC: N/A FT LIMITED USE: N/A FT PRIVATE: N/A FT NON-POTABLE: N/A FT
BUILDING FOUNDATIONS: 5 FT PROPERTY LINES: 15 FT POTABLE WATER LINES: 75 FT
SITE SUBJECT TO FREQUENT FLOODING? [ ]YES [X]NO 10 YEAR FLOODING? [ ]YES [X]NO]
10 YEAR FLOOD ELEVATION FOR SITE: FT [ MSL /FE11 SITE ELEVATION: 11.40 FT [ MSL / NGVD
SOIL PROFILE INFORMATION SITE 1 SOIL PROFILE INFORMATION SITE 2
USDA SOIL SERIES: Urban land USDA SOIL SERIES: Urban land
Munsell#/Color Texture Depth Munsell#/Color Texture Depth
10YR 3/1 Fill-Sand 0 To 40 10YR 3/1 Fill-Sand 0 To 40
REFUSAL Fractured Rock 40 To 40 REFUSAL Fractured Rock 40 To 40
OBSERVED WATER TABLE: INCHES [ ABOVE / BELOW ] EXISTING GRADE TYPE: [ PERCHED / APPARENT ]
ESTIMATED WET SEASON WATER TABLE ELEVATION: 94 INCHES [ ABOVE / FLOW ] EXISTING GRADE
HIGH WATER TABLE VEGETATION: [ ]YES [X]NO MOTTLING: [ ]YES [X]NO DEPTH: INCHES
SOIL TEXTURE/LOADING RATE FOR SYSTEM SIZING: Replacement 4-FS/0.60 DEPTH OF EXCAVATION: 62 INCHES
DRAINFIELD CONFIGURATION: [ ] TRENCH [XI BED [ ] OTHER (SPECIFY)
REMARKS/ADDITIONAL CRITERIA
SITE EVALUATED BY: DATE: 05/24/2016
Ettrick,Kemble(Title:)(Mr C"s Plumbing)
DH 4015, 08/09 (Obsoletes previous editions which may not be used) Incorporated: 64E-6.001, FAC Page 3 of 4
AP1241141 EID1684487 v 1.0.2