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PL-12-231Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: I NSP- 169832 Scheduled Inspection Date: March 26, 2012 Inspector: Hernandez, Rafael Owner: GOMEZ, RODOLFO AND SUSANA Job Address: 1156 NE 101 Street Miami Shores, FL Project: <NONE> Contractor: A AARON SUPER ROOTER Permit Number: PL -2 -12 -231 Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Septic Phone Number (305)898 -8841 Parcel Number 1132050190250 Phone: 305 -944 -8886 Building Department Comments PUMP AND ABANDON AND REPLACE BROKEN SEPTIC TANK WITH NEW SYSTEM 900 GALLON SEPTIC AND EXISTING 300 SQ FT DRAINFIELD REMAIN Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments HRS IN FILE March 23, 2012 For Inspections please call: (305)762 -4949 Page 15 of 37 Q113 11;31-Ni S BUILDING Miami Shores Village Building Department EL, U J w 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 1E-251 PERMIT APPLICATION FBC 20 Master Permit No. Permit Type: PLUMBING r OWNER: Name (Fee Simple Titleholder): .10d Ok� `t (SV SO ".61 &Phone #: Address: k1 £e lot S-t City: RE CI IY\ i S ko (e S State: ft- Zip: 3 313c-F' Tenant/Lessee Name: Phone #: Email: JOB ADDRESS: City: R[5G N►N 101 Miami Shores County: Miami Dade Folio/Parcel #: 320& c °t _ 0 2 S-5 Zip: :33i3 Is the Building Historically Designated: Yes NO X Flood Zone: CONTRACTOR: Company Name: )--°' "—I (SN' (2 4---er Phone #: Address: ' O2 SS-°- 3S C City: M IY"Gtin-Nq r Qualifier Name: J O E'i \ To Phone #: State: E., 31 Q a14- -gags zip: 5302 3 State Certification or Registration #: Certificate of Competency #: Contact Phone #: Email Address: DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: Square/Linear Footage of Work: Type of Work: Address ❑Alteration Description of Work: New $Repair/Replace m G cry ) g C< ibN [Cey- c 4 ❑Demolition ** * * * * * *** * *** * * * ** :**** ***** ** **$***** Fees*************** * ************ **************** 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 $ cn .30 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 AI'!H'III)AVIT: 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 ill be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencem for the first inspection which occurs seven (7) days after the building permit is issued. In the inspection will not be approved and a reinspection fee will be charged. Owner or Agent The foregoing instrument was acknowledged before me this 8 day of fief, , /12_ , by a �' G rfrte_ , day of , 20 _, by -40/111 Tu Signature must be posted at the job site nce of such posted notice, the Contractor The foregoing instrument was acknowledged before me this who is personally known to me or who has produced D� As identification and who did take an oath. NOTARY PUBLIC: who is pe sonally known to me or who has produced Dom. l gc' as identification and who did take an oath. NOTARY PUBLIC: Sign: -c. Sign: My Commission Expires: soLorato dsiY COMMlSStNE131936 ON # EEC ,, EXPIRES November 08. „� o; • EXPIRES 1Vu■embr:e 08,-2015 (407) 398-0183 FloddallotarySarvice.i om (407) 398-0153 FUa dallotaryServiae.com * * * * * * * * * * * * * * * * * * * * * * * * ** ************************************************** **************m**************** APPROVED BY � 2-46 Plans Examiner Zoning Structural Review Clerk (Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09) 'au, na ! [ttlaPtLid Cdr o G(o ;nrinn 7 STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT CONSTRUCTION PERMIT FOR: OSTDS Repair APPLICANT: Rodolfo Gomez PERMIT #:13 -SC- 1391428 APPLICATION #: API060828 DATE PAID: FEE PAID: RECEIPT #: DOCUMENT # : PR865959 PROPERTY ADDRESS: 1156 NE 101 St Miami, FL 33138 LOT: 2 BLOCK: 177 SUBDIVISION: PROPERTY ID #: 11- 3205 -019 -0250 [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 [ 900 ] 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 t 200 ] 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.: 8.90' NGVD. I ELEVATION OF PROPOSED SYSTEM SITE E BOTTOM OF DRAINFIELD TO BE L D FILL REQUIRED: [ 0.00] INCHES 0 T H E R [ 14.40 ] (I INCHES I' FT ] [ ABOVE ABELOW bBENCHMARK /REFERENCE POINT [ 44.40 ] [I INCHES 1 FT ] [ ABOVE /I BELOW b BENCHMARK /REFERENCE POINT EXCAVATION REQUIRED: [ 0.00 ] INCHES 1— Install 900 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- Existingl 300 sf of drainfield in bed configuration. certified by " A Aaron super Rooter" on 02/06/2012 to remain. 4. This permit includes the Abandonment of existing septic tank THIS PERMIT IS NOT FOR ADDITION(s). soieonr,aMorr ►Ti r acerb, o the dr is roc, to a;n/i SPECIFICATIONS BY: '" r •'ion at ` APPR• BY: reins .•:.,..� -iu . b. •, i the �]p�� „ ofie as " cation an ompare the DATE ISSUED: 02/07/ &1f the sir, essep ii fitted. AAea tim�mpa� ` contra A DH 4016, 08/09 (Obsoletes all previous editions whi' Incorporated: 64E- 6.003, FAC not be used) `• • v 1.1.4 AP1: 6�..•= 2� ~• ' 'SE 2073,,, Dade CHD EXPIRATION DATE: 05/07/2012 Page 1 of 3 STATE OF FLORIDA DEPARTMENT OF HEALTH APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT 1 s Permit Application Numt;0 .t -)°' PART II - SITE PLAN Scale: Each block represents 5 feet and 1 inch = 50 feet. f t I 1 r i t' i ' .,_�E • i • • Notes: �_•.._._r_ .F.. -•._ :.., i ?1_'_ } r} ..} 1 i 1 i } J •i 1t i , i` 1_ _J s: "1 I �` —(' }- '1 }t._ E5O nel CZ — USG l\ 1 S-r {vvS bD s '3)31? r(Jrn7/ c tic /0 tr. 14 C.12. �-1))< G tha n� Site Plan submitted by: Plan Approved By Signature a C,a� hrG c /44 Title Date County Health Department ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT 0144015, 10/96 (Replaces HRS -H Forth 4015 which may be used) (Stock Number: 5744 -002. 4015 -6) Page 2 of 3 I' • AX CoLLEC' OHS t • 140 W. FI,AGLER Si. Ust FLOOR �..`` - MA I FL33130 349403 -6 201i LOCAL BUSINESS TAX RECEIPT 2012 MIAMI -DARE COtffi Y -STATE OF FLORIDA MUST as Dts�PLAYESET AT LA E OF BUSINESS PURSUANT TO COUNTY CODE CHAP ER SA - ART. 9 & 9 ) i ata i&7 NOT A DILL - • DO UOT : 4',Y RENEWAL BurqUAINEWRENOCITER INC sTATEWRPOU64a DOING BUS IN DADE CO °" P ARON SUPER ROOTER INC SIpECTAIiY PLUMBING CONTRACTOR WORKER /S Vag .a Oi LY A Bum-S3 nix RECOBT t ER Q 4"JA1 mp uw" a t OP COUNTY CR CME9t NOR COM MUM RIMM Y ON a PEsftr DR ucesag RE1191212 BYLAW.7lpg Iii N14 LC 88W$ UAAMYCA. PMBENrAirawn MW19ANCMMM Th C°"- mm11/18 /2011 09010017001 000086.25 SEE OTHER SIDE t.'d DO NOT FORWARD AAARDN SUPER ROOTER INC JOHN 'FUFFY PRES 6 SW MIRAMAR FL 3023 • } FIRST-CLASS US. POSTAGE MIAMI, Fl. PERMIT NO.231 364996 -0 dLQ :EQ 13 90 090 Registered Septic Tank Contractor w ti AM" t r SRO 21112 JOHN J TUFFf E022 SW 35T14 COURT MIRAMAR FL 33023- A -AARON SUPER ROOTER, INC_ Business Authorization: SA092 0648 Registration Expires on September 30, 2012 e17b :80 1 EZ oeO Dec 20 11 01:25p CERTIFICATE OZ ABILITY INSURANCE PRODUCER Arhelaez Inaurance, ►n_ 9971 Miramar Parkway VJramar, FL 33025 Phone (954) 436-S544 Fax (854) 435.7738 INSURES Aaron Super Rooter . Inc. 0022 SW 35 COURT Miramar, FL33023- j (954) 967 -933 P.1 DATE MAW/YY) 12120111 THIS CERTIFICATE Is ISSUED AS A MATTER OF INFORMATION ONLY AMU CONFERS NO RIGHTS UPON THE CERTIFICATE ALTERR�TtlE THIS COVERAGE RAGEAFEOROED BY THE FCLLCIEES BELOW, INSURERS AFFOROING©OVERAGE NAIC IY INSURER A: ACCIDENT INSURANCE CO INSURER B: TECHNOLOGY INSURANCE CO INSURER G — COVERAGES INSURER O; IN URER THE POLICIES OP INSURANCE LISTED HAVE MEN ISSUED TO THE 1Msuiwwp tamp ABOVE FOR THE POLICY PERIOD WOIGATED NOT MTH9TANOINCi MAY PERTAt. HE WSL NcE APFORDEDaev THE POLICITA OR OTHER.CIOCUMENY IS SUBJECT TO ALL THE TERMS. EXMISION5 ANQ COnmtntoNS OF SUCH POLICIES, AGGREGATE LN FrS SHOWN MAY HAVE BEEN REDUCED D BY PA TT CLAIMS. U ADG'L POLICY SFFECTIVE POLICY =MAIM SRO TYPE OP INSURANCE i Pol.= NursEER ! DATE rMronnone TY mn IIAI4'LamYYl CENE1zAL LIABILITY 2 COMMERCIAL GENERA!. LIABluTY A6L9001824 I 0a129fZOt1 a91,29t1a12 A El • GLANS ►H AVE ® OCCUR ! 5.060 PERSONA/. 8 AOY WJURY 1.000.000 GENERAL ACCRECATE _ 2000.060 PROOUITS- COMPIDPAGG INC Lows EACii OCCURRENCE DAMAGE TO REiNTO- PRQu1Isss IEOQaau•rnne9 MED OP (Any a )Ic parson) i 000.Gti 100.OQ0 ❑ . GENT. AGOReCATE LIMIT APPUEs PEI I -- - ❑ PM.= ❑ PR1JECT ❑ LOC AUTOMOBILE LIABILITY ❑ ANY AUTO ❑ AU. CWNEOAUT'os ❑ ❑ SCHEDULED AUTOS ❑ HatebAUTCU3 G Nom °WNWAUTOB GARAGE LIABILITY 0 0 ANT AuTo B EXCESS / UMBRELLA LIABILITY O doom iI WAS MADE ❑ DECUCTIBLtc ❑ RETENTICII womeRs CoMPENSATIDN /WD tamovERA *LtA01i„ITY YAN TWC356B61 ANY PROPRIETOR I PARTNER 1 EXECUTIVE OFFICER maw= er.ouroEDy (Mandatary In NH Iy� � 1PROVISfl�5 below OTHER co WANED SINGLE LIMIT {Ea oxidant) LILY INJURY cr tea BODILY INJURY (Pa sootdant) PROPERTYDAMAGE (Par accident) AUTO ONLY - EA ACCIDENT O'THER'MAE Ell ACC AUTO ONM AGG EACH OCCURREmcE AAATTB 00/ 23/2011 1 09!2312012 WC STATU- ❑ OTN- _Zplty r IwtrrS _ �r F.L. EACPfACCiEHT E.L. DISEASE- EA EMPLOYEE S.L. OIsESE . POLCY LIMIT 1.000.000 1000.000 1.000:UCO DESCRIPTioN OPOPRRATIONE f LOCAT1o1VS /VEHICLES 1 Ei(CLUssms ADDED By Elgyp_ENT/ SPECIAL PROy{GION5 CERTIFICATE HOLDER GAMCELLATION VILLAGE OF NORTH MIAMI BEACH 17050 NE 19 AVE NORTH MIAMI BEACH FL 33162 A OYZD 23 (2009161) OF • sHOVl-0 ANY OP THE ABOVE DESCRIBED POLICIES VE CANCELLED BEFORE me EXPIRATION DATE TIB�tEOF, THE ISSUING INSURER WILL ENDEAVOR TO MAI,. 30 DAYS WRITTEN NUflCETO THE CERTIFICATE HOLDER NAMED TO THE Len. BUT PALMED) DO SO SHALL IMPOSE NO OSLIGATIO OR LIABILITY DP PMY KIND UPON THE INSURER. ITS AGENTS OR RCP . AIJTHOFEZED REPREsetTATIVE 0.088-212 The tsresented. of ACQFw Feb 14 2012 2:22PM ARBELAEZ INSURANCE 9544367733 p.1 CERTIFICATE OF LIABILITY INSURANCE DATE MUMMY) PRODUCER Arnelaez Insurance, Ins. 9977 Miramar Parkway Miramar, FL 33026 Phone (554) 435 -5544 Fax (654) 435 -7733 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. T1113 CERTIFICATE DOES NOT AMEND, EXTEND ALTER THE COVERAGE AFFORDED BY THE POJ,ICIES OR BELOW NAIC 0 INSURERS AFFORDING COVERAGE INSURED Aaron Super Rooter . Inc. 5022 SW 35 COURT Miramar, FL 33023- 1 (954) 9674933 INSURER A: ACCIDENT INSURANCE CO A INSURER B: TECHNOLOGY INSURANCE CO GENERAL LIABILITY n COMMERCIAL oENERAL LIABILITY INSURER 00/29/2011 INSURER D: EACH OCCURRENCE INSURER E: DAMAGE T5R!NTED PREMISES {Ea aoourrenml COVERAGES THE POLICIES OF INSURANCE LISTED HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FoR THE PQUCY PERIOD INDICATED. NOTIIYMTHSTANDINO ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH His CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OP SUCH PQLIICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ag �� ADD'L INeiiD TYPE OP INSURANCE • POLICY NUMBER DATAIMMIODIYYYYY pAYS tavNDDIY LIMITS A ❑ GENERAL LIABILITY n COMMERCIAL oENERAL LIABILITY AOL9001624 00/29/2011 00/29/2012 EACH OCCURRENCE 1.000.000 DAMAGE T5R!NTED PREMISES {Ea aoourrenml 100.000 • • CLAIMS MADE I: OCCUR MED EXP (Any one parson) _ 5.000 • PERSONAL & ACV INJURY 1.000,000 III GENERAL AGGREGATE 2.000.000 GEN'L AGGREGATE LASTAPPLIEB PER: ❑ FOLIGY ❑ PROJECT ■ Loo PRODUCTS - COMPIOFAOG INC 0 AUTOMOBILE LIABILITY ❑ ANY AUTO ❑ ALL OWNED AUTOS COMBINED SINOLE LIMIT (Ea accident) _ BODILY INJURY (Par person) • SCHEDULED AUTOS ■ HIRED AUTOS BOOILYINJURY (Par occident) • NON OWNED AUTOS PROPERTY DAMAGE • [] GARAGE LIABILITY Il ANY AUTO ■ AUTO ONLY - EA ACCIDENT OTHER THAN EA ACC AUTO ONLY: AGO ❑ • EXCESS 1 UMBRELLA LIABILITY • occur( • CLAIMS MADE ❑ DEDUCTIBLE ■ RETENTION 5 EACH OCCURRENCE AGGREGATE B EPLS MP L COMPENSATION AND EMPLOYERS' wN ANY PROPRIETOR / PARTNER / EXECUTIVE OFFICER /MEMBER EXCLUDED? (Mandatory In NI l!Xyea deoa ibe und8f SPEL:IAL PROVISIONS below TWC329S661 09/23/2011 09/23/2012 H. 56 TR% 0 E.L EACH ACCIDENT 1.000.000 El. DISEASE - EA EMPLOYEE 1.000.000 E.L. DISEASE - POLICY LIMIT 1.000.000 OTHER DESCRIPTION of OPERATIONS ) L.ocATloNS 1 VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT 16PECIAL PROVISIONS • • CERTIFICATE HOLDER CANCELLATION VILLAGE OF MIAMI SHORES 10060 NE 2 AVE MIAMI SHORES. FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES' BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING USURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE MOLDER NAMED TO TI E L EFT, BUT FAILURE TO DO 50 SHALL IMPOSE NO 0 - I TION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS GENTS OR REP' IVES, AUTHORIZED REPRESENTATIVE ACORD 2d (2005/01) CIF • All rights reserved. o are registered marks of ACORD The Florida Department of Health hereby certifies the business or entity named below has satisfied the requirements of Part 111, Chapter 489, Florida Statutes, for septic tank contracting and has been duly authorized by the department to provide septic tank contracting services under the name of March 31, 2013 Expiration Date