PL-15-2952 Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores,FL
Phone: (305)795.2204 Fax: (305)756.8972
Inspection Number INSP-248309 PermitNumber: PL-11-15-2952
Scheduled Inspection Date:January 25,2016 Permit Type: Plumbing -Residential
Inspector Diaz,Osvaldo Inspection Type: Final
Owner: CONSUELO BECERRA,JORGE Work Classification: Drainfield
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Job Address:34 NW 96 Street
Miami Shores,FL 33150- Phone Number
Project: <NONfa Parcel Number 1131010330480
Contractor. MR C'S PLUMBING&SEPTIC INC Phone:(305)651-7859
Building Department Comments
DRAIN FIELD Infractlo Passed Comments
INSPECTOR COMMENTS IF
f -Z1--I'b
Inspector Comments
Passed
Failed
Correction
Needed
Re-inspection
Fee L—J
No Additional Inspections can be scheduled until
re-Inspection fee is paid.
January 22,2016 w �� For inspections please call:(305)7624949 Page 8 of 61
> X2352
Miami Shores Village "P, llttlt j Pluttl�rrg` Reslde ttiis
10050 N.E.2nd Avenue NWa sot
Miami Shores,FL 33138-0000 11 WO
f?ormit Status:AI'PROV
' nom Phone: (305)795-2204
t"oRml* M "q f
� 1ll
15 Expiration: 05/3 /201
Project Address Parcel Number Applicant
34 NW 96 Street 1131010330480
JORGE BONAMINO CONSUELO
Miami Shores, FL 33150- Block: Lot:
Owner Information Address Phone Cell
JORGE BONAMINO CONSUELO 34 NW 96 Street
------ MIAMI SHORES FL 33138-
34 NW 96 Street
MIAMI SHORES FL 33138-
Contractor(s) Phone Cell Phone Valuation: $ 2,400.00 ,
MR C'S PLUMBING 8r SEPTIC INC (305)651-7859 Total Sq Feet: 300
Type of Work:DRAIN FIELD 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-Owners Bond $500.00 Invoice# PL-11-16-57857
CCF $1.80 11/23/2015 Credit Card $50.00 $612.30
DBPR Fee $2.25
DCA Fee $2.25 12/02/2015 Credit Card $500.00 $112.30
Education Surcharge $0.60 12/02/2015 Credit Card $ 112.30 $0.00
Permit Fee $150.00 Bond#:2917
Scanning Fee $3.00
Technology Fee $2.40
Total: $662.30
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 and zoning. Futhe I auth a above-named contractor to do the work stated.
December 02,2015
Autho ed Signature:Owner / Applicant / Contractor / Agent Date
Building Department Copy
December 02,2015 1
�c v® CERTIFICATE OF LIABILITY INSURANCE DATE(MMfDDIWYY)
12/1/2015
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 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 NOME:NTACT Nicole Biallas
LRA Insurance PHM o.E : (407)838-3445 FAC No: (407)838-3460
498 S Lake Destiny Dr ADDRESS.nbiallas@lrainsurance.com
INSURER(S)AFFORDING COVERAGE NAIC S
Orlando FL 32810 INSURERA Brid efield Employers Ins Cc 10701
INSURED INSURERS:
Mr. C's Plumbing & Septic, Inc INSURERC:
19932 NW 2ND AVENUE INSURERD:
INSURERE:
Miami FL 33169 INSURERF:
COVERAGES CERTIFICATE NUMBER: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.
LTR TYPE OF INSURANCE POLICY NUMBER POLICY
MOL EFF MPOMI POLICY EXP LIMITS
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $
DAMAGE TO RENTED
CLAIMS-MADE 1-1 OCCUR PREMISES Es occurrence $
MED EXP(Any one person) $
PERSONAL&ADV INJURY $
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $
POLICY PCT F1 LOC PRODUCTS-COMP/OP AGG $
OTHER: $
AUTOMOBILE LIABILITYCOMBINED SINGLEL M $
Ea accident
ANY AUTO BODILY INJURY(Per person) $
ALL OWNED SCHEDULED BODILY INJURY(Per accident) $
AUTOS AUTOS
NON OWNED PROPERTY TY AMAGE $
HIREDAUTOS AUTOS
UMBRELLA LIAB OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE AGGREGATE $
DED I I RETENTION $
WORKERS COMPENSATION X STATUTE ERH
AND EMPLOYERS'LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE F— NIA E.L.EACH ACCIDENT $ 100,000
A OFFICERIMEMBER EXCLUDED? 0830-54817 10/1/2015 10/1/2016
(Mandatory In NH} _ E.L.DISEASE-EA EMPLOYE $ 100,000
If yes,describe under r
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required)
Septic Systems Installations. License# SR061536
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Miami Shores Village THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
10050 NE 2nd Ave ACCORDANCE WITH THE POLICY PROVISIONS.
Miami Shores, FL 33138
AUTHORIZED REPRESENTATIVE
Brian Tomlinson/KPANT -
O 1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD
INS025(201401)
®\�a� Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 NOV20�
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949 ---- __
FBC 20 jq
BUILDING Master Permit No. RJ�
PERMIT APPLICATION sub Permit No.
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 34 w q b 5_
City: Miami Shores r®County: Miami Dade Zip: 33156
Folio/Parcel#: 1 .1�L C d 3� 0�{`(,b Is the Building Historically Designated:Yes NO -
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name(Fee Simple Titleholder): 5j rc e S or.,t,u,o Phone#A) n� 23`94
Address: 34 bw 16, SE _
City: State: Ti' Zip: 331
Tenant/Lessee Name: Phone#:
Email: / C
CONTRACTOR:Company Name: �15 PIlj&k e6z Sj,l Phone#:
Address: ��6131 �� O.� i ici
City: M.R.,.-, �( State: Zip: 3.7161
Qualifier Name: K",t l�'In(k Phone#:
State Certification or Registration M .0,0 61 5 3 G Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: '.,�,, City: State: Zip:
��II,
Value of Work for this Permit:$ t7`^ op n Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace ❑ Demolition
Description of Work: -1
Y q'
e
Spec!►f y ,Q�Q��. `cofbr ' �
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$I
(Revised02/24/2014) ��
I/
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 b approved and a reinspection fee will be charged.
Signature Signature
OWNER or AGENT CONTRACTOR
Thforegoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
33 day of
� � 120 , by 3 day ofp 6Af�l � ,20 l 5 , by
who is personally known to �6L ZWI_164 ,who is personally known to
me or who has produced as We 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: _"4ez a -11 1�
Print: KFMBI_ FTTRwK Print: 0sNuft" SHERYL A MENDES
I
°. , g-PTI :Notary Public - State of Florid NOh1y PUbHC-S�tB 01 F101idB
Seal: Seal: MY Comm.Expires Oct 23,2018
My Comm. Expires Sep 19,2C' Commission#FF 138887
Nl OP:
Commission #FF 055732 '•,, : 9w0l7bra*1 "AsoL
Bonded Through National Notary Assn.`
APPROVED BY //���"�� Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
r' A 17
PERMIT #:13-SC-1642152
APPLICATION #:AP1212338
STATE OF FLORIDA
DATE PAID:
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM FEE PAID:
CONSTRUCTION PERMIT RECEIPT #:
DOCUMENT #:PR994588
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: Jorge Bonamino
PROPERTY ADDRESS: 34 NW 96 St Miami, FL 33150
LOT: 7&8 BLOCK: 131 SUBDIVISION: Miami Shores Sec 6
PROPERTY ID #: 11-3101-033-0480 [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 AND SPECIFICATIONS
T [ 900 ] GALLONS / GPD existinq septic tank to remain CAPACITY
A [ 0 ] 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 [ 300 ] SQUARE FEET new bed confiq.drainfield SYSTEM
R [ 0 ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [x] STANDARD [ ] FILLED [ ] MOUND [ ]
I CONFIGURATION: [ ] TRENCH [x] BED [ ]
N
F LOCATION OF BENCHMARK: FFE 13.1'NGVD
I ELEVATION OF PROPOSED SYSTEM SITE [ 26.40 ] I INCHE3 FT ] [ABOVE BELOW BENCHMARK/REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 76.44 ] [ INCHES FT ] [ABOVE BELOW BENCHMARK/REFERENCE POINT
L
D FILL REQUIRED: 10.00] INCHES EXCAVATION REQUIRED: [ 62.00 ] INCHES
1.-Existing 900 gal.septic tank,certified by"Mr.C's Plumbing"on 11/12/2015 to remain.
0 2.-Install 300 sf of drainfield in bed configuration.
T 3.-Install 12"of slightly limited soil at the bottom of the drainfield.
H 4.-Perimeter of excavation area shall be at least 2 ft wider and longer than the proposed absorption bed or drain trench.
(Comments Continued on Page 2.)
E
R
SPECIFICATIONS BY: Mr C's Plb Sept TITLE:
APPROVED BY: TITLE: Engineering Specialist II Dade CHD
Yudeisy Martin
DATE ISSUED: 11/17/2015 EXPIRATION DATE: 02/15/2016
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E-6.003, FAC Page 1 of 3
v 1.1.4 AP1212338 SE977097
DOCLIbENr #: PR994588
5.-Invert elevation of drainfield to be no less than 7.23'NGVD.
6.-Bottom of drainfield elevation to be no less than 6.73' NGVD.
THIS PERMIT IS NOT FOR ANY ADDITIONS.
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.