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PL-13-156507-31-'13 06:43 FROM- hispoceldn- i1 rks-bba - Wami* Shoniti• 10960.NX. 2 Avdinue misiffil Shor#Si FL Phone: (39W954264 Tax: -(304)756.9079 T-624 P0008/0016 F-799 Inspeelidn Nufter: PO.Wmbor. P. 0 T Sobeduled l6sper#lion D*,a* July 40•2013 Permit Type; - ulmbino -.96SIdOhRal lfisp".e'cfdr: Diaz", Os.Vikldo Inspection Type: Final -Owner,. TORR.Y..C.QNSIANZA Work Ciusdlftmloll'. Sopfic 30 Address; 740 NE 9d d1roo • MlAini Shp.0t, FL. Phoft Number. Parcel'Number ------ I I.LA006i oip. Prol.ect: KNONE> ,QiDnt(4iqto*r: SMITH. 4g?TlQ TA.NK$..Qr,HQM4$'ljRAD., INQ.*. Phofie:406.24647-296 DRAINFIELD. RCPAIR FRISO Inspectord'oMmelito Passed EZ Foi led El Correction Nodded Re- Inspection Poo No AddAlOiql (Wactlft r4n be �Aiaftad uhr(I re-inwo6n fee Is PaW, July 2o,2013 Por In�p4orlph$, plda$e, call; (306)7.02-4949 Page 46 of 34 Master Septic Tank G©ntlRactae This%certifies that the person named on the front of this card has satisfied the requirements of Part III, Chapter 489, Florida Statutes,, for registration as a septic tank contractor and is registered by the Department of Health, Bureau off'Onsite Sewage Programs, to provide contracte& septic tank services. Report Unlawful Septic Tank Contracting: 1- 888 - 993 -9813 0 07/19/2013 1:38PM FAX 3052454323 u SMITH SEPTIC TANKS 120005/0005 /fs2 /a.Z �.cv "v CERTIFICATE OF LIABILITY INSURANCE DA -'IM" i 11 12 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 BETVIMEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holdar Is an ADDITIONAL, INSURED, the pollcy(fes) must bs endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the conificate holder In lieu of Such andamemen s . PRODUCER CMTACT Jules immup Horizon Insurance. Inc. ,E�,r 941 7s5 ssoo Li Nol IJ41 753 -9472 MAIL , 7347 52nd place E ADDRRrsI1: Iules�ftorixonlne.nst Bradenton, FL, 34203 Ih�ftR{sIAFFORO1NOICOVgAae __ —_ Np►gy INWRERA i American Safety IndemnItLConl INSURED INSURERS; Traveler's Insurance Company 2561 Smith Septic Tanks of Homestead, Inc. ►NeuI1�RC: F1JBA WsLrkelt0' GI�mR 15105 SW 308th Ter QtlEURERO; Homestead, FL 33033.4427 INSURERS: QOVERAGEJS THIS IS TO CERTIFY THAT nFV,Q7Vp1 "wMacm b 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 CONTRACTOR OTHER DOCUMENT WITH RESPECTTO WH1CH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, YHE INSURANCE APPORDED BY THE POLICIES WSCRISED HEREIN EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, 13 SUBJECT TO ALL THE TERMS, AR TYPE va=1NaupaNCE ADDL AURS ' POIJCY EXP POLICY NUMBER M LIMITS _.. _ . A o UAftuff N N ENV033152 -12-01 12107/2012 1210712013 EACH OCCURRENCE 5 1,000.000 X cOMMEROIAI•GENMVLUAMLIIY CLAIMS—MA. P1112W.S (Eatv�tlal. aoCIJR MED EXP (am one S 5.000 PERSONAL A ADV INJURY 1 OOO 000 -' WFNERAI.AGGREOATE 1,000,000 N1.A00RWATE.LUIUTAPPLIPAPER: P PROD�JCTB .coalwoPAaC sd 11000 000 X POLICY I IAC I $ i3 AUTOMOBILELUIBILITI N N BABA513803 12107/2012 12/07/2013 c 11 LELIM1r x,004,040 ANY AUTO ALL OYaNED VCHEDULED AUrOf; X e03111Y tNJURY 0"-W $ _ AUTO$ BODILY INJURY (ParaeclggAl) 3 X HIREDAUTOB X ANLDAM MIED PJ�PERT1f DA6IAae —' S UMCRELLA UAe OCCUR S EXCESSLIAB CLAIMS.MADE EACH OCCURRENCE $ _ AGGREGATE $ DEL) RET ,NMN $ C AND EMPLDYERe• LIAa1LITY AND EMRB COJRPEN6ATL IT N 10651088 1210712092 12/07/2013 X we s'raru. on1• o � S E.LEACHAGCIDENT OFFICER/MEMDE•RE7�GCILNRi v 7 NIA $ 100,000 (tMywmH7at00b NNL tORt4i:R1I MN OFD •RAT E.LIiItiFAt1E- FAEMPLOY[ — E 100,000 . ONN liglow t.L. 010uEL . POLICY ulaT a 600.000 �¢CRIPTtON OF OPERATIONS! LOGATIDNS! VEHICLES (A�dI ACbRD 1tH, AeglpoMl R�ma� JachsdW0. M mom apsaa Ie IeMgroq) I'! 917TIF1t'BATC WIN noo SHOULD ANY OF THN ABOVE DELICIOBED POLICIES BE CANCELLED BEFORE Miami Shores Village Hall THE EXPIRATION DATE THEREOP, NOTICE' WILL Be DELIVERMOIN 10050 NE 2nd Avenue ACCORDANCE WITH THE POLICY PROvnIONs. Miami Shores, FL. 33138 ,1uT>,oqMM REPREEENrATM J�[J JMJ 0IOBB -2010 ACORD CORPORATION. All f/nhin �—A —V— zo (x0Tutub) The ACORD name and logo are roglstered marks of ACORD Printed by JMJ on DsCBmber 11, 2012 at 10:34AM 07/19/2013 1:39PM FAX 3052454323 SMITH SEPTIC TANKS 160004/0005 10-24-2012 JEFF ATWATER STATE OF FLORIDA CHIEF FINANCIAL, OFFICER DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * CERTIFICATE OF ELECTION TG BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: 12/14/2012 EXPIRATION DATE: 12/14/2014 PERSON: SMITH WENDELL M FEIN: 650646754 BUSINESS NAME AND ADDRESS: SMITH SEPTIC TANKS OFD HOMESTiAO INC 15105 SW 308 TER HOMESTEAD FL 33033 SCOPES OF BUSINESS OR TRADE: i- IRRIGATION OR DRAINING SYSTEM IMPORTANT: Pureuent to chapter 440 . e8(14), F.S., on officer of o corporation who elects 9s0mplion from this chapter by filing a certificate of #faction under Ibis section may one recover benefits ar eampensatfon under Ibis chapter. Fareuaat to Chapter 440.06112), F,S„ Certificates of alaction to be exempt.,. apply only within rate Scope of the business or trade listed an 11a notice of electlorl to be exempt. Pursuant to Chapter 440.06;131, F,S., Notices of oloctioe to be exempt and certificates of alwaloa to be exempt shall be subject to revocation If, at any time after the Filing of the notice or the issuance of the certificate, [be person named ca the notice or catiillcate no longer meats the requirements Of Ibis section lot Issuance of s canfficata, The department %hall revoke I c0fifficate Of any halo ter failare of the person named all the certificate to meal the roquirontenls of 1110 #gotten. OWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01 -11 QUESTIONS? (850) 413 -1809 PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION CONSTRUCTION INDUSTRY CERTIFICATE OF ELECTION TO BE EXEMPT FROM RLORIDA WORKERS' COMPENSATION LAW EFFECTIVE: 12/14/2012 EXPIRATION DATE: PERSON: WENDELL M SMZ11j FEIN: 850848784 BUSINESS NAME AND- ADDRESS: SMITH SEPTIC TANKS OF HOMESTEAD INC i5I05 SW 305 TER HOMESTEAD, FL 33033 SCOPE OF BUSINESS OR TRADE: 1 • IRRIGATION OR ORAiNmo SYSTEM IMPORTANT 0 Pursuant to Chapter 440,05041, F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election L under this section may not recover benefits or compensation under this D chapter, 12/14/2014 Pursuant to Chapter 440,05(12), F.S., Certificates of election to be H exempt.. apply only within the scope of the t►usiness or trade listed on R the notice of election to be exempt E Pursuant to Chapter 440.05(13), F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the Issuance of the certificate, the person named on the notice or certif1011ite no longer meets the requirements of this section for issuance of a certificate. The department shell revoke a certificate at any time for failure of the parson named on the certificate to meet the requirements of this section, QUESTIONS? (850) 413 -1809 CUT HERB * Carry bottom portion on the job, keep upper portion for your rec3orda. OWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01 -11 07/19/2013 1:38PM FAX 3032434323 SMITH SEPTIC TANKS 40$040 -4 THIS 15 NOT A 811.L •- DO NOT FLAY BUSINESS NAME / LOCATION SNCTH SEPTIC TANKS OF HOMESTEAD 15205 SW 305 TERR 33033 UNIN DADE COUNTY OWNER SMITH SEPTIC TANKS OF HOMESTEAD TY PLUMBING CONTRACTOR Ml � AeataaRBC�CIV' TAX COLLEOior1; a 010229001 000075.00 SEE OTHER BIDE la0003/0003 FIRST-CLASS U.S. POSTAGI; PAID MIAMI, FL PERMIT NO. 231 RENEWAL RECEIPT NO. 219750-7 CC # SEPS90744 WORKER /S DO NOT FORWARD SMITH SEPTIC TANKS OF HOMESTEAD TINA SMITH PRES 15105 SW 305 TERR MIAMI FL 33033 11111111 111111 111111131111111111111111111111111111 )111]j14,1)1 THIS. IS NOT A DILL W DO NOT PAY RECEIPT NO. 30- 2197507 CC N0; SEP890744. BUSINESS NAME / LOCATION SMITH'SEPTIC TANKS OF HOMESTEAD TNC FIRST-CLASS '13.8.'Pt}5 CAGE •! PAID. M�AMI •FL PERMIT.10.251 RECEIPT HOLDER MAY DO ;:•, ; BUSINE88 As.A•CONTRi4GTOR A84SPE6IFIED HEREON:' ; •15105 SW 305 TERR: OWNER :SMITH SEPTIC TANKS- OF HOMESTEAD—,I' ••'SEE'BACK OF RECEIPT FOR. SPECIALTY PLUMBING CONTRACTOR`.,- " :-A LIST 'OF. NON= PARTICIPATI•NI; •MUNICIPALITIES' Racatpt �older moat DO NOT FORWARD radiator In Me dty ' whore work le-to be SMITH SEPTIC TANKS OF HOMESTEAD clone. INC TINA SMITH PRES PAir•1N16c1 15105 SW 305 TERR A6PM-DAM00014TVTAX MIAMI FL 33033 'L009/2012 ;022$0106001 D00175.00 h$ 1111r11111r11rrl1rrt11te1rr11111jrrrllifrtrliilortlt� 3a�r1� Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 INSPECTION'S PHONE Fax: UMBER: (305) 762.4949 s FBC 20 LDING Permit No. PERMIT APPLICATION Master Permit No. Permit Type: PLUMBING JOB ADDRESS: G'%L_1® N F_ 9 6 Is r City: Miami Shores County: Miami Dade Folio/Parcel #: 4L- - 3 FOCO- b t LP " 210 0 Is the Building Historically Designated: Yes NO ✓ Flood Zone: OWNER: Name (Fee Simple Titleholder): C_o rah 577 %r f'i Phone#: 36,, - 76 6-70,; Address: _7q® V e 5-r City: /\ l4A State: r—L Zip: --g, / Tenant/Lessee Name: Email: 5M+`rm 5- 4 N1f S ® rF CONTRACTOR: Company Name: &\o-r�q S if rvc> , ®� C . Phone#: 305.02 q:� o Address: � 2 /�J� 5 /") G TM City: 4 &Yi gE6T State: Zip: Qualifier Name: W eISA) W_ SY" t -r-H Phone#: 15 ® .S` State Certification or Registration #: ® ®� l50' � Certificate of Competency #: Contact Phone#: �� 9/1g, 7l / Email Address: DESIGNER: Architect/Engineer: Phone#: Submittal Fee $ t Permit Fee $ /-'5® - CCF Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ CO /CC $ DBPR $ Bond Technology Fee $ TOTAL FEE NOW DUE $ Q d= ®ca �� Value of Work for this Permit: $ 2-1-5v Square/Lineau f V Type of � Y ', � �'� �. ONew epic elac�e1et�o�tn ' fa &A ib�c i �a sj .� Descriptln 6f ,W Pc° All • JTYd �, q" y6 Submittal Fee $ t Permit Fee $ /-'5® - CCF Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ CO /CC $ DBPR $ Bond Technology Fee $ TOTAL FEE NOW DUE $ Q d= ®ca �� Bonding Company's Name (if applicable) Bonding Company's Address City State i Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State 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 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. Signature i ' T Signature Owner or Agent Contractor The foregoing instrument was ac ledged before me this ash The foregoin instrument was acknowl ed before me thisLJ+�1 day of Gti, 20, by day of , 20 ]�, by who is personally known to a or who has roduced who is personally known to me or who has produced l ®7- - 9*2- P� c� F7'4- 1 loon As i entification and who d take an oath. as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign: Print: �'• P o Print: M Commi i MY COIN xpires r . , Apr � MY CMINSsion 0 EE 88242 My son" Thrcaph tiatiolN! ft" Assn. APPROVED BY K� -� /C y 3 Plans Examiner f � r� :lfi4REf�,1`PA�E` R PoWv PuNic State of Florida pfffbomm' empires Apr 9, 2015 ComAsion #E EE 88242 Bonded Thrmh N4tWW tlogryr Assn. Zoning Structural Review Clerk (Revised3 /12/2012)(Revised 07 110 /07)(Revised 06 11012009)(Revised 3/15/09) STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT k� Av CONSTRUCTION PERMIT FOR: OSTDS Repair APPLICANT: Constanza Terry PROPERTY ADDRESS: 740 NE 96 St Miami, FL 33138 PERMIT #:13 -SC- 1483647 APPLICATION #: AP 1113712 DATE PAID: FEE PAID: RECEIPT #: DocmamT #: PR911481 LOT: 7, 8 BLOCK: 68 SUBDIVISION: Miami Shores Sec 3 PROPERTY ID #: 11- 3206 -014 -2100 [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 T I 900 ] GALLONS / GPD Septic CAPACITY A [ 0 ] GALLONS / 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 I 200 ] SQUARE FEET SYSTEM R [ 0 ] SQUARE FEET SYSTEM A TYPE SYSTEM: [X] STANDARD [ ] FILLED [ ] MOUND I ] I CONFIGURATION: [ ] TRENCH [X] BED I ] N F LOCATION OF BENCHMARK: Fininished Floor Of Existing Residence I ELEVATION OF PROPOSED SYSTEM SITE [ 25.90][ INCHE3 FT ][ABOVE BELOW BENCHMARK /REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ 55.90][ INCHES FT ][ABOVE BELOW BENCHMARK /REFERENCE POINT L D FILL REQUIRED: 1 0.00] INCHES EXCAVATION REQUIRED: [ 42.00] INCHES 1.- Existing 900 gal. septic tank, certified by "Wendell Smith Septic tankon 07/09/13" to remain. 0 2.- Install 200 sf of drainfield in bed configuration. T 3.- Install 12" of slightly limited soil at the bottom of the drainfield. i� 4.- Perimeter of excavation area shall be at least 2 ft wider and longer than the proposed ab �`I'��tY�i � °r des,gInee) is rewired to peno6 a e rmg a iacent t° the grainfield encavation a the H 5. -Invert elevation of drainfield to be no less than 6.58' NGVD. time of final inspection. i'ri ,r to Final Approval, th , 00H E 6. -Bottom of drainfield elevation to be no less than 6.08' NGVD. inspector s ha °i witness the soil boring and compare the 7. -This permit is not for ADDITION results to the original site evaluation submitted. R reinspection fca will t)s aa_oesced ij the rpnj is not at the jobsaa ai the arraoirged time. SPECIFICATIONS BY: endell S. TITLE: APPROVED BY; -4:: TITLE: Professional Engineer Supervisor Dade CHU DATE ISSUED: 07/1 01 EXPIRATION DATE: 10/10/2013 DH 4016, 08/09 (Obsoletea 1 previous editions which may not be used) Incorporated: 64E- 6.003, FAC Page 1 of 3 v 1.1.4 AP1113712 SE903205