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PL-15-136Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-226845 Permit Number: PL -1-15-136 Scheduled Inspection Date: January 27, 2015 Permit Type: Plumbing - Residential Inspector: Diaz, Osvaldo Inspection Type: Final Owner: HARDEN, SUSAN Work Classification: Septic Job Address: 169 NW 97 Street Miami Shores, FL 33150- Phone Number (305)716-4900 Parcel Number 1131010260140 Project: <NONE> Contractor: A ALLIGATOR, INC Phone: (954)763-4999 tsunaing uepartment comments SEPTIC TANK AND DRAIN FIELD REPAIR. TO CLOSE PERMIT#PL-13-1346. INSPECTOR COMMENTS False Inspector Comments Passed ;,° HRS IN FILE .�t Failed Correction Needed Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. January 26, 2015 For Inspections please call: (305)762-4949 Page 16 of 29 il 4 BUILDING PERMIT APPLICATION MIC111 II JI IVI CJ V IIId6C Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 21 2015 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949„ ❑BUILDING ❑ ELECTRIC ❑ ROOFING FF B' C 200 Master Permit No./V" o, I" L 1t -13 Sub Permit No. ❑ REVISION ❑ EXTENSION ❑ RENEWAL PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: / 6 ' e7) 7 E t Citv: Miami Shores Countv: Miami Dade Zia: 32 / 50 Folio/Parcel#: / 13 1 y ' i 0,2 b ON 0 Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): ' S �; /-� t Y�r �;'c` �' Phone#: '726 222_v 71 Sy Address: 16 1 A) �,/ 'i 7 f7— City: tCity: 441A&i i SNnAr -< stater zip: " t S U Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: _I 6X_'14, lam% Phone#: 1! 5Y, , 76 i If Address: 13(,j � �� 1'(S: City: l�-�s� � 1'Cc3.^./ State: PL Zip: 3Z 3 5' Qualifier Name: X10 t'VeJ Phone#: State Certification or Registration #: r.z. 10 S Certificate of Competency #: r 0 h_ L) b i DESIGNER: Architect/Engineer: one#: Address: _ tf" City: State: Zip: Value of Work for this Permit: $ �' ~� Square/Linear Footage of Work: <r U Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace ❑ Demolition Description of Work: S' Eff( c (�"/v>< (10 Mtr (0 Specify color of color thru tile: Submittal Fee $ Permit Fee $°'~w CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Structural Reviews $ Double Fee $ Bond $ TOTAL FEE NOW DUE S /' 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 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 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 appy ed and ar m pection fee will be charged. t Si nature C g r, -�L.Signature E°=t,°.••_ ,� OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this day of swA �� 20 by S N PP M ho is personally known to me or who has produced Fl, TDU>e�IZ �� N`�� as identification and who did take an oath. NOTARY P Sign:_ Print: �+�, tvotary Public Stale of Florida Seal: t Sindia Alvarez My Commission 'FF 156750 �e, 0 Expires MUMS The foregoing instrument was acknowledged before me this day of;,T` 20 I by who is personally known to me or who has produced VL- )i as identification and who did take an oath. NOTARY PUBLIC: Sign: MIUMMU L. WAMWMAITV Print:�l `�s :_'i' �S �• Public • Stste M Florida My Comm. Expk#g Nor 018 Seal:�a7 ComnissM it FF 144715 �,�'h`,�,'.``� Bmtd�dlhou�►M�N�Ykan APPROVED BY �_ -• ` t' r"d' S Plans Examiner Zoning Structural Review Clerk 3 •'REGISTERED SEPTIC TANK CONTRACTOR JOHN M. BURGUN PO BOX 22856 FORT LAUDERDALE, FL 33335- A-AL-GATOR, INC. DBA A- �' ALLIGATOR Business Authorization: SA0920613 SR0921075 Registration Expires on September 30, 2015 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale;FL 33301-1895 -954-831-4000 VALID OCTOBER 1, 2014 THROUGH SEPTEMBER 30, 2015 DBA; 162 - 6 5 8 Business Name: A ALZGATc z INC Receipt #:PLUMBING/LWN sPRNKL/Cl Business Type:{SEPTIC TANK CONTRACT( Owner Name: JOHNauxau<r Business Opened:l2/16/1997 Business Location: 2551 w STATE RD 64 FT LAUDERDALE State/COunty/Cert/Reg: A092a613 Business Phone: 954-763-4999 Exemption Code: Rooms Seats Employees Machines Professionals 4 For Vending Susinees Only Number of Machines: Vending Type: Tax Amount Transfer fee NSF Fee %na4 Y Prior Years Collection Cost Total Paid 27.00 0.00 0.00 a.?0 0.00 0.00 29.70 THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT This tax is levied for the privilege of doing business within Broward County and is non -regulatory in nature. You must meet all County and/or Municipality planning WHEN VALIDATED and zoning requirements. This Business Tax Receipt must be transferred when the business is sold, business name has changed or you have moved the business location, This receipt does not indicate that the business is legal or that it is in compliance with Mate or local laws and regulations, Mailing Address: JOHN SURGUN 1361 NW 115 AVE Receipt #03B-14-00000292 PLANTATION, FL 33323 Paid 10/21/2014 29.70 2014 - 2015 ACORL7►� CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 01/20/2015 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(ies) 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 Brown & Brown of Florida, Inc. 1201 W Cypress Creek Rd # 130 P.O. Box 5727 Ft. Lauderdale, FL 33310-5727 CONTACT PHONE FAX A/c No Ell: 954-776-2222 A/C No): 954-776-4446 E-MAIL ADDRESS: GENERAL LIABILITY Commercial Lines House INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Old Dominion Ins. Co. 40231 INSURED A Alligator, Inc INSURER B: RetallFlrst Ins Co 1361 NW 115th Avenue Plantation, FL 33323-2408 INSURER C : X INSURER D: INSURER E 04/28/2015 INSURER F COVERAGES CERTIFICATE NUMBER: 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. INSR LTR TYPE OF INSURANCE ADDL UB POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY X MPG4688A 04/28/2014 04/28/2015 DAMA 500,00 PREMISES Ea occurrence)$ CLAIMS -MADE FX_1 OCCUR MED EXP (Any one person) $ 10,00 PERSONAL & ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,00 X POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANY AUTO ALL OWNEDSCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ DAMAGE $ PERACCIDENT NON-OWNEDPROPERTY HIREDAUTOS AUTOS $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) N / A 52027060 01/16/2015 01/16/2016 X WC STATU- OTH- TORY LIMITS I I ER E.L. EACH ACCIDENT $ 100,00 E L. DISEASE - EA EMPLOYEE $ 100,00 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT I $ 500,00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) RE:Susan Harden 169 NW 97 Street Miami Shores, FL Miami Shores Village is additional insured with respects to General Liability if required by written contract. CERTIFICATE HOLDER CANCELLATION MIAMISH SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village g THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Attn: David A. Dacquisto, AICP (Planning & Zoning Director) 10050 NE 2nd Avenue AUTHORIZED REPRESENTATIVE Miami Shores, FL 33138 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD REPAIR MW&a#W_ COL"N mm-m D'PARwENT PERMIT #: 13-SC-1477072 APPLICATION #: AP1109798 STATE OF FLORIDA DEPARTMENT OF HEALTH DATE PAID: ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM FEE PAID: CONSTRUCTION PERMIT RECEIPT #: DOCUMENT #: PR908229 CONSTRUCTION PERMIT FOR: OSTDS Repair APPLICANT: (CAD Acquisitions) PROPERTY ADDRESS: 169 NW 97 St Miami, FL 33150 LOT: 14 BLOCK 2 SUBDIVISION: Bonmar Park PROPERTY ID #: 11-3101-026-0140 [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 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 [ J D [ 200] SQUARE FEET bed confiquration drainfiel SYSTEM R [ J SQUARE FEET SYSTEM A TYPE SYSTEM: [x] STANDARD [ ] FILLED [ J MOUND I CONFIGURATION: [ ] TRENCH [x] BED [ ] N F LOCATION OF BENCHMARK: FFE 13.2' NGVD I ELEVATION OF PROPOSED SYSTEM SITE [ 25.20][ INCHES FT ][ ABOVE BELOW BENCHMARK/REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ 55.20][ INCHES FT ][ABOVE BELOW BENCHMARK/REFERENCE POINT L D F O T H E R ILL REQUIRED: [ ] INCHES EXCAVATION REQUIRED: l 3U.UUJ tncnra 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. -Perimeter of excavation area shall be at least 2 ft wider and longer than the proposed absorption bed or drain trench. 5. -Invert elevation of drainfield to be no less than 9.10' NGVD. 6. -Bottom of drainfield elevation to be no less than 8.60' NGVD. SPECIFICATIONS BY: JOHN M BURGUN TITLE: APPROVED BY:TITLE: Engineering Specialist II Dade CHD Erlande Omisca DATE ISSUED: 06/04/2013 EXPIRATION DATE: 09/02/2013 DH 4016, 08/09 (Obsoletes all previous editions which may not be usea contractor (o OeFi. ]n1 +) s req jiret tp pga rf"i a 5 it tmrorlt a :? f 4' Pac�4, 1 Incorporated: 64E-6.003, FAC e r �; hn sE�iofKi 6 '� )r ,t �, rr .. .. AhikGS-9S3 InS'yif,C<<)1 ° ?�li f4 ,1, [,O0. t r `;..� i:,t " ai• r m. res[jjita" ICS fel'i5t)C i�i��P `V..i c ^i1 s ii r IS n')t DOCUMENT #: PR908229 .-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 00 gpd. 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 # AP1109798 DEPARTMENT OF HEALTH PERMIT # 13 -SC -1477072 ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM DOCUMENT # SE900270 SITE EVALUATION AND SYSTEM SPECIFICATION APPLICANT: CAD Acquisitions CONTRACTOR / AGENT: A -Alligator Inc LOT: 14 BLOCK: 2 SUBDIVISION: Bonmar Park ID#:11-3101-026-0140 TO BE COMPLETED BY ENGINEER, HEALTH DEPARTMENT EMPLOYEE, OR OTHER QUALIFIED PERSON. ENGINEERS MU37 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-TABLE1 / OTHER -TABLE 2 J AUTHORIZED SEWAGE FLOW: 450.00 GALLONS PER DAY [ 1500 GPD/ACRE OR 2500 GPD/ACRE J UNOBSTRUCTED AREA AVAILABLE: 400.00 SQFT UNOBSTRUCTED AREA REQUIRED: 300.00 SQFT BENCHMARK/REFERENCE POINT LOCATION: FFE 13.2' NGVD ELEVATION OF PROPOSED SYSTEM SITE 25.20 [FINCHES / FT ) [ ABOVE / 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: [ ]YES [ ]NO WELLS: PUBLIC: N/A FT LIMITED USE: N/A FT PRIVATE: N/A FT NON -POTABLE: 48 FT BUILDING FOUNDATIONS: 6 FT PROPERTY LINES: 6 FT POTABLE WATER LINES: 12 FT SITE SUBJECT TO FREQUENT FLOODING? [ ]YES [X)NO 10 YEAR FLOODING? [ ]YES [X]NO) 10 YEAR FLOOD ELEVATION FOR SITE: FT [ MSL / NGVD ] SITE ELEVATION: 11.10 FT [ MSL / NGVD SOIL PROFILE INFORMATION SITE 1 SOIL PROFILE INFORMATION SITE 2 USDA SOIL SERIES: Munsell #/Color Urban land Texture Depth 10YR 3/1 Sand 0 To 12 10YR 8/1 Sand 12 To 48 10YR 6/4 Sand 48 To 56 10YR 6/8 Sand 56 To 72 USDA SOIL SERIES: Munsell #/Color Urban land Texture Depth 10YR 3/1 Sand 0 To 15 10YR 8/1 Sand 15 To 51 10YR 6/4 Sand 51 To 55 10YR 6/8 Sand 55 To 72 OBSERVED WATER TABLE: INCHES ( ABOVE / BELOW ] EXISTING GRADE TYPE: [ PERCHED / APPARENT ) ESTIMATED WET SEASON WATER TABLE ELEVATION: 85 INCHES [ ABOVE / BELOW ] EXISTING GRADE HIGH WATER TABLE VEGETATION: ( ]YES [X]NO MOTTLING: [ ]YES [X]NO DEPTH: INCHES SOIL TEXTURE/LOADING RATE FOR SYSTEM SIZING DRAINFIELD CONFIGURATION: [ J TRENCH REMARKS/ADDITIONAL CRITERIA CXJ BED Sand/0.60 DEPTH OF EXCAVATION: 30 INCHES [ ] OTHER (SPECIFY) SITE EVALUATED BY: DATE: 05/20/2013 BURGUN, JOHN (Tide:) (A -ALLIGATOR, INC DBA A-ALGATOR) DH 4015, 08/09 (Obsoletes previous editions which may not be used) Incorporated: 64E-6.001, FAC Page 3 of 4 AP1109798 E101477072 v 1.0.2