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PLC-12-36Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number. INSP - 175934 Scheduled Inspection Date: July 25, 2012 Inspector: Hernandez, Rafael Owner: WEST CONDOMINIUM INC, SHORES Job Address: 621 NE 92 Street Miami Shores, FL 33138 -0000 Project: Contractor: <NONE> MR C'S PLUMBING SEPTIC INC Permit Number: PLC- 1 -12 -36 Permit Type: Plumbing - Commercial Inspection Type: Final Work Classification: Septic Phone Number Parcel Number Building Department Comments 11- 32060430001 Phone: (305)651 -7859 EXISINTG 1650 GALLONS SEPTIC SYSTEM TO REMAIN (CERTIFIED BY CONTRACTOR) AND INSTALLATION OF NEW 800 SQ FT DRAINFIELD Passed Failed Correction Needed Re- Inspection Fee No Additional inspections can be scheduled until re- inspection fee is paid Inspector Comments CREATED AS REINSPECTION FOR INSP - 168577. /Ai July 24, 2012 For Inspections please call: (305)762 -4949 8'd LLg8-W,9-g00 1VNOIIVNi3 LNI Agana ?d of AA d£0 :60 Z6 8Z In(' Shores Plaza West Condominium, Inc. 621 N. E. 92'd Street, Apartment 4A Miami Shores, Florida 33138 Telephone (305) 692 — 9054 July 12, 2012 To Miami Shores Village, Building Department From: Shores Plaza West Condominium Re: Refund of Bond Gentlemen, At the beginning of the year, our condominium installed a septic tank drain field at the above address. We posted a $500.00 bond with Miami Shores as part of the permitting process. We had been told that we had until July 21, 2012 to ask for a final inspection and refund of the $500.00. This is written to inform the Village that yesterday we ordered the contractor, Mr. C's Septic Tank company to order the inspection and present the bond, thereby processing the refund. Should there be any problems in accomplishing this, please advise me at the above telephone number. erely 2\) John Kilpatric Shores Plaza We Board of Directors. Miami Shores Village Building Department 1.0050 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. fkk,-/ts PERMIT APPLICATION Master Permit No. FBC 20 Permit Type: PLUMBING c '�4 ) ©2 e S d Ay- �J�S ti/Ur��/"1/ 'l/) Phone #: =_ , —90 6-11 OWNER: Name (Fee Simple Titleholder): Address: ` f ® ` "C4,) K !( /2%4t4L (CL / d / A1 , E . City: /97A-'f( 'S 0 4 r,S state: E:( A Tenant/Lessee Name: Email: cke � ii - CcI JOB ADDRESS: c -2/ )• E P l• C ' -Cr VA Zip: 3 3 1 Phone#: City: Miami Shores County: Miami Dade Zip: 7 ? / -3 Folio/Parcel #: Is the Building Historically Designated: Yes NO X Flood Zone: CONTRACTOR: Company Name: Int C s n04..4 j I Phone#: SOS-6S ( 7 "'VI Address: /45 Sot IV w :Z a "" „c de City: (4 State: r L Qualifier Name: 'AS; 14.41...A State Certification or Registration #: Contact Phone#: Email Address: DESIGNER: Architect/Engineer: Phone#: Zip: 33161 Phone#: /IC Zr 3 S S'$Z 7 Certificate of Competency #: Value of Work for this Permit: $ Jl 2 3 irD - °° Square/Linear Footage of Work: Type of Work: °Address °Alteration °New CRepair/Replace °Demolition Description of Work: of rea'f c. Lot '�-� -rl s i t -'s. ***:x*** ** **** ***+ u* ******* ******a:•x*** *** Fees****** gw * *** * *** ************+ * ***** ********* Submittal Fee $ Permit Fee $ /3 CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ No • 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 Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip 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 FT RCTRICAL 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 approved and a reinspection fee will be charged. / Signature 1_„ „, 4OT4,JJ S i gnature Owner or Agent ��-•--�� The f i - goin: trument was acknowledged before me this dayf o yll� , 20 A, by Contractor The forgoing instrument was acknowledged before me this day of J& ht"), 20 by who is personally known to me or who has produced who is personally known to me or who has produced As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUB Sign: Print: \,\1111 KEMBLE ERRICK My Commission a�E MY CO 1� ti = EXPIRES: September 14, 2013 '4.414.0:4' Bonded Thru Notary Public Underwriters Sign: Print: My Conunissio " KEMBLE ETTRICY eg ._ '.,-. MY COMMISSION # 00 891340 aQ= EXPIRES: September "e 2013 AFB tlit`` Bonded Thru Notary Public 1! .' 1 + x****** *•>, ******>K>k *>a> *** **+i< *>x *+ xw> x*** ****** xx�x> K�x�x> x> x> x****+ i<w �x�x�x+ t, a��n�x�x+ x�x�x *x�>K** ** *>k *>t:a�x��x�x�x�x�x> *** *x��: ****a�>A�xa��xx�x�**** APPROVED BY i 4 ` `® Plans Examiner Zoning Structural Review Clerk (Revised 07 /10 /07)(Revised 06/10/2009)(Revised 3/15109) STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT CONSTRUCTION PERMIT FOR: OSTDS Repair APPLICANT: (Shore Plaza West condo) PERMIT #: 13-SC-1385381 APPLICATION #: AP1057024 DATE PAID: FEE PAID:, RECEIPT #: DOCUMENT #: PR862863 PROPERTY ADDRESS: 621 NE 92 St Miami, FL 33138 LOT: na BLOCK: na SUBDIVISION: PROPERTY ID #: 11 -3206 -043 -0010 [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 [ 1,650 ] GALLONS / GPD Septic existing 0 ] GALLONS / GPD 0 ] GALLONS GREASE INTERCEPTOR CAPACITY ] GALLONS DOSING TANK CAPACITY D [ 800 1 SQUARE FEET R [ 0 1 SQUARE FEET A TYPE SYSTEM: [x] STANDARD I CONFIGURATION: [ ] TRENCH N F LOCATION OF BENCHMARK: FFE : 12.8' NGVD CAPACITY CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS] ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ SYSTEM SYSTEM [ ] FILLED [ ] MOUND [x] BED [ ] I ELEVATION OF PROPOSED SYSTEM SITE [ 26.401IIINCHES FT ][ABOVE (BENCHMARK /REFERENCE POINT [ 56.40 ] [I INCHES r FT ] [ ABOVE 4 BELOW b BENCHMARK /REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE L D FILL REQUIRED: 0 T E R [ 0.00 ] INCHES BELOW EXCAVATION REQUIRED: [ 42.00] INCHES - Install 800 sq ft drainfield. - Install 12" of slightly limited soil under bottom of drainfield. - Elevation of bottom of drainfield to be no Tess than 8.10' NGVD. - Existing 1650 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 final inspection. Prior to Final Approval, the DOH inspector shall witness the soil boring and compare the results to the original site evaluation submitted. A rninspection tee will be assesseu if the contractor is not at the jor,site at the arranged time. SPECIFICATIONS BY: APPROVED BY: Kemble Et :DATE ISSUED: 2012 TITLE: ITLE: Engineer Specialist II DH 4016, 08/09 = soletes all previous editions which may not be used) Incorporated: 64E - 6.003, FAC v 1.1.4 AP1057024 Dade CED EXPIRATION DATE: 04/03/2012 9E859342 Page 1 of 3 CERTIFICATE OF LIABILITY INSURANCE OP111,-,. SS . , 01.117itZ. .• ,. , , . THIS cERTNIOATE IS ISSUED AS A MATTER OF IINIORNATION ONLY AND CONFERS NO RIGHTS WON THE CERTIFICATE HOLDER. THIS OBTIWICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLCIES SEOUL THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. INIKRITATat if the certificate holder Is an ADDITIONAL NISURED, the polio** must be endOised. If SUBROGATION IS WAIVED, subject to thOVnns and condl�onsotthe policy, certain policies may Rusaino an endorsement A statement On this certifitatatIORS 'ebb:Gofer rights to tile Wier in lien of such orulorsementis). Ratemical thulerw falta I 8240 tiled o 52 TeiT, -Suite 404 tMeml FL 305477,0444 305499-2343 CUSTMERB# IVIRTZS4 040110 bk. CS Plumbing & Septic Inc. PO.Box, MIK FL 33269 INSURERMAFFORUDIG SOVERASE INSURERA : PERMITAGE INSURANCE CO. MOS INSURERC MEURER ft: INS Et INSURER F CERTIFICATE NUMBER REVISION NUMBER: RTIFV THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN 18SUED To THE INSURED NAMED ABOVE FQR THEPOLICY PERIOD ITHSTANDWG MW REOUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WnTI RESPECT TO WHICH THIS Y BE ISSUED OR MAY PERTAIN THE INSURANCE AFFORDED SY THE pouoss DESCRIBED HEREIN 18 SUBJECT TO Al.L 11-IE TERMS. DITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCE ay PAID CLAIMS. TYPE OF INSURANCE CESIENAL MAURY_ POLICY tRAABER GENERAL LJABIUTY per AINIFEGATE LIMITAPPUES PER Lec ummin 1.tuTo AOOWICRAUTOS IBNEIS,AUTOS NONOVINSB3 ANTOS ISLOESS-IJAIS wo DEDUCTIBLE YIN LDDED7 N /A • WTRATIQNS SCPO720863 04141142 01111113 EACNODCURRENCE $ 1,.004$0. ' I, emeket Te RENTED 2621Sg5 (geSIELIBESEL$ 100, HEDEXP ontone-perse 4 e) S / PIERSON& SADY1NJUFet ; 1000 MI, aptERA.AeOREVillt $ '2; CI VI 9. PRODUCTS. CONPIOP AS/B 1/00/000 colitton5D sNoLe um' (Ea eaddent) EMILY INJURY (Per peson s BODILY INJURY( stela OCCURREWE AGGREGATE 1Wti I Pk4ili : EL:EACH Acefobit EL I:AWARE. EA EMPLOYEE EL. DISEA$E- POLICY oda $ Talritstigraoss tvbecLes (AttackACORD Adalostal R CANCELLATION Miami Shores Village 10050 NE 2nd Avenue Miami Shores, FL 33138 SHOULD AY OF THE ABOVE DEINXIBED POLICIES BE CANCELLED BEFORE ME EXPIRATION RATE THEREOF NOTICE WILL se DUMPED IN ACOORDANOE WITH THE POLicY PROVISIONS. 0 19892009 ACORD The ACORD name and logo are registered marks of ACORD =N. Allithts reserved.