PL-12-178N Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 169510 Permit Number: PL -2 -12 -178
Scheduled Inspection Date: February 28, 2012
Inspector: Hernandez, Rafael
Owner: OLIVA, TERESA
Job Address: 301 GRAND CONCOURSE
Miami Shores, FL 33138-
Project: <NONE>
Contractor: MR C'S PLUMBING SEPTIC INC
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Drainfield
Phone Number (305)807 -1210
Parcel Number 1132060133850
Phone: (305)651 -7859
Building Department Comments
INSTALL DRAINFIELD
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
till,/
hrs in file
.0?
February 27, 2012
For Inspections please call: (305)762 -4949
Page 11 of 20
9
RE: Permit #
I
/4144k /14(, / /0-7Le,-
Miami Shores Viiiage
Building Department
INSPECTION AFFIDAVIT
(Print name and circle License Type)
License #: CC C /3 F /3i
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
DATE: /'30411_
licensed as a (n) Contractor / Engineer / Architect,
FS 468 Building Inspector
�II
On or about '� �t - I , I did personally inspect the roof deck nailing and
(Date & time)
Secondary water barrier work at a it-/E Fl j�''' q c -�
(Complete Job Site Address)
Based upon that examination I have determined the installation was done according to the Hurricane Mitigation Retrofit
Manual (Based on 553.844 F.S)
Signature
State of Florida
County of Dade:
The undersigned, being the first duly swom, deposes and says that he/she is the contractor for the above property
mentioned.
Swom to and subscribed before me this =
Notary Public, Sate of Florida at Large
1101/901E0
*General, Building, Residential, or Roofing Contractors or any individual certified under 468 F.S. to make such/64e , thil(tOudesphotographs of each plane of the roof with
permit # and address # clearly shown marked on the deck for each inspection
Revised on 5/21/2009
,•••■=a1.•
BU DING
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
Permit No.1 I
Master Permit No.
PERMIT APPLICATION
FBC 20
Permit T e: PLUMBING
OWNER: Name (Fee Simple Titleholder):
Address: 36 / CTa4 1.49
City: f411 G .. $h. rreo
1 r-r 5s
01r1vi4
Phone #:
State:
Zip: 33/ J5/
Tenant/Lessee Name: Phone#:
Email:
JOB ADDRESS: 3 0 1 G` rte.
City: Miami Shores County: Miami Dade Zip: 345/ 3d�
Folio/Parcel #: /1- 3 ,206 - a /3 - ,36 Sd
Is the Building Historically Designated: Yes NO -� Flood Zone:
CONTRACTOR: Company Name: or Ls 0,....1.3 ' a ' —�� Phone #: lbr-: u�7 7vs-,
Address: / f 9 3,l NW 7.4.
City: /'�:ti...,. State: Zip: 3 3 W� 0
Qualifier Name: E%., �t E � Phone #: 7�'' 3 3 3 06-e 7
State Certification or Registration #: 5 *. o4/5---3g Certificate of Competency #:
Contact Phone #: Email Address:
DESIGNER: Architect/Engineer: Phone #:
Value of Work for this Permit:
Type of Work: ❑Address
Description of Work: 1w dd l
2 30o. o�
$ Square/Linear Footage of Work:
❑Alteration ❑New ARepair/Replace
dretiA 16--e14
ODemolition
******** *** ** * * ** * * ****** * * ** ***** * **** Fees************* * ** * * ** **** ** * * *** * *** * *** * ** **
Submittal Fee $ Permit Fee $
Scanning Fee $ Radon Fee $
CCF $ CO /CC $
DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $
Bonding Company's Name (if applicable)
Bonding Company's Address
City State
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 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 1o�
Owner or Agent
The foregoing instrument was acknowledged before me this
day of , 20121, by
who is personally known to me or who has produced
Sign:
Print:
My Commissio
APPROVED BY
Contractor
The foregoing instrument was acknowledged before me this
day of
who i who has produced
identification and who did take an oath.
NOTARY PUBLIC:
20 IL by Krtdt4. �rY
Sign:
Print:
My Co
* * * * * *** * * ** * * * * *** * * * * * * * * * **
Z.— Plans Examiner Zoning
Structural Review
(Revised Q7 /10/07)(Revised 06/1012009)(Revised 3/15109)
Clerk
v
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM
CONSTRUCTION PERMIT
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT:
Teresa Oliva
PERMIT #: 13-SC-1389904
APPLICATION #: API059897
DATE PAID:
FEE PAID:
RECEIPT #:
DOCUMENT #: PR865118
PROPERTY ADDRESS: 301 Grand Consourse Miami, FL 33138
LOT: 25
BLOCK: 28 SUBDIVISION:
PROPERTY ID #: 11- 3206 - 013 -3850
[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 MAX 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 ] GALLONS / GPD Septic CAPACITY
A [ 0 ] GALLONS / GPD CAPACITY
N [ 0 ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ 1
D [ 300 ] SQUARE FEET SYSTEM
R [ 0 ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [x] STANDARD [ ] FILLED [ ] MOUND [ ]
I CONFIGURATION: [ ] TRENCH [x] BED [ ]
N
F LOCATION OF BENCHMARK: F.F.E.: 9.20' GVD.
I ELEVATION OF PROPOSED SYSTEM SITE
E BOTTOM OF DRAINFIELD TO BE
L
D FILL REQUIRED:
O
T
H
E
R
SPECIFICATIONS BY:
APPROVED BY:
[ 0.00] INCHES
( 22.80 ] (I INCHES f FT ] [ ABOVE A BELOW p BENCHMARK /REFERENCE POINT
[ 50.80 ] (i INCHES I FT ] ( ABOVE 4 BELOW 11 BENCHMARK /REFERENCE POINT
EXCAVATION REQUIRED: [ 40.00] INCHES
1- Existing 900 gal. septic tank certified by " Mr C's Septic & Plumbing" on 01/27/2012 to remain. 2- Install 300 sf of
drainfield in bed configuration. 3- Install 12" of slightly limited soil under the bottom of drainfield. 4- Perimeter of
excavation area shall be at least 2 ft wider and longer than the proposed absorption bed. 5 -Invert elevation of drainfield
to be no less than 5.46' NGVD. 6. Bottom of drainfield elevation to be no Tess than 4.96' NGVD.
THIS PERMIT IS NOT FOR ADDITION(s).
DATE ISSUED:
Pedro N Ospina
edro N Ospina
01/30/2012
TITLE:
TITLE:
Dade CHD
EXPIRATION DATE: 04/29/2012
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E - 6.003, FAC
v 1.1.4 A1'1059897 SE861369
Page 1 of 3
4
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 govemed 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.