PLC-17-1828Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Project Address
Parcel Number
Permit NO. PLC 7-1s7-1828
Permit Type: Plumbing - Commercial
Work Classification: Addition/Alteration
Permit Status: APPROVED
Expiration: 12/16/2018
Applicant
9450 NE 2 Avenue
Miami Shores, FL
1132060132780
Block: Lot:
MSVC LLC
Owner Information
Address
Phone
Cell
MSVC LLC
2310 HOLLYWOOD Boulevard
HOLLYWOOD FL 33020-
Contractor(s)
PSG PLUMBING SERVICES, INC
Phone
(305)796-7304
CeII Phone
Valuation:
Total Sq Feet:
$ 6,400.00
0
Type of Work: EXISTING LINE TO BE CONNECTED TO NE
Type of Piping:
Additional Info:
Classification: Commercial
Scanning: 4,
Fees Due
CCF
DBPR Fee
DCA Fee
Education Surcharge
Permit Fee
Scanning Fee
Technology Fee
Total:
Amount
$4.20
$4.50
$3.00
$1.40
$300.00
$12.00
$5.60
$330.70
Pay Date Pay Type Amt Paid Amt Due
Invoice # PLC-7-17-64603
06/19/2018 Check #: 1483 $ 330.70 $ 0.00
Available Inspections:
Inspection Type:
Top Out
Re Pipe
Main Drain
Heater
Water Service
Final
Water Main
Lavatory
Review Building
Underground
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, 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, I authorize the above -named contractor to do the work stated.
June 19, 2018
Authorized Signature: Owner / Applicant / Contractor / Agent
Date
Building Department Copy
June 19, 2018
1
CSPO ()
ppp0234364
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-312140 Permit Number: PLC-7-17-1828
Scheduled 'Inspection Date: September 13, 2018
Inspector: Massanet, Maykel
Owner: LLC, MSVC
Job Address: 9450 NE 2 Avenue
Miami Shores, FL
Project NE 2 AVE SEWER CONNECTION
Contractor: PSG PLUMBING SERVICES, INC
Permit Type: Plumbing - Commercial
Inspection•Type::Fnal r
Work Classification: Addition/Alteration
Phone Number O_-
Parcel Number 1132060132780
Phone: (305)796-7304
Building Department Comments
EXISTING LINE TO BE CONNECTED TO NEW SEWER
LINE FROM THE CITY AND ABANDON EXISTING
TREATMENT PLANT.
Infractio Passed Comments
INSPECTOR COMMENTS
False
Inspector Comments
Passed
Failed
Correction
Needed
Re -Inspection
Fee
No Additional Inspections can be scheduled until
re -inspection fee is paid.
September 12, 2018
For Inspections please call: (305)762-4949
Page 32 of 42
BUILDING
PERMIT APPLICATION
❑BUILDING ❑ ELECTRIC
❑■ PLUMBING ❑ MECHANICAL
JOB ADDRESS:
City: Miami Shores
Occupancy Type: C Load:
Miami Shores Village
Building Department 7
10050 N.E.2nd Avenue, Miami Shores, Florida 33138,/
Tel: (305) 795-2204 Fax: (305) 756-8972 Y
INSPECTION LINE PHONE NUMBER: (305) 762-4949
FBC 20 t"‘
Master Permit NoT Le-R t (32-9
Sub Permit No.
❑ ROOFING ❑ REVISION
❑ PUBLIC WORKS ❑ CHANGE OF
CONTRACTOR
County:
Miami Dade
❑ EXTENSION ❑ RENEWAL
❑ CANCELLATION ❑ SHOP
DRAWINGS
Zip:
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Sim Ie Titleholder): MSVG) (. -'C, , Phone#: T o -34 (b)4.
Addr s l � LAAT WaQO $1./0
City:
l3-� S vac x J] State:
Tenant/Lessee Name: t
Email: (1)5e-// Q-G✓ 1�-1. �- o M lal L.. C o Q-9
CONTRACTOR: Company Name: Pau Plumbing Contractor, inc.
Address: 7740 W 2nd Court, Bay #3
Zip: 3 St) -41D
Phone#:
Phone#: 305-558-0535
City: Hialeah State: FL Zip: 33014
Qualifier Name: Reynaldo Soto
State Certification or Registration #: CFC1426010
DESIGNER: Architect/Engineer: 1Jl4bk.
Phone#: 305-934-2894
Certificate of Competency #:
Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ '• quare/Linear Footage of Work:
Type of Work: ❑ Addition Alteration Ll New ❑ Repair/Replace
❑ Demolition
Description of Work: Existing sewer line to be connect to new sewer line, from the city
jlfUst s4 , o,J *.1Ct. r-Tre-9 ,1.y'T PIO N-r
Specify color of color thru tile:
Submittal Fee $ Permit Fee $ 300 I CCF $ CO/CC $
Scanning Fee $ Radon Fee $ CJf DBPR $ ' • S13 Notary $
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ Bond $
TOTAL FEE NOW DUE $ 3a� •
(Revised02/24/2014)
Bonding Company's Name (if applicable) N �A
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 $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection ..'ch occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not b approve• • nd a reinspection fee will be charged.
Signature
l_LC) Signature
�tkArVrePri.ltk"NA
The foregoing instrument was acknowledged before me this
/9/4 day of J U y , 20 / 7 , by
O$/ar skin ( , who is personally known to
me or who has produced AZ .7L • as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
OWNER or AGE
*is`tg-I•Zike, DORAI GOMEZ 1H%14
* MY COMMISSION it FF 159405
EXPIRES. Nnvgmbpr 18, 201B
4freoltder Bolded 1Mn Budget Notary Surkee
APPROVED BY
CONTRACTOR
The foregoing instrument was acknowledged before me this
day of Jt)iy
/
Reykiki 00 uO1 ° 1 , who is personally known to
me or who has produced S'31:5° Si _ t{°
identification and who did take an oath.
NOTARY PUBLIC:
Sign.
Print:
Seal:
Plans Examiner
Structural Review
r
C_J(-'0(A✓ PETto
,20 _. ,by
r{o'ary Public State of Florida
:{;•..,dia D Petrola
», co-nmission FF 046299
08/18/2017
Zoning
Clerk
(Revised02/24/2014)
MIAMI SHORES VILLAGE
10050 NE 2nd Ave Miami Shores. FL 33138
Connection Details
ELECTRICAL CONNECTION
The grinder pump station requires a 120/240 volt, 30-Amp, single-phase circuit. The property owner
is responsible for bringing electrical power to the control panel through a disconnect switch
installed next to the pump control panel. Miami Shores will install the pump control panel. Please
contact the Miami Shores Building Department at (305) 795-2204 for guidance on electrical permitting
and installation requirements.
PLUMBING CONNECTION
Building sewer piping must slope away from the building at the usual minimum of 1/8" per foot (1%
slope or 1' drop in 100' run).
Trenching
When trenching, over excavate to allow room for some bedding material such as sand or fine gravel. The
bedding is easily adjusted to the correct slope. Laying the pipe on the prepared bedding will result in fast
achievement of the correct slope and-even_support for the pipe. When planning for the alignment that
--- will _ most efficiently pipe your building sewer to the sewer collection system lateral, keep in mind that
the Florida Standard -Plumbing Code-callsfor 5 feet of-hor7' ntaLseparation from your water service -pipe
unless the sewer pipe is at least one foot lower. IMPORTANT: The Miami Shores properties will likely
encounter existing drainfields. Work with an established plumber that understands working in this
condition. Damage to the existing drainfield could cause sewer back-ups.
Cleanouts
A cleanout is required at the building drain connection at a minimum. A cleanout is also required every
100 feet and at every change of direction of greater than 45 degrees. If there is more than one change
of direction, a cleanout is required every 40 feet. Please keep in mind, a long radius bend will allow flow
more easily than a sharp bend. Use PVC Schedule 40 fittings. Review your proposed configuration and
any difficult situations with the Building Inspector before construction to better ensure approval of the
work. Situate your cleanouts such that there is 18" minimum clearance for working room. The cleanout
at the lateral connection must be easily accessible.
Connection at the Grinder Pump Station
The connection from the building sewer to the sewer lateral must not be made with any connector
utilizing stainless steel bands such as a "Fernco" or "no -hub" coupling. They do not withstand South
Florida exposure. The connection point at the station will be a 6" PVC pipe at 48" below grade.
Warning!
It is imperative that rocks and debris not be allowed to enter the building sewer or lateral piping!
Leave a cap on the end of the PVC service lateral until ready to connect.
MIAMI SHORES VILLAGE
10050 NE 2nd Ave Miami Shores, FL 33138
This packet is intended to provide the basic information needed to connect a property to the Miami
Shores Central Low Pressure Sewer System. The process includes working with the Miami Shores
'Building Department and the Miami -Dade County Health Department (DOH).
Connection Tasks Overview
1. Obtain Permits
2. Begin Construction
3. Receive Required Inspections.
4. Hook-up electric to the Pump Control Panel
G)
5.' Hook-up plumbing to the Conne ction,Point.at the Grinder Pump Station }
6. Abandon the Septic Tank
Responsibilities
The responsibility to connect a property ultimately falls with the property owner. Owners will
hire electrician(s) and plumbers) tn, tain necessary permits. Plumber(s) will make,,the
connections and abandon the existing septic -tank.
Notifications
Property Owners will receive a "30-Day Notice of Service Availability" when the central
system is available and ready for their connection. Construction may begin before the "Notice
of Availability" is issued, however, the sewer tie-in and electrical connection to the grinder
pump system must not be completed until written notice is received from Miami Shores and
the owner has successfully passed the applicable Building Inspections. Connection prior to
this notification can lead to sewage back-ups and equipment damage and may result in
additional costs to the property owner.
MIAMI SHORES VILLAGE
Central Business District Low Pressure Sewer System
PROPERTY OWNER'S ELECTRICTIAN
1)PULL PERMIT
2)PROVIDE 30A SERVICE FROM BUILDING'S PANEL
3)INSTALL SERVICE DISCONNECT SWITCH NEXT TO OUTSIDE
CONTROL PANEL
4)INSTALL CONDUIT AND WIRES
5)CONNECT SERVICE DISCONNECT TO CONTROL PANEL
PROPERTY UNE imp
ALARM PANEL
MIAMI SHORES
RESPONSIBILITY
CLEAN OUT
GRINDER PUMP �j
STATION �\
CONCRETE COLLAR
A 5FT STUB -OUT IS
PROVIDED OUTSIDE THE
GRINDER STATION
MOE
I" CONDUn
MIAMI SHORES WILL INSTALL A
;CONTROL PANEL ON THE BUILDING
OR A CONCRETE POLE. OWNER'S
ELECTRICIAN WILL RUN SERVICE
NEXT TO THE CONTROL PANEL AND
`CONNECT
SERVICE DISCONNECT
(PROPERTY OWNER IS
4RESPONSIBLE
TO MAINTAIN POWER SUPPLY
FROM
BLDG. PAD SERVICE PANEL TO SERVICE
DISCONNECT AND GRAVITY SEWER
LATERAL FROM BUILDING TO
'PUMP STATION
GRAVITY PIPE
FROM
BUILDING
OWNER'S PLUMBER TO
•PULL PERMIT AND INSTALL
SEWER LATERAL FROM BUILDING
PTO GRINDER PUMP STATION 1
OWNER 1
RESPONSIBILITY;
OWNER'S PLUMBER TO
LP_
NSTALL CLEAN -OUT
ER CODE
MIAMI SHORES LATERAL CONNECTION DETAIL FOR
LOW PRESSURE
Page 1 of 1
Property Search Application - Miami -Dade County
4,:
Summary Report
Property Information
Folio:
11-3206-013-2780
Property Address:
9400 NE 2 AVE
Miami Shores, FL 33138-2703
Owner
MSVC LLC
Mailing Address
2310 HOLLYWOOD BLVD
HOLLYWOOD, FL 33020
PA Primary Zone
6400 COMMERCIAL -CENTRAL
Primary Land Use
1111 STORE : RETAIL OUTLET
Beds / Baths / Half
0/0/0
Floors
1
Living Units
0
Actual Area
12,578 Sq.Ft
Living Area
12,578 Sq.Ft
Adjusted Area
12,370 Sq.Ft
Lot Size
35,425 Sq.Ft
Year Built
2006
Assessment Information
Year
2017
2016
2015
Land Value
$921,050
$921,050
$779,350
Building Value
$838,848
$687,050
$561,894
XF Value
$71,521
$0
$65,288
Market Value
$1,831,419
$1,608,100
$1,406,532
Assessed Value
$1,768,910
$1,608,100
$1,406,532
Benefits Information
Benefit
Type
2017
2016
2015
Non -Homestead Cap
Assessment Reduction
$62,509
Note: Not all benefits are applicable to all Taxable Values (i.e. County,
School Board, City, Regional).
Short Legal Description
MIAMI SHORES SEC 1 AMD PB 10-70
LOTS 1-2-3-4- & 5 BLK 21
LOT SIZE IRREGULAR
OR 22502-2791-2814 THRU 2819 0704
Generated On : 7/17/2017
Taxable Value Information
2017
2016 2015
County
Exemption Value
$0
$0
$0
Taxable Value
$1,768,910
$1,608,100
$1,406,532
School Board
Exemption Value
$0
$0
$0
Taxable Value
$1,831,419
$1,608,100
$1,406,532
City
Exemption Value
$0
$0
$0
Taxable Value I $1,768,910
$1,608,100
$1,406,532
Regional
Exemption Value
$0
$0
$0
Taxable Value
$1,768,910
$1,608,100
S1,406,532
Sales Information
Previous
Sale
Price
OR Book -
Pa 9a
Qualification Description
07/01/2004
$0
22502-
2787
Sales which are disqualified as a result
of examination of the deed
07/01/2004
$950,000
22502-Sales which are qualified
2791
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:
http://www.miamidade.gov/propertysearch/
7/17/2017
Detail by Entity Name Page 1 of 2
Florida Department of State
1r...a
:org r, (,f
Department of State / Division of Corporations / Search Records / Detail By Document Number /
vl>ION OF Co0Po/A' ONS
Detail by Entity Name
Florida Limited Liability Company
MSVC, LLC
Filing Information
Document Number L04000045828
FEI/EIN Number 20-1311464
Date Filed 06/17/2004
State FL
Status ACTIVE
Principal Address
2310 HOLLYWOOD BLVD
HOLLYWOOD, FL 33020
Mailing Address
2310 HOLLYWOOD BLVD
HOLLYWOOD, FL 33020
Registered Agent Name & Address
SKLAR, NEAL IESQ
2310 HOLLYWOOD BLVD
HOLLYWOOD, FL 33020
Authorized Person(s) Detail
Name & Address
Title MGR
MSVC MANAGEMENT LLCI
2310 HOLLYWOOD BLVD
HOLLYWOOD, FL 33020
Annual Reports
Report Year Filed Date
2015 01/06/2015
2016 01/22/2016
2017 01/24/2017
Document Images
01/24/2017 ANNUAL REPORT
01/22/2016 -- ANNUAL REPORT
01/06/2015 -- ANNUAL REPORT
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Detail by Entity Name Page 2 of 2
01/10/2014 -- ANNUAL REPORT
01/10/2013 -- ANNUAL REPORT
01/04/2012 ANNUAL REPORT
01/06/2011 -- ANNUAL REPORT
01/06/2009 -- ANNUAL REPORT
01/18/2008 — ANNUAL REPORT
01/29/2007 ANNUAL REPORT
01 131/2006 -- ANNUAL REPORT
05/19/2005 -- ANNUAL REPORT
06/17/2004 -- Florida Limited Liabilites
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Florid, Ciep,rtoiern: of ¶ZtCiividlori or Colipor, ions
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Detail by Entity Name Page 1 of 2
Florida Department of State DIVISION OF. CORPORK ONS
Department of State / Division of Corporations / Search Records / Detaii By Document Number /
Detail by Entity Name
Florida Limited Liability Company
‘MSVC MANAGEMENT,_LLC
Filing Information
Document Number L04000045826
FEI/EIN Number 20-1011414
Date Filed 06/17/2004
State FL
Status ACTIVE
Principal Address
2310 HOLLYWOOD BLVD.
HOLLYWOOD, FL 33020
Mailing Address
2310 HOLLYWOOD BLVD.
HOLLYWOOD, FL 33020
Registered Agent Name & Address
SKLAR, NEAL IESQ
2310 HOLLYWOOD BLVD.
HOLLYWOOD, FL 33020
Authorized Person(s) Detail
Name & Address
Title MGRM
FAR, AR
23 0 HOL'Lf1NOOD BLVD
HOLLYWOOD, FL 33020
Title MGRM
SKLAR, ARI L
2310 HOLLYWOOD BLVD
HOLLYWOOD, FL 33020
Title MGRM
SKLAR, NEAL I
2310 HOLLYWOOD BLVD
HOLLYWOOD, FL 33020
http: //search. sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=Entity... 7/17/2017
Detail by Entity Name
Page 2 of 2
Annual Reports
Report Year Filed Date
2015 01/06/2015
2016 01/22/2016
2017 01/11/2017
Document Images
01/11/2017 --ANNUAL REPORT
01/22/2016 -- ANNUAL REPORT
01/06/2015 - ANNUAL REPORT
01/10/2014 -- ANNUAL REPORT
01/10/2013 -- ANNUAL. REPORT
01/04/2012 ANNUAL REPORT
01/0612011 -- ANNUAL REPORT
01/06/2010_..... ANNUAL_REPORT
01/062009 -- ANNUAL REPORT
01/18/2008 -- ANNUAL REPORT
01/29/2007 ANNUAL REPORT
01/31/2006 -- ANNUAL REPORT
05/09/2005 ANNUAL REPORT
06/17/2004 -- Florida Limited Liabilites
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Property Search Application - Miami -Dade County
Page 1 of 1
Summary Report
Property Information
Folio:
11-3206-013-2780 4t
Property Address:
9400 NE 2 AVE
Miami Shores, FL 33138-2703
Owner
MSVC LLC
Mailing Address
2310 HOLLYWOOD BLVD
HOLLYWOOD, FL 33020
PA Primary Zone
6400 COMMERCIAL - CENTRAL
Primary Land Use
1111 STORE : RETAIL OUTLET
Beds / Baths / Half
0/0/0
Floors
1
Living Units
0
Actual Area
12,578 Sq.Ft
Living Area
12,578 Sq.Ft
Adjusted Area
12,370 Sq.Ft
Lot Size
35,425 Sq.Ft
Year Built
2006
Assessment Information
Year
2017
2016
2015
Land Value
$921,050
$921,050
$779,350
Building Value
$838,848
$687,050
$561,894
XF Value
$71,521
$0
$65,288
Market Value
$1,831,419
$1,608,100
$1,406,532
Assessed Value
$1,768,910
$1,608,100
$1,406,532
Benefits Information
Benefit
Type
2017
2016
2015
Non -Homestead Cap
Assessment Reduction
$62,509
Note: Not all benefits are applicable to all Taxable Values (i.e. County,
School Board, City, Regional).
Short Legal Description
MIAMI SHORES SEC 1 AMD PB 10-70
LOTS 1-2-3-4- & 5 BLK 21
LOT SIZE IRREGULAR
OR 22502-2791-2814 THRU 2819 0704
Generated On : 6/19/2018
Taxable Value Information
2017
20161 2015
County
Exemption Value $0
$0
$0
Taxable Value $1,768,910
$1,608,100
$1,406,532
School Board
Exemption Value $0
$0
$0
Taxable Value $1,831,419
$1,608,1001 $1,406,532
City
Exemption Value $0
$0
$0
Taxable Value $1,768,910
$1,608,100
$1,406,532
Regional
Exemption Value $0
$0
$0
Taxable Value $1,768,910
$1,608,100
$1,406,532
Sales Information
Previous
Sale
Price
OR Book -
Pa 9a
Qualification Description
07/01/2004
$0
22502-
2787
Sales which are disqualified as a result
of examination of the deed
07/01/2004
$950,000
22502-Sales which are qualified
2791
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:
https://www.miamidade.gov/propertysearch/
6/19/2018
OPyl L-i c k State: Cam- Zip: g.� a -5 C/
Qualifier Name: POd� (7 0 Z ! v ' a in Phone#: 305- 79'4- 73 0 L j%
State Certification or Registration #: e pc / (/ z (' 7 Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of,Work for, this Permit: $ , S 0Q
Type'of Work: ❑ Addition ❑ Alteration
Description of Work: /SesPi4,frec,
BUILDING
PERMIT APPLICATION
BUILDING ❑ ELECTRIC
Miami Shores Village RECEIVED
Building Department JUN 19 201�I
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 u_
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949 SA
FBC 201-1'
Master Permit No. 9LGi1 1 Y2-1,5-
Sub Permit No.
❑ ROOFING ❑ REVISION ❑ EXTENSION ❑ RENEWAL
/EPLUMBING ❑ MECHANICAL PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: </go G- Iv/4 V+e.
City: , Miami Shores
County:
Miami Dade Zip:
Folio/Parcel#: ,/ ` 3 2 6 -0/3 - 0 7 60 Is the Building Historically Designated: Yes
Occupancy Type: Load: Construction Type:
OWNER: Name (Fee Simple Titleholder): /14 S V ( / L. LC
Address: 0 o� 3/ b trt O l �A/ /.U(�/)Ca' 6 l V d
City: l / / D if r to D (7 d , l State: F-1
Tenant/Lessee Name: /1//4
Email: 0 5 e A/2 ,S k 4 2
Flood Zone:
NO
BFE: FFE:
Phone#: C/-"8/a9D
Zip: 93 Ua a
Phone#: 8
/la; -Cot 3 04, - 157
CONTRACTOR: Company Name: r s 6 efe,610,4ft wi !/i'7 �` S(�VVi C Pl Phone#:
Address: 5Y 9 a- � I �.. c -C n `/
City:
Square/Linear Foot ge of Work:,
a
❑ New 'Repair/Replace', - ❑ Demolition
5 e L//o G, 7v.�.... g6 e-r y 601 'o), r)C 74-D
'*r /'%eYl �i/o_`hit Qyh d /72?e /- fe %1 e� 1A //Gez-e. , r= J (4N 7i//
5/-!n pieS- S L'( -Y . Iy S ie r,-) - ,v1)0() e. X/fj 7 n5 7r N&£.. i.t,t, t'id »)( /
Specify color of color thru tile:
Submittal Fee $
Scanning Fee $
Technology Fee $
Structural Reviews $
Permit Fee $ 3 V c
CCF$ 4•2,3
Radon Fee $ DBPR $
Training/Education Fee $
CO/CC $
Notary $
Double Fee $
Bond $
(Revised02/24/2014)
TOTAL FEE NOW DUE $ `, JV •% 0
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 pe 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.
Signature
OWNER or AGENT
The foregoing
rpegoing instrument
was acknowledged before me this
t C� day of J U P , 20 �6_, by
/fiajLAij 314(/A-,7. , who is personally known to
me or who has produced
identification and who did t
NOTARY PUBLIC:
Sign:
Print:
Seal:
APPROVED BY
as
RICARDO CESAR RAMOS
Notary Public - State of Florida
' = Commission If GG 139002
Po ,. My Comm, Expires Aug 28, 2021
liondiA1Mfingfilh•INNO **low
Signature
CONTRACTOR
The foregoing instrument was acknowledged before me this
18 day of C9 ,i
)
/ , 20 l` , by
Po (4 � S ( LJ-744 e), who is personally known to
me or who has produced
as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
Plans Examiner
Structural Review
RICARDO CESAR RAMOS.
Notary Public - State of floc ilia
• Commission If GG 139002
My Comm. Expires Aug 28, 2021
Bonded through National Notary AY.n.
Zoning
}
Clerk
(Revised02/24/2014)
WASTEWATER TREATMENT FACILITIES
ABANDONMENT PROCEDURES
Rule 62-600.410(7) states:- All treatment plant permittees shall be responsible for making all facilities safe
in terms of public health and safety at all times, including periods of inactivation or abandonment. The
permittee shall give the Department written notice at least 60 days before inactivation or abandonment of a
treatment plant and shall specify what steps will be taken to safeguard public health and safety.
The following items must be addressed to ensure the safe disposition of the wastewater treatment facility
and its contents:
• Remove remaining liquid and residuals from the wastewater treatment plant tankage and dispose of the
material at a permitted wastewater facility with the capacity and equipment for proper treatment,
including residual stabilization as necessary, and disposal.
• Clean and disinfect the wastewater treatment plant tankage and piping. Provide interim and final
disposition and security of the wastewater treatment plant components to assure against hazardous
conditions, i.e., if tanks are to be left in place, the permittee shall put holes in the bottom of each tank
to prevent water accumulation from rain, etc.
• Clean and disinfect the disposal system.
• Percolation ponds must be drained and backfilled, remove or stabilize in place bottom sediments.
Reference: Program Guidance Memo DOM-94-01.2, dated April 13, 1994
Quote: from DOM-94-01.2
"Conclusion
In summary, the Department has the authority to regulate for public health and safety only as it
related to pollution. Once a facility no longer requires a permit, the Department no longer has jurisdiction
absent a threat of or actual pollution. Currently, the only rule on the abandonment of water and wastewater
treatment plants is rule 62-600.410(7) of the Florida Administrative Code, but this rule must be interpreted
within the scope of the Department jurisdiction."