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PL-11-1560
Permit Number: PL -8 -11 -1560 J Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 169964 Inspection Date: February 13, 2012 Inspector: Hernandez, Rafael Owner: INC, NICAMERICAN Job Address: 1360 NE 103 Street Miami Shores, FL 33138- Project: <NONE> Contractor: WESTLAND PLUMBING CORP Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Septic Phone Number Parcel Number 1132050300070 Phone: (305)863 -6223 Building Department Comments NEW SEPTIC TANK AND DRAINFIELD Passed Inspector Comments CREATED AS REINSPECTION FOR INSP- 165334. CREATED AS REINSPECTION FOR INSP- 163705. HRS IN FILE missing sod r % MI Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled re- inspection fee is paid. until For Inspections please call: (305)762 -4949 February 13, 2012 Page 1 of 1 )rlt tvston M1s'mi, `F,[ 33175 TANK INSTALLATION TANK SIZE [1]/210C) [2] TANK MATERIAL OUTLET DEVICE 7-7:— ULTI - CHAMBERE OUTLET FILTEF3f [ LEG END 13 —d7 { WATERTIGHT LEVEL DEPTH TO LID [01 ] [02] [03] [04] [05] [061 [07] [08] CRAINFIELD INSTALLATION [110] f AREA [1 [2] SOFT [111 L j DISTRIBUTION BOX HEADER — :_[42]- BER OF DRAINLI NES i [13] D FN ARATION m DRAINLINE©PE t . i f [1 1 r'[1 - {1 DEPTFU -OP COVER ELATION [ GV (J BM -t O'STEI*C6CATION d.* _.1:_ h - c it teG PUMP O] AGGREGATE EXCESSIVE FINES" r. 9 eAGGiEGATE SIZEJ/0/ ]j SETBACKS FT [27] SURFACE WATER FT [28] DITCHES [29] PRIVATE WELLS. FT [30] PUBLIC WELLS. FT [31] IRRIGATION WELLS FT [32] POTABLE WATER LINES •'r FT .��' FT [33] BUILDING FOUNDATIONS FT [34] PROPERTY LINES [35] OTHER FT FILLED / MOUND SYSTEM [36] DRAINFIELD COVER [47] SHOULDERS [38] SLOPES ] [391- STABILIZATION ADDITIONAL INFORMATION [40] UNOBSTRUCTED AREA [41] STORMWATER RUNOFF [42] ALARMS w, -3e7 [43] MAINTENANCE AGREEMENT [44] BUILDING AREA [45] LOCATION CONFORMS WITH SITE PLAN ,Ai i ? [46] FINAL SITE GRIN [47] CONTRACTOR [481 " OTHER ? [ AGG EGATE DEPTH FILL / EXCAVATION MATERIAL [22] FILL AMOUNT- [23] FILL TEXTURE [24] EXCAVATION DEPTH [25] AREA REPLACED [26] REPLACEMENT MATERIAL EXPLANATION OF VIOLATIONS / REMARKS: [ 1 1 1 CONSTRUCTION [APPROV, .. C • /DISAPPROVED]:VL 2 ` FINAL SYSTE [APPROV D/DISAPPROVED]:��° OH 4016 (Page 2), 10/97 (Previous Editions May Be Used) Stock Number: 5744 - 002 - 4016 -4 ABANDONMENT [49] TANK PUMPED [50] TANK CRUSHED & FILLED CHD DATE: CHO DATE: Yp PT 1: Applicant PT 2: Installer /Contractor PT 3: Building Department PT 4: Health Department Page 2 of 3 Recycled `S Pop■ Miami Shores Village Building Department 3&11_0,T1 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING Permit No`, 1I/oO PERMIT APPLICATION Master Permit No. FBC 20 Permit Type: PLUMBING OWNER: Nanie (Fee Simple Titleholder): n ( ea Ake Pte{ Phone #: Address: ID 8 % 6 C y t ��° �tJ 413 0 Co City: f /llrZ / 6 State: 154 Zip: .3 3) 3 2 Tenant/Lessee Name: Phone #: Email: JOB ADDRESS: / 3 670 i E A® 3 S 7- City: Miami Shores County: Folio/Parcel #: 1/ —32a -- 0.30 d C 0 7 D Miami Dade Is the Building Historically Designated: Yes NO ._ Zip: 3 3/.)— Flood Zone: /A /1`JI CONTRACTOR: Company Name: Le QV Lai e--t, 4— /T10 -4-® t 7 hone #: Address: 1 0 1 62 °4 ,s ,s-t- r City: °0 d 64.. t State: -~ 1 , ti , , 0 . . Zip:.. �s f Qualifier Name: eo/�lv�f 6 err Phone #: 5o/` 11 3 2/41 ii` State Certification or Registration #: Cv/'-..O 3 7/ / D Certificate of Competency #: Contact Phone #: ::$r St-3 i/ 1.-r-- Email Address: %Q.2f 5 -S.V' e3 CNC- 0 DESIGNER: Architect/Engineer: Phone #: Value of Work for this hermit: if O0 : - Square/Linear Footage of Work: Type of Wont:. ' ]Address CMAlteration New ARepair/Replace ❑Demolition Description of Work: /,! C' %ice .of ••—• 2 5,1" el • Submittal Fee $ Permit Fee $ 3c, Z -" CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ Technology Fee $ 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 conunencement 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 an = ;ins. ection fee will be charged. Signature ~dig weer or �hh,/ The foregoing instrument was acknowledged before me this g day of ✓ Z' , 20 f% by who is perso ally known to me or who has produced QZ505 ®TOI - e+,tif ssti..,ia,yi dial taYP y oath. "i "'••. KRI�ADEIPRAC� NOTARY PUBLI .� 4; :, " My OpMMISSi4I g DD 795288 t p� EXPIRES: June 8, 2012 Contractor The foregoing instrument was acknowledged before me this day of / , 20 d1, by who i personally known t me or who has produced Sign: Print: My Commission Expires: 6/p//L Sign: Print: 0/'My Commission Expires: ********* * * * * * * * * * * * * * * * * * * ** * * * * * * * ** ** . ************************************ * * * * * * * * * * * * * * * * * * * * * ** * * * * * * ** APPROVED BY 1/ Plans Examiner Zoning Structural Review (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) Clerk STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREA'rr1ENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT CONSTRUCTION PERMIT FOR: OSTDS Repair APPLICANT: (Nicamerican Inc) PERMIT #:13 -SC- 1365328 APPLICATION #: AP 1045044 DATE PAID: FEE PAID: RECEIPT #:. DOCUMENT #: PR852703 PROPERTY ADDRESS: 1360 NE 103 St Miami, FL 33175 LOT: 7 6 BLOCK: 5 SUBDIVISION: PROPERTY ID #: 11 -3205- 030 -0070 [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 [ 1,050 ] GALLONS / GPD Septic CAPACITY A [ 0 ] GALLONS / GPD CAPACITY N [ 0 ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS] K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ ] D [ 400 ] SQUARE FEET SYSTEM R [ 0 ] SQUARE FEET SYSTEM A TYPE SYSTEM: [x] STANDARD [ ] FILLED [ ] MOUND [ ] I CONFIGURATION: [ ] TRENCH [x] BED [ ] N F LOCATION OF BENCHMARK: F.F.E.: 8.60' NGVD. I ELEVATION OF PROPOSED SYSTEM SITE [ 30.80 ] [) INCHES V FT ] [ ABOVE A BELOW b BENCHMARK /REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ 48.80 ] [I INCHES Y FT 3 [ ABOVE A BELOW b BENCHMARK /REFERENCE POINT L D FILL REQUIRED: T E R SPECIFICATIO BY: PEDRO N OSP [ 0.00] INCHES EXCAVATION REQUIRED: [ 30.00] INCHES 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- 6.013(3)(f). 3- Install 400 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 5.03' NGVD 7. Bottom of drainfield elevation to be no less than 4.03'GVD. THIS PERMIT IS NOT FOR TITLE: APPROVED BY : mg adj#i r d `A 2 aired to per f$ u. . Pedro o�'na na ins action. Prior to Final A �rovaln at the inspector shall witness the soil boring and o DOH EXPIRATION DATE DATE ISSUED: OS/23/2�11 rosufts to the,or' i Sne DH 4016, 08/09 (Obsoletes all pr8ggti tth�aS$fll�fljed. q Incorporated: 64E - 6.003, FAC at the jobsite at the ar assess��e�d� if the contractor is notsssog�n v '_ . 1 . 4P'4 O�.f'+7� A Dade CHD 11/21/2011 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 govemed 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. STATE OF FLORIDA DEPARTMENT OF HEALTH APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Permit Application Number PART II SITEPLAN le: Each block represents 10 feet and 1 inch = 40 feet. Plan submitted,by:74.- - Approved NorPApproved Title Date County Health Department ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT 15, 10/96 (Replaces HRS-H Form 4016 which may be used) Number: 5744-002-4015-6) Page 2 of 4 4 Rug 25 2011 9:18RM Westland Plumbing Corp. 305- 863 -7355 p.2 CERTIFICATE OF LIABILITY INSURANCE OP ID SAS WESTL -5 05 /11 /11 WIZ IMWODMYYYI PRODBCER RST ins Brokers of Florida, FLA License 8L061315 3111 N University 64718 Coral Springs FL 33065 Phone: 888- 830 -4396 Fax: 800- 505 -7306 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 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # MUM Westland Fleshing Corp 101 W 24 Street Hialeah FL 33010 1 INSURER A: Mt. Vernon Ins. Co. 26522 POURER IN NEURER C: INSURER I7 INSURER E: COVERAGES TIE POLICIES OF 1160.KANC6 L11111613 BLOW IIAA BEEN HEWED TWINE INSURED NAMED MOVE MR THE MCI PERIOD INDICATED. NOTNT0/6TAHDWO ANT REQUIREMENT. TERM OR COMMON Of ANY CONTRACTOR OTHER DOCUABNT MATH RESPECT TO WHICH TINS CERTIFICATE MAT BE FEED OR MAY PERTAIN. THE 47811RANCEAFGORDED BY THE POUDIP3 DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS,* D CONOROONS IT E106 POLIGOB. AGGREGATE LADE UMW/ MAY RAVE BEEN REDUCED BY PAD CLAIMS. 600 L1R . •• TYPE OF INSURANCE POUGTNONIAPI POLICY EFFECTIVE OATS MOVE• POLICY EXPIRATION wan A A1.UAB011Y CONMERCW L LOENERALIABRIT/ CL2571980A 05/09/11 05/09/12 E601000URREICE V1,000,000 X DASIAGE TO PREMISES amA,E n„> a 300 000 :■ woes MADE 000UR UED6XP(Anymwp ) 6 10,000 PERSONAL&ACV AUURT 61 000 000 GENERALAGOREOATE 6 2,000,000 OEHLADXBREGATE UNIT APPUES PER POLICY n 616. Il Ear I I 1.06 PRODUCTS - CDLPATPA00 $ 2,000,000 X AUIOIRRE BLE/MLITT /V&A= ALLOWED AVM BONEOULEDAV10$ HEED AUTOS NOIYOY+AEOAUTOB X ENO Mall mar $ BODILYDUURY (Pa perm) 1 130013.0 130013.0 INJURY (Pa ARRAS> 6 PROPERTYPAYAOE 6 OARAGEUANMTY ANY ALTIO AUTO ONLY- EAACXIDENI 6 OTHER THAN EA AGE $ AUTO ONLY, AGO $ EXCESS)(UPDHaLA LMSO3TY OCCUR ❑ WASH MADE DEDUCTIBLE 1404 OCCURRENCE $ ■ A6REOATE i 6 6 $ WORICHICS CCIPPEASSATION AND W PLOT0A6' LMBRRY Y1 R ANY PRXS'IEETOWPARTNEfl1OtE0UDYE ❑ OFFICER IENBEA EICIAIDE01 piamigary I7 NH) ETa®yv AHAW SPECIAL PIEVBItRABDatw NC 11616. 014. TORY UNITS ER EFL EACH ACCIDENT E EL DISEASE- PA EMPLOYER 6 EA-DISEASE • POLICY LOUT 6 CANER OEBCISPI1D01 OF OPERATIONS / LOCATIONS IMECUM /0ACLUSION6 ADDm EYEA EOREIR EDI1ISPECIAL PROYISION6 f!CEPTICIP.ATC L14T1 nca MIAMI SHORES VILLAGE 10050 WE 2 AVENUE p0fl Ifl PL 33339 ACORD 2612o09ron 10 DAY6VYPoREN SHOULD ANY OF TIEMove Rascal= POUCH/1EE CRN0ELLE0 BBFOFE Dna SP1RAT11N DATE THIDusw.THELBUOIG INSURER WO.6606AYOR Pi MAIL NOTICE TO TrtECIRTTNOATE HOLDER NAIL TO TAM LEFT, DDT PAQIAE TO DO PO SHALL 66066 NO0DUOATTON OR LIADILTIY OP ANV RAID UPON MI INSURER. LIE Amami OR REPTULELRATWE6. AUTHORIZED REPR ®°'°TATNE /� .•f�' ©7988 -2009 ACO CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD