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PL-15-311Zvi Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-228122 Permit Number: PL -2-15-311 Scheduled Inspection Date: March 17, 2015 Permit Type: Plumbing - Residential Inspector: Diaz, Osvaldo Inspection Type: Final Owner: ATASH, KARIM & METIS CORINA Work Classification: Septic Job Address: 1195 NE 100 Street Miami Shores, FL Phone Number (305)790-5551 Parcel Number 1132050190360 Project: <NONE> Contractor: STATEWIDE SEPTIC CONNECTIONS Phone: (954)963-0082 building Department comments REPLACING SEPTIC TANK AND DRAIN FIELD ABANDON Infractio Passed Comments EXISTING TANK I INSPECTOR COMMENTS False Inspector Comments Passed ED" HRS ON FILE �c Failed Correction "T g r" Needed ❑ ��c/�-, �� �� rf- Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid March 16, 2015 For Inspections please call: (305)762-4949 Page 9 of 38 BUILDING Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 Fte 122015 FBC 20 10 Master Permit No.��. PERMIT APPLICATION Sub Permit No. ❑ BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑ RENEWAL ]PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP 7� CONTRACTOR DRAWINGS JOB ADDRESS: t G 01 S N E City:_ Miami Shores PPnn County Miami Dade ZID: 0 3 Folio/Parcel#: ' 3 2-'©S " `1 '® ;-?6 0 Is the Building Historically Designated: Yes NO X Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): �z//d .►1;%'�J� Phone#: Address: l4 l e� E 1 C ST City: ;t-A"s (les State: b= Zip: Tenant/Lessee Name: Email: CONTRACTOR: Company Name:A kE� ,W k0� h R �_TN� �N $hone#: tl C 6 -3-3Address• � G N oj 6 FIs ,t 19 City: P Vii; t° State: Zip: �5`t Qualifier Name: <Ce' q �bLo (\&o Phone#: State Certification or Registration #: �SMOci 19 Z 6 Z_ Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $_ COS Q Q Square/Linear Footage of Work: °Y1 S Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: C0Y-0, i� 0 Specify color of color thru tile: Submittal Fee $ Permit Fee $ I "0 o Y CCF $ CO/CC $ Scanning Fee $ Technology Fee Structural Reviews $ (Revised02/24/2014) Radon Fee $ Training/Education Fee $ DBPR $ Notary Double Fee $ :. TOTAL FEE NOW DUE02.221) i -O it -- %i i . 20 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 r it 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 certiTted 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 approv and a reinspection fee will be charged. Signature �4 Signature OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this loo day of 20 V 5 by `mho is personally known to me or who has produced ��l'� �.i k as identification and who did take an oath. NOTARY PUBLIC: Print: �(le4v, 1 10y"', The foregoing instrument was acknowledged before me this day of A.112—y 20 ICS , by who is personally known to me or who has produced Z_-PP_..j, VESyOPi cas identification and who did take an oath. NOTARY PUBLIC: �O-� Sign: Print: 9 �► ' TER ESA J SOLOMON Seal: a� Notary Public State of Florida Seal: p :- •': MY OOMMISSION # EE131935 Sindia Alvarez EXPIRES November 06, 2015 +�My Commission FF 156750 $pRgd� Expires 09103/2018 198-0153 Fbrld6Not¢ � . -- ffi***�k**�k&**�Ie�k�R*�k�k�N�k&�k�k�k�de�k�k�k�k�k�kM�k�k�k�le�k�k�k�k�k�k�ir�k�[e�RM�k�k���Rak#�k�le+k+k�N�k�k�kde�k tle�P#�k�k�k�k$+k+P�k�N�k�k�h�k�R+P��k�k�kil��k�F�k�k+R�k�kN#�k�NB+R�k�k�kAw�kl��R APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) ,N 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.. Therefore, you may be aersonally liable for the worker compensation iniuries of any 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. r Signature: State of Florida County of Miami -Dade The foregoing was acknowledge before me this ( 0 day of Feb , 20 By M ? -8� �—"�- who is personally known to me or has produced o J as identification. Contractor Signature: State of Florida County of Miami -Dade The foregoing was acknowledge before me this 1 -2 - day of"�RJZ( jaQy , 20A5_ - By _ 0,5.By'(;nzE_S a! c DLA who is personally known to me or has produced R__. t)eA ,l [':fir�� nc irlantifratin Notary:n�n�c, ' Notary: SEAL: r,_ SEAk h I i►ieL'i Notary Public State of Florida :,,TER VY CO�SA $®Lo 40 % < My Com lesion FF 158750 o� MI$$/ pfp� Expires 09/0312018 • ' 391. 1,5,1 tyove SO gI2p,55 STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT CONSTRUCTION PERMIT FOR: APPLICANT: Karim Atash OSTDS New PROPERTY ADDRESS: 1195 NE 100 St Miami, FL 33138 LOT: 15 BLOCK: 177 SUBDIVISION: PROPERTY ID #: 11-3205-019-0360 PERMIT #:13 -SC -1577715 APPLICATION #:AP1170194 DATE PAID: FEE PAID: RECEIPT #: DocumENT #: PR962746 [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 SPECIFICATIONS T I 900 GALLONS / GPD Septic CAPACITY A [ ] GALLONS / GPD N/A CAPACITY N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS] K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ ] D [ 375 SQUARE FEET Trench confiquration drain SYSTEM R [ ] SQUARE FEET N/A SYSTEM A TYPE SYSTEM: [x] STANDARD [ ] FILLED [ ] MOUND [ ] I CONFIGURATION: [x] TRENCH [ ] BED [ ] N F LOCATION OF BENCHMARK: CL NE 100 st., 8.79' NGVD I ELEVATION OF PROPOSED SYSTEM SITE [ 2.76 ][INCHES FT ][ABOVE BELOW BENCHMARK/REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ 32.76][ INCHES FT ][ABOVE BELOW BENCHMARK/REFERENCE POINT L D FILL REQUIRED: [ 0.00] INCHES EXCAVATION REQUIRED: [ 33.00] INCHES Inspector to verify the existing septic tank is properly abandoned before final approval. o *Invert elevation of drainfield to be no less than 6.56' NGVD. T *Bottom of drainfield elevation to be no less than 6.06' NGVD. H *Install 42" of slightly limited soil under the bottom of drainfield. -Perimeter of excavation area shall be at least 2 ft. wider and longer than the proposed absorption bed or drain trench. E The system is sized for 3 bedrooms with a maximum occupancy of 6 persons (2 per bedroom), for a total estimated flow of 300 gpd. R SPECIFICATIONS BY: Teresa J APPROVED BY: TITLE: TITLE' Master Septic Tank Contractor DATE ISSUED: 02/03/2015 DH 4016, 08/09 (Obsoletes all previous editions which may not be used) Incorporated: 64E-6.003, FAC 11 v 1.1.4 AP1170194 Dade CHD EXPIRATION DATE: 08/03/2016 SE949667 Page 1 of 3