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PL-15-1819 �s °!SES Miami Shores Village � tt7T��"� , PlUMb1n9-,-, eS1d li 1r4ki 10050 N.E.2nd Avenue NE {�I ark. fa s caticrr:Sepl c Miami Shores,FL 33138-0000 > Pofmit Status.APPROVE© tiE= e� Phone: (305)795-2204 Expiration: 01/1912016 Isstt`�s :7/2312 '15 Project Address Parcel Number Applicant 379 NE 94 Street 1132060136130 Miami Shores, FL 33138- Block: Lot: WILLIAM JONES Owner Information Address Phone Cell WILLIAM JONES 379 NE 94 Street MIAMI SHORES FL 33138-2842 Contractor(s) Phone Cell Phone •- �� ALLSTATE DIVERSIFIED ENGINEERI� 305 256-0306 $ 8,500.00( ) (305)258-7797 ['Valuation: Total Sq Feet: 619 Type of Work:INSTALLATION OF SEPTIC TANK&DRAIN Available Inspections: Type of Piping: Inspection Type: Additional Info: HRS Approval Bond Return: Final Classification:Residential Scanning:3 Review Plumbing Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $5.40 Invoice# PL-7-15-56409 DBPR Fee $4.50 07/21/2015 Check#:4445 $50.00 $ 282.40 DCA Fee $4.50 Education Surcharge $1,50 07/23/2015 Check#:4446 $282.40 $0.00 Permit Fee $300.00 Scannin —f-re $9.00 Technology Fee $7.20 Total: $332.40 In consid6i.tion of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertainingoereto and in strict conformity with the plans,drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting.-tois permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required WELECTRICAL, PLUMBING, MECHANICAL,WINDOWS, DOORS,ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing informatio is accurate\and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore, I authorize the above-na conctor to do work stated. *3°r July 23, 2015 uthorized Signature:Owner / Applicant / Contractor / Agent Date Building Department Copy July 23, 2015 1 I 21 Miami Shores Village `2 g � JUL 2 � 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 � y BUILDING Master Permit No.,&- PERMIT APPLICATION Sub Permit No.'PL 5- �9`(q ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ]PLUMBING ❑ MECHANICAL PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP 2�q t CONTRACTOR DRAWINGS JOB ADDRESS: J + l Ki F- 9y City: Miami Shores 56 2 County: Miami Dade Zip: J ? Folio/Parcel#: - �J��'a(3 ' �0( Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): 11J j\�`�Q'�1 �OYI��, Phone#: Address: '( S`t✓[�p-�- City: EA"'Ctrnt State: L zip:.- Tenant/Lessee Name: Phone#: Email: 1 ` CONTRACTOR:Company Name: I 1 Phone#: 36 S-e 1�"] Address: ( ao �A\ City: 4a�z�� C`)- State: �r Zip:5 - Sa,2 Qualifier Name: CIO i I 10 G J` Phone#: 2)0�� State Certification or Registration#: Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: '� ity: State: Zip: Value of Work for this Permit: OSquare/Linear Footage of Work: (,n�-9— Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace ❑ Demolition Description of Work: Specify color of color thru tile: Submittal Fee$ Permit Fee$ t`� CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ a _(1-4— 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: Asn 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 wi delivered to the person whose property is subject to attachment. Also,a certified copy of the recorded notice of commenceme must a posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the a ence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. 12,117 Signature Si nature / g g �1 G OWN9AGWITRACTORThe foregoing instrument wasedged before me this The foregoing instrument was acknowledged before me this 16 day of 20 t S ,by J I day of a-0=1LkU20 IS .by kk�, who is personally known to �4U�l uZcGro�4L�who is to me or who has produced bL �r C)A �l`2, as me or who has produced as identification and who did take an oath. identification and who didtf a an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign. Sign: Print: eQ� �'i �cC7lI(\C� Print: l rMAv ' BAIISTA Seal: �" RF f3ECA M.PASTRANA Seal: , .: MY CO MSS ON#EE 873354 bIY COMMISSION#EES72624 'a,` EXPIRES:May 11,2017 w EXPIRES:February 07,2017 •;p ��° Bonded Thru Notary Public Underwriters *s*sssss*s*ss****sssss**ssssss*ssss**s*ss*ss**s**ss****ssssss*sssss*ss*ss***sssss****ssss*ssssss**s**s**s*ss � APPROVED BY �� f '2'1'45 Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) 7/21/15 10 : 42AM EDT Allstate Diversified Engin -> Cintia 3057568 2 Pg 2/5 BT oca�ss - •local 'Business.-Tax IF -CAunm State. ofi: Miami—Dade;_ worn ani 00 f TPAY sysss w�*��„ ►,,,o.+ �rMo.: ICp1RES. ... 2015 atL ATE DivER. MW Ei�(CfAIEER�NG tNc. R ► :S P_TEMBEfi'3. .. 5 i 41 AVE 68�7Z. -Mri;i o.alioisirod it 25525 5W v! +nae 255F 141.2 pwvonl w CeunH owe 940! llki AA:9&10 OWNER SEC.TYPE OF BUSINFER PAYMENT RICSIVIM - ALLSTATE DIVERSIFIED E1IGWEERING 196 SPECln1TY PLUMBING CONTRACTOR TAX C*LLIRCTOR CPC1a57= $75.00 07/23/2014 INC viloc (s) 1 •OiECK21-14-032014 Thislocal8vuieasTallli�c�ivroMll_gnfi f�fiathwLmaobupnouB H*lfdir� a °`" r Mar csrlMleafYre of d1a ��noe�r.■rwnantiLrap�inory�we.M/rpulrsnMrtnWhich apply�tl*ba TM RECEIPT am above mode dIsplowl oal ME ala!YaAieNs—R �a CoOa 4aG q Yl6. Fwawo�l�On�uGoart+it4t .., A�® CERTIFICATE OF LIABILITY INSURANCE alio ois' 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 pollcy(les) 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 NA EAT David M. Lopez Eastern Insurance Group, Inc. jo�tPHONE (305)595-3323 1F .(305)595-7135 9570 SW 107 AvenueILADDRE .amanda@easterainsurance.net .Quite 104 INSURERS AFFORDING COVERAGE NAIC i Miami FL 33176 INSURERAColony Insurance Company INSURED INSURER B.Brid efield Employers Insuranc Allstate Diversified Engineering, Inc. INSURER C: 7399 SW 45 Street INSURER D: INSURER E Miami FL 33155 INSURER F: COVERAGES CERTIFICATE NUMBER:Master 15-16 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. rA TYPE OF INSURANCE POLICY NUMBER MWD JBR POLICY EFF POLKA P LIMITS GENERAL LIABILITY �y EACH OCCURRENCE $ 1,000,000 R COMMERCIAL GENERAL LIABILITY PREMISES 000urrenoe $ 100,000 CLAIMS-MADE ®OCCUR 103GL0007204-00 1/13/2014 1/13/2015 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICYFX PRO LOCNFDING $ AUTOMOBILE LIABILITY a acci ent L L I ANY ALTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Per accident) $ $ UMBRELLALIAB OCCUR EACH OCCURRENCE $ __ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED I I RETENTION $ B WORKERS COMPENSATION g WC STA' DTH AND EMPLOYERS'LIABILITYER ANY PROPRIETOR/PARTNEWEXECUTIVE Y/N E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory In NH) 30-50170 1/27/2015 /27/2016 E.L.DISEASE-EA EMPLOYE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space is required) Septic tank systems, installation servicing or repair CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Shores village ACCORDANCE WITH THE POLICY PROVISIONS. Building Deptartment AUTHORIZED REPRESENTATIVE 10050 NE 2 Avenue Miami Shores, FL 33138 David Lopes/AMANDA ACORD 25(2010/105) ®1988-2010 ACORD CORPORATION. All rights reserved. IN3I98 r,)mnnri nt The Anr%mn name an,i Inn^era ranfefana,t martre of annan PERMIT #: 13-SC-1595259 APPLICATION #:AP1181578 STATE OF FLORIDA DATE PAID: DEPARTMENT OF HEALTH FEE PAID: ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT RECEIPT #: 010 DOCUMENT #: PR972036 CONSTRUCTION PERMIT FOR: OSTDS New APPLICANT: William Jones PROPERTY ADDRESS: 379 NE 94 St Miami, FL 33138 LOT: 15 BLOCK: 45 SUBDIVISION: [SECTION, TOWNSHIP, RANGE, PARCEL NUMBER) PROPERTY ID #: 11-3206-013-6130 [OR TA.: ID NUMBER] T BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF SECTION SYSTEM MUS 381.0065, T S. , AND CHAPTER 64E-6, F.A.C. DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE SPECIFIC PERIOD OF TIME. ANY CHANGE IN MATERIAL FACTS, SATISFACTORY PERFORMANCE FOR ANY WHICH SERVED AS A BASIS FOR ISSUANCE OF THIS PERMIT, REQUIRE THE APPLICANT TO MODIFY NULL AND VOID. PERMIT APPLICATION. SUCH MODIFICATIONS MAY RESULT IN THIS PERMIT BEING MADE EXEMPT THE APPLICANT FROM COMPLIANCE WITH OTHER FEDERAL, ISSUANCE OF THIS PERMIT DOES NOT STATE, OR LOCAL PERMITTING REQUIRED FOR DEVELOPMENT OF THIS PROPERTY. SYSTEM DESIGN AND SPECIFICATIONS CAPACITY T [ 1,050 ] GALLONS / GPD new septic tan •••• A [ ] GALLONS / GPD A CAPACITY N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:125A0PALLON3+ •• 000000 GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES P0009 0 ElRS ••NP0 [ 0• • ] K [ 0000•• •• 0000•• • 000.00 • • 0 D ( 619 ] SQUARE FEET new bed confiq.drainfield SYSTEM •60060 • • N/A SYSTEM R _� ] SQUARE FEET 0000 • •• 00000 FILLED [ ] MOUND [ ] [x] STANDARD [ ] •• • • A TYPE SYSTEM: 0000• [ ] • •• TRENCH [X] BED I CONFIGURATION: I ] • •••0•• • Interception NE 4 Ave&94 ST: 10.04'NGVD :00:*:• • F LOCATION OF BENCHMARK: • POI��- I ELEVATION OF PROPOSED SYSTEM SITE [ 8.88 ] [ INCHES FT ] [ tiBOVE BELOW B�NCHM�RK/RE�9 FT ][ ABOVE BELOW BEVQA1A1tK/REF$V0 POIX�••• [ 38.88 ] [ INCHES00 • • E BOTTOM OF DRAINFIELD TO BE • • • j L D FILL REQUIRED: [ 0.00] INCHES EXCAVATION REQUIRED: [ 72.00 ] INCHES System#2 O 1.-Install a 1050 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 with s.64E-6.013(3)(f), FAG - H 3.-Install 619 sf of drainfield in bed configuration. E 4.-Install 42"of slightly limited soil at the bottom of the drainfield. 5.-Perimeter of excavation area shall be at least 2 ft wider and longer than the proposed absorption bed or drain trench. R SPECIFICATIONS BY: _ TITLE: G TITLE: Engiriefeaing Specialist II Dae CHD APPROVED BY: Martin EXPIRATION DATE: 1d(22/2016 DATE ISSUED: 0 22!2015 DH 4016, 08/09 (Obsoletes all previous editions which may not be used) Page' 1 of 3 Incorporated: 64E-6.003, FAC SZ956237 J 3..1,4 ' ; PR972036 6.-Invert elevation of drainfield to be no less than 7.30'NGVD. 7.-Bottom of drainfield elevation to be no less than 6.80'NGVD. The system is sized for 4 bedrooms with a maximum occupancy of 8 persons(2 per bedroom),for a total estimated flow of 640 gpd• 0000 • • •Y0• 00!00• 0000•• •• 0000•• 0000•• 0000 of • • • • • • • • ••0•A• i i 00.0• •• of • 0.00.0 Y••••• • • . ,. • • ! • *09*00 0000•• • • 0 • • • • • 0000••