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PL-11-1461Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 163136 Permit Number: PL -8 -11 -1461 Scheduled Inspection Date: February 08, 2012 Inspector: Bruhn, Norman Owner: LONGMAN, JOHN Job Address: 333 NE 92 Street Miami Shores, FL 33138- Project: <NONE> Contractor: A LEAGUE CONTRACTORS, INC. Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Septic Phone Number - Parcel Parcel Number 1132060136370 Phone: 305 - 256 -0306 Building Department Comments INSTALLATION OF NEW SEPTIC SYSTEM 1,050 GALLONS. DRAINFIELD BED CONFIGURATION 667 Passed d Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments HRS IN FILE February 07, 2012 For Inspections please call: (305)762 -4949 Page 3 of 19 1 1 Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Parcel Number PRO, Expiration: 02/19/2012 Applicant 333 NE 92 Street Miami Shores, FL 33138- 1132060136370 Block: Lot: JOHN LONGMAN Owner Information Address Phone Cell JOHN LONGMAN 333 NE 92 Street MIAMI SHORES FL 33138 -3133 ()_ Contractor(s) Phone Cell Phone A LEAGUE CONTRACTORS, INC. 305 -256 -0306 Valuation: Total Sq Feet: $ 1,500.00 0 1 Type of Work: PLUMBING Type of Piping: SEPTIC & DRAINFIELD Additional Info: Bond Retum : Classification: Residential Scanning: 1 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Total: Amount $1.20 $4.50 $4.50 $0.40 $300.00 $3.00 $1.60 $315.20 Pay Date Pay Type Amt Paid Amt Due Invoice # PL -8 -11 -41712 09/02/2011 Check #: 1213 $ 315.20 $ 0.00 Available Inspections: Inspection Type: HRS Approval Final 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. September 02, 2011 Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy Date September 02, 2011 1 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 BUILDING PERMIT APPLICATION FBC 20 Permit Type: PLUMBING OWNER: Name (Fee Simple Titleholder): Address: City: UMMTWEI AUG 1 0 2011 Permit No. Pl 1IH Master Permit No. ,n 1 I SAS Tenant/Lessee Name: Phone#: Email: JOB ADDRESS: a n E 9 City: Miami Shores County: / Miami Dade Zip: ' / ,-a / Folio/Parcel #: / / GJ c — n ) —60-7/ Is the Building Historically Designated: Yes NO CONTRACTOR: Company Name: — y @e [�� �. / ( Phone #: .' _� SZ Address: / PZ) 1.A7 P� t City: 16 ) 1 State: Zip: OtElP Qualifier Name: c (O QQ &C Phone#: ibState Certification or Registration Certificate of Competency #: Contact Phone#: /� or� zl3 r) Email Address: (/ fj o d�� I�z.E /� j"/ O (D7 `` J Phone#: Flood Zone: DESIGNER: Architect/Engineer: Value of Work for this Permit: $ 1) to Square/Linear Footage of Work: Type of Work: Address Description of Work: Alte.. tion / / /l't, //S ORepair/Replace ODemolition + x************* **+ x**+x***************: *** Fees******+ x****** ***** ** * ******** ***** ********** Submittal Fee $ Permit Fee $ 300 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) 1 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 deli 're.. to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be t the job site for the first inspection whi • ccurs seven (7) days after the building permit is issued. In the absence 'f s . ch posted notice, the inspection will not be a and a reinspection fee will be charged. Owner or Agent The foregoing instrument was acknowledged before me this 1 day of $J qUs , 20 , by , day of who is Aersonally na me or who has produced Cwho is personall As identification and who did take an oath. NOTARY PUBLIC: Contractof The foregoing instrument was ackno -dged before me this )3, , 2011_, by me or who as produced Sign: N OF FLORIDA � ,/.ion 2 My COMIO.CMDING aID1 * 1** k* N* B ****N***d******tl*************** APPROVED BY as 'fication and who did take an oath. NOTARY POI,' ! : Sign: Print: My Commission Expires: **************** **N*********** **,k* ************ 1/ Plans Examiner Structural Review (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) _;; °kk SARIMA BATISTA f * . : r _ MY COMMISSION # DD 885425 EXPIRES: May 11, 2013 -4,Rs,,," Bonded Thru Notary Public Underwriters sis '+s rw ***.:-::...- ....** Zoning Clerk • C/� Y PERMIT #: 13-SC- 1312242 JSTATE OF FLORIDA DEPARTMENT OF HEALTH V' APPLICATION #:AP1001147 ONSITE SEWAGE TREATMF�jjil;..�ib Health h Departme11tTE PAID: SYSTEM 1Y1� 1��0q+.SS..�T.D.S..�&�Well Program FEE PAID: CONSTRUCTION PERMIT , CONSTRUCTION PERMIT FOR: OSTDS New APPLICANT: Frank Hornstein nlitil\■ RECEIPT #: DOCUMENT #: PR843627 PROPERTY ADDRESS: 333 NE 92 St Miami, FL 33138 LOT: 15 +16 BLOCK: 47 SUBDIVISION: PROPERTY ID #: 11- 3206 - 013 -6370 [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 [ ] GALLONS / GPD N/A CAPACITY N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS] K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ ] D [ 667 ] SQUARE FEET bed configuration drainfile SYSTEM R [ ] SQUARE FEET N/A SYSTEM A TYPE SYSTEM: [x] STANDARD [ ] FILLED [ ] MOUND [ ] I CONFIGURATION: [ ] TRENCH [x] BED [ ] N F LOCATION OF BENCHMARK: F.F.E., 11.70' NGVD I ELEVATION OF PROPOSED SYSTEM SITE [ 20.60] (J INCHES I/ FT ][ ABOVE BELOW1BENCHMARK /REFERENCE E BOTTOM OF DRAINFIELD TO BE 1 50.60 ] II INCHES Y FT ] [ ABOVE 4 BELOW b BENCHMARK /REFERENCE L D FILL REQUIRED: 0 T H E R [ 0.00] INCHES EXCAVATION REQUIRED: [ 72.00] INCHES POINT POINT Inspector to verify the existing septic tank is properly abandon before final approval. *Invert elevation of drainfield to be no less than 7.98 ft. NGVD. *Bottom of drainfield elevation to be no less than 7.48 ft. NGVD. *Install 42" of slightly limited soil under the bottom of the drainfield. - Perimeter of excavation area shall be at least 2 ft wider and longer than the proposed absorption bed or drain trench. -The licensed contractor installing the system is responsible for installing the minimum category of tank in accordance with sec. 64E- 6.013(3)(f). F.A.C. SPECIFICATIONS BY: APPROVED BY: DATE ISSUED: Carlos M Icaza Carlos M Ioaza 05/03/2011 TITLE: TITLE: Dade CHD EXPIRATION DATE: 11/03/2012 DH 4016, 08/09 (Obsoletes all previous editions which may not be used) Incorporated: 64E - 6.003, FAC seaa�2o£ v 1.1..4 A2100114? Page 1 of 3 , 4 R CERTIFICATE OF LIABILITY INSURANCE I DATE il THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POUCIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER Eastern Insurance Group, Inc. 9570 SW 107 Avenue Suite 104 Miami. FL 33176 CONTACT David M. Lopez PHONE (305) 595 -3323 IA /c. No): (305)595 -7135 ADDRESS :car @easterninsurance.net INSURER(S) AFFORDING COVERAGE NAIC S INSURER A Kid-Continent Casualty Company LIABIU1 Y COMMERCIAL GENERAL UABIUTY INSURED A- League Contractors Environmental, Inc. 13020 SW 85 Avenue Rd Miami FL, 33156 INSURERB :Bridgefield Employers Insuranc 04 -GL- 000822016 INSURER C: 3/19/2012 INSURER D: $ 1,000,000 INSURERE: $ 100,000 INSURER F : COVERAGES CERTIFICATE NUMBERMaster 11 -12 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION 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 IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POUCIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE 1 INSR INSR W BR- WVD POUCYNUMBER POLICY EFF IMM/DDIYYYYI POLICY EXP IMM/pD)YYYYI WRITS A GENERAL X LIABIU1 Y COMMERCIAL GENERAL UABIUTY 04 -GL- 000822016 3/19/2011 3/19/2012 EACH OCCURRENCE $ 1,000,000 DAMAGES ( RENTED PREMISES (Ea ocarrexe) $ 100,000 �j CLAIMS -MADE FIE I OCCUR MED EXP (my one person) $ Excluded PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 EGEM. AGGREGATE LIMIT APPUES PER: G ''1 3—C-1 POLICY I I !Ng n LOC $ AUTOMOBILE — _ LIABILITY ANY AUTO ALL OWNED HIRED RED SCHEDULED NON-0 ED AUTOS (Ea aoddErD ) SINGLE LIMIT BODILY INJURY (Per person) $ BODILY INJURY (Peracddent) $ PROPERTY DAMAGE IPer accident) $ $ UMBRELLA UAB EXCESS UAB OCCUR CLAMS-MADE EACH OCCURRENCE $ AGGREGATE $ $ DED RETENT ON$ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PRQPRIETOR/PARTNER/EXECUTIV9 Y/ N (Mandatory ER EXCLUDED? I I (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA 830 -45469 7/1/2011 7/1/2012 X I TORY L TU- I I OT ER E.L EACH ACCIDENT $ 1,000,000 E.L DISEASE - EA EMPLOYEE $ 1,000,000 $ 1,000,000 E.L DISEASE - POUCY OMIT DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Addltlona! Remarks Schedule, If more space Is required) Septic tank installation, drainage installation CANCELLATION Miami Shores Village 10050 N.E. 2nd Ave Miami, F133138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POUCY PROVISIONS. AUTHORIZED REPRESENTATIVE David Lopez /ANA ACORD 25 (2010/05) ItJCM4 ion+mcx n © 1988-2010 ACORD CORPORATION. All rights resery ed. TA.. A rnon ..n.nn an,J Iwo.....w ...n:e4w...A .wn.Le, .a A Pnon