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PL-16-2211 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores,FL Phone: (305)795-2204 Fax: (305)7564972 Inspection Number: INSP-264865 Permit Number: PL-8-16-2211 Scheduled Inspection Date: October 27,2016 Permit Type: Plumbing - Residential Inspector: Hernandez, Rafael Inspection Type: Final Owner: ROSSY,PEDRO Work Classification: Drainfield Job Address:965 NE 92 Street Miami Shores, FL Phone Number (305)298-1665 Parcel Number 1132060060040 Project: <NONE> Contractor: MR C'S PLUMBING S SEPTIC INC Phone: (305)651-7859 Building Department Comments DRAINFIELD INSTAL Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed Failed , Correction a Needed Re-Inspection Fee No Additional Inspections can be scheduled until re-inspection fee is paid. \a\V SWI \ Vp A IS ^* l IF mg de e' U R 4 r, Miami Shores Village Petr . fy 10050 N.E.2nd Avenue NEoI�t3STJl � �ra� �(t3 Miami Shores,FL 33138 0000 Phone: (305)795-2204 SEX Expiration: COR1pp' 8 2/08/2017 Project Address Parcel Number Applicant 965 NE 92 Street 1132060060040 STEVEN KLICK Miami Shores, FL Block: Lot: Owner Information Address Phone Cell PEDRO ROSSY 965 NE 92 Street (305)298-1665 MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone Valuation: $ 3,500.00 MR C'S PLUMBING&SEPTIC INC (305)651-7859 Total Sq Feet: 300 Type of Work:DRAINFIELD INSTAL 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 Bond Type-Owners Bond $500.00 Invoice# PL-8-16-60896 CCF $2.40 08/05/2016 Credit Card $50.00 $619.90 DBPR Fee $2.25 DCA Fee $2,25 08/12/2016 Credit Card $ 119.90 $500.00 Education Surcharge $0.80 08/12/2016 Credit Card $500.00 $0.00 Permit Fee $150.00 Bond#:3193 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 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. August 12, 2016 Authorized Signature:Owner / Applicant / ntractor / Agent Date Building Department Copy August 12,2016 1 Miami Shores Village p Ja Building Department A o 016 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION UNE PHONE NUMBER:(305)762-4949 E FBC 201' BUILDING Master Permit I PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ELECTRIC ® ROOFING ® REVISION ❑ EXTENSION ®RENEWAL f I 0 PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ®CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS /[ L ,OB ADDRESS: �0 ✓ �c= f� r/ City Miami Shores County- Miami Dade 290: 3 7 67I Fano/Parcel#: /I- 3 a o 6 0a 6 O)g� Is the Building Historically :Yes No Occupancy Type: Load: Construction Type: Flood Zone: SFE: fFE: OWNER:Name(Fee Simple Titleholder): ��r, �� Phone#: Address: 265— AAF eZ-Sf' City: State: i6G rip: Phone#: Tenant/Lessee Name: Email: Mr C's Piumbin and Septic Phone#: 305 6517859 CONTRACTOR:Company Name: 9 Address: 19932 NW 2 Ave City: Miami state: FL Zip: 33169 Qualifier Name: Kemble Ettrick Phone#: 305 6517859 f SR061536 State Certification or Registration#: Certificate of Competency#: j DESIGNER:Architect/Engineer: Phone#: Address: City: ___,_State: Zip: Value of Work for this Permit:$ 3 Sim ,�� Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ® Repair/Replace ❑ Demolition Description of Work: .Specify color oo/f�color thru tile: Subernittal Fee$ LJ�' Permit Fee$ �� CCF$ U t0/CC$ Scanning Fee$ ::T' C10 Radon Fee$ 2 5 DBPR$ 2 Notary$ Technology Fee$ ' . 2® Training/Education Fee$ C3 Double fee$ Structural Reviews$ Bond GOO . TOTAL FEF NOW DUE$ (Revised02/24/2014) J B&Wing Corhpany's Name(if applicable) Bonding Company's Address _ City State Zip Mortgage lender's dame(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. t 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. t 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." t Notice to Applicant. As a condition to the issuance of a building permit with an estimated value exceeding$25W, the applicant must promise in good faith that a copy of the notice of commencement and construction lien low 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 wilt be charged. Signature Signature OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of 20 ,by day of (d S-r— .20 ,by who is personally known to who is personally known to me or who has produced ='ry 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: Sign: �. �.,,, KEMBLE ETTRICK print• -.6- Print: ""Sky P(,B,, ; ue` Notary Public-State of Florida Seal: ?•; My Comm.Expires Sep 19,2017 Seal: - %�y� 'oe= Commission#FF 055732 - t Q?My Comm.Expires Oct 23,2018 Bonded Through National Notary Assn -%�; �F`°�°•' Commission#FF 136597 auni" Bonded Through National Notary Assn. ***s*****sssssssssssssots*ss*sss*sss*sssfsffs+•ssswsssss*ssssss*ss*s**s***ss APPROVED BY04A Y` Plans Examiner Zoning Structural Review Clerk (Revnsea02/24/2014) PERMIT #:13-SC-1698309 APPLICATION #:AP 1250106 STATE OF FLORIDA DATE PAID: DEPARTMENT OF HEALTH ONSITE SENA= TREATMENT AND DISPOSAL SYSTEM FEE PAID: CONSTEWCTION PERMIT RECEIPT #: DOCUMENT #:PRI 027737 CONSTRUCTION PERMIT FOR: OSTDS Repair APPLICANT: Steven Klidc PROPERTY ADDRESS: 965 NE 92 St Miami,FL 33175 LOT: 4 BLOCK: SUBDIVISION: PROPERTY ID #: 11-3206-006-0040 [SECTION, TOWNSHIP, RANGE, PARCEL NUMBER] [OR TAX ID NUMBER] SYSTEM MUST BE CONSTRUCTED IN ACCOr4XV 6 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 =wm%NCE WITH OTHER FEDERAL, STATE, OR LOCAL PERMITTING REQUIRED FOR DEVELOPMENT OF THIS PROPERTY. SYSTEM DESIGN AND SPECIFICATIONS T [ 900 ] GALLONS / GPD EXISTING Septic TO REMAIN CAPACITY A [ 0 ] GALLONS / GPD CAPACITY N [ 0 l GALLS Gran= INTERCEPTOR CAPACITY [bawmMuM CAPACITY SINGLE TANK:1250 aArrnN K [ ] S DOSING TANK CAPACITY [ ]GALLONS @[ ]MOSES �Pf "Z" 13 '� ��.�"ii\gid •�,��'�Cu' �;^•t`. .,.`_:�_C: '"' ,�;ttil D L 300 ] FEET DF IN BED CONFIGURAT SYSTEM :} ,; '`.� , �� y ;.•. v+ FEET SYSTEM S+ \'•��=,1` �� F .t.``° R [ 0 ] SQUARE , A TYPE SYSTEM: Ixl STADIDARD [ ] FILLED [ ] MOUND I CONFIGURATION: [ ] TRENCH [xJ BED [ ] -�`'� U;,�,�v.,t•`cCr�' N p l , F LOCATION OF BENCHMARK: FFE.............11.WNGVD I ELEVATION OF PROPOSED SYSTEM SITE [ 3.60 ] INCHES ][ABOVE/BENCHMARK/REFERENCE POINT E BOTTOM OF DRAIIUIELD TO BE [ 41.52]fn—W—M--ST FT ][ABOVE�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. D 2.- Install 300 sf.of drainfield in bed configuration. T 3.-Install 12"of slightly limited soil at the bottom of the drahiWd. H 4:Perimeter of excavation area shall be at least 2 ft wider and longer than the proposed absorption`i d or,trench. (Comments Continued on Page 2.) E R SPECIFICATIONS BY: L Philizaire TITLE: Engineering Specialist II APPROVED BY: TITLE: Engineer Supervisor III Dade CHD- trid v F�+TMa8 DATE ISSUED: 06/01/2016 EXPIRATION DATE: 10/30/2016 DH 4016, 08/09 (Obsoletes all previous editions Which may not be used) Incorporated: 64E-6.003, FACPage 1 of 3 v 1.1.4 AP1250106 SE1003618 ■��NEIMEE INONO MMmMMMMMMMMM MMMmmMM mom No I��r��t■ ■N�`Mmmm MSMMMMMMMMMMINNMMMEN ME ftl4olumml mom ME wida MMMMKMMM ■sl��:'��IC�S��i��rWi1��11�fiir��t■ ■��MMINNIMM■MEMEMMIEms ININMEMM■ 1A 71 M. [ILI lirIEJ IS OlMNLi r, �� H [ - Oki