PL-18-1208 Permit N0. PL-8- 18-1208
�e3yO1 S r,� Miami Shores Village M t Permit Type:Plumbing-Residential
e, 10050 N.E.2nd Avenue NE Work Classification:Septic
Miami Shores,FL 33138-0000 Per I
Phone: (305)795-2204 Permit Status:APPROVED
FLORtDp'
Issue Date:614/2018 Expiration: 12/01/2018
Project Address Parcel Number Applicant 1
5 NE 107 Street 1121360070330
Miami Shores, FL 33161-7029 Block: Lot: TIMOTHY A'WILLIAMS
Owner Information Address Phone I Cell
TIMOTHY A WILLIAMS 5 NE 107 Street (786)877-1808
MIAMI SHORES FL 33161-
5 NE 107 Street
.MIAMI SHORES FL 33161-
Contractor(s) Phone Cell Phone $ 4,800.00
ALFONSO SEPTIC CONTRACTOR INC (786)251-4099 Valuation:
._. _..� . _ Total Sq Feet: 300
Type of Work:PUMP AND ABANDON EXISTING SEPTIC TA Available Inspections:
Type of Piping: Inspection Type:
Additional Info:PUMP AND ABANDON EXISTING SEPTIC TA HRS Approval
Bond Return
Final
Classification:Residential Scanning:3 Review Plumbing
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
Bond Type-Contractors Bond $500.00 Invoice# PL-5-18-67453
CCF $3.00
DBPR Fee $4.50 05/07/2018 Credit Card $50.00 $779.50
DCA Fee $3.00 06/04/2018 Cash $779.50 $0.00
Education Surcharge $1.00 Bond#:3787
Notary Fee $5.00 ,
Permit Fee $300.00
Scanning Fee $9.00
Technology Fee $4.00
Total: $829.50=
,
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 AFFIDAV . Ice a foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction an or h rize the above-named contractor to do the work stated.
June 04, 2018
Aut rued Signature:Owner / Applicant / Contractor / Agent Date
Building Department Copy
June 04, 2018 1
Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores,FL
Phone: (305)795-2204 Fax: (305)756.8972
Inspection Number: INSP-303429 PermitNumber: PL-5-18-1208
Scheduled Inspection Date:June 05,2018 Permit Type: Plumbing -Residential
Inspector: Hernandez,Rafael Inspection Type: Final
Owner: WILLIAMS,TIMOTHY A Work Classification: Septic
Job Address:5 NE 107 Street
Miami Shores,FL 33161-7029 Phone Number (786)877-1808
Parcel Number 1121360070330
Project <NONE>
Contractor: ALFONSO SEPTIC CONTRACTOR INC Phone:(786)251-4099
Building Department Comments
PUMP AND ABANDON EXISTING SEPTIC TANK INSTALL lnfractio__ __ _ Passed Comments
ANEW 900 GALLONS SEPTIC TANK AND 300 SQFT OF INSPECTOR COMMENTS False
DRAINFIELD
Inspector Comments
Passed
Failed
Correction ❑
Needed
Re-Inspection
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid
June 04,2018 For Inspections please call: (305)762-4949 Page 22 of 50
DIVISION OF
e O�`O ® Environmental Health
ReQ� ` Florida HealthAlfam
Dade Count
r Fell Division
STDS �jp
11805 SW 26th Street• O
Inspector /7 Miami,FL 33175
Address Date C�
C
osT �
omments. DS#
Signature � � yt
7;
,2
Miami Shores Village RF— .
g 4101 1018 I
Building Department May
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 '
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949
FnBC 20 F
BUILDING Master Permit No.
PERMIT APPLICATION Sub Permit No.
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
�+ CONTRACTOR DRAWINGS
JOB ADDRESS: S- N 0� SST �
City: Miami Shores County: Miami Dade zip: r/6 I
Folio/Parcel#: /1-�)I-3(n-nQ7-0 S Sri Is the Building Historically Designated:Yes NO 2<
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name(Fee Simple Titleholder)T ffQ"7-4� UJI kj r ria W Q Phone#:
Address: S. SUE - 1D7 S7^
City: th dill\ S 130ft-2 S State: j-�,�- Zip:
i
Tenant/Lessee Name: Phone#:
Email: ti
CONTRACTOR:Company Name: t-� ( �(�a1St7��C t c �QI(1 4 IL Phone#: 7&o ;I
Address: 1321 UJ,0 S?` 36 S7 0 udP a; - )
City: State: ��G2 Zip: /Z
Qualifier Name: Phone#:7,(?a- 25,1A'Q 0?
State Certification or Registration#: SRig7 I 'D)--7(,, Certificate of Competency#: SA '-?1221. I
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$__ Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace
Q� ❑ Demolition
Description of Work:_I UE 2 A ib 40-0 U(fib(IL(eA;F 61 LSZrA,-3 S'e Pe--�C.
uoy- ono a4(1rxft-r S,A '(PT,00A jujn
N\A kA,irt
Specify color of color thru tile:
Submittal Fee$ Permit Fee$ 3300— CCF$ CO/CC$
Scanning Fee$ Radon Fee$ O7 DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$ '�IDo
TOTAL FEE NOW DUE$ �
(Revised02/24/2014) zi
"z
i
{
1
r �
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.....
1
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." J
{
Notice to Applicant: As a condition to the issuance o a building '
pp f g 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 1
for the first inspection which occurs seven (7) s°after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved a reins ctio fee will be charged.
Signatur r. Signature
OWNER or AGENT CO TRACTOR
The foregoing instrument was acknowledged before me this Th regoing instrument was owledged before me this
— 19 r day of i® �20 ( by day ofd ctack 20 by
f//J T_Who is personally known to ho is personally known to J
me or who has produced asa or who has produced��{/I ( as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: N BL
Sign: Sig .
Print: Print: `" '° MAHARAI K.GONZALEZ
=N iMT MISSION#GG 044602
S I: Seal: o EXPIRES:November 2,2020
; �•� 's �L:ON�IIM F�F F QQ Bonded Thru Notary public Underwriters
_•• *= MY COMMISSION#FF 150202 „-------
+�, e,EXPIRES:October 8,2018
APPROVED BY �'�� Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
SHORES
1.932 -I`
NOW
Miami shores Village
Building Department
Ila 10050 N.E.2nd Avenue
ORNp' Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
Notice to Owner - Workers' Compensation Insurance Exemption I
1
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,astatement 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: 1
O r �
State of Florida
f
County of Miami-Dade
The foregoing was acknowledge before me this�_day of �� ,20 /9-.
BY-11-A 14-Fik`l l; A Lb 6m c mho is personally known to me or has produced
as identification.
Notary:
SEAL: JOSE BOLMOS
r /MY COMMISSION 150202
EXPIRES:October 8,2018
BoWW niru Notary Public fte wbrs
f
r
Alfonso Septic Contractor, INC. `
1391 West 36 Street
' Hialeah, FL 33012
Alfonsoseptic@gmail.com
Date: May 012018
r
1
State of Florida
County of Dade
Before me this day personally appeared Jose Bolanos who, being duty sworn,
Deposes and says: }
That he or she will be the only person working on the project located at: ,
5 NE 107 ST ST Miami Shores FLA.
I I
'Contractor Signature
Sworn to (or Irmed) andubscribed before me this day ofQ 20
by d�
Personally Know
OR Produced Identification
Type of Identification Produced
MAHARAI K.GONZALEZ
MY COMMISSION#GG 044602
:o EXPIRES:November 2,2020
Rp' Bonded Th.Notary Public Underwriters
Print, Type or Stamp,Name of Notary
5/7/2018 Propertv Search Application-Miami-Dade County
OFFICE OF THE PROPER APPRAISER
1
Summary Report
Generated On:5/7/2018 {
Property Information -�
Folio: 11-2136-007-0330 '^` r
Property Address: 5NE107ST v�
Miami Shores,FL 33161-7029
Owner TIMOTHY A WILLIAMS
ELIZABETH WILLIAMS t
455 NE 5 CT
Mailing Address j mF
BOCA RATON,FL 33432 USA
PA Primary Zone 1000 SGL FAMILY-2101-2300 SQ
_m,
0101 RESIDENTIAL-SINGLE
Primary Land Use FAMILY: 1 UNIT �� • •"• y �" �� )
Beds/Baths/Half 3/2/0
Floors 1
Living Units 1 `
Actual Area 2,422 Sq.Ft 01
Living Area 2,044 Sq.Ft
Adjusted Area 2,227 Sq.Ft Taxable Value Information
Lot Size 9,225 Sq.Ft 2017 2016 2015
Year Built 1949 County j
Assessment Information
Exemption Value $0 $0 $0
Year 2017 2016 2015
Taxable Value 1 $416,439 $384,170 $339,346 k
_ E
Land Value School Board
$230,638 $198,007 $163,894
BuildingValue Exemption Value $0 $0 $0
$154,999 $154,999 $154,999
Taxable Value $416,439 $384,170 $339,346
XF Value $30,802 $31,164 $20,453
City
Market Value $416,439 $384,170 $339,346
Exemption Value $0 $0 $0
Assessed Value $416,439 $384,170 $339,3461Taxable Value $416,439 $384,170 $339,346
Benefits Information Regional
Exemption Value $0 I $0 $0
Benefit Type 2017 2016 2015
Note:Not all benefits are applicable to all Taxable Values(i.e.County,School Taxable Value 1 $416,439 $384,170 $339,346
Board,City,Regional).
Sales Information
Short Legal Description Previous Price OR Book- Qualification Description
DUNNINGS MIAMI SHORES EXT NO 3 Sale Page
PB 42-33 01/11/2018 $665,000 30839-3559 Qual by exam of deed
LOT 9 BILK 210 03/12/2015 $359,100 29539-2107 Financial inst or"In Lieu of Forclosure"
LOT SIZE 75.000 X 123 stated
OR 19257-1926 06 20001 07129/2013 $100 28770-0750 Corrective,tax or QCD;min
consideration
06/01/2000 $189,000 19257-1926 Sales which are qualified
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:
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ONSITE SEWAGE TREATMENT AND DISPOSAL FEE PAID:
SYSTEM
.11W
RECEIPT (I:
`'°� DocUMeNT #:PR1115369 t
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: TIMOTHY WILLIAMS !
PROPERTY ADDRESS: 5 NE 107 St Miami,FL 33161 I
LOT: 9 BLOCK: 210 SUBDIVISION: 1
PROPERTY ID #: 11-2136-007-0330 [SECTION, TOWNSHIP, RANGE, PARCEL NUMBER) i
[OR TAX ID NUMBER]
SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF SECTION t
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 NEW SEPTIC TANK TO INSTALL CAPACITY
A [ 0 I GALLONS / GPD CAPACITY !
N [ 0 j GALLONS GREASE INTERCEPTOR CAPACITY (mAxn UM CAPACITY SINGLE TANK:1250 GALLONS]
K [ I GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps I ]
D [ 300 ] SQUARE FEET NEW D.F BED CONFIGUR SYSTEM
R ( 0 ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [xl STANDARD [ ] FILLED [ ] MOUND [ l
I CONFIGURATION: ( ] TRENCH [x] BED I ]
N i
,Y F LOCATION of BENCHMARK: FFE 12.96 NGVD
I ELEVATION OF PROPOSED SYSTEM SITE [ 1.00 It INCHES/ FT ] [ ABOVE/BELOW]BENCHMARK/REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 41.76 ][ INCHES/ FT ] [ABOVE BELOW BENCHMARK/REFERENCE POINT
L
D FILL REQUIRED: [ 0.001 INCHES EXCAVATION REQUIRED: [ 34.00 ] INCHES
I.-Install a 900 gal.septic tank with an approved filter.
0 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.
a 3-Install 300 sf.of drainfield in...BED...... configuration.
4.-Install,12"of slightly limited soil at the bottom of the drainfield.
E 5.-Invert elevation and Bottom of drainfield to be no less than 9.75&9.25 NGVD respectively.
R (Comments Continued on Page 2.)
SPECIFICATIONS BY: Jose Bolanos TITLE:
• • •
APPROVED BY: TIJLS: PVgjff jifq=cialist II Dade CHD
•
DATE ISSUED: 05/03
•• ••• •• • • • •• EXPIRATION DATE: 08/01/2018
DH 4016, 08/09 (Obsoletes all pr u editio�s which may:of be used) page 1 of 3
Incorporated: 64E-6.003, FAC • • • • • • • • • • i
v 1.1.4 ••• • A91342215: • ••• :SE1075695
1
... . . . . ••• . .
. . . . . . . . . .
0:0 . .•• •• ..• . .. ..
s ,
... . .
F
Permit Application Number `
--------------------------- PART II-SITEPLAN ---------------------------
Scale: Each bl ck re resents 10 feet and 1 inch= 40 feet.
v 3
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1
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6
1
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4
I
Notes: _(V t 1 D:Z S i 04 c IA VA( L� o S )C/11 ARE NO PERTINENT FEA URES ON _
k GENT PROPERTIES AND OR ACROSS
��.Q A- d` MAT WAY AFFECT THE NEW
Site Plan submitted by:_�� c
Plan Approved Not Approved Date05-6/-/
By County Health Department
ALL CHANGES MUST BE APPROVEDeY-FHE'4COt1A1Ta(.HEALTH DEPARTMENT-
DH 4015,08/09(Obsoletes previous editions which may not be used) InGworated: VE-6.001,FAC • Page 2 of 4
(Stodc Number 5744-002-4015-6) • • • • • • • • . •
• • • • • • • •• • •
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• • ••• • ••• •
0:0 • • • • ••• • •
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