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PL-16-69 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-252075 Permit Number: PL-1-16-69 Scheduled Inspection Date: February 03, 2016 Permit Type: Plumbing - Residential Inspector: Diaz, Osvaldo Inspection Type: Final Owner: GRIMBERT, DAVID AND MEGHAN Work Classification: Drainf➢eld Job Address:253 NE 92 Street Miami Shores, FL 33138- Phone Number Parcel Number 1132060133560 Project: <NONE> Contractor: MR C'S PLUMBING&SEPTIC INC Phone: (305)651-7859 Building Department Comments DRAIN FIELD INSTALLATION Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-250696. HRS TAG IN FILE E11SOD SHALL BE COMPLETED IN RIGHT OF WAY FOR FINAL Failed Correction ❑ � Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid February 02,2016 For Inspections please call: (305)762-4949 Page 38 of 42 Health fF//r�/rr fF ✓ '// ` rr a / /'`/f r / r� �� 1, ' 26th'," �f•Mtatnl, L 33175,` f ,/ Y' gosor .t �3 Permit No PL-' -1 2 Miami Shores Village Permit Type Plumbltg �siClt) 3; 4. 10050 N.E.2nd Avenue NE Mp, 1Nort�Clr�araratiiold Miami Shores,FL 33138-0000 'vsp o� Phone: (305)795-2204 il,�t/S. PPROVED �� 711102016 114312 due at . k Expiration: Project Address Parcel Number Applicant 253 NE 92 Street 1132060133560 Miami Shores, FL 33138- Block: Lot: DAVID AND MEGHAN GRIMBER' Owner Information Address Phone Cell DAVID AND MEGHAN GRIMBERT 253 NE 92 Street MIAMI SHORES FL 33138- 253 NE 92 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone Valuation: $ 4,200.00 MR C'S PLUMBING&SEPTIC INC (305)651-7859 Total Sq Feet: 300 Type of Work:DRAIN FIELD INSTALLATION 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 Bond Type-Owners Bond $500.00 CCF $3.0o Invoice# PL-1-16-58293 DBPR Fee $2.25 01/13/2016 Credit Card $ 121.50 $550.00 DCA Fee $P.25 01/11/2016 Credit Card $50.00 $500.00 Education Surcharge $1.00 01/13/2016 Credit Card $500.00 $0.00 Permit Fee $150.00 Bond#:2956 Scanning Fee $9.00 Technology Fee $4.00 Total: $671.60 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: Icertify that a foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhe e,I e the above-named contractor to do the work stated. January 13, 2016 Authori ignature:Owner / Applicant / Contractor / Agent Date Buil ng Department Copy January 13,2016 1 Miami Shores Village RZCEIVED t Building Department JAN I1,20% QI 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 $Y; Tel: (305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 201 " BUILDING Master Permit No. ®9 PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION [:]RENEWAL [PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP �y CONTRACTOR DRAWINGS JOB ADDRESS: LAS.3 WE OIL Q� City: Miami Shores County: Miami Dade zip: 33 13 y Folio/Parcel#:��3ZO(y - O ] 3 —,3 K66 Is the Building Historically Designated:Yes NO Occupancy Type: Load: wpA�Construction Type: Flood Zone: BFE: FFE: OWNER: Name(Fee Simple Titleholder): IYICg1�ah ? Qa.V���) PTr� m �7e r Phone#: 3 6 aZ3 7 7-00 Address: 2 53 N C oil S f r-C C- 1- City: IV1La» I Shores' State: zip: 3313 b' Tenant/Lessee Name- Phone#: 30 S 3Z 3 7700 Email: b1,& r1 j a 1 `. Cd 1�, CONTRACTOR:Company Name: /` L I U '7�{ J�IJ Z Phone#: So (, y 78-S-5 Address: Air City: lot k., State: Zip: 33 161 Qualifier Name: K,�,���� Liz Phone#: ?4F5-f State Certification or Registration#: �'e d�6��� Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ O Square/Linear Footage of Work: '500 , Type of Work: ❑ Addition ❑ Alter ti n ❑ New ® Repair/Replace ❑ Demolition a Description of Work: j Specify color of color thru tile: Submittal Fee$T cr��_Permit Fee$ ' °� CCF$ 3'` CO/CC$ Scanning Fee$ a Radon Fee$ -- DBPR$ Notary$ Technology Fee$ • VCS Training/Education Fee$ • Double Fee$ 9) Structural Reviews$ Bond$ •� TOTAL FEE NOW DUE$ (Revised02/24/2014) ` ►�® (®p70 Bonding Company's Name(if applicable) ti + 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 abse ce of such posted notice, the inspection will not be approv d and a reinspection fee will be charged. Signature Signature OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The f legoing instrument was acknowledged before me this day of JR100 2014 by �day ofa 20�f` , by .hah Gr.w.b�/f" who is personally known to l &1111 �C t6Tj(�C. wh is personally known to me or who has produced G•66 —553' $a'Y-Vas 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: Print: "" KEMBLE ETTRICK Print: 2 Notary Public a e o Seal: ;• My Comm.Expires Sep 19,2017 Sea .a"" �', SHERYL A MENDES 's:* 'o`° Commission#FF 055732 : P�;'. p,.� Notary Public-State of Florida iF OF F���� Bonded Through National Notary Assn. �. " a My Comm.Expires Oct 23,2018 Commission#FF 136597 * *** ************** ***** aux ** *** * ** ************** **' kt * ��hl�ptlfi9' 'YVor aryAssn. **** ***** ***** APPROVED BY /� �'� � Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) ►�""'� MRCSS-1 OP ID:AL ACORODDmYv) DATE(MM/ CERTIFICATE OF LIABILITY INSURANCE FDATE 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(ies) must be endorsed. H 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 CONTACT Combined Underwriters of Miami NAME: RONALD M. LASTER 8240 N.W.52 Terr,Suite 408 PHC No Ext:305-477-0444 ND No:305-599-2343 Miami,FL 33166 E-MAIL RONALD M.LASTER ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:AIX SPECIALTY INSURANCE CO. INSURED Mr.C'S Plumbing&Septic Inc. INSURER B: Attn: Michael Cocking P.O.Box 693239 INSURER C: Miami,FL 33269 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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. INSR TYPE OF INSURANCE D B POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER M D M D A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 CLAIMS-MADE XOCCUR L1JA19162601 01/11/2016 01/11/2017 DAMAGE PREMISES TOPa occurrence $ 100,00 Blanket Additiona MED EXP(Any one person) $ 5,000 Insured PERSONAL BADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER! GENERAL AGGREGATE $ 2,000,000 POLICY PRO- JECT LOC PRODUCTS-COMP/OP AGG $ 1,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION PER —70TH- AND EMPLOYERS'MILITY �,/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? ❑N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Septic Tank Systems-installation,... 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 g ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2nd Ave Miami Shores„FL 33128 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD • PERMIT #:13-SC-1648223 -," "'"'TAPPLICATIoN #:AP1216450 �t STATE OF FLORIDA DEPARTMENT OF HEALTH DATE PAID ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM FEE PAID: k CONSTRUCTION PERMIT RECEIPT #: DOCUMENT #: PR998187 CONSTRUCTION PERMIT FOR: OSTDS Repair APPLICANT: Meghan Grimbert PROPERTY ADDRESS: 253 NE 92 St Miami, FL 33138 LOT: 1112 BLOCK: 26 SUBDIVISION: PROPERTY ID #: 11-3206-013-3560 [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 a.,e EM R [ 0 ] SQUARE FEET SYSTEM A TYPE SYSTEM: [x] STANDARD [ ] FILLED [ ] MOUND [ ] I CONFIGURATION: [ ] TRENCH [x] BED [ ] N F LOCATION OF BENCHMARK: FFE 11.9'NGVD I ELEVATION OF PROPOSED SYSTEM SITE [ 18.00 ] [ INCHES FT ] [ABOVE BELOW BENCHMARK/REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ 68.00 ] I INCHES FT ] [ABOVE BELOW BENCHMARK/REFERENCE POINT L D FILL REQUIRED: [ 0.00] INCHES EXCAVATION REQUIRED: [ 62.001 INCHES 1.-Existing 900 gal.septic tank,certified by"Mr.C's Plumbing"on 12/14/2015 to remain. O 2.-Install 300 sf of drainfield in bed configuration. T 3.-Install 12"of slightly limited soil at the bottom of the drainfield. 4.-Perimeter of excavation area shall be at least 2 ft wider and longer than the proposed absorption bed or drain trench. H (Comments Continued on Page 2.) E R SPECIFICATIONS BY: Plb Sept TITLE: APPROVED BY: TITLE: Engineering Specialist II Dade CHD Yu i tin DATE ISSUED: 0 EXPIRATION DATE: 03/16/2016 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 AP1216450 SE979913 I ■■■■■■■■■■■■■■■■■■�■■■■rte/■■■■■ ■■■■■■■■■■■■■■■■■■■■■■riI■■■RAJ■■ ■■li■■■■■■■■■■■■■!■II■■■�■■■I■Iii■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ Thwe are no pertinent - on reproperties and or • street that may affectthe New Septic system itlY. I off . DOCUMENT #: PR998187 5.-Invert elevation of drainfield to be no less than 6.73'NGVD. 6.-Bottom of drainfield elevation to be no less than 6.23'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.