PL-17-668Project Address
Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Parcel Number
Expiration: 09/12/2017
Applicant
987 NE 96 Street
Miami Shores, FL
1132060143240
Block: Lot:
THOMAS JOHNSON
Owner Information
Address
Phone
Cell
THOMAS JOHNSON
987 NE 96 Street
MIAMI SHORES FL 33138-
(206)351-1870
987 NE 96 Street
MIAMI SHORES FL 33138-
Contractor(s)
MR C'S PLUMBING & SEPTIC INC
Phone CeII Phone
(305)651-7859
Valuation:
Total Sq Feet:
$ 10,000.00
400
Type of Work: DRAINFIELD REPAIR
Type of Piping:
Additional Info: DRAINFIELD REPAIR
Bond Return :
Classification: Residential
Scanning: 1
Fees Due
Bond Type - Owners Bond
CCF
DBPR Fee
DCA Fee
Education Surcharge
Permit Fee
Scanning Fee
Technology Fee
Total:
Amount
$500.00
$6.00
$4.50
$4.50
$2.00
$300.00
$3.00
$8.00
$828.00
Pay Date Pay Type
Invoice # PL -3-17-63287
03/16/2017 Credit Card
03/13/2017 Credit Card
03/16/2017 Check #: 7917
Bond #: 3343
Amt Paid Amt Due
$ 278.00 $ 550.00
$ 50.00 $ 500.00
$ 500.00 $ 0.00
Available Inspections:
Inspection Type:
HRS Approval
Final
Review Plumbing
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 pe• I a ,ume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for EL CA 1, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNERS A i17' IT: 1 ce ify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction a h ore, I authorize the above-named contractor to do the work stated.
March 16, 2017
Authorized S nature: Owner / Applicant / Contractor / Agent
Building Department Copy
Date
March 16, 2017 1
4,
BUILDING
PERMIT APPLICATION
❑BUILDING ❑ ELECTRIC
❑PLUMBING ❑ MECHANICAL
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
❑ ROOFING
❑PUBLIC WORKS
JOB ADDRESS: f lel k -E._ 7 ivy �e
City: Miami Shores
MA3 2017
•
FBC 2014 51"1.\
Master Permit No. PL 11 - 6
Sub Permit No.
❑ REVISION ❑ EXTENSION ❑ RENEWAL
❑ CHANGE OF 0 CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
County:
Miami Dade Zip: 77-2-)1-22,5
Folio/Parcel#: 3 ZC— --32-110 Is the Building Historically Designated: Yes
Occupancy Type: Load:
Construction Type:
OWNER: Name (Fee Simple Titleholder):Til-iai2-.r.StE
Address: ctv1 T`l - 1l..r Sl
City: t• -it G— TLS State:
NO
Flood Zone: " . BFE: FFE:
Phone#: Z0IP 3S( I &7
Zip: 3 113 0
Tenant/Lessee Name: Phone#:
Email: ►I cry -1701-1 99/%t'i�i� : C �(�
CONTRACTOR: Company Name: v'r de ��� / 1 ono: seic-6C7-7g/
Address: /f 3 2 Nk0 oz 2Al Gam -
City: /14 k :t22 ,, State:
Qualifier Name: e6/ 3'(,
State Certification or Registration #:
DESIGNER: Architect/Engineer:
Address:
Value of Work for this Permit: $ 1L9 000
Type of Work: ❑ Addition ❑ Alteration
Description of Work:
Zip: 3 &-l6
Phone#:
Certificate of Competency #:
Phone#:
City: _ State: Zip:
Repair/Replace n Demolition
Square/Linear Footage of Work:
Fl New
Specify color of color thru tile:
Submittal Fee $ Permit Fee $ 3520 / CCF $
Scanning Fee $ Radon Fee $ . S C)
Technology Fee $ Training/Education Fee $
Structural Reviews $
(RevisedO2/24/2014)
CO/CC $ ��
DBPR $ ` I ^1C Notary $
Z.. Double Fee $
Bond $ 500
TOTAL FEE NOW DUE $ Z R 500
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 commence' a ust be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In th absen of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature �>`_ ,—• R a �dt
OWNER or AGENT
The flipping instrument was acknowledged before me this
q day of ' ` , 20 I , by
'11/1.0114Ctb 5 h ikA
, who is personally known to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
KEMBLE ETTRICK
Notary Public - State of Florida
My Comm. Expires Sep 19, 2017
Commission # FF 055732
h • final ot Assn.
APPROVED BY
(Revised02/24/2014)
5-I ti
Signature
CONTRACTOR
The foroing instrument was acknowledged before me this
3 day of �1i1 , 20 / 7 , by
Xemb/e_ /C ..who is personally known to
me or who has produced
as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
Plans Examiner
MIAMIerrs �.
Structural Review
*
i° A Notary Public - State of Florida
E.E. lP My Comm. Expires Oct 23, 2018
,�rF��F p. Commission # FF 136597
Bonded Through National Notary Assn.
*****
* * * * * * *
*
Zoning
Clerk
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: (Elizabeth Hatch/Tom Johnson)
PEST #: 13 -SC -1744484
APPLICATION #: API278963
DATE PAID:
FEE PAID.
RECEIPT #.
DOCUMENT #: PR1052405
PROPERTY ADDRESS: 987 NE 96 St Miami, FL 33138
LOT: 13 & 14 BLOCK: 77 SUBDIVISION: Miami Shores
PROPERTY ID #: 11-3206-014-3240
[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 MATE.RIM. 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 New Septic 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 [ 400 ] SQUARE FEET Bed confiouration drainfield SYSTEM
R [ 0 ] SQUARE FEET SYSTEM
[3
A TYPE SYSTEM: (X] STANDARD [ ] FILLED
I CONFIGURATION: [ ] TRENCH [X] BED [ ]
1'
F LOCATION OF BENCHMARK: F.F.E., 11.20' NGVD
MOUND [ ]
ELEVATION OF PROPOSED SYSTEM SITE [ 19.20 ] d INCHES t FT ] [ ABOVE 4 BELOW Y BENCHMARK/REFERENCE POINT
[ 69.24 ] (1 INCHES a FT 1 [ ABOVE 4 BELOW 6 BENCHMARK/REFERENCE POINT
BOTTOM OF DRAINFIELD TO BE
FILL REQUIRED:
[ 0.00 ] INCHES EXCAVATION REQUIRED: [ 62.00 ] INCHES
Inspector to verify the existing septic tank is properly abandoned before final approval.
*Invert elevation of drainfield to be no less than 5.93' NGVD.
*Bottom of drainfield elevation to be no less than 5.43' NGVD.
*Install 12" of slightly limited soil under the bottom of drainfield.
-Perimeter of excavation area shall be at least 2 ft. wider and longer than the proposed absorption bed or drain trench.
'THIS PERMIT IS NOT FOR "ADDmON(s) ".
The system is sized for 4 bedrooms with a maximum occupancy of 8 persons (2 per bedroom), for a total estimated flow of
SPECIFICATIONS BY:
APPROVED BY:
DATE ISSUED: 03
TITLE:
Dade CHD
DB 4016, 08/09 (Obsoletes'`all 'Eirev ous edit .gnat which may not be used)
Incorporated: 64.5-6.003;FAC ' '? t',.
:1.1 i[ ,,, v lal A$127E963
qtr 5..L,; :)2i i . . l!} 4
tt, hill l S C , NJ? : L.)r .( .,•,
EXPIRATION DATE: 06/05/2017
5E1025679
Page 1 of 3
(\)6. `- ��
NOTICE OF COMMENCEMENT
A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION
1111111 11111 11111 11111 11111 11111 11111 1111 1111
CFN 2017813128403
OR BK 30447 Ps 821 (1Pss)
PERMIT NO. TAX FOLIO NO. RECORDED 03/07/2017 12:56:00
HARVEY RUVIN? CLERK. OF COURT
I1IAi1I-DADE COUNTY? FLORIDA
STATE OF FLORIDA:
COUNTY OF MIAMI-DADE:
_ ; LOF?i .=, �OU1r4
THE UNDERSIGNED hereby gives notice that improvements 4F6e tnaldeiidideritlri'
property, and In accordance with Chapter 713, Florida Statutes,` i falidWing' t' U
is provided in this Notice of Commencement - —
Space above reserved for use of recording office
1. Legal description of property and street/address: L --o i 4 134 )�`g Lot.k 71 f t;
T i Si�►Zi�S
. „�1..►. 3 , ��r� i t 0 r �p t &. "i 7 r r>`1 � / }�P� r r n.�t
; -c i Stit•oi>�S - 151— X313
2. Description of improvement: The -e & _21:6
3. Owner(s) name and address: i -nt-c r - 4&4 } I4V L" •1 -
Interest in property: 61,1-4 >�
Name and address of fee simple titleholder: 9 6 NE- 16114SE. i `7 J 7351-277351-279J
4. C actor's name, address and phone number J14P - '3 /u 4 -Lk?
5. Surety: (Payment bond required by owner from contractor, if any)
Name, address and phone number.
Amount of bond $
6. Lender's name and address:
7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided by
Section 713.13(1Xa)7., Florida Statutes,
Name, address and phone number: 14,.. t_ ± C . -01N.3- r)1? Dl 11-µ L ►_ t I"�; �N.i n 3313 , 7
` 1 306 7 9 Lt —6,17 1...
6. In addition to himself, Owners designates the following person(s) to receive a copy of the Lienor's Notice as provided in Section
713.13(1)(b), Florida Statutes.
Name, address and phone number: %l_t1 £ A1-11 7 °J 1 G3'. } �: A-t�ti ► �{ 1 3�1� °j
3G 7Li4—t7L
9. Expiration date of this Notice of Commencement
(the expiretion date is 1 year from the date of recording unless a different date is specified)
WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED
IMPROPER PAYMENTS UNDER CHAPTER 713, PART 1, SECTION 713.13. FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR
IMPROVEMENTS TO YOUR PROPERTY A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POS►cu ON THE JOB SITE BEFORE THE
FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK
OR RECORDING YOUR NOTICE OF COMMENCEMENT.
Signature(s) ofwwt5t(s) or Owners)' Atuthorized Officer/Director/Partner/Manager
Prepared By ► 4 -kW �4 —1044-ov 4---- Prepared By
Print Name j , -ryi } _ \apt -r 4 So k. Print Name
Title/Office li, `)t✓ R.
STATE OF FLORIDA
COUNTY OF MIAMI-DADE AY17y�
The fo going in entwas acknowledged before me this ft, day of / /1t�
eil-
B� }�E /I)tc� �G/ r)
❑ Individually, or ❑ as for
❑ Personally known, otWEIONced the following type of idem i r + • : -i�0 � 2 �' /
a'~'P
State Of FIOTt$S9
yonature of Notary Public: ULl
•
IOn 1211612 9 Print Name: %
P� My Commission Elm (SEAL)
"P2.° Commission No. FF 944254
VERIFICATION PRSUANT TO SECTION 92.525. FLORIDA STATUTES
Under penalties of perjury, I declare that I have read the foregoing and
that the facts stated in It are true, to the best of my knowledge and belief.
Signature(s) of Owner(s) or Owner(s)'s Authorized Officer/Director/Partner/Manager who signed above:
Title/Office
20/ 7
By By
123_01-52 PAGE3 W12
Return to:
Christopher P. Kelley, Esquire
Christopher P. Kelley, P.A.
11098 Biscayne Boulevard, Suite 205
Miami, Florida 33161
Instrument Prepared By:
Christopher P. Kelley, Esquire
Christopher P. Kelley, P.A.
11098 Biscayne Boulevard, Suite 205
Miami, Florida 33161
Folio No. 11-3206-014-3240
111111111111111111111111111111111111111111111
TRUSTEES' WARRANTY DEED
CFN 201780099768
OR BK 30429 Pss 879-S82 (4Pss)
RECORDED 02/22/2017 09:10:02
GEED DOC TAX4:050.00
HARVEYRUVIN, CLERK OF COURT
1A41I-GAGE COUNTY, FLORIDA
THIS INDENTURE, Made this - /day of February, 2017, Between ELEANOR
H. ASHTON and ROBERT HACH, both single persons, individually and Co -Trustees
of the ELIZABETH M. HACH LIVING TRUST DATED MAY 12, 2005, the GRANTORS,
and THOMAS P. JOHNSON, a single man, and THERESE L.R. DAY, a single woman,
as tenants in common, whose post office address is 987 NE 96 Street. Miami Shores,
Florida 33138, the GRANTEES,
WITNESSETH, That said GRANTORS, for and in consideration of the sum of Ten
and 00/100 Dollars, and other good and valuable considerations to said GRANTORS in
hand paid by said GRANTEES, the receipt whereof is hereby acknowledged, have
granted, bargained and sold to the said GRANTEES, and GRANTEES' heirs and assigns
forever, the following described land, situate, lying and being in Miami -Dade County,
Florida to -wit:
Lots 13 and 14, Block 77, MIAMI SHORES SECTION 3, according to the
Plat thereof as recorded in Plat Book 10, at Page 37, of the Public Records
of Miami -Dade County, Florida.
SUBJECT TO: Applicable zoning and/or restrictions and prohibitions
imposed by governmental authority; Conditions, Restrictions limitations,
reservations, easements, and other matters appearing on records, if any;
Utility easements of record, taxes for the year 2017 and subsequent years.
and said GRANTORS do hereby fully warrant the title to said land, an
same against the lawful claims of all persons whomsoever.
Page 1 of 3
Trustees' Warranty Deed
Elizabeth M. Hach Living Trust dated May 12, 2005 sit Johnson & Day.
IN WITNESS WHEREOF, GRANTORS, have hereunto set GRANTORS' hands
and seals the day and year first above written.
Signe, sealed, and delivejd in our press
Witness Name
LO 2
Print
/llO, ./L- Gt /5-2. i e_
Print
STATE OF NORTH CAROLINA
COUNTY OF tlehotersa,-t_
ELEANOR H. ASHTON ' Grantor
Individually and as Co -Trustee of the
ELIZABETH M. HACH LIVING TRUST
DATED MAY 12, 2005
56 Wolfe Cove Road
Asheville, North Carolina 28804
I HEREBY CERTIFY that on this day, before me, an officer duly authorized in the
State aforesaid and in the County aforesaid to take acknowledgments, personally
appeared ELEANOR H. ASI-ITON, as individually and as Co -Trustee of the
ELIZABETH M. HACH LIVING TRUST DATED MAY 12, 2005, who produced
a tkiLrYtq c r vers /,.g. -.-as identification, and who executed the
foregoing instrument and acknowledged before me that she executed the same..
Witness my hand and official seal in the County and State last aforesaid this
day of F -...-1c, -z , 2017. t1 %tliiiiih
�� o
`�I SE 2 Yi
NO ; - Y - fC, Statsaf ISO Ai 0141A at Large
My Commission Expires;oi.//ii/ = 2 .2' G z
;6�i-2. ����`
'it
iiiiitittO
Page 2 of 3
Trustees' Warranty Deed
Elizabeth M. Hach Living Trust dated May 12, 2005 sit Johnson & Day
2/&
Witness Name
)61..\6=4-V_ Co -r c.c pa
Print
O rO j P./'LEY
Print
STATE OF FLORIDA�I�/°i
COUNTY OF ,.s,. /7=4)
ROBERT HACH Grantor
Individually and as Co -Trustee of the
ELIZABETH M. HACH LIVING TRUST
DATED MAY 12, 2005
1191 North 52 Avenue
Hollywood, Florida 33021
i HEREBY CERTIFY that on this day, before me, an officer duly authorized in the
State aforesaid and in the County aforesaid to take acknowledgments, personally
appeared ROBERT HACH, as individually and as Co -Trustee of the ELIZABETH M.
HACH LIVING TRUST DATED MAY 12, 2005, who produced
PK as identification, and who executed the
foregoing instrument and acknowledged before me that he executed the same.
Witness my hand and official seal in the County and State last aforesaid this
day of f; , 2017. "?
My Commission Expires:
PTAR; Plf1'IC, Stat- IDA at Large
4 FL •
esti' Pk* CHRISTOPHER P. KELLEY
* MY COMMISSION 0 FF 880841
,C1r EXPIRES; May 21, 2020
onsThraRAO Naryrbaro es
Page 3 of 3
OR BK 30429 PG 832
LAST PAGE
MIAMI SHORES VILLAGE
Building Department
10050 NE 2 Ave, Miami Shores FI, 33138
Tel: 305-795-2204• Fax: 305-756-8972
Permit No. REOC-1-17-189
Certificate of Re -Occupancy
Address: 987 NE 96 Street
City: Miami Shores
State: FL
Zip:
This certificate verifies that the. reference property has been inspected by Miami Shores
Village and has. been determined to presently comply with schedule of regulations of
Miami Shores Land and Development Code pertaining solely to the requirement that each
one -family dwelling is used and intended to be used for a' one -family dwelling purpose
only; however, this certificate does not constitute arty representation or warranty as to the
condition of the dwelling or other structures on the premises described herein, or any
aspect of such condition, and interested persons are advised and encouraged to make
their own inspections of the premises in order to determine the condition thereof.
Building Approval:
113V/7
ProlinAddress
987 NE 96 Street
Miami Shores, FL
Miami Shores Village
1'3050 N E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone (305)795-2204
• THOMAS JOHNSON
\Contractor(%)
MR C'S PLUMB
JO DJ-
cf Piping
al 010 DP
Return
cator, Pet,
e
Permit Na PL. -3-17-668z
Permit Type: Piumbiov- Residential
Work Classification: Drainfield
Permit Status: APPROVED
Expiration: 09/12/2017
IssueDate 3/16/2017
Parcel Number
1132060143240
Block: Lot:
Phone
Address
987 NE 96 Street
MIAMI SHORES FL 33138-
987 NE 96 Street
MIAMI SHORES FL 33138 -
Applicant
THOMAS JOHNSON
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