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PL-15-2743 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-249053 PermitNumber: PL-10-15-2743 Scheduled Inspection Date: January 07,2016 Permit Type: Plumbing - Residential Inspector: Diaz, Osvaldo Inspection Type: Final Owner: HURTADO,MINA Work Classification: Drainfield Job Address:10916 NW 2 Avenue Miami Shores, FL 33168-4303 Phone Number Parcel Number 1121360020200 Project: <NONE> Contractor: A AARON SUPER ROOTER Phone: 305-944-8886 Building Department Comments REPLACE DRAINFIELD Infractio Passed comments INSPECTOR COMMENTS False Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-246766. sod required Failed Correction Needed s n Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid January 06,2016 For Inspections please call: (305)762-4949 Page 9 of 34 NMI, t ."..'• �..�;� �\ �\\�,..\ d \\\\��� a��\\�. �.,.... \ \�. \. x \��Ox\ o .; a \ \ \ \\\ \ \ Y\ \ �\\ x.• \ RM A a A»vvv gAa i V A\ s" v v v vv �v v v A v y., � .� yA \,IMPOSEyIA > \VwAv. vyyv �L vyyA® y���:A 'ey"v`��vw• A'�'\ � � \, M' r�a v��Z�c �\ v V��\ �wA\vv v- a ��� v��V�y��\V AA��• �uayvA " � � wA �A\ �� Vv� AA �F~v .A.�\�;n 0. y, Z aA� A\�a\AVy�� VAwA\V�� a \\V\�^ `O A�..\ \ \ \z\ \\u\ \\\\ \\\ \ ° \\\ \ \ \. \ \. ,•'�'� ..fru. ..�-' � ,y,8 � - „A xv, ..v A \.�\. A:A._-�\\� as �" Wit\, Pe t ,P 6- �sµO' Miami Shores Village P8171TI#lye;Plumbing-Relitiential 10050 N.E.2nd Avenue NW Miami Shores,FL 33138-0000 11 VoCTaa#tarp braitlfield Phone: (305)795 2204 T� lT I[i u#sfi+S'Ahl OVED �toRm� Expiration: 0413012016 Issus>�abe.11/2/201�a - Project Address Parcel Number Applicant 10916 NW 2 Avenue 1121360020200 Miami Shores, FL 33168-4303 Block: Lot: YINA HURTADO Owner Information Address Phone Cell YINA HURTADO 10916 NW 2 Avenue MIAMI SHORES FL 33168-4303 Contractor(s) Phone Cell Phone Valuation: $ 2,400.00 A AARON SUPER ROOTER 305-944-8886 Total Sq Feet: 225 Type of Work:REPLACE DRAINFIELD 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 $1.60 DBPR Fee Invoice# PL-10-15-57578 $2.25 10/28/2015 Check#:1012 $50.00 $118.30 DCA Fee $2.25 Education Surcharge $0.60 11/02/2015 Check#:1018 $ 118.30 $0.00 Permit Fee $150.00 Scanning Fee $9.00 Technology Fee $2.40 Total: $168.30 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 th foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and z Futhermore,I a t orlze4e above-named contractor to do the work stated. November 02, 2015 A horized S gnature:Owner / Applicant / Contractor / Agent Date Buildin epartment Copy November 02,2015 1 Miami Shores Village Building Department artment 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 OCT 2 8 2015 Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 -- -_ - _-. FBC 20I� BUILDING Master Permit No. ( _ Is-_2_:7q3 PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION [:]RENEWAL t6PLUMBING ❑ MECHANICAL F1 PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP yy p� CONTRACTOR DRAWINGS t JOB ADDRESS: 1 ®9 1 G ``� � yy City: Miami Shores County: Miami Dade Zip: ,� 1 Folio/Parcel#: ( I �5(3 -00 —'30 2_0 Is the Building Historically Designated:Yes—N O Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): 7 °� � ����� Phone#: ZC�j ' S--(v Address: 1 0C ` 0 9J-A) I f' -4-, �y City: , Cs( tn!�)) 5 110 fCJ State: p: �(.� Zi Tenant/Lessee Name: Phone#: Email: t�YY rr CONTRACTOR:Company Name: o Stp� fl-0 � Phone#:3 (:3 &P6 Address: 6, 0,2,2_ SI-Z 2)S C J City: I Y- a V- State: Zip: Qualifier Name: 3,-1 v1'n `3 Phone#: State Certification or Registration#: Certificate of Competency#: 5e®g 21 9.1 z DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ 2-4 00 427 Square/Linear Footage of Work: 22S Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace ❑ Demolition Description of Work: e P Ce P Specify color of color thru tile: 9 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) 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 comrnencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. 1 he absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Signature OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this !S day of 20�S by r S daytt of C)C-V' ,20 \S by who is personally known to t��Yl I1 �J l who is personally known to me or who has produced Y::Z A- qD 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: Z Sign: Sign: C Print: � s �' Print: ,;ii<.o�;-; ^���sec�4 ¢I SOLOMON _ a .OM®N Seal: . Seal: „ , TF .S� EE131935 " hr1311935 nber 08.2015 1 �;�.�`,orA•� �+j• .�' tall�i:a Nr .+-she`06, FtoddeNotarlService.com fid! ' d Ke22,y erv�e.com ? 398-0153 k*kkk"+k"k+k+k&kk+k+kh k&*&kkkkkkkk**k*##*k"9*&"+k#k&&*kkk+k+k �-'3y�5�k*kk +kkkk*kkkkkkkkkkkkk APPROVED BY °S Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) �1 t PERMIT #:.13-SC-1635303 APPLICATION #: P1207687 STATE OF FLORIDA ►.. ow" DEPARTMENT OF HEALTH DATE PAID: ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM FEE PAID: CONSTRUCTION PERMIT RECEIPT #:F, DOCUMENT #: R990892 ropp .2 4:tFxa 'w i `�LA nr;�r.gr.s-qFT CONSTRUCTION PERMIT FOR: OSTDS Repair APPLICANT: Yina Hurtado PROPERTY ADDRESS: 10916 NW 2 Ave Miami, FL 33168 LOT: 18 BLOCK: na SUBDIVISION: PROPERTY ID #: 11-2136-002-0200 [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 Da..,s 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 [ 688 ] GALLONS / GPD Septic(Existing) CAPACITY A [ 0 ] GALLONS / GPD CAPACITY N [ 0 ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 ONS] K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ ] D [ 225 ] SQUARE FEET Trench Drainfield SYSTEM v R [ 0 ] SQUARE FEET SYSTEM A TYPE SYSTEM: [x] STANDARD [ ] FILLED [ ] MOUND [ ] I CONFIGURATION: [x] TRENCH [ ] BED [ ] N F LOCATION OF BENCHMARK: FFE 13.3'NGVD I ELEVATION OF PROPOSED SYSTEM SITE L 22.807 [ INCHES FT ] [ABOVE BELOW BENCHMARK/ FERENCE POINT E BOTTOM OF DRAINFIELD TO BE L 62.80 ] [ INCHES FT ] [ABOVE BELOW BENCHMARK/ FERENCE POINT L D FILL REQUIRED: [ 0.00] INCHES EXCAVATION REQUIRED: [ 40.00 ] INCHES ***THIS PERMIT IS NOT FOR ADDITIONS*** O *Perimeter of excavation area shall be at least 2 ft wider and longer than the proposed absorption bed. T *Invert elevation of drainfield to be no less than 8.57'NGVD. H *Bottom of drainfield elevation to be no less than 8.07'NGVD. The system is sized for 3 bedrooms with a maximum occupancy of 6 persons(2 per bedroom),for a total estimated flow E of 300 gpd. R SPECIFICATIONS BY: JT147� TITLE: APPROVED BY: Vk \IV TITLE: Engineering Specialist II Dade CHD DATE ISSUED: 10/15/2015 EXPIRATION DATE: 01/13/2016 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 AP1207687 SE974212 -- STATE OF FLORIDA DEPARTMENT OF HEALTH APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT �L Permit Application Number ti ------------------- PARTII-SITE PLAN----------.-- Scale: LAN--------- —Scale: Each block represents 5 feet and 1 inch=50 feet. IV . _ ) i - P - f - 04. .i S j j , , f' : t T, -' - -- - :y - � t r t i t , , ,. - ... .. : : ... .. ere are no p 1irment.t'eatures.acr oss khe treat lot a jacentto`the property atinay-a ect:septicsysiem. i t 1 _ 1 1 I , Votes: QTA' .�'�', IAJ -_._. _.�....___. J" . �;^�����<_,_._ _�.___ _� _.•_ _.�.. .___....__.-� lite Plan submitted by: rf Signature Title LTt 'Ian Approved_ pproved Date– tD jL i S 3y NI CO ICL2 S— l County Health Department ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT 14015.10196(Replaces HRS-H Form 4015 which may be used) lock Number:5744-00&4015-6) s. Page 2 of 3 0 n R) m N N W 0 REGISTERED SEPTIC 6rANK-CONTRACTOR JOHN J TUFFY {� 6022 8W 35TH COURT M I RAMAR.FL 3.3023 •A--AARON SUPER'ROAi'ER,INC. SRO 211124 Business Aathookatiori; SA09,20648 Rrcistraiior. Expires erj Upternber 30.2.016 0 m (A 0) 00 w N 0 �D - N W i i 001270 Local Business Tax Receipt Miami-Dade County, State of Florida -THIS IS NOTA BILL - 00 NOTPAY 3494036 BUSINESS NAME/LOCATION RECEIPT NO. L V PI ES A AARON SUPER ROOTER INC RENEWAI. 5���•��B� 30� 20�6 DOING BUS IN DADE CO 3649960 Must be displayed a place of business Pursuant to C unty Code Chapter SA-Art,9&10 OWNER SEC.TYPE OF BUSINESS AAARON SUPER ROOTER INC 196 SPECIALTY PLUMBING CONTRACTOR PAYME T RECEIVED $EP000648 BY TA COLLECTOR Worker(s) 1 $75.00 07/21/2015 CHECK 1-15-101627 This Local Business Tax Receipt only confirms payment of the Local Business Tax. The Receipt is not aicense, permit,or a certification of the holder's qualifications,to do business. Holdef+nest comply with any gov rnmental Of nongovernmental regulatory laws and requirements which apply to the business. The RECEIPT NO,above must he displayed on all commercial vehicles.-Miami-Dade Code Sec sa-276. For more information,visit www.miamidadsgavltaxaollector 2/2: *d 21L6e9S1LS02:01 :woad t72:T2 Sti02-02-100 3014N J "PUFFY A-AARON SUPER ROOTER, INC. 6022 SW 35Th COURT MIRAMAR, FL 33023- FLORIDA DEPARTMENT OF HEAL'T'H CERTTFICATE OF AUTHORIZATION FOR SEPTIC TANK CONTRACTING � TH - The Florida Department of Health hereby certifies the business or entity named below has satisfied the r eguirements of Part .111, Chapter,189, Florida Siatutes,for septic tank contracting and has been duly authorized by the Dep ll rtment In provide septic tank contracting services under the name of: A-AARON SUPER ROOTER, INC. Qualifying Contractor: JOHN I TUFF Y SA0920648_ _April 6, 2015 M._ ch 31, 2017 Authorization Number Date lssued Expiraiion Date 2/2:abed 2L609SZS02:01 :wojj £Z:ZZ ST02-02-100 A a CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDtYY) 10!22!15 P906UCER Arbelaez Insurance,Inc. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 9971 Miramar Parkway ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR Miramar,FL 33025 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELO_W.- Phone (954)436-5544 _ Fax (954)436.7733 INSURERS AFFORDING COVERAGE NAI_C_# _ INSURED AAARON SUPER ROOTER,INC. I INSURER A: ACCIDENT INSURANCE CO 6022 SW 35 COURT INSURER B: COMMERCE& INDUSTRY INS CO. I NSURER C: Miramar, FL 33023- I ---- — _ 1305 944-888$ INSURER D: INSURER E: -_ COVERAGES THE POLICIES OF INSURANCE LISTED 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.AGGREGATE LIMITS SHOWN MAY HAVE_BEEN REDUCED BY PAID CLAIMS. INSR ADD'L� POLICY EFFECTIVE I POLICY EXPIRATION LTR INSRD TYPE OF INSURANCE POLICY NUMBER DATE(MMIDD/YYYY(DATE(nnMn7omrY)— LIMITS GENERAL LIABILITYEACH OCCURRENCE �^ 1.003.000 COMMERCIAL GENERAL LIABILITY UA-I GE TO RENTED CPP0006004 03 09!29/2015 09/29/2016 PREMISES(Ea occurrence)_ 100.000 ❑❑ CLAIMS MADE � OCCUR MED EXP{Anyone person) 55.000 A [� ❑ � PERSONAL&ADV INJURY 1,000,000 ❑ — i GENERAL AGGREGATE 2.000.000 _P GEN'LAGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG t i I _ _ _ _ _ _ INC ❑ POLICY ❑PROJECT I 1 LOC I I — AUTOMOBILELIABILITY❑ --.. ...- ;- - --- --•- ••---_ .; _ ... .. ...._ _!.__.__ -----;--- -__--- --�---- I it COMBINED SINGLE LIMIT ANY AUTO (Ea accident) ❑ ALL OWNED AUTOS B ❑ ❑ SCHEDULED AUTOS BODILY INJURY ❑ _(Pperson) HIRED AUTOS I er ❑ NON OWNED AUTOS BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) GARAGE LIABILITY - —� AUTO ONLY-EA ACCIDENT ❑ ❑ ANY AUTO { OTHER THAN EA ACC ❑ _ -j _ �I AUTO ONLY: — AGG EXCESS I UMBRELLA LIABILITY �� I _ _EACH OCCURRENCE_ ❑ ❑ OCCUR ❑ CLAIMS MADE I I-AGGREGATE ❑ DEDUCTIBLE — ❑ RETENTION $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITYYIN I WC QB127719 �j 09123!2015 109/23/2018 I Vj WC STATU- ❑ OTH- TORY LIMITS _.__ER_ � B ANY PROPRIETOR I PARTNER/EXECUTIVE OFFICER l MEMBER EXCLUDED? E.L.EACH ACCIDENT 1.000.000 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEEI 1.000.000 Des describe under I E.L.DISEASE-POLICY LIMIT 1.000.000 SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS #SA0920W CERTIFICATE HOLDER — CANCELLATION _ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL VILLAGE OF MIAMI SHORES 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO 10050 NE 2 AVE THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY MIAMI SHORES. I OF ANY KIND UPON THE INSURAAGENPRESEN TlAUTHORIZED REPRESENTATIVFL 33138ACORD 25(2009!01)QF ©1988-2IO .All rights reserved. TheACORDregistered marks of ACORD