PL-10-555Project Address
Owner Information
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138 -0000
Phone: (305)795 -2204
Address
Parcel Number
226 93 Street
Miami Shores, FL 33150-
1131010331080
Block: Lot:
BRIGITTA CUADROS
BRIGITTA CUADROS
226 93 Street
MIAMI SHORES FL 33150 -2236
Valuation:
Total Sq Feet:
$ 7,500.00
Contractor(s)
F A JOHNSON INC
Phone Cell Phone
(305)728 -7393
Phone
Type of Work: PLUMBING
Type of Piping: SEPTIC
Additional Info: DRAINFIELD
Bond Return :
Classification: Residential
Fees Due
CCF
Education Surcharge
Notary Fee
Permit Fee - Additions/Alterations
Scanning Fee
Technology Fee
Total:
Amount
$4.90
$1.60
$5.00
$300.00
$3.00
$6.40
$320.80
Pay Date Pay Type
Invoice # PL-4-10 -37467
04/01/2010 Credit Card
Amt Paid Amt Due
$ 320.80 $ 0.00
Expiration: 01/01/2999
Applicant
Cell
Available Inspections:
Inspection Type:
HRS Approval
Abandonment
Final
Rough
Landscaping
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.
Authorized Signature: Owner / Applicant / Contractor / Agent
Building Department Copy
April 01, 2010
Date
April 01, 2010 1
BUILDING
PERMIT APPLICATION
FBC 20
Permit Type: PLUMBING
Owner's Name (Fee Simple Titleholder)
Owner's Address � !v "" `73 c j ,'
N
City MOM � e/LaS State Ft,' l :.
Tenant/Lessee Name,
Email
Job Address (where the work is being done)
City Miami Shores Village County Miami -Dade
FOLIO / PARCEL # 11-3101-035-1 ? 'b
Is Building Historically Designated YE$ NO
Contractor's Company Name
Contractor's Address
Cit y0A( / (-+7 7 , /51 _ Stag Ft.. /9. Zip •33 ; Q l
Qualifier Name j /I ` at i f eA1J /3.. C�.c+N Phone T �
Certificate of Competency No.
State Certificate or Registration No. S/Y1 Q rb' 6‘ q
c7* tu7
Contact Phone
Architect/Engineer's Name (if applicable)
Value of Work For this Permit $ 7S ----4 .
Addition ❑Alteration
/icy -ra, N
Type of Work:
Describe Work:
Submittal Fee $
Notary $
Scanning $_
Double Fee $
Structural Review. $
Radon $
Miami Shores Village
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (05) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
Permit N7L 1 0 33 5
Master Permit No.
Permit Fee $
Buillding Department
226 Mt) 3 S7:
E -mail
Training/Education Fee $ � • Can
Zip Jj /5Q
Phone #
Phone #
Zip
Phone #
33i so
Flood Zone
`774- - 77C -913J
FOP
L• 3 d1 C
B Y. M----- ------ - -----
Phone # Jo 5— 7 j r -'73 93
Square / Linear Foot a Of Work: *O, fp
[New [7 RepaiiReplace ❑ Demolition
— r � —14v it) POCr-
1
* * * * * * * * ** * * * * * * * * * ** * * * * * * * * * * * * ** F * * * * * * * * * * * * * * * * * * *:* * * * * * * **
300 -a0
DPBR $
CCF OA ° CO /CC $
Technology Fee $ (.12 .40
Bond $
Violation date:
Total Fee Now Due $ 32O - /c J
See Reverse side -*
Bonding Company's Name (if applicable) A
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable) /f/ A
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 ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and 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.
Signature
Owner or Agent
The foregoing instrument was acknowledged before me this 1 �
day o (— , 2010 , by clay o
who is personally known to me or who has produced I 1 ) who is
As identification arOveci k an oath.
ntification and who did take an oath.
fatth
My Commission Expires : ,,.,,..,. (sueja
a ' t tetJ
X 6},1 - "octio 0114
** tear******* de*9 *k irsk .Y3e4rie***4r ***** *9r9ele *** *** *** ***. Y*****&. Y9: 9e9r9 :.Ya:.Y4e4e:Y** * *de9e ******** R a *** *****:tr ** ***
APPROVED BY Plans Examiner Zoning
Clerk checked
CONSTRUCTION PERMIT FOR:
APPLICANT: Gavin Macphail
PROPERTY ADDRESS:
LOT: 4
PROPERTY ID #: 11 - 3101 - 033 - 1080
SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF SECTION
381.0065, F.S., AND CHAPTER 64E -6, F.A.C. DEPARTMENT APP.tOVAL OF SYSTEM DOES NOT GUARANTEE
SATISFACTORY PERFORMANCE FOR ANY SPECIFIC PERIOD OF TIME.j 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.
T [ 900 ] GALLONS / GPD Seotic CAPACITTY
A [ 0 ] GALLONS / GPD CAPACITY
N [ 0 ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS 8[ ]DOSES PER 24 HRS #Pumps [ ]
D
R
A
1
N
41F
I
E
L
D
0
T
H
E
R
SYSTEM DESIGN AND SPECIFICATIONS
[ 200 ] SQUARE FEET SYSTEM
[ 0 ] SQUARE FEET SYSTEM
TYPE SYSTEM: [x] STANDARD [ ] FILLED [ ] MOUND []
CONFIGURATION: [ ] TRENCH [x] BED [ 1
LOCATION OF BENCHMARK: F.F.E.: 10.43' NGVD
ELEVATION OF PROPOSED SYSTEM SITE [ 1.56 ][ INCHES FT ][ABOVE
BOTTOM OF DRAINFIELD TO BE
FILL REQUIRED:
1— Install 900 gal. category-3 septic tank equipped with an approved filter. 2 -The licensed contractor installing the system
is responsible for installing the minimum category of tank in accordance with sec. 64E- 6.013(3)(f). 3- Install 200 sf of
drainfield in bed configuration. 4- Install 12" of slightly limited soil under the bottom of drainfield. 5- Perimeter of excavation
area shall be at least 2 ft wider and longer than the proposed absorption bed. 6 -Invert elevation of drainfield to be no less
than 8.46' NGVD 7. Bottom of drainfield elevation to be no Tess than 7.96' NGVD.
THIS PERMIT IS NOT FOR ADD
SPECIFICATIONS
APPROVED SY:
a..
DATE ISSUED:
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM
226 NW 93 St Miami, FL 33150
BLOCK: 135
OSTDS Repair
( 0.00 ] INCHES
DH 4016, 10/97 (Previous Editions
u 1.1.4
SUBDIVISION: Miami Shores
[ 29.56 ] [I INCHES r FT ] [ ABOVE
BELOW
BELOW
EXCAVATION REQUIRED: [ 40.00] INCHES
T PCP
A1 SE811901
PERMIT # -SC- 1127205
APPLICATION # : AP957821
DATE PAID:
FEE PAID:
RECEIPT #:
DOCUMENT #: PR803976
[SECTION; TOWNSHIP, RANGE, PARCEL NUMBER]
[OR TAX ID NUMBER]
BENCHMARK /REFERENCE POINT
BENCHMARK /REFERENCE POINT
EXPIRATION DATE:
Page 1 of 3
Site Plan submitted by:
Plan Approved
By
STATE OF FLORIDA
DEPARTMENT OF HEALTH
APPLICATION FOR ONS1TE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT°..
Permit. Application Number
DH 4015,10/96 (Replaces HRS•H Form 4016 whkh be used)
(Stock Number: 5744 - 00274015.6)
• PART II SITE PLAN -- r-� —.-
ALL CHANGES MIST BE APPROVED BY. THE: COUNTY- HEALTH. DEPARTMENT
C
Title
Date
::County Health. Department
Page 2of3
PART II - SITE PLAN—
Scale: Each block represents 5 feet and 1 inch .--50.tfeett.
Notes:
Site Plan submitted by:
Plan Approved
By
STATE OF FLORIDA
DEPARTMENT OF HEAL*
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT_
Permit Application Number
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ALL CHANGES MUST BE APPROVED By THE COUffrY HEALTH DEPARTMENT
DH 4015, 10/96 (Repiao3s HRS Form 4015 which may be used)
(Stock Number: 5744-002-4015-6)
Tide
•• :q
Date
County Health Department
Page 2 of 3
This certifies that the person named on the front of
this card has satisfied the requirements of Part III,
Chapter 489, Florida :St+ es for registration as a
septic tank contractorered by the
D of Health, a nsi� Sewage
;L Programs, to pro
.F services.
Report UnlawfaSeidelUnk Contracting:
1- 888-993 -9813
J 21
..00
SEE OTHER SIDE
DO NOT FORWARD
F A JOHNSON INC
ARCHIBALD CAMERON PRES
4700 POWERLINE RD
FT LAUDERDALE FL 33309
THE
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REQUIREMENT,
PERTAIN,
Mil.
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GENERAL
OR INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED
TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT
THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN
AGGREGATE LIMITS SHAWN MAY HAVE BEEN REDUCED BY PAID
Tin OF INSURANCE p POLICYNUMBER
NAMED ABOVE FOR THE POLICY
WITH RESPECT TO WHICH
IS SUBJECT TO ALL THE TERMS.
CLAIMS.
PERfOD INDICATED, NOTWITHSTANDING
THIS CERTIFICATE MAY BE
EXCLUSIONS ANC CONDITIONS
ISSUED OR
OF
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SPECIAL PROVISION
04/01/2010 13:46 9547762851 F A JOHNSON INC PAGE 02
A C u 04/01/2010
� �CERTIF ICATE OF LIABILITY INSURANCE N,. 4 �4�F 1/2,
?RODuCER (305)822 -7800 FAX (305)558 -4294
Collinsworth, Alter, Fowler & French LLC
P. 0. Box 9315
Miainl Lakes, FL 33014 -9315
F.A. Johnson Inc.
OSA: F.A. 3ohnsort Environmental Services
4700 Powerl1ne Road
Fort Lauderdale, Ft. 33309
COVERAGES
Miami Shores Building Department
10050 NE 2nd Avenue
Miami Shores, FL 33133
THIS CERTIFICATE I3 ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE
IFiSIURR A:
iNSUP.EIC B:
INSfRES C.
INSURER 0'
INSURE ^r• E'
Amerisure Insurance Co
Michael NI al aon/SANDYS
CANCELLATION
NAIC #
19488
SHOULD ANY OF nit f*BOYS NeCRIBBD POLICIES ME CANCELLED BEFORE
E7(PIRATION DATE THEREOF, THB ISSUING INSURER WILL ENDEAVOR TO MATE
DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE L6FT.
BUT FAILURE TO MAR SUCH NOTICE SMALL IMPOSE NO OISLttiATION OR L ABILI1Y
CIF ANY I(NIO UPON THE INSURER. ITS AGENTS OR REPREOETITATlWIL
AUTROINZED REPTIRSENTATIVE y. .
ACORD 25 (2001J08) MACORD CORPORATION 1888
04/01/2010 13:46 9547762851
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CERTIFICATE OF LIABILITY INSURANCE I a o ��
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r TIES GERTFIGAT! Ili ISSUED AA A !WAITER OF WFWFORINATI Y AND CODERS NO 06014Ti AI THE CERTIFIC MOLDER THIS
CERTIFICATE DGES NOT AFFIftIAATNPLY OR N[aATIVl4Y AMEND, L'XTENO aR ALTER THE COVERAGE AFWOHGIGD •Y 'net POLJCIES
I MOW. Ms CV- RTFIGATE OF INSURANCE DOES 11107 COIYSTRUTL A CCNTRAcT U 1W EN Tie 1SSUWO INSURER (), AUTHORIZED
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PRODUCER, ANO THE cERT1PICATE HOLDER.
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Exhale (941) 748-0555
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4700 PawerIFna Road
Ft Lauderdale, FL 33305
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Miami Shales Balkh; Dept
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1'2050 NE 2 Avanw
Miami Shares. FL
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Fax (141) 1408553
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PAGE 01
NA,C rl .I
••I
COVERAGES GERTTFIQ,AT! M9fat: �'. (0/1 N RERc
T9.ss IS TO Cili TFIA THE MOLICia$ or INaURAN0p UET'�D' !IAA MN IUED Tp ThE MGM% NAlaibitiMP T k'& Milo
INDICATIIID, NGIWITIOTANDIND AM/ NEctuotsmaNT, TERN OR CONDITION OF ANY CONTRA= OR OTHER DOCUMENT WETH RESPECT TO W I11CH MIS
CERTtui Att It Se ISSUED OR MAY PERTAIN. THE INe AFFORDED BY THE AOUCi1le DH$CRI1PD HEREIN 18 9LJI LIEGT TOP4.I. THE TERNS,
exowsiONa AND C10NOTPIQNa Of SuCM PCUCIEB. UMfTS $ -1DWN MAY HAVE 515*1 REDUCED BY PAID CLAW.
111101E fasuaAwaR a l : �l PcppY MtlMn1S fNIIafYY Y
, MORAL LJASIt17Y EACH OOCU
WMARPCIAL MOM Lam 11 (
1 ❑ a C1.AME.IAADE El OOMM
w4 • J �•
$
5 ;000770_91
t 100000ol
--I
1161011I.b ANY DP ill AWN, 010iCNI5 POUCIS* SE CAMEL= E SPORE
TN! eXPIRATIOM OAT! THIMIEX, NDTIO5 WILL IN DWVIMID IN
AGCOIIDAIYLE` MTH TIN MUD PROVISION&
® ISaa soap AVOID CORPORATION. All rights reserve&
The ACORD nine and low are teguaa and marks of ACORO
F_di 0 — 55
CHECKED [X] ITEMS ARE NOT IN MPLIANCF WITH ,STATUTE- OR RULE
F .`
TANK INSTALLATION
]
[01] TANK SIZE [1 ]
[02] TANK. MATERIAL -*
[03) OtIt ET DEVICE
] [04] MULTI-CHAMBERED
) [05] OUTLET FILTER
] [06] LEGEND )1— / -
' lrt C
] (07] WAT
] [08] LEV1
] [09] D(= TO LID
DRAINFIELD INSTALLATION
] {10] A 1j�i -$OFT i..
] [11] D STRIBUN1 DER J/
] [12] N MBER OF DRAINLINES
] [13] D AINLINE SEPARATION 7 •
] [14] D AINLINE SLOPE
] ` [15] DE TH OF COVER f_
] [10] EL VATI0N [ABOVE.lBELO
}' [17] SYSTEM LOCATION
] [18] DOSNG PUMPS
[19] AGGR GATE SIZ
] [20] AGGR GATE EXC SSIVE FINE
] [21] AGGR` ATE DEP H _ =?
FILL / EXCAVAT iN= MATERI `
[22] FILL AMOUNT . .
[23] FILL TEXr0145- ` 4
] [24] EXCAVATION'61'PTFT
[25] AREA REPLACED
] [26] REPLACEMENT MATERIAL
DH 4Gi6'(Pa 2), 1'0197`1'; v O11S Ed[tiQos May.
Stock Number. 5744- 002 - 461$ - 4
FINA[ OrEM`[AE_PRO` E6 /DIS P#PROVED] ' ?
SURFACE WATER,
1 [28] DITC44S FT
[ ] [29] PRIVATE WELLS - FT .
[ ] [30] PUBLIC WELLS FT
1 [ ' ] [31) IRRIGATION WELLS ' FT
} q - \] [32] POTABLE WATER LINES FT
[ ] [33] BUILDING FOUNDATION FT
[ ] [34) PROPERTY LINES r C) FT
[35] OTHER •
�, \ \ / FILLED /MOUND SYSTEM
[ ) [36] DRAINFIELD"
[ ] [37] SHOULDERS
[
PERMIT NO, I l f
DATE PAID:
FEE PAID:
RECEIPT #.
RT 1 App
p€ ' ([ulafler!ccniteefot
R7 `B ulfding DerArtp ft
pT4i, Health Department
[38] SLOPES
[39] STABILIZATION
ADDITIONAL INFORMATIOiN
t40] UNOBSTRUCTED` AREA
[41] STOFRMWATER RUNOFF
] [42] _ ALARMS
1 [43] MAINTENANCE AGREEMENT
{44] BUILOt OiAREA
] [45] PLC _CATJON- -0QNFORMS - WIT t 'SSJTg- PLAN,-
] [46] FtINAL tlT R AD'NG
] [47] GC � r,l��
] [48] OTHER
ABANDONMENT
]49] TANK PUMPED - ' t_
TANK CRUSHED 8 FILLED
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMEN.T.AND'_DISPQSAL SYSTEM
CONSTRUCTION INSPECTION AND FINAL APPROVAL
Inspection Number: INSP - 139545
Scheduled Inspection Date: May 05, 2010
Inspector: Hernandez, Rafael
Owner: CUADROS, BRIGITTA
Job Address: 226 NW 93 Street
Miami Shores, FL 33150-
Project: <NONE>
Contractor: F A JOHNSON INC
Building Department Comments
May 04, 2010
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
c�-
For Inspections please call: (305)762 -4949
Permit Number: PL -4 -10 -555
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Septic
Phone Number
Parcel Number 1131010331080
Phone: (305)728 -7393
INSTALLING NEW SEPTIC TANK (900 GALLONS) AND
DRAINFIELD IN BED CONFIGURATION (200SQ FT)
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
HRS APPROVAL IN FILE
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