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PL-15-665Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-234460 Scheduled Inspection Date: May 28, 2015 Inspector: Diaz, Osvaldo Owner: WHITMAN, STANLEY Job Address: 1234 NE 94 Street Miami Shores, FL Project: <NONE> Contractor: STATEWIDE SEPTIC CONNECTIONS Building Department Comments REPLACE DRAIN FIELD Permit Number: PL -3-15-665 Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Drainfield Phone Number (305)335-9039 Parcel Number 1132050100210 INSPECTOR COMMENTS False Inspector Comments Passed E�rHRS ON FILE Failed 1) G/C Correction ❑ Needed Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid Phone: (954)963-0082 May 27, 2015 For Inspections please call: (305)762-4949 Page 21 of 32 CONTRACTOR: Company Name: I C 01+Y\S' f')( Phone#: -3 I- C C 3 Address: M-14- Ne- 9L�- '&t State: Zi X13 City: �`�-�`� �.�; � Qualifier Name: T 9�_n% .-, Phone#: State Certification or Registration #: ,R 1-1\U5:7 l 2 6.2- Certificate of Competency M DESIGNER: Architect/Engineer: Phone#: Address:City: State: Zip: // Value of Work for this Permit: $ , 44 W - M Square/Linear Footage of Work: 3<3,0 Type of Work: ❑ Addition ❑ Alteration ❑ New A Repair/Replace ❑ Demolition Description of Work: ev—, °O 'Ca Specify color, of color thru tile: Submittal Fee $ Permit Fee.$ ��®y tr CCF $ CQ/CC;$ Scanning Fee $ Technology Fee $ Structural Reviews $ (Revised02/24/2014) Radon Fee $ Training/Education Fee $ DBPR $ Notary Double Fee $ Bond $ TOTAL FEE NOW DUE $ ° qq Miami Shores Village CFITVED Building Department SIA 2 205 10050 N.E.2nd Avenue, Miami Shores, Florida. 33138 BY. Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LIN HONE NUMBER: (305)'762-4949 W'' 10_1&� FBC 20[6 BUILDING Master Permit No. GG� PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL 09 PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 214 1�1 City: Miami Shores County: D Ol k Miami Dade Zip: 33 ( 5S' Folio/Parcel#: '?)zoS—�J1 Q ,oz( ® Is the Building Historically Designated: Yes NO 1of Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): �� '1 �� Phone#: Address: 1154 -NE q k*,fit City: M1 a re*Ni S- rcs State: Zip: -3 ;A 3S Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: I C 01+Y\S' f')( Phone#: -3 I- C C 3 Address: M-14- Ne- 9L�- '&t State: Zi X13 City: �`�-�`� �.�; � Qualifier Name: T 9�_n% .-, Phone#: State Certification or Registration #: ,R 1-1\U5:7 l 2 6.2- Certificate of Competency M DESIGNER: Architect/Engineer: Phone#: Address:City: State: Zip: // Value of Work for this Permit: $ , 44 W - M Square/Linear Footage of Work: 3<3,0 Type of Work: ❑ Addition ❑ Alteration ❑ New A Repair/Replace ❑ Demolition Description of Work: ev—, °O 'Ca Specify color, of color thru tile: Submittal Fee $ Permit Fee.$ ��®y tr CCF $ CQ/CC;$ Scanning Fee $ Technology Fee $ Structural Reviews $ (Revised02/24/2014) Radon Fee $ Training/Education Fee $ DBPR $ Notary Double Fee $ Bond $ TOTAL FEE NOW DUE $ ° 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 andiinstallations 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. -It Signature Signature OWNER or AGENT The foregoing instrument was acknowledged before me this C2' 3— day of 20 , by W a IvV* who is personally known to me or who as produced as identification and who did take an oath. NOTARY PUBLIC: CONTRACTOR The foregoing instrument was acknowledged before me this day of OLf C , 20 by SQ �� °1r1 , who is personally known to me or who has produced identification and who did take an oath. NOTARY PUBLIC: Sign: r a Sign:_ Print: ti 1Z e Lt ---)i -s Print:' - Seal: Seal: Lie Notary Public s� of Flora Trenceffa Lewis a my C.txnmisskw FF ISM? ExPIre< 11n�»,019 APPROVED BY -5 Plans Examiner Structural Review (Revised02/24/2014) Nft" PubUc SUM of Florida TrerMos Lewis F , o7 w MExPiM 0?1Gli► ig AL A.A%-4 as - Zoning Clerk 1-2,3yd6- 9L/ ST Miami Shores Village Building Department 10050 N.E.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 and has acknowledge that he or she will not use day labor, part-time employees or subcontractors for your project. The contractor has provided an affidavit stating that he or she will be the only person allowed to work on your project. In these circumstances, Miami Shores Village does not require verification of workers' compensation insurance coverage from the contractor's company for day labor, part-time employees or subcontractors. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. v�r Signature: Owner State of Florida County of Miami -Dade The foregoing was acknowledge before me this 043 day of �e f�_ , 20 �® BW K 1 n in, who is personally known to me or has produced as identification. Notary: I %/ :-frencelia Lewis SEAL: 'w . My Commission FF 186307 00a E*res OZ/ wo19 CONSTRUCTION APPLICANT: EPAIR PERMIT #:13 -SC -1589867 Mil l -DADS COUNTY HEAL`114 DF" "EYCATION #: AP1177QCIQ TE OF FLORIDA ARTMENT OF HEALTH DATE PAID: ITE SEWAGE TREATMENT AND DISPOSAL SYSTEM FEE PAID: STRUCTION PERMIT RECEIPT #: FOR: OSTDS Repair f Whitman TRS) PROPERTY ADDRESS: 1234 NE 94 St Miami, FL 33138 LOT: 23. 24 PROPERTY ID # BLOCK: 1-3205-010-0210 SUBDIVISION: DOCUMENT #: PR965976 Miami Shores Bay View [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 1 A [ 0 1 N [ 0 1 K [ 300 l D f3OO QU; R [ ] Sm A TYPE SYSTEM: I CONFIGURATION: N F LOCATION OF BEN I ELEVATION OF PR E BOTTOM OF DRAIN L D FILL REQUIRED: —Permit was adm( O 1. -Existing 900 gal T 2. -Install 300 gal. c H 3. -Install 300 sf of 4. -Perimeter of exc E (Comments ( R SPECIFICATIONS BY: APPROVED BY: DATE ISSUED: DH 4016, 08/09 (Ob Incorporated: 64E qS / GPD existing septic tank to remain CAPACITY JS / GPD CAPACITY GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS] DOSING TANK CAPACITY 167.00 ]GALLONS 6 ]DOSES PER 24 HRS #Pumps [ 1 ] FEET new trench confiq. drainfie SYSTEM FEET SYSTEM [X] STANDARD [ ] FILLED [ ] MOUND [ ] [X] TRENCH [ ]'BED LRK: FFE: 8.7' NGVD SED SYSTEM SITE [ 25.201[ INCHES FT ][ABOVE BELOW BENCHMARK/REFERENCE POINT A) TO BE 162.161[ INCHES T FT ](ABOVE BELOW BENCHMARK/REFERENCE POINT 0.001 INCHES EXCAVATION REQUIRED: [ 37.001 INCHES by Y.Martin on 3/16/2015 for addition of dosing tank. c tank, certified by "Statewide Septic" on 2/25/2015 to remain. tank. aid in trench configuration. n area shall be at least 2 ft wider and longer than the proposed absorption bed or drain trench. ied on Page 2.) J Solomon i Martin 5 TITLE: Master Septic Tank Contractor TITLE: Engineering Specialist II Dade CHD oletes all previous editions which may.not.be used) 6.003, FAC v 1.1.4 AP17799 EXPIRATION DATE: 05/31/2015 Page 1 of 3 SE952658 5. -Invert elevation of dr 6. -Bottom of drainfield i The system is sized for 400 gpd. THIS PERMIT IS NOT Performing Lift Dosing. Pumps must be certifies DOCUMENT #: PR965976 afield to be no less than 4.02' NGVD. vation to be no less than 3.52' NGVD. bedrooms with a maximum occupancy of 8 persons (2 per bedroom), for a total estimated flow of ANY ADDITIONS. as suitable for distributing sewage effluent. SIA I E OF FLORIDA DEPARTMENT OF HEALTH APPLICATION FOR CONSTRUCTION PERMIT Permit Application Number F ... .and I inch i�EEMMMM�M11MEEnmm�� 0 SME 1MMMMMM.MNUMMMMM:w 10 wr��w ONE mom, 0 ■MM ' ; �,i1�%II��I �� L��1�1 ! IM'1EMENEWUN 00940,10, 21 MEMNON mom EMMEM��«��■��li��■ mom EMEMMEMEMOMMEMEMENE Elm to .- �� A . Not App�oved Date County Health Department ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT DH 4015, 08/09 (Obsoletes previous editions which may not be used) Incorporated: 64E-6.001, FAC (Stock Number. 5744-002-40154;) Page 2 of 4 ,rg Project Address Parcel Number Applicant 1234 NE 94 Street 1132050100210 STANLEY WHITMAN Miami Shores, FL Block: Lot: Owner Information Address Phone cell STANLEY WHITMAN 1234 NE 94 ST (305)335-9039 MIAMI SHORES FL 33138-2947 Contractor(s) Phone Cell Phone STATEWIDE SEPTIC CONNECTIONS (954)963-0082 Type of Work: REPLACE DRAIN FIELD Type of Piping: Additional Info: Bond Retum : Classification: Residential Scanning: 3 Fees Due Miami Shores Village Bond Type - Contractors Bond 10050 N.E. 2nd Avenue NE ""` Miami Shores, FL 33138.0000 ` Phone: (305)795-2204 Project Address Parcel Number Applicant 1234 NE 94 Street 1132050100210 STANLEY WHITMAN Miami Shores, FL Block: Lot: Owner Information Address Phone cell STANLEY WHITMAN 1234 NE 94 ST (305)335-9039 MIAMI SHORES FL 33138-2947 Contractor(s) Phone Cell Phone STATEWIDE SEPTIC CONNECTIONS (954)963-0082 Type of Work: REPLACE DRAIN FIELD Type of Piping: Additional Info: Bond Retum : Classification: Residential Scanning: 3 Fees Due Amount Bond Type - Contractors Bond $500.00 CCF $1.80 DBPR Fee $2.25 DCA Fee $2.25 Education Surcharge $0.60 Permit Fee $150.00 Scanning Fee $9.00 Technology Fee $2.40 Total: $668.30 Valuation: $ 2,400.00 Total Sq Feet: 300 Pav Date Pav Tvue Amt Paid Amt Due Invoice # PL -3-15-54924 03/25/2015 Check #: 9408 05/14/2015 Check #: 4699 Bond M 2711 $ 50.00 $ 618.30 $ 618.30 $ 0.00 Available Inspections: Inspection Type: HRS Approval Final Review Plumbing In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS 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 an Hing. Futhem1orp, I authorize the above-named contractor to do the work stated. May 14, 2015 Aut oriz Signature: Owner i Applicant / Contractor / Agent Date Building Department Copy May 14, 2015