PL-10-574Owner Information
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138-0000
Phone: (305)795 -2204
1450 103 Street
Miami Shores, FL
1132050310040
Block: Lot:
MELETIOS PLATON
Fees Due
Bond Type - Contractors Bond
CCF
Education Surcharge
Permit Fee - Additions/Alterations
Scanning Fee
Submittal Fee
Technology Fee
Total:
Amount
$300.00
$1.80
$0.60
$100.00
$3.00
$50.00
$2.40
$457.80
Address
MELETIOS PLATON
1450 103 Street
MIAMI SHORES FL 33138-
(305)513 -6347
Valuation:
Total Sq Feet:
$ 2,400.00
400
Contractor(s) Phone
CHAPMAN SEPTIC SERVICE, INC. (305)815 -9901
Cell Phone
Type of Work: DRAINFIELD
Type of Piping: SEPTIC
Additional Info: PLUMBING
Bond Retum :
Classification: Residential
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
Expiration: 10 /06/2010
Phone
Pay Date Pay Type
Invoice # PL-4-10 -37504
04/06/2010 Check #: 13866
04/09/2010 Credit Card
Bond #: 1954
Invoice # PL 410 - 37550
04/09/2010 Credit Card
Bond #: 1954
Amt Paid Amt Due
$ 50.00 $ 107.80
$ 107.80 $ 0.00
$ 300.00 $ 0.00
Date
Available Inspections:
Inspection Type:
Final
Rough
Landscaping
1
April 09, 2010
Cell
April 09, 2010 1
BUILDING
PERMIT APPLICATION
FBC20
Permit Type: PLUMBING
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
Owner's Name (Fee Simple Titleholder) i l %4i OS f 1 104 ; #/ 7 22 �' 0 7 T Y
Owner's Address 1 ( WO kV L I +
City +4) State Ft Zip . 63 OS
Tenant/Lessee Name Phone #
Email
Job Address (where the work is being done
FOLIO / PARCEL #
Is Building Historically Designated YES
Company Name C/
Contractor's Address *0- ta on
City 1/14L,u„) State o'l
Qualifier Name a444-126 CArrifiA4A%-
State Certificate or Registration No. *1
Contact Phone & ' (240a
Architect/Engineer's Name (if applicable)
Submittal
Notary $
Scanning $`00® Radon $
Double Fee $
Structural Review. $
1LSc
City Miami Shores Village County Miami -Dade
f ilLA A 4,1 a.1
E -mail
Permit No.• 1 51"1
Master Permit No.
Zip 3
NO Flood Zone
hone # &,sr '44 1
Zip 3 3.3
Phone # 3o • -8 Z-
J
Certificate of Competency No.
Phone #
Value of Work For this Permit $ a WOO
Type of Work: EAddition DAAteration ce 719,61-Cali t iO 0 al
I , p p ['Demolition Describe Work:
Square / Linear Foota Of Work:
]New E! Re air/Re la
g 4,15: * * * *tx * * * * * ** F ees * * * * * ** ;ti* * * * * * * * * ** *** * * * * ** * * *** * * ** * **
See
Pi •••e tettt*tett! telftt tin
n O16Z 9 0. mdtl
ASR- ."E
Permit e ;"" CCF $ CO /CC
Training/Education Fee $
g Technology Fee $
DPBR $ Bond $
Violation date: P �^�
Total Fee Now Due $ 10 1 • ® °
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.
Agent
The foregoing instrument was acknowledged before me this
day of ' If E , 20 W , by L7
who is pers� llv nown to - or who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
Sign: UWY(-Li _d►
Print: VAf esa► C 0044
My Commission
I w VANESA Notary Public - State of Florida
2 . My Comm. Expires Jun 15, 2013
t * *9emngssioni#41997882,*
nded Through National Notary Assn.
* * * * * * * * * * * * **
APPROVED BY
(Revised 07 /10 /07)(Revised 06/10/2009)
* * * * * * * * * * * * * * * * *
Plans Examiner
Engineer
Signature
Contractor
The foregoing instrument was acknowledged before me this
0.404 5
day of - -, 20 & , by
who is personally known to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
Sign: Vahlika. C-0 d0
Print: JO n .S a,, Coi � -h-
My
41, - PrresVANESA CANTRELL
V°. Notary Public - State of Florida
•1 My Comm. Expires Jun 15, 2013
og Co mission # DD 897782
* * ** 'ihraag i atitailibitlld'Blt
* * * * * **
Zoning
Clerk checked
SEE OTHER SIDE
DO NOT FORWARD
CHAPMAN SEPTIC SERVICE INC
CHARLES J CHAPMAN PRES
PO BOX 431911
MIAMI FL 33243
hi ll Sta
10/06/2010 22:24 3054539304
ChUfic CriM
GQvcrnor
•
1 ,(4k A L
i -897
4 , M. Viaukrtue:
Stmt.- SUr�cati Gomm?
3
PAGE 01
DO NOT FORWARD
CHAPtMAN SEPTIC SERVICE INC
CHARLES J CHAPMAN PRES
PO BOX 431911
NImI FL 33243
aa l laPdL IIf.J lt tt Jt, Ittatallra , uaRl�te , {ruii8aaa�ia PSa.
04/02/2010 10:24 FAX
COMSTRUC3TTON PST FOR:-
APPLICANT: Metetios Piston
PROPERTY ADDRE88:
LOT: Ne
STATE OP FLORIDA
DEPARTMENT OF =ALTA
ON$XTE SEA TREATMENT AND DISPOSAL
STATEN
1450NE103St
BLOCK: Na
PROPERTY ID • c 11420$- 031.0040
OSTDS Repair
Miarni, FL 33138
8VEDIVISIONr Mist Shores
(SECTION, TOWNSHIP, SAM S, PARCEL NUMBER)
TAX ID NOS)
SYSTEM MUST 8E CONSTRIXTED IN ACCORDANCE WITH 8PICIPIGTION$ AND BTANDAID8 of SECTION
3$1.0065, F.S., AND CBAE 64E -6, F.A.C. DEPARIADACT APPROVAL OF SYSTEM DOES NOT SOARNATIMI
SATISFACTORY PERFORM= FOR ANY SPECIFIC »MCP OF TIME. ANY CHANCE IN N®1TERIAL FACTS,
WHICH sumo AS A EASES FOR ISSUANCE OF THIS PERMIT, REQUIRE THE APPLICANT TO MODIFY THE
PERMIT APPLZcAT ;ON. SVCH MODIFICATIONS MAT RRSULT IN THIS PERMIT NEzwa MADE MOLL ACID VOID.
MUM= OF THIS PERMIT DOES NOT EXEMPT THE APPLICANT FROM COMPLIANCE WITH OTHER FEDERAL,
STATE, OR LOCAL P$' TTTSNG MINX= FOR DEVELOPMENT OF THii PAOPSAY' %
SYBT 6 DEED AND SPECIFZCATZaNS
T [
A
N (
R [
1,050 ] GALLONS / OPD
0 ] GALLONS / GPD
0 ) GALL02t8 GREASE YNTTZRCEPTOR CAP'ACITT
300 GALLONS DOSING TANA mourn'
Septic Tank
D ( 400 MUM FEET Bed conflouratitm SYSTEM
R [ 0 ] SQUARE FAST SYSTEM
CAPACITY
CAPACITY
ti' CAPACITY SIN0Z1 TANR :1230 GALLONS]
)GALLON'S et ]DOSES PSR 24 ERB 4P421apa [ 1
A TYPE SYS MM [x] STANDARD [ ) WILLED [ lM em t 1 0 , x _
I CONFICUNATZON: [ ] TRENCE [x] BED [ )
N
1 LOCATION OP BE3TC014RM:: FFE 6.47' Now
I ELEVATION OF PROPOSED BITTEN BITE [ 6.72 ] ( FT) [ ABOVE BENCEMASS/REVERENCE POINT
2 BOTTOM of DRAZNFIELD TO ESE 1 34.721 ,, : FT 11 ABM i - ji nENCmfARtt/REEecece POINT
L
D FILL REQUIRID: [ 0.00 ] IBS
0
T
R
EZCAVATION Mt:P RED: 1 40.00) MOM
1.- Existing 1050 gal. septic tank and 300 gal pump tank to remain,
2.-Install 400 sf of drainfleldiin bad configuration.
3. -Install 12" of slightly limited soil at the bottom of the dremfield.
4.- Perimeter of excavation area shall be at least 2 R wider and longer than the proposed absorption bed.
5.-Invert elevation of drainfield to be no less than 4.07 ft NGVO.
6.-Bottom of drainfeld elevation to be no less than 3.57 ft NOVO.
THIS PERMIT IS NOT FOR "AODMON(s) ".
SPECIFICATIONS BY; Gerard L Phalle
APPROVED 8Yt 4
DATE ISSUED: ,,% 4 MT,
ON 4026, 10/87 t o+na Editions Nay Os U.ad)
v 1.1.4
PERMIT # : 1340. 1128999 _
APPLICATION 8 : AP9592 4
DATE PAID;
FEE PAID:
RECEIPT B:
D=COM6MT • : PR804914
engineer epeeisliet II
*v959224 sE812723
® 001/001
Dade ctID
=sPATSON DATE: 0613012010
Page 1 of 3
Inspection Number: INSP - 139824
Scheduled Inspection Date: April 16, 2010
Inspector: Bruhn, Norman
Owner: PLATON, MELETIOS
Job Address: 1450 NE 103 Street
Project: <NONE>
Contractor: CHAPMAN SEPTIC SERVICE, INC.
April 15, 2010
Miami Shores, FL
Building Department Comments
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
For Inspections please call: (305)762 -4949
Permit Number: PL -4 -10 -574
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Drainfield
Phone Number (305)513 -6347
Parcel Number 1132050310040
Phone: (305)815 -9901
INSTALL 400 SQ FT DRAINFIELD
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
v(
c7
Page 13 of 23
10 ~~ 5
111E PoucTEB OF INSURANCE LISTED BELCIW NAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REGUIREMENT, TERM OR COMMON 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 19 SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAS) CLAWS.
t rn TYPE INSURANCE
POLICY NUMBER
P ne m
LI �PFRA
Laws
GENERAL
LIABILITY
CONMEFICML GENERAL UAHLFIY
1
OCCURRENCE
2
CLAWS WADE ® OCCUR
FR EDAM' (AsyOeeRN)
2
MED EWE (Any one person)
.t
PERSONAL &AU /:NLWRY
1
''GCE')NLAL�EDAA7E
DENERIIADGREGATE
1
AAPPLIES PER:
1 P te`' I 1 IFt`.T' fLOC
PROWCTS -COMP/OP AGG
1
AUTOMOBILE
,e
......
—
LIABILITY
dWYAUTO
ALL OWNED AUTOS
SCHEDULED
HIRED AUTOS
N
NON-OWNED AUTOS
COED SINGLE MST
(Es scaidarN)
800LYEUURY
(Per person'
=
BOOLYIKARY
(Per acddeaU
=
PROPERTY DAMAGE
(Per accident)
S
GARAGE LIABILITY
RANV
AUTO ONLY -EA ACCIDENT
i
OTNER THAN EA ACC
$
AUTOOM.Y; A35
-
$
•—•
EXCESS
LIABILITY
OCCUR ®CLAyNS MA
ma-, OCCURRENCE
2
AGGREGATE
1
DEDUCIBLE
RETENTION $
s
S
S
A
WORKERS COMPENSATION AND
EMPLOYERB'uA841TY
1077779991701
04/01/2010
04/01/2011
�
X 1 ""'Glp^ 1 ITN
EL. EACHACCDENT
$ 1000000
EL. DISEASE • EA EMPLOYEE
S 1000000
EL. (+ a9E• POUCT mu
$ 100000
OTHER
R
-
LOWS
2
LOWS
$
DESORIPTION 02 OPERATIONSILOCATIDNBArEHICLENE XCL05(0NS ADDED BY ENDORSEMENTtSPECVL PROVISIONS
1. This certificate remains in effect, provided the client's account is in ood standing with ANS.
Coverage is not provided for any employee for which the client is not reporting wages to ANS.
Applies to 100% of the employees of ANS leased to CHAPMAN SEPTIC SERVICE INC. effective 04/01/2010
2. Insured is afforded Workers Compensation & Employers liability as a co- employer under the policy
for enployees leased from ARS Staft Leasing, Inc.
T
'
CHAPMAN SEPTIC SERVICE 954-749 -2088
APR/09 /2010 /FRI 12:41 PM Contractors Payroll FAX No. 2397686367
ACORQ CERTIFICATE OF LIABILITY INSURANCE I CERTIFICATE NO.I DATE
sc10- 1500813. sans
n2 /71/7e1n 117• wa
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
AI TER THE COVERAGc B VErnarlED B TI+= a'^I ICIE BSVJI10
INSURERS AFFORDING COVERAGE
PRODUCER
Highpaint Risk Services LLC
14160 Dallas Parkway 8500
Dallas, TX 75254
(800) 632 -5096 (972) 715 -0959
INSURED: ASS 1 /c /f:
CHaPNB►N SEPTIC SERVICE INC.
808D N'i 515T
LAUDERIHILL, FL 33351
(305) 561 -0628 lax: (3053 453 -5531
COVg5DGES
ACDR D 25-S (7/97)
INSURER A
INSURERS'
INSURER C:
INSURER 0:
INSURER E:
p.1
P. 001 /002
Companion Property and Casualty Insurance C
CERTIFICATE HOLDER 1 1 ACOITIGNN- IlLSURED ;INSURERLETTER:
City of South Miami.
Department of Planning i zoning
6130 Sunset Drive
Miami, 8L 33143
CYANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPBATION
MITE THEREOF. THE ISSUING INSURER WALL ENDEAVOR TO MAR 30 DAYS WRITTEN
NOTICE t0 THE CERTIFICATE HOLDER NAMED TO THE LEFT. BUT FAILURE TO DO SO SHALL
IMPOSE 140 OBLIGATION OR LIABILITY OF MY FOND UPON THE INSURER RS AGENTS OR
REPRESENTATIVES.
AUP1ton:2ED REPRESENTATIVE
CO ACORDCORPORATION 1988
CERTIFICATE OF LIABILITY INSURANCE
EMPLOYEE ROSTER
Certificate Number :ACIO- 1300813- 862289
Attached raster includes employees paid through 03/14/2010. To verify employee's wha may have been added since 03 /14/2
please call 1- 800 -728 -0623.
* Please note employee roster for this client is updated on a WEEKLY basis.
EmDlovee List:
AGUTAR, ROLANDO
CHAPMAN, CHARLES J
CHAPMAN, MELODY `
FERNANDEZ, JUAN J.
HALL, DAVID
HALL, MICHAEL W.
LOPEZ, ROBERTO
MACIAS, LAZARO
MOORE, JARRAID
MOORE, ROBERT
RODRIGUEZ, JUAN
TELLEZ, VICTOR
APR/09 /2010/FR1 12:41 PM Contractors Payroll FAX No.2397686387
41912010
CHAPMAN SEPTIC SERVICE
954-749-2088
p.2
P. 002/002
Page 1 of 1