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PL-15-1313Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-235847 Permit Number: PL -6-15-1313 Scheduled Inspection Date: June 25, 2015 Permit Type: Plumbing - Residential Inspector: Diaz, Osvaldo Inspection Type: Final Owner: BAILEZ, JOSE Work Classification: Drainfield Job Address: 660 NE 93 Street Miami Shores, FL Phone Number (305)7574337 Parcel Number 1132060141520 Project: <NONE> Contractor: MR C'S PLUMBING & SEPTIC INC Phone: (305)651-7859 Building Department Comments DRAIN FILED INSTALLATION Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Pas EE HRS IN FILE SO L) Failed - LXrsii,'-� Correction ❑ � `2.�1L� Needed Re -Inspection Fee No Additional Inspections can be scheduled until re -inspection fee is paid. June 24, 2015 For Inspections please call: (305)762-4949 Page 17 of 40 BUILDING PERMIT APPLICATION Miami Shores Village Building Department Jum 0i 20W 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC 20 Id Master Permit No. �✓�' L3 3 Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ME PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS 660 1� 5�— JOB ADDRESS: AF' City Miami Shores County Miami Dade Zip: 5? 13 � Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): R E4 lAf � _Phone* 4d Address: A&`/ ✓ 7 City: State: Zip: 313 Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: Mr C's Plumbing and Septic Address• 19932 NW 2 Ave one#: 305-651-7859 City: Miami state: FL Zip: 33169 Qualifier Name: Kemble Ettrick Phone#: 305-651-7859 State Certification or Registration #: SR061536 Certificate of competency #: DESIGNER: Architect/Engineer: Address: % City: State: Zip: Value of Work for this Permit: $ r,kar a Square/Linear Footage of Work: 301> Type of Work: ❑ Addition ❑ Alteration ❑ New 0 Repair/Replace ❑ Demolition Description of Work: Specify color of color thru the: Submittal Fee $ Permit Fee $ Scanning Fee $ Technology Fee $ Structural Reviews $ (Revised02/24/2014) Radon Fee $ Training/Education Fee $ CCF $ CO/CC $ DBPR $ Notary $ Double Fee $ Bond $ -=f]D• 03 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 Zip 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 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 b roved and a reinspection fee will be charged. Signature Signature OWNER or AGENT The foregoing instrument was acknowledged before me this day of ���� , 20 ,l , by & who is personally known to me or who has produced identification and who did take an oath. CONTRACTOR The foregoing instrument was acknowledged before me this _I day of ., U AAG , 20 J r , by KeAA(Z E -X who is personally known to a— as me or who has produced identification and who did take an oath. NOTARY PUBLIC- NOTARY PUBLIC: Sign: Sign: 5 / d� Print.• Print Seal: ; osPR� PGe� ,, KEMBLE ETTRICK �°�`Y P6;� Notary Public - State of Florida Seal: ° �+ fps Notary Public State of Florida ; . _ My Comm. Expires Oct 23. 2018 :•. . •; My Comm. Expires Sep 19, 2017 =N, •°e,= Commission # FF 1385!37 op�O'` Commission # FF 055732 -':;�ol� �o�� •r, OF F''�" t 0� B0 "pwLti I�FYW1��ww!J. APPROVED BY f f Plans Examiner Structural Review (Revised02/24/2014) as Zoning Clerk 91vtSION of EWmamentat "th 101 Florida Health Miami -Dade County OSTDS/Well Division 11805 SW 261h Street • Miami, FL 33175 61 1 SInspector Date Ne� S)r OSTDS # I 19 �01 Address Comments: Signature lk i Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 '® Phone: (305)795-2204 Project Address 660 NE 93 Street Miami Shores, FL Parcel Number 1132060141520 Block: Lot: JOSE BAILEZ Owner Information Address Phone Cell JOSE BAILEZ 660 NE 93 ST (305)757-4337 (407)963-5399 MIAMI FL 33138-2907 Contractor(s) Phone Cell Phone MR C'S PLUMBING & SEPTIC INC (305)651-7859 Type of Work: DRAIN FILED INSTALLATION Type of Piping: Additional Info: Bond Return : Classification: Residential Scanning: 3 Fees Due Amount Bond Type - Owners 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: $ 2,200.00 Total Sq Feet: 300 Pay Date Pay Type Amt Paid Amt Due Invoice # PL -6-15-55784 06/01/2015 Credit Card $ 50.00 $ 618.30 06/05/2015 Credit Card $ 118.30 $ 500.00 06/05/2015 Check #: 288 $ 500.00 $ 0.00 Bond #: 2739 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 cert' hat all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoningoFdfermore, I authorize the above-named contractor to do the work stated. June 05, 2015 Signature: Owner / Applicant / Contractor / Agent Building Department Copy June 05, 2015 1 A� ®Y CERTIFICATE OF LIABILITY INSIURANC DATE(IAM(DDM�YY) 6/3/2015 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 poGcy(tes) must be endorsed. H SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require en endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorserne s . PRODUCER SUNZ Insurance Solutions, LLC. ID: TLR cNAoMEA`� Almee Gray c/o TLR of Bonita, Inc 700 Central Ave Suite 500 St. Petersburg, k 33701 PHONES727-520-7676 x222 FaxC. No : 727-525-3862 l%& ADDRESS: s ct?vERAGe NAtc # INSURERA: SUNZ Insurance Cornpan 34762 EACH OCCURRENCE INSURED TLR of Bonita, Inc dba EnterpriseHR Encore Business Solutions, Inc INsupim a: Aspen Re - London - Best Rating A INSURER c: Catlin Syndicate ate - Lloyds - Best Ratim W INSURER o: Brit Syndicate - Lloyds - Best Rating A" and its Subsidiaries IN E, 700 Central Ave, Suite 500 St. Petersburg FL 33701 INSURER F COVERAGES CERTIFICATE NUMBER_ 2AWIMn 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. LTR TYPE OF INSURANCE 10050 NE 2nd Ave ACCORDANCE WITH THE POLICY PROVISIONS. POLICY NUMBER POLICY EFF D EXP COMMERCIAL GENERAL LIASILnY EACH OCCURRENCE DAMAGE TO RERTE15- PREMISES Me acaffence)$ CLAIMS-MADE 1-1 OCCUR MED EXP (Ary one person) $ PERSONAL & ADV INJURY $ GEN`L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGO $ POLICY ❑ JECT F-1 Loc $ OTHER: AUTOMOBILE LIABILITY Me acddwM C BtNED SINGLE LIMA $ BODILY INJURY (Per PerW) $ ANY AUTO BODILY INJURY (Pea accMeno $ AALL UTOS OWNED SCHSCHEDULEDU AUTOS NON -OWNED HIREDAUTOS AUTOS PROPERTY DAMAGE $ er $ UMBRELLA U" , . OCCUR EACH OCCURRENCE $ AGGREGATE $ 4EXCESS LIAR CLAIMS -MADE DED I I RETENTION $$ A WORKERS COMPENSATION AND EMPLOYERS LIABILITY YIN MY PROPR(ETORIP.ARTN ECUTNEE-i_ OFFICER/MEMSER EXCLUDED? (Mandatory in NH) N t A WCPE00000009 11 VVCPEO0000001 10 1!2015 6/1/2014 6/1/2016STATUTE 6/1/2015 OIH I UI - EACH ACCIDENT $ 1,000,0 00 E.L. DISEASE - EA EMPLOY $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1'0w'000 if yes describe under DESCRIPTION OF OPERATIONS bebw B Workers Compensation This is for infornwitional purposes urpoig t C Excess Coverage and nothing show create D under such reinsurance. DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 101, AddM*nW Remarks Soule, may be anached II mare space is reached) Coverage Provided for all leased employees but not subcontractors of: Mr C's Plumb ft & Septic, Inc Client E tectivef� : 1/6114 CERTIFICATE HOL®ER CANCELLATION ©1988-2014 ACORD GORPORATIQN. Alt ngms reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD 29960300 1 Master Certificate I AiMee Gray 1 6/3/2015 6:05:17 PM (CDT) I Page 1 of 1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village THE EXPIRATION DATE THEREOF, NOTICE M -L BE DELIVERED DI 10050 NE 2nd Ave ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores„ FL 33128 AUTHORIZED REPRESENTATIVE Glen J Distefano ©1988-2014 ACORD GORPORATIQN. Alt ngms reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD 29960300 1 Master Certificate I AiMee Gray 1 6/3/2015 6:05:17 PM (CDT) I Page 1 of 1 STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREMMMU AND DISPOSAL SYSTEM CONSTRUCTION PERMIT CONSTRUCTION PERMIT FOR: APPLICANT: Jose Bailez OSTDS Repair PROPERTY ADDRESS: 660 NE 93 St Miami, K 33138 T.nm. SUBDIVISION: PROPERTY ID #: 11-3206-014-1520 PERMIT # :13-SC4 607864 APPLICATION #: AN 189771 DATE PAID: RECEIPT #: RIT61,777y [SECTION, TOWNSHIP, RANGE, PARCEL ] [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 POR DEVELOPMENT OF .THIS PROPERTY. SYSTEM DESIGN AND SPECIFICATIONS r T t 900 ] GALLONS 1 GPD existing septic tank to remain CAPACITY A [ 0 ] GAISANS / GPD CAPACITY N [ 0 ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUK CAPACITY SINGLE TANK:1250 GALLONS] K I =F&ET DOSING TANK CAPACITY I IGALLONS @I ]DOSES PER 24 HRS #pumps [ ] D I 300 neve bed Confq. drainfield SYSTEM R L 0 ] SQUARE FEET SYSTEM A TYPE SYSTEM: Ix] STANDARD[ } FILLED [ ] MOUND [ ] I CONFIGURATION: [ ] TRENCH ix] 13ED N F LOCATION OF BENCHMARK: Crown of road: 9.9' NGVD I ELEVATION OF PROPOSED SYSTEM SITE 13.60 ] 1INCHES FT I BELOW IBENCHMARK/REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE t 46.44][ INCHES T FT IIABOVE: BELOW BENCM ARK/REFERENCE POINT L D FILL REQUIRED: t 0.00] INCHES EXCAVATION REQUIRED: [ 62.001 INCHES 1. -Existing 900 gal. septic tank, certified by "Mr.C's Plumbing" on 5/21/2015 to remain. O 2. -Install 300 sf of drainfieid in bed configuration. , T 3. -Install 12" of slightly limited soil at the bottom of the drainfield. Q H 4. -Perimeter of excavation area shall be at least 2 tt, wider and Idnber' than the proposed absorption bed or drain trench. A (Comments Continued on Page 2.) E 7 SPECIFICATIONS BY: Mr Ift*_. Sept TITLE: APPROVED BY: ® TITLE: Engineering Specialist II Dade CHD Yut�' DATE ISSUED: 05!27 EXPIRATION DATE: 08/25/2015 DH 4016, 08/09 (Obsoletes all previous editions which may not be used) page 1 of 3 Incorporated: 64E-6.003, FAC V 1.1.4 AP1189771 t. SE961649 5/30!2015 CCF05212015 OOOOOjpg STATE OF FLORIDA DEPARTMENT OF HEALTH APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Permit Application Number -------------------------- PART II - SITEPLAN------------------------ blar�c represents 10 feet and 1 inch= 40 feet. J ! .,. - IMEN ON ■■■■■■■■■■E■■R ■■■■■■■■M/■i■■IMMMKI�i�l!■■N ■■■■■■/r■/.■■■■ ■■■■I■■//■■//■■■■■�■■■■■■■■■ilk■■■®I■■ ■■■■■ ■■■■..�1]<�■■■■■■■■■■■■i■■■■■�N■ %M■/I■■■■■■■■■■■■■■■■l�■■■I■■ �! - Wasm --- ■I■111MIF■C1�4'ePIWOME■■■■I■■ ' MORE■■ ■■■■!:I�■■■ ■■■■■i■■ 6- There are t ' • t -features •adjacent• o • • street . I S. t rac (>n Vic. �e d 6e -T , � recv, c r r Site Plan submitted by: Pian Approved Not Approved By County Health Department ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT DH 4415, 10/96 (Replaces HRS -H Farm 4016 wWeh maybe used) Page 2 of 4 {Stock Number. 5744 -W2 -4015-M f hdpslldrive.google.com/drive/u/Ot#folders/0B3SYVJuZWiRfVnJ1TilhaTdDNTgIOB3SYVJuZWiRWiaW5MRmlxelU 1/1