PL-16-1782 Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores,FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number. INS P-261937 Permit Number: PL-6-16-1782
Scheduled Inspection Date: October 18,2016 Permit Type: Plumbing - Residential
Inspector: Hernandez, Rafael
Inspection Type: Final
Owner: QUIJADA, ISABEL Work Classification: Drainfield
Job Address:103 NW 97 Street
Miami Shores, FL 33150- Phone Number
Parcel Number 1131010260090
Project: <NONE>
Contractor. STATEWIDE SEPTIC CONNECTIONS Phone: (954)963-0082
Building Department Comments
INSTALL NEW 500 SQF BED DRAINFIELD Infractio Passed Comments
INSPECTOR COMMENTS False
Inspector Comments
Passed HRS ON FILE
Failed
Correction ❑
Needed
Re-Inspection 0
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid.
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Miami Shores Village ��M It Yl )i1t1t )� R@i id' ti
10050 N.E.2nd Avenue NW
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•'• Miami Shores,FL 33138-0000
Phone: (305)795-2204 Ps All
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Ex iration: 12/26/2016
Project Address Parcel Number Applicant
103 NW 97 Street 1131010260090
Miami Shores, FL 33150- Block: Lot: ISABEL QUIJADA
Owner Information Address Phone Cell
ISABEL QUIJADA 103 NW 97 ST
MIAMI FL 33150-1734
Contractor(s) Phone Cell Phone Valuation: $ 2,100.00
STATEWIDE SEPTIC CONNECTIONS (954)963-0082
Total Sq Feet: 500
Type of Work:INSTALL NEW 500 SQF BED DRAINFIELD 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 $1.80
DBPR Fee Invoice# PL-6-16-60349
$2.25 06/27/2016 Check#:6116 $50.00 $118.30
DCA Fee $2.25
Education Surcharge $0.60 06/29/2016 Check#:6119 $ 118.30 $0.00
Permit Fee $150.00
Scanning Fee $9.00
Technology Fee $2.40
Total: $168.30
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 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 o do the-Ovork state .
� June 29,2016
Authorized Signature:Owner / Applicant / Contractor / Agent Date
Building Department Copy
June 29,2016 1
Miami Shores Village
Building Department JUIN 212016 E
a 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 20
BUILDING Master Permit No. -PL i6- n-bz
PERMIT APPLICATION Sub Permit No.
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION [:]RENEWAL
LUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
(— CONTRACTOR DRAWINGS
JOB ADDRESS:
Com: Miami Shores County: Miami Dade Zip: '?)?aI so
Folio/Parcel#: 1( —3 I Q ( — 0 2 —®0 q 0 Is the Building Historically Designated:Yes NO¢/
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): )(A d Q Phone#:
Address: ® tj V4 �(r� S�
City:�1 f��`") S4'10ir—e—X State: Zip: 153190
Tenant/Lessee Name: Phone#:
Email: 1
CONTRACTOR:Company Name: 1 `'����� CQ C' l C &+Y,!; ( "Aone#: ('
Address: ff-�65 0 A,� 4-- (c)
City: 0a L c fe-q C State: i Zip: Za 3os Lo
Qualifier Name: _T �+S 4 Ll t'��.-� Phone#:
State Certification or Registration#: 3 moq-7(2� Z Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:0-100 Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace ❑ Demolition
Description of Work:
V, A I N e t-y J�
.a#a.., v�- gp3Rsrs$ !'• �:, T d • 111:9 � � 4°,: N
Specify colo'of f*or, 4fMj+,jjp: 47
2081Af'n'r Erb.
Submittal Fee$ as-g Permit Fee$ ;' / 0 CCF$ s ESL°? 8a4� :,ux,co y
Scanning Fee$ Radon Fee$ �"�` DBPR$ ... 0 Notary$
Technology Fee$ D' �� Training/Education Fee$ G` (Sri Double Fee$ 0
Structural Reviews$ Bond$ ,5— (�
TOTAL FEE NOW DUE$ I ° 30
(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 a
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrum.nt was acknowledged before me this
day of 20 by day of 20 k-0 , by
who is personally known to who is personally known to
me or who has produced as me or who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: t1 Sign:
Print: Print: V" 0 .
Seal: JUM L.AIIIIIIIIIIISTRIM11 Seal:
s
Un Il4i k-snit a lHorld>t „��•
`;►�"'�'4a, J><ItRl�A4i1NMSTl�
Ct mWian 0 FF 1l1� Nott y PWft-State of Florida
*' •,moi e:� +!! * �
'•.FOFc�go• My Comm.Expires Fen '.l,2019
APPROVED BY L � Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
$TATE OF FLORIDA PERMIT #: 13-SC-1633283
DggAR2XM= OF HEALTH APPLICATION s:AP1206355
ONSITE TREAD' J= DI8I?O= DATE PAID:
FM PAID:
CONSTRUMIOD TRECEIPT 0:4P.
:
parr s: PR992693
CCW8aV CT1GN PERs4XT NICK: OSTDS ExiWng Modification
APPLICANT: lsaW Quijada
PROPERTY ADDRESS. 103 NW 97 St Mismi, FL 33150
LM: 9 BLOCK: 2 SUBDIVISION:
PROPERTY ID #: 11-3101-026-M [SECTION, TOMWIP, RANGE, PARCEL ICER)
JOR TAX ID NMOER)
SYSTEM MUST BE CONSTRUCTED IN ACCOFMMM WITH SPECIFICATIONS AND STANDARDS OF SECTION
381.0065, F.S., AND CHAPTER 642-6, F.A.C. DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE
SATISFACTORY PERFMOMCE FOR ANY SPECIFIC PERIOD OF TIME. ANY CHANGE IN MATERIAL FACTS,
WHICH SERVED AS A BASIS FOR ISSUANCE OF THIS PERMIT, REQUIRE THE APPLICANT To WDIFY THE
PERMIT APPLICATION. SUCH NODIFICATICNS MAY RESULT IN THIS PERMIT BEING MADE NULL AND VOID.
ISSUANCE OF THIS PERMIT DOES NOT E=MPT THE APPLICANT FROM CMdPLIANCE WITH OTHER FEDERAL,
STATE, OR LOCAL. PERMITTING REQUIRED FOR DEVELOPMENT OF THIS PROPERTY.
SYSTEM DESIGN AMID SPECIFICATIONS
T E 900 ] GALIA)NS / GPD Existing Septic tank to remain CAPACITY
A [ ] GAIJAW { GPD WA CAPACITY
N t I GA=NS GREASE INTERCEPTOR CAPACITY (MASIMUM CAPACITY SINGLE TANK:1250 GAL.LMS1
K [ ] GALLONS DOSING TANK CAPACITY I IGALU MS @t )DOSES PER 24 HRS #Pumps [ )
D [ r300 I SQUARE FEET bed Configuration drainfiel SYSTEM
R [ I SQUARE FEST NIA SYSTEM
A TYPE SYSTEM: [$) STANDARD I I FUZJM I I MOUND [ I
I CoNFIGURATION: I I TRENCH Is) BED I I
N
F 1OCAT10W OF BENCHMARK-- CL NW 1 ave.&97 st., 10.20'BNGVD
I ELVMTION OF PROPOSED SYSTEM SITE [ 13.20 I INCHES FTI[ At3av2 BELOW) POINT
E BOTTOM of DRAINFIELD TO BE 116.80 l d—n=MSj FT )[ABOVE�BMCBMARK/RZFEREUM POINT
L
D FILL REQUIRED: [ 0.00I INams EXCAVATIom REQUIRED: t 30.003 INKS
O -An approved outlet filter shah be installed.
-Invert elevation of drainflieid to be no less than 9.30'NGVD.
T -Bottom of drainfield elevation to be no less than 8.80'NGVD.
H The system is sized for 3 bedrooms Wb a maximum occupancy of 6 persons(2 Per bedroom),for a total estimated flow
of 300 gpd.
E
R
SPSCZFICATIDMiB BY: Teresa J Solomon TITLE: Master Septic Tank Contractor
Date CHD
APPROVED BY: TITLE:
a area
DATE ISSUlvD: 10f30i2015 EdwrMION DATE: 0+4/3Q12017
DH 4015, 08/09 (Obsolet®S all previous edat:ions which may not be used) Page i of 3
Inmxporatel: 64E-6.003, FAC