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PL-15-1764 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-240114 Permit Number: PL-7-15-1764 Scheduled Inspection Date: August 04, 2015 Permit Type: Plumbing - Residential Inspector: Diaz, Osvaldo Inspection Type: Final Owner: AWONSA, FATAAB JIMMY Work Classification: Septic Job Address: 325 NW 111 Street Miami Shores, FL 33168-3303 Phone Number Parcel Number 1121360010750 Project: <NONE> Contractor: STATEWIDE SEPTIC CONNECTIONS Phone: (954)963-0082 Building Department Comments PUMP AND ABANDON REPLACE BROKEN TANK WITH Infractio Passed Comments NEW 900 TANK AND NEW 200 SQFT DRAINFIELD INSPECTOR COMMENTS False Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-239110. HRS IN FILE EZ' SOD REQUIRED Failed Correction Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. August 03, 2015 For Inspections please call: (305)762-4949 Page 25 of 37 i ._�. �, v� { Pyr€NQ. P -" - - � Miami Shores Village Pem?1t Type:Pllulm HOREs f{ 10050 N.E.2nd Avenue NWWork 1C8 to/!:SEt "r; - Miami Shores,FL 33138-0000 Phone: (305)795-2204 PlIu`t�;�P��{��I"�. ORtDA issue,== 7t16l2t11 Expiration: 01/1212016 Project Address Parcel Number Applicant 325 NW 111 Street 1121360010750 FATAAB JIMMY AWONSA Miami Shores, FL 33168-3303 Block: Lot: Owner Information Address Phone Cell FATAAB JIMMY AWONSA 325 NW 111 Street MIAMI FL 33168-3303 Contractor(s) Phone Cell Phone Valuation: $ 5,500.00 STATEWIDE SEPTIC CONNECTIONS (954)963-0082 P Total Sq Feet: 200 Type of Work:PUMP AND ABANDON REPLACE BROKEN TAN Available Inspections: Type of Piping: Inspection Type: Additional Info: HRS Approval Bond Return : Final Classification:Residential Scanning: 1 Review Plumbing Fees Due Amount Pay Date Pay Type Amt Paid Amt Due Bond Type-Contractors Bond $500.00 Invoice# PL-7-15-56343 CCF $3.60 DBPR Fee $4.50 07/16/2015 Check#:4819 $771.60 $50.00 DCA Fee $4.50 07/15/2015 Check#:4818 $ 50.00 $0.00 Education Surcharge $1.20 Bond#:2794 Permit Fee $300.00 Scanning Fee $3.00 Technology Fee $4.80 Total: $821.60 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 nd zoning. Futher re, I authorize the above-named contractor to do the work stated. July 16, 2015 uthorized Signature:Owner / Applicant / Contractor / Agent Date Building Department Copy July 16, 2015 1 Miami Shores Village JUL 15 2015 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 FBC 20 1 v3y BUILDING Master Permit No.T �-'� S `—� l 6 [ PERMIT APPLICATION Sub Permit No. F--]BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL PLUMBING ❑ MECHANICAL [:]PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 2) NW ( t� City: Miami Shores 11 County: Miami Dade Zip: 3 ( 6 Folio/Parcel#: 2 f�)6 1 QQ 1 Q�S V Is the Building Historically Designated:Yes—IN O Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: p OWNER: Name(Fee Simple Titleholder):_rci fa� A1,14 ®�G' Phone#: �Y6 3S( • 1 p 1 Address: �S tl AJ (� City: M ��,p�S State: 12, Zip: 331" Tenant/Lessee Name: Phone#: Email: r CONTRACTOR:Company Name: ��\ "T�C.J C " t G �� �'''C Phone#: �-6 3 Address: �;C'40 Q\&) (S Ayt -d— k S City: Oi-;,c- to oeq State: Zip:T �)O( � . Qualifier Name: \ e�s r, c�01 p ,' Phone#: State Certification or Registration#:L1 M o C 1t Z6Z Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ S�'��� Square/Linear Footage of Work: —C-CC' Type of Work: ❑ Addition ❑ Alteration ❑ New X Repair/Replace ❑ Demolition Description of Work: d a—qo s- q ►^o�ef� -E u�� 0 r N pA,J 7106 DYac,y-,i�iej Specify color of color thru tile: Submittal Fee$ Permit Fee$ �d0CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ (Revised02/24/2014) Bonding Company's Name(if applicable) / Bonding Company's Address City State Zip 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 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. Signature Signatu e OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this C ,�f (o day of 20 by day of A U1 20 c�- , by CcC+G G who is personally known to who is personally known to me or who has produced ��'� f p as me or who has produced Ef-y 10 as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: / sign: Print: f—tPrint: / ✓SLP ( C Seal: Seal: : vtn Florida Koury Public State a Florida Notary PubliC State or Trencella Lewis Trencella Lewis J My Commission FF 196307 i ; My Commission FF 196307 Expires 02/05/2019 rr ?q n Expires 02/05/2019 APPROVED BY els Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) SNoR�s G Int �:... X11 ,,,,Z� Miami shores Village �. — Building Department �LORiDp` 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Notice to Owner — Workers' Compensation Insurance Exemption figir 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. Signature• ` Owner State of Florida County of Miami-Dade The foregoing was acknowledge before me this day of 20_[S . By F ct tc cA ( A-yio ►1 SQ who is personally known to me or has produced as identification. Notary , SEAL: +r Notary pudic Stale or Florida . Trencella Lewis My Commission FF 196307 PERMIT #: 13-SC-1616977 STATE OF FLORIDAtk APPLICATION #:AP1 1 95707 DEPARTMENT OF HEALTH DATE PAID: ONSITE SEWAGE TREATMENT AND DISPOSAL SS7'EM �''r FEE PAID: r u- CONSTRUCTION PERMIT W6 RECEIPT #: DOCUMENT #: PR980777 CONSTRUCTION PERMIT FOR: OSTDS Repair APPLICANT: Fataab AWonsa PROPERTY ADDRESS: 325 NW 111 St Miami, FL 33168 LOT: 27 BLOCK: 3 SUBDIVISION: PROPERTY ID #: 11-2136-001-0750 [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 , WHICH SERVED AS A BASIS FOR ISSUANCE OF THIS PERMIT, REQUIRE THE APPLICANT MTOERIAL MODIFY FACTS CTHE 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(New Tank) CAPACITY [ 0 1 GALLONS / GPD CAPACITY N [ 0 ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS] K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ ] D [ 200 ] SQUARE FEET Bed Drainfield SYSTEM R [ 0 ] SQUARE FEET SYSTEM A TYPE SYSTEM: [X] STANDARD [ ] FILLED [ ) M6UND I CONFIGURATION: [ ] [ 7 TRENCH IXI 'BED [. ]...,. ._ .. N F LOCATION OF BENCHMARK: FFE 12.9'NGVD I ELEVATION OF PROPOSED SYSTEM SITE [ 15.60 ] [ INCHES FT ] [ ABOVE 4 BELOW BENCHMARK/REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ 15.60 ] [ INCHES FT ] [ ABOVE BELOW BENCHMARK/REFERENCE POINT L D FILL REQUIRED: [ 0.00 ] INCHES EXCAVATION REQUIRED: [ 45.00 ] INCHES "`THIS PERMIT IS NOT FOR AUDITIONS— I.-Install a 900 gal min. septic tank with an approved filter. T 2.-The licensed contractor installing the system is;responsible for installing the minimum category of tank in accordance H with s. 64E-6.013(3)(f), FAC. - 3.-Install 200 sf of drainfield in bed configuration. E 4.-Perimeter of excavation area shall be at least 2 ft wider and longer tha:'i the proposed absorption bed. R 5.-Invert elevation of drainfield to be no less than 8.35' NGVD. _. SPECIFICATIGNS BY: T r S o TITLE: Master Septic Tank Contractor APPROVED BY: TITLE: Engineering Specialist II 1 e s Dade CHD DATE ISSUED: _ 07/10/2015 DH 4016, 08/09 (Obsoletes all previous editions which may not be used) EXPIRATION DATE: 10/08/2015 Incorporated: 64E-6.003, FAC I 1A Page 1 of 3 - S89oSEsLi3 STATE OF FLORIDA DEPARTMENT OF HEALTH APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Wel Permit Application Number ------------------- PART II = SITE PLAN--------------- ='---- Scale: Each block represents 5 feet and 1 inch=50 feet. , w. , ti ,} q i � v t ii w,< Y i T� � < a {., , 14i. Votes: 4 , a t . Site Plan submitted by: -` Signature Title 'Ian Approved Not Approved Date ! County Health Department ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT H 4015,10/96(Replaces HRS-H Form 4015 which may be used) ;(ock Number:5744-002-40156) Page 2 of 3 . , M DOCUMENT #: PR980777 6.-Bottom of drainfield elevation to be no less than 7.85' NGVD. 7.-This permit includes the abandonment of the existing septic tank. The system is sized for 2 bedrooms with a maximum occupancy of 4 persons(2 per bedroom),for a total estimated flow of 300 gpd. Required drainfield area based on rule 64E-6.015(6)(c)2. Install a new drainfield to achieve Drainfield size requir?ment. 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.