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PL-15-2647 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores,FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number. INSP-245951 PermitNumber: PL-10-15-2647 Scheduled Inspection Date: December 08,2015 Permit Type: Plumbing - Residential Inspector Diaz,Osvaldo Inspection Type: Final Owner. PETERSON, DIRK&ELIZABETH Work Classification: Septic Job Address:1350 NE 101 Street Miami Shores,FL Phone Number Parcel Number 1132050230020 Project <NONE> Contractor STATEWIDE SEPTIC CONNECTIONS Phone:(954)9630082 Building Department Comments REPLACE DRAIN FIELD AND SEPTIC InfracHo ted Comments INSPECTOR COMMENTS False Inspector Comments Passed k- Failed Correction Needed a o � Re-Inspection Fee No Additlonal Inspections can be scheduled until reinspection fee Is pati. December 07,2015 For Inspections please call: (305)762-4949 Page 17 of 44 o ' Was .11 ry' E V64 WN iG Luis ne" AmR, ade�I VZO tr Ali eet 444=41� p 14.._ , x lC{ r sNE,V - TICS# s _ OEM --n CKEINX At '7.. V➢ A5RY9-ih- 10t 1 - Y x Tei- 43.'`.-- ..x?�" ,. `��""'t* � ,kt •'. r a A Miami Shores Village - Building Department OCT x9z®,� 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 201 BUILDING Master Permit No. PZ. /_r 2Z 9-7 PERMIT APPLICATION sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL PLUMBING ❑ MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP 2 CONTRACTOR DRAWINGS JOB ADDRESS: ' J so �EF to I City: Miami Shores County Miami Dade Zip: -:2� � Folio/Parcel#: 23 9 tO 2-o Is the Building Historically Designated:Yes NO i.-/ Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name(Fee Simple Titleholder): D I R K I 1C LIQ• Pe Tj,�,7gL&o rl Phone#: Address: I S® 141 S-T City: �A C' State: ��- Zip: 3-� Tenant/Lessee Name: Phone#: Email: y� CONTRACTOR:Company Name: A 0 � 1,5 9E r Te C C I-jTrPhon#: 31661-6633 Address: f�G�rro�o J i C1 City: b CVA ^^ State• Zip: 33o (* Qualifier Name:_ TtT Yo(0 Phone#: State Certification or Registration#: ,1� bnto_km 7-6-, Certificate of Competency M DESIGNER:Architect/Engineer: Phon#: Address: City: State: Zip: Value of Work for this Permit:$ 6;1-�nn Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace ❑ Demolition Description of Work: PCL 0SliZ 6 Specify color of color thru tiler Submittal Fee$ Permit-Fee$ � CCF$ 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) t 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. p�' Signatur Signature OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this _day of CJ- 20 r� by i day of ®C-� 20 �-5' by -� ►���P XWf who is personally known to r TAItS ;5SR) 0 OAf,who is personally known to me or who has produced KR 10 as me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign Sign:_ A i j4t Print: ,v C` I I Lr-lx ls Print: I�r-�,v���1`a, -e Seal: Seal: ' " Notary Publb Stele of FbrWa Nomry Publt 8mte of Fbtida TrenceUa Lawns Trenceffe Lewis My Canmissbn FF 196307 +� �1' My Comm�smon FF 196307 orw Expires02iowo19 'a! wd'` ExWres02/08!2019 **** * ** t ***xc************ * ** ********* 1 APPROVED BY T Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) PERMIT #: 3-SC-1606658 STATE OF FLORIDA. APPLICATION #: p1 1 89055 ALTH DEPARTMENT OF HEAI, HADE( OIJi4?TY HE DEBAR DATE PAID: ONSITE SEWAGE TREATMENT AND. DISb6.SAI SYSTEM FEE PAID: CONSTRUCTION PERMIT RECEIPT #: DocumENT #:PR975927 CONSTRUCTION PERMIT FOR: OSTDS Repair APPLICANT: Dirk&Elizabeth Peterson PROPERTY ADDRESS: 1350 NE 101 St Miami, FL 33138 LOT: 2 BLOCK: 1 ; SUBDIVISION: .Miami Shores Bay Park Estates ' ry '.` [SECTION, TOWNSHIP, RANGE, PARZEL NUMBER] PROPERTY ID #: 11-3205-023-0020 ter.: jOR TAX ID NUMBER] SYSTEM MUST BE CONSTRUCTED IN A6CORDANCE 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 APPLICAN2 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 r i T [ 1,050 ] GALLONS / GPD new septic tank �ITY A [ 0 ] GALLONS / GPD CAPACITY N [ 0 ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS] K [ ] GALLONS DOSING TANK CAPACITY ��ONS @[ ]DOSES PER 24 HRS #PumpsD I 300 7 SQUARE FEET new bed confq.drainfi@l R [ 0 ] SQUARE FEET SYSTEM A TYPE SYSTEM: [X] STANDARD [ ] FILLED [ ] MOUND [ ] I CONFIGURATION: [ ] TRENCH [X] 'BED [ ] N , F LOCATION OF BENCHMARK: FFE 8.00'NGVD'"-^ I ELEVATION OF PROPOSED SYSTEM SITE "k .28.80:] [ p0CgZsj IFT ] [ ABOVE BELOW BENCHMARK/REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ 53.807 [ INCHES ;FT 7I ABOVE BELOW BENCHMARK/REFERENCE POINT L D FILL REQUIRED: [ 0.007 INCHES } EXCAVATION REQUIRED: [ 60.001 INCHES 1.-Install a 1050 gal min.septic tank with an approved filter. O 2.The licensed contractor installing the system is responsible for installing the minimum category of tank in accordance T with s.64E-6.013(3)(f), FAC. H 3.-Install 300 sf of drainfield in bed configuration. 4.-Install 12"of slightly limited soil at the bottom of the drainfield. E 5.-Perimeter of excavation area shall be at least 2 ft wider and longer than the proposed absorption bed or drain tr anch. R (Comments Continued on Pa a 2.) , SPECIFICATIONS BY: Tere S lomon TITLE: Master Septic Tank Contra for APPROVED BY: C TITLE: Engineering Specialist II Dade CHD Y DATE ISSUED: 05/27/ EXPIRATION DATE: 08/25/2015 DH 4016, 08/09 (Obsoletes all previous editions which may not be used) Incorporated: 64E-6.003, FAC Page 1 of 3 AP1189055' SE961683 t Kc IF; } DOCUMENT #: PR97 927 6.-Invert elevation of drainfield to be no less than 4.00'•NGVD. 7.-Bottom of drainfield elevation to be no less than 3.50'NGVD. 8.-This permit includes the abandonment of the existinjseptic tank: The system is sized for 3 bedrooms with a maximum occupancy of 6-persons(2 per bedroom),for a total estimated fl w of 400 gpd. THIS PERMIT IS NOT FOR ANY ADDITIONS. ol E, ti Ys . - STATE OF FLORIDA A � DEPARTMENT OF HEALTH APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PE MIT Permit Application Number ------------------• PART II =SITE PLAN---------- - r �--- CERTIFICATE OF LIABILITY, INSURANCE DATE(MWODIYYM TIi1S CERTIF(CQTE IS tSSUEp AS A MQ'I R OK INFO"ATIOH ONLY AND CONFERS NO RIGHTS UpaN THS CERTtFI TE 1{OLDFJx,T{IIS CERTIFICATE DOES NOT AFFIRMATIVELY OR Ne6ATIVELY AMEND,EXTEND OR ALTER THE COVERAsg AFFOI�p)=p Y THE POLI S &FLOW. THIS CRRTtFIGATE OF INSURANCE DOLS NOT CpNgT1T(JTEACONTRACT BETWEEN THE ISSUING FORDINSURE REPFtESENTATNE OR PIZOPUCi=R,AND 1 HE CEI REIGATE HOLDER. S),AUTHORIZED IMPORTANT, con cerlifrcete hwlderls an ADDITIpNAL INSUREb,tho poll10- Iea)most be endorsed. ItSUBROOATION IS WAIVED,evbj to the tcrma and holder I I Ions ofthc pollcY,eertab) Ge cats holdor in lieu of such endorsomsnt sPollcles may requires an endo; ;enk Aatatcment on this certificate CIO to not oonfer rlgl IS to tiro PRODUCLR Slaize&TYson Instance NA T eT 5956 SW 21st Street 0 Hollywood,FL 39023 MAIL _ Phone (954)989-9324 P DOC Fax (954)fl39.5998 INSURED - � INSURE AFFORDING GpVERAGp StstuMde Septio Connections,Ino INSI A; CAPITOL SPECIALTY INS CORP Niue 15640 NW 19TI•l AVE BAY 15 SURE a: PROGRESSIVE INSURANCE OPA LOCKA,FL 33054 INSURER c: (954)963-01332 FNSURER D;i COVE ES INSURER P I TI IIS I TO CERTIFY THAT TFIE FOLIC $ WSU�NCE MSTEa BELQW INSURER F s INDICATED, NOTV+ryTHSSU DING ANY PERTAINWIP(M CHT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESP ON NUMSI R OL POLICY CERTIFICATE MAY BE ISgGED OR MAY PERTAIN THE INSURANCE AFFORDED BY Tl E POLICIES DESCRIBED HER MED ABOVE I'OR TH PO WHICH THIS EXCLUSIONS AND GONDr ANI OF SUCH POLICIES,LIMITS SHOWN MAY t(AVE BEEN ITR HEREIN IS SUBJECTTO A L TRI:TER0A5,THIS •nPB OF INSURANCE REDUCt:'D 8Y PAID CLAIMS. GENERAL LIABILITY gR POLICY NUMBEq LI D EFF (MM/D 2COMMERCIAL GENERAt LIABILITY EACH OccyRREll LII EDMADE pi o=Lm A ❑ Cwma- $ 1000000 II � ❑ N N GL-216062.00 EMISF r_, s 100,000 ❑ — — 10/1?J2018 10/1=018 MED- pfAnYant perl } S 4000 GSMLAGGREGATE worAPPLIES PES t'ERSONAL B ADV 1NJ Y S 1000,000 11�� 01, POLICY ❑ JRa- 1—I Loa GENERALAGCREGATE S 2, 0,000 AUTOMOBtLELtA�LJYY iJ PRODUCTS.COMPIO AGE 5 211 ❑ ANY AUTO S COMBINED SINGLE LIM ❑ ALLOWNEDAUTOS (EaeecldenQ S 300,000 B © SCHEDULIZDAUTOS 03443464 g BODILY INJURY(per pe ) S ❑ HIRED AUTOS 03)21/2018 W/21/2018 SODILY INJURY(Per em S ❑ NON-OWNED AUTOS PROPERTY DAMAGE ❑ (Per 200denq S 13atcESSLrAe� ❑OCCUR PIP S 10,000 LAtMa-BsOE ISLE EACH OCCURRENCE 1 J DEDLICT5 AOGREGATE 5 ON S WORKERS COMPENSATION S AND EMPLIOl Ul ANY PR0pRgr0R/PARTNERqXECUTI+IE Y/ TATU. 5 10OFFICF,Rry in N ER EXCLUDED? NIA ,.,,,� I-1 0 N_ 1 6 drmo to NN) Cf„EACH-ASC+1.1�bEJ_I.111 ttffyeg�Rl NOrtlOPERATJONSbelow $ OES E.I..DISFABE-EA ElypL, E S E•Ll DISEASE-POLICY LI IT $ OESCMPRON OF OKRATtpNS t LOCATIONS t VEHICLES(Attacy ACORD 7e1,Additional RernarkB Sa>tsdWq tr nt0,c s SEPTIC TANK INSTALLATION,REPAIR AND SERVICE 11auo f8 i=gWred) CERTIFICATE HOLDER • CANC$LLATION . ViLLAGI=OF MIAMI SI'IORk SNOULD ANY OF THE ABOVE DESCRIBED POLICIES BE ANCELLED BEFORE 10050 NE ZND AVE THE EXPIRATION I)AI THEREOF,NOT1 WILL BE DELI RED IN ACCORDANCE WITH THE POLICY PROVISIONS. WI MIAMI SHORES,11133138 FAX.,954-003.0085 Allm RIM0 REPRESENTATIVE i ACORD 25(2008/09)OF ©1SM2000ACORD CrORPORATIO 1. All rig htsMsgrvod. The ACORD naMe alts(logo M rages RrOd marks Of ACORD i I TIT:aepd 2Z699S2_S0£:oI :w0jj £T:£2 ST02-6T-190