PL-15-986Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Project Address
Permit
Permit NO. PL-44 6-986
Permit Type: Plumbing - Residential
Work Classifcation: Septic
Permit Status: APPROVED
Issue Date: 4/24/2015
Expiration: 10/21/2015
Parcel Number
Applicant
1263 NE 101 Street
Miami Shores, FL
1132050250040
Block: Lot:
CLAUDIO RODRIGUEZ
Owner Information
Address
Phone
Cell
CLAUDIO RODRIGUEZ
1263 101 Street
MIAMI SHORES FL 33138-
1263 101 Street
MIAMI SHORES FL 33138-
Contractor(s) Phone
STATEWIDE SEPTIC CONNECTIONS (954)963-0082
Cell Phone
Valuation:
Total Sq Feet:
$ 7,500.00
0
Type of Work: INSTALL NEW 1350 TANK AND 750 DRAIN
Type of Piping:
Additional Info:
Bond Return :
Classification: Residential
Scanning: 1
Fees Due
CCF
DBPR Fee
DCA Fee
Education Surcharge
Permit Fee
Scanning Fee
Technology Fee
Amount
$4.80
$4.50
$4.50
$1.60
$300.00
$3.00
$6.40
Total: $324.80
Pay Date Pay Type
Invoice # PL-4-15-55323
04/24/2015 Check #: 4661 $ 324.80 $ 0.00
Amt Paid Amt Due
Available Inspections:
Inspection Type:
HRS Approval
Final
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.
rmore, I authorize the above -named contractor to do the work stated.
Authorized Signature: Owner
/ Applicant / Contractor / Agent
April 24, 2015
Date
Building Department Copy
April 24, 2015 1
BUILDING
PERMIT APPLICATION
I
BUILDING I I ELECTRIC
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
ROOFING
RECEIVED
APR 2 4 201
BY:
FBC 20 it'
Master Permit No. C -- 1 I— 1 2— 2. 10 5
Sub Permit Permit No.
REVISION 0 EXTENSION
RENEWAL
%PLUMBING ❑ MECHANICAL ❑ PUBLIC WORKS n CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS:
City:
Gii4
Folio/Parcel#: \ 1 �32.05. 029— 0O Is the Building Historically Designated: Yes
Occupancy Type:
i z NE-- 1— 1
Miami Shores County:
Load:
Miami Dade
Construction Type: Flood Zone:
BFE:
i3g
oNO V
-44
FFE:
OWNER: Name (Fee Simple Titleholder): C. 1 0_. Q44T i � Z. Phone#: 3_ Z / & ZZ2 L/
Address: 1 Z eg-i (_ 1 J 1
City: fr "L . 1� L(�c"`�r_ ,� State: T
Zip: 3 30
Tenant/Lessee Name: Phone#: 3 S. Z. 1 6 -22, 2 2,
Email:
c� G -i-ec-� > GQZ �� C GNC Phone#: 3/6 6 (.--6 6 347
CONTRACTOR: Company Name: "+
Address: t°5660 ,Nv- 1 S Pr`eJ tc3 I S
State: r
City: Ci
Qualifier Name: 1—eaek���+o
Zip: 0 S
State Certification or Registration #: $, 1" O -7 u6a Certificate of Competency . JP
DESIGNER: Architect/Engineer: -r 5ttie)r 61�_ Phone#:3 5—g 2. 9L�_9
Address: 1 C J b it} 1::, J i £.# -1- . City: ? . G . .r/ State: EL Zip: 3 ?, i 6
Value of Work for this Permit: $ 1( SO0 "'' Square/Linear Footage of Work:
Type of Work: ❑ Addition I I Alteration A New ❑ Repair/Replace
Description of Work:
\ --c N- (3so tqF.2K
.R..A=h .E &1k Ki LA 1 S ) r $ d
Specify color of color thru tile:
n Demolition
Submittal Fee $ Permit Fee $
Scanning Fee $ Radon Fee $
Technology Fee $
Structural Reviews $
n
(Revised02/24/2014)
3do1 rY C C F $
DBPR $
'CO/CC $
Notary $
Training/Education Fee $ Double Fee $
Bond $ .Jvc3 •J`�
r
Pc-12-2.155
TOTAL FEE NOW DUE $ �L1
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 rei` pection fee will be charged.
Signature
OWNER or AGrNT
n
The foregoing instrument was acknowledged before me this
'' day of AV" I , 20 l S , by
GJC I 0 god n q (435 is personally known to
me or who has produced Or O 1 V LI as
identification and who did take an oath.
NOTARY PUBLIC:
Sign: / Q
u) ► s
Print: ► c/��II L£ a.
•••- v'1.0"h Y ., iti
Seal: '} �►^` :. Nc -:;,,u, ;:: of rianda
Trencdila w s
a4 My Conrmasi; FF 196307
******** -140114;140144144
APPROVED BY
Signature
The fore vig-i
Z y of I
CONTRACTOR
t
ment was acknowledged before me this
,20 ,by
who is personally known to
me or who has produced r..41-- DYt ie/S C'1C&c
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print: `-r—cf, Ci j(- Lcc-)1-S
Seal:
�7i-L3 fS Plans Examiner
NotaryPubic State of Florida
Trencella Lewis
�` My Commission FF 196307
at►A" Expires 0210612019
* * * *
as
************
Zoning
(Revised02/24/2014)
Structural Review
Clerk
Miami Shores Village
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 YOUR KNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS
CONTENTS.
Signature:
Owner
State of Florida
County of Miami -Dade
The foregoing was acknowledge before me this
C\ Q cUt 0 q Lie z.
ei_ ()() - L t corx
Notary::,
By
SEAL:
rite notary PuW,c State or Florida
. Trencelia Lewis
My Commission FF 1A830i
f
'c oires 02/05/2018
day of Afnt20 1✓E .
who is personably known to me or has produced
as identification.
Office
From: Torres, Diana <Diana.Torres@flhealth.gov>
Sent: Thursday, July 05, 2018 12:39 PM
To: Office
Subject: FW: OSTDS_PDF.aspx.pdf
Attachments: OSTDS_PDF.aspx.pdf
Follow Up Flag: Follow up
Flag Status: Completed
Categories: RECEIVED
Hello,
Please see inspection results attached.
Thanks,
Diana Torres
Florida Department of Health in Miami -Dade County
Administrative Assistant I
Email: Diana.Torres@fhealth.gov
Phone: 786-315-2444
Mailing Address: 11805 SW 26 STREET Floor: 01 Room: 120
MIAMI, FL 33175
How is my customer service? Please let me know by taking our
survey: http://www.survevmonkev.com/r/dohmdsurvev
Our Mission is to protect, promote & improve the health of all people
in Florida through integrated state, county, & community efforts.
Please note: Florida has very broad public records law. Most written
communication to or from state officials regarding state business are
public records available to the public and media upon request. Your
e-mail communications may therefore be subject to public disclosure.
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION INSPECTION AND FINAL APPROVAL
APPLICANT: Claudio Rodriguez
AGENT: Statewide Septic
PROPERTY ADDRESS:
LOT: 5
SUBDIVISION:
APPLICATION #:AP1181930
PERMIT # :13-SC-1595797
DOCUMENT # : FI 1000789
DATE PAID:05/14/2015
FEE PAID:100.00
RECEIPT #:13-PID-2662595
1263 NE 101 St Miami, FL 33138
Bay Breeze
BLOCK: 185
ID# : 11-3205-025-0040
CHECKED [X] ITEMS ARE NOT IN COMPLIANCE WITH STATUTE OR RULE AND MUST BE CORRECTED.
TANK INSTALLATION
[01]
[02]
[03]
[04]
[05]
[06]
[07]
[08]
[09]
TANK SIZE [1] 1500.00 [2]
TANK MATERIAL Polyethylene
OUTLET DEVICE
MULTI -CHAMBERED [ Y / N ]
OUTLET FILTER Tuf-Tite EF-4
LEGEND 1, 70-109-23DC3 2.
WATERTIGHT
LEVEL
DEPTH TO LID
DRAINFIELD INSTALLATION
[10]
[11]
[12]
[13]
[14]
[15]
[16]
[17]
[18]
[19]
[20]
[21]
FILL
[22]
[23]
[24]
[25]
[26]
AREA [1) 675 [2]
DISTRIBUTION BOX
NUMBER OF DRAINLINES
DRAINLINE SEPARATION
DRAINLINE SLOPE
DEPTH OF COVER
ELEVATION [ ABOVE
SYSTEM LOCATION
DOSING PUMPS
HEADER
1. 3.00 2.
BELOW
SQFT
X
]BM 12.12
AGGREGATE SIZE
AGGREGATE EXCESSIVE FINES
AGGREGATE DEPTH
/ EXCAVATION MATERIAL
FILL AMOUNT
FILL TEXTURE
EXCAVATION DEPTH
AREA REPLACED
REPLACEMENT MATERIAL
Comments: Comments are on
page 2.
SETBACKS
[27]
[28]
[29]
[30]
[31]
[32]
[33]
[34]
[35]
SURFACE WATER
DITCHES
PRIVATE WELLS
PUBLIC WELLS
IRRIGATION WELLS
POTABLE WATER
FT
FT
FT
FT
FT
55 FT
BUILDING FOUNDATIONS
PROPERTY LINES
OTHER
14 FT
6 FT
FILLED / MOUND SYSTEM
[36] DRAINFIELD COVER
[37] SHOULDERS
[38] -- SLOPES- - --
[39] STABILIZATION
ADDITIONAL INFORMATION
[40]
[41]
[42]
[43]
[44]
[45]
[46]
[47]
[48]
FT
UNOBSTRUCTED AREA
STORMWATER RUNOFF
ALARMS
MAINTENANCE AGREEMENT
BUILDING AREA
LOCATION CONFORMS WITH SITE PLAN
FINAL SITE GRADING
CONTRACTOR Teresa J Solomon (Statewide
OTHER ADS ARC 24
ABANDONMENT
[49] TANK PUMPED
[50] TANK CRUSHED & FILLED
CONSTRUCTION [
FINAL SYSTEN.
APPROVED
r
L APPROVED
/ Dade CHD DATE : 05/14/2015
DISAPPROVED ] ' Engineering Specialist II Erlande Omisca (Department of Health in Dade
Dade CHD DATE : 05/14/2015
/ DISAPPROVED ]:
(Explanation of Violations on foi_'.owing page)
DH 4016, 0B/09 (Obsoletes all prey -ices
Incorperated: 54E-6.003, FAC
EH Databasr. v 1.0.1
Engineerinc Specialist II Erlande Omisca (Department of Health in Dad
editions
which may not be '.:_sed)
t:3U15
Page of
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION INSPECTION AND FINAL APPROVAL
APPLICATION #:AP1181930
PERMIT # :13-SC-1595797
DOCUMENT # : F 11000789
DATE PAID:05/14/2015
FEE PAID:
RECEIPT #:13-PID-2662595100.00
Violation Number
Comment
Comments
- Septic system information, setbacks, drainfield size and chambers were taken during previous inspections by previous
inspectors.
- 42" inches of sand provided below drainfield.
- 45 ARC24 chambers DF- 675 sf trench
The system is sized for 5 bedrooms with a maximum occupancy of 10 persons (2 per bedroom), for a total estimated flow of 520
gpd.
DH 4016, 08/09 (Obso3etes all previous edition,._ wY.ic^ may not be used)
Incorporated: 64E-6.003, FAC
Wxt3Pt<es
E1D1597
Page 2 of 3
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM
CONSTRUCTION PERMIT
CONSTRUCTION PERMIT FOR:
APPLICANT:
Claudio Rodriguez
PROPERTY ADDRESS: 1263 NE 101 St Miami, FL 33138
LOT: 5 BLOCK: 185
SUBDIVISION: Bay Breeze
PROPERTY ID #: 11-3205-025-0040
OSTDS New
PERMIT, #: 13-SC-1595797
APPLICATION #: AP 1181930
DATE PAID:
FEE PAID:
RECEIPT #:
DOCUMENT #: PR971932
[SECTION, TOWNSHIP, RANGE, PARCEL NUMBER]
[OR TAX ID NUMBER]
SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF SECTION
81.0065, 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 GE INWHICH SERVED AS A BASIS FOR ISSUANCE OF THIS PERMIT, REQUIRE THE APPLICA�tT TOERIAL MODIF-Y AC TSTHE
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 SPECIFICATIONS
T [ 1,350/J GALLONS / GPD
septic tank CAPACITY
[ ) GALLONS
/ GPD
N [ ] GALLONS GREASE INTERCEPTOR CAPACITY CAPACITY
K [ [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
G LLONS DOSING TANK CAPACITY [ ]GALLONS 81
]DOSES PER 24 HRS #Pumps [ ]
D [ 650 SQUARE FEET trench configuration drainf SYSTEM
R [ ] SQUARE FEET
SYSTEM
A TYPE SYSTEM: [x] STANDARD [ ] FILLED
CONFIGURATION: [ ] MOUND [ ]
[xJ TRENCH [ ] BED ( ]
F LOCATION OF BENCHMARK: center of NE 101 St 7 16'NGVD
I ELEVATION OF PROPOSED SYSTEM SITE
E BOTTOM OF DRAINFIELD TO BE
D FILL REQUIRED:
0
T
H
[ 1 68 ] [f INCHES k FT ] [I ABOVE k BELOW ] BENCHMARK/rEFERENCE POINT
[ 25.92 ) [[ INCHES V FT ] [ ABOVE /I BELOW I] BENCHMARK/REFERENCE POINT
] INCHES EXCAVATION REQUIRED: [ 69.60] INCHES
"This permit is a re -issue of previous permit AP1091197-N.
1 -Install a 1350 gal min. septic tank with an approved filter.
2 -The licensed contractor installing the system is responsible for installing the minimum category of tank in accordance
with s 64E-6 013(3)(f), FAC
Install 650 sf of drainfield in trench configuration
Install 42" of slightly limited soil at the bottom of the drainfteld.
(Comments Continued on Page 2 )
SPECIFICATIONS BY: Teresa J Solomon
TITLE: Master Septic Tank Contractor
APPROVED BY: TITLE: Engineering Specialist II
Erlande Omasca
ATE ISSUED: 04/21/2015
08 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E-6.003, FAC
v 1.1.4
Dade CHD
EXPIRATION DATE: 10/21/2016
SE958140
Page 1 of 3
Miami Shores Village
Building Department
10050 NE 2 Ave, Miami Shores, FI 33138
Tel: (305)795-2204 • Fax; (305)756-8972
11/24/2015
To: Current Owner
1263 NE 101 Street
Miami Shores, FL 33138
Permit: PL-4-15-986
Address: 1263 NE 101 Street Miami Shores FL 33138
Date Expired: 10/21/2015
Dear Sir or Madam,
Our records indicate that the above referenced permit has expired without obtaining the
proper final inspection. In order to serve you better, we need to keep our files up to date.
As per section 105.4.1 of the Florida Building Code, "Every permit issued shall become invalid
(expired) unless the work authorized by such permit is commenced within six months after its
issuance, or if the work authorized by such permit is suspended or abandoned for a period of
six months after the work is commenced, or completed without obtaining the final inspection
of the work performed.."
Please be advised that open permits will hinder your ability to refinance or sell this property
Please contact the Building Department, within 15 days of receipt of this letter in order to take
care of this matter.
Sincerely,
"idt
Ismael Naranjo (CBO)
Building Director
Date:
To:
PERMIT #;
ATTN:
`Property Address: 1263 NE 101 STREET
STATEWIDE
SEPTIC CONNECTIONS, INC.
13640 NW 19 AVE., BAY #15 OPA LOCKA, FL 33054
Phn: (786) 359-4980 * Fax: (786) 353-2759
LIC# SM0971262 & INSURED
STATEWIDESEPTIC@GMAIL.COM
NOVEMBER 19, 2015
MIAMI SHORES VILLAGE
BLDG DEPT PL-15-986
PL-15-986
ISMAEL
LRECEIVED
NOV 19 2015
,I�iY2iL�._,
THIS LETTER IS TO REQUEST THE ABOVE ADDRESS PERMIT RENEWAL. THE PROPERTY
OWNER HAVE NOT PAID THE BALANCE FOR INSTALLATION, EVEN AFTER WE WENT
ABOVE AND BEYOND ALL OF HIS REQUEST.
THIS PROJECT WILL BE TRANSFERRED TO OUR LEGAL DEPARTMENT TO PURSUE SMALL CLAIMS FOR
COLLECTION.
THE PROJECT WAS INSPECTED AND APPROVED BY THE HEALTH DEPT.
WE HUMBLY REQUEST YOU TO DELAY THIS RENEWAL, PENDING THE COURTS OUT COME OR
PAYMENT IN FULL FROM OWNER.
Solomon, president