PL-15-2719 {
Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores,FL
Phone:(305)795-2204 Fax:(305)758-8972
Inspection Number: INSP-246531 Permit Number: PL-10-15-2719
Scheduled inspection Date:April 27,2016 Permit Type: Plumbing-Residential
Inspector:Hernandez,Rafael
Inspection Type: Final
Owner. CHMSTIAN AND MICHELLE GAVIRIA, Work Classification: Drainfield
Job Addrew 136 NE 91 Street
Miami Shores,FL Phone Number
Parcel Number 1131010190040
Project <NONE>
Contractor: MR C'S PLUMBING&SEPTIC INC Phone: (305)651-7859
Building Department Comments
DRAINFIELD INSTALL Inftcdo Pasmd Commence
INSPECTOR COMMENTS Faire
Inspector Comments
Passed HRS IN FILE
Failed
Correction ❑
Needed
Re-Inspection
Fee
No Ad IlWai In specibm can be scheduled untli
re-inspee ion fbe Is pail.
�. DIVISION OF
• Environmental Health
Florida Health
AID Miami-Dade County
40M
OSTDSlWell Division 11805 SW 261h Street•Miami,n 33175
Inspector / C°i s/ 1 o.7 le/ o Date
Address 6 /� OSTDS#_Q -2g
Comments:
Signature
J
Miami Shores Village
10050 N.E.2nd Avenue NE
Miami Shores,FL 33138-0000
Phone: (305)795-2204
. Expiration: 05/30/2016
Project Address Parcel Number Applicant
136 NE 91 Street 1131010190040
TOMAS GAVIRIA JTRS CHRISTI
Miami Shores, FL Block: Lot:
Owner Information Address Phone Cell
TOMAS GAVIRIA JTRS CHRISTIAN AND 136 NE 91 Street
-- - - - - -- MIAMI SHORES FL 33138-2810
136 NE 91 Street
MIAMI SHORES FL 33138-2810
Contractor(s) Phone Cell Phone Valuation: $ 2,400.00
MR C'S PLUMBING S SEPTIC INC (305)651-7859 Total Sq Feet: 300
Type of Work:DRAINFIELD INSTALL Available Inspections:
Type of Piping: Inspection Type:
Additional Info:
HRS Approval
Bond Retum: Final
Classification:Residential Scanning:3 Review Plumbing
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
Bond Type-Owners Bond $500.00 Invoice# PL-10-15-57552
CCF $1.80 10/26/2015 Credit Card $50.00 $618.30
DBPR Fee $2.25
DCA Fee $2.25 12/02/2015 Credit Card $118.30 $500.00
Education Surcharge $0.80 12/02/2015 Cash $500.00 $0.00
Permit Fee $150.00 Bond#:2918
Scanning Fee $9.00
Technology Fee $2.40
Total: $668.30
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. Futhermo rOfForize above-named contractor to do the work stated.
December 02,2015
Autho gnature:Owner / Applicant / Contractor / Agent ate
.0011-Building Department Copy
December 02,2015 1
Miami Shores Village �CR,117FF)
Building Department OCT 2 6 ,5
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 BYe
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 201q SIVA
BUILDING Master Permit No. ?L is
PERMIT APPLICATION Sub Permit No.
❑BUILDING ❑ ELECTRIC ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING ❑ MECHANICAL [-]PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
1 CONTRACTOR DRAWINGS
JOB ADDRESS:
City Miami Shores County: Miami Dade Zip: 331 3k
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: _Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): '1&ilfs,5 6A V14-4 Phone#: 3br 7
Address: 134 �►f+�'g, Sr
City: 01&4 �kcr& State: Zip: :3 3 131
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: r Phone#: 6
'A
Address: HM N M f
City: I kl f� GGState: �"� Zip: ��Uiq
Qualifier Name: K �eJJ,��
emiike 11 lk Phone#:
State Certification or Registration#: d6 S36 Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ Square/Linear Footage of Work: 30o o
Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace ❑ Demolition
Description of Work: 41
Specify color of color,>thru t1k
Submittal Fee$ Permit Fee$ l�r�• CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$ G(W
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 Itachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection ich occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be rove 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
dayof20 by day of ((�j 0 !' ,20 IS .by
g1faG S l�Tfh�(irt� .who is personally known to "Oml fiUL .who is personally known to
me or who has pr d c as me or who has produced as
identification an } a an oa MBLE ETTRI f identification and who did take an oath.
Notaryfublic-State of Florida
NOTARY PUBLIC- '?My Comm.Expires Sep 19,2017 NOTARY PUBLIC'
Commission#FF 055732
Borrel Through National Notary Assn.
Sign: Sign: J2 L
Print: Prin o` SURri END c
,s u C-State r
Seal: Seal: Idy mm.Expires Oct 23,2018
omission#FF 136597
'�• slo S=W Rooto National Nater Assn.
�r*sa����*a�x��w**we�xwx��ss��x�s*s�s�*��a**�*�s**�s**wx��*�xw�*w�s�s�w�s**���s��*�s�**��xe�xa��**�a�**s�►�s��*s��*�xm*�x�ss��**�x�x**���a
APPROVED BY `� t� i� Plans Examiner Zoning
Structural Review Clerk !<
(Revised02/24/2014)
ACORN® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYY1)
�.�+"' 6/6/2015
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 policy(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 SUNZ Insurance Solutions, LLC. ID:TLR NME. Aimee Gra
C/o TLR of Bonita, Inc PHONE 727.520-7676 x 222 FAX No: 727-525-3662
700 Central Ave Suite 500 EMAIL
St. Petersburg, k 33701 ADDRESS:
INSURER(s)AFFORDING COVERAGE NAIC#
INSURER A: SUNZ Insurance Company 34762
INSURED INSURER a: AsDen Re-London-Best Rating°A°
TLR of Bonita, Inc dba Enter riseHR
Encore Business Solutions, Inc INSURER c: Catlin Syndicate-Lloyds-Best Rating°A°
and its Subsidiaries INSURER D: Brit Syndicate-Uo ds-Best Rating°A°
700 Central Ave Suite 500 INSURER E:
St. Petersburg k 33701
INSURER F
COVERAGES CERTIFICATE NUMBER: 25007302 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.
ILTR TYPE OF INSURANCE JUM SUER wvp POLICY NUMBER POLICY EFF POLIO EXP LIMITS
COMMERCIAL GENERAL LL421U Y EACH OCCURRENCE $
CLAIMS-MADE FIOCCUR DAMAGE T RENTED
PREMISES Ea occurrence $
MED EXP(Any one person) $
PERSONAL&ADV INJURY $
GEN'LAGGREGATE UMITAPPLIES PER: GENERAL AGGREGATE $
POLICY D PRO-
JECT F LOC PRODUCTS-COMP/OP AGG $
OTHER: $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $
Ea accident
ANY AUTO BODILY INJURY(Per person) $
ALL OWNED SCHEDULED
AUTOS AUTOS BODILY INJURY Per accident) $
NON-OWNED PROPERTY DAMAGE $
HIRED AUTOS AUTOS P r de
UMBRELLALIAB OCCUR EACH OCCURRENCE $
EXCESS LIAR CLAIMS-MADE AGGREGATE $
DED I I RETENTION $
A WORKERS COMPENSATION WCPE0000000111 6/1/2015 6/1/2016 PER OTH-
ANDEMPLOYERS LIABILITY Y/N WCPE00000001 10 6/1/2014 6/1/2015 STATUTE ER
ANY PROPRIETOR/PARTNER/EXECUTIVEE.L.EACH ACCIDENT $ 1,000,000
OFFICER/MEMBER EXCLUDED? ❑N/A
(Mandatory in NM E.L.DISEASE-EA EMPLOYEE $ 1,000,000
If yes describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000
B Workers Compensation This is for informational purposes
C Excess Coverage and nothing shall create any right
D under such reinsurance.
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached M more space is required)
Coverage Provided for all leased employees but not subcontractors of:Mr C's Plumbing&Septic,Inc
Client Effective:1/6/14
CERTIFICATE HOLDER CANCELLATION
7441
Miami Shores Village SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Miami h r 2nd Ave THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
Miami Shores FL 33138
AUTHORIZED REPRESENTATIVE
Glen J Distefano
01988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
25007302 1 Master Certificate I Aimee Gray 1 6/8/2015 3:49:21 PM (CDT) I Page i of 1
✓4
AA�
PERMIT #:13-SC4 636461
APP�Icmxam #:AP1208452
STATE OF FLORIDA (PL DATE PAID:
DEPARTMENT OF HEALTH
�16ITE SEWAGE TREATMENT AND .=�. ctve�rFA FEE PAID:
CONSTRIICTION PERMIT >� � � RECEIPT #:
j QTY 2015 DOCUMENT, #:PR991244
fly:
CONSTRUCTION CONSTRUCTION PERMIT FOR: OSTDS Repair
i
I 1
APPLICANT: Thomas Gaviria
PROPERTY ADDRESS: 136 NE 91 St Miami,FL 33138
i LOT: 5 BL<=: 7 SUBDIVISION:
[SECTION, RESHIP, RANGE, PARCEL NUMBER]
PROPERTY ID #: 1t-3101-019-0040 [OR TAX ID NUMBER]
� I
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 NM GUARANTEE
SATISFACTORY PERFORMANCE IM 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 CMWLIANCE WITH OTHER FEDERAL,
STATE, OR LOCAL PERMITTING REQUIRED FOR DEV WRONT OF THIS PROPERTY.
I
SYSTEM DESIGN AND SPECIFICATIONS
T [ 90O ] GENS / GPD Septic CAPACITY
A [ 0 ] GALLONS / GPD CAPACITY
N [ 0 I GALLONS GREASE INTERCEPTOR CAPACITY ISM CAPAC SINGLE x:1250 GALLONS]
(; $ [ ] GALLONS DOSING TALAR CAPACITY t ] #[ IDOSIM
PER 24 HRS #Pumps [ i
! D [ 300 I SQUARE T _ed configuration drainW SYS
R [ 0 ] SQA FEET STEM
A TYPE SYSTEM: [x] STANDARD [ I F [ I MOUND t ]
I CONFIGURATION: [ I TR21NCH 1XI BED [ ]
N
FLOCATION OF ARK: FFE 11.7 NGVD
I ELEVATION OF PROPOSED SYSTEM SITE t 14.40 I IDTCHES FT ] ABOVE
E BOTTOMOF DRAINFIELD TO BE 164.447 _n_q_=__Sj FT I[ABOVE HE BSNCHMARWREFERSNCB POINT
L
D FILL REQUIRED: t 0.00] INCHES EXCAVATION REQUIRED: t 62.001 S
1.-Existing 900 gal.septic tank,certffied by"Mr.as Septic and Plumbing"on 10/1312015 to remain.
0 2.4n"300 sf of drainfasid in bed configuration.
T 3.4nsWl 12" ted soil at the bottom of the draiMield.
of slightly limited
of excavation area shall be at least 2 ft wider and"or than the proposed absorption bed or drain trend.
H
E 5: (Comments Continued on Page 2.)
R •• ••e • • • • • •+
SPECIFICATION C'1:s4pti0 i i0+ �• TITLE:
APPROVED BY: ITLE: Engineering specialist II Dade CHD
DAIS ISSUED: •1 1SM15 • • • i • • •i• EXPXRATION DATE: 01/17/2016
DH 4016, 06/09 (Obsold*s j4l•Pry�•e&i$i4o8 ch may P1c
incorporated: 64E-6.Vn, P'AC •• • • •
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