PL-14-1382Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 214942 Permit Number: PL -6 -14 -1382
Scheduled Inspection ate: July 10, 2014
Inspector: Diaz, Osvaldo
Owner: DANIEL,1NYCE
Job Address: 82 NW 98 Street
Miami Shores, FL 33150-
Project: <NONE>
Contractor: JOE LEWIS SPECIALTY SEPTIC
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Septic
Phone Number (786)517 -7915
Parcel Number 1131010330230
Phone: (305)662 -7979
Building Department 'Comments
SEPTIC SYSTEM AND DRAIN FILED
Infractio Passed Comments
INSPECTOR COMMENTS
False
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid
Inspector Comments
HRS ON FILE
lic
July 09, 2014
For Inspections please call: (305)762 -4949
Page 22 of 44
midi' Health tailleattli
M mi -Dade County
/Well Dton;: v
�. Qs M
a {: .11805 SW26°',Street • Miami, FL 33195
T spect� � '� p Date ' /3(.z.o i 11
tithei s ,
Cotntnens'
Miami Shores Village
Building Department
1050 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
t T LU 1NG
JOB ADDRESS:
FBC 20/0
Permit No.
Master Permit No:.pZ /7 /3E a
City: . ...Miami Shores
County: Miami Dade
1lio/Parcel # :.
Is the Building Iistarlcally Designated: Yes
OWNER: Name (F Simple Ti� r):
Address:
City: lam/
Tenant/Lessee Name:
Email:
Zip :,
NO
Flood Zone:
Phones# . & ep ` `! 9' c.,s
9 `
rzA
State: I.
Zip:
Phone#:
CONTRACTOR: Company Name: J1t. L ! r pez.1A- 6'?
Address: 3 aV ,ti✓ . 9i 5.74
City: ... /h i0 M , State: F /
Qualifier Name: cid, .e:- //
GC -t� � T
State Certification or Registration #:
Contact Phone#: 7g4-243 -172 3 Email Address:
DESIGNER: Architect/Engineer: •
eirhone#:
7g4- 213±723
Zip: 23 /Cl 7
Phone#:
Certificate of Competency #:
4;1)3 iC e.r i`J° 476 gel A
Phone#:
Value Work for this Permit: $ / C'°7° Square/Linear Footage
Type of Work: LIAddress OAlteration UNew
Description of Work: �e ii B iG .sVi 9 PM 2
Work: jP2 2.5 S,.,7d
/Replace Obemoliition
+ *v* e. ****** ** * a**e***s* e;e * ***p *** * **Fees***aexca** ***fla** ** ** * ** ***********e***** o
Submittal Fee $ Permlt. Fee $ 130CA icy CCF $ CO /CC $
Scanning Fee $ ; Radon Fee $ .. DBPR $ Bond $
Notary $ Training/Education Fee $ Tee,,,;,.:; Fee $
Double Fee $ Structural Review $��
TOTAL FEE NOW DUE $ 1 o U
Bolding Company's Name (if applicable)
Bonding Company' Address
City State Zip
Mortgage Lender's Nante (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 Fi.F.CTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, I}URNACES, BOILERS, HEATERS, TANKS and AIR CONDiTIONERS, ETC.....
OWNER'S AVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all
applicable laws reg Ling 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
FINANCIN_ - , CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORDING YOUR NOTICE . OF COMMENCEMENT."
Notice w Applicant: As a condition to the issuance of a building permit with an. estimated value exceeding $2500, the applicant must
pose in good f
whose property is
for the first inspe
inspection will not
that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
ect to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
on which occurs seven (7) days after the budding permit is issued ti the absence such posted notice, the
e approved and a reinspection fee will be charged. O
Fflir Agent:
The. foregoing instrument ackno fwledged before me this _
day of J rie, 20'i 4, by IL/ 9 C b 1
who is personally known to me or who has produced
As identification and who did take an oath.
NOTARY PUBLIC:.
sign:
Pruti:. ►^
My Co
°e, SHUNDRA S. HARDY
Notary Public - State of Florida
,3tillifz411113,441 b .x104424
Commission # EE 64890.
Signature
Contractor
The forego %' g instrument was acknowledged before me this jU
day of J1-4(1C , 2014 , by j4'e L,_c, , • i s
who is personally known to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print
My C
ha!3000CCCCCCCC * *+N *CCC
APPRO
Plans Examiner
Structural Review
(ttevised3 /I2l2O12)(Revised 07/10/07XRevised 06/1012009j(Revised 3115/09)
ss.* " � s t DY.
-NO ary Public - State of Florida
: My. Comm. Expires Feb 15, 2015
•
Commission # EE 64890
Zoning
Clerk
Miami Shores Viiiage
Building Department
1005b N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
CONTRACTORS' REGISTRATION
ALL CONTRACTORS MUST PROVIDE COPIES OF LICENCES AND INSURANCES EACH TIME A PERMIT IS SUBMITTED.
IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR:
A. COPY OF QUALIFIER'S STATE LICENCES
B. COPY OF LOCAL BUSINESS TAX RECEIPT
C. COPY OF LIABILITY INSURANCE*
D. COPY OF WORKERS COMPENSATION INSURANCE*
IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY:
A. COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER
B. COPY OF LOCAL BUSINESS TAX RECEIPT
B. COPY OF STATE REGISTERED CONTRACTOR LICENSE OR MIAMI DADE COUNTY MUNICIPAL
CONTRACTOR'S TAX RECEIPT.
C. COPY OF LIABILITY INSURACE*
D. COPY OF WORKERS COMPENSATION INSURANCE*
*YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE AS FOLLOW:
Certificate Holder:
MIAMI SHORES VILLAGE BLDG DEPT
10050 NE 2ND AVE
MIAMI SHORES, FL 33138
Certificate must specify the description of operations or contractor license number.
BUSINESS NAME: 'Joe. Lew,s ._.Sep f �c
BUSINESS ADDRESS:
2 iS 'VJ 9i Sf CITY Mil6A4'
STATE p ZIP CODE 3314/ 7
BUSINESS PHONE: ( ae:c ) / 7 023 FAX NUMBER ( )
CELL PHONE ( 7n) ,20-/ 7 2 3 QUALIFIER'S NAME: J 0 4-
QUALIFIER'S LIC NUMBER: J i2.00 Is 9
LOG s� e+ e
Miami -Dade �r CouIn s 8 Stage of Fla Florida
-TN* IS, NOT 7A etti DO NOT PAY
71724:
subanhit a NAME/LOCAttON
LEWIS Jt SPECIRLr(SEPTIC.''
LLC
2325,
te�eser_ . �g e.�'s
vrrarrti -.. •
SEPTEMBER 30; 2014
Must be diypioyed at placa of business
Pursuant to County Coati
Chapter 0
o uER SEC. TYPE OF atasitESS PAYMEtb7 RECEIVED
LEWIS JOE SPECIALTY SEPTIC LLC 1AB SPECIALTY PLUMBING BY T,AX COu,ECros
CIO JOE LEWIS MGR CONTRACTOR 7580 ' 08/25/2014
Wo ker(S). 1 SE0081499 0224 -14- 008018
Tbis Lapel BuelaaesTax Receipt only confirms payment at* lapel BusinessTax.The Receipt tint a Haense,
opneL g overn ior a cerftiBt toa n oa toy t e bo and s q uaeglfl ulone,
in ats t do o bu staesa
b applyto Hthoe ld
gautplygwi t anygvomeon)l
`Te RECEIPT* above a displayed malt vehicles - Mtarei- badeCade Bop Se-28. o
Forn►reiuf rIratoa:vltt
L C
. CERTIFICATE OF LIABILITY 1 0/1 01201 2
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. TMS
CERTIFICATE DOES NOT AFFSIMATIVBX OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY 1HE 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 certMcWholderis an ADDITIONAL liBURED, the policy/fee) must Be endorsed. If SUBROGATION IS WAIVED, s to
the terms and conditions of pig, sorb* poffclos may require an endorsement A statement on this calfilcate does not confer rights to the
certificate holder le lieu °fetich s),
PRODUCER CONTACT
Admire! Insurance, Inc. PHONE .No. Egg_ �1 -1378 -_ _ __ •
17340 NW 27th Ave.
adrairalinselanmaLcom
Miami Gardens, FL 33056 8) A _ __ _ _ ._. COVERAGE __
Phone (3051621 -1370 �.__.
i ntsuRst A • LLOYDS OF LONDON.
LEWIS SEPTIC sISU B;.
INSURER c:
3075 SW 61 Ave INSURERN :
iiAIRAMAR, FL 33023- EIMER E: ....
_..__ THE ins is .� - -- INSURER F: COVERAGES . CERTIFICATE NUMBER: REVISION NI/MBER: D CERTIFY TST LICINSURANCE o BEEN ISSUED
TO THE INSiREn MANED ABOVE R THE POLICY PERIOD r CUfTi I REO E T TERM BELOW }!itH
• CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS Sf�ECl�OOALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
L7R _ T TYPE OF E 'NER : WED �YnUDBER tv DYYyyi
LOWS
• GE ERI L IjfY
aftcH oCCut .SE s 100:000.00
COMMERCIAL MINERA.LIABE.irt : DAMAGE TO RENTED
n PRBaS� c� I_. S 1t� 80D fit
u CLA7 4DE OCCUR GUCOI AfSD E3T tArsy one person; ... �. 5�t10€}.00
A 101012012 10102014 2014 _ -
,YEWINAL &ASV BURY $ 100,00000
GENERAL GAVE - s 200,0)0.00
: PRODUCTS- /OP AGO s 100_800_00
DATE (NM+ODmYn
-___ WAWA _ —
•• •
0
GENT. AGGREGATE LENT APPLIES PER
POLICY L_i_ D _L
AWITNADINLE ITT
Q ANY Aura
0 AUT OWNED 0 SCHEDULED
n
HIRED AUTOS [;
... .-.i ._....- __..._...
j t LLALiAB 0 ..._ :. OccuR
• 0 EXCESS use ' '
.- DEO o RETENNONS
AND EMPLOYERS' LtraTY YIN
ANY PROPRETOmpARTNEIVEXEcUTIVE •
Mandatory In NfA
Um describe under •
__ mSCRIPTION OF OPERATIONS beIe t
.DESCIEPTION OF OPERATIONS/ VEHICLES (Attach ACORD 101, Additional R de. if mass space Is required)
SEPTIC TANK CONTRACTOR
LICENSE # SR0081599
CERTIFICATE HOLDER
Miami Shores Village
Building Department
10050 NE 2 Ave FL 33138
ACORD 25 (2010/05) QF
$
COMBINED SINGm • tsar Ma ao 4 s
BODILY INJURY (Per per) S
BODILY INJUI'tYMer =Nat) $
$
EACH O�__.. $ ________
- AGGREGATE $
= _TORYLnoT�... ERA.
E.L. EACH AST S
E.L. DISEASE -4A EMPLOYEE $
EL. DEMASE- YLt T<
_
CANCELLATION
10/27 -2012
JEFF ATWATER STATE OF FLORIDA
CHIEF FINANCIAL OFFICER DEPARTMENT OF FINANCIAL SERVICES
DIVISION OF WORKERS' COMPENSATION
* * CERTIFICATE OF ELECTION TO 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: 10/27/2012 EXPIRATION DATE: 10/27/2014
PERSON: LEWIS JOE JR
FEIN: 262847579
BUSINESS NAME AND ADDRESS:
LEWIS SEPTIC SERVICE LLC
3075 SW 61 AVE NORTH APT.
MIRAMAR FL 33023
SCOPES OF BUSINESS OR TRADE:
1- DRAINAGE 2- SEPTIC TANKS
IMPORTANT: Pursuant to Chapter 440. 0504), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this
section may not recover benefits or compensation under this chapter. Pursuant to Chapter 440.05(12), F.S., Certificates of election to be exempt... apply only within the
scope of the business or trade listed on the notice of election to be exempt. 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
certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person
named on the certificate to meet the requirements of this section.
STIONST 185 IN 413-1609
IC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09-
Registered Septic tank :Contractor
SR0081899
Registration Expires on September 30, 2014
JOE LEWIS
3075 NW 61 AVENUE
MIRAMAR FL 33023.
JOE LEWIS SPECIALTY SEPTIC
Business Authorization: SE0081499
•
Notice to
Miami Shores Viiiage
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
wner - Workers' Compensation Insurance Exemption
Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05
allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project
prior to obtaining a building permit. Pursuant to the Florida Division of Workers' Compensation Employer Facts Brochure:
An
employer in the construction industry who employs one or more part-time or full -time
employees, including the owner, must obtain workers' compensation coverage. Corporate
officers or members of a limited liability company (LLC) in the construction industry may
elect to be exempt if
1. The officer owns at least 10 percent of the stock of the corporation, or in the case
of an LLC, a statement attesting to the minimum 10 percent ownership;
2. The officer is listed as an officer of the corporation in the records of the Florida
Department of State, Division of Corporations; and
3. The corporation is registered and listed as active with the Florida Department of
State, Division of Corporations.
No more than three corporate officers per corporation or limited liability company members
are allowed to be exempt. Construction exemptions are valid for a period of two years or until
a voluntary revocation is filed or the exemption is revoked by the Division.
Your contractor is requesting a permit under this workers' compensation exemption. In these circumstances, Miami Shores Village
does not require verification of workers' compensation insurance coverage from the contractor's company. Therefore, you may be
personally liable for the worker compensation iniuries of any person allowed to work under this permit Please check with your
insurance carrier since most property insurance policies DO NOT cover this type of liability.
BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS
CONTENTS.
Owner
Print Name: Nyoe
Signature:
State of Florida )
County of Miami -D
Sworn to And, sub
day of
By PM-AV—I&
e)
bed before me thi
(
Teype of Identification produced I4#25
20 /
Print Name:
Signature:
Contractor
State of Florida )
County of Miami -Dade )
Sworn to -:i d subscribed before me thi
20 / •
.001116111/17/4#
,mil,
ttn
aEE0
. EAL)
ype of Identification produced t±7/2 `--y ejer
.e p
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM
CONSTRUCTION PERMIT
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: Nyle Daniel
PROPERTY ADDRESS : 82 NW 98 St Miami, FL 33150
L/
T D
JUN 2 7 2014
PERMIT #: 13-SC- 1542666
APPLICATION 5:A131149358
DATE PAID:
43'2 FEE PAID:
RECEIPT #:
DOCUMENT #: PR942317
LOT: 11 12
BLOCK: 129 SUBDIVISION:
PROPERTY ID 5: 11- 3101 -033-0230
[SECTION, TOWNSHIP, RANGE, PARCEL NUMBER]
[OR TAX ID NONZERO
SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF SECTI
381.0065, F.S., AND CHAPTER 64E -6, F.A.C. DEPARTMENT APPROVAL OF SYSTEM DOES NOT
SATISFACTORY PERFORMANCE FOR ANY SPECIFIC PERIOD OF TIME. ANY CHANGE IN MATERIAL FACTS
WHICH SERVED AO A BASIS FOR ISSUANCE OF THIS PERMIT, REQUIRE THE APPLICANT TO MODIFY
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.
NV
SYSTEM IGN SPECIFICATIONS
T 900 7 GALLONS / GPD Septic CAPACITY
A l GALLONS / GPD CAPACITY
N [ 0 ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
K [ 1 GALLONS DOSING TANK CAPACITY [ }GALLONS @[ ]DOSES PER 24 HRS #Pumps [
D [ 225 ] sQv19RE FEET Trench configuration drain SYSTEM
R [ 0 ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [x] STANDARD [ ] FULLED [ ] MOUND [ ]
I CONFIGURATION: [x] TRENCH [ ] BED [ ]
N
F LOCATION OF BENCHMARK: COR
I ELEVATION OF PROPOSED SYSTEM SITE [ 5.40 ](J INCHES I FT ][ ABOVE BELOW BENCHMARK /REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE
L
D FILL REQUIRED:
0
T
H
E
R
[ 0.00 ] INCHES
[ 41.40 ] (J INCHES FT ] [ ABOVE BELOW BENCHMARK /REFERENCE POINT
EXCAVATION REQUIRED: [ 48.00] INCHES
1.-Install a 900 g.! min. septic tank with an approved filter.
2.-The licensed Contractor installing the system is responsible for installing the minimum category of tank in accordance
with s. 64E- 6.013(3)(f), FAC.
3.-Install 225 sf of drainfield in trench configuration.
4. Install 12" of slightly limited soil at the bottom of the drainfield.
5.- Perimeter of excavation area shall be at least 2 ft wider and longer than the proposed absorption bed or drain trench.
(Comments Continued on Page 2.)
SPECIFICATIONS BY: Joe Lewis
APPROVED BY:
Betsy Lange- olmino
DATE ISSUED: 06/13/2014
TITLE:
TITLE: Engineering Specialist II
Dade CHD
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E- 6.003, FAC
v 1.1.9 AP1149358 SE931156
EXPIRATION DATE: 09/11/2014
Page 1 of 3
STATE OF FLORIDA
DEPARTMENT OF HEALTH
APPLICATION FOR ONSITE SEWAGE. DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permit Ammon Number
PART II - SITEPLAN
Scale-, Each {, - • -� - 10 feet and 1 inch = 40 feet.
U. !rJIiii Siii1J11! 1UIliiiiii.Iii
111111111111111111111111111111111111 IMMO imunnniiiimill111111
11111111111111111111111111111111111111111 RIM i•••••• ii1iulu
11111111111111111111111111111111111111111111111111111111111121ailin,11111111111111111
1111111GYMEIMEICIMIMIMI 11111111111111111112111111111111111
i
urguarrelesemsweremborZogNitchingtammomm
"ENAVEM iii ham.._ liminin ��i11 iii.
ma iiiUi lun;i r all ass! isiii tU
IIMEIZZIMONMEMEIEZZLVEil111 1111111111111111
1111 1111111111111MMEMPIE112 I.1II ft !Ii MS 1111111111111111111
111111111111111111111111111122Mmingimmoun IR 11111111filiiia
1111iil1iiiiiii11iiiiioiZii
nummanumniamanmmuniimmummucaunms
Iti�ii�l 11111= i1I#�ai>rai __ •Ih_i li_____i�i>�i�i•____t_
e are no pertinent on a properties and or across the street that may a the New Septic system installer=
es:.
F 2 •t,J $ sT ► Qs-!
/11'104✓_5 - R'k Fro U Nom& -s/s1/4i,
Site Plan submitted by:
Plan Approved Not Approved Date
By • County Health
ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
DH 4115, I (Repay }S-H Form 4016 %Web maybe teed) p - , - 2 at 4
(Stock . 5744 - 002 - 4015 -8)