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DEMO-13-2195 f 3 -211-d Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL Phone:(305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-203408 Permit Number: DEMO-9-13-2195 Scheduled Inspection Date: December 10,2013 Permit Type•. Demolition Inspector: Diaz,Osvaldo Inspection Type: Final Owner: CACCAMISE, RICHARD AND TERESA Work Classification: Plumbing Job Address:1490 NE 101 Street Miami Shores,FL 33138- Phone Number Parcel Number 1132050350030 Project: <NONE> Contractor: BEAR PLUMBING INC Phone: (305)940-8180 Building Department Comments SEWER CAPPING ABANDON SEPTIC Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments CREATED AS REINSPECTION FOR INSP-200003. provide health Passed department approval for demo HRS APPROVAL IN FILE JF 1215/13 Failed Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. I December 09 2013 For Inspections please call: (305)762-4949 Page 19 of 32 Miami Shores Village Building Department SEP 2 2 6 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel: (305)795.2204 Fax:(305)756.8972 INSPECTION'S PHONE NUMBER:(305)762.4949, FBC 20 BUILDING Permit No.P-y101'5 -- Z S PERMIT APPLICATION Master Permit No.-DE MOA 13-2I Permit Type: PLUMBING JOB ADDRESS: I H C1 Q N E I Q a S T City. Miami Shores County:_Miami Dade Zip: 1 Folio/Parcel#: 1 1'_5 205—03 5 00 Is the Building Historically Designated:Yes NO Flood Zone: OWNER:Name(Fee Simple Titleholder):f?i A Address: I L-I4q C, N 6 1®I S city: M i At State: Zip: Tenant/Lessee Name:_ t A Phone#:b80 L'Z3 5-1 g5_ Email: .W M 1,�sc. CONTRACTOR:Company Name: & ? PL-U M E51 N1 Q " Phone#:(M5 q 4t,l°E*1,180 Address: P,0. E5M (01 !Z2=5,5 city. WPTIA MIAMI State: F 1_ Zip: 53 2(p 1 Qualifier Name: GLANS State Certification or Registrration#: L 1=C Q 517`- Certificate of Competency#• Contact Phone#: Email Address: L 1')b I .o l:t DESIGNER:Architect/Engineer. Value of Work for 2-CO '� this Permit:$ 5 S� /�DT S nare/I.in q ear Footage of Work. Type of Work: OAddress OAlteration ONew ORepair/Replace jg&emolition Description of Work: 1S EVE Submittal Fee$ �2 Permit Fee$ ®`SGT• CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Bond$ Notary$ Training/Education Fee$ Technology Fee$ Double Fee$ Structural Review$ TOTAL FEE NOW DUE$ • Bondin°g Goa 's Name(if applicable) Bonding Company's Addres City State zip Mortgage Lender's Name(if applicable) Mortgage Lender's Address City State zip IA- 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 MPROVEMENTS 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, tie 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 oc 7) days after the building permit is issued In the absence of such posted notice, the inspection will no proved and a reinspec ' n fee will be charged. Signs Signature �CC. _ Owner or Ag Con The fore oing instrument was ackno edged before me this The foregoing instrument was me this day of 20 by t day of 20 3 by , to who is personally known to me or who has produced who is personally known to me or who has produced 4ha As identification and who did take an oath. as identification and who did take an oath. NOTARY P C: NOTARY LIC: Sign: Sign Print: Print: JESSICA GONZALEZ My Commission Expires • - My Commission ralvAtes. < - MY COMMISSION#EE843682 -- '�.,;�, i=itPlR s oaober 20,2ot6 :''''�'a°` JESSICA GONZALEZ FlaAdaN �m MY COMMISSION#EE843682 (40Z 3B6.OtS3:. , i)7i 398.0153 %ide AM APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised3/122012)Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) CERTIFICATE OF LIABILITY INSURANCE 11130/12 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATQ4 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 SOLDER. IMPORTANT: If the cortifloate holder is an ADDITIONAL INURED,tho Polioy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the term and conditions of the policy,certain policies may require ah endorsement A statement on this certificate doss not confer rights to the certMlcate holder in lieu of such endomema s. PRODUCER NAME: NOVUS INSURANCE Navus Insurance PHONE (954)979-1110- WFAI De Brfiea ld Beach,FL 3 Sample Road L 3 3084 (954)582-5239 De D S. NOVUS INSURANCE@HOTMAIL.COM Phone (954)979-1110 Fax (954)582-5239 INSURER(S)AFFORCINGCOVERAGE NAICB INSURED INSURER A: LANDMARK AMERICAN INSURANCE CO BEAR PLUMBING,INC.ID 344171 INSURERB: PROGRESSIVE INSURANCE COMPANY PO Box 812255 INSURER C: COMMERCE AND INDUSTRY INSURANCE COM NORTH MIAMI,FL 33281- INSURER D: (305)940-8180 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY 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 APFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN.'A AY HAVE BEEN REDUCED BY PAID CLAIMS. 1R TYPE OF INSURANCE POU Y NUMBER LIMITS GENERAL I[A LnY EACH OCCURRENCE $ 1,W0,00C ® COMMERCIAL GENERAL LWBILITY PREMISES a rtence $ 100,00C A ❑ ❑ CLAIMS-MADE © OCCUR LBA14437900 MED EXP one person $ 5,0DC ❑ Y N 12/032012 12!03!2013 PERSONAL&ADV INJURY $ 1,000,00C ❑ GENERAL AGGREGATE $ 1,000,00( GENL AGGREGATE LIMIT APPLIES PEP: PRODUCTS-COMP/OP AGG $ 1,000,00( ❑ POLICY ❑ PRO- ❑ LOC $ AUTOMOBILE LLAMLITY COMBINED SINGLE LIMIT $ (Es accident) ® ALL OWN BODILY INJURY(Per Person) $ 500,00C ❑ SCHEDULED S 04448118-3 BODILY INJURY(Per acdd S 500,00( B ❑ SCHEDULEDAUTOS Y N 12!032012 12/032013 PROPERTY DAMAGE $ 500,Q0C ❑ HIREDAUTOS (PereoddenQ ❑ NON-OWNED AUTOS $ ❑ UMBRELLA LIAB © OCCUR EACH OCCURRENCE $ 1000,00( C © EXCESS UAR ❑ CLAIMS-MADE Y N ESU02DO01475 04272012 04272013 AGGREGATE $ 1000,00C ❑ DEDUCTIBLE $ RETENTION $ 1000,000 $ WORKERS COMPENSATION WCSTATW OTH AND EMPLOYERS'LII0.BI W Y 1 fi 1-1 ANY PROPRET ER E CLLER/EXECUTME E.L.EACH ACCIDENT $ OFFICER/MEMBEREXCLUDED? N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ Kyes descrOfe order DES6RIPTION OF OPERATIONS belay E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,A 6onal Renmrke Schedule,B more apace Is re**B* PLUMBING SERVICES CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN MIAMI SHORES VILLAGE ACCORDANCE WITH THE POLICY PROVISIONS. ATTN:BUILDING DEPARTMENT 10050 NE 2 AVE AUTHORED REPRFAENTATP&A MIAMI SHORES FL 33138 ADELIO ASSUN 1 TION. All rights reserved ACORD 25(2008108)CIF The ACORD name and logo are registered marks of ACORC PERMIT #: 13-SC-1495459 - APPLICATION #:AP1120569 $TATE of FLORIDA DEPARTMENT OF HEALTH DATE PAID: ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM FEE PAID: CONSTRUCTION PERMIT RECEIPT #: Documm #:PR917052 CONSTRUCTION PERMIT FOR: OSTDS Abandonment APPLICANT: Richard J Caccamise PROPERTY ADDRESS: 1490 NE 101.St Miami,FL 33138 LOT: 3 BLOCK: 1 SUBDIVISION: Dunnings Waterway PROPERTY ID #: 11-3205-035-0030 [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 I 7 GALLONS / GPD CAPACITY A [ I GALLONS / GPD CAPACITY N [ I GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS] K [ 7 GALLONS DOSING TANK CAPACITY [ IGLLLONS @[ ]DOSES PER 24 HRS #Pumps [ ] D [ ] SQUARE FEET SYSTEM R I 7 SQUARE FEET SYSTEM A TYPE SYSTEM: I l STANDARD [ ] FILLED [ ] MOUND I I I CONFIGURATION: [ l TRENCH I I BED I I N F LOCATION OF BENCHMARK: I ELEVATION OF PROPOSED SYSTEM SITE [ ] [ / ] [ABOVE/BELOW]BENCHMARK/REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ ] [ / ] [ABOVE/BELOW]BENCHMARK/REFERENCE POINT L D FILL REQUIRED: 10.00 I INCHES EXCAVATION REQUIRED: [ I INCHES Have the tank abandoned in accordance with the following procedures:(a)The tank shall be pumped out.(b)The bottom 0 of the tank shall be opened or ruptured,or the entire tank collapsed so as to prevent the tank from retaining water,and(c) T The tank shall be filled with clean sand or other suitable material,and completely covered with soil.Have the system H inspected by the health department after it has been pumped and ruptured but before it is filled with sand and covered. E R SPECIFICATIONS BY: TITLE: APPROVED BY: ' TITLE: Engineering Specialist II Dade CHD Erl a Omisca DATE ISSUED: 09/1712013 EXPIRATION DATE: 12/16/2013 DH 4016, 08/09 (Obsoletes all previous editions which may not be used) Incorporated: 64E-6.003, FAC Page 1 of 3 v 1.1.4 AR1120569 SE-1 NOTICE OF RIGHTS A party whose substantial interest is affected by this order may petition for an administrative hearing pursuant to sections 120.569 and 120.57, Florida Statutes. Such proceedings are governed by Rule 28-106, Florida Administrative Code. A petition for administrative hearing must be in writing and must be received by the Agency Clerk for the Department, within twenty-one(21)days from the receipt of this order. The address of the Agency Clerk is 4052 Bald Cypress Way, BIN#A02,Tallahassee, Florida 32399-1703. The Agency Clerk's facsimile number is 850-410-1448. Mediation is not available as an alternative remedy. Your failure to submit a petition for hearing within 21 days from receipt of this order will constitute a waiver of your right to an administrative hearing, and this order shall become a'final order'. Should this order become a final order, a party who is adversely affected by it is entitled to judicial review pursuant to Section 120.68, Florida Statutes. Review-proceedings are governed by the Florida Rules of Appellate Procedure. Such proceedings may be commenced by filing one copy of a Notice of Appeal with the Agency Clerk of the Department of Health and a second copy, accompanied by the filing fees required by law, with the Court of Appeal in the appropriate District Court. The notice must be filed within 30 days of rendition of the final order. PLUMING,P nets l�®� Approved - Disapproved Date- PERMIT #:13-SC-1495459 STATE OF FLORIDA APPLICATION #:AP1120569 DEPARTMENT OF HEALTH DATE PAID: ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM FEE PAID: CONSTRUCTION PERMIT RECEIPT #: DOCUMENT #:PR917052 CONSTRUCTION PERMIT FOR: OSTDS Abandonment APPLICANT: Richard J Caccamise PROPERTY ADDRESS: 1490 NE 101 St Miami,FL 33138 LOT: 3 BLOCK: 1 SUBDIVISION: Dunnings Waterway PROPERTY ID #: 11-3205-035-0030 [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 [ ] GALLONS / GPD CAPACITY A I ] GALLONS / GPD CAPACITY N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS] K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ ] D I I SQUARE FEET SYSTEM R I I SQUARE FEET SYSTEM A TYPE SYSTEM: 17 STANDARD [ ] FILLED [ ] MOUND [ ] I CONFIGURATION: [ ] TRENCH I I BED I I N F LOCATION OF BENCHMARK: I ELEVATION OF PROPOSED SYSTEM SITE [ ] [ / ] [ABOVE/BELOW]BENCHMARK/REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ ] [ / ][ABOVE/BELOW]BENCHMARK/REFERENCE POINT L D FILL REQUIRED: [ 0.00 I INCHES EXCAVATION REQUIRED: [ ] INCHES . Have the tank abandoned in accordance with the following procedures:(a)The tank shall be pumped out.(b)The bottom O of the tank shall be opened or ruptured,or the entire tank collapsed so as to prevent the tank from retaining water,and(c) T The tank shall be filled with clean sand or other suitable material,and completely covered with soil.Have the system H inspected by the health department after it has been pumped and ruptured but before it is filled with sand and covered. E R SPECIFICATIONS BY: TITLE: APPROVED BY: d la / TITLE: Engineering Specialist II Dade cHD Erl a Omieoa DATE ISSUED: 09/17/2013 EXPIRATION DATE: 12116/2013 DH 4016, 08/09 (Obsoletes all previous editions which may not be used) Incorporated: 64E-6.003, FAC Page 1 of 3 v 1.1.4 AP1120569 S8-1 NOTICE OF RIGHTS r A party whose substantial interest is affected by this order may petition for an administrative hearing pursuant to sections 120.569 and 120.57, Florida Statutes. Such proceedings are governed by Rule 28-106, Florida Administrative Code. A petition for administrative hearing must be in writing and must be received by the Agency Clerk for the Department,within twenty-one(21) days from the receipt of this order. The address of the Agency Clerk is 4052 Bald Cypress Way, BIN#A02,Tallahassee, Florida 32399-1703. The Agency Clerk's facsimile number is 850-410-1448. Mediation is not available as an alternative remedy. Your failure to submit a petition for hearing within 21 days from receipt of this order will constitute a waiver of your right to an administrative hearing, and this order shall become a'final order'. Should this order become a final order, a party who is adversely affected by it is entitled to judicial review pursuant to Section 120.68, Florida Statutes. Review proceedings are governed by the Florida Rules of Appellate Procedure. Such proceedings may be commenced by filing one copy of a Notice of Appeal with the Agency Clerk of the Department of Health and a second copy, accompanied by the filing fees required by law, with the Court of Appeal in the appropriate District Court. The notice must be filed within 30 days of rendition of the final order. Vv o—, Kati e/ Miami Shores Villa ge Building Department,,, 10050 N.E.2nd Avenue Miami Shores, Florida 33138 �^ k 0 Tel: (305) 795.2204 LpRYpp► Fax: (305) 756.8972 Date: Cl--I(-- -13 Permit No: � Plumbing Critique Osvaldo "Ozzie" Diaz Chief Plumbing Inspector Plan review is not complete, when all items above are corrected, we will do a complete plan review. If any sheets are voided, remove them from the plans and replace with new revised sheets and include one set of voided sheets in the re-submittal drawings. OM757 4 Lo -1 Business Tax,Receipt 11 ism, '1-Dade County,State of Florida THIS IS NOT.A BILL-00 NbT PAY -4432084 .. y BUSINESS NA 01LOCAMN1 Re em"NO. EXPIRES PL Iik? �(�G�Nc RENEEWAL SEPTEMSE .30, x614 11389 QPA COCkA BLVD 4$2 1$ Must,be dlaplayed at pleas at business 0PA L60%01.33054 P'ursuont to County Code Chapter SA-,Art:0&10 OWNER SEC.TYPE OF BUSINESS PAYMENT RECEMED BEAR PLUMBING INC 196 PLUMBING COWMCTOR BY TAX COLLECTOR Worker(s) 2 CFC057720 845.00 07/22/2013 paY�a TXHS1-13-033504 .o s Gees R c ow "s ftm ptl otof ft Lowl Budem Tau.TIm Ilcoei�tt lz eat a llmse. qol m to db bad Holder must sump terms Sap ttaeerael or aopgotrarelnentel relaterydeweel-tegldromaNswhlob lytotho business.. The IIECOPT NO. resuw ba;dis0o" on eU omsia nebI0#s",VWd-I>ude.:Code See ft-M . - Eor aura inforsudtoo vis& �? rbn�n� g� � mram�9a✓ vo v cay .sc