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MC-17-215Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 90 NE 96 Street Miami Shores, FL 33138- Owner Information Permit Permit NO. MC -1-17-215 Permit Type: Mechanical - Residential Work Classification: A/C Replacement Permit Status: APPROVED Issue Date: 4/25/2017 J Expiration: 10/22/2017 Address Parcel Number 1132060130600 Block: Lot: Applicant VERO HOMES LLC Phone CeII 701 BRIECKELL AVE MIAMI FL 33131- Contractor(s) SM INTERCONSULTING LLC Phone CeII Phone (305)972-2371 Valuation: $ 6,000.00 Total Sq Feet: 3000 Tons: 2 Additional Info: REPLACE 2 TON UNIT Classification: Residential Approved: In Review Comments: Date Denied: Scanning: 3 Date Approved: : In Review Type of Work: REPLACE 2 TON UNIT Fees Due CCF DBPR Fee DCA Fee Education Surcharge Notary Fee Permit Fee Scanning Fee Technology Fee Total: Amount $3.60 $3.15 $3.15 $1.20 $5.00 $210.00 $9.00 $4.80 $239.90 Pay Date Pay Type Invoice # MC -1-17-62742 04/25/2017 Credit Card 01/26/2017 Check #: 2221 Amt Paid Amt Due $ 189.90 $ 50.00 $ 50.00 $ 0.00 Available Inspections: Inspection Type: Final Review Mechanical 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 e foregoing information is accurate and that all work�will be done in compliance with all applicable laws regulating workrk e - construction and zoni s:.. onze e above- ed ttq do th worC k rt ted. April 25, 2017 Author ed Si • ature P / Applicant / Contractor / Agent Building Department Copy Date April 25, 2017 1 BUILDING PERMIT APPLICATION ❑BUILDING ❑ ELECTRIC PLUMBING MECHANICAL JOB ADDRESS: City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Flood Zone: BFE: FFE: 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 Master Permit No. Sub Permit No. ❑ ROOFING ❑ REVISION ❑PUBLIC WORKS ❑ CHANGE OF CONTRACTOR �p N� N6* 5f JA( 2202.017 FBC20(U 12.c, ZGO3 MC ❑ EXTENSION ❑RENEWAL ❑ CANCELLATION ❑ SHOP DRAWINGS 33(3 OWNER: Name (Fee Simple Titleholder): ( Address: 'Tv ` �(�f t ( p 'QtIcs'v-I G ✓ O City: j afi'%) State: Construction Type: \lero \—ieS) (._tom C Phone#: '902 ^ 7 6(0 Tenant/Lessee Name: Email: S) v' k O>1&S Phone#: Zip: CONTRACTOR: Company Name: nil. ,4/2 Address: '3 70 4° . t71~ /' / City: G{ Le_444._ Qualifier Name: /) L4 C X31 k22g )r� V7o+7 1419 �vC S �l c,�: Phone#: 4 tt4 ,X30 z State: State Certification or Registration #: DESIGNER: Architect/Engineer: Phone#: Address: Phone#: Zip: 370/2_ 3°)-- 7 ZZ Certificate of Competency #: Value of Work for this Permit: $ (woo - Type of Work: ❑ Addition n Alteration Description of Work: P--tf-P L (Z) City: State: Square/Linear Footage of Work: ❑ New ❑ Repair/Replace 2 To.i UniotS Zip: Som0 ❑ Demolition Specify color'of color ttirutile: `Sti h,ittal Fed" 276r'6 .Permit Fee $ 22\0 vDDCCF$ 3 Scanning Fee $ 9 Radon Fee $ S DBPR $ 3• I s 15 O Technology Fee $ 4- Training/Education Fee $ /' 227 Double Fee $ Bond $ CO/CC $ Notary $ Structural Reviews $ (Revised02/24/2014) TOTAL FEE NOW DUE $ 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 commencemen anc construction lien_iaw bcochuce wilLba4elivered.t 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 absence of such posted notice, the inspection will not be approved and a reinspe on fee will be charged. Signature OWNER or AGENT The foregoing instrument was acknowledged before me this 23 day of Th -1 4 J 20 l"1 by ru,�• (t'.who personally known to me or who has produced PI-- Thr -4'(12_ as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: ,41i11iirri#9 P y�• ^r^a�91�fs`r • Ma'f- . s x•V'))• CONTRACTOR The ivregoing instrument was acknowledged before me this day of Cin -t•)- C16 ek \Qe2,.. , who iperm sonally know me or who has produced identification and who did take an oath. NOTARY PUBLIC: , 20 Z7 , by Sign: ,, _ Print: C \,�a s\e „ to as Seal: Charles Gonda Notary Public. State of Raids MY Comm. Expires Mg 1, 2018 Commission No. FF 238786 *************************** *******111****************************************************************** if APPROVED BY 2 V ' lans Examiner Structural Review (Revised02/24/2014) Zoning Clerk BUILDING PERMIT APPLICATION ❑ BUILDING ❑ PLUMBING JOB ADDRESS: City: Folio/Parcel#: Occupancy Type: 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 Master Permit No. Sub Permit No. ❑ ELECTRIC ❑ ROOFING ❑ REVISION MECHANICAL ❑PUBLIC WORKS HE CHANGE OF Jj�� /•�jCONTRACTOR qo / n V 6v S Miami Shores County: Miami Dade r a' C E,1 V E D APR _12017 '3Y. FBC 201. 5+11 12.0 I —16O� Mcrrz[5 ❑ EXTENSION ❑RENEWAL ❑ CANCELLATION ❑ SHOP DRAWINGS Zip: 331 3 ' Is the Building Historically Designated: Yes NO Load: Construction Type: Flood Zone: BFE: FFE: �`•' .05 7-71 Cg6o OWNER: e Name Fee_SSiim�/ pleeTitleholder): / Er O 1 -kr -C)1 e5/ LL C Address: ?'i O Uj�( e61 ifA)'Q 5u 1 2-zo City: Mf wl 1 State: � L Tenant/Lessee Name: Email: two €Vterk r esCoyri CONTRACTOR: Company Name: Address: Z +1 vi City: Qualifier Phone#: Phone#: Zip: 3 l 3 1 one#: 'l State: Name: ,;4- ' 5 4/67 5q 1 • Zip: 53 p0 Phone#: (3c -T) /9 2 Z� 9 Stat"` a C?rfi icf ation or Registration #:_ Certificate of Competency #: DESIGNER: Architect/Engineer: • Phone#: Address: Value of Work for this Permit: $ 6 000 Type of Work: ❑ Addition ❑ Alteration Description of Work: t7y,c i (z Chain -e OF ,me City: State: Zip: Square/Linear Footage of Work: 2 000 E7 New ❑ Repair/Replace ❑ Demolition IXJI tT�t!'1 E,Y Specify color -of color'i*hru: tile:'""'__ f J 1 Submittal Fee $�`.. Permit Fee $ \ O " `� CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ �('a TOTALFEENOWDUE$ (/ 1 •` Cpa6 (Revised02/24/2014) SM InterConsulting Juan J. Santandreu, P.E 271 W 59 St Hialeah FL. 33012 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 which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspectiog fee will be charged. Signature OWNER or AGENT The foregoing instrument^was acknowledged before me this ith day of Mardi) Aardi) kV -CX-o r 5 • Al kA CUM, who is personally known to me or who has produced `jr,.tkv as identification and who did take an oath. NOTARY PUBLIC: , 20 r1 , by Sign: Print: Seal: •t2 y'•. W YANAD TJ IETO •.: MY COMMISSION # FF 214031 �; a ` EXPIRES: March 25, 2019 '•,;' of F.°.•` Bonded Thru Notary Fub!ic Underwriters Signature CONTRACTOR The foregoing instrument was acknowledged before me this day of , 20 \ , by b.1, '0 , who isElmally know)to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: �, Print.. 300.., 4S V12 -O 2--- Seal: ********* *** ****p **** ********************** APPROVED BY Plans Examiner (Revised02/24/2014) Structural Review 131r):; ,,, CHARLES GONZALEZ =; Notary Public • State of Florida Commission # FF 239788 My Comm. Expires Aug 1, 2019 90188d111b11Qtl1 itlr1 PoHRy1tj5hw1 Zoning r Clerk 4 Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax:(305) 756.8972 AIR CONDITIONING REPLACEMENT DATA PERMIT NUMBER: MC This form must accompany ALL air conditioning replacement permit applications. Each unit change -out must be on its own data sheet. Multiple units on single sheets are not acceptable. / ' Job Address (where the work is being done): 0 V E C/6 S 2 City: Miami Shores Village County: Miami Dade Zip Code: 7 3 13 ALL CONDENSING UNITS MUST BE ON A 4 INCH SOLID CONCRETE SLAB ALL UNITS MUST COMPLY WITH F.E.M.A MINIMUM FLOOD ELEVATION A COPY OF THE CONTRACT IS REQUIRED WITH ALL SUBMITALS AHRI DATA SHEET REQUIRED Change disconnecting means: YES ❑ NO ❑ ARHI Sheet Attached: YES ❑ NO ❑ Contract Attached: YES ❑ UNIT BEING REPLACED DATA NEW UNIT MANUFACTURER AHU or PKG. UNIT MODEL # COND. UNIT MODEL # KW HEAT NOM TONS AHU CU PKG 1) M.C.A AHU CU PKG AHU CU PKG 2) M.O.P AHU CU PKG AHU CU PKG 3) VOLTS AHU CU PKG PKG UNIT / / PKG UNIT / / EER/SEER YES NO REPLACING DUCTS YES NO YES NO REPLACING THERMOSTAT YES NO YES NO NEW 4"CONCRETE SLAB YES NO YES NO NEW ROOF STAND YES NO YES NO NEW RETURN PLENUM BOX YES NO 1. Minimum Circuit Ampacity (Wire Size): 2. Maximum Overcurrent Protection (Fuse/Breaker Size): 3. Voltage of Circuit (208/240/480): 4. Size Disconnecting Means: Contractor's Company Name: Phone: State Certificate or Registratior\NoN Signature (Revised02/24/2014) Ns (Qualifier' Si: ature) Vi Certificate of Competency No. Date: -47 -9/i-4' SM InterConsulting Juan. Santandreu, P.E 271 W 59 St Hialeah FL. 33012 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 2601 BLAIR STONE ROAD TALLAHASSEE FL 32399-0783 SANTANDREU, JUAN JOSE SM INTERCONSULTING, LLC 271 WEST 59TH STREET HIALEAH FL 33012 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.myfloridalicense.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 Department's 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! 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.myfloridalicense.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 Department's 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! ►�''. STATE OF FLORIDA DEPARTMENT'OF BUSINESS AND PROFESSIONAL:REGULATION CGC1523738,, ' ISSUED:' 07/07/2016 CERTIFIED GENERAL CONTRACTOR SANTANDREUJUAN JOSE , SM INTERCONSULTING.LLC; r4. r IS CERTIFIED under the.provisions of Ch.489 FS. Expiry&on date 'AUG 31. 2018 L1607070001066 Vit.. STATE OF FLORIDA DEPARTMENT'OE-BUSINESS AND !>' PROFESSIONAL.REGULATION CMC1250521 ' , ISSUED:: 07/07/2016 CERTIFIED MECHANICAL CONTRACTOR SANTANDREU, JUAN JOSE SM INTERCONSULTING,:LL'C, -r IS CERTIFIED under the provisions of Ch.489,FS. Expiration date : 'AUG 31, 2018 L1607070001132 total_BusinessTaaeteipt- Miamt-Oade County, State of Fforida —THISIS, NOT A .BILL — 00 NOTM 6726866 BUSINESS NAME/LOCATION SM INTERCONSULTING LLC 271 W 59.ST HIALEAH, FL .33012 OWNER SKINTERCONsyLTING LLC, ' . Worker(s) MIAM IS &CBOT NO. RtNEWAL 7900318 SEC. TYPE OP13USINESS 196 GENERAL MECHANICAL CONTRACTOR, PAYMENT RECEIVED BY TAX COLLECTOR 149.5o 10/11/2016, CMC125421 EXPIRES SEPTEMBER 30, 2017 Must be displayed at place of business Pursuant to County Code Chapter 8A — Art. 9 & 10 1 0223-17-000072 This Local Business Tax RecitIpt only,confirms payment of the Local BusinessTai. The Receipt is not IVECONE, pennit, or. tiestilidation of thatoiderls qualifications, to dibushiess.Holdii must comply wlth any poitrainental or nongovernmental regulatory laws and requilaiiients which apply to the Iusin.ss. The RECEIPT NO. 'heaviest be displayed oil all commercial vehicles — Mlaini4lade Code Sec ea -275. 1 k ,For moisinformatiort,yisit www.Mlamidade.goidiutcollectoi SM INTERCONSULTING, LLC. t l.4,GN0 v1 Date: l 19 State of �L County of iov t 10.(ce. Before me this day personally appeared Win J• SAn7.uiIrev who, being duty sworn, . deposes and says: That he or she will be the only person working on the project locate)� at: qD All 94' Ilam, Shares, Ft 33/3Y Sworn to or ed) and subscribed before me this `I day of kpvi I 20 11 , by Personally know OR Produced Identification Type of Identification Produced Print, Type• 'r'� • Name of Notary Miami Shores Viiiage Building Department 10050 N.E.2nd Avenue 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. 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. Signature: State of Florida County of Miami -Dade The foregoing was acknowledge before me this 2_9-"* day of 1NA.QrC V\ , 20 1 . By -14-CC--o- San .cno 6 Coro' Notary: SEAL: who is personally known to me or has produced l'1 c\ Y'3 - as identification. YANADY PRIETO MY COMMISSION # FF 214031 EXPIRES: March 25, 2019 %,e dv F•P` Bonded Thru Notary Fub§c Underwriters JEFF ATWATER STATE OF FLORIDA CHIEF FINANCIAL OFFICER DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW * CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. 05-16s2016 EFFECTIVE DATE: PERSON: 06/23/2016 EXPIRATION DATE: 06/23/2018 SANTANDREU FEIN: 272629353 BUSINESS NAME AND ADDRESS: SM INTERcONSULTING, LLC 08A N/A 271 W 58 ST HIALEAH 33012 SCOPES OF BUSINESS OR TRADE: 1- SEWER CONSTRUCTION ALL OPERATI 3- CONCRETE CONSTRUCTION NOC JUAN J 2- HEATING, VENTILATION, AIR-COND 4- LICENSED GENERAL CONTRACTOR IMPORTANT: Pursuant to Chapler 440 . O6(14), F.S., ss officer of a corporation who elects exemption from this chapter by filing a certificate of election ander this section may not recover benefits or compensation under this chapter. Pursuant to Chapter 440.06112). F.S., Certificates of election to be exempt... apply only wnbIn the scope of the business or trade listed on the notice of election to be exempt. Pursuant to Chapter 440.06(13), F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no langet meets the regeirements of this section for issuance of a certificate. The department shall revoke a certificate et any time for failure of the person named on the certificate to meet the requirements of this section. OWC-152 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01-11 QUESTIONS? (850) 413-1609 PLEASE CUT OUT THE CARO BELOW AND RETAIN FOR FUTURE REFERENCE STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS• COMPENSATION CONSTRUCTION INDUSTRY CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW EFFECTIVE: 08/23/2018 EXPIRATION DATE: 08/23/2018 PERSON: JUAN J SANTANDREU FEIN: 272829353 BUSINESS NAME AND ADDRESS: SM INTERCONSULTING, LIC OBA N/A 271 W 59 ST HIALEAH, FL 33012 SCOPE OF BUSINESS OR TRADE: I- SEWER CONSTRUCTION ALL OPERATI 2- HEATING, VENTILATION, AIR-COND 3- CONCRETE CONSTRUCTION NOC 4- LICENSED GENERAL CONTRACTOR 0 L D H E R E Pursuant to Chapter 440.05(13), F.S., Notices of election to be exempt end certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. IMPORTANT Pursuant to Chapter 440.05(14), F.S., an officer elects .exemption from this chapter by filing a under this section may not recover benefits or chapter. Pursuant to Chapter 440.05(12), F.S., Certificates exempt.. apply only within the scope of the bus the notice of election to be exempt. of a corporation who certificate of election compensation under this of election to be iness or trade listed on QUESTIONS? (850) 413-1609 CUT HERE * Carry bottom portion on the Job, keep upper portion for your records. DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01-11 DRIVER LCE D425-33793-O52M HECTOR SANTIAGO DE LA CANAL 496 C►E.:L AVE APT 702 MIAMI, FL 33131 DOB 02-12-1993 sEx 0746-2012 s C2-12-2021 T i., AC Opel *t tart o4 a rnrxtor vehoc COMM t .4C01? ® ZB CERTIFICATE OF LIABILITY INSURANCE R054 DATE (MM/DD/YYYY) 4/24/2017 THIS CERTIFICATEIS 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 INSURANCE MANAGEMENT ASSC INC/PHS 263311 P: (866) 467-8730 F: (888) 443-6112 PO BOX 29611 CHARLOTTE NC 28229 CONTACT NAME: (NC,,"No.Ext): (866) 467-8730 FAX WO, (888) 443-6112 ADDRIESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: Sentinel Ins Co LTD 11000 INSURED SM INTERCONSULTING, LLC 271 W 59TH ST HIALEAH FL 33012 INSURER B : LL I^ INSURER C : INSURER D: 20 SBM AB0996 INSURER E: 07/11/2017 INSURERF: $1,000,000 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. IN,SR LTR TYPE OF INSURANCE ADDL IA:SR SUBR WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP IMM/DD/YYYY) LIMITS A COMMERCIAL GENERAL -MADE Liab LL I^ LIABILITYEACH I OCCUR 20 SBM AB0996 07/11/2016 07/11/2017 OCCURRENCE $1,000,000 CLAIMS DAMAGE TO RENTED PREMISES (Ea occurrence) $1,000,000 X General MEDEXP(Anyoneperson) $10, 000 PERSONAL BADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PRO- JECT PER: LOC GENERAL AGGREGATE $ 2 000 000 POLICY PRODUCTS - COMP/OP AGG $2,000,000 OTHER: OTHER: $ A AUTOMOBILE _ X LIABILITY ANY AUTO OWNED AUTOS ONLY HIRED AUTOS ONLY SCHEDULED AUTOS NON -OWNED AUTOS ONLY 20 SBM AB0996 07/11/2016 07/11/2017 COMBINED SINGLE LIMIT (Ea accident) $1000,000 I BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ --- X PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N OFFICER/MEMBER EXCLUDED? (Mandatory In NH) ❑ If yes, describe under DESCRIPTION OF OPERATIONS below N/A PER OTH- STATUTE ER 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) Those usual to the Insured's Operations. Engineer, Mechanical & General Contractor and Engineering Services. CERTIFICATE HOLDER CANCELLATION MIAMI 10050 MIAMI SHORES VILLAGE NE 2ND AVE SHORES, 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 ` �,a,- ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM SITE EVALUATION AND SYSTEM SPECIFICATIONS PERMIT #. APPLICANT: ARILYNN TURNER / HECTOR DELA CANAL AGENT : MR. C'S PLUMBING & SEPTIC INC. LOT : 1 & 2 BLOCK :5 SUBDIVISION: MIAMI SHORES SEC 1 PROPERTY ID # : 11-3206-013-0600 [ Section/Township/Parcel No. or Tax ID Number 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: [✓] YES [ ] NO NET USABLE AREA AVAILABLE: TOTAL ESTIMATED SEWAGE FLOW: 400 AUTHORIZED SEWAGE FLOW: 850 UNOBSTRUCTED AREA AVAILABLE: 600 BENCHMARK/REFERENCE POINT LOCATION:FFE12.2' 0.34 ACRES GALLONS PER DAY [ RESIDENCES -TABLE 1 GALLONS PER DAY [2500 GPD/ACRE SQFT UNOBSTRUCTED AREA REQUIRED: 600 SQFT ELEVATION OF PROPOSED SYSTEM SITE IS14.4 [INCHES THE MINIMUM SETBACK WHICH SURFACE WATER: NA FT WELLS: PUBLIC: NA FT BUILDING FOUNDATIONS : 8 ] [BELOW ] BENCHMARK/REFERENCE POINT CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES DITCHES/SWALES:NA FT NORMALLY WET? [ ] YES [✓] NO LIMITED USE: NA FT PRIVATE: NA FT NON—POTABLE: NA FT FT PROPERTY LINES:8 FT POTABLE WATER LINES:20 FT SITE SUBJECT TO FREQUENT FLOODING: [ ] YES [✓] NO 10 YEAR FLOOD ELEVATION FOR SITE: FT MSL/NGVD SOIL PROFILE INFORMATION SITE 1 MUNSELL #/COLOR TEXTURE 10YR 3/1 DG SAND FILL REFUSAL FRAC ROCK USDA SOIL SERIES: URBAN LAND DEPTH 0 TO 40 40 TO 40 TO TO TO TO TO TO TO OBSERVED WATER TABLE:>72 INCHES [BELOW 10 YEAR FLOODING? [ ] YES [✓] NO SITE ELEVATION:11.0 FT MSL/NGVD SOIL PROFILE INFORMATION SITE 2 MUNSELL #/COLOR TEXTURE I OYR 3/1 DG SAND FILL REFUSAL FRAC ROCK DEPTH 0 TO 40 • 40 TO 40 • • • •• • TO •••• •• • TO • •�— • •• TO.... •••• • TO • •••• TO • TO.... •••• •••• ••• • TO.... USDA SOIL SERIES: LAZE3A11.I"LAND•� • • •••• •• • • • • • • • • •• • • • • • • • EXISTING GRADE. PE : [•APPAR;Iyj : ""r' ESTIMATED WET SEASON WATER TABLE ELEVATION:90 INCHES [.BELOW : • ] •EXISTING• HIGH WATER TABLE VEGETATION: [ ] YES [4 NO MOTTLING: [ ] YES [1/1°N0* DEP�4i','N I S• •• • SOIL TEXTURE/LOADING RATE FOR SYSTEM SIZING: TABLEVI DEPTH OF EXCAVATION:0 DRAINFIELD CONFIGURATION: [ I TRENCH [I] BED [ ] OTHER (SPECIFY) REMARKS/ADDITIONAL CRITERIA: INCHES HWT 3.5' AS PERMIAMI DADE CONTOUR MAP SITE EVALUATED BY: - DE 4015, 08/09 (Obsoletes previous editions which may not be used) Incorporated: 64E-6.001, FAC DATE: litilik, Page 3 of 4 APPLICANT: STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM EXISTING SYSTEM AND SYSTEM REPAIR EVALUATION PERMIT # tom' v`1 1L,r vQ 14-eG-'uY .2)€(4t, C'r-t. wl rcr- C(5 eUtlitkAtY15 4 SemWc. 5- SUBDIV: MAC -G S)'1C ' Sl: (t ' 3Z06 CONTRACTOR / AGENT: LOT: ( Z BLOCK: ®f q- oCoa TO BE COMPLETED BY FLORIDA REGISTERED ENGINEER, DEPARTMENT EMPLOYEE, SEPTIC TANK CONTRACTOR OR OTHER CERTIFIED PERSON. SIGN AND SEAL ALL SUBMITTED DOCUMENTS. COMPLETE ALL APPLICABLE ITEMS. COMPLETE TANK CERTIFICATION BELOW OR NOTE IN REMARKS WHY THE TANKS CANNOT BE CERTIFIED. EXISTING TANK INFORMATION GALLONS SETS' TADGPD ATU GALLONS SEPTIC TANK/GPD ATU GALLONS GREASE INTERCEPTOR GALLONS DOSING TANK LEGEND: LEGEND: LEGEND: LEGEND: MATERIAL: Ci - BAFFLED:[Y /(25 MATERIAL: BAFFLED:[Y / N] MATERIAL: MATERIAL: # PUMPS:[ I CERTIFY THAT THE LISTED TANKS WERE PUMPED ON t /r( /ISo BYOf r' 657 A t.& 1 '� C'e����HAVE THE VOLUMES SPECIFIED AS DETERMINED = ■ i NSION`+/ FILLING / LEGEND ], ARE FREt' OF OBSERVABLE DEFECTS OR LEAKS AND HAVE A llEr' •• �' OUTLET FILTER DVICE ] INSTALLED./ BUSINESS NAME DATE SIGNATURE OF LICENSED CONTRACTOR EXISTING DRAINFIELD INFORMATION [11'00 ] SQUARE [ ] SQUARE TYPE OF SYSTEM: CONFIGURATION: DESIGN: ELEVATION FEET PRIMARY DRAINFIELD SYSTEM NO. OF TRENCHES [ ] DIMENSIONS: G7 5x {{D FEET SYSTEM NO. OF TRENCHES ] DIMENSIONS: X [ STANDARD [ ] FILLED [ ] MOUND [ ] [ / ] TRENCH )(lb] BED [ ] ] DOSED SYSTEM . HES [•AEOVL [)c] HEADER [ ] D -BOX [ GRAVITY OF BOTTOM OF DRAINFIELD IN RELATION O EXISTING SYSTEM FAILURE AND REPAIR INFORMATION [ 141"7/ ] SYSTEM INSTALLATION DATE [ ] GPD ESTIMATED SEWAGE FLOW SITE [ ] DRAINAGE STRUCTURES CONDITIONS: [ ] SLOPING PROPERTY NATURE OF [ ] LIC OVERLOAD FAILURE: [ ] D GE / RUN OFF FAILURE [ ] SFg'WA E ON GROUND SYMPTOM: [ ] PLUMBING BACKUP REMARKS/ADDITIONAL CRITERIA 9 rI' TYPE BASED ON SYSTEM GRADE OF WASTE ] METERED IN�r • • • • • •• • •• • • • • • • • • 00 • • • • [ l DOM 5T/C [ •1•Co 'a•: WATER t 1•TABLE•l.. E-6,•FAF. • • ••• • [ ] POOL [ ] PATIO / DECK 5.' .PARKING ••� [ ] • •• • • • • • • • [ OILS [ ] MAIN'I<E CE4 ] . SYSTESQ• P GE [ ROOTS [ ] WATERt `` ABLE L•• : • • •• • • • •••• [ J T? K [ ] D BOA`/HEADER [ ] D' INFIELD [ ] as1A/ tli 64-s �-: - 3:4-' 1J - SUBMITTED BY: TITLE/LICENSE 56)C>6%, i53 6 DATE: 0%-((, DH 4015, 08/09 (Obsoletes previous editions which may not be used) Incorporated 64E-6.001, FAC Page 4 of 4 STATE OF FLORIDA DEPARTMENT OF HEALTH APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Permit Application Number PART II - SITEPLAN icale: tach MOCK represents l u ICGL Cll MI 1 it IVI I - - 4�,... ,. 1li IIIiiii...i. I mow p 40. rinsi w. L 11111111 1 irki ' ■■■■■.�u ice.. ■■.II���rE11..i .... «� ■�� 111111 III -. ■■ s' ■� .. ■SII I.u..IIuI IIa11ti�I pi _ UlIIU1, ■amau.a����� ■ 1 NINE II I.i11II 11.111111UI 111111 11. ! , 1 , i_ . ! i Ill 1 . I i:...... . .• . . •. `• •. •.. • w j•6, •• •• • •- • • •� • There are no pertinent features on adjacent properties and or across the street that may affect the New Appl c•vstem yys liailon. • •. • •• •• •• • • • • • • • . L • 90 o6— 9G c -s' • v t,c�Ut.vc • • • • • L .• S' -2 .�" K� S� g-�lrv► t 9 cwr 1 Yt5 a I�5 T I r-- ,:c— • —••• .••• Site Plan submitted by: Plan Approved By Not Approved • .• CoVfrc c -4-by Date 11 t 1(4- County «County Health Department ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT DH 4015, 10/06 (Replaces HRS -H Form 4016 which may be used) (Stock Number 5744-002-4015-6) Page2of4 • • .. • • . • .• • • • .• ELEVATION CERTIFICATE Owners Name: ARI LYNN TURNER Property Address: 90 NE 96 ST Miami Shores, FL 33138 LEGAL DESCRIPTION: FOLIO #: 11-3206-013-0600 Lot 1 & 2, Block 5 of "MIAMI SHORES SEC 1 AMD" according to the plat thereof as recorded in Plat Book 10 at Page 70 of the Public Records of Dade County, Florida. SURVEYOR'S NOTES: 1) Not valid without the signature and the original raised seal of a Florida Licensed Surveyor and Mapper. 2) Additions or deletions to this certificate by other than the signing party or parties are prohibited without written consent of the signing party or parties. 3) This certificate elevation is for the. purpose of septic and drains repair and/or construction. 4) This certificate elevation must not be use for the purpose of acquiring flood insurance 5) Elevations are based on the National Geodetic Vertical Datum of 1929. TOP OF BOTTOM FLOOR: 12.2 TOP OF NEXT HIGHER FLOOR: N/A ATTACHED GARAGE (at the door): N/A GRADE @ DRAINFIELD AREA 11.0: ••• CROWN OF THE ROAD: 10.5 • •••• ••• Field Date: 09/14/2016 •••• ••.. • • ••.• ..• • • • •. .•• • 1•• • •.. ••• ••• ••.• • • • • Pablo J. Alfonso P.S.M. Professional Surveyor & Mapper State of Florida Reg. No.5880 �.� gra IF - L A N D SURVEYORS, I N D. 6175 NW 153`° STREET, SUITE 321, MIAMI LAKES, FLORIDA 33014 Phone: 305-822-6062 *' Fax: 305-827-9669 Mission: To protect, promote & improve the heath of all people in Florida through integrated state, county & conrruiity efforts. te 10 HEALTH Vision: To be the Healthiest State in the Nation Rick Scott Governor Celeste Philip, MD, MPH State Surgeon General and Secretary November 29, 2016 Hector De la Canal 701 Brickell Avenue Miami, FL 33131 RE: Modification to a Single Family Residence - No Bedroom Addition Application Document Number: API260603 Centrax Permit Number: 13 -SC -1715747 90 NE 96 Street Miami, FL 33138 Lot: 1 2 Block: 5 Subdivision: Dear Applicant, This will acknowledge receipt of a floor plan and site plan on 10/24/2016 for the use of the existing onsite sewage treatment and disposal system located on the above referenced property. Internal renovation. No objection letter was issued by C. lcaza on 11/29/16. This office has reviewed and verified the floor plan and site plan you submitted, for the proposed remodeling addition or modification to your single-family home. Based on the information you provided, the Health Department concludes that the proposed remodeling addition or modification is not adding a• • bedroom and that it does not appear to cover any part of the existing system or encroach on the required setback or unobstructed area. No existing system inspection or evaluation and assessr+ient, • • • •' • or modification, replacement, or upgrade authorization is required. • • • • Because an inspection or evaluation of the existing septic system was not conducted, the•I?Mrnent . • • • •. cannot attest to the existing system's current condition, size, or adequacy to serve the proposed use. "" . • You may request a voluntary inspection and assessment of your system from a licensed septic tank • • contractor or plumber, or a person certified under section 381.0101, Florida Statutes. • • • • •• • • If you have any questions, please call our office at (305) 623-3500. Since Ca En.I Department of Health in Dade County • • • • • •• • los lc • •••• • • • Florida Department of Koala in Dade County • • , Florida PHONE: (305) 623-3500 wwwdbrldakaaMt.gor TWITTER:HealthyFLA FAC EBOOK:FLDepartmentofH ealth YOUTUBE: fldoh • • 1• TS A las LI.4,..e.„7,t1 Auta,3 PC' • fits • • • J•oCfm --- • • • • t L. 0. •• • • • • ••• • .•• ••••; e•• -03 l' • fts • • • • • • •••EL. --•A • • • • - • • •• , ••• • • • • I • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • LJ ISAC • ri ?..A I r 1 1.1:,574 RCS. 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