PL-18-433 Permit NO. PL.-2-18=433
�st!O1s o,� Miami Shores Village Perrrtit Type:Plumbing-Res"itlential'
10050 N.E.2nd Avenue NW
� 1
Work Cfass�oal5on.jDrainfietd
Miami Shores,FL 33138 0000 Pgrrnjt Status:APPROVED
,- mac Phone: (305)795-2204
�ioRivA Expiration: 08/25/2018
' I�ue c�ate:M26/2018
k
Project Address Parcel Number Applicant
242 NW 92 Street 1131010331250
Miami Shores, FL 33150- Block: Lot: VILMA E ROMERO, ROBERTO B
Owner Information Address Phone Cell
VILMA E ROMERO, ROBERTO BACA 242 NW 92 ST
MIAMI SHORES FL 33150-2231
Contractor(s) Phone Cell Phone Valuation: $ 3,000.00
PULLES PLUMBING COMPANY (786)295-0256
Total Sq Feet: 0
Type of Work:DRAINFIELD Available Inspections:
Type of Piping: Inspection Type:
Additional Info:DRAINFIELD HRS Approval
Bond Return: Final '
Classification:Residential Scanning:3 Review Plumbing
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
Bond Type-Owners Bond $500.00
Invoice# PL-2-18-66503
"CCF
$1.80 02/20/2018 Credit Card $50.00 $618.05
DBPR Fee $2.25
DCA Fee $2.00 02/26/2018 Credit Card $618.05 $0.00
Education Surcharge $0.60 Bond#:3671
Permit Fee $150.00
Scanning Fee $9.00
Technology Fee $2.40
Total: $668.05
r
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans,drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zoning. Futhermore,1 authorize the above-named contractor to do the work stated.
>6er-T � February 26, 2018
v Authorized Signature:Owner / Applicant / Contractor / Agent Date
Building Department Copy
February 26,2018 1
1
Inspection Worksheet
Miami Shores Village /J
10050 N.E.2nd Avenue Miami Shores,FL (.✓
Phone: (305)795.2204 Fax: (305)756-8972
Inspection Number: INSP-297713 Permit Number: PL-2-18-433
Scheduled Inspection Date: February 27,2018 Permit Type: Plumbing -Residential
' Inspector: Hernandez,Rafael Inspection Type: Final
Owner. BACA,VILMA E ROMERO,ROBERTO Work Classification: Drainfield
Job Address:242 NW 92 Street
Miami Shores,FL 33150- Phone Number
Parcel Number 1131010331250
Project: <NONE>
Contractor: PULLES PLUMBING COMPANY Phone: (786)295-0256
Building Department Comments
DRAINFIELD Infractio Passed comments
INSPECTOR COMMENTS False
Inspector Comments
Passed HRS APPROVAL ON FILE
Failed
Correction ❑
Needed
Re-Inspection
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid
February 26,2018 For Inspections please calk(305)762-4949 Page 26 of 39
i
", ,DIVISION
rt E6W6nniental Health 1
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Florida Health `
mi-Dade County $f ��j�
OSTDS7Wel1l)' :, �D
ivisioin °
11805 5'W 26[h Street•Miamy FL 33175
nspector. /t O
Date
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FEB 2 0 2018
Miami Shores Village
Building Department BY' `W---_
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972
{ INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 201
BUILDING Master Permit No.` L I ) - 433
PERMIT APPLICATION Sub Permit No.
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
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JOB ADDRESS: Z�Z o/j e-) r�
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name
(Fee Simple Titleholder):k �b&Y—'d A ��� Phone#:
Address,'-2-KZ nAl 99 57-
C
$T
City: /'/%GL{'�1 5`ar&5 State: 15z— Zip: 3J5 )C5'0
Tenant/Lessee Name: Phone#:
Email: 6d- `i
CONTRACTOR:Company Name: Phone#:
Address: --2 3
City: Sate: Zip:
Qualifier Name: Cres Phone#:
State Certification or Registration#: C`����� -� Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ G�l� Square/Linear Footage of Work:
Type of Work: ❑ Addi 'on ❑ Alteration ❑ New [Repair/Replace ❑ Demolition
Description of Work:
I i
Specify color of color thru tile:
Submittal Fee$ 1 Permit Fee$ CCF$ CO/CC$
Scanning Fee$ Radon Fee$ e:)- JCS DBPR$ ;t 02 S Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$ 01�s
TOTAL FEE NOW DUE$
(Revised02/24/2014)
1 I
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 reinspection fee will be charged.
{
Signatur e,- ' � Signature
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
_ i�',,qday of �U J I 20 by _ day of 20 by
ok° �' A - Qa-C\ ,who is personally known for �C�S ( � I personally known to
me or who has producedI I(\ as me or who has produced as
identification and who did take an oath. identification and who did take an oath.
°.�,P�
NOTARY PUBLIC: * * NOTARY PUBLIC:
o � S.JM 1�r204,
' ,.Sign: � Sign.
Print: w1� Cc wl s L'f Print: ;�c."Y•, e-, MAHARAI K.GONZALEZ
Seal: t,JkyPVQ A1IALNL Mf! Seal: '"F a P1RES:Novernber2,2020
yP: g °••
Af Y COIMSSION A OG 08Bonded Thru Notary Public Underwriters
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tlh�o� E)PIRES:Am 12,2021
ssss*ssr*ssrsssssrsssss*sss*rr*ssssss*s*******s*****r# r**sss*
APPROVED BY �'� ' Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
Property Search Application- Miami-Dade County Page 1 of 1
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�� ICE OF THE PF"Ru"PERTY" APPRAISER
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Summary Report
Generated On:2/20/2018
Property Information
Folio: 11-3101-033-1250 '
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Property Address: 242 NW 92 ST
Miami Shores,FL 33150-2231
VILMA E ROMERO ROBERTO A
Owner BACA&
JACQUELINE E GONGORA q
242 NW 92 ST
Mailing Address
MIAMI SHORES,FL 33150-2231
PA Primary Zone 0800 SGL FAMILY-1701-1900 SQ
Primary Land Use 0101 RESIDENTIAL-SINGLE
FAMILY: 1 UNIT
Beds/Baths/Half 2/110
Floors 1 -` �
Living Units -
a
Actual Area 1,526 Sq.Ft
Living Area 1,526 Sq.Ft Taxable Value Information
Adjusted Area 1,526 Sq.Ft 2017 2016 2015
Lot Size 9,375 Sq.Ft County
Year Built 1940 Exemption Value $50,000 $50,000 $50,000
Taxable Value $46,845 $44,854 $44,195
Assessment Information
School Board
Year 2017 2016 2015 Exemption Value $25,000 $25,000 $25,000
Land Value $206,250 $206,250 $152,250 Taxable Value $71,845 $69,854 $69,195
Building Value $106,210 $106,210 $106,210 City
XF Value $1,944 $1,971 $1,598
.____.._._..�._. _._.�__ Exemption Value $50,000 $50,000 $50,000
Market Value $314,404 $314,431 $260,058 Taxable Value $46,845 $44,854 $44,195
Assessed Value $96,845 $94,854 $94,195 Regional
Exemption Value $50,000 $50,000 $50,000
Benefits Information
Taxable Value $46,845 $44,854 $44,195
Benefit Type 2017 2016 2015
Save Our Homes Assessment Sales Information
Cap Reduction $217,559 $219,577 $165,863
Previous Sale Price OR Book-Page Qualification Description
Homestead Exemption $25,000 $25,000 $25,000 10/01/1994 $76,000 16545-1074 Sales which are qualified
Second Exemption $25,000 $25,000 $25,000 12/01/1984 $67,000 12367-0948 Sales which are qualified
Homestead
Note:Not all benefits are applicable to all Taxable Values(i.e.County,
School Board,City, Regional).
Short Legal Description
MIAMI SHORES SEC 6 PB 10-39
LOT 6&W1/2 LOT 5 BILK 136
LOT SIZE 75.000 X 125
OR 16545-1074 1094 1
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 hftp://www.miamidade.gov/info/disclaimer.asp
http://www.miamidade.gov/propertysearch/ 2/20/2018
PULLES PLUMBING CO.
-8541-S:W 133-PL.
MIAMI, FLORIDA 33183
PH: (305)-558-0410 FAX: (305) 382-8914
CFC056693
Date: "2-
-STATE
2-STATE-OF-FLORIDA
COUNTY OF DADE
BEFORE ME THIS DAY PERSONALLY APPEARED CARLOS PULLES WHO, BEING
DULY SWORN, DEPOSES AND. SAYS:
THAT HE OR SHE WILL BE THE ONLY PERSON WORKING ON THE PROJECT
LOCATED AT:
242 N.W. 92 ST. MIAMI SHORES, FLORIDA 33150
CONTRACTOR SIGNATURE
SWORN TO (OR AFFIRMED) AND SUBSCRIBED BEFORE ME THIS/3DAY OF
rrC13 . 201
BY 6AXC65
P
Personally Know
OR Produced Identification rL
Type of Identification Produced P5461./a9 52 - )e-1-1—0
..4"A4O4
rint,Type or Stamp Name of Notary
ohmN
WALDOLAURENCIO
o:: Notary Public-State of Florida
Commission#GG 069120
B dedthroughXNationaaalNoaryAsm.
r
s� OR
Miami Shores Village
Building Department
g
TIES
ES to 10050 N.E.2nd Avenue
ORIDp` 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.
Signatuie42Qzeo� l%gr�
Owner
State of Florida
r.
County of Miami-Dade tt �
The foregoing was acknowledge before me this f t day of —t�PVOI ,20 .
By ° �G1;C L3� who is personally known to me or has produced
rL �� C,-f_vA S as identification.
Notary: :o�;�:� ! �AtIAIEYTON
SEAL: Uy410 #GG061100
OF
no�`� 5:Jin*12,al
Bpd�d Ttw 6ud�t tom,gM�
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PULLES PLUMBING CO.
8541 SW 133rd Place •
��AN1l, FL 331X33
7684
005) 558-0410 FAX (305) 382-8914
Contr... Lic. #CFC056693
TO00"-
0 DATE r JOB NO.
N� .' � ✓ � �-� � JOB NAME
JOB LOCATION
TERMS
DESCRIPTIONAMOUNT
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THANK YOU
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9
STATE OF FLORIDA PERMIT #: 13-SC-1819991
DEPARTMENT OF HEALTH APPLICATION #: AP1326593
if ONSITE SEWAGE TREATMENT AND DISPOSAL DATE PAID:
SYSTEM
CONSTRUCTION PERMIT FEE PAID:
RECEIPT #:
DOCUMENT #: PR1092265-
CONSTRUCTION PERMIT FOR: OSTDS Repair
'APPLICANT: -Vilma-E Romero
PROPERTY ADDRESS: 242 NW 92 St Miami, FL 33150
LOT: 6 BLOCK: 136 SUBDIVISION: Miami Shores Sec 6
PROPERTY ID #: 11-3101-033-1250 -[SECTION, TOWNSHI-P, -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 _[ '900 -] GALLONS / GPD -EAstina-SeDtic Tank to remain 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 [ 200 ] -SQUARE FEET . NEW DF IN BED CONTIG SYSTEM
R [ 0 } SQUARE FEET SYSTEM
A TYPE SYSTEM: [x] STANDARD [ ] FILLED [ ] MOUND [ ]
I CONFIGURATION: J -1 TRENCH [X] BED _[ -]
N
F LOCATION OF BENCHMARK: FFE..........13.14'NGVD
I ELEVATION OF PROPOSED SYSTEM SITE ( 19.90 ] [ INCHES FT ] [ ABOVE BELOW BENCHMARK/REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 79.90 ] [ INCHES FT ] ( ABOVE BELOW BENCHMARK/REFERENCE POINT
D FILL REQUIRED: j 0.001 INCHES EXCAVATION REQUIRED: [ 96.001 INCHES
-o 1.-EXISTING-900 GAL. septic tank-with and approved filterTOREMAIN.
2.-The licensed contractor installing the system is responsible for installing the minimum category of tank in accordance
T with s.64E-6.013(3)(0 FAC.
H 3.-Install 200 sf. of drainfield in ...BED....... configuration.
E 4.-Install 12"of slightly limited soil at the bottom of the drainfield.
5.-Invert elevation and Bottom of drainfield to be no less than 5.00'& 4.50' NGVD respectively
R 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: Carlos -H -Pulles TITLE:
APPROVED BY: TITLE: Engineering Specialist II Dade CHD
Gerard L P i izaire
DATR ISSUED._ 02/05/20.18_ EXP.IRATION.DATE_-. 05/06/2018
DH 4016, 08/09 (Obsoletes all previous editions which may not be used) i
Incorporated: 64E-6.003, FAC Page 1 of 3
V 1.1.4 AP1326593 SE1063147
DOCUMENT #: PR 1092265
The licensed contractor installing the system is responsible for installing the minimum category of tank in accordance with s.
64E-6.013(3)(0, FAC. Required drainfield area based on rule 64E-6.015(6)(c)2.
Install a new drainfield to achieve Drainfield size requirement.
i
• 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.
r
STATE OF FLORIDA
DEPARTMENT OF HEALTH
zAr�,
APPLICATION FOR CONSTRUCTION PERMIT
Permit Application Number
- --------- -- --- ------- - - --- PART II SITEPLAN - - -- - ----- --- ------- -- --- - -
Scale: Each block re resents 10 feet and 1 inch = 40 feet.
.F 1 •' ,
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7771
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Notes: Z o a /�rr�
�,rthr✓,���-fes ue P-2P .�rEl ,1�77-41eAvl"Ae4-fzW-!!!5
Site Plan submitted by:. C� �� —
Plan Approved Not Approved Date
BY County Health Department
ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
DH 4015,08/09(Obsoletes previous editions which may not be used) Incorporated: 64E-8.001,FAC Page 2 of 4
(Stock Number: 5744-002-4015-6)
r 09/0512803 14:53 3852626129 GUARANTEE MANAGEMENT PAGE 01
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SURVEYOR'S SEAL &P.C"SgT 1/2"PIN 6 CAP L8»7Ha T:e•'ound Irea Rebar Elevations based on
S.PCPm SET PERMANENT CONTPC:-DINT L84736 Cam M
�=CENTERIJN.=. P/LL=PAt7?SRT r moi`: O/L=ON N=
h1,H.•MANHG;.i WM•WATcR:"17_34. FI=•PONE^n POLE Eley: NGV Qa:im.
PC,-FENCE CORNEA. R•P-tCOn :+•
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mm-4 sxcas aa: s.mtr_-0 AN ius:moi:
NOTES: UNL Ess OTNERNIts-SPHOWN.THE FOLLOWING DOTES APPLY. 3)a eer,,A.isen is Slrn-, A-1 tsa:ingS aM eisLancea eAWA a:® CFO $a- 'S pla.e v�lt:es. 3)
Ths IF
_
REVISED: shown hereon were not abstra::a_for Easements or other recordetl ernCu nbran6es not shown on the ,-ia: t
any may not be shown on this s<arch. 4)Underground portions of Footings. Foundation$or other irnFrovs
Ioca:2d. 5) Elevations are bew: on f Miona{GeCdeUc 0aw.m. 6) Fence Ties are to the Cantefline o! t le
- Tips to the lace of the Wall.,