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PL-16-2552 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores,FL Phone: (305)795-2204 Fax:(305)756,8972 Inspection Number: INSP-267391 PermitNumber: PL-9-16-2552 Scheduled Inspection Date: November 15,2016 Permit Type: Plumbing -Residential Inspector. Hernandez,Rafael Inspection Type: Final Owner: DEROSA,JAMIE S AMY B Work Classification: Dminfield Job Address:1173 NE 103 Street Miami Shores,FL 33138-2651 Phone Number (561)699-2428 Parcel Number 1122320310070 Project <NONE> Contractor. MR C'S PLUMBING&SEPTIC INC Phone: (305)6517859 Building Department Comments DRAINFIELD TO BE REPLACED Infractio Passed comments INSPECTOR COMMENTS False Inspector Comments Passed HRS ON FILE Failed Correction Needed Re-Inspection Fee No Additional Inspections can be scheduled until re-inspection fee is paid DIVISION OF 444�4" Environmental Health Florida Health %Aw Miami-Dade County e01OOSTDS/Well Division 11805 SW 26 Street•Miami,FL 33175 �� O s �M � Inspector Date Address �� gAlf ld"V OSTDS# 4101 ZSo ke} Comments: Or Signature �i 3 i� Miami Shores Village 41ltd 1411, 10050 N.E.2nd Avenue NE 1 .... Miami Shores,FL 33138-0000Al Phone '�305 795-2204 �� r � � e ti " L �D� 3 395 I. ... 1q, f 3 Expiration: 03619/2017 Project Address Parcel Number Applicant 1173 NE 103 Street 1122320310070 JAMIE&AMY B DEROSA Miami Shores, FL 33138-2651 Block: Lot: Owner Information Address Phone Cell JAMIE&AMY B DEROSA 1173 NE 103 Street (561)699-2428 MIAMI SHORES FL 33138- 1173 NE 103 Street 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 TO BE REPLACED Available Inspections: Type of Piping: Inspection Type: Additional Info:DRAINFIELD TO BE REPLACED HRS Approval Bond Retum: Final Classification:Residential Scanning:1 Review Plumbing Fees Due Amount Pay Date Pay Type Amt Paid Amt Due Bond Type-Owners Bond $500.00 Invoice# PL-9-16-61353 CCF $2.40 DBPR Fee $2.25 09/20/2016 Check#:1999 $500.00 $163.90 DCA Fee $2.25 09/20/2016 Credit Card $ 113.90 $50.00 Education Surcharge $0.80 09/15/2016 Credit Card $50.00 $0.00 Permit Fee $150.00 Bond#:3216 Scanning Fee $3.00 Technology Fee $3.20 Total: $663.90 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 ac urate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore,I authorize the above-named tractor to do the work stated. September 20,2016 Authorized Signature:Owner / Applicant / Contractor / Agent Date Building Department Copy September 20,2016 1 Miami Shores Village l g g��, 2016 Building Department BY: 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 2014 BUILDING Master Permit No.VL q — 116 '-22552 PERMIT APPLICATION Sub Permit No. ®BUILDING ❑ELECTRIC ❑ ROOFING ❑ REVISION ❑ DXTENSION ❑RENEWAL PLUMBING ❑MECHANICAL ®PUBLIC WORKS ❑ CHANGE OF ® CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 1173 NE 103 ST City: Miami Shores County: Miami Qade Zip: Folio/ParceKf: 11-2232-031-0070 Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: F Flood Zone: BFE: I FFE: OWNER: Name(Fee Simple Titleholder):JAIME DEROSA Phone#:561-699-2428 Address: 1173 NE 103 ST City: MIAMI State: FL Zip: 33138 Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: MR C's PLUMBING &SEPTIC Phone#: 3056517859 Address: 19932 NW 2 AVE City: MIAMI State: FL Zip: 33169 Qualifier Name. KEMBLE ETTRICK Phone#: 3056517859 State Certification or Registration#: SR061536 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$3500.00 Square/Linear Footage of Work: 300 Type of Work: ❑ Addition ❑ Alteration ❑ New El Repair/Replace ❑ Demolition Description of Work: DRAINFIELD TO BE REPLACED ,Specify color of color thru die: Submittal Fee$ • Perm1tFee$ Cos 5). cam, n Co/CC$ S� Scanning Fee$ �' Radon Fee$ Z • 2S` DBPR$ 2. 2S Notary$_,� TecMologV Fee$ 3. 20 Training/Education Fee$ Double Fee$ Structural Review$ Bond$ SM, Q TOTAL FEE NOW DUE$ . (3 - �n (Revised02/24/2094) G(3 •9O Bonding company's Name(if applicable) N/A Bonding Company's Address city State Zip Mortgage Lenders Name(if applicable) N/A Mortgage Lenders 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. 1 understand that a separate permit must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS, FURNACES,BOILERS,HEATERS,TANKS,AIR CONDITIONERS,ETC..... OWNER'S AFFIDAVIT: 1 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$250,the applicant must promise In good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property Is subject to attachment. Also,a cert/fled copy of the recorded notice of commencement must be posted at the Job site for the first Inspection which occurs seven (7)days after the building permit is issued. In the o¢such posted notice, the Inspection will not be appro and a reinspection fee will be charged. Signature Signature NER or AGENT CONTRACTOR The foregoing IrhstrumeM was acknowledged before me this The formoing instrument was acknowledged before me this _ day ofd 14 20 by �_day of�V��Mf .20_!�by r-%� DPYs,�, ,who is personally known to who Is personally known to me or who has produced C as me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: ' Sign: ",'pr PUe''s ),AV Print: 4Lfftm 111gPPN Print• MY CO Mi ION#FF171659 Seal: EXPIRES October 26,2018 Seal: SNERYL A MENDES * _ No public-State of Florida (rop)398-0153 FlorldallotarySerWce.com a' `oP,, My Comm.Expires Oct 23,2018. sssss••ss.s.ssssssssssss•sssss sssss•s*•s•*s.sss*sss•s•sssssss r�gP�o COMMISSl0h1Rg_#I_ � FF 136�597 se•s9aade� , sn. •sssssss• APPROVED BY 'If—t1�r �azYAs Plans Examiner Zoning Structural Review Clerk PtWWnd02/24/20141 PERMIT #:13-SC-1699282 40 STATE OF FLORIDA APPLICATION #:AP1250665 DEPARTMENT OF HEALTH DATE PAID: ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM FEE PAID: CONSTRUCTION PERMIT RECEIPT #: DOCUMENT #:PRI 028180 CONSTRUCTION PERMIT FOR: OSTDS Repair APPLICANT: Jaime Derosa PROPERTY ADDRESS: 1173 NE 103 St Miami,FL 33138 LOT: 3 BLOCK: 2 SUBDIVISION: PROPERTY ID #: 11-2232-031-0070 [SECTION, TOWNSHIP, RANGE, PARCEL NUMBER] [OR TAX ID NUMBER] SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARD$ 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 1 GALLONS / GPD EXISTING Septic TO REMAIN CAPACITY teQ� caVa��o\,�be�kr.- A [ 0 l GALLONS / GPD CAPACITY �CO� N [ 0 ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:125ct-I K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES to �S� � D [ 300 l SQUARE FEET DF IN BED CONFIGURAT SYSTEM soy\b 1t,�a\ R [ 0 ] SQUARE FEET SYSTEM `��Oto I5he��`g A TYPE SYSTEM: [XI STANDARD [ ] FILLED I ] MOUND I ] -0-rt" ..ea\ I CONFIGURATION: [ ] TRENCH 1x] BED [ ] N F LOCATION OF BENCHMARK: CL OF NE 103 ST........10.94'NGVD I ELEVATION OF PROPOSED SYSTEM SITE [ 3.60 ] [ INCHES FT ] [ABOVE�BENCHMARK/REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE 145.601 [ INCHE3 FT ] [ABOVE BELOW BENCHMARK/REFERENCE POINT L D FILL REQUIRED: [ 0.00] INCHES EXCAVATION REQUIRED: [ 54.00 ] INCHES 1.-EXISTING 900 gal.septic tank with and approved filter TO REMAIN. 0 2.- Install 300 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 r (Comments Continued on Page 2.) E R SPECIFICATIONS BY: Gera L Philizaire TITLE: Engineering Specialist II APPROVED BY; L TITLE: Engineer Supervisor III Dade CHD Astrid V Edward. DATE ISSUED: 4 08/04/2016 EXPIRATION DATE: 11/02/2016 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 AP1250665 SE1004030 r MEN■■OMM■■■■■■■■■■■■■■■IAA■■■■■■ ■■■■■■■■■■■MUMNIV,RNE#■■■rol■■■■■■ ■■■■■M■ME■■M■■II■■OMIEMM/■■■■■■■■ ■■■■■■'imam■■■EEMmmENOi ■■■II■■■■■■■■ ■■■■■u■■■■1■■■■IgiLsoumm■■■■■■■■■■■ ■■■■■■■■■■I■m■m■I■mu_C';amrI■■■■■■■■■ ■■■■■■■■■■I■■■■r■■■m■m%/■■■■■■■■ ■■■■■■■■■■I■■■■■■■■■■■oomm■■■■■■ ■■■■■■■■■■I■■■!�"■rtl■■■■■tl■■1me■■■■ ■■■■■■■■■■i■■■■immmm■■■■■■■o■■■■■ ■■■■■■■■■■I■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■is■�■■■r►a �l■ ��I �■■■■■■■■■ • • • - - • - 1 • - i • • � -_