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PL-11-1434Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 162962 Scheduled Inspection Date: August 24, 2011 Inspector: Hernandez, Rafael Owner: COX, RONALD Permit Number: PL -8 -11 -1434 Job Address: 126 NE 108 Street Miami Shores, FL Project: <NONE> Contractor: MR C'S PLUMBING SEPTIC INC Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Septic Phone Number Parcel Number 1121360090060 Phone: (305)651 -7859 Building Department Comments EXISTING 750 GAL TANK TO REMAIN AND INSTALLATION OF NEW DRAINFIELD 200 SQ FT IN BED CONFIGURATION Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments HRS IN FILE August 23, 2011 For Inspections please call: (305)762 -4949 Page 13 of 23 91 H ;11orsaia : epaxtnter:t of Heat Miaar; €- ade ( a ;ter He-aith )epart,'J, -'ut i'r ➢r I I iti5 Ste' ;.b St. Dwe "11 -; 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 Permit No. 9 1 1I Master Permit No. BUILDING PERMIT APPLICATION FBC 20 Permit Type: PLUMBING OWNER: Name (Fee Simple Titleholder): Address: % L /vL% l (SCSI City: State: — Zip: 33 31(, 1 Tenant/Lessee Name: Phone#: Email: ,67 AUG 0 2011 Phone #: WC 333 es-0 JOB ADDRESS: I °'6 toe ) O8s1 City: Folio/Parcel #: Miami Shores County: Il- aI36— (-09— csi360 Miami Dade Zip: 33 (6 1 Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: /4(1. r C PLL1 3 a Phone #: ?t S ‘57 78-5-1 Address: / y.?d /WA) a fit. City: il:-w: State: fe_— Zip: Z3( ` S Qualifier Name: b Phone #: State Certification or Registration #: Certificate of Competency #: Contact Phone #: Email Address: DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ � 0 0 • Square/Linear Footage of Work: Type of Work: ❑Address ❑Alteration ❑New Description of Work: . T4 A,r4 ■ e\.� CitI epair/Replace 29°D pC ODemolition ***** ******************** ************** Fees**x:: x***** ***** *** ** * *** *********** ** *** *x * ** Submittal Fee $ Permit Fee $ /.�� ' CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approve h and �t rei ion fee will be charged. W Signature Signature Owner � gent Contractor The foreg ' g instrument was acknowledged before me this The foregoing instrument was acknowledged before me this t day of 20 A, by , day of , 20 1( , by who is rsonalTy known to me or who has produced who is known to me or who has produced Pe y o o ha p oduced ho s p As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Exp as identification and who did take an oath. NOTARY PUB !`C: Sign: Print: My CO11111 s io .Ex t �DD8 RICK . q 0014 # 891340 EXPIRES: September 14, 2013 flooded Wu Notary Mk Underwriters ***************************** sIs ********* **** **********ffi*********it4e sk*Ni*+ k**+ k*****+ 1<B *************+N*N *** APPROVED BY Plans Examiner Structural Review (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) Zoning Clerk CERTIFICATE OF LIABILITY ;INSL NCE THIS CER71FIIOATE ISJSSUED AS A MATTER OF IN.FO.RMATION ONLY;AND CONFERS NOR1GHT S PON THE CER'tlfiOAT iOLDpR CERTIFICATE DOES NOTAFI=I,RAtATINELy OR NEGATIVELY AMEND, EXTEND OR ALTER THECOVERA:0. AFFQRDE[ B' BELOW. ,11416-,ERTIFICATtOf INSURANCE DOE$ NOT.CONS7ITUTE A CONTRACT BE TWEEN'l*E ISS'LIING 1 RRIC tFCS AL1TL1d#RIZfitl' REPRESENTATIVE GR PRODUCER; AND mE CERTIFICATE" HOLDER,, II ORTA r If`the.cert e*ebOlderisan AtibITIKRIAL IN.$URER, thepolicy(Ies) must be endorsed, If SUBR ONO' t e terms and conditions -bf thepodcy,Leettahl pollcies May require an endorsement A statement an thlteettlfteatedasliatt c cerilf sate hoiden to IlettOrsuch etldorsemendsk, PROOUCCR. Caroiy11Rur11Mel Agency a97o state°ROad 64I st - Branton,. FL 34208 Phone (941) 748 -855; Fax (941);748- 3 E Tani Bernhard PHONE, No. Extr (941) 7454555 -. ADDRESS: PRODUCER OUSTOMFR IO #: fA/O,P101. Tcoi,;Sit iatti'einsurahee 0E0010 tNSuREF. Mr, C's Plumbing & Sew, Inc k) -Box: 693239 Miami, Pt. 33266-0239 941 fF SUREI*S A`OR4fN INSURERA : r thadraRtt C mpaf % INSURERS iNSURER c JNSURER:0: <tNSURER' ^E r`- COVERAGES CER1U TE NUM& - INSURERS; T1-H IS TO CERTIFY TIFY THAT THE PQLIQtESi7F ' SURANCE LISTED BELOW HA ANY ISSUED-TO THE NSURED NAMED ABQUE OR" AIDIC ,TEI0c ERTIF T EAT11?I IO Xts1Y REQUIREMEttTT TERM QR CQNDLTIOE OF ANY,CQ LiCIECDOR LSTtiEF :I Jf ENt IfitiTi# -RE gRTIFiCAT,E741 -r BEJSS£ lEDORMAY.PER`AIN,THE1N.�LiFF2AN EAFFOHDEDBEENREJ lE.t�St=.R161OjECEINI?.r, 61E Tf EXCL :ISIORSpND OM1tD1 I SOFSUCHPOU( IES. LIMITSSFIOIi +lMAYHAVEB N REtx EE) Y AIDO+Li4lfitt�'r.. EvrsloN NUMB> TYPE.OI °INSURANCE GENERAL L1ABiLW 0 COINMERCI.LSENERALUTA9IUtV • 00 CLAIMS:MADE. 0 OCCUR Q , 1.� POLTOYEFP MMIDD1Yr t rlerrrS (iERI. AOGREGI§TEL war APPLIES PER: • POT:tcY Fla El IOC Atfn7400I1:Z LIABILRY^ • ANr;AUJO. AtL OWN}AtJ'[OS Q scr1OFWLED'Atlrt1S;; HO?FDAUTQS NON,0161NEI,AUTOS EACH:'! P MISOS MfMN} =oi PERS gottoigt 4 car,>PJNED $Oi > I 45a acotaoyin aorxxownffitiotoitl 'BODILY ,IN RY P do PRQF1 IP9f'e 0 ' .4m LLAL1AB E{YCcua DEDUCTIBLE Fl RETENTION= ,G 1RKERS- r:OMPERSAHOt 'ERS' E TORJF'ARTJVER/EXE0UTIVE Y t Elvis EXCt oaD?? {NN OF UP5WieN$bNow 111A wto243033: 07701291 1 071(1 12 r T llT E:1 SAC11 ACCEENT ELL ttISEASE -EAEMP O 500000 1= L:43}SEA DESORPTION OF OPERAT{CN1S.1 LOCATIONS /VEHICLES (Ai CERTIFICATE HOLDER'. CORD 1s1, Ad re Remarks Sahedu,ktfmoreispeetisteg4i10d) CANCELLATION Miami Shores Village 10050 NE 2nd Avenue Miami Shores, FL 33138 = SHOULD A N Y O P TH NE DESCRIBE PO THE EXPIRATION DATE TTHEREOO, NOTICE: ACCORRANCE:W I H'INE.POLIcYPROViSiONS fc AUTHOR! D f ER- R4SE,I 'TA'nVE © 19 -t RACOR# The AGORA cyan a antti OE RUG. 4. 1011 3.39PM DERM STATE OF PlIORTDA DEPAR y; t "NT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PE :` +° T CONSTRUCTION PERMIT FOR: AP P =CANT : Laura Ramey PROPERTY ADDRESS: 126 NE 108 St Miami, FL 33181 OSTDS Repair LOT: 6 BLOCK: 209 PROPERTY ID 8: 11-2136-009-D000 NO. 104 P. 1 PEST #:13 -SC- 1361803 ABPLICATi0+t7 it ! AP 1 Q42942 ttATE FEE PAID: RECEZFT 6: f0CVrENT e: PR851272 SUBDIVISION: Dunnklgs Miami Shores [SECTION, TOWNSHIP, FANGS, PARCEL NOMBER) [OR TAX ID NUMBER] SYSTEM MUST BE CONSTRUCTER TN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF SECTS 1 361.0065, S. s., AND CHAPTER 64E -6, F.X.C. DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE SATISFACTORY PERFORMANCE FOR ANY SPECIFIC PERIOD 0$ TIME. ANY CHANGE IN MATERIAL PACTS, ' WRICE SEA AS A SINUS FOR ISSUANCE OF THIS PERMIT, REWIRE THE APPLICANT TO M+ODTrr TEE PERMIT APPLICATION. SUCH MODIFICATIONS MAY RESULT IN IBIS PERMIT BEING. MADE NULL AND VOID. ISSUANCE OP THIS PERMIT DOES NOT EXEMPT THE APPLICANT FROM COMPLIANCE WYTH OTBER FEDERAL, STATE, O. LOCAL PERMITTING REQUIRED FOR DEVELOPMENT OF THIS PROPERTY. SYSTEM DESIGN AND SPECIFICATIONS T [ 760 l GALLONS / OFD A [ 0 l GALLONS / GPO N [ 0 ] GALLONS GREASE iNTERGEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GcALI,oNS3 K [ Send CAPACITY CAPACITY ] G LL0M@ DOSING HANK CAPACITY n E 200 ] SQOAR13 PKET R [ 0 ] Ma= MT A TYPE "MEN: [x) STANDARD I CONFIGURATION: [ ] TRH.NCH N F LocATioN os m c: FFE 12.8' NGVb I ELEVATION or PROPOSED SYSTEM SITE E BOTTOM OP DRAINFTELD TO BE FILLED [x] BED [ 3GALLONS 9[ ]BOSS PER 24 SRS *Pampa SYSTEM SYSTEM L D FILL REQUIRED: 0 E [ 0.00 INCHES [] tenzto L ) [ 24.00 J [ AsovE SENCHbwR/aziERYNCB POINT L 54.00 ] FT 31 AB0VC/lil BENC> [/REFRRBNen 8011vT sxCAVATION REQUIRED: [ 30.00 ] =CMS 1) Existing 760 gal septic tank certified by Mr. C's to remain. 2) Install 200 sq. ft. of drainfield In bed Configuration. 3) Invert elevation of the drainfield to be no Tess than 8.8' NGVD. 4) Bottom of the drainfield elevation to be no Tess than 8.3' NGVD. Required dralnfield area based on rule 64E-5.015(6)(c)2. Install a new drainfield to achieve Drainfield sire requirement 3EECIS'ICATICW$ EY: APPNGV'ED S ! DATE ISSUED: .r uYihiast DR 4016, 08/09 (Obsoletes ,' 1 previous editione wbioh may not be need) Incorporated: 64E- 6.003, V 1 1,4 AP1041p42 EXPTION DATE; tlE042104 Page l of 3