PL-17-1883Project Address
Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Permit
Permit NO. PL -7-17-1883
Permit Type: Plumbing - Residential
Work Classification: Drainfield
Permit Status: APPROVED
Issue Date: 8/3/2017
Expiration: 01/30/2018
Parcel Number
Applicant
89 NE 102 Street
Miami Shores, FL 33138-2322
1132060131690
Block: Lot:
PALOMA TEPPA
Owner Information
Address
Phone
Cell
PALOMA TEPPA
89 NE 102 Street
MIAMI SHORES FL 33138-2322
89 NE 102 Street
MIAMI SHORES FL 33138-2322
Contractor(s)
MR C'S PLUMBING & SEPTIC INC
Phone
(305)651-7859
Cell Phone
Valuation:
Total Sq Feet:
$ 2,400.00
200
Type of Work: DRAINFIELD REPAIR
Type of Piping:
Additional Info: DRAINFIELD REPAIR
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
Invoice #
07/24/2017
08/03/2017
08/03/2017
Bond #: 3471
Pay Type
PL -7-17-64662
Check #: 1289
Check #: 1123
Credit Card
Amt Paid Amt Due
$ 50.00 $ 618.30
$ 500.00 $ 118.30
$ 118.30 $ 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 ELECTRICAL, PLUMBING, MECHANICA , WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: I certify that all information accurate and that all work will be done in compliance with all applicable laws regulating
construction and zoning. Futhermore, I a . • . Nie -n med contractor to do the work stated.
August 03, 2017
Authorized Signature: Owner / Applicant / Contractor / Agent
Building Department Copy
Date
August 03, 2017 1
iVi$To
Environmentat Hea
Iorola Width
rkliallei-fhttle County
(POTE4'4,104:11 Division
1181W -.S bjH-it;ci!! RfflL Et 33175
41'
Date
h
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
-04
FBC20(4-p,
BUILDING Master Permit No 'LI - t EJw3
PERMIT APPLICATION Sub Permit No.
❑ BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑ RENEWAL
c] PLUMBING ❑ MECHANICAL El PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 89 NE 102 Street
City: Miami Shores County: Miami Dade Zip:3( 3g
Folio/Parcel#:11-3206-013-1690 Is the Building Historically Designated: Yes NO X
Occupancy Type: SFH Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): Paloma Teppa
Address:89 NE 102 Street
Phone#:
City: Miami Shores
State: FL Zip: 33138
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: Mr. C's Plumbing & Septic
Address: 19932 NE 2 Avenue
Phone#: 305-651-7859
City: Miami State: FL Zip: 33169
Qualifier Name: Kemble Ettrick Phone#: 305-651-7859
State Certification or Registration #: SR061536 Certificate of Competency #:
DESIGNER: Architect/Engineer: NA Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ 2400
Square/Linear Footage of Work: 200
Type of Work: El Addition ❑ Alteration ❑ New Repair/Replace ❑ Demolition
Description of Work: Drainfield Repair
Specify color of color thru tile:
Submittal Fee $ `50 • Permit Fee $ /P CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Notary $ s
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ Bond $
TOTAL FEE NOW DUE $
(Revised02/24/2014)
. Bonding Company's Name (if applicable) NA
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: 1 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 reinspection fee will be charged.
OWNER or AGENT
CONTRACTOR
The foregoing instrument
was acknowledged before me this The foregoing instrument jwas acknowledged before me this
el?. rj 1,4
day off 7/K S` , 20 I, , by %�/ da of 7 4a )r� 5� , 20 /7 , by
/ G1 /04-14t [� a , who is personally known to I e e Me -k---, who is personally known to
me or who has produced as me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
APPROVED BY
(Revised02/24/2014)
zie
: MY COMMISSION # GG102743
^�i'�*` EXPIRES May 09, 2021
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
Plans Examiner
;Y►" DONALD MARTIN
MY COMMISSION # GG102743
":�+yaM1 EXPIRES May 09, 2021
Zoning
Structural Review Clerk
7/10/2017
Property Search Application - Miami -Dade County
FFICE Of THE PROPERTY APPRAISER
Summary Report
Property Information
Folio:
11-3206-013-1690
Property Address:
89 NE 102 ST
Miami Shores, FL 33138-2322
Owner
PALOMA TEPPA
Mailing Address
89 NE 102 ST
MIAMI SHORES, FL 33138 USA
PA Primary Zone
1000 SGL FAMILY - 2101-2300 SQ
Primary Land Use
0101 RESIDENTIAL - SINGLE
FAMILY : 1 UNIT
Beds / Baths / Half
2 /2 / 0
Floors
1
Living Units
1
Actual Area
Sq.Ft
Living Area
Sq.Ft
Adjusted Area
1,873 Sq.Ft
Lot Size
11,923.76 Sq.Ft
Year Built
1948
Assessment Information
Year
2017
2016
2015
Land Value
$297,664
$297,664
$226,932
Building Value
$130,361
$130,361
$130,361
XF Value
$1,898
$1,924
$1,560
Market Value
$429,923
$429,949
$358,853
Assessed Value
$368,952
$361,364
$358,853
Benefits Information
Benefit
Type
2017
2016
2015
Save Our Homes Cap
Assessment Reduction
$60,971
$68,585
Taxable Value
Homestead
Exemption
$25,000
$25,000
$25,000
Second Homestead
Exemption
$25,000
$25,000
$25,000
Note: Not all benefits are applicable to all Taxable Values ('.e. County, School
Board, City, Regional).
Short Legal Description
MIAMI SHORES SEC 1 AMD PB 10-70
LOTS 22 & 23 BLK 12
LOT SIZE IRREGULAR
OR 13718-2883 0688 4
Generated On : 7/10/2017
Taxable Value Information
Previous
2017
2016
2015
County
Exemption Value
$50,000
$50,000
$50,000
Taxable Value
$318,952
$311,364
$308,853.
School Board 1
41
Exemption Value
$25,000
$25,000
$25,000
Taxable Value
$343,952
$336,364
$333,853
City
Exemption Value
$50,000
$50,000
$50,000
Taxable Value
$318,952
$311,364
$308,853
Regional
Exemption Value
$50,000
$50,000
$50,000
$308,8531
Taxable Value
$318,952
$311,364
Sales Information
Previous
OR
Sale
Price
Book-
Qualification Description
Page
08/14/2014
$421,500
29287-Qual
by verifiable & documented evidence
4381
10/30/2013
$100
28906-
0068
Financial inst or "In Lieu of Forclosure"
stated
10/01/2013
$200,100
28876-
1270
Financial inst or "In Lieu of Forclosure"
stated
13718-
Sales which are disqualified as a result of
06/01/1988
$0
2883
examination of the deed
The Office of the Property Appraiser is continually editing and updating the tax roll. This website may not reflect the most current information on record. The Property Appraiser
and Miami -Dade County assumes no liability, see full disclaimer and User Agreement at http://www.miamidade.gov/info/disclaimer.asp
Version:
{'f hict.i'crD�.�rceit' �� �1E 162sT��•
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RECEIVED
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STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM
CONSTRUCTION PERMIT FOR:
APPLICANT: Paloma Teppa
OSTDS Repair
PERMIT #: 13 -SC -1776505
APPLICATION #: AP1299018
DATE PAID:
FEE PAID•
RECEIPT #•
DOCUMENT #: PR1069192
PROPERTY ADDRESS: 89 NE 102 St Miami, FL 33138
LOT: 2223 BLOCK: 12 SUBDIVISION:
PROPERTY ID #: 11-3206-013-1690
[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 [
A [
N [
K [
750 ] GALLONS / GPD EXISTING Septic TO REMAIN CAPACITY
0 ] GALLONS / GPD CAPACITY
0 ] GALLONS GREASE INTERCEPTOR CAPACITY
] GALLONS DOSING TANK CAPACITY
[MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ ]
D [ 200 ] SQUARE FEET NEW DF IN BED CONFIG SYSTEM
R [ 0 ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [x] STANDARD [ ] FILLED [ ] MOUND [ ]
I CONFIGURATION: [ ] TRENCH [x] BED [ ]
N
F LOCATION OF BENCHMARK: FFE 12.80'NGVD
I ELEVATION OF PROPOSED SYSTEM SITE
E BOTTOM OF DRAINFIELD TO BE
L
D FILL REQUIRED:
O
T
H
E
R
[ 0.00 ] INCHES
[ 25.20 ] [ INCHES / FT ] [ ABOVE /
BELOWbBENCHMARK/REFERENCE POINT
]BENCHMARK/REFERENCE POINT
[ 75.20 ] [I INCHES / FT ] [ ABOVE /
BELOW
EXCAVATION REQUIRED: [ 62.00] INCHES
1. -EXISTING 750 gal. septic tank with and approved filter TO REMAIN.
2.- Install 200 sf. of drainfield in... BED....... configuration.
3.- Install 12" of slightly limited soil at the bottom of the drainfield.
4.- Invert elevation and Bottom of drainfield to be no less than 7.03' & 6.53' NGVD respectively
5.- Perimeter of excavation area shall be at least 2 ft wider and longer than the proposed absorption bed
THIS PERMIT IS NOT FOR ANY ADDITIONS.
The system is sized for 2 bedrooms with a maximum occupancy of 4 persons (2 per bedroom), for a total estimated flow of
SPECIFICATIONS BY:
APPROVED BY:
Mr C' lb Sept
DATE ISSUED: 07/18/20 7
i izaire
TITLE:
TITLE: Engineering Specialist II
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E-6.003, FAC
v 1.1.4 AP1299018
Dade
EXPIRATION DATE: 10/16/2017
SE1041070
CHD
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: Paloma Teppa
APPLICATION # AP1299018
PERMIT # 13 -SC -1776505
DOCUMENT # SE1041070
CONTRACTOR / AGENT: Mr C"s Plumbing
LOT : 22 23
SUBDIVISION:
BLOCK: 12
ID# : 11-3206-013-1690
TO BE COMPLETED BY ENGINEER, HEALTH DEPARTMENT EMPLOYEE, OR OTHER QUALIFIED PERSON.
REGISTRATION NUMBER AND SIGN AND SEAL EACH PAGE OF SUBMITTAL. COMPLETE ALL ITEMS.
ENGINEERS MUST PROVIDE
PROPERTY SIZE CONFORMS TO SITE PLAN:
TOTAL ESTIMATED SEWAGE FLOW:
AUTHORIZED SEWAGE FLOW:
UNOBSTRUCTED AREA AVAILABLE:
[X ]YES [ ]NO
300 GALLONS PER DAY
674.99 GALLONS PER DAY
300.00 SQFT
BENCHMARK/REFERENCE POINT LOCATION:
ELEVATION OF PROPOSED SYSTEM SITE
FFE 12.80'NGVD
NET USABLE AREA AVAILABLE: 0.27 ACRES
RESIDENCES-TABLE1
[ 1500 GPD/ACRE OR
UNOBSTRUCTED AREA REQUIRED:
/
OTHER -TABLE 2
2500 GPD/ACRE
300.00
]
]
SQFT
25.20 [
INCHES
/ FT ] [ ABOVE /
BELOW
] BENCHMARK/REFERENCE POINT
THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES
SURFACE WATER: 0 FT DITCHES/SWALES: 0 FT NORMALLY WET: [ ]YES
WELLS: PUBLIC: 0 FT LIMITED USE: 0 FT PRIVATE: 0 FT NON -POTABLE:
BUILDING FOUNDATIONS:
5 FT PROPERTY LINES: 2 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:
Munsell #/Color
Urban land
Texture
Depth
10YR 3/1
Fill - Sand
0 To 40
REFUSAL
Fractured Rock
40 To 40
OBSERVED WATER TABLE: 72.00
ESTIMATED WET SEASON WATER TABLE
INCHES [ ABOVE /
ELEVATION:
BELOW
80
HIGH WATER TABLE VEGETATION: [ ]YES [X]NO
SOIL TEXTURE/LOADING RATE FOR SYSTEM SIZING:
DRAINFIELD CONFIGURATION: [ ] TRENCH
REMARKS/ADDITIONAL CRITERIA
NGVD
[ X ] NO
0
POTABLE WATER LINES: 70
FT
FT
10 YEAR FLOODING? [ ]YES [X]NO]
] SITE ELEVATION: 10.70 FT [ MSL /
SOIL PROFILE INFORMATION SITE 2
NGVD
USDA SOIL SERIES:
Munsell #/Color
Urban land
Texture
Depth
10YR 3/1
Fill - Sand
0 To 40
REFUSAL
Fractured Rock
40 To 40
] EXISTING GRADE TYPE:
INCHES [ ABOVE /
MOTTLING: [ ]YES [X]N0
BELOW
[ PERCHED /
] EXISTING GRADE
DEPTH: INCHES
APPARENT
]
Replacement 4-FS/0.60 DEPTH OF EXCAVATION: 62 INCHES
[ X ] BED
[ ]
OTHER (SPECIFY)
SITE EVALUATED BY:
Mr C's Plb Sept, (Title: ) (Mr C's Plb Septic)
DH 4015, 08/09 (Obsoletes previous editions which may not be used) Incorporated: 64E-6.001, FAC
AP1299018 EID1776505
DATE: 07/12/2017
Page 3 of 4
v 1.0.2
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
EXISTING SYSTEM AND SYSTEM REPAIR
EVALUATION
APPLICANT: Paloma Teppa
APPLICATION # AP1299018
PERMIT # 13 -SC -1776505
DOC # RE398380
13 -SC -1776505
CONTRACTOR / AGENT: Mr C"s Plumbing
LOT: 22 23 BLOCK: 12
SUBDIVISION:
ID# : 11-3206-013-1690
TO BE COMPLETED BY A FLORIDA REGISTERED ENGINEER, DEPARTMENT EMPLOYEE, SEPTIC TANK CONTRACTOR OR OTHEE
CERTIFIED PERSON. SIGN AND SEAL ALL SUBMITTED DOCUMENTS. COMPLETE ALL APPLICABLE ITEMS. COMPLETE TAN)
CERTIFICATION BELOW OR NOTE IN REMARKS WHY THE TANKS CANNOT BE CERTIFIED.
EXISTING TANK INFORMATION
[ 750
[
[
] GALLONS Septic Tank
] GALLONS
] GALLONS GREASE INTERCEPTOR
] GALLONS DOSING TANK
LEGEND: Unknown
LEGEND:
LEGEND:
LEGEND:
MATERIAL: Concrete BAFFLED: [ y / N i
MATERIAL:
MATERIAL:
MATERIAL:
BAFFLED: [ Y / N ]
# PUMPS:[ ]
I CERTIFY THAT THE ABOVE NOTED TANKS WERE PUMPED ON 07/15/2017 BY Mr C Plumbing & Septic , HAVE
THE VOLUMES SPECIFIED AS DETERMINED BY [
DEFECTS OR LEAKS AND HAVE A [
DIMENSIONS
FILLING / LEGEND ], ARE FREE OF OBSERVABLE
SOLIDS DEFLECTION DEVICE
SIGNATURE OF LICENSED CONTRACTOR
/ OUTLET FILTER DEVICE ] INSTALLED.
Mr C's Plb Sept (Mr C's Plb Septic) 07/12/2017
BUSINESS NAME
DATE
EXISTING DRAINFIELD INFORMATION
[ 200 ] SQUARE FEET PRIMARY DRAINFIELD SYSTEM NO. OF TRENCHES [ ] DIMENSIONS: 10.00 X 20.00
[ ] SQUARE FEET SYSTEM NO. OF TRENCHES [ ] DIMENSIONS: X
TYPE OF SYSTEM: [X] STANDARD [ ] FILLED [ ] MOUND [ ]
CONFIGURATION: [ ] TRENCH [X] BED [ ]
DESIGN: [X] HEADER [ ] D -BOX [X] GRAVITY SYSTEM [ ] DOSED SYSTEM
ELEVATION OF BOTTOM OF DRAINFIELD IN RELATION TO EXISTING GRADE
50.00 INCHES [ ABOVE /
BELOW
SYSTEM FAILURE AND REPAIR INFORMATION
[ 01/01/1948 ] SYSTEM INSTALLATION DATE TYPE OF WASTE EX ] DOMESTIC [ ] COMMERCIAL
[ 200 ] GPD ESTIMATED SEWAGE FLOW BASED ON [ ] METERED WATER [ X] TABLE 1, 64E-6, FAC
SITE
CONDITIONS:
NATURE OF
FAILURE:
FAILURE
SYMPTOM:
[ ] DRAINAGE STRUCTURES
[ ] SLOPING PROPERTY
[ ] HYDRAULIC OVERLOAD
[ ] DRAINAGE / RUN OFF
[ ] SEWAGE ON GROUND
[ ] PLUMBING BACKUP
[ ] POOL [ ] PATIO / DECK [X] PARKING
[
[ ] SOILS [X] MAINTENANCE
[ ] ROOTS [ ] WATER TABLE
[ ] SYSTEM DAMAGE
[ ]
[ ] TANK [ ] D -BOX / HEADER [X] DRAINFIELD
[
SUBMITTED BY: TITLE/LICENSE DATE: 07/02/2017
Mr C's Plb Sept (Mr C's Plb Septic)
DH 4015, 08/09 (Obsoletes previous editions which may not be used)
Incorporated 64E-6.001, FAC
v 1.0.0 AP1299018 E1D1776505
Page 4 of 4