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PL-10-245 r Miami Shores Village m N RA ;. 10050 N.E. 2nd Avenue Miami Shores, FL 33138-0000 Phone: (305)795 -2204 [ N O W Expiration: 0812112010 Project Address Parcel Number Applicant 1065 94 Street 1132050120100 Miami Shores, FL Block: Lot: ALICIA MANGHAM Owner Information Address Phone Celt ALICIA MANGHAM 1065 NE 94 ST MIAMI SHORES FL 33138 -2944 Contractor(s) Phone Cell Phone Valuation: $ 10,900.00 ALL PRO SEPTIC & SEWER INC / ALL (305)635 -3002 (305)206 -4473 :.:... .. Total Sq Feet: 0 f Type of Work: REPLACE SEPTIC AND DARINFIELD For Inspections please call: Type of Piping: (305)7624949 Additional Info: PLUMBING Available Inspections: Bond Return: Inspection Type: Classification: Residential HRS Approval Abandonment Final Rough Landscaping Fees Due Amount Invoice # Invoice Total Amt Paid Amt Due Bond Type - Contractors Bond $300.00 PL -2 -10 -37070 CCF $6.60 Education Surcharge $2.20 $670.60 $670.60 $0.00 Permit Fee - Additions/Alterations $30000 Bond #: 1928 Scanning Fee $3.00 Submittal Fee $50.00 Technology Fee $8.80 Total: $670.60 Building Department Copy February 22, 2010 2 Miami Shores Village Buildin g Department artment FEB 17 2010 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BYE Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING Permit No. VI —� L A `> PERMIT APPLICATION master Permit No. FBC 20 Permit Type: PLUMBING Q' Owner's Name (Fee Simple Titleholder) A �?rC '-� � ' G Phone # C3C)O a t) 3 9 3j Owner's Address '0 5 - A-) C 9 1 City e State T— L Zip 3 3 Y Tenant/Lessee Name & A Phone # -30 X73 — `�J-1, Email /✓�jC} Job Address (where the work is being done) / 9 !9 7— City Miami Shores Village County Miami -Dade Zip FOLIO / PARCEL # L=��,a 0 /Z -- 0 /00 Is Building Historically Designated YES NO Z'1� Flood Zone Contractor's Company Name, - � 1 r ,; � /,/J(_.- Phone # -5p,5J Contractor's Address ;Z /2 City / State l Zip Qualifier Name ��f YP AA Phone # ,��J✓��� 3,j ° �i State Certificate or Registration Certificate of Competency No. Contact Phone s� E -mail Architect /Engineer's Name (if applicable) /��� Phone # Value of Work For this Permit $ Square /Linear Footage Of Work: Type of Work: ❑Addition ❑Alteration ❑New Repair /Replace ❑ Demolition Describe Work: , " Z __Z I �elc 3 V Sig T' d aw a.. `1 _,� Submittal Fee $ r Permit Fee $ `�'��, a CCF $ CO/CC $ �A —� Notary $ Training /Education Fee $ Technology Fee $ Scanning $ Radon $ DPBR $ Bond $ Double Fee $ Violation date: Structural Review. $ Total Fee Now Due $ See Reverse side 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 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 g Signature Owner or Agent Contractor The foregoing instrument was acknowledged before � thAi /sue /S The foregoing instrument was acknowledged before me this day of �j , 20 IV, by t►T f LG% / A- f'T� day of 20 > by �15p ��&eve ( who is personally known to me or who has produced who is personally known to me or who has produced As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign- Sign: Pr t? Print' My Commi JEFFREY DOYISETT My Commis s' MY COMMISSION # OD 947106 ' `�I JEFFREY DOWSETT �•``f MY COMMISSION # DD 947106 EXPIRES• fill 11, 2014 EXPIRES: April 11, 2014 Bonded Thru Notarfr Publk Underwriters eat Tluu � PuM� Underwriters APPROVED BY `Plans Examiner Zoning Engineer Clerk checked (Revised 07 /10 /07)(Revised 06/10/2009) ADDENDUM TO BUILDING PERMIT APPLI- CATION (AN APPLICATION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS B. OBTAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.) PLUMBIN ELECTRICAL MECHANICAL ITEM UNIT FEE ITEM UNIT FEE ITEM UNIT FEE BATH TLB SWITCH OUTLETS SPACE HEATERS BIDET LIGHT OUTLETS CENTRAL HEATING BISHRASHER RECEPTACLES A/C (WIND) ..DISPOSAL SERVICE TEMPORARY A/C '(CDnR&) DRINKING FOCJliTA I N SERVICE SIZE IN AMPS DUCT WORK FLOOR [MAIN SERVICE REPAIRACTER CRAM REFRIGERATION GREASE TRAP APPLIANCE OUTLETS PROCESS AND PRESS PIPING INTERCEPTOR RANGE TOP UNO TANKS LAVATORY OVEN ABOVE GROUND TANKS Lamy TRAY WATER DATER U.F. PRESSURE VESSELS CLOTHES WASHER MOTORS 0- 1 HP STEAM FILERS SHOWER MOTORS OVER 1- 3 HP HOT WATER BOILERS SINK, POT/3 COMP. MOTORS OVER 3- 5 HP WCHANICAL VENTILATION SINK, RESIDENCE MOTORS OVER 5- 8 HP TRAN90RTING ASSEMBLIES SINK, SLOP MOTORS OVER 8- 10 HP EL EVA7&lq/ESCALATOL� TO PGRARY WATER CLOSET MOTORS OVER 10- 25 HP FIRE SPRINKLER SYSTEMS URINAL MOTORS OVER 25-100 HP COOLING TOWERS WATER CLOSET MOTORS OVER 100 If VIOLATION INDIRECT WASTES- A/C WINDOW REINSPECTION WATER &MY TO: AIR CONDITIONERS A/C UNIT STRIP HEATER FIRE SPRINKLER GENERATORS TRANSFORMERS } 'HEATER -NEW INST. GENERATORS TRANSFERS HEATER - REPLACE GENERATORS TRANSFORMERS LAWN SPRINKLER -WELL SPECIAL PLPPOSE SWIMMING POOL. OUTLETS COI&OCIAL WATER SERVICE SIGN TUBES SEWER CMCT IONS SIGN TRANSFORMERS UTILITY -SEWER SIGN TIME CLOG( UTILITY-WATER FIXTL RES SEPTIC TANK ANTENNA RELAY TELEVISION OUTLETS DRAINFIELD, 4' TILE/RES. VIOLATION RW & ABANDON SEPTIC fiANK RE1NSPECTION SOAKAGE PIT CU. FT. CATCH BASIN DISCHARGE WELL CAST IC WELL AREA -DRAIN ROOF INLET SOLAR WATER- HEATER FIRE STANDPIPE POOL. PIPING LAWN SPRINKLER SYSTEM GAS RANGE METER. SET (GAS) GAS PIPING NOTICE OF 40MMENCEMENT ., CF14 20108010613 A RECORDED C OPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION . 'OR Si: 27.144 Ps 467? ➢ t l a a) . '. RECORDED-02/17/2010 10:28.48 PERMIT-NO.- TAX FgL10 NO: HARVEY. "RUVINt CLERK OF COURT HI-AH1 .6ADE: COUNTYP FLORIDA STATE OF FLORIDA: I fl / Z�S— OIL .. d. f d Q LAST F`A�1= COUNTY OF MIAMI -DADE: THE UNDERSIGNED hereby gives:ndke that impwvemerits will be made to'owWn.real property, and in accordance with Chapter 713; Florida Statutes, the following Information Is provided In this' Notice of Commencement.. 1. Legal description of property and. street/address: ' Q 2. Descri tion of =tin vement: 3.Owner(s) name and address: try '� 1 /6 Interest in property. JI / .V 4ez Name and address of fee :simple titleholder. �! 011Y It 4. Contractor's name.-and address: $ 3/ . 5: Surety: - (Paympnt bond required,:by owner from contractor, if OF FLORIDA, COti � F DARE 8Y ERTtFY that tP? IS tv Cat+,y Name and address: aye . claim nb Amount of bond $ ^ A D20 6: Lender's name and address: f`� 7. Persons within the state: of 'Flarida'designa #ed;by Owner u o hom not1 or other documentss may. be served as .provided by Section_(1} 7., .f=1 rich Statutes, : a: Name and address.. �. 8. in addition to himself ;: Owners designates :the following persons) to receive a oopy of the Lienor's::NOtice as provided :In Section 713 3(l)(b);. Statutes Name and address. 9 Facpiratian date of this. Notice of - Commenccemsnt , (the expiration date is 1 year from Pal date o f ' . recording unless a: dif#e nt date Is.apecified) �� ,1 Signature - of .Owner Print Owner's Name L Sworn to and subscribed before me -this day of � 20 Notary Publ Print No s' ' 4.35+ /�fz MY corxmmiss on expires: 02/18/2010 05:14 FAX ALLPRO 1j003 /005 PERMIT x:13 -SC- 1121343 STATE OF FLORIDA APPLICATION 0 ; _ AP952688_ DEPARTMNT OE HFAL DATE PAM ONSITE SEWAGE TIMATMENT AID! DISPOSAL PEE FAZD: SYSTEM 4D RECEIPT noeman #: PR799341 CONSTRUCTION PBRMIT FOa: OSTDS Repair "PTACANT: Michael Man ham PROPERTY ADDR 5SS: 1065 NE 94 St Miami, FL 33138 LOT° 10 BLOCK: Na SaBDlvsszCll: PROPERTY ID #: 11- 3205-012 -0100 [SECTIOW, TGWSHIP, RANGE, PARCEL DER] [OR TAX ID xMd8zR] SYSTEM MUST as CONSTRUCTED IN ACCORDANCE WIT1t SPECIFICATIONS A= STANDARDS OF SECTION 381.0065, F.S., AND C HAPTE R 64E -6, S.A.C. DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARRNTER SATISFACTORY ft"Omw= FOR ANY Sk$CISIC PERxOD OF TIME. ANY CHANGE IN MATERIAL FACTS, WHICH SERVED AS A BASIS FOX ISSUANCE OF THIS PERtUT, RSQU"M THE APPLICANT TO 140DZFY THE PERMIT APPLICATION. SUCH MODIFICATIONS MAX PASULT IN THIS PERMIT BEING MADE NULL AND VOID. ISSUANCE OF THIS PERMIT DOES NOT ZMWT THE APPLICANT FROM CoMpLIANCE WITH OTHER FEDERAL, STATE, OR LOCA PERMITTWO REQUIRED FOR DEVELOPMM OF THIS PROPERTY. SYSTEM DESIGN AND SPECIFICATIONS ^!— T C 900 ] GALLONS / a= 5eotie CAPACITY A [ 0 j GALLONS / GPD CAPACITY N [ 0 r-%LL GREASE =1iHiCRPT= CAPACITY [MAXIMUM CAPACITY SINGLE TANIC :1250 GALLONS] K L ] GALLONS DOSZrfG TAM CAPACITY I GALLONS a [ ) DOSES PER 24 FATS orumpm [ ] D [ 300 ) SQUARE PET SYSTEM R [ 0 ] SQUARE FEET SYSTEM A TYPE SYSTM: Lx] STANDARD [ ] FILLED L ] MOUND [ ) I CONFIGQRATIONa I ] TRZNCH LxI BED [ ) N F LOCATION OF BENCMnmK: F.F.E.: 8.60' NGVD Z ELEVATION OF PROPOSED SYSTEM SITE L 26.40 ] INCSEB FT ] [ ABOVE AE =NCZ.AWVZpERENCZ POINT E BOTTOM OS DRAINSIELD To SE [ 58.40 FT I L ABOV , / HZNCSt0JW /"F&A$NCz POINT L D FZLL RSQU WD: 1 0.00 ] INCHES zxcAvATZON R>1: untty: [ 44.00 1 INCHES 0 1– Install 1050 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- 8.013(3)0. 3- install 571 sf of T drainfield in bed configuration. 4- Ins1all 12° of slightly limited soil under the bottom of drainfleld, S- Perimeter of excavation a area shall be at least 2 ft wider and longer then the proposed absorption bed. 8- Invert elevation of dralnfleld to be no less E than 4.23' NOVD. 7. Bottom of draintield elevation to be no leas than 3.73' NOR E P A I R THIS PERMIT IS NOT FOI (s} Mw:aOrADIR TH 1"r SFRCIFICATION PEDRO N OSP APPROVED Sy. TITLE: OV Dade CND Yete:to oep +... DATE ISSUED a 0211 712 01 0 EXPIRATION DA=. 0.rWj 2010 DH 4016, 10/97 (Provioun Ed:Ltiona Macy as Uaod) vase 1 of 3 V 1.1.4 ARDS2888 jiM08034 02/19 {2010 05:14 FAX ALLPRO 1a004/005 STATE OF FLORIDA - DEPARTMENT OF H=EALTH �e APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CON'aSTRUCTION RER'MIT Permit Appiicstfon 'N +um. bar CN S' --------------- ------------ PM.TIJ -9FM d' -I & - __"'�•. . . ► .SNG, s cale: Each block re res " � ' ; i i "'! '' :. + •! � ' �' �! , �' t , qfi �' � � ;i ; ro ; "tr� "'. r 1 iPSh r a ` 1 • .tf' , ( •'�' +, ''� i �i p ,MI + +er f ,s• ,�i ' +.. . M P H n' 5 , 0 5 , • r: <I f•.� y •, i re ." ° r„� r '•�''�r t' '�e� .�i f •! LA e vil Dip .s Ju l, 9 n �� r.. r i, +�1r9 4,I •vt • !' • _ _ • ._ r � •, _,sly �`TiI" M!n' '. 4r r t •' t • r . • , .•M_�. '. r r' • ,•fA ••1i•!t �' •ra-« -. w i G Site Plan submitted by: Titia Signature Date Flan Approved, Not Approved By County Health [)apartment ALL CHANGES MUST BE AP'P'ROVED BY THE COUNTY HEALTH DEPARTMENT 7H 4015, 10196 (Replaces HRS -H Form 4416 which may be us ed) Page 2 of 4 (Stock Number: 5744. 002 - 4015 -6) 02/19/2010 05:15 FAX ALLPRO Ij005/005 PERT�T #: 13 -SC- 1121344 STA OF FLORIDA APPLICATION #: AP9 DEPARTTMMT OF HEALTH DATE PAID s 4D ONSITE 3TWAM TREATbwNT AM DISPO FEE PAxns SYSTEM RECEIPT $: Docmd=T #, PR799331 CONexRUCTION FBRMST FOR: OSTDS Abandonment AP PLICANT s Michael Ma _ ham PROPERTY ADDImss: 1065 NE 84 St Miami, FL 33138 LOT! 10 Rt=: Ma SvsnxvlsxON: PROPERTY ID #: 11- 3205 -012 -0100 [SECTION, TOMORIP, RANGE, PARCEL NUMBER] [ OR TAX XD NUMBER] SYSTEM! MUST as CONS TRUCTED T N ACCORMNCE WITH SPECIFICATIONS AND STANDARD O SECTION 361.0068, P. O., AMID C HAPTER 64E - 6, F.A.C. DEPARTMNT APPROVAL o f SY DOES NOT GUARANTEE SATTSFACTORy VZRPO4VW= FOR ANY SPECTFxC PERIOD OF Tna . AM CHANGE IN MATERTAL FACTS, WNICB SERVED AS A SA$IS FOR ISStrANCE OF THIS PERMIT, REC=RE MM APFLICAidT To MODIFY T11 PERMIT AFPLTCATTON, SUCH MODIFICATIONS MAY IMSULT xN THIS PERMIT 8EING MADE NrJLL AND VOxD. ISSQANCE OF THIS PERMIT DOES NOT EXWT THE APPLICANT FROM CCmLIANCE WITH O THHIZ FEDERAL, STATE, OR LOCAL PERMxTTxNG IM=RED SOR DEVELOPMENT OF THIS PROPERTY. SYSTEM DES-TON AMID SP.ECIFICAW;[ON T [ ] GALLOY�tS / GPD CAPACITY A [ ' G ALLO N S / GPD CAPACITY N L 7 GA,"*ta GREASE TNTE RCEPTOR CAPACITY (MMOMM CAPACITY SINGLE TAW GAIJ.ONS] K [ ] GALLONS Z*SING TANK CAPACITY [ ]GALLONS ®[ ]DOSES PER 24 HRS #Pumps [ 7 D [ ] Sac%= FEET SYSTEM R [ ] SNARE FEET SYSTEM' A TYPE SYSTEM: [ ] STANW= [ ] FILLED [ ] MOUND [ ] I CONFIGURATION: I ] TRENCH [ ] BED I ] N F LOCATION OF BENCH4am! I ELEVATION OF PROPOSED SYSTEM SIT Z [ ] [ / ] I ASOVE / BELOW ] BENCKWAM / RESI:R=cz FOxNT E BOTTOM O$ DR&INMID TO ;SE ] I ABOVE / 13Ei.Ow ] SENCHtm►itK /RzvzR=GE POINT L D FILL REQUIRED: [ 0.00] xNalms EXCAVATION REQUSRW [ ] INCHES o Have the tank abandoned In accordance with the following procedures:(&) The tank shall be pumped out.(b) The bottom of the tank shall be opened or ruptured, or the entire tank collapsed so as to prevent the tank from retaining water, and(c) The T tank shall be filled with clean sand or other suitable material. and completely covered with soii.Have the system inspected u by the health department after it has been pumped and ruptured but before it is filled with sand and covered. E is s7tECxsxCATZCN3 SY: PEDRO' N o8 3?INA TI APPROVED BY: o TITLE: ��a Dade Ctlo &Pia+ DA X SStrED• 02/17/2010 EXPIRATION DATE 0511132010 DH 4016, 10/97 (PCQVioua Ediblunn May as Voed) Face 1 of 9 V 1.1.4 A8952699 SE -1 02/19/2010 06:21 FAX ALLPRO 001 /001 ACORD CERTIFICATE OF LIABILITY INSURANCE DTWrfYY) o PROW= 305.558.1101 FAX 305.822.4722 THI CERTIFICAT IS SSUED AS A OTTER OF INF ION KBM Construction Ynsurance Inc. ONLYAND CONFERS NO RIGHTS UPON THE CERTIFICATE 7850 Northwest 146 Street HOLDER. THIS CEIZnFICAT'E DOES NOT AMEND, EXTEND OR Miami Lakes, FL 33016 ALTER THE COVERAGE AFFORDED HY THE POLICIES BELOW. Reeni Gershman INSURER AFFOR DINe COVERAGE N,AIC 0 iNSUReo q' f pro 5uDi6eng rp., � "ro Sep[�e & !ELPLu At Seotts Insurance Co Sewer, Xnc., All Pro Plumbing Septic & INBUIERN:_ Ham psh� ri Tnsuiin — o Co Sewer, Inc. S All Pro Investment wsmmm Bridgefield Fmploye Ims 2700 NW 27th Avenue INSURM1 �.• Mi mi , Fl 331.42 - - -- " W6URER EI COVERAGEIi THE POUOIES OF INSURANCg LISTED $FLOW HAVE BEEN ISSUED TO THE INSUP50 NAMEDABOVE FOR THE POLICY PE9td6INDICATED. N0TwrnjsTAN0IN3 MAY PERTAIN THE INSURANCE FFORDED B TH P OLICIES DE9�ED MBRE�IN SUBJWT TO ALL TH MS EXCLUSIONS AND CONDITIONS OF OR SUCH POUCIe3, AG GREGATE LIMITS SHOWN MAY HAVE BEEN RED BY PAID CLA04. A — TYD1 OF IN ®URANCr POLICY NUCMD@R ^� DA A o Y �� UMITS 0ENERALL34HILITY CP51150071 02/01/2010 02 01/201,1 EA O s 1 000 000 Gpnea@FtdAl GCN @pAL Wnu.IYY REld19ES 1 e� 8 mraripraal S 1�0 Q00 _ J OtAIA$ beADE � OCCUR 1 -• -- -- - « P ERSONAL & ADV INJURY S « - 1.000.00 0 sE NERALAGGREG ATE 6 „ « Z J 0 0..0 GEn AGGREGATE LIMIT APPLIES PERT DUCTS C D MPtDP AGG S ~ , UO OO POLICY P LOC -- Z A UTONOSILHLIABILITY D ICA0196S62320000 0 /20/2009 05/20/2010 ( d LIMIT X ANYAUro $ 1, 000 00 ALLOWNEDAUTOS - - - •• ° ^^• SCHODULED AUTOS SODU.Y WJURY $ g (rerp BODILY INJURY X NON.OWNEDAIJTOS IP�aatldnnl} s R- IIAWAILIANILFTY AUTO ONLY. EA ACCIDENY $ ANYAUfQ pT1{TM� I � ^ S AGO S AXCe66IUM®RBLLALIANZY XLS0057214 02-01/2010 02/01 201 EA CHOCCURR eNce s Y 000 • . X CCGUR CLAfALSMADL? J. .k;9 AGGAWATE S i s QOO , OO A -- -- OF.DUCTIBLE .... ,.r •.�M. S RE'rI:NTION $ — AM 110PLOVE sATLrN 83027445 04/06/2009 04/06 2010 AND BAIPLOYERS LIABILITY 83027445 �- AN PRDRI TQ+PARTNEWElLECLITIVEa Y P E.L. EA ,CH ACCIDENT C ANY E AWNERW {M LL. OIMME- EAEMPLO S 1 000 O $ sPl? P ' w�+f slLms t1New et. 0I59A9E - POLICY LIMIT s 1 000,000 OTHI: OE6CRP TION pF ORERATIONS I LOCATIONS I VEHICLBS 12XCLUS@NS ADDED BY ENDORSEMENT 1 SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION BHOVLV ANY Of YIN ABOVE 0119CR16aD POLCM6 an CMLCRLLBO IMRII THS GXPIRATION DATE THEREOF, THE IB UM INSURER WILL OCIEAYOR TO MAIL 10 _ IAA WfflrMN NOTICE TO THE CERnPICATE NOL.DER NAMU* TO THE LQPT, BUT FAP,USU TO DO ®O SHALL City of M iami Shores Village WF Or: NO CALIQATION OR LIABILITY OF ANY)OND UPON THE MMUItM 11.9 AGENTS OR 10050 NE 2 Ave REPAVOUTATIVEa, Miami Shores, FL 33138 -2304 AUYMMIZED Fora SENTAT vi Alex Perez REENZE 4 �- •���.� ACORD 25 (2009107) FAX; 305.756.8972 01953.2009 AGO —1 0ORPOII NTIO N. 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Y '. 4 1 t � S4iTEfVI f l I 1 1181 DOSING PUMPS [ I z fd t(t,l tai ,„ " tturw�'U k.a f I 1 AGP REP I TE SIZE f"�/ f � k [ j . j [431 � :.tylAl a I�ENANIriE REEMENT > t I 1 [201 AGGREGATE EXCESSIVE FINES I 1 [I SUILDIN AREA 1 1 [211 AGGREGATE DEPTH [ J [45] LO T�,� `� Fu MS Yi!G�i s U ' �r N f y' `• �...: r• (46] ' FI NAI,.13 IT F 4Ii -DING FILL P EXGAVAT"('ON MATERIAL [ ] [471 GG>"AGT ©� I 1 [22J FILL AMOUNT .• ! [ 1 I4$1 OTHEl> f ] [231 FILL TEXTURE `' <r [ ] 1241 EXCAVATION DEPTH ABANDONMENT 1 1 1251 AREA REP .. [' j >">[49l' ' TANK PUMREb`kr�_,_� > t [ 1 [261 REPLACEMENT MATERIAL [ J 1501 TANK CRUSHED & FILLED EXPLANATION OF VIOLATIONS 1 REMARKS: a:.r [ 1 . f 1 CONSTRUC PD RA : /Dt5Al?F'ROVED]: GHD QATE' FINAL T EM'[AI?PRO ED/DISAPPROVEDJ °'?�/ i � GHD... QATE � ' '� t . '�:'. V c� Page 2 of 3 OH 4016 (Page 2), 10/97 (Previous Editions May Be Used) Stock Number: 6744-002- 4016.4 PT 1: Applicant PT;?: InstOw/Contractor PT 3: Building Depart neM a y iL r p.,' PT 4 Heahh DeparNT -d ��.,. `rx�l'� .•ate f 5 l #,l w -a" l� r ��alk "" �, , �r 1 ,} q r � � ",,. � �r iii_ r W r � � r> ��r # �ts. "?,h�� �+ "�t'�i 1 ! �.� F,e >� "� aFr'.'a� q lr ,.?z — '�,+'.+�aY�=k. Wl � "� 1 i !°' h r'•_ I 43 1 h, 1 4 yY t r t r 1 w� u*s3�`q � ' ��+x -�. ` k �� x, Ait �a a � � r , ��„ a, ^ 44 z,� 1n r �'� � y �`P ,�+✓ t��. ; �"` 7 r � I p X t .. �,� ,s`,�.,�. '".` x� `�`� F •'ua'Kk���'fY;af�' f Y' wi' ,, .............�- °` t.. }' ,r� }� IfL� � ✓ 'a::�a' _ re..n v ae 'Ti i5 '�dki, s °� . .tea _ N' ,��J�` i ' u v hS��, Aq.:,�; �7�.sy A. 9a ��s c A f�'•* ` � .��� ns, �, M1 'g4�,r19t fi3'�. .' �..,�,- ..- 1.. �� r�i_ .3341 y3 °s3� r� �' i ,s =3.di h n r:. ; 4d�� ib tr td � 6 �i� ^ ;.'�5 .�'a _ ; � 'R• �4 4 t � a � '!" �� Is. � �• '6�sy� I I S , ,�. 'it �} va, s , 5:'� t �W.nQ 'fi � r e . "f n �, rF r. 5Li ° � $� � 11$Wa as, `� �• :'�i �.w�a, p� . � h I a 6 � �'�, �"��,"'t� x �¢�a 5 il'�x'� q �'y,`•��5 i r,, .� �`���o`'��`�� � �r ,� '.� & �k , •� a �` p N d� _!Z� "r � I I Y�Fr� y s s � �V r � . x� , i' x , � n �v 5^� 1s t '�" "� ', ', u� '+ av � h a g at S 4 ,=5'„ '�� a � ,. ��� ` � .n w �'�•l.,�e.. ' 4 � ' �" rl "�t� r� _., y��L �� ,�t` .� ��" '+2•'S�e`��. �� .`��;�1 ; 4l �1 {Y . �� �. a ` � , f3� W % "i .T; S ` ' . ? I " ,x.� ' t ������a sy _rz -�' a` •,'� a 6`�.� d !.�99 qi k LSR ��aw# a.,�3- �+�`y� �' �' r � >' ��,; r ,•4;, � #,��r ^''�$ n.�sx �� t�,���e����?c���' acy' " ., , k, t'i _ � ^* �P � ���r r!�',;?• �,• �4 � "a�. t, ' �� t • } �. ": t��vx� �?�Ili�� �� g x� m � A �� , a,, Y a ,a ��"� " � � .�z��� �' c 5l''�"`, �,n � �,X. I, a � t nl� 1 � a���� � � Gv (fit � AS � •...� � � � '• �, d - , s{ , k � � � �,, , .. � F w L a g - I -- r,z°4 ^: yf .- � e r� �£ a � � :•, � x v« �. � � t �''�'�r� � m s =� 1 G ".Fi , 1 a '` G . 1. �'=;Y4 � s,R .�� r � e • `�s � }8 e.y 1�2'a'� z�P�vt r � , 2 r .I , Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 135837 Permit Number: PL -2 -10 -245 Scheduled Inspection Date: March 12, 2010 Permit Type: Plumbing - ,Residential Inspector: Hernandez, Rafael Inspection!;Type: Final Owner: MANGHAM, ALICIA Work Classification: Septic Job Address: 1065 NE 94 Street Miami Shores, FL Phone Number Parcel Number 1132050120100 Project: <NONE> Contractor: ALL PRO SEPTIC & SEWER INC / AL L PRO PLUMBING SEP' Phone: (305)635 -3002 Building Department Comments Inspector Comments Passed l Failed Correction ❑ Needed Re- Inspection ❑ Fee No Additional Inspections can be scheduled until re- inspection fee is paid. March 11, 2010 For Inspections please call: (305)762 -4949 Page 8 of 17