PL-12-1359JO
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) 7624949
--11913 rt -rte
iJII.DING
PERMIT APPLICATION
Permit Type: PLUMBING (� ,
JOB ADDRESS: 3'1 NE ''1 lv s1 I ct+
FBC 201'0
Permit No. `P L- - 12_- k 3
Master Permit No.
i t am! Shores
City: Miami Shores County: Miami Dade Zip: 33 pa
Folio/Parcel #: 11 •'- 320 (o 0 (3 '`e4
Is the Building Historically Designated: Yes NO i Flood Zone: N / %-
OWNER: Name (Fee Simple Titleholder): Ni o f ns P/l e C-0 ! Phone#:
Address: 3 S`t�
NE Q.(.Q re-c l
City: WiTaIY1I Jhyfeg State: -
Tenant/Lessee Name: 1J 1 fi
Finail•
Phone#:
Zip: 33138
P tuh1doi ng
CONTRACTOR: Company Name: 1 itmcri can Sep + Phone#: — g(ete 57000
Address: t 2 5 X33 kid l vie R " Q 90
City: N - itlI I l l State: Pi__ zip: 33 18 I
Qualifier Name: WI ill VA Al- W D 061. (J,f , Phone#: 305 Scat) O
State Certification or Registration #: 42 00061({ Certificate of Competency #: R 0U(3 t 3 a
n'10 p sa(ncric. d\plutebl I►'C.
%/n,
Contact Phone#: -n (Q 2347 554 q Email Address:
DESIGNER: Architect/Engineer.
N/1
Phone#:
e-o
Value of Work for this Permit: $ � Square/Linear Footage of Work:
Type of Work: OAddress ❑Alteration ❑New ! ' ' air/Replace ODemolition
Description of Work: hs l ( a D OI Ct () '� �~Z P� 1L �'\ SR S� 7r1
aa-s S4 . Ar al,+v 6e a t re &tr
**** s**** ******* * * * * *** * * * *** *** *** * * * *F ************* *** *** * * * * * * ********* * * * * * * * ***
Submittal Fee $ ° 00 Permit Fee $ :76'.) CCF $ CO /CC $
Scanning Fee $ �� t Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FJi E NOW DUE $ 1 ✓ ` d-
4
Bonding Company's Name (if applicable) N
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City State Zip
in-
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 inspection which occurs seven (7) days after the building permit is issued In the absence of such posted notice, the
inspection will not be appro ` and a reinspection fee will be charged
Signature Al PA
or Ag i t
The fore oing instrument w:,; ackn• • le�dngead�before me this 2
day of u 1 20 ��,by\11P Is tW\
who is personally known to me or who has produced "R-
D LI ( As identification and who did take an oath.
NOTARY PUBLICATATE OF FLORIDA
NOTARY PUBLIC: . Jazzmin Cruz
,r �. Commission # EE030407
•,,,,,,;.' Expires: SEP. 28, 2014
m T t ATLA \TIC BONDt QCO., arc.
Sign:
Print
1t nor
cAle-
My Commission Expires: 041)61.114
Contractor
The foregoing instrument was acknowledged before me thi
day of <iU Y , 20 by t 1 "f�
who is p'" ersas y known to Ise or who has produced
as identification and who did take an oath.
NOTARY PUBLIC•STATE OF FLORIDA
NOT ' � PUBLI s Jazzrnin Cruz
Commission # EE030407
,., „,,es Expires: SEP. 28, 2014
BONDED TRIM ATLANTIC BONDING CO., INC.
Si
Print:.. \)6 W f C
My Commission Expires: t 2-S (tt
Mgt **************** *** ** #**** **IP* *** #*****9 ******** ********* * ** lif+t** ****** ** *** * ***** *, *** *ERR ***********
APPROVED BY Mans Examiner
Structural Review
(Revised3 /1212012 )(Revised 07 /10/07)(Revised 06/10i2009)(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: James Mccoy
PROPERTY ADDRESS: 325 NE 96 St Miami, FL 33138
LOT: 1516
PERMIT 8: 13-SC- 1420563
APPLICATION 8: API077698
DATE PAID:
FEE PAID:
RECEIPT 8:
DOCUMENT 8: PR880572
BLOCK: 43 SUED/VISION:
PROPERTY ID #: 11- 3206-013 -5890
[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 ] CALLOUS / 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 [ 225 ] SQUARE FEET in trench configuration SYSTEM
R [ 0 1 SQUARE FEET SYSTEM
A TYPE SYSTEM: [x] STANDARD [ ] FILLED [ ] MOUND [ ]
I CONFIGURATION: [x] TRENCH [ 3 BED [ ]
N
F LOCATION OF BENCHMARK: FFE: 12.2' NGVD
I ELEVATION OF PROPOSED SYSTEM SITE [ 24.00 ] [ IITCHES FT ] [ ABOVE BELOW BENCHMARK /REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 56.00 INCHES Y FT ] [ ABOVE 4 BELON i BENCHMARK/REFERENCE POINT
L
D FILL REQUIRED:
0
T
E
R
SPECIFICATIONS BY: William Woodard
APPROVED BY:
[ 0.00 ] INCHES
EXCAVATION REQUIRED: [ 32.00] INCHES
- Install 225 sq ft drainfield in trench configuration.
- Install 900 g septic tank.
- Elevation of bottom of drainfield to be no less than 7.53' NGVD.
- The system is sized for 3 bedrooms with a maximum occupancy of 6 persons,
for a total estimated sewage flow of 300 g /d.
- Not for additions
Joseph R Piverger
DATE ISSUED: 07/19/2012
TITLE:
TITLE: Engineer Specialist II
Dade
EXPIRATION DATE : 10/17/2012
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E- 6.003, FAC
v 1.1.4 AP1077698 SE874906
Page 1 of 3
STATE OF FLORIDA
DEPARTMENT OF HEALTH.
ONSITE sEWAGN TREATMENT AND DIPOSAL SYSTEM
CONSTRUCTION INSPECTION AND FINAL ,tP17ovi.L
12--(35�
PERMIT N0.
DATE PAID: 7O i
FEE PAID:
RECEIPT *:
APPLICANT:
Acs:
ti
. PROPERTY ADDRESS: cam' 2 S-
LOT: Pj1'1C BLOCK: Y45 SUBDIVISION :.
cc [X] ITEMS NOT IN COMPLIANCE WITS STATUTE OR RULE AND MUST BE CORRECTED,
PROPERTY ID #: /J - 0 4.- 61/ 50
(
t
TAng TNSTALLATIoN
] 1011 UBE SIZE [3,V> Q:? [2]
1 [02] TANK NATRRIAT ("
3 toil OUTLET DEVICE,- 9 C
1 (041 MULTI -CH NIIBREDDr_4/ N
] [ 053 O T FILTER,
3 (06] LEGEND -.2S'r
3 ,[071 WATERTIGHT
3 [OS1 LEVEL
] [093 DEPTH TO LIP
VRA.IN3'IxX.D TNRMA4LATXON
3 (X01 AREA C �1is-x/ ! [ �] •2/ °SM.
3 [113 DISTRIBUTION BOX DER ✓
3 [12] =KM OF DRA.; NLI S Y7--
3 . [131 DRIli1NLINFi SEPARATION ,Z. Y '
3 [143 MAINLINE SLOPE
1 [151 DEPTH OP COVER Itf
] [163 ELEVATION (ABO E /BELOM
1 (17] SXS'A'EM LOCATION
3 [183 DOSING PUMPS 04
3 [193 Ac�GREGAAR SIZE �/
3 (20] AOGREO,21,TE EXCECg2{twhital
3 [213 AGcrRE@ATB DEPTH T/ 1
rxtr., / i CCAVA'rToN MA'] XXIAL
[221 i7ILL AMOUNT
[23] FILL TExTu J �✓
[24] EXCAVATION 3327T2
1251 AREA REPLACED
t26] REPLACEMENT MATERIAL
E 3
[
C 3
(
[ 3
PLANATION OF VIOLATIONS / REMARKS:
[ 3
[ 3
( 1
C 3
CONSTRU•CT[O
3
1
3•
1
[ 3
[ ]
[ ]
[
SETBACKS
[271 SURFACE WATER PT
(28] DITCHES FT
DS] PRXVATE WELLS 8T
[303 PUBLIC WELLS FT
[213 SRRTOATTON 4.9741,120 VT
(323 POTABLE WATER LINES „lir FT
1333 BUILDING FOUNDATION _� erg.
[343 PROPERTY JA ES � FT
[351 OTC 'FT
FILLED / STS
13 6] DRAINFIEID COVER
[371 • SHOULDERS
(301 SLOPES
[391 STABILIZATION
ADDITIONAL INPDRMATION
[403 UNOBSTRUCTED AREA �L
[413 UTORMWA.TRR R llorr . e� ! 2541b J
(421 ALA12M3
[431 MAINTENANCE AGREEMENT
[44] BUILDING AREA
1451 LOCATION QONFORMS WITH SITE PLAN
(461 FINAL SITE GRADING
[473 CONTRACTOR A �-
[483 OTHER
ABANDONMENT
1493 TANK PVMPED '7//_/Z
[50] • 'Max C&SSRRn R FZ7+LLo 1 2
ISAPPROV,ED3:
FINAL, SL'STSM tent: /T1xSAPPROVEDI:
DH 4016, 00/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E- 6.003, PAC
DATE :2 - -
CBD DA-27J
Page 2 of 3
CERTIFICATE OF LIABILITY INSURANCE
IDUE Q ODJYYYY)
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 COMMUTE A CONTRACT BEIWIE N THE ISSISNG INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE MATE HOLDER.
IMPORTANT: If the certificate holder Is an ADDITIONAL SOURED, the pollcyfies) must be endorsed. If SUBROGATION IS WAIVW, subject to
the terms and coraiitions of care policy, certain pollcles may require an endorsement. A statement on tide certificate does not cam rests to the
certificate hailer In lieu of such endows).
PRODUCER 954-318-2469 954 - 318-2474
INFINITY INSURANCE SOLUTIONS
6412 N UNIVERSITY DRIVE
SUITE 132
TAMARAC. FL 33321
Its 305-866 -5600 305- 891.8905
A AMERICAN SEPTIC & PLUMBING, INC
12555 BISCAYNE BLVD
SUITE 970
NORTH MIAMI. FL 33181
COVERAGE CERTIFICATE NUMBER
CONTACT INFINITY INSURANCE SOLUTIONS
��` aEic� 1 `IISFL.coM . � 18-2474
newts") AFFORDING COVEN E
IN A:ASCENQANT INS. CO.
mums: SOUTHERN INS. CO.
NAIC 0
IBC:
INSURER D:
INSURER E:
INSURER F:
REVISION NUMBElt
THIS IS TO cE TIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCY PERIOD
INDICATED. NO1WTHSTANDING 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 IS SUBJECT TO ALL THE TERMS.
EXCLUSIONS AND CONDITIONS OF SUCH POLICES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
ll rr ifYYYf
LTR
TYPE OP
ADDLA
INSURANCE DER WD POLICY NUMBER
GENERAL UABD I Y
A ✓ COAL GENERAL LIABILITY
ICLAIMS-MADE n OCCUR
GENT. A ATE UNIT APPLIES PER
V l POUCt IFt�f n LOC
GL- 38401 -01
04/21/12
04/21/13
EACH OCCURRENCE
DAMAGETO RENTED
S
MED ESP (Any ono MOEN)
PERSONAL &ADVINJURY
GENERAL AGGREGATE
PRODUCTS - COMP/OP G0
AWfOMOBILE MOLDY
ANY AUTO
AALAMED
HIREOAUTOS
AUi
NONNWNED
AUTOS
(`E t OMIT
BODILY INJURY (Par puma)
51.000.000
s 100.000
35.000
s 1.000.00
s 2.000.000
81.000.000
s
BODILY INJURY (Pbrac )
PROPERTY DAMAGE
_RIMMED_
ILA UA9
E>D LYIB
CLAIIrSMADE
DEO I ' RETENTION
EACH OCCURRENCE
AGGREGATE
WORKERS COMPENSATION
AND EMPLOYERS' ANY PROPRD fOR/PAAT�E YI�(
F
in feu
D ON OF OPERATIONS below
NIA
PWC002043 -12
02{09;2012
021032013
✓ITORYLIARI 1011-
5
S
s
$
s
S
$
5
EL EACH ACCIDENT
E.LCISME-EA EMPLOYEE,
E.L. DISEASE POUCY LBAPT
8100.000
1100.000
1500.000
PTSONOPOPERATIONSILOCA1IONSIV8UCS .E8 (AthACORD�1.Ad tanaI S Hmxsspaeeler
98482 PLUMBING COMMERCIAL & INDUSTRIAL
98483 PLUMBING RESIDENTIAL & DOMESTIC
98805 SEPTIC TANK SYSTEMS CLEANING
(WC) 5183 AIR CONDITIONING SYSTMERS NON PORTABLE PLUMBING & DRIVERS
CERTIFICATE HOLDER
CANCELLATION
MIAMI SHORES VILLAGE
10050 N.E. 2"d AVENUE
MIAMI SHORES, FLORIDA 33138
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL. BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
REPRESENTATIVE
'25$
®1 CORPORATION. All rights reserved.
AFORD 25 (201011) The At ORD none and logo are registered marks ACORD