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PL-16-2781
Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Perm t Issue Date: 11 / Permit NO. PL -10-16-2781 Permit Type: Plumbing - Residential Work Classification: Septic Permit Status: APPROVED 6/2016 Expiration: 05/15/2017 Parcel Number Applicant 1135 NE 100 Street Miami Shores, FL 33138- 1132050340050 Block: Lot: THOMAS WENSJOE Owner Information Address 1135 NE 100 Street MIAMI SHORES FL 33138 Phone Cell Contractor(s) Phone ALL PRO PLUMBING SEPTIC AND SE (305)635-3002 Cell Phone Valuation: Total Sq Feet: $ 500.00 0 Type of Work: PUMP OUT SEPTIC TANK/ ABANDON TANK Type of Piping: Additional Info: PUMP OUT SEPTIC TANK/ ABANDON TANK Bond Return : Classification: Residential Scanning: 1 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Total: Amount $0.60 $2.00 $2.00 $0.20 $100.00 $3.00 $0.80 $108.60 Pay Date Pay Type Invoice # PL -10-16-61644 10/14/2016 Check #: 344 11/16/2016 Check #: 366 Amt Paid Amt Due $ 50.00 $ 58.60 $ 58.60 $ 0.00 Available Inspections: Inspection Type: HRS Approval Final In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS 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. Futhermore, I authorize the above-named contractor to do the work stated. November 16, 2016 Author 6d Signature: Owner / Applicant / Contractor / Agent Building Department Copy Date November 16, 2016 1 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-268907 Permit Number: PL -10-16-2781 Scheduled Inspection Date: December 07, 2016 Inspector: Hernandez, Rafael Owner: WENSJOE, THOMAS Job Address: 10025 BISCAYNE Boulevard Miami Shores, FL 33138-2645 Project <NONE> Contractor: ALL PRO PLUMBING SEPTIC AND SEWER INC Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Septic Phone Number 954-596-8061 Parcel Number 1132050340040 Phone: (305)635-3002 Building Department Comments PUMP OUT SEPTIC TANK/ ABANDON TANK Infractlo 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 HRS APPROVAL ON FILE Miami Shores Village 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 BUILDING PERMIT APPLICATION ❑BUILDING ❑ ELECTRIC ❑ ROOFING Master Permit No. Sub Permit No. TPc E:TVED OCT 1 1016 BY: oT,N FBC 20 t Itcmo Ico ` ZiEso PI -1(0- E 1(0- E REVISION ❑ EXTENSION PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS n CHANGE OF CO NTRACTO R JOB ADDRESS: City: 0 /002S [ g- eiric /vt Miami Shores County: RENEWAL ❑ CANCELLATION ❑ SHOP DRAWINGS Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes Occupancy Type: Load: Construction Type: Flood Zone: OWNER: Name (Fee Simple Titleholder):: OMS Address: 1/35 ff� 570e g' City: iCLV111( tnc � State: Tenant/Lesee Name: Email: BFE: Phone#: NO FFE: Phone#: Zip: 3 (2(f - CONTRACTOR: Company Name;7k\..\ pro p\---u•Lk-fl D ptlC, SC - Phone Address: 1 G City: ONL\ Stater Qualifier Name: 12)Ut/Ik-- Yok State Certification or Registration DESIGNER: Architect/Engineer: Phone#: Address: City: Value of Work for this Permit: $ • Z :33IL-12- Phone -('2 Phone Certificate of Competency #: Type of Work: ❑ Addition ❑ Alteration Description of Work: State: Zip: Square/Linear Footage of Work: ❑ New Repair/R^peplace El Demolition 4)� 1 01-11-3V e+1 ✓1 k / 74X-t,n n tan Ic._. Specify color Submittal Fee $ Scanning Fee $ of c&kis.thru tile: Permit Fee $�:_ �— •-'�Radon•Fee'$'' Technology Fee $ • 80 Training/Education Fee $ Structural Reviews $ tRPvispdro/74i?n1 41 • 6J1t1 !i r slA 7r: 1 , li'r'r *,/ Atit CCF IrscA)'f4A3 � CO/CCf �,. $...� DBPR $ . Notary $ 2•© Double Fee $ Bond $ TOTAL FEE NOW DUE $ 5 5 • 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, PLUMING, 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 brochure will be delivered/ to th person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at tljob 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. C=S'; .tures OWNER or/ GENT The fore instrument was acknowledged before me this day of , 20 \ , by 0-o 7A who is personally known to me or who has produced 4— �3L"L'`l`i identification and who did take an oath. NOTARY PUBLIC: Sign: Printer �c Seal: "Y ",., IRENIA GUTIERREZ Notary Public • State of Florida I Commission* FF 960737 r•• My Comm. Expires -Feb 22, 2020 Signature CONTRACTOR The foregoing instrument was acknowledged before me this day of Liar ,20 by 0-11L /CA , who is personally known to O me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: Ca Y011 na Nino **************** APPROVED'BY 1 / Plans Examiner Structural Review lao..ico'Ini CAROLINA PAI'INO •'c MY COMMISSION rr FF23O855 s4C( 8{.'53 Fief elo!lySevlce.cort. Zoning Clerk ------"I ACCIRD CERTIFICATE OF LIABILITY INSURANCE DATE NtilOONYYY) klirgr''''' ', 11i1 6r2o1 6 Ti4IS CERTIFICATE IS ISSUED AS A MATTER OF INFOOMAiitifONLYAND CONFERSNGRIGHTST/PON THCCERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT.; If the certificate holder ls an ADDITIONAL INSURED, tnePolicy(ies) lutist Lte endorsed:If SUBROGATION IS WAIVED, sunt to the terms and conditions of the policy, certain policies may require an eildOrSeittent. A statement on this certificate does not confer rights to the NAME' _........ ._, .. certificate holder In Ileu of such endorsements). PRODUCER ROBERTO A GONZALEZ 11 Nima Enterprises Inc DO° United Ins ! _we, Nix cm, . (30 13810 __ PHONE (05) 541-3811 ... „.. ...._. . ... 215 SW 17th Avenue Suite #217 I ADDRESS: robadriangehotmaii.corn MLsMi, FL 33135 INSURER(S) AFFORDING COVERAGE . NALIC # I 1 Phone (305)54138l0 Fax 005) 5413811 _ _ ........ . I INSURER A : Underaditers at Lloyds, Londod 1 INSURED I INSURER El ' I ; ALL PRO PLUMBING SEPTIC AND SEWER INC, i INSURER C : I INSURERP, 1 rttsuFERg.,... .,,” ..... 1930 NW 2Ist TERRACE, KAM' FL 33142] INSURER F : COVERAGES CERTIFICATE NUMBER: .._ REVISION NUMBER: ! THIP., IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMELI ABOVE FOR THE POLICY PERIODINDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR [MY PERTAIN. THE INSUP.ANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 1S SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LITS SHOWN MAY HAVE BEEN REDUCES% BY PAID CLAIMS, IADDLISUBRI r Py ii---,-T-pcimy-iii, . - --- — I 1 yi COMMERCIAL GENERAL LIABUTY ' :, , LEACH OCCURRENCE < $ 100,000.00 LIMItS TYPE OF INSURANCE „ LINSR ;AND -4— POLICY NUMFIER _ iLMWEIOrIfYr0 I OR,,II.P.W_T_M____ _ ______ OCCUR i i , I DAMAGE TO RENTED pREMIS,'E,S3jEacecuirencvl , $ 100,000 00 I„ ..`i .i MED EXI"Any um. pelseri I Si 5,000.00 A I 11 11/26, 8 r .... Y PU115081 ! PERSIONAL & ADV INJURY i 5 100,000.00 ...,— _ GENt AGGREGATE LIMIT .APRLES PER' 1 GENERAL AGATE• $ 303,000_ 1)1 ..oucy LJ ipei [ j Lc., , PROtAXIS -,OOMP/OR AGO 1,-.:.., 100,000.00 I — r 1 OSIERI $ TERRORISm-TRiA 000 _. „...... Auromoeme LIABILINtIL TY 4I: Co -M431- NEID SIE Lima i , 'Fa accident) s 800I4.Y INJURY (Per petser i; 5 ... . }, EOOILY INJURY (Per accicherThl 5 r *fik..CPERTY PALMAGE , $ 1 (F.IIII".P.c:C4PF-t1. I $ I — 4. - EACH OCCURRENCE 1 , I $ It . AGGREGATE t . i r-1 PER I 4 " I .ii...E..it. EACH „ccoi3;' T., i. , ---I F LDISETSE : EgiEMFJOYE I 3 ' E L DISEASE • PWCY Umir i s BARRY G IFIXEIRA SEPTIC SERVICE L ANY AUTO F ALL OWNED SCHMULED , AUTOS 1 AUTOS r tsiONOWNW ; , I HIRED AUTOS AuTOS r I • , UMBRELLA LIAR °rap I El ExcEss LIAR CLAImS,HADE D1 j 1L0NDECs WORKERS COMPENSATION I ANO EMPLLi OYERS'LIVABILITY Y / N j ANY PROPRIETORIPARTNEWEIXECtITIV : i OFFICER/MEMDER EXCLUDED? / A I I 1 (Mandatary in NI.4) ; yes riescnbe under I i ] I DESCRIPTION OF OPERATIONS beiow i DESCRIPTOR OF OPERATiONSILOCATIONS4VENC.LES (Attach ACORD 101, AcUlltionalkernarks Schedule, 11 more space Is requtred ..... PLUMBING CONTRACTOR - RESIDENTIAL -COMMERCIAL - SEPTIC TANK CLEANER . , CERTIFICATE HOLDER MIAMI SHORES VILLAGE BUILDING DEPARTMENT 10050 NE 2 AVE MIAMI SHORES, FL 33138 LOFFICE 305-795-2204 ACOR 25 (2014)01) QF CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, __— AUTHORIZED REPRESENTATIVE 13834014 ACORD CORPORATION, All rights reserved. The ACORD name and logo are registered marks of ACORO TE� MEC OPLES MALE September 2, 2016 Jorge Cedeno Allied Demolition, inc. 7950 NW 53"' Street Doral, FI. 33166 Proposed Demolition: 10025 Biscayne Blvd. Miami Shores After a review of our facilities within the above referenced areas, we would like to inform you that Teco Peoples Gas has no service lines to said property. If you are planning to excavate the surrounding area of the work site, please contact Sunshine State One Call of Florida by dialing 811 at least 48 hours in advance, there might be other underground utilities. By contacting SSOCOF, the risk of personal injury and property damage can be reduced. You can get the latest information on SSOCOF by visiting their web site at www.cal lsunshine.com. Should you have any additional questions conceming the above, please contact me at 305-957- 3857, extension 77247. Sincerely, #7j Yolande Hong Ting for Jesus Vega Territory Manager North Miami Division PEOPLES GAS 15779 W D'aie Hwy NORTH MIAMI, FL 33162 AN EQUAL OPPORTUNITY COMPANY Prepared by : Yolande Hong Ting FAX 305-957-3804 HTTP:/ WWW.TECOENERGY.COM 61 �.. DIVISION OF Environmental Health 4c,11 Florida Health,�� Miami -Dade County �� QeQ% OSTDS/VVell Division Q `► 11805 SW 26th Street • Miami, FL 33175 O Inspecto15A 01)-k[0I X EA MLA Date �/�/ /-p l 40 Address t b0i/lOyte VIAIP , OSTDS # & t2s 11'10' A c� Comments: 'Ch -11 1t• r+ti G— D its t Er,, con'm.'rk-u Signature r. j. fY 11 1 ` >_ i !i ! , DIVISION Of Environmental Health . a Health Florida de osTD Mia°n'S ellDivisi lis Street . Mtatnt, 11805 SW 26th Date p P • p5TDs # 0 Inspector Address Continents: Signature STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION INSPECTION AND FINAL APPROVAL APPLICANT: Thomas R Wensjoe & Monica Kuljich APPLICATION #:API257990 PERMIT #:13 -SC -1711031 DOCUMENT # : F11076494 DATE PAID :09/29/2016 FEE PAID :80.00 RECEIPT # :13 -PI D-3110890 AGENT: Barry G Teixeira Septic Service PROPERTY ADDRESS: LOT: D SUBDIVISION: 10025 Biscayne Blvd Miami, FL 33138 BLOCK: ID# : 11-3205-034-0040 CHECKED [X] ITEMS ARE NOT IN COMPLIANCE WITH STATUTE OR RULE AND MUST BE CORRECTED. TANK INSTALLATION [01] [02] [03] [04] [05] [06] [07] [08] [09] TANK SIZE [1] TANK MATERIAL OUTLET DEVICE MULTI-CHAMBERED [ Y / N ] OUTLET FILTER [2] LEGEND 1. 2. WATERTIGHT LEVEL DEPTH TO LID DRAINFIELD INSTALLATION [10] AREA [1] [2] [11] DISTRIBUTION BOX HEADER [12] NUMBER OF DRAINLINES 1. 2. [13] DRAINLINE SEPARATION [14] DRAINLINE SLOPE [15] DEPTH OF COVER [16] ELEVATION [ ABOVE / BELOW ]BM [17] SYSTEM LOCATION [18] DOSING PUMPS SQFT [19] AGGREGATE SIZE [20] AGGREGATE EXCESSIVE FINES [21] AGGREGATE DEPTH FILL / EXCAVATION MATERIAL [22] FILL AMOUNT [23] FILL TEXTURE [24] EXCAVATION DEPTH [25] AREA REPLACED [26] REPLACEMENT MATERIAL Comments: Comments are on page 2. SETBACKS [27] [28] [29] [30] [31] [32] [33] [34] [35] SURFACE WATER DITCHES PRIVATE WELLS PUBLIC WELLS IRRIGATION WELLS POTABLE WATER BUILDING FOUNDATIONS PROPERTY LINES OTHER FILLED / MOUND SYSTEM [36] [37] [38] [39] DRAINFIELD COVER SHOULDERS SLOPES STABILIZATION ADDITIONAL INFORMATION FT FT FT FT FT FT FT FT FT [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 Barry Teixeira (Barry Teixeir [48] OTHER ABANDONMENT [ ] [49] TANK PUMPED 09/29/2016 [ ] [50] TANK CRUSHED 6 FILLED 09/29/2016 CONSTRUCTION [ FINAL SYSTEM [ APPROVED APPROVED DISAPPROVED ] : Engineer / DISAPPROVED ]: (Explanation of Violations on following page) Dade CHD DATE : 09/29/2016 ervisor III Altrid V Edwards (Deparbnent of Health in Dade Co L. Dade CHD DATE: 09/29/2016 En r Supervisor III Astrid V Edwards (Department of Health in Dade Co DH 4016, 08/09 (Obsoletes all previous editions which may Incorporated: 64E-6.003, FAC EH Database v 1.0.1 API257990 not be used) EID1711031 Page 2 of 3 y�V STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION INSPECTION AND FINAL APPROVAL APPLICATION # : API 257990 PERMIT #: 13 -SC -1711031 DOCUMENT #:F11076494 DATE PAID :09/29/2016 FEE PAID :80.00 RECEIPT #:13 -PID -3110890 Violation Number Comment Comments Inspection performed by Barry Teixeira Septic. Photos provided. DH 4016, 08/09 (Obsoletes all previous editions which may not be used) Incorporated: 64E-6.003, FAC EH Database v 1.0.1 AP1257990 EID1711031 Page 2 of 3