Loading...
PL-11-1185Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 kA Inspection Number: INSP- 165805 Permit Number: PL -6 -11 -1185 Scheduled Inspection Date: October 26, 2011 Permit Type: Plumbing - Residential Inspector: Hernandez, Rafael Inspection Type: Final Owner: RESPONDEK, CAROL Work Classification: Drainfleld Job Address: 1162 NE 105 Street Miami Shores, FL Phone Number Parcel Number 1122320280150 Project: <NONE> Contractor: ALL PRO SEPTIC & SEWER INC / ALL PRO PLUMBING SEP' Phone: (305)635 -3002 Building Department Comments INSTALL NEW TANK 1,200 CATEGORY 4 WITH TRAFFIC LID AND DRAINFIELD 834 SYSTEM Inspector Comments Passed CREATED AS REINSPECTI FOR INSP- 161523. HRS IN FILE missing sod Failed Correction Needed ❑ Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. October 25, 2011 For Inspections please call: (305)762.4949 Page 22 of 33 T I TANK INSTALLATION SETBACKS [ [01] TANK SIZE [IJ ° [2] [ ] [27] SURFACE WATER FT [ [02] TANK MATERIAL Qgt_- c'-..nm,4 [ ] [281 DITCHES FT [ s j [031 OUTLET DEVICE. [ ] (291 PRIVATE WELLS FT 1 1 (04] MULTI- CHAMBERE <3 / N J, [ 1 [301 PUBLIC WELLS FT [ "'] [05] OUTLET FILTER :- [ 1 [311 IRRIGATION WELLS FT [ -1 [06] LEGEND '2 k— �f� `l 94C ] [32] POTABLE WATER LINES 135 FT [ mp [ --1 [07] 1081 WATERTIGHT ' ( J LEVEL 2e�� -t [ I . [33] [34] BUILDING FOUNDATION 14, FT PROPERTY LINES FT [ _j- [09] DEPTH TO LID S% [ ] [35[ OTHER FT DRAINFIELD INSTALLATION FILLED / MOUND SYSTEM [ 1 1101 AREA [111 AX2A2j SOFT [ 1 [361 DRAINFIELD COVER ( j [11] DISTRIBUTION BOX HEADER G=! [ ] [371 SHOULDERS ( 1 [12] NUMBER OF DRAINLINES 6 [ J [381 SLOPES:. [ J [131 DRAINLINE SEPARATION "' ( J [391 STABILIZATION , [ 1 [141 DRAINLINE SLOPE [ J 1151 DEPTH OF COVER ADDITIONAL INFORMATION ( 1 [161 ELEVATION [ABOVEBELOW] BM [ [40] UNOBSTRUCTED AREA [ 1 (17] SYSTEM LOCATION [*-01 [41] STORMWATER RUNOFF 1 1 1181 DOSING PUMPS _ I l [421 ALARMS [ 1 1191 AGGREGATE SIZE A�j [ ] [431 MAINTENANCE AGREEMENT [ 1 1201 AGGREGATE EXCESSIVE FINES [ �"l` [441 BUILDING AREA [ ] [21] AGGREGATE DEPTH ),q [dam [45] LOCATION CONFORMS WITH SITE PLAN,., [ [461 FINAL' SITE GRADING' FILL ! EXCAVATION MATERIAL [ ] [471 CONTRACTOR [ J [22] FILL AMOUNT (48] OTHER [ 1 1231 FILL TEXTURE [ 1 (241 EXCAVATION DEPTH p "C!] ABANDONMENT a [491 TANK PUMPED I [ ] [25] AREA REPLACED REPLACEMENT MATERIAL QL] [501 1 TANK CRUSHED & FILLED.. [ ] [261 EXPLANATION OF VIOLATIONS / REMARKS: [ I [ l [ l • [ l """" °- �' CHD DATE: CONSTRUCTI [APPROV ANSAPPROVEOr �- Pi C�cm' DATE: FINAL SYST APPROVEDISAPPROVED]:�� L�-� ^CHD Page 2 of 3 DH 4016 (Page 2), 10/97 (Previous Editions May Be Used) Stock Number. 5744 - 002. 4016 -4 PT 1: Applicant PT 2: InstMer/Contractor PT 3: Building Department xra7etet i P.P. PT 4: Health Department T I Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Project Address Parcel Number Applicant 1162 NE 105 Street 1122320280150 CAROL RESPONDEK Miami Shores, FL Block: Lot: Owner Information Address Phone cell CAROL RESPONDEK 1162 NE 105 ST MIAMI SHORES FL 33138 -2108 Contractor(s) Phone Cell Phone ALL PRO SEPTIC & SEWER INC / ALL (305)635 -3002 (305)206 -4473 Type of Work: PLUMBING Type of Piping: TANK & DRAINFIELD Additional Info: Bond Return : Classification: Residential Scanning: 1 Fees Due Amount CCF $9.00 DBPR Fee $4.50 DCA Fee $4.50 Education Surcharge $3.00 Permit Fee $300.00 Scanning Fee $3.00 Technology Fee $12.00 Total: $336.00 Valuation: $ 14,441.00 Total Sq Feet: p Pay Date Pay Type Amt Paid Amt Due I Invoice # PL -6 -11 -41334 07/05/2011 Credit Card 06/30/2011 Credit Card $ 286.00 $ 50.00 $ 50.00 $ 0.00 Available Inspections: Inspection Type: Final Rough In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS 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. Futhermore, I authorize the above -named contractor to do the work stated. July 05, 2011 Authorized Signature: Owner / Applicant / Contractor / Agent Date Building Department Copy July 05, 2011 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 FBC 20 Permit Type: PLUMBING � �cs OWNER: Name (Fee Simple Titleholder): � an Permit No. I ® I Master Permit No. (N Pos — [ _137 L Tenant/Lessee Name: Phone#: Email: �— JOB ADDRESS: - � ` 02_1 City: Miami Shores Folio/Parcel #• `, L 7232_ 02_�3_OI Is the Building Historically Designated: Yes _ County: Miami Dade Zip: NO Flood Zone: CONTRACTOR: Company Name: u �L� 7 1 /1 7 � 3C&— V —3002-, Address: C City: Lcx �-t I State: Qualifier Name: ppli- --p Phone#: State Certification or Registration #: (� ! �yCertificate of Competency ,�,�],1 #: _ Contact Phone#: Email Address: CLURM0oPAI S( DESIGNER: Architect/Engineer: -- Phone#: Value of Work for this Permit: $ f Square/Linear Footage of Work: _ Type of Work: OAddress 0!A "on tion ONew Desc `pbn olrW'� - Tu f (k Sesc i pe DDernolition Submittal Fee $ Permit Fee $ 3 oc>' CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ 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 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 CONDMONERS, 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. "WARNE'14G 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. k�� — &— f ', Signature Signature rJJA ca LA- G Owner or Agent _� Contractor The foregoing instrument was acknowledged before me thi The fore in instrument was acknow edged I] day o €, 2� �by S day of , 20 U by who is use onally known to me or who has produced who p* -personally known to me or who has produced `U` Y t _vAs i ntification and who did take an oath. Lf\ as identification and who did take an oath. NOTARY P BLIC- 'NOTARY ;V LI 9 Sign: b Sign: o lorida state � , IRENIA GUTIERREZ i ion Expkes e r $ °'s Notary PUDUC - State in F-wo My Commission E ' -'� °`' Commission # DD 760394 ( My Co Canmission Exs Fob 2012 �'•.. ��°;:�� p..,�. -- •. � �. Commissbr► # �0 DD 7803384 eeea�eee�eeo�� :eeex+x+�e�eee�e�e� �ee�e�esaee�ex�eee����eee�eeeee�ee�+ eeee��ex�eeee�e�eee�eee�ex�x +�e�e��eee�eeeeeee� APPROVED BY tf Plans Examiner Zoning Structural Review Clerk (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) ./ t ADDENDUM TO BUILDING PERMIT APPLICATION (AN APPLICATION FOR .BUILDING PERMIT MUST. ACCOMPANY THIS ADD ENDUM. IF A MASTER PERMIT FIRS B. OBTAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.) D Y C,;) r�C. iC) S F- s PLUMBING ELECTRICAL MECHANICAL ITEM BATH TUB UNIT FEE ITEM SWITCH OUTLETS UNIT FEE ITEM SPACE HEATERS lMIT FEE BIDET LIGHT OUTLETS CENTRAL HEATING 91&% AM RECEPTACLES A/C (WIND) .DISPOSAL SERVICE TEMPORARY A/C (CENTRAL) DRINKING FOUNTAIN SERVICE SIZE IN AMPS DUCT WORK FLOOR DRAIN SERVICE REPAIR/MM CHANIGE REFRIGERATION GREASE TRAP APPLIANCE OUTLETS PROCESS AND PRESS PIPING INTERCEPTOR RANGE TOP UNDERGROUND TANKS LAVATORY OVEN ABOVE G1;OUND TANKS LAUNDRY TRAY WATER HEATER U.F. PRESSURE VESSELS CLOTHES WASHER MOTORS 0- 1 HP STEAM BOILERS SHOWER MOTORS OVER 1- 3 FP HOT WATER BOILERS SINK, POT/3 COMP. MOTORS OVER 3- 5 FP MEMICAL VENTILATION SINK, RESIDENCE MOTORS OVER 5- 8 NP TRANSPORTING ASSDBLIES SINK, SLOP MOTORS OVER 8- 10 HP ELEVATORS/ESCALATORS TEMPORARY WATER CLOSET MOTORS OVER 10- 25 HP FIRE SPRINKLER SYSTEMS URINAL MOTORS OVER 25-100 HP COOLING TOWERS WATER CLOSET MOTORS OVER 100 FP VIOLATION INDIRECT WASTES -` A/C WINDOW REINSPECTION WATER SUPPLY TO: AIR CONDITIONERS A/C UNIT STRIP HEATER FIRE SPRINKLER GENERATORS TRANSFORMERS HEATER -NEW INST. GENERATORS TRANSFORMERS HEATER - REPLACE GENERATORS TRANSFORMERS LAWN SPRINKLER -WELL SPECIAL PURPOSE SWIMMING POOL. OUTLETS COMMERCIAL WATER SERVICE SIGN TUBES SEWER CONNECTIONS -M / :SIGN TRANSFORMERS UTILITY -SEWER SIGN TIME CLOCK UTILITY -WATER FIXTURES SEPTIC TANK ANTENNA RELAY TELEVISION OUTLETS DRAINFIEID, 4' TILE/RES. / VIOLATION PUMP & ABANOON SEPTIC TANK / REINSPECTION SOAKAGE PIT CU. FT. CATCH BASIN 01SCHARGE WELL DOMESTIC WELL AREA DRAIN ROOF INLET SOLAR WATER HEATER FIRE STANDPIPE POOL PIPING LAWN SPRINKLER SYSTEM GAS RAVE METER SET (GAS) GAS PIPING PERMIT #:13 -SC- 1002322 STATE OF FLORIDA APPLICATIoN, #:AP935917 _ , DEPARTMENT OF HEALTH DATE PAID: ONSITE SEWAGE TREATMENT AND DISPOSAL FEE PAID: «• SYSTEM RECEIPT #: DOCUMENT #: PR788390 CONSTRUCTION. PERMIT FOR: OSTDS New ` APPLICANT: Alan Respondek PROPERTY ADDRESS: 1162 NE 105 St Miami, FL 33138 ' LOT: 15 BLOCK: 1 SUBDIVISION: Miami Shores Estates PROPERTY ID #: 11- 2232 - 028 -0150 [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 VROM COMPLIANCE WITH OTHER FEDERAL, STATE, OR LOCAL PERMITTING REQUIRED FOR DEVELOPMENT OF THIS PROPERTY. SYSTEM DESIGN AND SPECIFICATIONS T [ 1,200 1 GALLONS / GPD SeDtic CAPACITY A [ ] GALLONS / GPD N/A CAPACITY N [ (•GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]_ K [ I GALLONS DOSING TANK CAPACITY [ (GALLONS @[ ]DOSES PER 24`HRS #Pumps [ ] D [ 834 1 SQUARE FEET SYSTEM R [ I SQUARE FEET N/A SYSTEM A TYPE SYSTEM: [ I STANDARD [X] FILLED [ I MOUND [ l I CONFIGURATION: [.]:TRENCH [X] BED [ I N .. F LOCATION OF BENCHMARK: 5.68' NGVD C/L NE 105 St I ELEVATION OF PROPOSED SYSTEM SITE [ 0.24 l [INCHES FT 1E BELOW I BENCHMARK /REFERENCE POINT , E BOTTOM OF DRAINFIELD TO BE [ 8.16 1[ INCHES FT ICABOvE A BELowl BENCHMARK /REFERENCE POINT L D FILL REQUIRED: [ 9.60j INCHES EXCAVATION REQUIRED: C 51.00] INCHES 0 - ......... ,-.... yW..,,,. ,.--W-. '— --V.- wnn ..w, — cups, v•..v mw,. 2.-The licensed contractor installing the system is responsible for installing the minimum category of tank in accordance T with S. 64E- 6.013(3)(0, FAC. H 3.- Install 834 sf of drainfield in bed configuration. 4.- Install 42 of slightly limited soil at the bottom of the drainfield. E 5.- Perimeter of excavation area shall be at least 2 ft wider and longer than the proposed absorption bed R (Comments Continued on Page 2.) SPECIFICATIONS BY id V Edwar s TITLE: Engineer Specialist II APPROVED BY: TITLE: Engineer Specialist II Dade CHD Astrid V Edwards - - - DATE ISSUED: 10/21/2009 EXPIRATION DATE: DH 4016, 10/97 (Previous Editions May Be Used) gage, v 1.Z.4 AP935917 S &799379 ACORQ CERTIFICATE OF LIABILITY INSURANCE DATE IMMIDD/ 05/20/2011 PRODUCER 30S. SS9. 1101 FAX 305.822.4722 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Keen Battle Mead & Company ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 7850 Northwest 146 Street HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Suite 200 Miami Lakes, FL 33016 INSURERS AFFORDING COVERAGE NAIC # INSURED All Pro Plumbing Corp;All Pro Septic & Sewers INSURER A: Scottsdale Insurance Co 41297 Inc;All Pro Plumbing Septic & Sewers Inc; All INSURERS: Travelers Indemnity Company 09490 Pro Investment;All Pro Investment Holdings INSURERc: Bridgefield Employers Ins Co 10701 2700 NW 27 Avenue INSURER D: Miapi, FL 33142 INSURER E: COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR ADDL S TYPE OF INSURANCE POLICY NUMBER POLICYEFFECTiVE DATE MMID POLICYEXPIRATION DAZE D LIMITS 10050 NE 2 Ave A AUTHORIZED REPRESENTATIVE GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY �CLAIMS MADE OCCUR CPS1286866 02/01/2011 02/01/2012 EACH OCCURRENCE $ 11000,00 PREMISES Ea occurrence $ 100, OO MED EXP (Any one person) $ 5,004 PERSONAL & ADV INJURY $ 1,000,00( GENERAL AGGREGATE $ 2,000,00( GEN'L AGGREGATE LIMIT APPLIES PER: POUCY JET LOC PRODUCTS - COMP /OP AGO $ 2,000,00( B AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON - OWNED AUTOS BA0326R110 05/20/2011 05/20/2012 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ - GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC AUTO ONLY: AGG $ $ A EXCESS I UMBRELLA LIABILITY OCCUR FI CLAIMS MADE DEDUCTIBLE RETENTION $ XLS0072184 02/01/2011 02/01/2012 EACH OCCURRENCE $ 1,000000( AGGREGATE $ 1,000,00( $: $ $ C WORKERS COMPENSATION AND EMPLOYERS! LIABILITY ANY PROPRIETORIPARTNER/EXECUTIVE� OFFICERIMEMBER EXCLUDED? (Mandatory in NH) SPECIAL PROVISIONS vi below 83027445 04/06/2011 04/06/2012 TORY LIMITS ER E.L. EACH ACCIDENT $ 1,000,00( E.L. DISEASE - EA EMPLOYEE $ 1,000,00C E.L. DISEASE - POLICY LIMIT $ 1,000,60 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION AGUKD 25 (ZUUS /UT) FAX: 305.756.8972 V IV1H5 -ZUU1V AGUKL7 VUKYUKA 1 IUN. Ae rlgnLS reserves. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL City Of Miami Shores IMPOSE NO OBLIGATION OR LIABILITY OF ANY IONO UPON THE INSURER, ITS AGENTS OR 10050 NE 2 Ave REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Miami Shores, FL 33137 Alex Perez /7MC AGUKD 25 (ZUUS /UT) FAX: 305.756.8972 V IV1H5 -ZUU1V AGUKL7 VUKYUKA 1 IUN. Ae rlgnLS reserves. The ACORD name and logo are registered marks of ACORD IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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 certificate holder in lieu of such endorsement(s). DISCLAIMER This Certificate of Insurance does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. AGORD 25 (Z00Bi09 )