PL-13-67Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 184105
Scheduled Inspection Date: February 11, 2013
Inspector: Hernandez, Rafael
Owner: SITES, JACK
Job Address: 10401 NE 4 Avenue
Miami Shores, FL
Permit Number: PL-1-13-67
Project: <NONE>
Contractor: SR0061536 MR C'S PLUMBING & SEPTIC INC
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Addition /Alteration
Phone Number
Parcel Number 1122310150100
Phone: (305)651 -7859
Building Department Comments
INSTALL DRAINFIELD
Infractio
Passed Comments
INSPECTOR COMMENTS
False
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
hrsinfile
February 08, 2013
For Inspections please call: (305)762 -4949
Page 13 of 30
1d11Q.1111 0110.1 v 111agc
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
3.rto
BUILDING
PERMIT APPLICATION
10 /11 ilv) FBC 2%0 /
Permit No. ? �, 3 4—
Master Permit No.
Permit Type: PLUMBING
JOB ADDRESS: 1 0'4 o I ft/ g Lrtlf AvEn U E
zip: 33138
City: Miami Shores County: Miami Dade
Folio/Parcel #: ti " 22.3 — 01 Tj' - 0,00
Is the Building Historically Designated: Yes NO ✓ Flood Zone:
OWNER: Name (Fee Simple Titleholder): C S 16Pi 41-1'6" M Phone#: 301-- 1 s 1- 88° 8
Address: I 4 °! N¢ 4' Ave?' U E
City: %-1 l A.v► t S li-d ittb.s State: ft-
Tenant/Lessee Name: N bar
Finai1• 3c S ICES e %fro. . C M
CONTRACTOR: Company Name:
Address: ) ,
City: MI .
Qualifier Name:
State Certification or Registration #:
Zip: 331 3 8
Phone#:
,PLL,5 4,4,
Phone#: 35'6$1 7$ -3 l
State:
16.-41.
� -
-t is #76
Zip:. 3 /d%
Phone#: c4.5-4S7 7637
Certificate of Competency #:
Contact Phone#: Email Address:
DESIGNER: Architect/Engineer: Phone#:
Value of Work for this Permit: $ / q tT D . (.t9 Square/Linear Footage of Work:
Type of Work: ClAddress OAlteration
Description of Work: .Z -s-A-47 ..i
ONew ®$epair/Replace
ODemolition
**** * * ** x *** * * ****** * * * * ** *ear* *say * * *a ** Fees* see * *** *e * * * *** * * * * * * * * ** * * ** * * ** * * ** * * * * **
Submittal Fee $ Permit Fee $ /S—G
Scanning Fee $ Radon Fee $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
CCF $ CO /CC $
DBPR $ Bond $
Technology Fee $
TOTAL FEE NOW DUE $ 0 :ID
D
r 10, 10
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable) )ft- C. C rrCJ T!) sT I 10i t. law^ r . rxe444t, (jolcie fro mime.)
Mortgage Lender's Address (eqD t N *- Aveiw L
City Mwrovo S imei State f c Zip 3 313 $
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 FT FCTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and 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."
51 . i r . , t a u e
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 en ' of such posted notice, the
inspection will not be approved and a reinspection fee will be charged
Signature
The foregoing instruct was acknowledged before me this
day of 341a.ft '/ ,20‘1") ,by tve4,� 4r�'Ii
who is personally known to me or who has produced I` L
4✓rNfe r• Cr' ct.S a As identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print e 9
My Commission Expires:
lia1--)1110
Ay-' -0
!WM ARTOLA
Notary P Florida
Commission* EE 187448
mm. expires Fss -•^`
i '
** *** **** * ***** ** ******* * ** � ' ;M + aaame, a************** *****+n** ******* ** * * * * *** * sus ** * ** **** ********ae
Signature
Contractor
The foregoing instrument was acknowledged before me this /64'
day of TL dt. 20 jam, by %Ctz [ 6r7 f t
who is(personally town to me) r who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
i
' / y ilsNon 81017518
'4` 1o/ooeo
APPROVED BY
•
Structural Review
(Revised3 /12/2012)(Revised 07 /10 /07)(Revised 06/10 /2009)(Revised 3/15/09)
Zoning
Clerk
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCCTION PERMIT
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT:
Jack Sites
PENT #: 13. SC- 1446273
APPLICATION # : AP 1092167
DATE PAID:
FEE PAID:
RECEIPT #:,
DOCUMENT 8: PR892808
PROPERTY ADDRESS: , 10401 NE 4 Ave Miami, FL. 33138
LOT: 10
BLOCK: na
PROPERTY ID #: 11-2231-015-0100
SUBDIVISION:
[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
A
N [
K
900 ] GALLONS / GPD
0 ] GALLONS / GPD
0 ] GALLONS GREASE INTERCEPTOR CAPACITY
] GALLONS DOSING TANK CAPACITY
Existing Septic Tank
D [ 300 ] SQUARE FEET
R [ 0 I SQUARE FEET
A TYPE SYSTEM: [x] STANDARD
I CONFIGURATION: [ ] TRENCH
N
F LOCATION OF BENCHMARK:
I ELEVATION OF PROPOSED SYSTEM SITE
E BOTTOM OF DRAINFIELD TO BE
L
D FILL REQUIRED: [ 0.00 l INCHES
0
T
CAPACITY
CAPACITY
[MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
]GALLONS 81 ]DOSES PER 24 HRS #Pumps [ ]
SYSTEM
SYSTEM
[ ] FILLED [ ] MOUND
[x] BED [ ]
[ 32.40 l
[ 62.40 ] [
INCHES
FT ] [ ABOVE /E,ELOW b BENCHMARK
,iatm
PT ] [ ABOVE /SELOWW IIBEN
tiAtt% • VA a� PQ�� cow tot%
42.00 ] �9 � 41. • ot� eons D tk
°t �s
EXCAVATION REQUIRED:
1.-Existing 900 gal. septic tank, certified by "Mr. C'sSeptic on 12/12/12" to remain.
2- Install 300 sf of drainfield in bed configuration.
3.- Install 12" of slightly limited soil at the bottom of the drainfield.
4. -PBdireet refR inarea stud' be at teast2 ft wider and .longer than their
& - ite& c tY/
ito11
M 'The sysdem t sitad o= 3 tediums ;rte, W
SPECIFICATIONS BY:
APPROVED BY:
DATE ISSUED:
Astrid V Edwards
12/24/2012
TITLE:
tibon �a� ��`sP�.��,ess5 0 e.��vt re
to (Ito
TITLE: Engineer Specialist II
Dade
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E- 6.003, FAC
v 1.1.4 AP1092167
EXPIRATION DATE: 03/24/2013
8$885976
CND ,
Page 1 of 3
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.