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PL-14-57k, Inspection Worksheet, Miami Shores Village 10460 N.E. 2nd Avenue Mlomf S'hdNs, FL Phone: {305)795 -2204 Fax (305)756- $872 lnspec6on Number: WSP -20 W Permit'IVur,w. PI -44- x-57' Scheduled lnspecton late: Febmfy 11, 2014 Permit Type: Plumbing - Res Wntial lr►spwtkw. Diaz, Oscv6lela lnepftflarr T'yp#: Finial Owner: IGNQRgATi3, UGO Work Classificatlow. Q06MOIct Job AddM8$; 10 NE'97,Sbvd Miami Shores, 'FL. 331 W Phnnp hhimhAr February 10, 2014 or lnspec ►ns please call: tM)762.494 page 9 of 7` DIVISION OF Environmental Health ` Florida Department of Health Q�0 Miami -Dade County health DepartmentIO OSTDS/Well Division 11805 SW 26 St. • Miami, FL 33175 0 Inspector I V e ('A f Date 2- 1 Address 7 7 OSTDS # A P 112-10-07' Comments: �7 Signature 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) 762.4949 BUILDING PERMIT APPLICATION Permit Type: PLUMBING JOB ADDRESS: 10 b- e_�, 9 -1 S;q FBC 20 Permit No. JAN 12 2014 Master Permit No.,e/ City: Miami Shores County: Miami Dade Zip: Folio/Parcel #: 1 ®tom ► 7z- ®� Is the Building Historically Designated: Yes NO Flood Zone: 3dS OWNER: Name (Fee Simple Titleholder): �D Address: 1 CC) City: ! In-T=3 I '5r;l I✓Ic7 State: 0 kc.,'1Em—� Zip: Tenant/Lessee Name: Phone #: Email 3 C)S;' CONTRACTOR: Company Name: — �� Phone #: 3 0%-4 — ® i Address `-1 —1 C� 1 C�� City: HI IN i--I State: zip. —3 30 Qualifier Name: Yt a7_,a--•e. � Phone #: — State Certification or Registration #: � .FQ 1r) 4A%t Certificate of Competency #: Contact Phone #: "j br�1�� i�,`�f S Email Address: DESIGNER: Architect/Engineer: Value of Work for this Permit: Type of Work: ❑Address Description of Work* DAlteration ; .7 Sq relLihear Footage of Work: Submittal Fee $ Permit Fee $ 9 / -50- Y CCF $ CO /CC $ Scanning Fee $ Notary $ Radon Fee $ DBPR $ Bond $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ ODemolition 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 o Signature Owner r Agent ontractor The foregoing ' trument as acknowledged before me this The foreg ' g instrument was acknowledged before me this day of �, 20 by lrt l Sj�► 0 r day of 20 4, by who is personally kno to me or who has produced 1i i I W,' ��' who .is onal known to me or who has produced 154-• as identification and who did take an oath. s NELSON FRIT2 NOTARY PUBLIC • + Notary Public - StBte of Fhuida NOTARY PUBLIC: :• My Comm Expires Jul 4.2017 • „to %�S•' Commission # FF 033518 Sign: Sign: Print: �� fi �� Print: EZ My Commission Expires: My Commi Notary Public, State of Florida , t 7_017 F' • • Q= My Comm. Expires Nov 4, 2015 %;;.F Commission # EE 119518 APPROVED BY ��A ®�° /`� Plans Examiner zoning Structural Review Clerk (Revised3 /12/2012)(Revised 07 /10 /07XRevised 06 /10/2009)(Revised 3/15/09) e I f STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT CONSTRUCTION PERMIT FOR: OSTDS Repair APPLICANT: Ugo Ignozato PERMIT, #:13 -SC- 1501914 APPLICATION # :AP1124207 DATE PAID: RECEIPT #• DOCUMENT #: PR925123 PROPERTY ADDRESS: 10 NE 97 St Miami, FL 33138 LOT: 10 BLOCK: 6 SUBDIVISION: Miami Shores No.1 PROPERTY ID #: 11 -3206- 013-0800 [SECTION, TOWNSHIP, RANGE, PARCEL NUMBERI [OR TAX ID NUMBER] SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND S7WMARDS 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 MIATERTnT. FAC'T'S, WHICH SERVED AS A BASIS FOR ISSUANCE OF THIS PERMIT, REQUIRE THE APPLICANT TO MODIFY THE PERMIT APPLICATION. SUCH MODIFICATIONS NAY RESULT IN THIS PERMIT BEING MADE NULL AND VOID. ISSUANCE OF THIS PERMIT DOES NOT EXEMPT THE APPLICANT FROM COMPLI2= WITH OTHER FEDERAL, STATE, OR LOCAL PERMITTING REQUIRED FOR DEVELOPMENT OF THIS PROPERTY. SYSTEM DESIGN AND SPECIFICATIONS T [ 900 ] GALLONS / GPD Septic CAPACITY A [ I GALLONS / GPD CAPACITY N [ 0 1 GALLONS GREASE INTERCEPTOR CAPACITY [M1UMdUM CAPACITY SINGLE TANK:1250 GALLONS] R I I GALLONS DOSING TANK CAPACITY I ]GALLONS @I • ]DOSES PER 24 HRS #Pumps [ D [ 300 ] SQUARE FEET SYSTEM R [ I SQUARE FEET SYSTEM A TYPE SYSTEM: [RI STANDARD [ I FILLED [ I MOUND I l I CONFIGURATION: [xl TRENCH [ I BED [ ] N F LOCATION OF BENCHMARK: FFE: 11.8' NGVD I ELEVATION OF PROPOSED SYSTEM SITE [ 10.80 3 11 INCHES FT ] [ABOVE BELOW BENCHMARK /REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ 52.8o i fixc-H-E-sT FT ][ABOVE BELOW BENCHMARK/REFERENcE POINT L D E 0 T H E R SPE •1J+7+ nzwu± �- L U.UU J JNummu EX AV"ZIUM AEUVIliW: L 04.00 J JA4wnAa SYSTEM #2 - WEST SYSTEM $ 1: Existing 900 gal. septic tank, certified by "Drainmasters on 12/0612013" to remain. ��� to g� 2.-Install 150 sf of drainfield in trench configuration. t DD 3.4nstall 12" of slightly limited soil at the bottom of the drainfield. �� ;el �S e d s1�Q 4.-Perimeter of excavation area shall be at least 2 ft wider and longer than the proposed a tine to F ande p P is no 5. -Invert elevation of drainfield to be no less than 7.90' NGVD. IN. Av B oo a fax Soi�'� oo subm t�ctot 6. -Bottom of drainfield elevation to be no less than 7.40' NGVD. Soy \b ratty oess Q,�a� `he time of t s�at� {`it�� site [t es5� 14 /ITLTNI TTALfQ OV. .!7 {. M7 M - ` DSV��to't\S� `� .a.D 8n� APPROVED BY: DATE ISSUED: -- ' ilaa"oo a.oi , _ �_��hn�ry•• i4R ,lL V • - _ TITLE: Engineer Supervisor "�'!!,I @�UV , N Dade CHD Astrid V Edwards f 12/19/2013 EXPIRATION DATE: 03/19/2014 DH 4016,,08/09 (Obsoletes all previous editions which may not be used) Incorporated: 64E- 6.003, FAC v 1.1.4 AP1124207 SE915419 Page 1 of 3 JAN. 13.2014 1:46PM , f . 1 DERM N0, 852 P. 1 ' 1 i �1T r , r r +4pe� ek �►'sF F� .3 sft 3p;F 7 ! , r s r � ear CERTIFICATE OF LIABILITY INSURANCE DA 01/1N1 ' 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 13Y THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(SL AUTHORED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER IMIRORTANr: If the certificate holder Is an ADDITIONAL INSURE, the policy(Ies) must be endomed. If SUBROGATION IS WAIVED, subject to the terns and condition of the policy, certain policies may require an emlorsement A statement on this cerWbato days not corder rights to the certificate folder in lieu of such endorsenuad(s). PRODUCER Bla ize & Tyson Irazarnes 5955 SW 21st Stfea HDQyarood, FL33023 Phone (954) 989-9324 Fax W 988-59M ACT • PHO ( 989 9324 F ) 989 -5998 Eft coo AFFORDING COVERAGE NAIC0 INSURER A - ACCIDENT INSURANCE COMPANY INSURED A SUPER SEPTIC TANK, INC 7701 W 18 LANE HIALEAH, FL 33014 954 INSURER B 10i1Q/2014 INSURER C : INSURER D : $ 100,000.00 INSURER E : $ 5,00.00 INSURER F: $ 300,000.00 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 AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IL TYPE OF INSURANCE ADD POLICY NUMBER POLICY YYI OIP Lam A GENERAL LIABILITY Q COMMERCIAL GENERAL LIABILITY ❑ ❑ CLAIMSMADE Q OCCUR ❑ CCP0006254 -W 10/10f2013 10i1Q/2014 EACH OCCURRENCE PREM,. O RENTED $ 100,000.00 MED E XP ( one a $ 5,00.00 PERSONAL & ADV INJURY $ 300,000.00 ❑ GENERAL AGGREGATE $ 300,M.00 GE_fTL AGGREGATE LIMIT APPLIES PER: © POLICY ❑ PRO- ❑ LOC PRODUCTS - COMPIOP AM S 300,000.00 $ AUTOMOBILE LIABILITY ❑ ANY AUTO ❑ AUTOS WNED ❑ SOS EDULED ❑ HIREDAUTOS ❑ NOW NED 60M aNGLE LIMIT BODILY INJURY (Per Persona) $ BODILY INJURY (Pa $ PitO DAMAGE $ $ ❑ UMBRELLA LUIS ❑OCCUR ❑ EXCESS LIAB ❑ CLAIMSMAOE EACH OCCURRENCE $ AGGREGATE $ El DED D RETENTION S $ WORKERS COMPENSATION AND EMPLOYEW LIABILITY YIN ANY PROPRIETORIPARTNERIEXECUTIVE OFFICE IMEMBER EXCLUDED? (MmuNlwy in NH) El 99090"N uradet OF OPERATIONS b0ow N I A ❑ YW A [_ R E.L. EACH ACCIDENT S E.L DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT S DESCRiPT10N OF OPERATIONS I LOCATIONS J VEHICLES (Aumb ACORD 7e1, AddMonel Rem ft Schealase, H more m reams SEPTIC TANK INSTALLATION, SERVICE AND REPAIR CERTIFICATE HOLDER CANCELLATION CITY OF MIAMI SHORE VILLAGE 10050 NE 2ND AVE MIAMI SHORE VILLAGE, FL 33138 FAX 305 - 7564972 ACORD 25 (2(10105) OF SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 019 -2010 ACS CORPORATION. A8 6" MSWVOd. The ACORD name and logo are reglaterixf marks of ACORD 000410 Local Business Tax Receipt Miami -Dade County, State of Florida THIS IS NOT BILL -DO NOT PAY 3820314 :l BUSINESS NAMEA=ATION RECEUrr NO. EXPIRES A SUPER SEPTIC TANK INC RENEWAL SEPTEMBER 30, 2014 7701 W 18 LA 3988772 Must Pe displayed at place of business HIALEAH FL 33014 Pursuant to County Code Chapter 8A - Art. 8 & 10 OHVNER SEC. TYPE OF BUSINESS PAYMENT RECEMED A SUPER SEPTIC TANK INC 196 SPECIALTY : LUMBING CONTRACTOR BY TAX COLLECTOR Worker(s) 1 SEP890722 $49.50 10/09/2013 CREDITCARI}14 -00056 I This Local Business Tex ftceipt only cons payment of the Local Business Tax. The Rece Is not a license, permit or certlRcadon of theholder "sgmMeationa to do business. Holder must comply with govemmentel or nongovemmemml regulatory hoot and r quiremeem which apply to the business. The RECEIPT NO. above must be displayed on all commercial vehicles MGaml- pede,Code Sec So-M For more hdormenon visit • �1TE OF FLORIDA -OR F NA A SE B4ON Gp�TRi=1oN UsAlm -Y e CER7tF1C►'iTE � TO 13E EXEMPT FROM FLORIDA Q010CEW 6ovpb ATWN LAW STECTiVE 03/01/2012 EXPIRATION DATE: 03/01/2014 PERSON: ANDM N ZERO i .050455404 BUSM$S NAN E AND ADDRESS: A Mgt _'TANK tP1C 7701 W 18TH LANE HMEAK TL 33014 SCOPE OF` BUSMSS OR TRADE SEPnC.TANKS mat7cl 1rho Pu "wtl to CiWv 'CL5114 S.. a, office' of a ccfi► eis t exec on from this cfa�w by fit" ace tifit� nt ,mdar4n qot reww benefits or compeiM6on a�d� this - ttnde' his section mat► : . tw er. 440.0bl12i, FA, Certificates of etertion to l on Purl 4ttt _' t3tajlter of the business or trade exer.0t.. a�pM 'ply Within the scope the ,ice of - section to be exempt Pur to Cusoter 440.05f13i, f.5.. Notices ; election * toeMOO" e be `,fiatos o` election :o He exempt ,shat if. if_ any ='� after the filing of: the notice or th f;tss�tante nests cert. 13L8te, thw -i=ce awned on +�19 'tOtr[se ar °;r gniremeau cf this section for issL s of a cerUliurpe. I dep:W ,SWl tevol�e a cart' at time for fai +ore of the { xw, "r> Wed:-on the cert3flcata to sec ice. OUE,rTiONSi (850) 413-191-44 g A m M m mmmmg-lgl mmmm mmmmocwj 0 0 V11" On ommon smomm mmomm PRECS I! offismil som own mmoiai NOR= -Tr- mirl-2-1 N MEE MEN MEMMEMOMMEMEM