PL-11-192Inspection Number: I NSP- 155679
Scheduled Inspection Date: February 11, 2011
Inspector: Hernandez, Rafael
Owner:
Job Address: 10101 NW MIAMI Court
Project: <NONE>
Miami Shores, FL
Contractor: COLONY ACQUISITION CORP
Building Department Comments
February 10, 2011
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
For Inspections please call: (305)762 -4949
Permit Number: PL -2 -11 -192
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Septic
Phone Number
Parcel Number 1131010210080
Phone: (305)496 -7442
NEW 900 GALLON SEPTIC TANK AND DRAIN FIELD
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
Page 6 of 7
t A\ _ ikkho Nocua
BUILDING
PERMIT APPLICATION
FBC 20
Miami Shores Village
Building Department
10050 N.E2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
State:
Permit No.
Type of Work: ❑Address ❑Alteration ,New ..❑Repair/Replace
DescrJ n of Work: is a c ; ix' / , l 1 ,4 /
q' f'9 ! /'/ Iii G 7'4,714
J
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
fp) rN IT W7 A
ail
By:
Master Permit No.
Permit Type: PLUMBING
�f 1 r / f / ,/ ��C
OWNER: Name Simple at / . d e °, i Gad /, i' s C' Phone#: �� 1 /9 6 - � 2
(Fee S' le Titleholder):
Address: . IJ- Vf . 39 5ird
City: "'hair/ . J
Tenant/Lessee Name: — Phone#:
Email: /th/?..5p / /Ltd figvia i . Ce
JOB ADDRESS: leVn/ /V& Alte - -# 6f
City: Miami Shores County: Miami Dade Zip: 3 S,
Folio/Parcel #: / / 3/0/ ON- t!lo o
Zip: t- aa497
Is the Building Historically Designated: Yes NO R Flood Zone:
CONTRACTOR: Company Name: dit y dc,,,,, a a i/i, b Phone#: /Il °3 7 6
Address: St � / � &en. / l � /m'
City: FL-7 G tld2- 1 -drf.f , State: _.
Qualifier Name: e cosniit s
Zip: .SS.:�1� L
Phone#: f. 7 ° / 3 2S
State Certification or Registration #: Certificate of Competency #:
Contact Phone#: 3 y:525 Email Address: difil / " . " ' -
DESIGNER: Architect/Engineer: Phone#:
��,,,` l
Value of Work for this Permit: $ d°' ti�' ° � Square/Linear Footage of Work: �
r<_ J4 Zee
❑Demolition
** **R *e * ®** *** * ****a.e era. * * * ***** **s.**ee *F *****affix.******* * *** **** *e * * *w*a *enaa a*a *e.*
Submittal Fee / ` , Permit Fee $ v CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Technology Fee $
TOTAL FEE NOW DUE
/r
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 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 $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of co nt must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued F_ ' sence of such posted notice, the
inspection will not be approved and a reinspe i ' i n fee will be charged
Signature _ - Signature
Owner or Agent
Contractor
The foregoin rinstrument was acknowledged before me this 19 The foregoing instrument was acknowledged before me this 19
-'
day of , , 20 by hrrzt , day of 20 , by C �.. `4 o=bi 0 (( ,
who is perso i . y known to me or who has produced '�— who is personally own to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
,l °u, 1,6„cCs identification and who did take an oath.
NOTARY PUBLIC:
Structural Review
(Revised 07 /10/07)(Revised 06 /10/2009)(Revised 3/15/09)
Sign:
Print
N G. �, f it .i Ltd
:f
%, JACQUELYN S. ROBLI�O
: MY COMMISSION # DD 621981
W EXPIRES: February 16, 2011
My Commission
Clerk
0203/2011 11:52 FAX
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: (Real Estate Capital Partners)
FROPORTY AEIENUONir 10101 NW mlaml Gt Mel FL 33150
LOT: 10 -11
STATE OF FLORIDA
DEPARTS OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM
BLOCtt: 1
PROPERTY ID fi 113101- 021 -0080
SYSTEM MUST 88 CONSTRUCTED IN ACCOsnaNCS WITH 6PECI6'ICATXONS AND STANDARDS OF BOCTi0N
581.0065, F.8., AND CHAPTER 64E -6, F.A.C. DEPARTMENT APPROVAL OF SISTER DOHS NOT GUARANTEE
SATISFACTORY PERFORMANCE MANCE F`OR ANT SPECIFIC PERIOD OF TEMP. ANT CHARGE IN MATERIAL FACTS,
WHICH SERVED AS A WA$I6 FOR ISSUANCE OF THIS PERMIT, REQUIRE THE APPLICANT TO MODIFY THE
PERMIT APPLICATION. SUCH MODIFICATIONS MAY MOULT IN THIS PERMIT Ems 1910E NULL AND VOID.
ISSUANCE OF THIS PERMIT DOER NOT EXEMPT THE APPLICANT FROM COMPLIANCE WITH OTHER FEDERAL,
STATE, OR LOCAL PERMTTTDIO REQUIRED FOR DEVELOPI6SNT OF TRIO PROPERTY.
STSTE4t DESIGN AND BPOCIWICATIONB
T r 900 1 GALLONS / GPO New Seotic Tank CAPACITY
A [ 0 ] GALLONS / CPn CAPACITY
N [ 0 ) GALLONS GREASE INTERCEPTOR CAPACITY DRUM CAPACITY SINGLE TANK :1250 GALLONS]
R [ ) GALLONS DOSING TARR CAPACITY [ )GALLONS e[ )DOPES PER 24 HMS *Pumps [ )
D [ 225 j SQUARE FEET Trench Configuration draintl SYSTEM
R [ 0 ] SODA= FEET SYST]G!
A TYPE BYSTMK: [R] STANDARD [ ] FILLED [) MOM [ ]
I CONPIOQRATION: [x) TRENCH [ 3 SOD ( )
N
F LOCATION OF DP51Cl* RR:
I ELL''VATION OF FROWNED =SEMI BITE
E BOTTOM OF DRAINFIELD TO BE
D FILL REQUIRED:
0
T
a
E
a
Inspootor to verify the euisting septic tank la properly abandon before final approval.
'Invert elevation of dralnfield to be no leas than 9.34 ft. NGVD.
'Bottom of draintield elevation to be no less than 9.94 It. NGVD.
' - The licensed Contractor installing the system is responsible for installing the minknum category of tank in accordance With
sea 64E- 8.013(3)0. FA.C.
'THIS PERMIT IS NOT FOR "ADDITION(s) ".
BPECIBYCATIcNs BI:
APPROVED 8Y:
Crown of the road, 10.90' NGVO
S FT ) GiE/SELON3BENCIROUtit/REDICRTNCE ROINT
[ 24.68)(( =Casa FT 1 [ ABOVE rl =' B POINT
1 0.001 INCHES
Carlos
1UUu1044 ybiI�{�bt
.l
NEPAIR
S08DIVIBION:
[ 1,323
!XCRV .TION =WIRED: 26.001 INCHES
TITLE:
TITLE:
DR 4016, OS/09 (Obsolete, all psavioa.o aditione which may not be seed)
Incorporated: 648■6.003, PAC
v 1 .t 0 ATOM :a
acessoes
PIT * : . 13 -SC- 1297999
APPLICATION AP991732
001/004
3g2S336
DATE BAZD:
FRS PAID:
RECEIPT
DOCUMENT 4: PR833541
[SECTION, TOWNSHIP. RANGE, PARCEL NUMBER)
(OR TAX ID NUMBER)
1R'" temPrT M 933' F? A :n l
Dade CND
DATE I&BUOD: 021321+011 EXPIRATION /ATM! 05/03/2011
Page 1of3
o2 .
APPLICANT
AGENT:
PROPERTY ADDRESS:
LOT:
CHECKED [X] ITEMS ARE NOT IN COMPLIANCE WITH STATUTE OR RULE AND MUST BE CORRECTED.
- - - - - - — — - — — - - - - - - - - - - - — — - - - - — — - - - - - - - -
TANK INSTALLATION ----,- -.,. SETBACKS
[01] TANK SIZE [1] [2] 1 [ ] [27] SURFACE WATER FT
[02] TANK MATERIAL [ ] [28] DITCHES FT
[03] OUTLET DEVICE ? [ 1 [29] PRIVATE WELLS FT
[04] 1 MULTI - CHAMBERED [Y / N ] [ 1 [30] PUBLIC WELLS FT
[05] OUTLET FILTER [ [ ] [31] IRRIGATION WELLS FT
[06] LEGEND 3 [ ] [32] POTABLE WATER LINES FT
[07] WATERTIGHT [ ] [33] BUILDING FOUNDATION FT
[08] LEVEL [ ] [34] PROPERTY LINES FT
[09] DEPTH - TO LID ] "^° [ ] [35] OTHER FT
[13]
[14]
[15]
[
[
[18]
[
[20]
[
DRAINFIELD INSTALLATION
[10] AREA 1 - ` ' ]i4„ ...-_°_ SQFT,
[1 DISTRIBUTION BOX HEADER
[12] NUMBER Orb_AR INLINES
1:1AINLINE SEPARATION
RAINLINE SLOPE
EPTH OF COVER
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION INSPECTION AND FINAL APPROVAL
BLOCK SUBDIVISION•
ELEVATION [ABOVE/BELOW] BM
SYSTEM LOCATION
DOSING PUMPS
AGGREGATE SIZE
AGGREGATE EXCESSIVE FINES
AGGREGATE DEPTH
FILL / EXCAVATION MATERIAL
[22] FILL AMOUNT
[23] FILL TEXTURE
[24] EXCAVATION DEPTH
[25] AREA REPLACED
[26] REPLACEMENT MATERIAL
EXPLANATION OF VIOLATIONS / REMARKS:
DH 4016 (Page 2), 10/97 (Previous Editions May Be Used)
Stock Number: 5744- 002 - 4016 -4
CONSTRUCTION [ APPR D /DISAPPROVED]•
FINAL SYSTEM [APPROVE,DISAPPROVED]•
[ 1
[ ]
PERMIT NO
DATE PAID
FEE PAID -
RECEIPT #:
PROPERTY ID #•
FILLED / MOUND SYSTEM
[36] DRAINFIELD COVER
[37] SHOULDERS
[38] SLOPES
[39] STABILIZATION
ADDITIONAL INFORMATION
[40] UNOBSTRUCTED AREA
[41] STORMWATER RUNOFF
[42] ALARMS
[43] MAINTENANCE AGREEMENT
[44] BUILDING AREA
[45] LOCATION CONFORMS WITH SITE PLAN
[46] FINAL SITE GRADING
[47] CONTRACTOR
[48] OTHER
ABANDONMENT
[49] TANK PUMPED
[50] TANK CRUSHED & FILLED
[ 1
[ 1
[ 1
[ 1
CHD DATE
CHD DATE
PT 1: Applicant
PT 2: Installer /Contractor
PT 3: Building Department
PT 4: Health Department
Page 2 of 3
PERMIT NUMBER:
APPLICANT:
AGENT:
MAILING ADDRESS
LOT, BLOCK, SUBDIVISON
PROPERTY ID#:
Permit tracking number assigned by CHD.
Property owners fuU name.
Property owner's legally authorized representative,
P.O. box or stree mailing address or appicant or agent.
Lot, Biock and SubdMson for tot or
27 character number for property. (property appraiser 0 ti o'G|S location)
TANK SIZE (gaons) AS BUILT NSTALLATON SKETCH
TANK MATERIAL (concrete, flberglass, etc)
OUTLET FILTER (manufacturer, make, mod&)
LEGEND (manutacturer code)
DRAINFELD AREA (square feet)
DSTRIBUTION BOXI HEADER (check box)
NUMBER OF DRAtNUNES (number installed)
SYSTEM ELEVATION (in relation to BM)
DOSING PUMPS (number nstaUed)
SETBACKS (record actual setbacks in ft)
SETBACKS OTHER (as requfred)
STABILIZATION (date stabilized)
CONTRACTOR (contractor instalhng system)
ADDITIONAL INFORMATION (as required)
ABANDONMENT TANK PUMPED (date)
TANK CRUSHED AND FILLED (date)
EXPLANATION OF VIOLATIONS: Record item number, explanatlon of violation, and required
CONSTRUCTION APPROVAL: Circle approved or diaappmved. CHD signature and date.
ELEVATION WORKSHEET ELEVATION OF BENCHMARK OR REFERENCE POINT:
EXISTING GROUND TOP OF AGGREGATE
��SHOT H.I. Hi. H.I.
H.I. []SHOT H8HOT ______- HSHOT
ELEVATION
0
COUNTY HEALTH DEPARTMENT C KS NOT IN COMPLIANCE WITH CONSTRUCTION PEAMIT AND
STATUTE OR RULE. INFORMATION IS COMPLETED BY CHD ON FOLLOWING ITEMS:
FINAL APPROVAL: Circle approved or disapproved. CHD signature and date of approval.
Final approva shafl not be granted until the CHD has confirmed that buNding construction and lot grading are in substantial
compliance with plans and specifications submitted with the permit application.