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PL-14-72Y - Y Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: 1305)795-22C4 Fax: (305)756 -8972 Inspection Number: INSP- 205740 Permit Number: PL -1 -14-72 Scheduled Inspection Date: March 25, 2014 Permit Type• Plumbing - Residential Inspector. Diaz, Osvaldo . Inspection Type: Final Owner: COX, LAURENCE Work Classification: Drainfield Job Address: 226 NW 92 Street Miami Shores, FL 33150- Phone Number Parcel Number 1131010331240 Project <NONE> Contractor: PULLES PLUMBING COMPANY Phone: (786)251 -1234 Building Department Comments INSTALL 200 SQ FT DRAIN FILED Infracdo, Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed 5� J d k' Failed SID vL- l z� p LC( Correction ❑ Needed (f Re- Inspection ❑ Fee No Additional Inspections can be scheduled until re- Inspection fee Is paid March 24, 2014 For Inspections please call: (305)762 -4949 Page 8 of 35 DIVISION OF ' Environmental Health �0 Florida Department o f Health % Miami -Dade County Health Department 9� t '�� OSTDS1We11 Division O 11805 SW 26 St. • Miami, FL 33175 Date 90' Inspector Address `v'� Lr� OSTDS # Comments: I Signature Miami Shores Village Building Department im—cEivEm5l 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 ,JAN 15 2014 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (3057 762.4949 BUILDING Permit No. PERMIT APPLICATION Master Permit NoRl / 7 — 7-2 Permit Type: PLUMBING JOB ADDRESS: R.?. 4 %Z- &,/• 5 W c5;7- City: Miami Shores County: Miami Dade Zip: Folio/Parcel #: f/- -3 / e)J , .0" -,I e Xa Gad �l 61 A )34 Is the Building Historically Designated: Yes N Flood Zone: OWNER: Name (Fee Simple Titleholder):,-4�A- 0>1"` <—z, Phone #: Address:2 Z� �� %�Z .5'l" City: State: Zip: ,7-%l-c—z Tenant/Lessee Name: Phone #: Email: CONTRACTOR: Company Name: G Phone #: Address: City: State: f e- Zip: Qualifier Name: State Certification or Registration #: FC CAS- "5'� Certificate of Competency #: Contact Phone #:,j &--99�F =® ('"� Email Address: Z::!� � &,elU ,570c�° °,u DESIGNER: Architect/Engineen Phone #: Value of Work for this Permit: $ v2 Square%Linear F000tytaM, ,of Work: Type of Work: ❑Address ❑Alteration ❑New 34air/Replace ❑Demolition Description of Work: ^ 'go'd s y p Submittal Fee $ V '00 Permit Fee Scanning Fee $ Radon Fee $ ® �9 CCF Notary $ Training/Education Fee $ Double Fee $ Structural Review $ CO /CC $ DBPR $ Bond $ Technology Fee $ 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 CI IENCEENT MAY RESULT IN YOUR PAYING TWICE FOR ,C ON MRO�'EMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN .FIINANCYNG, 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 or Agent Contractor The foregoing instrument was acknowledged before me this day of , 20 e,hy w is personally known me or who has produced 1 fication and who did take an oath. NOTARY PUBLIC Cr XpIRES OWN Sign:'0��x�o�,�January 19, p Print: ?R a:7 --5' f The foregoing instrument was acknowledged before me this i S day of , 20 1 Q-, byPlt('�(j� JGl who is I personally known to me or who has produced identification and vY4910i ftke an oath. NOTARY PUBLIC: /, �w S.�v''� i-. __L ®lam Sign: Print: :, COtIlmiBStOfl # My Commission Expires- My Commission Expires: ° %,'�l • °' r OFf FL APPROVED BY Plans Examiner Zoning Structural Review (Revised3 /12/2012)(Revised 07 /10 /07XRevised 06 /10 /2009)(Revised 3/15/09) Clerk ACORO0 OP REP OF LIABILITY INSURANCE (,,_, DATE (MMIDDI"M 01/14/2014 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 BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and condltJons of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the cerdflcate holder In lieu of such endorseme s . PRODUCER Temax Insurance Inc 7990 SW 117 Ave Suite 113 Miami FL 33183 CONTACT Xamet Barreras NA PHONE 86) 539 - 5989 FAX (305 ) 356 -1235 -MAIL . xamet@temaxinsurance.com INSU S AFFORDING COVERAGE NAIC # INSURERA: Capacity Insurance Company INSURED Pulles Plumbing Corp 8541 SW 133Rd PI Miami FL 33183 INSURER B: 4110/2013 INSURER C: EACH OCCURRENCE INSURER D: DAMAGE TO RENTED INSURER E: MED EXP one person) INSURER F: PERSONAL & ADV INJURY COVERAGES CERTIFICATF NIIMRFR- 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 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP A GENERALLIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ❑X OCCUR CLM01002727A 4110/2013 4110/2014 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED $ 100,000 MED EXP one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE X I POLICY LIMIT APPLIES PER: APT F1 LOC PRODUCTS - COMP /OP AGG $ 2,000,000 $ AUTOMOBILE LIABILITY ANY AUTO AAL� ED SA��ULED NON -OWNED HIREDAUTOS AUTOS COMBINED SINGLE LIMIT BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per acciderW $ UMBRELLA LIAR EXCESS LIAR OCCUR EACH OCCURRENCE $ HCLAIMS-MADE AGGREGATE $ O $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If describe under O S EE N / A WC STATU- OTH- E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT I $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, It more space Is required) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 10050 NE 2 Ave I ACCORDANCE WITH THE POLICY PROVISIONS. I AUTHORIZED REPRESENTATIVE ll� Miami Shores FL 33138 ©1988 -2070 ACUKU GUKYUKA I tun. Au ngnls reserveo. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD FB7 ��ve Local Business Tax Receipt Miami —Dade County, State of Florida THIS IS NOT A BILL — DO NOT PAY 3252384 LBT BUSINESS NAME&OCATION RECEIPT NO. EXPIRES PULLES PLUMBING COMPANY RENEWAL SEPTEMBER 309 2014 8541 SW 133 PL 3388138 MIAMI, FL 33183 Must be displayed at place of business Pursuant to County Code Chapter 8A — Art. 9 & 10 OWNER SEC. TYPE OF BUSINESS PAYMENT RECEMED PULLES MARIA 196 PLUMBING CONTRACTOR BY TAX COLLECTOR 75.00 09/23/2013 Worker(s) 2 CFC056693 0228- 13-001791 This Local Business tax Receipt only confirms payment of the Local Business Tax. The Receipt is not a license, permit, or a certification of the holder's qualifications, to do business. Holder must comply with any governmental or nongovernmental regulatory laws and requirements which apply to the business. The RECEIPT N0. above must be displayed on all commercial vehicles— Mismi —Dade Code Sea 8s—VL IFor more information, visit wwwmiamidadLgavAsamellector Report Viewer d A 1 4 4 =/1 k H 1 100 * /0 * * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW CONSTRUCTION INDUSTRY EXEMPTION This cerifiies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: 11/26/2013 EXPIRATION DATE: 11/26/2015 PERSON: PULLES CARLOS H FEIN: 650502786 BUSINESS NAME AND ADDRESS: PULLES PLUMBING COMPANY 8541 S.W. 133 PL. MIAMI FL 33183 SCOPES OF BUSINESS OR TRADE: LICENSED PLUMBING CONTRACTOR Pursuant to Chapter 440.05(14), F.8., an ol0oer of a corporation who elects exemption from this draper Uv tOmg, a cer illcate of election under this section may not recover be-P or oompensetbn under tlrts chapter. Pursuant to Chapter 440.05(12), F.S., Ce of a action to be exempt... apply only within the scope attire bustrreas ortrede tisfed on Me rwtice of election to be exempt Purauamto Chapter 440.05(13), F.S., NT— of election to be exempt and certificates of election to be exempt shall be subject to revocation If, at a tbne aflertim flOng of th nonce or fhe)ssuarrce of the certificate, the person rremed on the notice or certlflCete no bnger meets the requirements ofthis section for tssuarn;e ota oertiflcete. The department shall revoke a certlfloets et erry tirrre for 1'eHum of the person nerd on the cartilbate to meet the requirements ofthis section. DFS- F2- DWG252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 07 -12 QUESTIONS? (850)41 3-1008 Page 1 of 1 https:// apps8. fldfs. com lcrreportviewerlreportViewer.aspx ?data.= kdvpginc9D7Q3gH6TER... 11/26/2013 STATE OF FLORIDA AC# 616 5 509 DXPARTMENT OF BUSINEBS AND PROFESSIONAL- RRGULATION. CFC056693 06/14/12 118205000 CERTIFIED PU M$TNG CONTRACTOR PuLims PL IS CERTIFIED under the Provisions Of ch.489 Fs 8xyirat:,on date: AUG 31, 2014 L12061800655 01/06/2014 11 36 FAX JAN 15 2014 STAn OF FLORIDA 6/ DZPARTDow OF 1118iLTI! ONSITZ SZN1lt,1E TREAMGW AND DISPOSAL STSTZtrt CONSTRUCTION PZMUT CONSTRUCTION PEAWT FOR: OSTDS Repair APPLICANT: Laurence Cop PROPERTY ADDRESS: 226 NW 22 St Miami, FL 33150 LOT: 4 BLOCK: 136 SUBDIVISION: [A 001/001 FZMT rr:1"G- 1611908 APPLICATION #. *AP1130190 OATZ PAia FEE PAIN: RECEIPT 0 DOCUMENT r: PR926020 PROPERTY ID A: 11- 3101. 033.1240 (SZCTION, TOWrmenzo, Rain, PARCEL "MOZA) (OR TAX ID NUMBER] sYsaw MUST U COWSTWC= IN ACCORDANCE W2TH SMC =FICATZOM AND STANDARDS OF SECTION 301.0065, F.S., AND CHAPTER 642 -6, F.A.C. DZPARftdM APPROVAL OF STSTN DOES NOT G1RUkW= SATISFACTORY PERFORMANCE rOR ANY SVZC172C PERIOD OY TZNZ. ANY CWQ= ZN .MATERIAL FACTS, MUCH GUWW AS A BASIS FOR ISSUANCE OF THIS PERMIT, REQUIRE THE APPLICANT TO MODIFY THE FERMIT APPLICATION. SUCH MODIFICATIONS MAY RESULT IN THIS PERMIT 88=0 MADE NULL AND VOZ. ISSUANCE OF THIS PERMIT DOES NOT EXEMPT THE APPLICANT FROM COMMXA= WITH OTHER FEDERAL, sTATZ, OR LOCAL MWVMKG RZQUIRSD FOR DEVELOF#ZNT OF THiB PROPERTY. 2YST1M DESIGN AND SPZCiFICATIONs T ( 900 I GALLONS / WK) Septic CAPACxl'Y A t 0 l GALLONS ! GPD CAPACITY N t 0 l GALLONS 41111"M INURCEPTOR CAPACITY DOMMVM CAPACITY 9WOL111 TANK :1250 GNIZANS) K t I GALLONS DOSING TANK CAPACITY t IONS 01 ]DOSES PER 24 HRS 4Pwgp0 I l D f 200 l SQUARE FEET SYSTEM R ( 0 l SQUARE FEET SYSTEM A TYPE SYSTEM: [XI STANDARD t I FUZZO I ] MOUND i CONFi0URr1TI0N: [ ] TRENCH [YI BED ( ) N F 14WION OF BENCHMARK: CIL NW 92 St: 11.78'NGVD [I I ELEVATION OF PROPOSED SYSTEM SITE I 6.361 INCfac9 FT I t ABOVEA�j POiml` 2 8O21*4 OF DRAIN Z= TO BE [ 42.381 INC1i>ES FT I t ABOVE 4 >ZKWCHMARK /REFERENCE POINT L D FILL REpUIRED: 1 0,001 INCHES EXCAVATTcm I INCHES The system is sized for 2 bedrooms with a maximum occupancy of 4 persons, for a total estimated flow of 300 gpd. O Rewired drainfield area based on rule 84E- 6.018(8)(0)2. T - Elevation Of bottom of drainfield to be no less than 8.25' NGVD. N Install s new drainfleld to achieve Drainfield size requirement The Ucensed contractor Installing the system is responsible for installing the minimum category of tank in accordance with e s, 64E4.013(3)M, FAC. R SPECIFICATIONS BY: APPROVED BY: DATE ISSUED: TITLE: Zngtnear, Spoaialist II Engineer speoialast II Dade CID DH 4016, 00/00 (Obsoletes all provious editions whaoh may not be used) IncoMoraaeds W- 6.003, 8AC V 1.1.4 hn130190 EXPIRATION DATE: 04ON014 SES16230 Pa" 1at3. I= T EMENNNEEME MEEMEMEMON mm mommomm mommmmoom