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PL-14-725Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number. INSP-210694 Scheduled Inspection Date: July 15, 2014 Inspector: Diaz, Osvaldo Owner: MARCELO BORODOWSKI, AAM U'00reeestrc I I f% Job Address: 10659 NE 11 Avenue Miami Shores, FL 33138 - Project <NONE> Contractor: JASON'S SEPTIC INC Building Department comments NEW SEPTIC TANK & DRAIN FIELD Permit Number: PL -4-14-725 Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Septic Phone Number (305)466-4243 Parcel Number 1122320280320 INSPECTOR COMMENTS False Inspector Comments Passed H.R.S ON FILE Failed Correction Needed ❑,, Re -inspection Fee No Additional Inspections can be scheduled until re -inspection fee is paid. Phone: 306-2624080 July 15, 2014 For Inspections please call: (305)762-4949 Page 4 of 31 �o Miami Shores Village; Building Department �� APR ZQ14 90050 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 PermitNo. �L 1 4-- A .4:175 Master Permit No. JOB ADDRESS: / UW 5 C1 / l q City: Miami Shores County: Miami Dade Zip: 1-3� 1 2 Folio/Parce1#: I/ 03'eNn Is the Building Historically Designated: Yes NO `X Flood Zone: OWNER: Name (Fee Simple Titleholder): A A /A �f M1\4* L&2ztS Phoae#: fJ City: " a &A i` state: Tenant/Lessee Name: Email: CONTRACTOR: Company Name:fffrnn'�(z Phone#: Address A7�) L4 I c si i RR QI,LQ City: Qualifier Name: y _ zip: 331 at'_ 1 Phone#: -7$.4 al Sr CIC1W I State Certification or Registration #-SRCTSI W U L -f Certificate of Competency #: Contact Phone#: ('1S ZS -a- 10'80 Email Address: � DESIGNER: Architect/En&eer. ones Value of Work for this Permit: $ /.20c) SquareMnear Footage of Work: Type of Work: DAddress OAlteration ONew Description of Work: &&.&,; n62n Le anni Submittal Fee $ Permit Fee Scanning Fee $ Radon Fee $ -360, r Notary $ Training/Education Fee $ Double Fee $ Structural Review $ ODemolition CCF $ CO/CC $ DBPR $ Bond $ Technology Fee $ TOTAL FEE NOW DUE $ I Bonding Cothpany'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 EMPROVEMENTS 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 po d notice, the inspection will not be approved and a reinspection fee will be charged Owner or Agent The fore oing instrument acknowledged before The day of , 20 , by utqV �, day who is personally known'to me or who has produced As identification and who did take an oath NQTADV DTTDT WN. Sig, Pr,n My APPROVED BY %V—/ Plans Examiner Structural Review M vkwd3/12W12XRevised 07/10NNReviwd 0&1Q/2W9)ftviwd 3/15/09) it was acknowledged before me this 20_, by n�lSC•Y1 N�- (ls`(a'rN is personally known to me or who has produced identification and who did take an oath. NOTARY PUBLIC: � fell `.,� ✓ Ri Zoning Clerk Detail by Entity Name INVESTMENTS, LLC ment Number L10000047285 ,IN Number 272489011 Filed 05/03/2010 FL s ACTIVE 0900 NE 30TH AVE 18 VENTURA, FL 33180 0900 NE 30TH AVE 18 VENTURA, FL 33180 ORODOWSKI, MARCELO 0900 NE 30TH AVE 18 VENTURA, FL 33180 & Address MGR ORODOWSKI, MARCELO 0900 NE 30TH AVE #318 VENTURA, FL 33180 MGR IUIZ, MIGUEL 0900 NE 30TH AVENUE #318 VENTURA, FL 33180 Report Year Filed Date Page 1 of 1 http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetaillEntityName/flal-11... 4/10/2014 ACC>kff ICERTIFICATE OF LIABILITY INSURANCE �r...�' '°�"'P"P' /10/ 4/10/2014 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 pollcy(les) must be endorsed. 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). PRODUCER LRA Insurance 498 3 Lake Destiny Rd Orlando 1!'L 32810 CONTACT NAME: Jacqueline Allen PHONE (407) 838-3445 F C E AC No: (407)838-3460 ADDRESS: INSURER(S) AFFORDING COVERAGE MAIC* INSURMA:Bridgefield Casualty Ins Co 10335 INURED Jason's Septic, Inc 13341 SW 88th Ave Miami TFL 33176 1 INSURER B : INURERC: INSURERD: INSURER E : INSURER F: COVERAGES CERTIFICATE NUMBER:13/14 REVISION NUMRr-R- - - ----- -- -- 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 MAYHAVE BEEN REDUCED BY PAID CLAIMS. ILS TYPE OF INSURANCE an SIM POLICY NUMBER POLICY EFF MMI POLICY EXP bit LIMITS GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TUR= PREMISES Ea occurrence $ COMMERCIAL GENERAL LIABILITY MED EXP (Any one person) $ CLAIMS -MADE D OCCUR PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPtOP AGG $ POLICY PRO LOC FC $ AUTOMOBILE LIABILITY M LE LIMI Ea accident BODILY INJURY (Per person) $ ANY AUTO ALL VED AUTOS D BODILY INJURY (Per accident) $ NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE Per accident $ UMBRELLA LRB HOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE $ DED I I RETENTION $ A WORKERS COMPENSATIONVYC AND EMPLOYED' LIABILITY YIN ANY PROPRIETORIPARTNERIDEC UTIVE 0 OFRCER/MEMBER EXCLUDED? (Mandatory in NH) IP s, describe under DESCRIPTION OF OPERATIONS below NIA 30-51549 /1/2013 91112014 STATU- OTH- X TORY LIMITS ER E.L. EACH ACCIDENT $ 100,000 E.L. DISEASE - EA EMPLOYEE $ 100,000 E.L. DISEASE - POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS t LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more apace is required) License #: SR0031444. Work performed: Repair, Service, Excavation, Maintenance and Cleaning of Septic Tanks. (305)756-8972 City of Miami Shores Attn: Building Department 10050 ME 2nd Avenue Miami shores, rL 33136 A\.V Ru zo kAwf ul uo) INS025 (201005).01 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Tomlinson/DCOGGO 01888-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 12/1112013 03:56 7862067066 STATEWIDE INSURANCE PAGE 01 CERTIFICATE OF LIABILITY INSURANCE F PRODUCER Galloway MBufdIm THIS CERTIFICATE IS ISSUED AS A MATTER OF INPQRMIA710N 1,48,4 South pbft Hwy ONLY AND CONFERS NO RIGM UPON THE CERTIFICATE HOLOM THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Miami, FL 33967 r AFF-ORMt>H�Iclss esLoi�y. Ptlorte (305M&1661..._.__. -F _.... INSURERS AFFORDING COVERAGE � NAIL B MOURNJason'e Sepdiio. no. t . Mesa UMI Ins. Co. 13341 SW SM Avenue Miami, Florida 33178 INSURER C' Vendor 4284584 COVERAGES THE PONES OF INSURANCE USTED HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITMSTANDING ANY RE•QUIRENENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT NTH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BYTHE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POIJCIMS. AGGREGATE L.I-W-8 8MOWN MAY MANE BEEN REDUCED BY PM GLAIIMS. M AWL .LTR A MMq 0 TYPE OF INSURANCE POLICY NUMBER M 12M 1/ 13 MGM Edam, 12M 112014 LlM!" EACH OCCURRENCE $1 000.00 Z'T&*Lw , ~ $10,=00 MID EXP (Any one pe111oN $$,00 GeNEIM LUUMRJTY �i COMMERCIAL GENERAL LIABILITY ❑ n CLAIMS MADE ❑ OCCUR PD: Ded: $1.0001CWun 1109083 PERSONAL &ADV NNW $1,UW,00 -- $2,000,00 GYRAL AGGRHQATE $1.000.00 GWK ACORROATO LIMIT APMM9 PER, ® POLICY ❑ PR0.wT ❑ LOC PRODUCTS - COMPIOP AGG AUTOMOBU LIABIL"Y ❑ ANYAUTO COMBINED SINGLE LIMIT _ ❑ ALL OWNED AUTOS_--- ❑ ❑ SCHEDULEDAUTOS ❑❑ NON OWNED AUTOS NOM N m ❑ _ . .. SODNLY INJURY TE ,�,) . - SOOILY INJURY (Perna" vRTY --- (Per+i d_" _ U GARAGE LrASILrr,► 13 ANY AUTO ❑ _ . AUTO ONLY- EAACCUDENT UTHW IRAN FAAGG AUTO ONLY: G EACH OCCURRENCE y ❑ EXCM I UMBRELLA LIABILITY ❑ OCCUR n CUM MADE AGGREGATE n DEDUCTIBLE ❑ RETENTION 8 _-- _......_ ..... _._._ amnA Vim, L� rvy AND IN ANY PROPRIETOR I PARTNER I BXECUTNEY OFFICER I MEMBER EXCLUDED? e.untler r m-4 _ bulA PRb�Vl9fom3 Wit- OTHER - ❑ _ EL EACH ACCIDENT ILL ILL DISEASE • NA EMPLOYEE F 1 niRFARF _ PrV MY I UT DEBoronwN or opcmTI®N9 / LWAIIOM a VEMCLES r I=CWDIONS ADD® BY ENDORSIBMEW t SPSML rkOVIMNS Ins 100n, Service, Repair, Excavation, Maintenance and Cleaning of Septic Tanks... "Please note that any changes to this policy must be submitted to the Insun mw Company fbr approval"... CERTIFICATE HOLDER City of Miami Shores 10050 NE 2nd Avenue Miami Shores, Florida 39138 Attn: Building Dept Fax S 305.758-8972 W1) OF - CANCELLATION -- SHOULD ANY OF TIB ABOVII DESCRIBED POLICIES 08 TIONDAoY$ =6 WOC1i1im MMURM W TO TH8mull' CA THE LWT, BUT FAILURE TO DO 80 MALL IMPOSE NO OF ANY KIND UPON THE INSURER, ITS AGENTS OR 'M AUMM I�PI�SENTATNL' Jose H Romero, Licensed Agent A225234 ® 1100 CO Tire ACORD atarre slai logo are :ANCELLBD SWORE THE J. WOaAV WR TO NWL HOLDER NAMED TO 81-1=I0N OR LIABILITY MOM of ACORD CONSTRUCTION PERMIT FOR: OSTDS Repair . APPLICANT: (AAM Investments) PROPERTY ADDRESS: 10659 NE 11 Ave Miami, FL 33138 LOT: 4 BLOCK: 3 SUBDIVISION: PROPERTY ID #: 11-2232-028-0320 PERMIT #:13 -SC -1528969 APPLICATION #: AP 1140758 DATE PAID: FEE PAID: RECEIPT #: DOCUMENT #: PR934459 [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 SPECIFICATIONS T [ 900 ] GALLONS / GPD Septic CAPACITY A [ 0 ] GALLONS / GPD CAPACITY N [ 0 ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS] K [ 225 ] GALLONS DOSING TANK CAPACITY [50.00 ]GALLONS @[ 6 ]DOSES PER 24 HRS #Pumps [ 1 ] r D [ 225 ] SQUARE FEET Trench confiquration drain SYSTEM R [ 0 ] SQUARE FEET SYSTEM A TYPE SYSTEM: [x] STANDARD [ ] FILLED [ ] MOUND I CONFIGURATION: [x] TRENCH [ ] BED [ ] N F LOCATION OF BENCHMARK: FFE 8.64' NGVD I ELEVATION OF PROPOSED SYSTEM SITE [ 2.14 ]I INCHES FT ][ABOVE BELOW BENCHMARK/REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ 26.14][ INCHES FT ][ABOVE BELOW BENCHMARK/REFERENCE POINT L D E 0 T H E R .L" "WU.LAW: L U.UU 1 1NUUxti 152LL; aVAT1UN 1MWU mrAW: L ao.UU J 11V1.211'i3 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)(0, 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: Jason TITLE: -;;� pppgpVE0 By; ,,��� TITLE. Engineering Specialist II Dade CHD t ge-01mino DATE ISSUED: 03/27/2014 EXPIRATION DATE: 06/25/2014 DH 4016, 08/09 (Obsoletes all previous editions which may not be used) Incorporated: 64E-6.003, FAC 2rfOP,o R c;ilof 3 v 1.1.4 AP1140758 The contractor (Opt"ate} L. iequired to p ant to the d'einfieid exeavation at the time 0f �ii�'1 boring adlac, roval, the FDOH inspector ,n_il .-sspection• Prior to Final App are the f�5UIt5 t0 the original vastness the soil boring and ccmp n submitted. A reinspection fee waill be assessed sitee•daluatio ,hsi:,oatthearran°edt'��n`: e rprtT2a0' 0 0 nocvrMU #: PR934459 6. -Invert elevation of drainfield to be no less than 5.0' NGVD. 7. -Bottom of drainfield elevation to be no less than 4.5' NGVD. 8. -This permit includes the abandonment of the existing septic tank. The system is sized for 3 bedrooms with a maximum occupancy of 6 persons (2 per bedroom), for a total estimated flow of 300 gpd. THIS PERMIT IS NOT FOR ANY ADDITIONS.