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PL-13-555Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 187705 Permit Number: PL -3 -13 -555 Scheduled Inspection Date: April 10, 2013 Inspector: Hernandez, Rafael Owner: DAVITAN, GEORGE Job Address: 85 NW 102 Street Miami Shores, FL 33150 -1229 Project: <NONE> Contractor: A AMERICAN SEPTIC & PLUMBING Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1131010180080 Phone: (305)866 -5600 Building Department Comments DRAINFIELD REPAIR Infractio Passed Comments INSPECTOR COMMENTS False Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments HRS APPROVAL IN FILE April 10, 2013 For Inspections please call: (305)762 -4949 Page 14 of 28 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 64.0ft9 'TO 1.(23 BUILDING PERMIT APPLICATION Permit Type: PLUMBING L` N\/) t0-2, c"r JOB ADDRESS: MAR 19 2013 FBC2010 Permit No. Master Permit No. F (- 1 `3 -55s City: Miami Shores p County: Miami Dade Zip: 3 3 I c 0 Folio/Parcel#: 11 "' 3 I 0 t - 0 J" 00 5 0 Is the Building Historically Designated: Yes NO Flood Zone: / Fi OWNER: Name (Fee Simple Titleholder): Cy or n Phone#: Ads: W j02 Ss City: 1�''ii (Air - t S State: Zip: 3 3 vx 0 Tenant/Lessee Name: NIA Phone#: 31 W - r 8 t Email: CONTRACTOR: Company Name: � f�-�i C. a--(N. �� " t P � UYPh na#L 30-S !wow 5bao Address: L BC� C..ta, \( - B(A) d ' 9.Dro - mi-D--'fl^ 1 c L 3 3 LE ( City: State:`` Zip: Qualifier Name: t i GLY Vi 0- 0 d Ca. ril Phone#: State Certification or Registration #: S T" 00013 ii a Certificate of Competency #: SO . 9- Contact Phone#: 3 1 VAS BOO Email Address: , mar K P 0.01/4rf tr i c r\ e 1 i..t.mi31 r-j Lt 2 C..at,•. DESIGNER: Architect/Engineer: Ni i Pt Phone#:' Value of Work for this Permit: $ 74 • " Square/Linear Footage of Work: Ko 13 Type of Work: OAddress CDAlteration ONew Repair/Replace L (Demolition Description of Work: t) ru4� -fie �� �;r SO P *8a 8Si«* *** *****8***Cs********* ****RM*k ees******** *3+ ID******** **************dd**** **+ *** Submittal Fee 0 0 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 $ 1112: Bonding Company's Name (if applicable) I Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip dJ I �i 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 commencement must be posted at the job site for the first ins ection which occurs seven (7) days after the building permit is issued the absence of s posted notice he inspection w not be appred and a reinspection fee will be charged. Signature '' L � - Signa Owner or Agent The foregoing instrument was acknowledged before me this Z_ day of Ka, 20 3 by , who is personally known to me or who has produced �- P Y4l As identification and who did take an oath. NOTARY PUBLIC: Sign: Print NOT C- STATE OFFLORIDA .ruz ion # EE030407 ire s: SEP. 28, 2014 n,,.i The. BONDED My Commission Expires: * * * * * * * * *** * * ** * * * ** APPROVED BY Contractor 'Me lo - going instrument was acknowledged before me this day of ti.rZ\ , 20 , 11, by 'V.4114 i17, ms's who is rsonall kn to me or who has produced as identification and who did take an oath. NOTARY P Sign: •, ,,, ` Aires, am L8, GUi`t Print: B ? THRU AnA� nc soN ING CQ,MC. My Commission Expires: I 2-4 11--( LIC: ARY PLBLIC:SThTE OF FLORIDA `F. 3. Cruz si EE030407 **** ******* **w***** ** * ****** * **** *** *** *** * *** *axe .ara * ******* * **sws * *+ ***** Plans Examiner Structural Review (Revised3 /1212012)(Revised 07 /10/07)(Revised 06/10/2009)(Revised 3/15/09) Zoning Clerk STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT CONSTRUCTION PERMIT FOR: OSTDS Repair APPLICANT: George Davitian PERMIT #: 13-SC-1460867 APPLICATION #: AP 1100692 DATE PAID: FEE PAID: RECEIPT #: DOCUMENT #: PR900269 PROPERTY ADDRESS: 85 NW 102 St Miami, FL 33150 LOT: 17 BLOCK: 1 SUBDIVISION: PROPERTY m #: 11- 3101- 018 -0080 [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 DOE$ NOT GUARANTEE SATISFACTORY PERFORMANCE FOR ANY SPECIFIC PERIOD OF TIIIE. 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 existing CAPACITY A [ 0 3 GS / GPD CAPACITY N C 0 ] GALLONS GREASE INTERCEPTOR CAPACITY CIOXIM M CAPACITY SINGLE TANK:1250 GALLONS] K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS 8( ]DOSES PER 24 HRS #Pumps [ ] D [ 150 ] SQUARE FELT in trench configuration SYSTEM R [ 0 ] SWAM FEET SYSTEM A TYPE SYSTEM: [ml STANDARD [ ] FILLED [ ] NCOND I CONFIGURATION: [x] TECH [ 3 BED [ 3 N P LOCATION OF BENCHMARK: FFE: 12.5'ngvd I ELEVATION OF PROPOSED SYSTEM SITE E BOTTOM OF DRAINF'IELD TO BE L D FILL REQUIRED: 0 T H E R SPECIFICATIONS BY: William Woodard APPROVED BY: [ 0.00 INCHES 1 25.20 ] [ INCHES FT 1 [ ABOVE A BENCHMARK /REFERENCE POINT [ 57.20 ] [I INCHES f FT ] [ ABOVE 4 BELOW b BENCHMARK /REFERENCE POINT EXCAVATION REQUIRED: 1 32.00] INCHES - Install 150 so ft drainfield in trench configuration. - Elevation of bottom of drainfield to be no less than 7.73' NGVD. - Existing 900 g septic tank, to remain. - The system is sized for 2 bedrooms with a maximum occupancy of 4 persons, for a total estimated sewage flow of 200 g /d. - Not for additions Joseph R Piverger DATE ISSUED: 03/16/2013 TITLE: TITLE: Engineer Specialist II Dade CHD DH 4016, 08/09 (Obsoletes all previous editions which may not be used) incorporated: 64E- 6.003, FAC v 1.1.4 AP1100692 EXPIRATION DATE: 06/13/2013 3E892917 Page 1. of 3 AAMER -1 OP ID: BG m `- - CERTIFICATE OF LIABILITY INSURANCE DATE (Nwmamrq 04/01/2013 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 POLICIES 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 poacy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain polices may require an endorsement- A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER Insurance Market Place Phone: 352237 2700 �aSW College Rd, Suite 3 Fax: 352-237-5884 House Account CONTACT t EA: I SAVC. Nou ADDRESS: INSURERS) AFFORDING COVERAGE NAIC # INSURER A :Ascendant Commercial Insurance LIABILITY CO CIAL of em'. LLABIL rt INSURED A American Septic & Plumbing Inc 12555 Biscayne Blvd Ste 970 North Miami, FL 33181 INSURER B : Southern Insurance Company $ 1,000,000 INSURER C $ 100 000 INSURER D: ENSURER E: X INSURER F : MED EXP (Any one ) COVERAGES CER THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCY 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 1S SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDHTIONS OF SUCH POUCIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE OF INSURANCE value POLICY NUMBER GL371261 04/21/2012 )tIYYYY{ Laws A GENERAL X LIABILITY CO CIAL of em'. LLABIL rt 04/21/2013 EACH OCCURRENCE $ 1,000,000 ° � TO RENTED PREM�ES ma oxearence) $ 100 000 CLAIAAS -MADE X OCCUR MED EXP (Any one ) $ 5,000 PERSONAL & AOV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIM T APPLIES PER: 1l I POLI n CY IFRT 1— LOC PRODUCTS - COMP/OP AGG $ 1,000,000 $ AUTOMOBILE — LIABILITY ANY AUTO A OOg NED HIRED AUTOS � NON-OWNED COMBINED SINGLE UMrr (Ea acckiect) $ BODILY INJURY (Per person) $ BODILY INJURY (Per strident) $ PROPERTY DAMAGE $ EXCESS LI4B OCCUR CLAIMS-MADE EACH OCCURRENCE $ AGGREGATE $ DED 1 1 RETENT ON $ $ B AND KERB COMPENSATION EP NS Y ANY PROPRIETORIP0.RTNERf[ THE YIN N /A PWC�048 -13 02/03/2013 02103/20/4 �yC g x 1 TORY `, MITTS EAR EL EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED' n (Mandatory In NH) t/ m describe DESCRIPTION OF OPERATIONS below L E DISEASE -EA EMPLOYEE $ 100,000 E.L DISEASE - POLICY LIAR $ 500,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks mule, If mere apace Is required) Plumbing & Septic pump contractor CERTIFICATE HOLDER CANCELLATION MIAMISH Miami Shores Village Building Department 10050 NE 2nd Ave Miami Shores, FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POUCY PROVISIONS. AUTHORS REPRESENTATIVE ACORD 28 (2010105) ®1$88.2010 ACORD CORPORATION. Ail rights reserved. The ACORD name and logo are registered marks of ACORD The Florida Department of Health hereby certifies the business or entity named below has satisfied the requirements of Part III, 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: