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PL-18-341 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores,FL Phone:(305)795-2204 Fax:(305)756-8972 Inspection Number: INSP-297077 Permit Number: PL-2-18-341 Scheduled Inspection Date: March 26,2018 Permit Type: Plumbing -Residential Inspector: Hernandez,Rafael Inspection Type: Final Owner: KLINE,JANET Work Classification: Drainfield Job Address:10331 NE 6 Avenue Miami Shores,FL 33138- Phone Number (305)285-3402 Parcel Number 1122310120220 Project <NONE> Contractor: ALFONSO SEPTIC CONTRACTOR INC Phone:(786)2544099 Building Department Comments nfractio _ Passed..... omments INSTALL A 300 SQFT DRAINFIELD INSPECTOR COMMENTS False Inspector Comments HRS APPROVAL ON FILE Passed Failed Correction Needed Re-Inspection a. Fee No Additional Inspections can be scheduled until re-inspection fee is paid. March 23,2018 For Inspections please call:(305)762-4949 Page 10 of 24 Per mit` o. PL-2-18-341 Miami Shores Village Permit Type:Plumbing-Residential Avenue 10050 N.E.2nd ANE Wot*,Classification:Drainfield Miami Shores,FL 33138-0000 t- Perl '111 Permit Status:APPROVED Phone: (305)795-2204 Issue Date:2121120118 f Expiration: 08/26/2018 Project Address Parcel Number Applicant 10331 NE 6 Avenue 1122310120220 Miami Shores, FL 33138- Block: Lot: JANET KLINE Owner Information Address Phone Cell JANET KLINE 10331 NE 6 Avenue (305)285-3402 MIAMI SHORES FL 33138- 10331 NE 6 Avenue MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone Valuation: $ 4,000.00 ALFONSO SEPTIC CONTRACTOR INC (786)251-4099 Total Sq Feet: 300 Type of Work:INSTALL A 300 SQFT DRAINFIELD Available Inspections: Type of Piping: Inspection Type: Additional Info: HRS Approval Bond Return: Final Classification:Residential Scanning:3 Review Plumbing Fees Due Amount Pay Date Pay Type Amt Paid Amt Due Bond Type-Contractors Bond $5-0000 Invoice# PL-2-18-66402 CCF $2.40 02/09/20118 Credit Card $50.00 $624.65 DBPR Fee $2.25 DCA Fee $2.00 02/27/2018 Cash $624.65 $0.00 Education Surcharge $0.80 Bond 3672 Notary Fee $5.00 Permit Fee $150.00 Scanning Fee $9.00 Technology Fee $3.20 Total: $674.65 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. F hermore,I authorize the ove-named contractor to do the work stated. February 27, 2018 Aut)(brized Signature:Owner / *plicant / Contractor / Agent Date Building Department Copy February 27,2018 1 a C'i 4v t°K R 1 i Miami Shores Village \ Building Department E 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 O(�� Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 j+k FBC-2011 BUILDING Master Permit No.PLI ?-341 PERMIT APPLICATION Sub Permit No. BUILDING ELECTRIC ROOFING REVISION Ej EXTENSION RENEWAL I (PLUMBING ❑ MECHANICAL F-1 PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP rT CONTRACTOR DRAWINGS„ e / i JOB ADDRESS: - City: Miami Shores County: Miami Dade Zip: Folio/Parcel# 11-2 2 2 1 -0 12,012 2 U Is the Building Historically Designated:Yes NO Occupancy Type: 19�—Load:` * ! Construction Type: Flood Zone: BFE: FIFE: ` OWNER:Name(Fee Simple Titleholder): A UQT At12 e Phone#: Address: LO--? i IU Q _ !� a ut— City: He 4 we i S Co[v n State: r'�!/L. Zip: Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name:_[�/ r20A.-15o 9e-f f C CDA, " —Phone#: Za:;�.2 Address: 3 9-/j We r- 3 G 4 P- le'l / City: fob f4-le/_/d— State: G'214, Zip: 9 1, Qualifier Name; n42 B01'y-1LLQd- Phone#: ;&2-2 a-1 State Certification or Registration#' R ��1 127C Certificate of Competency#:500-0 l 1 1 9?'s I DESIGNER:Architect/Engineer: f'°{�l Phone#: Address: City: State: Zip: f Value of Work for this Permit:$ ~ Square/Linear Footage of Work: 30c) Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition r ' Description,of Work J b S(-4 0 IA, 2 66 5; Qi ice` © b Ol 4-c A.-,Pell f -'T-1'w 1.^,% P�� <`t'H.w.r->W,.'jx Y4�.�:s.�iraF�+.Mwa+saraY�+.�•aM f Specify color" f colorthru the `� Dom' t l n;rr� t iXe.1_'•UC Fi::tr i " i5 Submittal Fee$_50w�Permit Fee$ CCF$ Scanning Fee$ it r ., Radon Fee$ �� DBPR$ (3• Notary$ 5 CR Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ S30. TOTAL FEE NOW DUE$ ( � (Revised02/24/2014) Bonding Company's Name(if applicable) Bonding`Company's Address City State Zip Mortgage Lender's Name(if applicable) Mortgage Lender's Address I 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 law's 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..... F -- 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. 1 "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." a Bio€ 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 Signature OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before Cme this a foregoing instr ent was acknowledged before a this t=day of .VtAo 20 9 day of 20 , by tje_:r KJJfa who is personally known to �C.� on who is personally known to me or who has produced as qe or who has produced _ I as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign: Pr' t0. Print: Lvi:" ` MY COMMISSION#GG.044602 �Y EXPIRES:Novem er ,2020 2020Seal: Seal: �oP BondadThruNotaryPuWicUndervvriters +: MY COMMISSION#FF 150202 -- � f EXPIRES:October 8,2018 Boned Tft Not"Pudic Undsmtm r� APPROVED BY le Plans Examiner~ Zoning a Structural Review Clerk (Revised02/24/2014) i r Alfonso Septic Contractor, INC. 1391 West 36 Street Hialeah, FL 33012 alfonsoseptic@gmail.com Date: February 08, 2018 State of Florida County of Dade Before me this day personally appeared - Jose Bolanos who, being ' duty sworn, deposes and says: That he or she will be the only person working on the project located at: 10331 NE 6 Ave Miami Shores, FL actor Signature Sworn to (or affirmed) and subscribed before me this day of February 2018-, By Personally Known _ OR Produced Identification T Type of Identification Produced OV l <:�I :2P�'j''r'v'• M i `At. AHARAI K.GONZALEZ ?„ t; MY COMMISSION#GG 044602 EXPIRES;November 2,20 Bonded Th.,Nota 20 ry Publlo Underwriter t�"(Ov( R Print, Type or Stamp Name of Notary { a . F OR y s� �;e Miami shores Village sell ,' Building Department artment ,�e 10050 N.E.2nd Avenue ��ORIDA Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Notice to Owner - Workers' Compensation Insurance Exemption Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05 allows corporate officers in the construction industry" to exempt themselves from this requirement for any construction project prior to obtaining a building permit. Pursuant to the Florida Division of Workers'Compensation Employer Facts Brochure: An employer in the construction industry who employs one or more part-time or full-time employees,including the owner,must obtain workers' compensation coverage. Corporate officers or members of a limited liability company (LLC) in the construction industry may elect to be exempt if: 1. The officer owns at least 10 percent of the stock of the corporation, or in the case of an LLC,a statement attesting to the minimum 10 percent ownership; 2. The officer is listed as an officer of the corporation in the records of the Florida Department of State,Division of Corporations;and 3. The corporation is registered and listed as active with the Florida Department of State,Division of Corporations. No more than three corporate officers per corporation or limited liability company members are allowed to be exempt. Construction exemptions are valid for a period of two years or until a voluntary revocation is filed or the exemption is revoked by the Division. Your contractor is requesting a permit under this workers'compensation exemption and has acknowledge that he or she will not use day labor,part-time employees or subcontractors for your project.The contractor has provided an affidavit stating that he or she will be the only person allowed to work on your project.In these circumstances,Miami Shores Village does not require verification of workers'compensation insurance coverage from the contractor's company for day labor,part-time employees or subcontractors. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature 111477 Owner State of Florida County of Miami-Dade The foregoing was acknowledge before me'this day of Fe— ,20 By,\Ne who is personally known to me or has produced as identification. ANotary: SEA . J06E 80LI 3+ { MY COMMISSION 1"FF 156M ' R���h•''• �^�Thro Notary Publk UndanarRen I i , CIIe-1+ Ic0--,sfroCt0-- HEJ�►-TM DEPARTjWENT PERMIT #: 13-SC-1819249 I STATE OF FLORIDA LDADE000NV APPLICATION #:AP1326088 DEPARTMENT OF HEALTH DATE PAID: ONSITE SEWAGE TREATMENT AND DISPOSAL FEE PAID: ur SYSTEM tWIL �4 RECEIPT #: DOCUMENT #: PRI 091784 r J.J xL L'`'.: CONSTRUCTION PERMIT FOR: OSTDS Repair APPLICANT: Janet Kline PROPERTY ADDRESS: 10331 NE 6 Ave Miami, FL 33138wt� �t" 1 ki" LOT: 24 BLOCK: SUBDIVISION: Golf View Est Corr PI PROPERTY ID #: 11-2231-012-0220 [SECTION, TOWNSHIP, RANGE, PARCEL NUMBER] I [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 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 ••• 0000 0000•• • •• • • • •• T [ 900 ] GALLONS / GPD existina septic tank CAPACITY •••••• 0 0••• •0 0.0• A [ ] GALLONS / GPD CAPACITY 0000• • • • 000••0 N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:14QA"GALLONSjO•O • • K [ j GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER'244RS 'tlPtimps [ "�']•0 69••0• • •• 0000• D [ 225 j SQUARE FEET Trench confiauration drainfi SYSTEM 0• " �'•• •••••• • R [ ] SQUARE FEET SYSTEM �•��0� 0 •• A TYPE SYSTEM: [X] STANDARD [ ] FILLED [ ] MOUND [ ] • 0 0 000i• "00•• I I CONFIGURATION: [x] TRENCH [ ] BED [ ] • • • 0000•• • N • • • F LOCATION OF BENCHMARK: crown of road 103 St. 9.04' NGVD • I ELEVATION OF PROPOSED SYSTEM SITE [ 7.20 ] [ INCHES FT ] [ ABOVE BELOW]BENCHMARK/REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ 36.80 ] [ INCHES FT ] [ ABOVE BELOW BENCHMARK/REFERENCE POINT L D FILL REQUIRED: [ ] INCHES EXCAVATION REQUIRED: [ 44.001 INCHES f 1.-Existing 900 gal.septic tank, certified by Alfonso Septic on 01/18/2018,to remain. 0 2.-Install 225 sf of drainfield in trench configuration. T 3.-Perimeter of excavation area shall be at least 2 ft wider and longer than the proposed absorption bed or drain trench. H 4.-Invert elevation of drainfield to be no less than 6.47'NGVD. 5.-Bottom of drainfield elevation to be no less than 5.97'NGVD. E The system is sized for 3 bedrooms with a maximum occupancy of 6 persons(2 per bedroom),for a total estimated flow of R 400 gpd. **THIS REPAIR PERMIT IS NOT FOR ANY ADDIITONS** SPECIFICATIONS BY: Jose Bolanos TITLE: Registered Septic Tank Contractor t APPROVED BY: ( �� TITLE: Engineering Specialist II Dade CHD Erlande Onisca DATE ISSUED: 02/01/2018 EXPIRATION DATE: 05/02/2018 DH 4016, 08/09 (Obsoletes all previous editions which may not be used) CONTRACTOR 1.1 KR IM incorporated: 64E-6.003, FAC ■■■ AP1326088 Thest*Mr=or(of designee)is required to perforrn a soil bor adjacent :o the drainfel.d excavation at the time of fire; ir.spec'icn. Prior to Final Approval, the FDCH inspector shall witness the soli boring and compare the results to the original site evaluation submitted. A reinspection fee will be assessed if the contractor is not at the jobshe at the arranged time. APPLICATION FOR CONSTRUCTION PERMIT ` Permit Application Number PART II -SITEPLAN ----------------------- ----/-----------;t� 0qV---- r � E ch block resents 10 feet and 1 inch =40 feet. `Ct 14/ I 1K .. .. . ... .. q ROA N Al ItJRES TI S �t,ACR( 7f t T .. - ... --E a T A M AJ.. . HEN . YS ... .. Notes: Site Plan submitted Jose Bol• nos Plan Approved n6'e,(jjwbAt)proved DateBy e am County Health Department ZS ALL SPROVED BY THE COUNTY HEALTH DEPARTMENT DH 4015,08/09(Obsoletes previous lions which may not be used) Incorporated: 64E-6.001,FAC Page 2 of 4 (Stock Number: 5744-002-4015-6) NDARYSURVW •lavr • • • • • • -MOM IA1Afr1 11MORML IL 331a �a • vaI. • • G,.D f �• . ..• � Gy ML SU m N 5 FUGAL a arms 16 �! • - -• , 1RC 3'mC Iwu6 1Y[ab111PIC Ttl�Rf+FLXT TItFA(pr;AS smumm N F'fAr DOOR N.V'Aq 14 7. - h Rcimwe•w Mtww�nt�I R�dOAt rl tc ro sigma ELaO__yANEAEORMAON• �r .gip RA®cm be FLOW M71R►NfflAir NW or me 1lOOt4 r�iAf kCi Yr1YAr11AiiY AC01Cf RLM{Fl�al QS/N/r4i sm to 14n MAP Rtg=os OfrhlM fht OA�pIi GNt6Y pgAC11p��)411 PH or Im kv w w2wr a m*w w.m off4Asc rMWMW E=m%V 7q RIA Oft-"MARC a Jt%M UM a11=1:0UM YM t F'M& fr71 MM790tti00tp1 5Y►r:x t i' Sr p�I rr9m g de SYMBOLS a r '" �Yc it ab1FTF1W Oft■'M400a J�CAf !rk qY r }F d P MU sp .si sip/FIFE 41111 it {* • �IVIII?1 pp��r r C t SN ■ brmx ONO rON 7• p4A' C 'SK'WYL 'F y rW Z' � pp�.S.9RIOOfI FP1r1P �a. ��NIE1�11) A.9!IILIN_ �! 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WARHZ.. 6UIL1R13a11-AND.YAPPCB PR9PMM&Mt11R4MR AND'MOM SrAltt Or.Fi bl &UG. VISION OF Enviro"VISION Health Florida Health eMiami-Dade County r OSTDS/Well Division 0� 11805 S"'26th Street•1Nlami,FL 33175 Inspector `>i••- c n j'o 3Date Address O t �'------ v OSTDS it Comments: Signature