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PL-13-2407Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 207516 Permit Number: PL -10 -13 -2407 Inspection Date: May 13, 2014 Inspector: Diaz, Osvaldo Owner: KOEPF, ULRICH Job Address: 395 NE 92 Street Miami Shores, FL Project: <NONE> Contractor: STATEWIDE SEPTIC CONNECTIONS Building Department Comments Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Addition/Alteration Phone Number Parcel Number 1132060136410 Phone: (954)963 -0082 REPLACE DRAINFIELD Infractio Passed Comments INSPECTOR COMMENTS True Inspector Comments Passed CREATED AS REINSPECTION FOR INSP- 205933. HRS OK L�J SOD OK SIDEWALK REPAIR REQUIRED Failed El r �- Correction Needed Re-Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. For Inspections please call: (305)762 -4949 May 13, 2014 Page 1 of 1 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 c, o Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 FBC 20 l BUIL ING Permit No. PERMIT APPLICATION Master Permit No:Ll3_. Li -- Permit Type: PLUMBING JOB ADDRESS: 39S N � 91 S- City: Miami Shores County: Miami Dade Zip: 3 3 (3 19 Foho/Parcel #: 11 -3 Z.,O G - ® I -;� s ro+ ( O Is the Building Historically Designated: Yes NO Ll_*� Flood Zone: OWNER: Name ee Simqe Titleholder): Wn C h N 4 2� ri r e K Pone # q i L4 , 6 & 2_ 1 Z Z Address: SGYYV City: Tenant/Lessee Name: Email: State: Zip: CONTRACTOR: Company Name: Phone #: (w 6 (- C6 3 3 Address: (00 rb L C,,3 Z33_9+' City: FA % State: �ar�� Qualifier Name: T_Q, J'4 L- La rna-- Phone #: State Certification or Registration #: (3M ®6) -7 (2-6 2- Certificate of Competency #: _ Contact Phone #: Email Address: DESIGNER: Architect/Engineer: Phone #: 33023 Value of Work for this Permit: $ 3500,W4 Square/Linear Footage of Work: '300 Type of Work: ❑Address DAlteration ONew� �G� /Replace ODemolition en Description of Work: q Submittal Fee $ Permit Fee $ �- CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ a�u 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Signature JJ/3 ' U weer or t Contractor The foregoing instrument was acknowledged before me this day of �C '� , 20 ?by CjI r, Ch J<4-e b� , who is personally known to me or who has produced RA P! `y L, cnc< As identification and who did take an oath. NOTARY PUBLIC: Sign:. e dv-e� Print: -Tere `p c 4�o I ,o �a�--• My Commission Expires: z APPROVED BY i1R1M8p d SOLOMON MY COMMISSION # EE131935 -- ...­en,har 08.2015 The foregoing instrument was acknowledged before me this day of 20 D by ] iL f,4 -1A SO C-0 w s person y known to or who has produced 1 ,-c i as identification and who did take an oath NOTARY PU$� " "' Q. Sign: Print: My Commiss�yol�plj �0 Y Plans Examiner Structural Review (Revised3 /12/2012 )(Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09) Zoning Clerk STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT j 5 CONSTRUCTION PERMIT FOR: OSTDS Repair APPLICANT: Hanrlque Gregi PROPERTY ADDRESS: 395 NE 92 St Miami, FL 33138 LOT: 23 24 BLOCK: 47 SUBDIVISION: PROPERTY ID #: 11- 3206 -013 -6410 PERMIT #:13 -SC- 1500702 APPLICATION #: AP1123515 DATE PAID: FEE PAID: RECEIPT #: DOCUMENT # : PR919787 [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 [ 750 ) GALLONS / GPD Existlnq septic tank t0 remain. 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 [ 300 ] SQUARE FEET Trench configuration drain SYSTEM R [ 0 ) SQUARE FEET SYSTEM A TYPE SYSTEM: [X] STANDARD [ ] FILLED [ ] MOUND [ ] I CONFIGURATION: [X] TRENCH [ ] BED [ ] N F LOCATION OF BENCHMARK: F.F.E., 10.00' NGVD I ELEVATION OF PROPOSED SYSTEM SITE [ 13.20)[ INCHES FT ][ABOVE BELOW BENCHMARK /REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ 55.20)[ INCHES FT ][ABOVE BELOW BENCHMARK /REFERENCE POINT L D FILL REQUIRED: [ 0.00] INCHES EXCAVATION REQUIRED: [ 42.00] INCHES Inspector to verify the existing septic tank is properly abandoned before final approval. 0 'Invert elevation of drainfield to be no less than 5.90' NGVD. T *Bottom of drainfield elevation to be no less than 5.40' NGVD. H "THIS PERMIT IS NOT FOR " ADDITION(s) ". The system is sized for 4 bedrooms with a maximum occupancy of 8 persons (2 per bedroom), for a total estimated flow E of 400 gpd. R Required drainfield area based on rule 64E- 6.015(6)(c)2. SPECIFICATIONS BY: Teresa �So onion a / TITLE: Master Septic Tank Contractor APPROVED BY: DATE ISSUED: 1 TITLE: Dade CHD EXPIRATION DATE: 01/16/2014 DH 4016, 08/09 (Obsoletes all previous editions which may not be used) Incorporated: 64E -6. 003, FAC The contractor (nr dt;SigrlBe) ;S W0,Uired t0 perform a x • ,l soil boring ad { ac t_A to drainfieid excavatiQ&,abtttfl time of final inspection. Frior to Final Approval, the DOH inspector shall witness the soil boring and compare the results to the original site evaluation submitted. A reinspection fee will be assessed if the contractor is not a` lee jobsite at the ar!a iirne. Page 1 of 3 DIVISION OF Environmental Health Florida Department of Health Miami -Dade County Health Department ��� OSTDS /Well Division ®`�►O 11805 SW 26 St. • Miami, FL 33175 inspector j c/ e !' 2 Date 1 a�Z S Zo 13 Address 3 H 5 N E `3 Z OSTDS # 12 3S_ l 6 Signature CERTIFICATE OF LIABILITY INSURANC — _ DATE(N[ItiDD1YYYY) 90/04113 THIS CERTIFICATE 13 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE OF- RTW-ICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER TrHL COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOE=S NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED IZEPMENTATIVE OR, PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL. IWUkEb, Pte 90110083) must he endorasd. ff SUBROUTiON IS WANED. aut jeot to the tarns and conditions of the P oltuy, certain Policies may require an endorsement A statement on 11119 eert)tilhlte does not confer rights to the certificats holder in Ifeu of such andn=pinp W.lk PRODUCER BWw & Tyson IrLsu mm 5555 SW 21 St Stlaet Hollywood. FL 33023 Phone (994) 989.9324 INSURED Statewide Seytio donneIclions. Inc 6032 SW 23RD ST Miramar, FL 33023 (964)963-0082 COVERAGES Fix (954) 989-5998 �I. heorn. D • . - inouncK r 3 KavrolUllt MUMMK; S IS TO CIRTIpY T"AT T'liE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE IN$IJRBD NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIRI =MINT. -WRM OR CONpITION OF ANY CONTRACT OR OTHER DOCUMENT WITH ReSpECT TO WHICH THIS CERTIRICATI? MAY 134 ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HERMN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE SEEN REDUCED BY PAID CLAIMS. TR TYPE OF INSURANCE POLICY NUMBER 6AwUD MID LIMITS OIaVERAL LIABILITY CL00034762 10/07/2012 10/0712014 OCC0 S 300,000 A FVI c:oMMI3tCIAL GENCRAL LIABILITY ❑ ❑ CLAIMs•MADS © OCCUR ❑ rl GF�rL AGGREGATE LIMB APPLIES PI'sR: © POLICY El t: M 0 Lo N MED EXP pw r, 100,000 6,000 PEES r L INJURY' S 300000 GENERAL AGGRECATG 5 SDD,I)00 PRODUCTS -COMP AGC3 S =low s AUTOMOBILE L14MUTY ❑ ANYAUTO CW0INED8ING A-UMiY (EaSWdenh S ❑ ALL OWNM AUTOS 8WLY INJURY (Pei• PMM) s ❑ SCHEDIAED AUTOS BDDILY INJURY (Pef awdeg S ❑�� ❑ NON.OWNEDAUTOS PROPERTY DAMAGE aomem S S Lj OCCUR EXCESS t3AB (.� AIAgS IIdAp6 !AO OCCURRENCB S A(3MWMTE S ❑ DEDUOT191.B 3 WCSTA S WORtKM COMPENSATION AND EMPLOYERS' LIABILITY Y 1 ANY PROPMETORIPARTNERRXECLITIVE OFFICERIM MI)SR EMLUDED? FN fMyyaeenS5d,d .1 b NH) DESCRIFFRONN OF OPERATIONS below IA E.L. EACH ACCIDENT S EL DISEAW • EA 6tdPLOVE S E.L. DISFJI$E - POLICY LIMB S ANCkIMM OF OFBMTIONB I.LOCAT(ONS I VENCLER (ARnW ACORD "I, Addl#wW Remarks 5chedui% ff more space ls requb*M MIAMI SHORES 10050 NE 2ND AVE ACORP 25 (2008108) QF L.ALYI MLLA 11UN SHOULD ANY OF THE ABOVE DEWRI6LD POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL HE DELIVEpim m ACCORDANCE WITH THE POLICY PROVISIONS. 0 1988 2009 ACORD CORPORATION. All rights reserved. The ACORD Dame and Wq* are registered marks of ACORD