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PL-12-714Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 172665 Permit Number: PL -4 -12 -714 Scheduled Inspection Date: April 27, 2012 Inspector: Hernandez, Rafael Owner: HABERSIN, HELEN Job Address: 950 NE 96 Street Miami Shores, FL 33138- Project: <NONE> Contractor: MALU PLUMBING INC Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Drainfield Phone Number Parcel Number 1132060142960 Phone: (305)336 -8034 Building Department Comments DRAINFIELD REPAIR Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments HRS IN FILE April 27, 2012 For Inspections please call: (305)762 -4949 Page 7 of 11 DIVISION OF Environmental Health Floriartment of Health Miami -Dade County Health Department OSTDS /Well Division 11805 SW 26 St. • Miami, Ft. 33175 Inspector t� -tf �+--" ' Date Address ` Comments: Signature U Ss i P /©I; .2w CHECKED [X] ITEMS ARE NOT IN COMPLIANCE WITH STATUTE OR RULE AND MUST BE CORRECTED. TANK INSTALLATION [,./1" [01] TANK SIZE [1] [ate [02] TANK MATERIAL [‘...K. 031 OUTLET DEVICE [ .3 [04] MULTI - CHAMBERED Y' N ] 9] [05] OUTLET FILTER "e/ ] [06] LEGEND A/71 [;../T- [07] WATERTIGHT [ (08] LEVEL (,...r" [09] DEPTH TO LID [2]. z 42.0 DRAINFIELD INSTALLATION (10] AREA [1] /5) [2] 3OC QFT [11] DISTRIBUTION BOX _ HEADER [12] NUMBER OF DRAINLINES (13] DR,AINLINE SEPARATION ,Z.. y , . [14] DRAINLINE SLOPE ,s [15] DEPTH OF COVER / [16] ELEVATION [ABO E BM [17] SYSTEM LOCATION [18] DOSING PUMPS /4 [19] AGGREGATE SIZE .050 /•9 [20] AGGREGATE EXCESSIVE FINES [21] AGGREGATE DEPTH /1% FILL / EXCAVATION MATERIAL [22] FILL AMOUNT /2/J [23] FILL TEXTURE [24] EXCAVATION DEPTH [25] AREA REPLACED [26] REPLACEMENT MATERIAL EXPLANATION OF VIOLATIONS / REMARKS: [ ] [ ] [ SETBACKS [27] SURFACE WATER FT [28] DITCHES FT [29] PRIVATE WELLS FT [30] PUBLIC WELLS FT [31] IRRIGATION WELLS FT [32] POTABLE WATER MINES a o FT [33] BUILDING FOUNDATION 57 FT [34] PROPERTY LINES [35] OTHER FT— FILLED / MOUND SYSTEM [36] DRAINFIELD COVER [37] SHOULDERS [38] SLOPES [39] STABILIZATION /VA ADDITIONAL INFORMATION [40] UNOBSTRUCTED AREA [41] STORMWATER RUNOFF [42] ALARMS [43] MAINTENANCE AGREEMENT [44] BUILDING 'AREA [45] LOCATION CONFORMS WITH SITE PLAN [46] FINAL SITE GRADI [47] CONTRACTOR [48] OTHER ABANDONMENT [49] TANK PUMPED / / [50] TANK CRUSHED & FILLED / / CONSTRUCTIO FINAL SYS /DISAPPROVED] :i S CHD DH 4016, 08/09 (Obsoletely: all previous editions which may not be used) Incorporated: 64E- 6.003, FAC Page 2 of 3 DISAPPROVED]: VIA✓ DATE: 1—R2.6-12-. DATE: Y-02 C 2N(17 12— —tet#11° BUILDING PERMIT APPLICATION FBC 20 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. P-La 119 APR 202012 U Master Permit No. Permit Type: PLUMBING OWNER: Name (Fee Simple Titleholder): Helen L. Habersin, Trustee Address: 950 N.E. 96th St. Phone #: (305) 759 -0719 City: Village of Miami Shores State: Florida Zip: 33138 Tenant/Lessee Name: n/a Phone #: n/a Email: n/a JOB ADDRESS: 950 N.E. 96th St. City: Miami Shores County: Miami Dade Zip: 33138 FoliolParcel #: 11- 3206 - 014 -2960 Is the Building Historically Designated: Yes NO applicable Flood Zone: X Plumbing Inc. Malu CONTRACTOR: Company Name: g Phone* (305) 336 -8034 Address: 13155 Ixora Ct. No. 206 — ,239 — 5Za City: North Miami State: Florida Zip: 33181 Qualifier Name: Roberto Alasa Phone #: State Certification or Registration #: CFC1426383 Certificate of Competency #: Contact Phone #: (786) 232 -5284 Email Address: CidiRAM @BellSouth.Net DESIGNER: Architect/Engineer: n/a Phone #: n/a Value of Work for this Permit: $ $2 , 20o Square /Linear Footage of Work: 300 sf Type of Work: ClAddress ❑Alteration ONew ®Repair /Replace ODemolition Description of Work: Blackwater Septic System: DRAINFIELD REPAIR ONLY. $:= k*x*xxx xf xxpx�k4 3c= kdcdF> k> c******=k.k-k=k-k:i:%k**>k*** Fees****** 3:: k: kx: k: k= k =k=k:k **.Y:k>k:k ** **-Y****=Y=Y Y• k Y-**** * ** Submittal Fee $vs-- Permit Fee $ 150 • oo CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ ' 2, • G.Jo 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 bro ure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of comme ment must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. I . th ' bs ' - of such posted notice, the inspection will not be apprb .'ed a reinspection fee will be charged. Signature G Ownek or Agent The foregoing instrument was acknowledged before me this / £1 day of 4 22c ( , 20 /0, by Po/a -a do Aril e 0% who is personally known to me or who has produced D 4. A ‘s 07 .:77-0 5• aflOAM identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission - =o aeo • •a 344 43 • � orb sssion DD838347 of Ro Expires 12/09/2012 Signature Contractor The foregoing instrument was acknowledged before me this t9 day of %iiie/ , 20 /Z , by 7d-e/ 4 4/04/4 , who is personally known to me or who has produced 2.--1 41120 7a- 0510S3 0 as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commissi e IAA CaIA sion`bD838347 Expires 12/09/2012 ************** ************** ****w** ANA•***************************************** ** *****%•**N•******* ****** ***** APPROVED BY "2-3 J ' ! 1' Plans Examiner Zoning Structural Review Clerk (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) • STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT CONSTRUCTION PERMIT FOR: OSTDS Repair APPLICANT: (Helen L. Habersin, Trustee) PERMIT #: 13-SC-1405068 APPLICATION #: AP 1 069284 DATE PAID: FEE PAID:, RECEIPT #: - DOCUMENT #: PR873289 PROPERTY ADDRESS: 950 NE 96 St Miami, FL 33138 LOT: 1 -2 BLOCK: 76 SUBDIVISION: Miami Shores Sec 3 PROPERTY ID #: 1- 3206 - 014 -2960 [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 [ A [ N [ K [ 630 ] GALLONS / GPD Septic eXiStinq CAPACITY 0 ] GALLONS / GPD CAPACITY 0 ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS] ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ ] D [ 300 ] SQUARE FEET R [ 0 ] SQUARE FEET A TYPE SYSTEM: [x] STANDARD I CONFIGURATION: [ ] TRENCH N F LOCATION OF BENCHMARK: FFE : 10.70' NGVD SYSTEM SYSTEM [ ] FILLED [ ] MOUND [x] BED [ ] I ELEVATION OF PROPOSED SYSTEM SITE E BOTTOM OF DRAINFIELD TO BE L D FILL REQUIRED: [ 0.00 ] INCHES 0 T H E R SPECIFICATIONS BY: APPROVED BY: [ 15.40 ] [I INCHES k FT ] [I ABOVE i BELOW ] BENCHMARK /REFERENCE POINT [ 50.36 ] [I INCHES 1/ FT 3 [ ABOVE 4 BELOW I] BENCHMARK /REFERENCE POINT EXCAVATION REQUIRED: [ 47.00] INCHES - Install 300 sq ft drainfield. - Install 12" of slightly limited soil under bottom of drainfield. - Elevation of bottom of drainfield to be no less than 6.50' NGVD. - Existing 630 g septic tank, to remain. - Not for additions The contractor (or designee) is required to perform a soil boring adjacent to the drainfield excavation at the time of Tina! inspection. Prior to Final Approval, the OOH inspector shall witness the soil borir:g and compare the results to the original site evaluatio■ submitted. A reinspection tee will be as rs sari ii the r;Uritractor is not at the jobsite at the arranged time, DATE ISSUED: Rolando Arrieta DH 4016, 08/09 (Obso TITLE: Engineer TITLE' Certified Environmental Health Profess cialist II J 04/ gar es all previous editions which may not be used) Incorporated: 64E -• 03, FAC v 1.1.4 AP1069284 Dade EXPIRATION DATE: 07/17/2012 SE868493 CID Page 1 of 3 Apr. 19 2012 6:07PM HP LASERJET FAX mar CERTIFICATE OF LIABILITY INSURANCE PRODUCER HIALEAH GENERAL INSURANCE 1432 WEST 49 ST HIALEAH , FL 33012 p.2 DATE (IIIMI/DD/YYYY 10/21/2010 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ' ONLY AND CONFERS VO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAM # INSURED MALU PLUMBING INC 13155 IXORA CT $206 NORTH MIAMI FL 33 '81 INSURER k GRANADA INSUFANCE NSURER B: INSURER C: NSURER D; NSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BE.N ISSUED TO THE INSU 1ED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY COIMBRACT OR OTHER DOCLMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE FOLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAW BEEUREDUCED BY PAID CLAMS. IN -R - AULTL - LTR INSRO TYPE OF INSURANCE PRICY NUMBER I. It.. " y i ►J ' -.t' V I. 4'. E LIMITS A GENERAL LIABILITY NZ COMMERCIAL GENERAL LIAB LITY 01SFLO0M0318 -3 , 06/30/2011 06/3C/20 •2 • EACH OCCURRENCE $ 1.000.001 DAMAGE TO RENTED PREMISES (Ea oceurenee) $ 50.00' CLAIMS MADE s,/ OCCUR MED EXP (Any one person) $ 5.00' PERSONAL &ADVINJURY $ 1.000.00 GENERAL AGGREGATE $ 2.000.00. GE�N'L AGGREGATE LIMIT APPLIES PER: I POLICY I ^ I PROJECT n _OC PRODUCTS - COMP /OP AGO $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AJTOS HIRED AUTOS NON•OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Pet person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Pet accident) $ GARAGELIABIJIY ANY AUTO 7 AUTO ONLY -EA ACCIDENT $ OTHER 7H N EA ACC $ AUTO ONLY: AGG $ EXCESSNMBRELLALIABILITY OCCUR 0 CLAIMS MADE DEDUCTIBLE 7 RETENTION S EACH OCCURRENCE S AGGREGATE S $ E WORKERS COMPENSATION AND EMPLOYERS' UASJTf ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? K a dascrlbeundeT S PECIAL PROVtS10NS below V� -835 -0 10/04/2011 10/04/2012 .71 TW LIAMIUT- S I OEH E.L. EACH ACCIDENT $ 100.00 E.C. DISEASE -FA EMPLOYEE S 100.00 E.L. DISEASE - POLICY LMIT $ 500.00 OTHER DESCRIPTION OF OPERATIONS / LOCATIONS 7VEHICLLSTEXCLU=NB ADDELTETENDORSEMERMPECIAL PROVISIONS CERTIFICATE HOLDER INSURANCE CERTIFICATE HOLDER CANCELLATION MIAMI SHORES VILLAGE BUILDING DPTO 10050 NE 2 AVE MIAMI SHORES ,FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRA DATE THEREOF, TIE ISSUING I USURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTI NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SH. IMPOSE NO OBLIGATION CR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE MARCO FIGUEROA ACORD 251 (2001108) IS ACORD CORPORATION 1 DATE BATCH NUMBER 544361 -9 BUSINESS NAME / LOCATION MALU PLUMBING INC 13155 IXORA CT 33181 NORTH MIAMI THIS IS NOT A BILL - DO NOT PAY OWNER MALU PLUMBING INC Sec. Type of Business. THIS IS ONLY 196A PLUMBING CONTRACTOR BUSINESS TAX RECEIPT. IT DOES NOT PERMIT THE HOLDER TO VIOLATE ANY EXISTING REGULATORY OR ZONING LAWS OF THE COUNTY OR CITES.. NOR DOES R EXEMPT THE HOLDER FROM ANY OTHER PERMIT - OR LICENSE REQUIRED BY LAW. THIS IS NOT A CERTIFICATION OF TONBHOLDER'S GUALIFlCA- PAYMENT RECEIVED MIAMI -DADS COUNTY TAX COLLECTOR: 07/.13/2011 • 6012000053-1 000045.00. • SEE OTHER SIDE RENEWAL FIRST -CLASS U.S. POSTAGE PAID MIAMI, FL PERMIT NO.231 RECEIPT NO. 568335 -5 STATE#- CFC1426383 206 DO NOT FORWARD MALU PLUMBING INC ROBERTO ALASA PRES 13155 IXORA CT 206 N MIAMI FL 33181 IuII, uiiu, IlilnI„ uJI. ,LI „il,,,i,i„ii„I,I } ►ii,>,yld,I NORTH 1 MIAMI F =L ❑ RI D_.A City of North Miami 776 N.E.125 Street •. North Miami, FL 33161 • 305 - 893 -6511 Business Tax Receipts Issued Date: 10/11/2011 Expiration Date: 9/30/2012 Business Tax Receipt #: BT- 003811 MALU PLUMBING, INC. MALU PLUMBING 13155 IXORA CT 206 NORTH MIAMI, FL 33161 OFFICE ONLY FOR PLUMBING COMPANY. HOME INDUSTRY LICENSE. Business Name / Address: MALU PLUMBING 13155 IXORA CT, 206 NORTH MIAMI, FL 33161 Clerk NOTICE: BUSINESS TAX RECEIPT. MUST BE TRANSFERED WHEN BUSINESS IS MOVED OR SOLD. ' `: NON - TRANSFERABLE • POST IN A CONSPICUOUS PLACE • NON - TRANSFERABLE