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PL-14-784Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-212485 Permit Number: PL4-14-784 Scheduled Inspection Date: November 13, 2014 Permit Type: Plumbing - Residential Inspector: Diaz, Osvaldo Owner: GRIFFITH, WILLIAM Job Address: 795 NE 97 Street Miami Shores, FL Project <NONE> Inspection Type: Final Work Classification: Septic Phone Number (305)401-6279 Parcel Number 1132060142360 Contractor: ALLSTATE DIVERSIFIED ENGINEERING INC Phone: (305)256-0306 Building Department Comments SEPTIC TANK AND DRAIN FIELD INSPECTOR COMMENTS False Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-211012. grade lot 5;J/ provide sod repair side walk Failed ,o Cf— Correction Needed Re -Inspection Fee No Additional Inspections can be scheduled until re -inspection fee is paid November 13, 2014 For Inspections please call: (305)762-4949 Page 3 of 45 tr a APPLICATION #:P1119601 STATE OF FLORIDA PERMIT #:13 -SC -1493807 DEPARTMENT OF HEALTH DOCUMENT #:F1953867 ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM DATE PAID:09/09/2013 CONSTRUCTION INSPECTION AND FINAL APPROVAL FEE- PAID :375.00 RECEIPT #:13 -PID -2246991 APPLICANT: Griffin Residence AGENT: All State Diversified Engineer PROPERTY ADDRESS: 795 NE 97 St Miami, FL 33138 LOT: 6 BLOCK: 70 SUBDIVISION: ID#: 11-3206-014-2360 CHECKED [X] ITEMS ARE NOT IN COMPLIANCE WITH STATUTE OR RULE AND MUST BE CORRECTED. FILL / EXCAVATION MATERIAL TANK INSTALLATION SETBACKS [ ] [22] [ ] [01] TANK SIZE [1] 1050.00 [2] 300.00 [ ] [27] SURFACE WATER FT [ ] [02] TANK MATERIAL Concrete [ ] [28] DITCHES FT [ ] [03] OUTLET DEVICE I ] [29] PRIVATE WELLS FT [ ] [04] MULTI-CHAMBERED [ Y N ] [ ] [301 PUBLIC WELLS FT [ ] [05] OUTLET FILTER Tuf-Tito [ ] [31] IRRIGATION WELLS FT [ ] [06] LEGEND 1. 13-045-08DC3 2. 13-045-02SC4 [ ] [32] POTABLE WATER 60 FT [ ] [07] WATERTIGHT [ ] [33] BUILDING FOUNDATIONS 5 _ FT [ ] [08] LEVEL [ ] [341 PROPERTY LINES 5 FT [ ] [09] DEPTH TO LID [ ] [35] OTHER FT DRAINFIELD INSTALLATION FILLED / MOUND SYSTEM [ ] [10] AREA [1] 525 [2] 120 SQFT [ ] [36] DRAINFIELD COVER [ ] [11] DISTRIBUTION BOX HEADER X [ ] [37] SHOULDERS [ ] [12] NUMBER OF DRAINLINES 1. 7.00 2. 4 [ ] [38] SLOPES [ ] [13] DRAINLINE SEPARATION [ ] [39] STABILIZATION [ ] [14] DRAINLINE SLOPE [ ] [15] DEPTH OF COVER ADDITIONAL INFORMATION [ ] [16] ELEVATION [ ABOVE / BELOW ]BM 45.00 [ ] [40] UNOBSTRUCTED AREA [ ] [17] SYSTEM LOCATION [ ] [41] STORMWATER RUNOFF I ] [18] DOSING PUMPS [ ] [42] ALARMS [ ] [43] MAINTENANCE AGREEMENT r ] [19] AGGREGATE SIZE [ ] [20] AGGREGATE EXCESSIVE FINES [ ] [44] BUILDING AREA [ ] [45] LOCATION CONFORMS WITH SITE PLAN [ ] [21] AGGREGATE DEPTH [ ] [46] FINAL SITE GRADING FILL / EXCAVATION MATERIAL I ] 1471 CONTRACTOR (ALC Excavators, Inc.) [ ] [22] FILL AMOUNT I I [481 OTHER ADS ARC 24 [ ] [23] FILL TEXTURE [ ] [24] EXCAVATION DEPTH ABANDONMENT I ] [25] AREA REPLACED [ ] [49] TANK PUMPED [ ] [26] REPLACEMENT MATERIAL [ ] [50] TANK CRUSHED b FILLED Comments: Comments are on page 2. CONSTRUCTION I APPROVED / DISAPPROVED ]: FINAL SYSTEM [ APPROVED / DISAPPROVED ]; (Explanation of Violations on following page) Dade Dade DH 4016, 08/09 (Obsoletes all previous editionsch may not be used) Incorporated: 64E-6.003, FAC EH Database v 1.0.1 AP1119601 EID1A93807 CHD DATE: 05/07/2014 ade Cou CHD DATE: 05/07/2014 )ade Co Page 2 of 3 _ e Miami Shores Village I� BuildingDepartment VI p APR 1 7 2014 ?0050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 ]BY: INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION Permit Type: PLUMBING FBC W ,9 Permit No. U / L(J - 7o Master Permit No. T-(-- 13 " %f T3 - JOB ADDRESS:.,c Ne 7� Pr— City: Miami Shores County: Miami Dade Zip: 7313 Folio/Parcel#: 11 , 3Zc(-, ` D 14 _ zzx� \ Is the Building Historically Designated: Yes NO )c) Flood Zone: lti 0 OWNER: Name (Fee Simple Titleholder): W . N Rl pr o � Phone#: 30Y- Y01 " 57'q� Address: 6-1 4_7 W SI -d: City: ll� TenanW.essee Name: Email: State: CONTRACTOR: Company Name: Aq S°A-iZ� I>>�7Lg�L51 �'lf-Q , Phone#:'3o,�' 2�" ?�cle Address: z City: tlkop-jssn5l� State: Zip: 3 Z Qualifier Name: Phone#: 3c r' Z-3, 2�D3 State Certification or Registration #: 2 6�1 Certificate of Competency #: Contact Phone#: _216S _2Z P, -) e11 Email Address: DESIGNER: Architect/Engineer: V 0 Phone#: Value of Work for this Permit: $ P M dD Square/Linear Footage of Work: Type of Work: ❑Address _ _ ®Alteration ❑New ❑Repair/Replace ❑Demolition Submittal Fee $ Permit Fee $ CCF $ CO/CC $ Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ DBPR $ Bond $ Technology Fee $ TOTAL FEE NOW DUE $ -1-7 / lal\ Or 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 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 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 exceedi $2500,he applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure ill be deliv red to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commence nt must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the b ence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. 11 Signature caner or Agent The foregoing instrument was acknowledged before me this day of _, 20 1' by Aal G 69AA who is personally known to me or who L produced L -*- OA 91� As identification and who did take an oath. NOTARY Print: The foregoing instrument was as acknowledged before e this I day of U 20 L4 , by O � who is personally known to me or who has produced aslaentu NOTARY PUBL Sign: Print: and who did take an oath. My Commission Expires: av `ti REBECA M. PASTRANA My Commission Expir S, , MY COM &IISSION / E UM24 " ati �� ° EXPIRES: Fabr MY07, 2017 J SARSSION 1STA * 1�Y CflA�SSIaV # EE 873354 x�x�x�s<u�x�x�x�x�x�x��xs«Mx�x�x�a��rx�>kx�x�x�mx�x��nx�x�x�x�x�x�>kx��xx� 1lnvrde�s APPROVED BY ��'%� c% Plans Examiner Zoning Structural Review (Revised3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) Clerk CONSTRUCTION PERMIT FOR: APPLICANT: (Griffin Resident PROPERTY ADDRESS: 705 NE OSTDS New PERMIT :13 -SC -1493807 APPLICATION # AP1119601 DATE PAID: FEE PAID: RECEIPT DOCUMENT #: PR920613 LOT: 8 BLOCK: 70 - SUBDIVISION: PROPERTY ID #: 1.1.-3206-014-z360 [SECTION, TOWNSHIP, RANGE, PARCEL NUMBER] [OR TAX ID NUMBER] SYSTEM MUSTBE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF SECTION 381.00.65, 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 AND VOID. ISSUANCE OF -,THIS PERMIT DOES NOT EXEMPT THE APPLICANT FROMCO1dPLLANCE WITH OTHER FEDERAL, STATE, OR LOCAL, PERMIT'TING.REQUIRED FOR -DEVELOPMENT OF THIS PROPERTY. SYSTEM DESIGN AND SPECIFICATIONS T L. 1,050 1 GALLON$ f GM -Septic CAPACITY A L 275:1 GALLONS / GPD Laundry CAPACITY N I ] GALLONS -GREASE INTERCEPTOR CAPACITY [L4A7CIMUM CAPACITY SINGLE TANK -1250 GALLONS] K L I GALLONS -DOSING TANK .CAPACITY I (GALLONS @j ]DOSES PER 24 HRS #Pumps I I D L 500 1 SQUARE FEET Bed configuration drainfiel SYSTEM R [ 100 1 SQUARE FEET Uundru Intrench. SYSTEM A,TYPE SYSTEM: [s].STANDAlU3 [.] FILLED [ ] MOUND [ } I CONFIGURATION: [ 1 TRENCH LXl BED` [ ] N F LOCATION OF BENCHrtmi FFE 10.531 NGVD I ELEVATIOk OF PROPOSED SYSTEM SITE L 16.6011 INCHES FT ][ABOVEBELOH' BENCMdARK/REFERENCE POINT E BO'PTOK `OF DRAINiFITLD .TO BE E. 46.60 ] rINCREST FT ] [ ABOVE BELOW BENCHMARK/REFERENCE POINT L D FILL REQVIRED: [ 0.001 INfCHES. EXCAVATION REQUIRED: L 72.001 INCHES O -main system: l instal# a 1050 gal min septic tank with an approved ftlter. T 2. -The licensed contractor installing the system is responsible for Installing the minimum category of nk in a rdance H with s. 64)_-6:01.3(3)(0, FAC.: ���31 3-lnstat(infi 500 sf of draeld in, tied configuration eC E 4 -Install 42" of slightly limited: soil at the bottom of the drainfield. , ��ah R 5. Perimeter of excavation area shall be at least 2 ft wider and longer than the proposed absorption (Comments Continued_ on Page 2.)PC e! SPECIFICATIONS BY: Betsy Lange-Olmino TITLE: Engineering Spe TZ fol, 0— APPROVED BY: TITLE: Engineer Supervisor III Kbade CHD Man X. za-w-ards DATE ISSM 10/29/2013 EXPIRA ION 04/29/2015 DH 4016, 08/09 (Obsoletes all previous editions which may not be used) Incorporated: 64E-6.003, FAC Page 1 of 3 0 1.1.4 AP1119601 SE911428 a '- DOCUMENT #; PR920613 6. -Invert elevation.of drainfield to be no. less than, 7.20' NGVD. - 7. -Bottom, of drakfield elevation to be"no less than 6.70` NGVD. `Laundry: -System: . 1.-Inst9ll a 275 gat min,septic tank with an approved filter. 2. -The licensed contractor instalfing"the system is responsible for installing the minimum category of tank in accordance with s. 64E-6.013(3) ft FAC. 3: Install 100 sf of drainfield intrench,00nfiguration. instOW42" of slightly limited sol,at the bottom of the drainfield. 5. -Perimeter of excavation area shall. be at least 2 iC wider and longer than the proposed absorption bed or drain trench. 6. -Invert 'elevation of drainfield Via. be no less than 7.20 NGVD. 7: Bottorn of drainfield elevation to be no less than 6-70' NGVD. The system is sized for 3 bedrooms with a maximum occupancy of 6 persons (2 per bedroom), for a total estimated flow of 14 0 gpd., v b9t b. TDA s �..., Pr a im t N.r ✓F , }r . t .!. 'Y. � t e,t. EPA, AC i i'' \E drib L6 DATE: BAM 11.82 i. W q'Zs�g•M ,,y. ai��i �.�► cl s 'AUa 31, X4 4 yRX a Y'ri/ , .. , �` AWS' y' hwi M „'aa• �' w `v W _� , . -EN h •GIN 13 020 0 Avv FL. 331 MAKI 56 SON �vV s OTT SAA �Yd{'HB P• �$ p qg�� me�qy{#<�g y to a� c g� p� } [ �g �� �r ' v AC RQ� CERTIFICATE OF LIABILITY INSURANCE ii3o� oD14") 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 policy(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 Eastern Insurance Group, Inc. 9570 SW 107 Avenue Shite 104 Miami FL 33176 CCOONNTACT David M. Lopez PHONE (305)595-3323 NO). -7135 E-MAIDRL SS:csr@easterninsurance.net D INSURERS AFFORDING COVERAGE NAIC d INSURER AMld-Continent Casualty Company INSURED Allstate Diversified Engineering, Inc. 7399 SW 45 Street Miami FL 33155 INSURER b :Brid of ield Employers IAsuranc C: -INSURER INSURER D: INSURER E: INSURER F COVERAGES CERTIFICATE NUMBERkiaster 14-15 REVISION NUMBER: 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 MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSRTYPE LTR OF INSURANCE D BR POLICY NUMBER POLICY EFF MM/DD POLICY EXP MM/DD LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ® OCCUR 4 -GL -000896244 /23/2014 /23/2015 DAMPREMMISES RE ocxurrNT rrence $ r 100 000 MED EXP (Any one person) $ Excluded PERSONAL & ADV INJURY $ 1,000,000 _ GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 R POLICY M PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE $ Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED I I RETENTION $ $ B WORKERS COMPENSATION% AND EMPLOYERS' LIABILITY Y/ N ANY PROPRIETOR/PARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? (Mandatory in NH) N/A 830-50170 1/27/2014 1/27/2015 WC STATU- OTH- TORY LIMITS I ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 11000,000 DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, M more apace Is required) Septic tank installation, drainage installation CERTIFICATE HOLDER CANCELLATION ACORD 25 (2010/05) INSn9.ri mmansi ni ©1988-2010 ACORD CORPORATION. All rights reserved. Th® Annan nama and Innn aro rani*tora i mark* of Annian SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Shores village ACCORDANCE WITH THE POLICY PROVISIONS. Building Deptartment AUTHORIZED REPRESENTATIVE 10050 NE 2 Avenue Miami Shores, FL 33138 David Lopez/ANA ACORD 25 (2010/05) INSn9.ri mmansi ni ©1988-2010 ACORD CORPORATION. All rights reserved. Th® Annan nama and Innn aro rani*tora i mark* of Annian