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PL-13-2178yr& • -4 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 205932 Permit Number: PL -9 -13 -2178 Scheduled Inspection Date: February 20, 2014 Permit Type: Plumbing - Residential Inspector: Diaz, Osvaldo Inspection Type: Final Owner: LOPEZ, JUAN Work Classification: Drainfield Job Address: 9740 N MIAMI Avenue Miami Shores, FL Phone Number Parcel Number 1131010330170 Project: <NONE> Contractor: A AARON SUPER ROOTER Phone: 305 -944 -8886 sunamg uepartment comments PUMP ABANDON AND REPLACE TANK AND DRAIN FILE[ Infractio Passed comments INSPECTOR COMMENTS False Inspector Comments Passed CREATED AS REINSPECTION FOR INSP- 199899. NO PERMIT NO ANSWER AT RESIDENCE uL cwt" Failed .50D H-04, G Correction Needed ❑ 6 Re- Inspection ❑ Fee No Additional Inspections can be scheduled until re- inspection fee is paid. February 19, 2014 For Inspections please call: (305)762 -4949 Page 12 of 31 DIVISION OF Environmental Health Florida Department of Health Miami -Dade County Health Department OSTDS /Well Division 11805 SW 26 St. • :Miami, Ft, 33175 0/ Inspector �+ �a �_ ---`� Date /© f Address " _ � Y /, 2?'(.c,,, �� , �sTDS # Signature ��_ A •. DIVISION OF Environmental Health Florida Department of Health Miami -Dade County Health Department AM OSTDS/Well Division � 11805 SW 26 St. • Miami, FL 33175 Inspector --�-� (" ---� Date /0 Address 31 yr n' .�.� �STDS #A Pl u _ is z Signature 4Aenage6Z C — F/ 13 - 0 7-E ��Miami Shores Villa plt e l� g 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 BUILDING PERMIT APPLICATION Permit Type: PLUMBING 'Y: FBC 20 Permit No. Master Permit No. SEP 2 6 2013 JOB ADDRESS: "� J . A °�L a i C� ,� � %�'c City: Miami Shores County: Miami Dade Zip: 51 'o Folio/Parcel #: Is the Building Historically Designated: Yes OWNER: Name (Fee Simple Titleholde Address: C -SQ (f City: Tenant/Lessee Name: Email: State: 19 Qfle Zone: CONTRACTOR: Company Name: A0 i1J-, � �'�� JP ���7�� Phone #: J Address: Qa City: �'► ; ►' e4 i-n (, State: 1 i_ Zip: Qualifier Name: ��� �P ^ 1 1 Phone #• State Certification or Registration #: Contact Phone #: Email Address: Certificate of Competency #: DESIGNER: Architect/Engineer. Phone #: c� Value of Work for this Permit: $ r Square/Linear Footage of Work: 150 Type of Work: ❑Address DAlteration ONew )2lRepair/Replace ODemolition Description of Work: �+ r Submittal Fee $ ) Permit Fee $ T CCF $ CO /CC $ Scanning Fee $ �° C� 0 Radon Fee $ . S DBPR $ Y ` Bond /$ Notary $ 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 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencemeplinust be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the ab a ce of such posted notice, the inspection will not be a andpection fee will be charged. Signature Signature Own or Agent Contractor The fore g instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of , 20 � 3 , by `� yu "-n �O � °Z day of 20 75 , by jo k.--i T'' who is personally known tome or who has produced D r V L +4?—k who is personally known tome or who has produced K'A As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: .t►e' dam_ Si -1 Print: Print: TIP–Pde. L'.���. My Commission Expires:. • p; - f�NESA J SOLOMON My Commis �"E���� J .►a SOLOMON MY COMMISSION # EE131935 ±.� •'.: MY COMMISSION # +''a EXPIRES November 08.2015 o, EXPIRES Ee131935 dr3e3e�Y3e3eie9 :�Y�Y�Y�Y�YiJe3e3: &:e4e�Y3e4e 5��9t�fl�eicFr3c�Y r�i0`e.�m�e�Y9r4r sYar4nte4e9e3nY�Y�Y3earoY�Y3e3r�1r� Y3e�Y3e�Y�Tr�eB�� e •�l :COrtt APPROVED BY 9 -2 6-/ j Plans Examiner Zoning Structural Review Clerk (Revised3 /12/2012XRevised 07 /10 /07XRevised 06/10 /2009 )(Revised 3/15/09) -``�`„'``'"® CERTIFICATE OF., L II�ITY !N>$URANCE O9 S�1D3lYY) PRODUCER Arbeleez Insurance, Inc. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 9971 Krarnair parkway ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE "Miramar, FR 33D2$ HOLDER. THIS CERTIFICATE DOES NOT AMEND. EXTEND OR Phone (950) 5544 Fax {954) 438.7733 ALTER THE GL]VERAGE AFFORDED BY THE POLICIES BELOW -_ INSURERS AFFORDING COVERAGE NAIC r1 INSURED.. A Aaron Super Rooter . Inc. INSURER A: ACCIDENT INSURANCE CO 6022 SW 35 COURT INSURERS: TECHNOLOGY INSURANCE CO ' Miramar, FL 33023 INSURER C: (954) 967 -9933 INSURER D! INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED HAVE B£EN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PER= INDICATED. NOTWrrHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH TKS 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 POLICIES, AQCSRBgA• E LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIM$. INSR ADO L SR OF MSURANCt? POLICY NUMBER POAATE MIYWDfl�" -f 0AA'f (MI�IyYYYY� LIMITS GENERAL LIABILITY AL LI ❑V COMMERCIAL GENERAL LIABILITY - EACH OCCURRENCE 1.000.000 ❑❑ CLAIMS NWDE ] OCCUR AOL9001826 09/29/2013 09/29/2044 PRMA eS O RENT 15 100.000 A ❑ Mgt) EXP (Anyone person) 5.000 _ ❑ PERSONAL & ADV INJURY 11000.000 __,_ OENERALAGGREGATE 2.000,000 GUN I. AGGREGATE LIMIT APPLIES PER: ❑ POLICY 0 PROJECT ❑ c, PRODUCTS - COMPIOP AGO INC AUTOMOBILE LIABILITY r q ANY AUTO COMSINEO SINGLE LIMIT ❑ ALL OWNl;DAUTOS sccident) ❑ Q SCHEDULED AUTOS BODILY INJURY ❑ HIRE D AUT05 (Per person) ❑ NON OWNED AUTOS BODILY INJURY ❑ w (Per xeldenl) PROPERTY DAMAGE I GARAGE UAHIUTY (Per acatdent) ❑ 10 ANY AUTO AUTO ONLY - EA ACCIDENT rVy EXCESS 1 UMBRELLA LIABILITY q ❑ OCCUR q CLAIMS MADE ❑ DEDUCTIBLE _ ❑ RETRNTION S WORKERS COMPENSA ION AND EMPLOYPRS' LIABILITY l i ANY PROPRIETOR I PARTNER t EXL'- CUTIVE OFFICER I MEMBER EXCLUDED? (MandmorY in NNI 0 ER ._ DESCRIPTION OF OPERATIONS I LOCATIONS CERTIFICATE HOLDER VILLAGE OF MIAMI SHORES 10050 NE 2 AVE MIAMI SHORES. FL 33138 1/01) OF 09123/2013 1 09/23/2014 OTKER THAN EAAGC AUTO ONLY: A3G EACH OtxuRRENCE A©GREGATE E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L. DISEASE • POLICY LIMIT I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL pRCMSIONS 1.000.000 1.000.000 9.000.000 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSIJWG INSURER WILL ENDEAVOR TO MAIL. 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, rr5 AGENTS OR REPRESENTATIVES, la.twn ACORD I ne A901410 name and 1090 are reglster6d marks of ACORD Registered Septic Tank Contractor i L'XVrXkVXX Auuxaab: V f4U N M18MI Ave Miami, FL 3315U LOT: 2 3 BLOCK: 129 SUBDIVISION: PROPERTY ID #: 11- 3101 -033 -0170 [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 ] GALLONS / GPD CAPACITY N [ 0 ] GALLONS GREASE INTERCEPTOR CAPACITY [MA]XIMUM CAPACITY SINGLE TANK:1250 GALLONS] K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ D [ 150 ] SQUARE FEET R [ 0 ] SQUARE FEET A TYPE SYSTEM: [X] I CONFIGURATION: [X] N Trench configuration drain SYSTEM SYSTEM STANDARD [ ] FILLED [ ] MOUND TRENCH [ ] BED [ ] F LOCATION OF BENCHMARK: FFE 12.3' NGVD I ELEVATION OF PROPOSED SYSTEM SITE [ 18.00][ INCHE3 FT ][ABOVE BELOW BENCHMARK/REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ 56.00][ INCHE3 FT ][ABOVE BELOW BENCHMARK /REFERENCE POINT L D E O T H E R .L" 1MWU11Q;U: L U.UU J INCHES EXCAVATION MWU110EU: L SiS.UU J JLM;Uz* 1.- Install a 900 gal min. septic tank with an approved filter. 2. -The licensed contractor installing the system is responsible for installing the minimum category of tank in accordance with s. 64E- 6.013(3)(f), FAC. 3.- Install 150 sf of drainfield in trench configuration. 4.-Perimeter of excavation area shall be at least 2 ft wider and longer than the proposed absorption bed or drain trench. (Comments Continued on Page 2.) SPE ICA2 ONS BY: Betsy Lange TITLE: Engineering Specialist II R BY: y �� TITLE: � 1]� j Dade CHD DATE ISSUED: 09/20/2013 EXPIRATION DATE: 12/19/2013 DH 4016, 08/09 (Obsoletes all previous editions which may not be used) Incorporated: 64E- 6.003, PAC Page 1 of 3 v 1.1.4 "1120625 SE908537 Tale contractor (or cesl9reee) ,s regWreb to periorrr a soil borintn aujacmt to the rtrainiieid excz.ta cn ai ih° time of i;nal irtshr;ciion. Prior to Final Approval, the 01-1 inspector shall vaitness the soil boring artcl cornpare ;,iii r(,,sults to the original ss:e aaaluatiun submittet. A reirlspectior+ `ee +.vii! :)e a� t;�asspo ii tt;e cor+iractor is not ;ai t�,:_ tat.af, a`, tale s.rrarep�:r� tirn�: DOCUMENT #: PR917467 .-Invert elevation of drainfield to be no less than 8.13' NGVD. . -Bottom of drainfield elevation to be no less than 7.63' NGVD. . -This permit includes the abandonment of the existing septic tank. he system is sized for 2 bedrooms with a maximum occupancy of 4 persons (2 per bedroom), for a total estimated flow of ) gpd. IS PERMIT IS NOT FOR ANY ADDITIONS.