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PL-16-1623 Permit-No. PL-6-16-1623 `yKOR Miami Shores Village ■. Permit Type:Plumbing-Residential r � 10050 N.E.2nd Avenue NE ' WorkCfassi�catiah:Septic " Miami Shores,FL 33138-0000 "Peril"'I'lPermit Status:APPROVED Phone: (305)795-2204 FKORiDA Issue Dat�:6123/2016 Expiration: 12/20/2016 Project Address Parcel Number Applicant 1420 NE 103 Street 1132050310030 MARC AND ANNE LITZENBERG Miami Shores, FL Block: Lot: Owner Information Address Phone Cell MARC AND ANNE LITZENBERG 1420 NE 103 Street MIAMI SHORES FL 33138- 1420 NE 103 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone Valuation: =8,000.00G&L PLUMBING SERVICE 305-551-5090 (786)225-3648.�. ...,,,..._ Total Sq Fee Type of Work:SEPTIC TANK 1350 AND DRAINFIELD 725 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 CCF $4.80 Invoice# PL-6-16-60152 DBPR Fee $4.50 06/10/2016 Credit Card $50.00 $280.80 DCA Fee $4.50 Education Surcharge $1.60 06/23/2016 Credit Card $280.80 $0.00 Permit Fee $300.00 Scanning Fee $9.00 Technology Fee $6.40 Total: $330.80 In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans,drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTR PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS AFFID41110/11 certify tha.e11 the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and,z '1 g. Futher re,I authorize the above-named contractor to do the work stated. June 23, 2016 Authori d Signature:Owner / Applicant / Contractor / Agent Date Buildin ' Department Copy June 23,2016 1 !:" i. .,# �� °�• DIVISION OF A' 4 r Environmental Health+� � , Florida Health i O� Miami-Dade County' , O ��DSDivision. n Q - 11805.�W 26th�Street mi,FL 33175,,,,%-_ '• _� } _.O �.�•� I Inspector �l d+�^ r /"1 e G`�I �f s o"e. Date t •� ��C1 l..� w /�� /�-^ �vT�1C��y * Addre$s x y�ty { " fi �0 /1 6 osfoL tt COO"ment.S' dL Signature 2 f ( � Miami Shores Village 40 NAF 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 SA FBC 2014 BUILDING Master Permit No. 126 PERMIT APPLICATION Sub Permit No. �I ❑BUILDING ❑ ELECTRIC ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL [R4LUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: Jqa n Pv� to a sf City: Miami Shores County: Miami Dade Zip: 75 3 133 Folio/Parcel#: '" 3c n�-�3)- �d3O Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: / Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): f I�rc_ X �"en 6 C rj Phone#: Address: 14' � I0/10 "V /0�5 Sr , City: � ) CA n'l 1 State: G' Zip: 3 3 3 Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: c Un e rU�G j Phone#: Address: ,n 5 + q 0"Zi _ /- 1 City: ►v ` I State: :��L' Zip: Loy I�r 2 ra 3/�ociD�g Qualifier Name: Phone#: State Certification or Registration#: F-C-©5& 455 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: �7 Zip: Valuee-6f Work for-this•Perniit:$ Sclaa-fe'/Linear•Footage•of Work: 7L_� IN Type of Work: ❑ Addition ❑ Alteration RZrNew ❑ Repair/Replace ❑ Demolition escription of work: ' Q Sc( n t2 '9 Specify color of color thru tile: Submittal Fee$ 'C� Permit Fee$ 60 CCF! 0 CO/CC$ SID Scanning Fee$ ,�p Radon Fee$ -1 DDBPPR$ Notary$ Technology Fee$ �. T 0 Training/Education Fee$ i 1 Double Fee$ ��^^ Structural Reviews$ Bond$ ®1n= TOTAL FEE NOW DUE$ 280• UO (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 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 r 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 r 'nspection fee will be charged. 1 Ry 1ivatbre. Signature - OWN R-grAGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this dI ay of SU'- 20 1 to by day of�� Vni& 20 1 U , by hn L s he—�who is sonally kno to ,cr..•-e r'-G who is personally known to me or who has produced v as me or who has produced��.c o\� NL n� -) identification and who did take an oath. identification and who did take an oath. NO ARY:P_UBL'IC TARY PUBLIC: Sign. Sign: Print: Print: GH G°•� NATHALIESHAHIN 3+; " COMMiSSION0FF242181 Seal: y�=.' t ftlYCOA1641SSI0NEE?237i4 Seal: p. RES: •2019 October 18 `_X.?IRES:August 9,2016 P \°' ...,cau fhru Notary Public Underwriters �, i, bended Thru Notary Public Underwriters ************************************************************************************************************ 1 APPROVED BY 6`� ` Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) �s�2G ,:1a. AC�4 DATE(MM/DD/YYYY) CCERTIFICATE OF LIABILITY INSURANCE 06/06/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 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 Is an ADDITIONAL INSURED,the policy(les)must be endorsed. 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). PRODUCER NAME:CT JUAN G TUNON ROYAL CARIBBEAN INS.AGENCY PHONE 305 642 4541 Fv No:305-642-1087 1772 W FLAGLER STREET noDRE :JTUNONROYALI1@GMAIL.COM MIAMI,FL 33135 INSURERS AFFORDING COVERAGE NAIC R INSURER A;SCOTTSDALE INSURANCE CO. INSURED INSURERS:TECHNOLOGY INSURANCE CO. G&L PLUMBING SERVICE, INC. INSURERC: 13957 SW 140TH STREET INSURER 0: MIAMI,FL 33186 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW 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 OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDLSUOR TYPE OF INSURANCE POLICY NUMBER POLICY EFF POLI Y EXP LTR YYY MM DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CPS2405076 05/04/2016 05/04/2017 EACH OCCURRENCE $ 1,000,000.00 DAMAGE TO RENTEU_ i CLAIMS-MADE 2XI OCCUR $ 100,000.00 MED EXP(Any one person) S 5,000.00 PERSONAL&ADV INJURY $ 1,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE S 2,000,000.00 POLICY a PROJECT- ❑LOC PRODUCTS-COMP/OP AGO S 2,000,000.00 OTHER: S AUTOMOBILE LIABILITY MB NE 1 GLE UMIT S Ea accident) ANY AUTO BODILY INJURY(Per person) S ALL OWNED SCHEDULED BODILY INJURY(Per accident) S AUTOS AUTOS NOM-OWNED PROPERTYDAMAGE S HIRED AUTOS AUTOS er accident) S UM13RELLALIAB OCCUR EACHOCCURRENCE S EXCESS LIAR CLAIMS-MADE AGGREGATE S OED I I RETENTIONS S B WORKERS OR EMPLCOMPENSATION YERS SAT ON TW AC3469712 05/10/2016 05/10/2017 STATUTE °R" ANY PROPRIETOR/PARTNER/EXECUTIVE NTY N/A E.L.EACH ACCIDENT $ 1,000,000.00 OFFICENUEMSER EXCLUDED? - (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE S 1,000,000.00 U yes.describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 1,000,000.00 t DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached It more space Is required) PLUMBING CONTRACTOR. LICENSE 9 CFC056755 CERTIFICATE HOLDER CANCELLATION t SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE MIAMI SHORES VILLAGE THE EXPIRATI —DATE THEREOF, NOTICE WILL BE DELIVERED IN AC ORDAN BUILDING DEPARTMENT WITH THE P ICY PROVISIONS. 10050 NE 2ND AVE AUTHORIZED ESENTATVE MIAMI SHORES, FL 33138 O 1988014 ACORD IbOFTPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and loco are reaistered mar of ACORD PERMIT #: 13-SC-1623532 STATE OF FLORIDA APPLICATION #: AP1199820 DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL DATE PAID: SYSTEM FEE PAID CONSTRUCTION PERMIT RECEIPT #- 011P DOCUMENT #: PR991973 CONSTRUCTION PERMIT FOR: OSTDS New APPLICANT: Marc Lltzenberg 9 PROPERTY ADDRESS: 1420 NE 103 St Miami, FL 33138 LOT: 12 BLOCK: 5 SUBDIVISION: tPROPERTY ID #: 11-3205-031-0030 [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 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 [ 1,350 ] GALLONS / GPD Septic CAPACITY � A [ ] GALLONS / GPD N/A CAPACITY N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS] K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ ] D [ 725 ] SQUARE FEET Trench Drainfield SYSTEM R [ ] SQUARE FEET N/A SYSTEM A TYPE SYSTEM: [ ] STANDARD [x] FILLED [ ] MOUND [ ] I CONFIGURATION: [x] TRENCH [ ] BED [ ] N F LOCATION OF BENCHMARK: TBM COR of NE 103 St&projected East property line:4.53'NGVD I ELEVATION OF PROPOSED SYSTEM SITE [ 14.40 ] [ INCHES FT ABOVE/BELOW]BENCHMARK/REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ 6.40 ] [ INCHES FT ] [ ABOVE BELOW]BENCHMARK/REFERENCE POINT L D FILL REQUIRED: [ 10.00] INCHES EXCAVATION REQUIRED: [ 50.701 INCHES 0 FILL SYSTEM-This is a fill system and must comply with all the requirements of Chapter 64E-6.009(4). *Install 42"of slightly limited soil at the bottom of the drainfield. T *Perimeter of excavation area shall be at least 2 ft wider and longer than the proposed absorption bed. H *Invert elevation of drainfield to be no less than 5.50'NGVD. *Bottom of drainfield elevation to be no less than 5.00'NGVD. E The system is sized for 4 bedrooms with a maximum occupancy of 8 persons(2 per bedroom),for a total estimated flow R of 580 gpd. (Comments Continued on Page 2.) r SPECIFICATIONS BY: Rolando Arrieta TITLE: I APPROVED BY: TITLE: Engineering Specialist II Dade CHD Nicole P Gumbs DATE ISSUED: 10/23/2015 EXPIRATION DATE: 04/23/2017 DH 4016, 08/09 (Obsoletes all previous editions which may not be used) Page 1 of 3 Incorporated: 64E-6.003, FAC sE9�5o33 v 1.1.4 AP1199820 DOCUMENT #: PR991973 The licensed contractor installing the system is responsible for installing the minimum category of tank in accordance with s. 64E-6.013(3)(f), FAC. s 1 i k* J C 4 t 1 1 I i S t f