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PL-16-2212 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-264868 Permit Number: PL-8-16-2212 Scheduled Inspection Date: September 26,2016 Permit Type: Plumbing - Residential Inspector: Hernandez, Rafael Inspection Type: Final Owner: RASSIF,JENNA Work Classification: Drainfield Job Address:10634 NE 11 Court Miami Shores, FL 33138- Phone Number (305)308-4774 Parcel Number 1122320280440 Project: <NONE> Contractor: MR C'S PLUMBING&SEPTIC INC Phone: (305)651-7859 Building Department Comments SEPTIC TANK& DRAINFIELD INSTAL Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed HRS IS FILE Failed Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. September 23,2016 For Inspections please call: (305)762-4949 Page 16 of 36 A, Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-264869 Permit Number: PL-8-16-2212 Scheduled Inspection Date: September 26, 2016 Permit Type: Plumbing - Residential Inspector: Hernandez, Rafael Inspection Type: HRS Approval Owner: RASSIF,JENNA Work Classification: Drainfield Job Address:10634 NE 11 Court Miami Shores, FL 33138- Phone Number (305)308-4774 Parcel Number 1122320280440 Project: <NONE> Contractor: MR C'S PLUMBING&SEPTIC INC Phone: (305)651-7859 Building Department Comments SEPTIC TANK&DRAINFIELD INSTAL Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments P Passed Failed Correction ❑ Needed Re-Inspection Fee No Additional Inspections can be scheduled until re-inspection fee is paid. September 23,2016 For Inspections please call: (305)762-4949 Page 17 of 36 i oivtsAUM OF °� Environmental Heatth `Q Florda,Health Maml-Dade County eQ� OSTDS%Well Division, Q` 11805 SW 26th Street•Miaml,FL 33175 . � Inspector � C��'1. ' Date Address �� '�'� _ � f/d ()STDs# 12f0'��J Comments: All ` Signature V 2,12 ', yKs y� Miami Shores Village = ■ Pew i"' It#iit � i +lntiai 10050 N.E.2nd Avenue NE �v Miami Shores,FL 33138-0000 X Phone: (305)795-2204 fTtlSi`ti APP�R � Expiration: 02/1112017 7777 Af, Project Address Parcel Number Applicant 10634 NE 11 Court 1122320280x40 Miami Shores, FL 33138- Block: Lot: JENNA RASSIF Owner Information Address Phone Cell JENNA RASSIF 10634 NE 11 Court (305)308-4774 MIAMI FL 33138- 10634 NE 11 Court MIAMI FL 33138- Contractor(s) Phone Cell Phone Valuation: $ 6,500.00 MR C'S PLUMBING&SEPTIC INC (305)651-7859 Total Sq Feet: 200 Type of Work:SEPTIC TANK&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-8-16-60897 CCF $4.20 08/05/2016 Credit Card $50.00 $779.20 DBPR Fee $4.50 DCA Fee $4.50 08/15/2016 Check#: 1317 $500.00 $279.20 Education Surcharge $1.40 08/15/2016 Credit Card $279.20 $0.00 Permit Fee $300.00 Bond#:3194 Scanning Fee $9.00 Technology Fee $5.60 Total: $829.20 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 a urate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore,I authorize the above-named ntractor to do the work stated. August 15,2016 Authorized Signature:Owner / Applicant / Contractor / Agent Date Building Department Copy August 15,2016 1 � . Miami Shores Village C7�A `7_1�� Building Department 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 BY: Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 - FC 2® BUILDING Master Permit No.�? - 21 PERMIT APPLICATION Sub Permit No. ❑BUILDING ®ELECTRIC ❑ ROOFING ❑ REVISION ® EXTENSION ❑RENEWAL I a PLUMBING ❑MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ®CANCELLATION ❑ SHOP ICONTRACTOR DRAWINGS JOB ADDRESS: /04,13L/y NC_ O//� (611(f-t Ci Miami Shores County Miami Dade zip: 3 313 8 Follo/ParcelM Is the ing Historically ted:Yes NO p l Occupancy Type: Load: Construction Type: / Flood Zone: BFE: FFE: / OWNER:Name(Fee Simple Titleholder): �f�N� ®L�F ®l�f ""�J /F Phone#: 3�; 3 0'y 7 7 Address: / C T i City: State: �� zip: Phone#: Tenant/Lessee Name: Email: ��NNA, '8AES I F TAC(SaN L.EIA/!S ('U/�{ I CONTRACTOR,Company Name: Mr C's Plumbing and Septic Phone#: 305 6517859 Address: 19932 NW 2 Ave City_ Miami state: FL zip: 33169 Qualifier Name: Kemble EttriC)c Phone#: 305 6517859 r State Certification or Registration#: SR061536 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ �D. w Square/linear Footage of Work: Type of Work: ElAddition ❑ Alteration ❑ New ® R epair/Replace ❑ Demolition Description of Work: Specify colors of color thru tile: Submittal Fee$vv ` c Permit Fee$ ! CCF S . 20 C0/CC S Scanning Fee$ ,�� Radon Fee$ ( �� DBPR$ Notary$ Technology Fee$ .�c�C'1 Training/Educadon Fee$ I. U Double Fee$ Structural Review$ Bond$ yam — TOTAL FEE NOW DUE$ 2-0 (RevisedO2/24/2014)�. �� Zonding 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 OWNERS 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 opp/icont 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 cert#1ed 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 OWNER or T U CONTRACTOR The foregoing instrument was acknowledged beforemethis The foregoing instrument was acknowledged before me this 7 day of U Us7 20 Jv ,by day of �r .20 JK •by �0. 5 I who is personally known to r who is personally known to me or who has prod me or who has produced as identification and w a,:►61 My Public-State of Florida identification and • aaunq -•. =My Comm. Expires Sep 19,2017 �.trnyPQ10. SHERYL A MENDES NOTARY Pik � s Commission#FF 055732 NOTARY PUBLIC: ,ter° moo', Notary Public-State of Florida „",` Bonded Through National Notary Assn. My Comm.Expires Oct 23,2018 11 � /Commission#FF 136597 Sign: Sign: National Notary A-w Print: Print.• L Seal: Seal: APPROVED BY G '' • Plans Examiner Zoning Structural Review Clerk (RevMW2/24/2014) PERMIT #: 13-SM-1699085 STATE OF FLORIDA APPLICATION #:AP1250555 _ r DEPARTMENT OF HEALTH DATE PAID: ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM FEE PAID: CONSTRUCTION PERMIT RECEIPT #: •�� we DOCUMENT #:PRI 028003 CONSTRUCTION PERMIT FOR: OSTDS Repair APPLICANT: JENNA RASSIF PROPERTY ADDRESS: 10634 NE 11 Ct Miami, FL 33138 LOT: 16 BLOCK: 3 SUBDIVISION: Miami Shores Estates PROPERTY ID #: 1122320280440 [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 NEW Septic TANK CAPACITY �°Q?o�a�e��e A [ 0 l GALLONS / GPD CAPACITY �epV`�ee `r N [ 0 l GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1?eTQ`y �d�°ed•P�'�S�` K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES D [ 200 ] SQUARE FEET DF IN BED CONFIGURAT sxsxEM 'NST ,aace�eti�o sS re��\a�aae`�°rtre° R [ 0 l SQUARE FEET SYSTEM A TYPE SYSTEM: [XI STANDARD [ ] FILLED [ ] MOUND [jso�� ayra oa ve�aaea I CONFIGURATION: [ ] TRENCH IXI BED [ l S, N ` yp`�S'\%P F LOCATION OF BENCHMARK: FFE...............7.40'NGVD I ELEVATION OF PROPOSED SYSTEM SITE [ 26.401 [ INCHES FT ] [ ABOVE BELOW BENCHMARK/REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ 46.40 ] [ INCHES FT ] [ABOVE BELOW BENCHMARK/REFERENCE POINT L D FILL REQUIRED: [ 0.001 INCHES EXCAVATION REQUIRED: [ 32.00 ] INCHES 1.-Install a NEW 900 gal.septic tank with an approved filter O 2.-The licensed contractor installing the system is responsible for installing the minimum category of tan T with s.64E-6.013(3)(f)FAC. H 3.-Install 200 sf.of drainfield in bed configuration. 4.-Install 12"of slightly limited soil at the bottom of the drainfield. E 5.-Perimeter of excavation area shall be at least 2 ft wider and longer than the proposed absorptio ' or trench. R (Comments Continued on Page 2.) SPECIFICATIONS BY: Ge2pn L Philizaire TITLE: Engineering Specialist II APPROVED BY: TITLE: Engineer Supervisor III Dade CHD Astrid V Edwards DATE ISSUED: 08/03/2016 EXPIRATION DATE: 11/01/2016 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 AP1250555 SE1003881 „ OH 4018, 08/08 (Obsoletes previous eatioas Vhiab may not be used) -' Incorporated 64£-6.001, I= Page 1 of 4 i ME STATE OF FLORIDA DEPARTMENT OF HEALTH APPLICATION FOR ONSITE SEWAGE DISPOSAL.SYSTEM CONSTRUCTION PERMIT Pei AppkaMon Number, -----------_---------------PART 11-3iTEPLAN---------- ----------------- i Std EaO bkwk t 10 aid 1 hwh=40 fest. rt T-1 LJ Lr 'F 3'< S M 7 ; EEEE': a i • a L I barelk4y sww•.B�haeswl W and waa%=ft StresZ04nMwaged”i;;. E;p 1063(f rs Gf- c � 33ls V+V Sw Ptan Batu by - Pian AWavei Not Approved Date BY County Health Department ALL CHANM MUST SE"PROM BY THE COUNTY HEALTH DEPARTMENT i ON 4016.1088 Mases HIiB•H Fant 4016 w*ch maybe Page Z d 4 (8 w a[OlfPfbet:6744-002 K1" 3£ iEt s=s£ [s..rl��..v.. ........................uLvua......,...u..�_. .., ,��,_.. �....................�........mew............... a3a F.a2...v,�.�....,.....�... .....a......w,.....lw..w STATE OF FWRMA DEQ OF IMALTH OVSXTE SENA= TREATMMT MW DSSPOSn SYSTM SITE WALDATICS AM SUM Spacmc• cm APMUST:Jana A :lit CSPUBHUNG68EPtiC Lw.,10 Brd=:a s01Dt1IVI8ION•andshmi