PL-17-1717 i.
,
�ermmit - 7-179 7
Miami Shores Village � T TypL � ntiaE
10050 N.E.2nd Avenue NW
Ift
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Miami Shores,FL 33138 0000
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Expiration: 01/14/201
Project Address Parcel Number Applicant
188 NW 104 Street 1121360131500
FRANCISCO QUINONEZ
Miami Shores, FL 33150- Block: Lot:
Owner Information Address Phone Ceti
FRANCISCO QUINONEZ 188 NW 104 ST
MIAMI SHORES FL 33150-1240
Contractor(s) Phone Cell Phone Valuation: $ 4,000.00
ALFONSO SEPTIC CONTRACTOR INC (786)251-4099 Total Sq Feet: 500
Type of Work:INSTALL A 900 GALLONS SEPTIC TANK A Available Inspections:
Type of Piping: Inspection Type:
Additional Info: Top Out
Bond Return: Final
Classification:Residential Scanning:1 Review Plumbing
Underground
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
Bond Type-Owners Bond $500.00 Invoice# PL-7-17-64472
CCF $2.40 07/18/2017 Check#:5486 $500.00 $318.40
DBPR Fee $4.50
DCA Fee $4.50 07/18/2017 Credit Card $268.40 $50.00
Education Surcharge $0.80 07/03/2017 Credit Card $50.00 $0.00
Permit Fee $300.00 Bond#:3458
Scanning Fee $3.00
Technology Fee $3.20
Total: $818.40
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. Futhermore,I authorize the above-nd c o the work stated.
July 18, 2017
Authorized Signature:Owner / A cant / C ntractor / Agent Date
Building Departme Copy
July 18,2017 1
��- 2� +� �� �� 1
d* DIVISION OF
Environmental Health
00,
Florida Health
OKI
Miami-Dade County
OSTDS/Well Division
11805 SW 26th Street•Mtam1,FL 33175 OI�
A43(
Inspector Date 7°�1 �17
Address_ ���/�✓��� .,(
OSTDS
Comments:
Signature �-
Miami Shores Villa a RECEIVED
g
t-A Building Department JUL 03 2017
r 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 el�
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 20 �-A
BUILDING Master Permit No. � 1
PERMIT APPLICATION Sub Permit No.
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
N]PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: IV (t.) /F)L/ �T—
City: Miami Shores County: Miami Dade Zia: 5. -)
Folio/Parcel#: 1J-a Ifo -til 3 -IS[7n Is the Building Historically Designated:Yes NO
Occupancy Type:�_Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): rg i4ySlS(i3 S Phone#:
Address: IL)V J D Ct S t—
City: u fI e S' State: Zip:
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: 6CW11 1&& Phone#! 7&6-25
Address:
City: State: �'/rl Zip: ?
Qualifier Name: Phone#;
State Certification or Registration#:SR 0 DCl 7( 2-744 Certificate of Competency#:5A -OC7/
DESIGNER:Architect/Engineer: Phone#: y
Address: pp,, City: State: Zip:
Value of Work for this Permit:$ `li?C7Ci Square/Linear Footage of Work: f;06
Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace ❑ Demolition
Description of Work: ;fel a) 0 -9co
n
Specify color of color thru tile:
Submittal Fee$ 1 � Permit Fee$ .30 CCF$ CO/CC$
Scanning Fee$ � Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
/gyp0 a2
Structural Reviews$ Bond$ -50 '
TOTAL FEE NOW DUE$ Gam® ' TQ
(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 commencement must be posted at the job site
for the first inspection whi occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be appro.. and a reinspection fee will be charged.
Signatter Signature
OWNER or AGEN /CONTRACTOR
The foregoing instrument was acknowledged before me this 11 foregoing instrument was acknowledged before me this
day of 'S.1 20 by t_day of U 20 by
-wvho is personally known to �{Z � �S o is rsonally kno n to
me or who has produce as me or who has produced
a ern as
identification and w o di oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
NATHALIE SHA 2L �JpIRES •.�b
Sig SSION#N4 21 g '
Sin � � . � .O �
IRES• : co
Print. Print: =z•='� I `� 'o=
Seal: Seal:
ao! '•qty
NOtP����
APPROVED BY s Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
s� Miami shores Village
logo
Building Department
artment
10050 N.E.2nd Avenue
�IORIUA Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
Notice to Owner - Workers' Compensation Insurance Exemption
Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05
allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to
obtaining a building permit. Pursuant to the Florida Division of Workers' Compensation Employer Facts Brochure:
An employer in the construction industry who employs one or more part-time or full-time
employees,including the owner,must obtain workers' compensation coverage. Corporate officers
or members of a limited liability company (LLC) in the construction industry may elect to be
exempt if-
1.
f1. The officer owns at least 10 percent of the stock of the corporation, or in the case of
an LLC,a statement attesting to the minimum 10 percent ownership;
2. The officer is listed as an officer of the corporation in the records of the Florida
Department of State,Division of Corporations;and
3. The corporation is registered and listed as active with the Florida Department of
State,Division of Corporations.
No more than three corporate officers per corporation or limited liability company members are
allowed to be exempt. Construction exemptions are valid for a period of two years or until a
voluntary revocation is filed or the exemption is revoked by the Division.
Your contractor is requesting a permit under this workers' compensation exemption and has acknowledge that he or she will not use
day labor,part-time employees or subcontractors for your project.The contractor has provided an affidavit stating that he or she will
be the only person allowed to work on your project.In these circumstances,Miami Shores Village does not require verification of
workers' compensation insurance coverage from the contractor's company for day labor,part-time employees or subcontractors.
BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS
CONTENTS.
\ 1
Signature:
e
State of Florid
County of Miami-Dade
The foregoing was acknowledge before me this`' —day of 0 PQ 20–G--
By I"1C l S�� L) k who is personally known to me or has produced
as identification.
GINA M.VASQUEZ
Notary: NOTARY PUBLIC
STATE OF FLORIDA
SEAL: Cerro*FF140816
Expires 10!16/2018
Alfonso Septic Contractor Inc
1391 West 36 St
Hialeah,FL 33012
Date:
State of
County of i"'�A Q e-
Before me this day of 2017 personally appeared e V-�--,ocIQ Les
who,being duly sworn,deposes and says:
That<he or she>will be the only person working on the project located at
tractor tore
Sworn to and subscribed before me this day of .2017.
onally known
Produced Identification
Q
r
`�.��o� Produced
`('��g to • FO 22
1.
NOTARY �� Print,Type or Stamp Name of Notary
ll1i111111111
%• • ••• • • • •••
•• • • • % •• •
• • • • • • • • • •
• • ••• • • • • •••
STATS OF FLORIDA
PERMIT #: 13-SC-1772863
DEPARTMENT OF HEALTH . ... ... VPL4%TIoN #:AP1296681
ONSITE SEWAGE TREATMENT AND DI§PbSAL• • : : •• . •: DATE PAID
SYSTEM : : : : : •
• • • • ••• •FEE PAID:
CONSTRUCTION PERMIT
RECEIPT #'
WKS'` . .00
• •• ••• tocuMENT #: PRI 067373
. ... . . . . .. .
.. . . . . . ... ..
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: Francisco Quinonez
PROPERTY ADDRESS: 188 NW 104 St Miami,FL 33150
LOT: 1112 BLOCK: 127 SUBDIVISION:
PROPERTY ID #: 11-2136-013-1500 [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 [ 1,050 ] GALLONS / GPD Sentic TANK TO REMAIN CAPACITY
A [ O ] 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 [ j
D [ 150 ] SQUARE FEET NEW DF IN TRENCH CON SYSTEM
R [ 0 ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [X] STANDARD [ ] FILLED ( j MOUND [ ]
I CONFIGURATION: [X] TRENCH [ j BED [ j
N
F LOCATION OF BENCHMARK: FFE 13.72
I TION OF PROPOSED SYSTEM SITE [ 38.60] INCHES FT ][ABOVE/®IBENCHMARK/REFERENCE POINT
E BOTTOM OF DRAINFIE?D TO BE [ 80.601[ INCAS FT I ABOVE J�RENCHMARK/REFERENCE POINT
L
D FILL REQUIRED: [ 0.00] INCHES EXCAVATION REQUIRED: [ 54.00] INCHES
0 1:EXISTING 1050 gal.septic tank with and approved filter TO REMAIN.
2.- Install 150 sf.of drainfield in...TRENCH....configuration.
T 3:Install 12"of slightly limited soil at the bottom of the drainfield.
H 4:Perimeter of excavation area shag be at least 2 ft wider and longer than the proposed absorption bed or trench.
E (Comments Continued on Page 2.)
R
SPECIFICATIONS BY: Miami Dade Envi TITLE:
APPROVED BY: TITLE: Engineering Specialist II Dade CHD
Loanlz X Gmgalez
DATE ISSUED: 06/30/2017 EXPIRATION DATE: 09/28/2017
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
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LOCATION MAP SCALE: i" = 150' SKETCH OF SURVEY SCALE: i" =20' LO
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LEGAL DESCRIPTION: "' Z
LO
¢ CC
The West 1/2 of Lot 11 and al of Lot 12, in Block 127, of " AMENDED ' ►� �, a w r-
PLAT OF SECTION N05 OF MIAMI SHORES" , according to the Plat thereof, �� Q `V0� 019 - 0 ¢ CL
as recorded in Plat Book 10, at Page 47, of the Public Records of Qp 90
Miami -Dade County, Florida. . lip o Y
PROPERTY ADDRESS: 188 NW. 104th St. Miami Shores, Florida. 33150 - — ¢ ao
SURVEYOR'S NOTES: IO,pZ 2 3 ? > C:) Q1
S.TYPE OF SURVEY: BOUNDARY WITH ELEVATIONS //So ``L cc o
LEGEND: �. 4 w
2.BEARINGS AND DISTANCES SHOWN ARE IN SUBSTANTIAL � �•- V • 4 -
COMPLIANCE WITH THOSE RECORDED UNLESS OTHERWISE NOTED. ® ELECTRIC POWER POLE –vi Q w
1 PROPERTY AREA: 9,016 SQUARE FEET _O/E _ OVERHEAD ELECTRIC LINE \ 3Z, 87 p C���?Aey oZ w w
M
4.THIS PROPERTY IS LOCATED IN FLOOD ZONE X.
BASE FLOOD ELEVATION:—-, AS PER F.E.M.A. —x—x—X— 4 HIGH CHAIN LINK FENCE N O w
/ S7'O/?Y C`.Q.S. '{� Ccwc', r14 — w w
MAP COMMUNITY N°: 120652, PANEL N°0090, SUFFIX J. > �
LAST REVISED ON JULY 17, 1995. CONCRETE AREAS I�
5.LEGAL DESCRIPTION AS PROVIDED BY: OWNER 'io ,7sE�tl�°� /{/.°/�� � 11• w a 0
'� f 6.N' a¢ o
6.UNDERGROUND FOOTINGS,FOUNDATIONS,UTILITIES,OR SEPTIC C_�__��- TILED AREAS L.F. •_ /3.72QO
TANKS WHERE NOT LOCATED BY THIS SURVEY.
7.THIS SURVEY HAVE BEEN PREPARED WITHOUT THE BENEFIT C.B.S.= CONCRETE BLOCK STRUCTURE Q 9
OF A TITLE SEARCH,THEREFORE THERE MAY BE ADDITIONAL A/C = AIR CONDITIONER ZB.OB'
RESTRICTIONS, EASEMENTS•OR RIGHT OF WAY OF OTHERS THAT S. I.P.= SET 1/2' IRON PIPE N°LB.3192 '0e N. 9,9Z
MAY BE FOUND IN THE PUBLIC RECORDS OF THIS COUNTY F. I.P.= FOUND IRON PIPE :- !1
B.ALL ELEVATIONS THUS ✓ARE BASED ON NATIONAL GEODETIC L.F.E.= LOWEST FLOOR ELEVATION _� 10 _`;G� �, JG W,5i Q
VERTICAL DATUM OF 1929, AS MEASURED FROM MIAMI-DADE COUNTY NBC.= NAIL AND CAPfv! ��" 5 lt' N.
BENCHMARK No N-567, WITH ELEVATION: 10.54', LOCATOR 3100, 1 =V'. N
AND IS A PK.NA I L AND BRASS WASHER IN CONC.CURB AT NW.EDGE l�t
OF HANDICAP RAMP. ni
NE. 104th ST. ---29'SOUTH OF Ch D w
N.MIAMI AVE.---14.5'WEST OF WEST EDGE OF PAVEMENT = , , ;, ;. ;�, �i-;�;-_._ `` 04e
O z
J. F. LOPEZ 6 ASSOCIATES, INC. �cT i � m --I
CONSULTING LAND SURVEYORS AND PLANNERS ti
CERTIFICATE No LB.3192,STATE OF FLORIDA
7900 NW. 155th STREET. SUITE 104, I MIAMI LAKES, FLORIDA, 33016. ` o
Ph: (305) 828-2725 Fax: (305) B28-3589 • •
•4, • •
eya'�udic� .`-`Yey. oi.;""� C�L?4�i�f'� � I ••• •� • • i i•i ••• t i� U)
I HEREBY CERTIFY: THAT A SURVEY OF THE PROPERTY AS DESCRIBE
THE FOREGOING CAPTION HAS BEEN MADE UNDER MY DIRECTION AND MEETS
X101 `,� l ,o \ ¢
THE
SURVEYORS
A TECHNICAL I CAL STANDARDS SET FORTH BY THE FLORIDA BOARD OF '� a N N L Cr
SURVEYORS AND MAPPERS IN CHAPTER 61-G17-6, FLORIDA ADMINISTRATIVE �, !' v . ... • w
CODE, PURSUANT TO SECTION 472.027, FLORIDA STATUTES, AND I S TRUE AND •;4, ' k ®3 ' U • • FDUN�
CORRECT TO THE BEST OF KNOWLEDGE, BELIEF AND PROFESSIONAL JUDGEMENT. r '"' ' 4b ' • c,o' /ROAI 54-k
t '� _ a•• �� • O��•• —• �--171 W
NOTE: B ,r3.t r 'S, Foanc/T,oq Cor 2'' LL
THIS IS NOT A VALID SURVEY WITHOUT JOSE F.LOP P. S.M. J ��! �- L G E y,
THE UNDERSIGNED SURVEYOR'S SIGNATURE Professional Surveyor 6 Mapper . •_ ••• • • ¢
AND EMBOSSED RAISED SEAL N°3086,State of Florida �¢ � ' U - ' " " ' ��• W
U