Loading...
PL-17-1908Project Address Miami Shores Village 10050 N.E. 2nd Avenue NW Miami Shores, FL 33138-0000 Phone: (305)795-2204 56 NW 93 Street Miami Shores, FL 33138- Owner Information Permit Permit NO. PL -7-17-1908 Permit Type: Plumbing - Residential Work Classification: Drainfield Permit Status: APPROVED Issue Date: 8/9/2017 Expiration: 02105/2018 Address Parcel Number 1131010170040 Block: Lot: Applicant PABLO JAVIER CALISTO CORN Phone Cell PABLO JAVIER CALISTO CORNEJO 56 NW 93 Street MIAMI SHORES FL 33150- (305)510-1012 56 NW 93 Street MIAMI SHORES FL 33150- Contractor(s) AAA PRO PLUMBING LLC Phone (305)639-8972 Cell Phone Valuation: $ 2,450.00 Total Sq Feet: 200 Type of Work: DRAINFIELD REPLACEMENT Type of Piping: Additional Info: DRAINFIELD REPLACEMENT Bond Return : Classification: Residential Scanning: 3 Fees Due Bond Type - Owners Bond CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Amount $500.00 $1.80 $2.25 $2.25 $0.60 $150.00 $9.00 $2.40 Total: $668.30 Pay Date Pay Type Invoice # PL -7-17-64688 07/26/2017 Credit Card 08/09/2017 Credit Card 08/08/2017 Credit Card Bond #: 3476 Amt Paid Amt Due $ 50.00 $ 618.30 $ 118.30 $ 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 permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICA,, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AFFIDAVI constructio an certi all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating th f • e, I authorize the above-named contractor to do the work stated. Aut • iz wner / Applicant / Contractor / Agent Building Department Copy August 09, 2017 Date August 09, 2017 1 JIU2 '=zt S. 0 0 3� rbDJ ey O O ra SIJ 009849 Local Business Tax Receipt Miami—Dade County, State of Florida -THIS IS NOT A BILL - DO NOT PAY 7170807 BUSINESS NAME/LOCATION AAA PRO PLUMBING LLC 8550 NW 64 ST MIAMI FL 33166 OWNER AAA PRO PLUMBING LLC C/O EDWIN M.GUERRA MGR Worker(s) 1 RECEIPT NO. RENEWAL 7449645 SEC. TYPE OF BUSINESS 196 PLUMBING CONTRACTOR CEC1428813-.._.-- EXPIRES SEPTEMBER 30, 2011 Must be displayed at place of business Pursuant to County Code Chapter 8A - Art. 9 & 10 PAYMENT RECEIVED BY TAX COLLECTOR $75.00 07/10/2017 CREDITCARD-17-045678 This Local Business Tax Receipt only confirms payment of the Local Business Tax. The Receipt is not a license, permit, or a certification of the holders qualifications, to do business. Holder must comply with any governmental or nongovernmental regulatory laws and requirements which apply to the business. The RECEIPT N0.'above must be displayed on all commercial vehicles - Miami -Dade Code Sec 8a-276. For more information, visit www.miamidade.gov/taxcollector j c>) Miami Shores Village Building Department 6();0e,(7‘' 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 BUILDING PERMIT APPLICATION El BUILDING ❑ ELECTRIC lk PLUMBING ❑ MECHANICAL JOB ADDRESS: 0 ROOFING Master Permit No. Sub Permit No. ❑ REVISION ❑ EXTENSION ❑RENEWAL RECEIVED JUL 262017 FBC 20 it -'k ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS 5C ow 13 &I-. City: Miami Shores County: Folio/Parcel#: c I- 3 o i —an _cxy-co Occupancy Type: C' Load: Construction Type: Miami Dade Zip: � 1 ca Is the Building Historically Designated: Yes NO X OWNER: Name (Fee Simple Titleholder): Pak uo J - Cctii i s N Address: Sb i✓,-) 52 S -t • City: c)A Flood Zone: BFE: FFE: Phone#: State: - Zip: 311 Tenant/Lessee Name: Phone#: Email: / CONTRACTOR: Company Name: 1 q I Fr � p (01"� L; ^-) LLL Phone#:(3 d fl b 311 -s-57-z__ ossa kiw (� S*• Address: City: KA LC& N` ' State: Qualifier Name: Ct-t-ci r y �' C&ACI 4 C State Certification or Registration #: 1C.. - 1 (41-412 Certificate of Competency #: r-- Zip: 13 I () Phone#:CiL11 63'l DESIGNER: Architect/Engineer: Address: Value of Work for this Permit: $ Phone#: City: State: Zip: 2D0 Square/Linear Footage of Work: Type of Work: 0 Addition 0 Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: bra I" (1 -q' lc`c t - Specify color of color thru tile: Submittal Fee $ Permit Fee $ /50i CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ 2 .2.-C Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ SID (c`� TOTAL FEE NOWDUE$ \ © -30 (Revised02/24/2014) 6i9.36 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 attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspectio ►ch o curs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be a aired . d a reinspection fee will be charged. Signature OWNER or AGENT The foregoing instrument was acknowledged before me this day of ZV1`—‘ , 20 ti , by , who is personally known to me or who has produced 1-).,1w'4.-- as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: ************ : 1.1r DEBORAH Y. HERNANDEZ '•''%A. Commission # FF 058713 t sn,, �s,�•i,�_ :I Expires September 30, 2017 ry - Bonded Thu Troy Fain !noisome 800385.7019 APPROVED BY (Revised02/24/2014) Aof 7- 31--19--- Signature CONTRACTOR The foregoing instrument was acknowledged before me this 1011 day of , 20 1,r3' , by (o �Gt.c�� , who is ersonally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC Sign: Print: Seal: O,Y Piyy , DEBORAH Y. HERNANDEZ t.; ,., Commission # FF 058713 j Expires September 30, 2017 .4g„As Bonded Thru Troy Fin Insurance 800385.7019 Plans Examiner Zoning Structural Review Clerk SIAItUI rwKIUA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 2601 BLAIR STONE ROAD TALLAHASSEE FL 32399-0783 CANCIO, GEORGE L MA PRO PLUMBING, LLC 6619 SOUTH DIXIE HIGHWAY #173 MIAMI FL 33143 Congratulations! With this license you become one of the nearly one million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range from architects to yacht brokers, from boxers to barbeque restaurants, and they keep Florida's economy strong. Every day we work to improve the way we do business in order to serve you better. For information about our services, please log onto www.myfloridaticense.com. There you can find more information about our divisions and the regulations that impact you, subscribe to department newsletters and learn more about the Departments initiatives. Our mission at the Department is: License Efficiently, Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, and congratulations on your new license! RICK SCOTT, GOVERNOR STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CFC1428813 ;, ':`-ISSUED: ` 07/04/2016 CERTIFIED PLUMBING CONTRACTOR CANCIO, GEORGE L -`;:> - - AAA PRO PLUMBING. ;LLC • IS -CERTIFIED under the provisions of Ch _489 FS. • Exiirdcn alb i AUG 31.4018 .41607040301534 DETACH HERE KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD LICENSE NUM6ER - :CFC1428813: !: The PLUMBING CONTRACTOR !--Named below IS CERTIFIED Under the provisions of.Chapter 489 FS. -.Expiiatit n date: -AUG 31, 2018 • E ;..CAN -C10, -GEORGE L• ,, rAAAPRO PLUMBING, LLC } �. 6619:S9UTH-DIXIE HIGHWAy41-747'" ; " MIAMI ,FL,33143.1 ( • - ISSUED: 07104/2016 Scanned by CamScanner DISPLAY AS REQUIRED BY LAW SEQ # L1607040001534 012006 Local Business Tax Receipt Miami—Dade County, State of Florida -THIS IS NOT A BILL - DO NOT PAY 7170807 BUSINESS NAME/LOCATION AM PRO PLUMBING LLC 6907 NW 51 ST MIAMI FL 33166 OWNER AAA PRO PLUMBING LLC C/0 EDWIN M GUERRA MGR Worker(s) 1 RECEIPT NO. RENEWAL 7449645 LBT SEC. TYPE OF BUSINESS 196 PLUMBING CONTRACTOR CFC1428813 EXPIRES SEPTEMBER 30, 2017 Must be displayed at place of business Pursuant to County Code Chapter 8A - Art. 9 & 10 PAYMENT RECEIVED BY TAX COLLECTOR $75.00 07/22/2016 CREDITCARD-16-043156 This Local Business Tax Receipt only confirms payment of the Local Business Tax. The Receipt is not a license, permit, or a certification of the holders qualifications, to do business. Holder must comply with any governmental or nongovernmental regulatory laws and requirements which apply to the business. The RECEIPT N0. above must be displayed on all commercial vehicles - Miami -Bade Code Sec Ba -276. For more information, visitwww.miamidade.cov/taxcollector s,4_,: Fm3a:r. +�eYa"c�osa�^T.aret'Yitni'ic-... 3si 0.5RMi te-' aitdtaalt:T 4��d CERTIFICATE OF LIABILITY INSURANCE DATE (MWD 7/10/2017D/vYYY) THIS QWIFICATE 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(ies) 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 SOUTH FLORIDA CASUALTY 415 North 4th Street CONTACT NAME: rPpH�[O;NyEFvn. (561) 533-6144 F No�(561) 533-6170 E-MAILn ADDRESS:Elaine@skhns .net Lantana, FL 33462 INSURER(S) AFFORDING COVERAGE NAIC# INSURER A- Scottsdale Insurance Company 41297 INSURED AAA Pro Plumbing, LLC 8550 NW 64th Street Miami, FL 33166 INSURER B: 1/16/171/16/18\ INSURER C: EACH OCCURRENCE INSURER D : PREMISES (Eatoccurrence) INSURER E: INSURER F: MED EXP (Any one person) CERTIFICATE NUMBER' 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 POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE MAL IVSD SUbK WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP jMM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY CPS2588825 1/16/171/16/18\ EACH OCCURRENCE $ 1,000,000 PREMISES (Eatoccurrence) $ 100,000 ICLAIMS -MADE X OCCUR MED EXP (Any one person) $ 5,000 PERsoNALBAtA/INJURY GENERAL AGGREGATE $ 1,000,000 $ 2,000,000 GEN'L AGGREGATE POLICY OTHER: X LIMIT APPUES PER: 78-.R LOC PRODUCTS - COMP/OP AGG $ 2 000 000 $ AUTOMOBILE — _ LABILITY ANYAUTO ALL OWNED AUTOS HIRED AUTOS — SCHEDULED AUTOS USNON-OWNED COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per acdd $ $ UMBRELLA LIAB EXCESS LIAB II OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED 1 J RETENTION $$ WORKERS COMPENSATION AND EMPLOYERS' UABIUTY ANY PROPRIETOR/PARTNER/EXECUTIVE1�1 OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A STATUTE I I OERH E.L EACH ACCIDENT $ E.L DISEASE - EA EMPLOYEE $ E.L DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Plumbing Operations CFC1428813 VLM.M IM Marl IL I IVWLM♦ Miami Shores Village Building Department 10050 N.E. 2nd Avenue Miami Shores, FL 33138 FAX•305-756-8972 t .......—��........ .. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 2,i:tiffs," 4,,,na 5 ACORD 25 (2013/04) ©1988-2013 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ACaRO® CERTIFICATE OF LIABILITY INSURANCE JDD ° Tip /2017 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(ies) must have ADDITIONAL INSURED provisions or 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 TriGen Insurance Solutions, Inc. 315 SE Mizner Blvd Suite 213 Boca Raton FL 33432 CONTACT PHON: Rhoden PHChris E (A/C No.Exq: (877) 987-4436 FNC.No): (954) 252-4426 E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Guarantee Insurance Company 11398 INSURED Integrity Employee Leasing II, Inc. 128 W. Charlotte Avenue Punta Gorda FL 33950 INSURER B : INSURER C: INSURER D: $ INSURERE: $ INSURER F : COVERAGES CERTIFICATE NUMBER: Cert ID 21527 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 ADDL NSD S WVD POLICY NUMBER POLICY EFF M/ (MDD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ AMAGE TO RENTED PREM SES (Ea occurrence) $ CLAIMS -MADE OCCUR MED EXP (Any one person) $ PERSONAL 8 ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE POLICY OTHER: LIMIT APPLIES PRO- JECT PER: LOC PRODUCTS-COMP/OPAGG $ $ AUTOMOBILE LIABILITY ANY AUTO OWNED AUTOS ONLY HIRED AUTOS ONLY _ SCHEDULED AUTOS NON -OWNED AUTOS ONLY COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LIAB EXCESS UAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ $ DED RETENTION$ A YERS'LSATION AND EMPLOYERS' LIABILITY NDWORKERSEMPLOYERS' ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED7 (Mandatory in NH) If yes, desaibe under DESCRIPTION OF OPERATIONS below Y/N N/A WCP500094702GIC 6/1/2017 6/1/2018 s PER TH- ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 $ $ DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Coverage provided for all leased employees but not subcontractors of: AAA Pro Plumbing LLC. Location coverage effective 6/01/17. CERTIFICATE HOLDER CANCELLATION Miami Shores Village Building Department 10050 NE 2 Avenue Miami Shore Village I FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Dwst( ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Page 1 of 1 ��y STATE OF FLORIDA Si ��55���i�c'a�O��DEPARTMENT OF HEALTH �� ,� KATION FOR CONSTRUCTION PERMIT ��'� �� �ay�d� Permit Application Nu i ••( \ '�a y, a° Pe pp illr 1 ��-(0*,aS����� PART II - SITEPLAN w .'Scale -`;t' P,:1 s, k re • resents 10 feet and 1 inch = 40 feet. ,l I. rall111 ■ ■■■■!1■■■ ■FlF3■_ ■■■■!g IN 111111111001111111111111101111 11111111111111111111113111 III hill' ■■■■i t ■t i7■ ■ ■I■■■■■ ■ imaimammus .NN Notes: Site Plan submitted • •;. • 7 '� 3 --1Plan Approved •• • •. • • Date • • • •• Jose 13 0-- (S County Health Department By S R•O �irus • `•22.7••6 • ALL CHANGES MUSJ•BE i%PPf41Ox/E. BY T..1-11E.PyUUNTY HEALTH DEPARTMENT ••• a,.. •• • • • Page 2 of 4 DH 4015. 08/09 (Obsoletes previous editions which may not be used) Incorporated: 64E-6.001, FAC (Stock Number 5744-002-4015-6) • • •• • • •• •• •• • •• ••• • • • • • • • • • •• • ••• • • • ••• • • • • • • ••• • • • • • • • • • • • • •• •• • ••• • • § mil Cl rrt—C~OCI0yg�Q�Q z 1"71r4 •°...A • 2i •g•• • ••• m ti b y m ON A3A21fS 2 :3140 0731d 6 6- n2 � Z o y • ar. O tY▪ R Z Ao• Q k • • • •44a. oco 0m Oy a) to 5 w - 5 •Now- PERMIT #: Miami Shcres Village APPROVED BY DATE ZONING DEPT BLDG DEPT ir 7-3( i9 --- SUBJECT TO CCMPLLPN E WITH ALL FED��99 E//R��/A��t —TATE AND CCUNri Y RULES AND REGCiiRTS l+� ni 1\ 6 _ .._. 4.9'1E 0.80' CL. s`Y (:C)MC. Q .DRIVI W/Vi &en / A 1 xt In a 7 0.1 43.00' u ,g0'ge 0.80' CL. ,oO'OC .Ol'1.01. 93dI S 13-1E6 MN STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT FOR: OSTDS Repair APPLICANT: Pablo Javier PERMIT #:13—SC-1774586 APPLICATION #: AP1297833 DATE PAID: FEE PAID: RECEIPT #• DOCUMENT #: PR1068066 PROPERTY ADDRESS: 56 NW 93 St Miami, FL 33150 LOT: 4 BLOCK: 2 SUBDIVISION: PROPERTY ID #: 11-3101-017-0040 [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 WHICH SERVED AS A BASIS FOR ISSUANCE OF THIS PERMIT, REQUIRE THE APPLICANT PERMIT APPLICATION. SUCH MODIFICATIONS MAY RESULT IN THIS PERMIT BEING MADE ISSUANCE OF THIS PERMIT DOES NOT EXEMPT THE APPLICANT FROM COMPLIANCE WITH STATE, OR LOCAL PERMITTING REQUIRED FOR DEVELOPMENT OF THIS PROPERTY. MATERIAL FACTS, TO MODIFY THE NULL AND VOID. OTHER FEDERAL, SYSTEM DESIGN AND SPECIFICATIONS T [ 750 ] GALLONS / GPD Septic - Exisitna A [ 0 ] N [ 0 ] K [ GALLONS / GPD GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ CAPACITY ed to Pett°a h e CApa CAPACITY nel ``� e4u`Sexcava`\0' the �oN GLE TANK: 25 1.1' 19L0NB,j't' �Pp�°co the0 he 0 hq�n DOS S;aP 24t.i311Sel\01 '�.0 #PLI\ �eao se of So uos��0' ansP�,c;°n the soo om-°n eu°r `�ca� �5 e °� �tnd� t�stti�ass�,`�41 era\u � et the °0n si t1n skAt t 7 Y W��\ r%L �Sse(1 l\ttl\ sese*tse5 tion AP. : ee�e a0 a.,N D [ 200 ] SQUARE FEET Bed confiauration drainfield SYSTEM R [ 0 ] SQUARE FEET SYSTEM A TYPE SYSTEM: I CONFIGURATION: N F LOCATION OF BENCHMARK: [X] STANDARD [ ] TRENCH [ ] FILLED [ ] [X] BED [ C/L Road 10.7' NGVD MOUND [ ] I ELEVATION OF PROPOSED SYSTEM SITE E BOTTOM OF DRAINFIELD TO BE L D FILL REQUIRED: [ 0.00] INCHES 0 T H E R [ 3.60 ] [ [ 42.00 ] [ INCHES V FT ][ ABOVE V BELOW ]BENCHMARK/REFERENCE POINT INCHES V FT ][ ABOVE 4 BELOW ] BENCHMARK/REFERENCE POINT EXCAVATION REQUIRED: [ 42.00] INCHES 1. -Existing septic tank certified by Alfonso Septic on 7/3/2017to remain. 3. -Install 200 sf of drainfleld in bed configuration. 3. -Invert elevation of drainfield to be no less than 8.0' NGVD. 4. -Bottom of drainfield elevation to be no Tess than 7.5' NGVD. 5. -Water line within 10 ftof septic system to be Sch 40 PVC or sleeved in accordance with FAC Ch 64 THIS PERMIT IS NOT FOR ADDITION(S)************ •. ••. • • • • • •• • • • SPECIFICATIONS BY: • •• ••• ade Envi. •• • -6.005(2)(b). •• • • • •• TITLE: APPROVED BY: / �.•• • •„ TITIA:• EnginQer •SSupervi sor I I I rid V Edwargs •• • • • • • • • • • • • • DATE ISSUED: 07/07/2017 • •• • • • i i • • • • • • • • ••• • .. • ••• • DH 4016, 08/09 (Obsoletes all previous editions which may not be used) Incorporated: 64E-6.003, FAC v 1.x:4• • • • • • • • • • ••• • • • • • • • • • .. • • ••• • • • • V12227833 • • • • • • • • • •• •• Dade CHD EXPIRATION DATE: SE1040030 10/05/2017 Page 1 of 3 NOTICE OF RIGHTS A party whose substantial interest is affected by this order may petition for an administrative hearing pursuant to sections 120.569 and 120.57, Florida Statutes. Such proceedings are governed by Rule 28-106, Florida Administrative Code. A petition for administrative hearing must be in writing and must be received by the Agency Clerk for the Department, within twenty-one (21) days from the receipt of this order. The address of the Agency Clerk is 4052 Bald Cypress Way, BIN A-02, Tallahassee, Florida 32399. The Agency Clerk's facsimile number is 850-413-8743. Mediation is not available as an alternative remedy. Your failure to submit a petition for hearing within 21 days from receipt of this order will constitute a waiver of your right to an administrative hearing, and this order shall become a 'final order'. Should this order become a final order, a party who is adversely affected by it is entitled to judicial review pursuant to Section 120.68, Florida Statutes. Review proceedings are governed by the Florida Rules of Appellate Procedure. Such proceedings may be commenced by filing one copy of a Notice of Appeal with the Agency Clerk of the Department of Health and a second copy, accompanied by the filing fees required by law, with the Court of Appeal in the appropriate District Court. The notice must be filed within 30 days of rendition of the final order. • • • • • • • • • •• ••• •• • • • •• •• ••• • • • • • •• •.• ••• • • • • • • • • • • • • •• • • •• • • • •• • • • •• • • • • • •• •• • •• •• • •• •• • • ••• •• •• • •••• • ••• • • • • •• • • • • • •• • ••• • •• • • • • • • • • • • • ••• • • • • • •• • • • • • • • • • • • •• ••• • • STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM SITE EVALUATION AND SYSTEM SPECIFICATION APPLICANT: Pablo Javier APPLICATION # AP1297833 PERMIT # 13 -SC -1774586 DOCUMENT # SE1040030 CONTRACTOR / AGENT: Alfonso"s Septic LOT: 4 SUBDIVISION: BLOCK: 2 ID#: 11-3101-017-0040 TO BE COMPLETED BY ENGINEER, HEALTH DEPARTMENT EMPLOYEE, OR OTHER QUALIFIED PERSON. ENGINEERS MUST PROVIDE REGISTRATION NUMBER AND SIGN AND SEAL EACH PAGE OF SUBMITTAL. COMPLETE ALL ITEMS. PROPERTY SIZE CONFORMS TO SITE PLAN: [X ]YES [ ]NO TOTAL ESTIMATED SEWAGE FLOW: 200 GALLONS PER DAY AUTHORIZED SEWAGE FLOW: 424.99 GALLONS PER DAY UNOBSTRUCTED AREA AVAILABLE: 600.00 SQFT BENCHMARK/REFERENCE POINT LOCATION: ELEVATION OF PROPOSED SYSTEM SITE C/L Road 10.7 NGVD [ NET USABLE AREA AVAILABLE: 0,17 ACRES RESIDENCES-TABLE1 1500 GPD/ACRE OR UNOBSTRUCTED AREA REQUIRED: / OTHER -TABLE 2 ] 2500 GPD/ACRE 300.00 ] SQFT 3.60 [ INCHES / FT ] [ ABOVE / BELOW ] BENCHMARK/REFERENCE POINT THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES SURFACE WATER: NA FT DITCHES/SWALES: NA FT NORMALLY WET: [ ]YES [X]NO WELLS: PUBLIC: NA FT LIMITED USE: NA FT PRIVATE: NA FT NON -POTABLE: NA FT POTABLE WATER LINES: 2 FT BUILDING FOUNDATIONS: 12 FT PROPERTY LINES: 5 FT SITE SUBJECT TO FREQUENT FLOODING? 10 YEAR FLOOD ELEVATION FOR SITE: SOIL PROFILE INFORMATION SITE 1 [ ]YES [X ]NO FT [ MSL / USDA SOIL SERIES: Urban land Munsell #/Color Texture Depth 10YR 8/3 Sand 0 To 72 OBSERVED WATER TABLE: 84.00 INCHES [ ABOVE / ESTIMATED WET SEASON WATER TABLE ELEVATION: BELOW 84 NGVD 10 YEAR FLOODING? [ ]YES ] SITE ELEVATION: 11.00 FT [ MSL / SOIL PROFILE INFORMATION SITE 2 [X]N01 NGVD USDA SOIL SERIES: Urban land Munsell #/Color Texture Depth 10YR 8/3 Sand 0 To 72 ] EXISTING GRADE TYPE: INCHES HIGH WATER TABLE VEGETATION: [ ]YES [X]NO MOTTLING: •• ••• • • • • • •• SOIL TEXTURE/LOADING RATE FOR SYSTEM SIZrN ): • • • $a10/0.60 DRAINFIELD CONFIGURATION: [ ABOVE / BELOW [ ]YES [X]NO [ PERCHED / ] EXISTING GRADE DEPTH: INCHES APPARENT DEPTH OF EXCAVATION: 42 INCHES [ ] TRE1!cH •: i[x]:B):D:•: [ •1 OTHER (SPECIFY) • • •• REMARKS/ADDITIONAL CRITERIA •••• • • •• • ••• • ••• • • • • • • • • • • • • • • • • • • • • • • • • • • • • SITE EVALUATED BY: ••• • •• ••• • DATE: 07/03/2017 Miami Dade Envi, (Title:) (Miami Dade Environmental S) DH 4015, 08/09 (Obsoletes previous editions Vic1 may:no: :Incorporated: 64E-6.001, FAC Page 3 of 4 • • • ••• • • • • • • • • • • • • • • • • • • • • AR1297838 • • EID1774586 v 1.0.2 ••• • • • ••• • •