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PL-14-2212Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number. INSP-221250 Permit Number: PL -10-14-2212 Scheduled Inspection Date: November 12, 2014 Permit Type• Plumbing - Residential Inspector: Diaz, Osvaldo ' Owner: JACK RUFF, NICK D ANGELO Job Address: 90 NE 106 Street Miami Shores, FL 33138-2035 Project: <NONE> Inspection Type: Final Work Classification: Drainfield Phone Number Parcel Number 1121360060010 Contractor: STATEWIDE SEPTIC CONNECTIONS Phone: (954)963-0082 tsunaing uepartment comments REPLACE DRAIN FIELD ONLY INSPECTOR COMMENTS False Inspector Comments Passed ED" HRS IN FILE. �dq Failed 6 Correction Needed Re -Inspection ❑ t Z- 2 `T Fee No Additional Inspections can be scheduled until re -inspection fee is paid. November 10, 2014 For Inspections please call: (305)762-4949 Page 29 of 49 f L,-1 14-2-2- t-2� r�N Miami Shores Village � Building Department 0C 08 2014 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 B INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC 20 M BUILDING Master Permit PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL PLUMBING ❑ MECHANICAL [:]PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP At i� n CONTRACTOR DRAWINGS JOB ADDRESS: 11L i � � � J� � � {-i=t`�7i•� r City_ Miami Shores County: Miami Dade ZiD' E3 r:3 Folio/Parcel#: ( 1 ^ IlLi3 6 ; c06- u®I Q Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): 1 Phone#: Q �� 912 Address: 9 0 MC_ [ a 6t tl City: iyliAbut Tenant/Lessee Name: Email: [I I C.� State: V �— Zip: ?� yx'U"Li 1 Co'�­l hone#: 1) 1CONTRACTOR: Comp any Name: ��� k ��� � e. ��' � �c Phone#: 3 �� � � � 315Address: 13640 Kkm ( c, Azve f�N #- (S City: LOCK,.) State: fl, Zip: -3505 W Qualifier Name:��+.�' Phone#: State Certification or Registration #: &�® ( Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: ` Value of Work for this Permit: $ a Square/Linear Footage of Work: 4 s o Type of Work: ❑ Addition ❑ Alteration ❑ New [Repair/Replace ❑ Demolition nucerinfinn of Wnr4- specify color of color thru tile: yk Submittal Fee $� , Permit Fee $ S-0` "` CCF $ I 0 ��q� CO/CC $ Scanning Fee $ �''i d Radon Fee $ DBPR $ Notary$�� Technology Fee $ Training/Education Fee $ Double Feee{{$ \\ Structural Reviews $ Bond $ Sal V s W TOTAL FEE NOW DUE $ 123 � 3 0 (Revised02/24/2014) Gaa 3O i �1 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 Zi 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 ELECTRIC, PLUMBING, SIGNS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, 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 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. 4 Signature2q Signature e OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this - day of O C + , 20 14 by C I� 01 � I Z . who is personally known to me or who has produced Fr ©fl V Ca–je as The foregoing instrument was acknowledged before me this day of 0Cf7 20 ty , by �(&�Y40- –BALL, who is personally known to me or who has produced 154— as identification and who did take an oath. ;•ot •�;, identification and who did take an oath. NOTARY PUBLIC:=4 Ems, • , NOTARY PUBLIC: � � Sign: X> 1. v m Sign: / Print: w ; N Print: Seal: o o Seal: o o M 0 L W LA � v / APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) S_ Miami shores If Village Building Department 10050 N.= -.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Notice to Owner _ 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 anv 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: te :n Signature: 35 0 to ' m C_ g c State of Florida) cn � � County of Miami -Dade) o ca CD z Sworn to and subscribed before me this D m O day of ®c�- , 20(4 m $ N .Wa Z By �- con 0 — (SEAL) Tune of Identification produced_ P T% I °C e AI Contractor Print Name: so Signature: State of Florida ) County of Miami -Dade ) Sworn to and subscribed day of 6 07 A .10 of Identification MHE � Off.•: ��•�®_ — °� ,ss: gar Emu= r ' 0 LOT: 1 BLOCK: 202 SUBDIVISION: Dunnings, Miami Shores Ext#2 PROPERTY ID #: 11-2136-006-0010 [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 [ 650 l GALLONS / GPD existing septic tank to remain CAPACITY A [ 0 ] GALLONS / GPD CAPACITY N [ 0 ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS] K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ ] D [ 150 l SQUARE FEET new trench confiq. drainfie SYSTEM R [ 0 ] SQUARE FEET SYSTEM A TYPE SYSTEM: [x] STANDARD [ ] FILLED [ ] MOUND I CONFIGURATION: [x] TRENCH [ ] BED [ ] N F LOCATION OF BENCHMARK: FFE 12.4' NGVD I ELEVATION OF PROPOSED SYSTEM SITE [ 21.60][ INCHES FT ][ABOVE E BOTTOM OF DRAINFIELD TO BE [ 59.64][ INCHES FT ][ABOVE L ME BENCHMARK/REFERENCE POINT BENCHMARK/REFERENCE POINT D FILL REQUIRED: [ 0.001 INCHES EXCAVATION REQUIRED: [ 38.001 INCHES 1.-E=1�00sfj septic tank, certified by "Statewide Septic" on 9/30/2014 to remain. 2.-Indrainfield in trench configuration. T 3.-Pexcavation area shallbe at least 2 ft wider and longer than the proposed absorption bed or drain trench. 4. -Invert elevation of drainfield to be no less than 7.93' NGVD. H 5. -Bottom of drainfield elevation to be no less than 7.43' NGVD. E The system is sized for 2 bed with a max occupancy R f 4 �ersons(2 per bed), for a total est. low of 300 gpd. THIS PERMIT IS NOT FOR ANY ADDITIONS. R � 0 SPECIFICATIONS BY: Yudeisy Martin I TITLE: APPROVED BY: aw _ TLE:\ Dade CHD DATE ISSUED: 10/06/2014 r! EXPIRATION DATE: 01/04/2015 DH 4016, 08/09 (Obsoletes all previous editions which may not be used) Incorporated: 64E-6.003, FAC Page 1 of 3 v 1.1.E AP1161623 SE939912 ak<. �r �S'T-f,Ti- CSI= f= LO R f D A DfEPARTNIENT QF �4EA.i_TH F�€ APPLICATION, FOR Ot�lS�TE,Sf 4�.'AG� �iSr�OSilL SYSTEM Etrf COfi(STF�C TUN PEW,[' �l ort t r;biPernit Ap;[ic: - - - - - - -- - — —_ _- -- — PART II -SITE PLAIN - .- — — --- - — — — — - — `E -ch block represents 5 feet and 1 inch = 50 feet. �. • r - - - r-, s:. _. Vp 1,--_ r t 4-• (' S../ ,�,r_a,,r`w�;,.?h�p` H" %,�.� `,�..... ir• 1. (y^e. {'` fi e'al $"„r SRR Plan submitted by: � ✓�.i,�� — --I___/---- ---- - w.r. Signature T.: P(a(t Apprdlfed Not Approved Date ��---- ---- ----- ourity Health Depar%r�-; ALL CHANGES MUST BE APPROVED BY TIF E COUNTY HEALTH DEPAR:TMEINT 9H 40'5. i f!)G (R..yytares Niia-Fi rcurr '9. s viiii n ;nay bo,;Mad) Sir�,lc FUr;txx:57A.�.CL?_�4gi5•n"1 �