PL-13-283Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 185734
Permit Number: PL -2 -13 -283
Inspection Date: March 13, 2013
Inspector: Hernandez, Rafael
Owner: ROBINET, PATRICE
Job Address: 1055 NE 96 Street
Miami Shores, FL
Project: <NONE>
Contractor: SOUTHERN SEPTIC CONTRACTORS INC
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Septic
Phone Number
Parcel Number 1132060143710
Phone: (305)598 -8266
Building Department Comments
S
SEPTIC SYSTEM REPLACEMENT
Infractio Passed Comments
INSPECTOR COMMENTS False .
Passed
Inspector Comments
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled
re- inspection fee is paid.
until
For Inspections please call: (305)762 -4949
March 13, 2013
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Miami Shores Village
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 ^�
� . &ND torkoac Z'30 ocurxreit FBC 20 1
BUILDING r' - 4
' ermit No. ?
PERMIT APPLICATION
p k °a -711.77L;'-1
FEB Y 12013
Permit Type: PLUMBING
JOB ADDRESS: ®®S'6 1� 6 ts sr
Master Permit No.
City: Miami Shores County: Miami Dade Zip: 35132'
Folio/Parcel #: L ° a2�lca ��
Is the Building Historically Designated: Yes NO Flood Zone:
OWNER: Name (Fee Simple Titleholder): ?Orb t s d f Phone #: O57- 7o4-4191
Address: 1 ®S't a.Je
City: \-1 /A141 .H'O?dS
State: ' F O 6.7)4 Zip: 13 �
Tenant/Lessee Name: Phone #: 3OS -°I �i "i err
Email: --Porrrti Ro o Ler / e H !iciA c. 1'
CONTRACTOR: Company Name: \i'V z" 'i #V' c' Phone #: ')°C 7S61(6 4 2
Address: t 1/4k, 2,1 S t `S3 ,'"? LA 1 Vii
City: t'-`•,:� State: C zip: ',1 9 `1
Qualifier Name: 2 :fi ,ks-93 ?.,•3 04'1,ue -1- Phone #: 5 a - 'VI dg-Lb -L
State Certification or Registration #: .5 v2icro '2-1112'1 Certificate of Competency #:
Contact Phone #: Email Address:
Phone #:
DESIGNER: Architect/Engineer:
-Nf
Value of Work for this Permit: $ a Square/Linear Footage of Work:
Type of Work: ❑Address UAlteration New )LsRepair/Replace
Description of Work:
ODemolition
Submittal Fee $ O P,, Permit Fee $ 3e'e7 .-- CCF $ CO /CC $
Scanning Fee $ �� `� Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
Technology Fee $
TOTAL FEE NOW DUE $
•
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 a 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 ELECTRICAL 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."
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 "piss ; ' the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature
Owner or Agent
The foregoing instrument was acknowledged before me this 44'
day of , 20 93 , by ari. & i o(3eeatie1
who is personally known to me or, who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission
r
fc.,Q�o
APPROVED BY
o•
Patricia A Reiss
z My Commission EE028728
+o, a°' Expires 10/02/2014
Signature
ontractor
The foregoing instrument was acknowledged be ore me this It
day of , 20 ‘3, by r7,00AIMO M ,
who is personally known to me or who has produced °t D
as identification and who did take an oath.
/ -3-13 Plans Examiner
Structural Review
(Revised3 /12/2012)(Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09)
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
ll /11111 1111t1`'�
Zoning
Clerk
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION PERMIT
CONSTRUCTION PERMIT FOR: OSTDS Repai
APPLICANT: Elsa Gagnon
PERMIT #:13 -SC- 1453794
APPLICATION #:AP1096401
DATE PAID:
FEE PAID:
RECEIPT #:
DOCUMENT #: PR896516
PROPERTY ADDRESS: 1055 NE 96 St Miami, FL 33138
LOT: 1213 BLOCK: 82 SUBDIVISION:
PROPERTY ID #: 11- 3206 - 014 -3710
[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
MATERIAL FACTS,
TO MODIFY THE
NULL AND VOID.
OTHER FEDERAL,
SATISFACTORY PERFORMANCE FOR ANY SPECIFIC PERIOD OF TIME. ANY CHANGE IN
WHICH SERVED AS A BASIS FOR ISSUANCE OF THIS PERMIT, REQUIRE THE APPLICANT
PERMIT APPLICATION. SUCH MODIFICATIONS MAY RESULT IN THIS PERMIT BEING MADE
ISSUANCE OF THIS PERMIT DOES NOT EXEMPT THE APPLICANT FROM COMPLIANCE WITH
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 [
New Septic Tank
D [ 300 ] SQUARE
R [ 0 ] SQUARE
TYPE SYSTEM:
CONFIGURATION:
A
I
N
F
I
E
L
D
0
T
H
E
R
CAPACITY
CAPACITY
[MAXIMUM CAPACITY SINGLE TANK :1250 GALLONS]
]GALLONS @[ ]DOSES PER 24 HRS #Pumps
FEET bed configuration drainfile SYSTEM
FEET SYSTEM
[ ] MOUND
[x] STANDARD
[ ] TRENCH
[ ] FILLED
[x] BED [ ]
LOCATION OF BENCHMARK: F.F.E., 10.91' NGVD
ELEVATION OF PROPOSED SYSTEM SITE
BOTTOM OF DRAINFIELD TO BE
FILL REQUIRED:
1 21.70 ] [) INCHES I FT ] [ ABOVE /) BELOW b BENCHMARK /REFERENCE POINT
1 59.70 ] [I INCHES I/ FT ] [ ABOVE 4 BELOW J BENCHMARK /REFERENCE POINT
[ 0.00] INCHES EXCAVATION REQUIRED: [ 38.00] INCHES
Inspector to verify the existing septic tank is properly abandon before final approval.
*Invert elevation of drainfield to be no less than 6.43 ft. NGVD.
*Bottom of drainfield elevation to be no less than 5.93 ft. NGVD.
-The system is sized for 3 of bedrooms with a maximum occupancy of 6 of persons (2 per bedroom), for a total estimated
sewage flow of 300 gpd.
-The licensed contractor installing the system is responsible for installing the minimum category of tank in accordance . �; ,
with sec. 64E- 6.013(3)(f). F.A.C. A„ � % � fO C,', 1',At,6)
SPECIFICATIONS BY:
APPROVED BY:
DATE ISSUED:
DH 4016, 08/09
Incorporated:
TITLE:
(Obsoletes all previous editions which may
64E- 6.003, FAC
The contractor (or dolnrel is required to perform a
soil boring adjacent to the Srainfield excavation the DOH oa
time of final inspection. Prior to Final Approval,
inspector shall witness the soil boring and compare the
results to the original site evaluation submitted. A
reinspection mef the contractor is not
at the jobsite at the arranged time.
not be used)
Dade CHD
EXPIRATION DAME: 05/07/2013
5E889390
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