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PL-15-1175Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Project Address Permit Perrnit NO. PL-5-15-1175 Permit Type: Plumbing - Residential Work Classification: Drainfietd Permit Status: APPROVED Issue Date: 5/21/2015 Expiration: 11/17/2015 Parcel Number Applicant 650 NE 97 Street Miami Shores, FL 33138- 1132060171640 Block: Lot: SYLVIA FLORES Owner Information Address Phone Cell SYLVIA FLORES 650 NE 97 Street MIAMI SHORES FL 33138- 650 NE 97 Street MIAMI SHORES FL 33138- Contractor(s) WESTLAND PLUMBING CORP Phone CeII Phone (305)863-6223 (786)236-0198 Valuation: Total Sq Feet: $ 2,500.00 400 Type of Work: REPAIR DRAINFIELD Type of Piping: Additional Info: Bond Return : Classification: Residential Scanning: 1 Fees Due Bond Type - Contractors Bond CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Amount $500.00 $1.80 $2.25 $2.25 $0.60 $150.00 $3.00 $2.40 Total: $662.30 Pay Date Pay Type Invoice # PL-5-15-55603 05/21/2015 Credit Card 05/18/2015 Credit Card Bond #: 2721 Amt Paid Amt Due $ 612.30 $ 50.00 $ 50.00 $ 0.00 Available Inspections: Inspection Type: HRS Approval Final Review Plumbing 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, PLUMING, MECI-,NIGAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certi that all the f reg mg information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futh rmo — ayjtho i4e t e above -named contractor to do the work stated. / / May21,2015 Authorized Signat / : Owner /;Applicant / Contractor / Agent Date Building Department Copy May 21, 2015 1 Slet115.- ALefilnp BUILDING PERMIT APPLICATION BUILDING ❑ ELECTRIC RLUMBING ❑ MECHANICAL 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 RECEJVED MAY 18 2015 BY. FBC 20 (0 Master Permit No. 'ZC. y— i C e8S Sub Permit No. In-- I 115 ❑ ROOFING ❑ REVISION ❑ EXTENSION 0 RENEWAL JOB ADDRESS: 66D vie - PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS City: (t:Miami Shores County:'.—rMiami Dade Zip: ✓! 1 �J S • Folio/Parcel#: l 1 .� a06 - 0 I1 V>0 Is the Building Historically Designated: Yes NO Occupancy Type: Load: BFE: FFE: Construction Type: Flood Zone: OWNER: Name (Fee Simple Titleholder): E1 / l' I (o 12--e- Address: 50 va•L S fi Phone#: •-7 q (/ � Li‘? City: State: � Zip: aJ l Tenant/Lessee Name: Phone#: Email: f U) ' r( . Pfu ! t, o 5r�s s 3)ist--- CONTRACTOR: Company Name: QI/L K-C� �' C:. p hone#: Address: 10 1. u2) c 2 C ' (4R City: }— I 0. State:` -t os : vi& S A Qualifier Name: State Certification or Registration #: w"0 Zip: 50 / V Phone#: 7a0— 2_ (p 6(6117 Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: • Address: City: State: Zip: Value of Work for this Permit: $ 'ir... Square/Linear Footage of Work:: to r 1fb0 S 1-7 Type of Work: ❑ Addition '- Alteration• ❑ New Repair/Replace. • -.. , �'�I> f;Qemolition Description of Work: V-27 C::t'\;:V -+i4s, f I • t .�. !„l +.• - f, P:AC''.. et' . Specify color of color thru tile: Submittal Fee $c -v r) Scanning Fee $ 3. w Technology Fee $ y 0 Structural Reviews $ Permit Fee $ / 5-0 0 V Radon Fee $ d.a5 Training/Education Fee $ CCF $ • • fru CO/CC $ DBPR $ o(•� S . Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ I Z ' a `• (Revised02/24/2014) Bonding Company's Name (if applicable) V2 `e1 I Q'� P( U I/(j 60-(p• 'Bonding ompan 's Address to 1 LLD `f � T- aw ! J/Q /- - /-1 State 2/a 2 i/J/J Zip w/ 11 V 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 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. ct`VIA god, Signature WNER or AGENT The foregoing instrument was acknowledged before me�bis by wn to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: ` t `���i�ii������ •• i Sign: Print: Seal: ****************************** APPROVED BY 5��q/1 •Plans Examiner Signature CONTRACTOR ti• The foregoing instrument was acknowledged before me this day of Me or who has produced as identification and yr�lvplid,tpke an oath. � ._.z...DEC 00 NOTARY PO ° • la* ry8 Sign: _ No7 .• . ftuy3 Print: /� .u,,I�•• Seal: t Zoning (Revised02/24/2014) Structural Review Clerk WESTPLU-01 CBRAMOS p , ACOII O* k....--- CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 5/15/2015 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(ies) 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 License # L077730 Assured Risk Solutions 1000 Sawgrass Corporate Parkway STE 552 Sunrise, FL 33323 CONTACT PHONE 888 830-4396 FAX 954 346-0244 (A/C. No, Extt: ( ) WC, No): ( ) AIL AD RESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Arch Specialty Insurance Company INSURED Westland Plumbing Corp 101 W 24 Street Hialeah, FL 33010 INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : R: 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 POLIC ES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE INSO SUBR POUCY NUMBER (MM POLICY EXP (MMIDDMYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY AGL001285501 05/09/2015 05/09/2016 EACH OCCURRENCE $ 1,000,000 pAMAGE TO RENTED REM SES Ea occurrence) $ 100,000 CLAIMS MADE X OCCUR MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L X AGGREGATE POLICY OTHER: LIMIT APPLIES PET PER: LOC PRODUCTS - COMP/OP AGG $ 2,000,000 $ AUTOMOBILE _ LIABILITY ANY AUTO ALL OWNED SCHEDULED COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per acddent) $ $ UMBRELLA LIAB EXCESS UAB O OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ $ DED RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N N / A PER STATUTE OTH- ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached H more space Is required) License # CFC037110 CANCELLATION I Miami Shores Village 9 10050 NE 2nd Avenue Miami, FL 33338 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 ED ACORD 25 (2014/01) © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT CONSTRUCTION PERMIT FOR: APPLICANT: Silvia Flores OSTDS Repair PERMIT #: 13-SC-1601359 APPLICATION #: AP1185483 DATE PAID: FEE PAID: RECEIPT #: DOCUMENT #: PR972237 PROPERTY ADDRESS: LOT: 4 650 NE 97 St Miami, FL 33138 BLOCK: 100 SUBDIVISION: PROPERTY ID #: 11-3206-017-1640 [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 [ A [ N [ K 1,050 ] GALLONS / GPD 0 ] GALLONS / GPD Exist. septic tank to remain CAPACITY CAPACITY 0 ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS] ] GALLONS DOSING TANK CAPACITY ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ ] D Bed configuration drainfiel SYSTEM R [ 0 ] SQUARE FEET SYSTEM A TYPE SYSTEM: [x] STANDARD [ ] FILLED [ ] MOUND [ ] I CONFIGURATION: [ ] TRENCH [x] BED [ ] N F LOCATION OF BENCHMARK: FFE: 10.65' NGVD [ 400 ] SQUARE FEET I ELEVATION OF PROPOSED SYSTEM SITE E BOTTOM OF DRAINFIELD TO BE L D FILL REQUIRED: 0 R SPECIFICATIONS BY: APPROVED BY: [ 0.00 ] INCHES [ 26.00 ] [I INCHES / FT ] [ ABOVE /+ BELOW b BENCHMARK/REFERENCE POINT [ 73.08 III INCHES / FT ] [ ABOVE 4 BELOW ] BENCHMARK/REFERENCE POINT EXCAVATION REQUIRED: [ 47.00] INCHES 1.-Existing 1050 gal. septic tank, certified by "Westland Plumbing" on 4/19/2015 to remain. 2.-Install 400 sf of drainfield in bed configuration. 3.-Invert elevation of drainfield to be no less than 5.06' NGVD. 4.-Bottom of drainfield elevation to be no less than 4.56' NGVD. System sized for 4 bed with a maximum occupancy of 8 persons (2 per bedroom), for a total estimated flow of 400 gpd. THIS PERMIT IS NOT FOR ANY ADDITIONS. Teresa J Solomon Betsy Lange-Olmino DATE ISSUED: 04/23/2015 TITLE: Master Septic Tank Contractor TITLE: Engineering Specialist II DH 4016, 08/09 (Obsoletes all previous editions which may not be used) Incorporated: 64E-6.003, FAC v 1.1.4 AP1185483 Dade CHD EXPIRATION DATE: 07/22/2015 SE958427 Page 1 of 3 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 governed 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.