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PL-16-3165 t i # Villa9e I �k Its <r, Miami Shores 10050 N.E.2nd Avenue N n:0512 1201? M Miami Shores,FL 33138-0000 EXp jratl0 �• a 305)795-2204 a��2��201i3 Phone: ••`�N-- ae Applicant ..pp parcel Number " W ATONIA MCINTYRP- Lpro�ject Address 112136003032Block: Lot: cell 20 N MIAMI AVenue Pbonemi Shores, FL 33168- Address r.. VE Owner Information 10920 N MIAMI A MIAMI FL 33168 326 -` LATONIA MCINTYRE 2,3 00.00 Valuation:Cell Phone Phone Feet: 300 Total Sq Contractors) 305-944-8886 . ON AASUPER ROOTE - - Available Inspections: A R Inspection Type: Type of work:REPLACE DRAINFIELD HRS ApprovalFinal Type of Piping: INFIELD Review Plumbing Additional Info:REPLACE DRA Bond Return: Scanning:3 Classification:Residential Amt Paid Amt Due Amount Pa Date Pa T e Fees Due 500 0 InvOice# PL-11-16-62118 $618.30 $ $50,00 Bond Type-Contractors Bond $1 30 11/21/2016 Check#:3558 $0,00 CCF $225 1/18/2016 Check#:5219 $50.00 DBPR Fee $2.25 I DBond#:3257 CA Fee $0.60 6 Education Surcharge $150-00 Permit Fee $9.00 Scanning Fee $2.40 Technology Fee $668.30 Total: the work covered hereunder in compliance with all ordinances and regula perform proper authorities of We Shores p i1�9 erinit, I agree top ecifications submitted to th to es. I understand that separate with the plans,drawings,statements or sp agent, servants, or emp Y In consideration of the issuance to me of this p either myself, my 9 pertaining thereto and in strict conformity ibility for all work clone by DOORS,ROOFING and SWIMMING POOL work. licable laws reg' ting this permit I assume responsibility WINDOWS, compliance with all app accrequired for ELECTRICAL,PLUMBING, oin in m the work stat 2016 ion is accurate and that all work will be done in cora that all the foregoing -n ed contractor o November 21, OWNERS AFFIDAVIT: I�1he ore,I authorize the abo ate cc nstructlon and zoning. ( Agent / Applicant / Contractor Authorized Signature:Owner nc%nartment Copy ` M OF fi ental Health E. ROOM I MMMUNNINW, • � �8l►�w5�'V 26th`StCeet•Miami,k'I.331'�����:�4 ���� . �� � Signature , Miami Shores Village NOV 18 2016 Building Department ` _ 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 201 BUILDING Master Permit No.f PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING REVISION ❑ EXTENSION [-]RENEWAL PLUMBING ❑ MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 1092-0 N ° 1 01 inn i A V'(?,, City: Miami Shores County: Miami Dade Zip: 3 b Folio/Parcel#: V-4o_ 010 3— t -3-ZZ� Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): Le:40')1ck "C"B n t rei Phone#: 76 6 2 S 13— 3 32-77 Address: 10 c1'2-,o N t-h!c4 r,r)1 City: State: rl_ Zip: 3 5 i G e Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name:� i^On Phone#: Address: G%0-22— SLk) 3S C'f ^ City: AA State: _ L Zip: Qualifier Name: ha^ Phone#: State Certification or Registration M Certificate of Competency M DESIGNER:Architect/Engineer: My> Phone#: Address: r� City: State: Zip: Value of Work for this Permit:$ aC Square/linear Footage of Work: 3 00 Type of Work: ❑ Addition ❑ Alteration ❑ New [Repair/Replace �9 ❑ Demolition Description of Work: !a r e 1�`«+ Specify color of color thru tile: Submittal Fee$ Permit Fee$_�5� CCF$ CO/CC$ Scanning Fee$ ril • Q Radon Fee$ sus DBPR$ �' oZs Notary$ Technology Fee$_ _ • �Q� Training/Education Fee$ 6 Q Double Fee ($ Structural Reviews$ Q2 Bond$ TOTAL FEE NOW DUE$ (Revised02/24/2014) r1836 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 ELECTRIC, PLUMBING, SIGNS, POOLS, FURNACES,BOILERS,HEATERS,TANKS,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$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law bra ure will be delivered to the person whose property is subject to attachment. Also,a certified copy of the recorded notice of co c ment must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In h absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Signature OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of ND--J 20 �6 by day of NUJ 20 16 by l C�.-�r ✓��� M C 1 V1 'e!( �vho is personally known to 'J'3 hn ��—who is personally known to LL Z me or who has produced F -vnv 10 as me or who has produced I as identification and who did take an oath �p�e identification and who did take arb�tfve� 7ERfSJ.lOMON �� )J OLOMON * ' o MY COMMISSItMt#FF 828161 NOTARY PUBLIC: SS FF 82ii8$ARY PUBLIC: * ' EXPIRES:Novwber 8,2019 •� 2Xr —3.Ncvember8,2019 mom, ��' BondedThrulludgetNoTaryServle� x (J �oF�oe\a BondedlNruBudgetMbryftts '&ovate r ��. cZ�d Sign: t Sign: o� �,' Print: ���` l 'q" Print: �� N * S Seal: Seal: APPROVED BY re Jerd tm° Plans Examiner Zoning Structural Review Clerk (ReAsed02/24/2014) TE(MDD/YY) CERTIFICATE OF LIABILITY INSURANCEFDA 11/ M/18/16 PRODUCER Arbelaez Insurance,Inc. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 9971 Miramar Parkway HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR Miramar,FL 33025 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Phone(954)436-5544 Fax (954)436-7733 INSURERS AFFORDING COVERAGE NAIC# INSURED A Aaron Super Rooter. Inc. INSURER A: ACCIDENT INSURANCE CO 6022 SW 35 COURT INSURER B: PROGRESSIVE INSURANCE CO Miramar, FL 33023- INSURER C: COMMERCE AND INDUSTRY INSURA INSURER D: (954)967-9933 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OF MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'L TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LTR IN RD DATE MWDD/YYYY DATE MM/DD LIMITS GENERAL LIABILITY EACH OCCURRENCE 1.000.000 COMMERCIAL GENERAL LIABILITY DAMAGE RENTED CPP0006004 04 09/29/2016 09/29/2017 PREM SES ea occurrence 100.000 ❑❑ CLAIMS MADE 0 OCCUR MED EXP(Any one person) 5.000 A 0 ❑ PERSONAL&ADV INJURY 1.000,000 ❑ GENERAL AGGREGATE 2.000.000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG 2,000,000 ❑ POLICY ❑PROJECT ❑ LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ❑ ANY AUTO 02571197-1 07/14/2016 07/14/2017 (Ea accident) ❑ ALL OWNED AUTOS BODILY INJURY 100000 B ❑ ❑ SCHEDULED AUTOS (Per person) ❑ HIRED AUTOS ❑ NON OWNED AUTOS BODILY INJURY 300000 (Per accident) ❑ PROPERTY DAMAGE 50000 (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT ❑ ❑ ANY AUTO OTHER THAN EA ACC ❑ AUTO ONLY: AGG EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE ❑ ❑ OCCUR ❑ CLAIMS MADE AGGREGATE ❑ DEDUCTIBLE ❑ RETENTION $ WORKERS COMPENSATION AND k WC STATU- ❑ OTH- EMPLOYERS'LIABILITY Y/N WC 031-52-2208 09/23/2016 09/23/2017 TORY LIMITS ER C ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT 1.000.000 OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE 1.000.000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT 1.000.000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS LICENSE SR0921112 BUSINESS AUTHORIZATION: SA0920648 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL VILLAGE OF MIAMI SHORES 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO 10060 NE 2 AVE THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY MIAMI SHORES. OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. FL 33138 AUTHORIZED REPRESENTATIVE ACORD 25(2009/01)QF ©1988-2009 ACORD CORPORATION.All rights reserved. The ACORD name and logo are registered marks of ACORD IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER This Certificate of Insurance does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25(2009101)QF Ilk PERMIT #:13-SC-1717893 APPLICATION #:AP 1261892 STATE OF FLORIDA DEPARTMENT OF HEALTH DATE PAID: ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM FEE PAID: CONSTRUCTION PERMIT RECEIPT #: REPAIR DOCUMENT #:PR1037777 MIAMI-DADS COUNTY HF.AJH(XPA!FII?,E xT CONSTRUCTION PERMIT FOR: OSTDS Repair APPLICANT: (Mc Intyre) PROPERTY ADDRESS; 09,_0 N Miami Ave Miami, FL 33161 LOT: 32 B OC 2 SUBDIVISION: PROPERTY ID #: 1- 36- 0 -03 0 [SECTION, TOWNSHIP, RANGE, PARCEL NUMBER] [OR TAX ID NUMBER] SYSTEMMU�s B t'rl IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF SECTION f 381.0065, IF.5., ���IIIAPTE 64E-6, F.A.C. DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE SATISFACTORY�PERI!6RMANCI�' FO�t 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 ] GALLONS / GPD Existinq septic tank 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 [ ] D [ 300 ] SQUARE FEET Trench conflquration drain SYSTEM R [ 0 ] SQUARE FEET SYSTEM A TYPE SYSTEM: [x] STANDARD [ ] FILLED [ ] MOUND [ ] I CONFIGURATION: [x] TRENCH [ ] BED [ ] N 7 LOCATION OF BENCHMARK: FFE: 11.5'NGVD I ELEVATION OF PROPOSED SYSTEM SITE [ 12.00 ] [ INCHES FT ] [ABOVE BELOW BENCMO.RK/REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ 60.00 ] I INCHES FT ] [ABOVE BELOW BENCHMARK/REFERENCE POINT L D FILL REQUIRED: [ 0.00] INCHES EXCAVATION REQUIRED: [ 48.00 ] INCHES 1.-Existing 900 gal.septic tank,certified by"Statewide Septic Connections Inc"on 10/20/2016 to remain. O 2.-Install 300 sf of drainfield in trench configuration. T 3.-Bottom of drainfield and invert elevations to be no less than 6.50'and 7.00'NGVD. H System sized for 4 bed with a max occupancy of 8 persons(2 per bed),for a total est flow of 400 gpd. THIS PERMIT IS NOT FOR ANY ADDITIONS. E •• ••• • • • • • •• • • • • ••• • SPECIFICATIONS BY: (Teresa J SolonAft ••• •• • • • SLE: Master Septic Tank Contractor APPROVED BY C.J TITLE: Engineering Specialist II Dade CHD Bet•Y Lange-_O ~ ��� • • �•ni` • • • • 11/04/2016 • • • • EXPIRATION DATE: 02/02/2017DATE ISSUED: • i • • •• • DH 4016, 08/09 (Obsoletes all prefrious•editi16160TWOomeill.1 a used)Incorporated: 64E-6.003, FAC o �a� Page 1 of 3 V i.i.a Thgcgn��gV B0, zi,r� ••• • •• e b 9�zld)excava,,ed?o ec;c.•.n a 30,i boring • • adj®�nt•to • • 1ps�et�ior� Ate. 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