PL-14-1380Miami Shores Village
Building Department JUN
10050 N.E.2nd Avenue, Miami Shores, Florida 33j38 2014
Tel: (305) 795-2204 Fax: (305) 756-8972
0
INSPECTION LINE PHONE NUMBER: (305) 762-4949~
FBC 20 Q6
BUILDING Master Permit No.d39�"d
PERMIT APPLICATION Sub Permit No.
❑BUILDING F-1 ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
®PLUMBING ❑ MECHANICAL F-1 PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS:-; N \lJ it) See,
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: VO % 4023- 6/.:Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: aS Flood Zone: A(D BFE: FFE:
City: MZ)g—m/ CS1'fD2C' State: _� Zip: ,j3_0
Oenant/Lessee Name:_
Email: •-J t
-Phone#:
CONTRACTOR: Company Name: —#q'I i� i'l ol�`%7 /,i(d Phone#: C3�
7 �°" a u 7 O
Address: 15 9�/
City: �lelyl ! State: Zip: szm �-
Qualifier Name: ogr lc�_T j/�,ern Phone#: y1 A�.
State Certification or Registration #: CS/�F, Imo, ��� u®� Certificate of Competency #: /�
DESIGNER: Architect/Engineer: Phone#: '7 5 � �epu"o
Address: City: State: Zip:
Value of Work for this Permit: $ !Mr Square/Linear Footage of Work:
Type of Work: ❑ Additionn /❑_ �� Alteration El New
.-� /' C, Repair/Replace ID Demolition
Description of Work: :_Ta 7L�A__n L l �/�K- t 1%*Gt-j 1�11449
Specify color of color thru tile:
Submittal Fee $ Permit Fee $ CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Notary $
Technology Fee $ Training/Education Fee $
Structural Reviews $
(Revised02/24/2014)
Double Fee $
Bond $
TOTAL FEE NOW DUE $
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€� the work an&b stalii�tions as indieaied. II I cer*. that no work or iistalladon has
3 tbat all work will be perforiped to meet the standards of all laws reguh6 as
separate permit must be secured for, jXCr IC WORK, PLUMBING, $IGNS
htto:/Aeeb.mail. tnet/seNce/haW— tim3ae.iow?auth=co&loc=en US8id=603341&oart=4
Zotung,
Clerk
From: 7865395989 Thu 26 Jun 2014 07:54:46 PM UTC
Page 1 of 1
CERTIFICATE OF LIABILITY INSURANCE
°A't(M`�°14
06/26/3014
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS.
CERTIFICATE. DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED .BY THE POLICIES
BELOW. THIS. CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE. HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the poticy(ies) must be endorsed. IF SUBROGATION IS WANED. subject to
the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder In lieu of such endorsement(s).
PRODUCER
Temax Insurance Inc
CONTACT
NAME Xamet BarreraS
PHONEF '
. (M) 539 -159139 Not (305) 356 -1235
7990 SW 117 Ave
A.MAILAppgEsa: xam6tQtemaxinsurance.cOm
Suite 113
Mlami. FL 33183
INSURER(4) AFFORDING COVERAGE NAIL S
INSURER : Capacity Insurance Company
INSURED
Pulles Plumbing Corp
INSURER
1NSURER C
8541 SW 13311d PI
INSURER D
INSURER E:
Miami FL 33183
INSURER F:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURff NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT'WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.
EXCLUSIONS AND CONDITIONS OF SUCHROLICIES. LIMITS SHOWN, MAY HAVE BEEN REDUCED BY PAID CLAIM$.
INLTR SR TYPE OF WSURANCE
AIYgL
SUER
POLICY NUMBER
POLICY EFF
POLICY EXP
LIMITS
GENERAL LIABILITY
COMMERCIAL GENERAL LIA6ILITY
CLAIMS -MADE � OCCUR
EACH OCCURRENCE S 1,000,000J'�
AAMAIETEMtSESNENTED S 100;Q04
MED EXP (Any oneperson) S. 5,1)00
A
CLM01002727B
4110/2014
411012015
PERSONAL& ADV INJURY 9 1,000,000
GENERAL AGGREGATE S 2,000,000•
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMPIOP AGG S 2,001)0a
POLICY PR LOQ
S•
AUTOMOBILE
LIABILITY
MINED SINGLE LIMIT
ANY AUTO
eODILY INJURY (Per person) S
AUTOS m
BODILY INJURY. (Per aocdern) S
AtC/Hr.OESol1LED
HIRED AUTQS AL TOSOWNED
PROPERTY DAMAGE S
S
UMBRELLALIAB
:OCCUR
EACH.00CURRENCE S
EXCESS LIAS
CLAIMS -MADE
AGGROGATE S
DIED I I RETENTION
S
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY .YIN
.VUC STATU. OTH-•
TORY LIMITS ER
ANY PROPRIErORIPARTNER/EXECUTNE
OFF(CER/AAEMSER EXC,LUDEW
NIA
E.L. EACH ACCIDENT S
51. DISEASE - EA EMPLOYEE S
(Mandatory in NHy
tf yes; describe under
DESCj
E.L.DISEASE-POLICYLIMT 9
ON below
DESCRIPTION OF OPERATION&I LOCATIONS l VEHICLES (Attach ACORDIOT. Additional Remarks Schad ule,.if more space Is required)
Plumbing Contractors. CF0056693
SHOULD ANY OP THE ABOVE DESCRIBED POLICIES BIE. CANCELLED OMR5
City Of Miami ShoresSHOULD
EXPIRATION DATE THEREOF, NOTICE VALL "BE" DELIVERED IN
Building and Zoning ACCORDANCE WITH THE POLICY PROVISIONS.
10$50 NE. 2 Ave
AUTHORIZED REPRESENtATIVE r
Miami Shores Village FL 33138 '` •`
01888 2010 ACORD CORPO•RAT10N, All rights reserved..
ACORD 25 (2010105k The ACORD name and logo are registered, marks of ACOR'D
r
EPAM
STATE OF FLORIDA`..' .,PI_n. D'-- COUNTY HEATH D-P.AR'%AF '
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION PERMIT
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: Leana Villareal
PROPERTY ADDRESS: 163 NW 101 St Miami, FL 33150
BLOCK: 2 SUBDIVISION: Bonmar Park
PROPERTY ID #: 11-3101-023-0150
PERMIT #:13 -SC -1544144
APPLICATION #: AP1150267
DATE PAID:
FEE PAID:
RECEIPT #:
DOCUMENT #: PR942707
[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
T ( 900 1 GALLONS / GPD septic tank CAPACITY
A [ ] GALLONS / GPD CAPACITY
N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps
D [ 200 1 SQUARE FEET bed configuration drainfiel SYSTEM
R [ 1 SQUARE FEET SYSTEM
A TYPE SYSTEM: [x] STANDARD [ ] FILLED [ ] MOUND [ ]
I CONFIGURATION: [ ] TRENCH [g] BED [ ]
N
F LOCATION OF BENCHMARK: crown of road NW 101 St. 10.89' NGVD
I ELEVATION OF PROPOSED SYSTEM SITE ( 0.24 1 INCHES FT ][ ABOVE BELOW BENCHMARK/REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 42.24 1 [FI—Nc-H—Es-T FT ][ABOVE BELOW BENCHMARK/REFERENCE POINT
L
D E
0
T
H
E
R
ILL REQUIRED: [ ] INCHES EXCAVATION REQUIRED: i, 04.UU J LL4L;n b
1. -Install a 900 gal 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 200 sf of drainfield in bed 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:
APPROVED BY:
DATE ISSUED:
DH 4016, 08/09
Incorporated:
TITLE:
A
TITLE: Engineering Specialist II Dade CHD
Erlande Omisca
06/18/2014 EXPIRATION DATE: 09/16/2014
(Obsoletes all previous editions which may not be used)
64E-6.003, FAC Page 1 of 3
v 1.1.4
si.All
DOCUMENT #: PR942707
.-Invert elevation of drainfield to be no less than 7.87' NGVD.
.-Bottom of drainfield elevation to be no less than 7.37' NGVD.
.-This permit includes the abandonment of the existing septic tank,
he system is sized for 2 bedrooms with a maximum occupancy of 4 persons (2 per bedroom), for a total estimated flow of
300 gpd.
"THIS REPAIR PERMIT IS NOT FOR ANY ADDITIONS"
NOTICE OF RIGHTS
A party whose substantial interest is affected by this order may petition for an
administrative hearing pursuant to sections 120.569 and 120.57, Florida Statutes. Such
proceedings are governed by Rule 28-106, Florida Administrative Code. A petition for
administrative hearing must be in writing and must be received by the Agency Clerk for the
Department, within twenty-one (21) days from the receipt of this order. The address of the
Agency Clerk is 4052 Bald Cypress Way, BIN # A02, Tallahassee, Florida 32399-1703. The
Agency Clerk's facsimile number is 850-410-1448.
Mediation is not available as an alternative remedy.
Your failure to submit a petition for hearing within 21 days from receipt of this order
will constitute a waiver of your right to an administrative hearing, and this order shall become
a 'final order'.
Should this order become a final order, a party who is adversely affected by it is
entitled to judicial review pursuant to Section 120.68, Florida Statutes. Review proceedings
are governed by the Florida Rules of Appellate Procedure. Such proceedings may be
commenced by filing one copy of a Notice of Appeal with the Agency Clerk of the
Department of Health and a second copy, accompanied by the filing fees required by law,
with the Court of Appeal in the appropriate District Court. The notice must be filed within 30
days of rendition of the final order.
STATE OF FLORIDA APPLICATION # AP1150267
DEPARTMENT OF HEALTH PERMIT # 13 -SC -1544144
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM DOCUMENT # SE931480
SITE EVALUATION AND SYSTEM SPECIFICATION
APPLICANT: Leana Villareal
CONTRACTOR / AGENT: Pulles Plumbing
LOT: 14.15 BLOCK: 2
SUBDIVISION: Bonmar Park ID#: 11-3101-023-0150
TO BE COMPLETED BY ENGINEER, HEALTH DEPARTMENT EMPLOYEE, OR OTHER QUALIFIED PERSON. ENGINEERS MUST
PROVIDE REGISTRATION NUMBER AND SIGN AND SEAL EACH PAGE OF SUBMITTAL. COMPLETE ALL ITEMS.
PROPERTY SIZE CONFORMS TO SITE PLAN: [X]YES [ ]NO NET USABLE AREA AVAILABLE: 0.18 ACRES
TOTAL ESTIMATED SEWAGE FLOW: 300 GALLONS PER DAY [ RESIDENCES-TABLEI / OTHER -TABLE 2 ]
AUTHORIZED SEWAGE FLOW: 460.00 GALLONS PER DAY [ 1500 GPD/ACRE OR 2500 GPD/ACRE ]
UNOBSTRUCTED AREA AVAILABLE: 400.00 SQFT UNOBSTRUCTED AREA REQUIRED: 300.00 SQFT
BENCHMARK/REFERENCE POINT LOCATION: crown of road NW 101 St. 10.89' NGVD
ELEVATION OF PROPOSED SYSTEM SITE 0.24 I INCHES / FT ] I ABOVE J BELOW ] BENCHMARK/REFERENCE POINT
THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES
SURFACE WATER: N/A FT DITCHES/SWALES: N/A FT NORMALLY WET: I ]YES [ ]NO
WELLS: PUBLIC: N/A FT LIMITED USE: N/A FT PRIVATE: N/A FT NON -POTABLE: N/A FT
BUILDING FOUNDATIONS: 5 FT PROPERTY LINES: 10 FT POTABLE WATER LINES: 40 FT
SITE SUBJECT TO FREQUENT FLOODING? [ ]YES [X]NO 10 YEAR FLOODING? [ ]YES [XINO]
10 YEAR FLOOD ELEVATION FOR SITE: FT[ MSL /NGVD ] SITE ELEVATION: 10.80 FT I MSL / NGVD
SOIL PROFILE INFORMATION SITE 1 SOIL PROFILE INFORMATION SITE 2
USDA SOIL SERIES:
Munsell #/Color
Urban land
Texture Depth
10YR 8/3
Sand 0 To 56
10YR 7/3
Oolitic Limestone 56 To 72
USDA SOIL SERIES:
Munsell #/Color
Urban land
Texture Depth
10YR 8/3
Sand 0 To 51
10YR 7/3
Oolitic Limestone 51 To 72
OBSERVED WATER TABLE: INCHES [ ABOVE / BELOW ] EXISTING GRADE TYPE: [ F PERCHED / APPARENT )
ESTIMATED WET SEASON WATER TABLE ELEVATION: 82 INCHES I ABOVE / BELOW ] EXISTING GRADE
HIGH WATER TABLE VEGETATION: [ ]YES [X]NO MOTTLING: [ ]YES [X]NO DEPTH: INCHES
SOIL TEXTURE/LOADING RATE FOR SYSTEM SIZING: Replacement 4-FS/0.60 DEPTH OF EXCAVATION: 54 INCHES
DRAINFIELD CONFIGURATION: [ ] TRENCH [X ] BED [ ] OTHER (SPECIFY)
7 REMARKS/ADDITIONAL CRITERIA
SITE EVALUATED BY: DATE:
(Title:)
D8 4015, 08/09 (Obsolete9 previous editions which may not be used) Incorporated: 64E-6.001, FAC
06/13/2014
Page 3 of 4
AP11GO267 EID1544144 v 1.0.2
p z_'_' / Ll - / SoL'-)
OIVIS10R or
Environmental Health
Florida Health
Miami -Dade County
OSTDS/Well Division
W SW 26ih Strcct • Miami, FL 33175