PL-13-68r
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 184108 Permit Number: PL- 1 -13 -68
Scheduled Inspection Date: February 21, 2013
Inspector: Hernandez, Rafael
Owner: RUBY, HELEN
Job Address: 145 NW 95 Street
Miami Shores, FL 33138-
Project: <NONE>
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Addition /Alteration
Contractor: SR0061536 MR C'S PLUMBING & SEPTIC INC
Phone Number (786)333 -8567
Parcel Number 1131010240310
Phone: (305)651 -7859
Building Department Comments
INSTALL DRAINFIELD
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
February 20, 2013
For Inspections please call: (305)762 -4949
Page 11 of 23
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Miami Shores Village
Building Department
90050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: 305) 762.4949
Stro 4440(1.0 °i IG� -- %, I us 13 FBC 20 It
BUILDING
PERMIT APPLICATION
Permit Type: PLUMBING
JOB ADDRESS: /4C N i) q s S-I--
City: Miami Shores County:
Folio/Parcel #: t k 0 (" (�a " (33 1 O
Permit No. PL. I e
Master Permit No.
Miami Dade
Zip: 3 3 (S'O
Ls the Building Historically Designated: Yes
NO Flood Zone:
OWNER: Name (Fee Simple Titleholder): He Pet / i/oy Phone #: 7g 3'3't5i 7
Address: /(45-- 57- /
City: i $hrPsr State: Pe- Zip: /..S -O
Tenant/Lessee Name: Phone #:
Email:
CONTRACTOR: Company Name:
Address: /9912 93oZ /W /r,vf
P S le, Phone #: 30C15
City: < 64,1- State:
Zip: 3.316°!
Qualifier Name: K bk l/ i`r C Phone #: 3‘)C-651 7157
State Certification or Registration #: SI - 06 1 5.36 Certificate of Competency #:
Contact Phone#: Email Address:
DESIGNER: Architect/Engineer: Phone #:
Value of Work for this Permit: $ 011k( & 0-0 Square/Linear Footage of Work: 300d
Type of Work: DAddress O// Alteration DNew ®Repair/Replace UDemolition
Description of Work: n
Submittal Fee $ c l% Permit Fee $ /6: CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ _ Structural Review $
TOTAL FEE NOW DUE $ 1 t v • 3o
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City S 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, BOIT.ERS, HEATERS, TANKS and AIR CONDITIONERS, ETC
OWNER'S AFF DAVIT: 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.
Owner or Agent
Signature
Contractor
The foregoing instrument was acknowledged before me this / / The foregoing instrument was acknowledged before me this
day of5 IuttiYit , 20 /5, by k1
'CL
day of �, 20 l3 , by // (`e& /UV
who is personally known to me or who has produced
NOTARY P
Sign:
Print:
L
•
s identification and who did take an oath.
My Commission Expires:
own to me
person. i y% r w o.
State of ROOS
as identifi ti w c. .1., th.
r oi'ii0r5t3
NOTARY PUBLIC: w. raI o
Sign:
Y./Z. /J%.
i
nt: S'tt . z' L •
My Commission
xpires:
* * * * * * * * * * * * ** x*a***a******** ****a****a*a ********* a******* e***************** ****** *e *** ***a* * ******eeee *e**
y9
APPROVED BY / f /413 Plans Examiner Zoning
Structural Review Clerk
(Revised3 /12/2012)(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09)
STATE OF FLORIDA
DEPARTMENT OP HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM
CONSTRUCTION PERMIT
CossirKUCTION PERMIT OR
APPLICANT: Joan Bill
PROPERTY ADDRESS:
LOT : 13
OSTDS Repair
PERMIT 0: 3'-SC1444206
APPLICATION 0: AP1092162
DATE PAID:
FEE PA/D:
RECEIPT 0:
DOCUMENT 4: PR892809
145 NW 95 St Miami, FL 33150
LOCK:
PROPERTY ID 0: 11-3101-024-0310
SUED/VISION:
(SECTION, TOWNSHIP, RANGE, PARCEL NUMBER)
[OR TAX ID NUMBER]
SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF SECTION
391.0065, 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.
ISSUNRCE 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 f 900 3 GALLONS / GPD Septic CAPACITY
A [ 0 3 GALLONS / GPD CAPAC/TY
N [ 0 ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
K [ ] GALLONS DOSING TANK CAPACITY ( JGALLONS 0( ]DOSES PER 24 HRS OPumps ( I
D. ( 300 3 SQUARE FEET SYSTEM
R [ 0 I SQUARE FEET SYSTEM
A TYPE SYSTEM: [R] STANDARD [ ] FILLED [ ] MOUND [ ]
1 CONFIGURATION: [ ) TRENCH txJ BED [ 3
F LOCATION OF BENCHMARK:
I ELEVATION OF PROPOSED SYSTEM SITE
• sorrom OF DRAINFIELD TO BE
Ij
D FILL REQUIRED:
0
H
[ 0.00 3 INCHES
9.60 INCHES I' FT 3 ( ABOVE A BELOW }BENCHMARK/REFERENCE POINT
39.60 (1 INCHES r FT If ABOVE 411BENCHMARIL/REFERENCE POINT
EXCAVATION REQUIRED: [ ] INCHES
1.-Existing 900 gal. septic tank, certified by "Mr C's Septic on 12/12/2012" to remain.
2.-Install 300 sf ot drainfield in bed configuration,
3.-Install 12" of slightly limited soil at the bottom of the drainfield.
4.-Perimater of excavation area shall be at least 2 ft wider and longer than the proposed absorption bed.
5.-Invert el. of drainfield to be no less than 9.50 NGVD.
6.-Bottom of drainfield el. to be no less than 9.00' NGVD.
(Comments Continued on Page 2.)
SPECIE
CATIONS BY; Astrid V Edwards
APPROVED Hy:
itxid V .dwards
TITLE: Engineer Specialist II
TITLE: Engineer Specialist II
Dade CHD
DATE ISSUED: 12/24/2012 EXPIRATION DATE: 03/24/2013
DH 4016, 08/09 (Obsolete all previous editiona which may not be used)
Incorporated: 64E-6.003, FAC
;,.?1216:: !;Ese,75q77
Page 1 of 3
DO2N # PR•892809
• -.•.•
• ••
1.A,NiOter line within 10 ft of septic system to be Sch 40:PVC or sleeved in accordance with FAC Ch $4E-6.005(2)(b). For
jii**Icting fines the water tine shall be a minimum of 12" above the sewage transmission line
tiltijiyaterrt is sized for 3 bedrooms with a max. occup. of 6 persons (2 per bedroom), for astotat esti. sewage flow of 300
:GPO:
0THIS PERMIT IS NOT FOR AIX)ITION(S)---*****
Registered Septic Tank Contractor
KEMBLE .G ETTRICK
19932 NW 2 AVENUE
MIAMI FL 33169-
MR. C'S PLUMBING & SEPTIC. INC.
Business Authorization: SA0121793
SR0061536
Registration Expires on September 30, 2013
I .• , .1 , n
macs Nor A au. - po Nor PAY Raley*.
286648-
BirierlfEMSN SEPTIC INC
19932 NW 2 AVE
33169 MIAMI GARDENS
mArcs PLUMBING 8 SEPTIC INC
snwvenvorrkG CONTRACTOR
iniramm
21(11141iii
000045.00
OVOTHERWE
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WORKER/3
DO NOT FORWARD
MR CS pLussine 8 SEPTIC INC
ETTRICK KEMBLE QUALIFIER
19932 NW 2 .AVE
mrami ft 33169
291917
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DATE tur~YyY)
01118143
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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 OONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER,
IMPORTANT: if the certifteate holder .1s. an ADDITIONAL INSURED, the policy(IeS) mast be endorsed. If SUBROGATIQN IS WAIVED, subject to
the tenns.end conditions of.the 064,, .certain pOliCles May require an endorsement. A stateinenton this certificate does not confer rights 10 the
certificate bolder In lieu:of such siniorsernestpg.
PRODUCER 405477.....0444
Combined UndenerlfeisOf Minn!
8240 N.W. al)" Suite 409 305499-2343
Wan% PL 33159
RONALD M. LASTER
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INSURERNRAFPORDING"COVERAOE
INSURED Mr. CS .Plumbing & Septic Inc.
P.O.Box 693239,
!tang, FL. 33269
INSURER A : HERMITAGE INSURANCE CO.
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INDICATED :NOTINITHSTANDIND ANY REOUIREMENT,.. TERM OR CONDITION OE ANY CONTRACT OR *OTHER DOCUMENT WITH RESPECT. TO WHICH THIS
caking/kit *two' BE ISSUED OR MAY ORDAIN. 'ME INSURANDE,WOMIED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS
EXCLUSIONS AND coNDRIoNE OF SUCH ROUDIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAP CLAIMS.
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Miami Shores Wage
'MOO NE 2nd Ave
Miami Shores„ FL 23128
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SHOULD ANY OF THE ABOVE DF.SCRISED POLICIES SE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZEOREPRESENTAINE
Itgareez de.
ACORD 25(2009109)
The ACORD name and logo are registered maths of Again
'
CERTIFICATE OF LIABILITY INSU CE
IIATE{MNE)DIYiihr .
0'118113
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIMATE:HOLDER. TI TS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EVEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW THIS CERTIFICATE OF INSURANCE DOES, NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESEI4TATLVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: ittluiserlificate holder ts an ADDITIONAL INSURED the palicy(lesiatot be Endorsed IfSUBROGATION IS WAIVED, subjectto
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PRODUCER
Carolyn Rummel Agency
3970 State Road 04 East
Bradenton, FL 3420$
Phone (941) 748 -8555'
Fax (941) 748 -8553
CONTACT Pat
ONE too ) 748,85557
trtl'signartirzonfret
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Mr, C's Plumbing &uepiit~ Inc.
PO Box 693239
Miami, FL 33289 -0239
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CERfIFR
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CANCELLATION
Miami Shores Village
10050 NE 2nd Ave
Miami Shores, FL 33138
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES SE CANCELLED E$SFORE
THE EXPIRATION DATE 'THEREOF, NOTICE AMU DE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTNORr=EQ REPRE$ENTA T1VE':
ACORI125 .(2009/09) OF
0.4. .2009ACOMOORPOIRATION., All rights reserved.
The ACORD. name and .10go are; reg;)s%retl Marks ACORD