DEMO-18-1556Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Project Address
Pe
Parcel Number
Permit NO. DEMO-6-18-1556
Permit Type: Demolition
Work Classification: Plumbing
PermitStatus: APPROVED
Expiration: 12/10/2018
Applicant
9301 NE 2 Avenue
Miami Shores, FL 33138-
1132060133650
Block: Lot:
MIAMI SHORES VILLAGE
Owner Information
Address
Phone
Cell
MIAMI SHORES VILLAGE
10050 NE 2 Avenue
MIAMI SHORES FL 33138-2304
305/751-1271
Contractor(s)
KINGS PLUMBING SERVICE INC
Phone CeII Phone
(305)625-5450 (786)251-9810
Valuation:
Total Sq Feet:
$ 1,500.00
0
Type of Demo: Plumbing
Additional Info: INSTALL HOSE BIB AND RISER ON WATER
Classification: Residential
Scanning: 1
Fees Due
CCF
DBPR Fee
DCA Fee
Education Surcharge
Permit Fee
Scanning Fee
Technology Fee
Total: ,
Amount
$1.20
$2.00
$2.00
$0.40
$100.00
$3.00
$1.60
$110.20
Pay Date Pay Type Amt Paid Amt Due
Invoice # DEMO-6-18-67829
06/13/2018 Money Order $ 110.20 $ 0.00
Available Inspections:
Inspection Type:
Final
Review Plumbing
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.
V42,L 1Lk
Authorized Signature: Owner / Applicant / Contractor / Agent
June 13, 2018
Date
Building Department Copy
June 13, 2018 1
-bem0A$'1504
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
nspection Number: INSP-305949
Permit Number: DEMO-6-18-1556
Inspection Date: August 15, 2018
Inspector: Massanet, Maykel
Owner: SHORES VILLAGE, MIAMI
Job Address: 9301 NE 2 Avenue
Miami Shores, FL 33138-
Project: <NONE>
Contractor: KINGS PLUMBING SERVICE INC
Permit Type: Demolition
Inspection Type: Final
Work Classification: Plumbing
Phone Number 305/751-1271
Parcel Number 1132060133650
Phone: (305)625-5450
Building Department Comments
INSTALL HOSE BIB AND RISER ON WATER METER TO
PROVIDE WATER FOR DUST CONTROL DURING
DEMOLITION AND PUMP OUT AND ABANDON SEPTIC
TANK PER HRS REQUIREMENTS
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.
For Inspections please call: (305)762-4949
August 15, 2018
Page 1 of 1
15O\ NE z 4v
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION INSPECTION AND FINAL APPROVAL
APPLICANT: Miami Shores Village
APPLICATION LAP1348996
PERMIT # :13-SM-1853804
DOCUMENT # : F 1119 8444
DATE PAID:06/11/2018
FEE PAID:100.00
RECEIPT # :13-PI D-3586302
AGENT: E17 Holdings Inc
PROPERTY ADDRESS: 9301 NE 2 Ave Miami, FL 33138
LOT: 10-11
SUBDIVISION:
BLOCK: 27
Miami Shores Sec 1 Amd ID#: 11-3206-013-3650
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]
TANK MATERIAL
OUTLET DEVICE
MULTI -CHAMBERED [ Y / N ]
OUTLET FILTER
[2]
LEGEND 1. 2.
WATERTIGHT
LEVEL
DEPTH TO LID
DRAINFIELD INSTALLATION
[10]
[11]
[12]
[13]
[14]
[15]
[16]
[17]
[18]
[19]
[20]
[21]
AREA [1] [2]
DISTRIBUTION BOX
NUMBER OF DRAINLINES
DRAINLINE SEPARATION
DRAINLINE SLOPE
DEPTH OF COVER
ELEVATION [ ABOVE / BELOW ]BM
SYSTEM LOCATION
DOSING PUMPS
1.
SQFT
HEADER
2.
AGGREGATE SIZE
AGGREGATE EXCESSIVE FINES
AGGREGATE DEPTH
FILL / EXCAVATION MATERIAL
[22] FILL AMOUNT
[23] FILL TEXTURE
[24] EXCAVATION DEPTH
[25] AREA REPLACED
[26] REPLACEMENT MATERIAL
Comments:
SETBACKS
[27]
[28]
[29]
[30]
[31]
[32]
[33]
[34]
[35]
SURFACE WATER
DITCHES
PRIVATE WELLS
PUBLIC WELLS
IRRIGATION WELLS
POTABLE WATER
BUILDING FOUNDATIONS
PROPERTY LINES
OTHER
FILLED / MOUND SYSTEM
[36]
[37]
[38]
[39]
DRAINFIELD COVER
SHOULDERS
SLOPES
STABILIZATION
ADDITIONAL INFORMATION
[40] UNOBSTRUCTED AREA
[41] STORMWATER RUNOFF
[42] ALARMS
[43] MAINTENANCE AGREEMENT
[44] BUILDING AREA
[45] LOCATION CONFORMS WITH SITE PLAN
[46] FINAL SITE GRADING
[47] CONTRACTOR
[48] OTHER
FT
FT
FT
FT
FT
FT
FT
FT
FT
ABANDONMENT
[ 4 9 ] TANK PUMPED 06/29/2018
[50] TANK CRUSHED & FILLED 07/24/2018
CONSTRUCTION
FINAL SYSTEM [
APPROVED
APPROVED
/ Dade CHD
DISAPPROVED ] ' Environmental Specialist II Erick Perera (Florida Department of Health
/ DISAPPROVED 1-
(Explanation of Violations on following page)
DATE : 07/25/2018
Dade CHD DATE: 07/25/2018
Environmental Specialist II Erick Perera (Florida Department of Health
DH 4016, 08/09 (Obsoletes all previous editions
Incorporated: 64E-6.003, FAC
EH Database v 1.0.1
which may not be
APi348996
used)
EID1853804
Page 2 of 3
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION INSPECTION AND FINAL APPROVAL
APPLICATION # :.API 348996
PERMIT # :13-SM-1853804
DOCUMENT #:FI1198444
DATE PAID:06/11/2018
FEE PAID : 1 00.00
RECEIPT #:13-PID-3586302
Violation Number
Comment
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E-6.003, FAC
EH Database v 1.0.1
APl343996
EID1853804
Page 2 of 3
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
�FBC 20
BUILDING Master Permit No. bcrfl0 t ‘5o4
PERMIT APPLICATION
Sub Permit No. DICM0 le, "1 SS6'
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
ELUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 301 /(% E 21'4 i11/LI)Ite...
City:
Folio/Parcel#:
Occupancy Type:
Miami Shores County: Miami Dade Zip:
\, 32,0 ( — 0 \3 — 3 (D5-0 Is the Building Historically Designated: Yes NO
Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): li)d►aM\ 61i0r.,GS Vt'��Q2 Phone#: 05.�i,Z..H./L/
Address: 1006 O »E Z"a fi1J-EnLA¢..
City: �(ii I am k 611 or-e 5 State: f
Tenant/Lessee Name:
Email:
Phone#:
Zip: 3� ►3
CONTRACTOR: Company Name:
tG:I,, IS piww►binq S.ivf a Phone#: 30S.6 85,517 3
Address: NO 50 i►u W (a /
City: Itiufkh Mlii►11 State: Pt
Zip: 331 Gg
Qualifier Name: Kenneth Diener Phone#: "PT. 6St5. fj'i 1 3
State Certification or Registration #: C PG 1 1'2.% 1 q 5 Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ Alpo ' c-/ Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New . _ • /❑__Re�p�air//,Replace• PrDemolition
DescriptionofWoork:. Ths it
hoe lI6 4
K4 Ir1 S'r d�. WAt ' nu ev �i itrvvj� �✓�1 ►'LL
: f A,u 0evi ba I. Ot`U, dirwv i �'1�M �tt q� t a7 S rl
l f
Specify"color'of `color thi�u;tle: _
Submittal Fee $ Permit Fee $ f°CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Notary $
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ Bond $
TOTAL FEE NOW DUE $
(Revised02/24/2014)
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State Zip
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address'
City i� ° 1 ,: V t ;. 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 anestimatedvalue 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 tile 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.
T i
Signature
t F R OWNER or AGENT
The foregoing instrument was acknowledged before me this
2L d,/e�y'of G� , 20 , by
'V'V lk n, who is personally known to
me or who has produced t� •as
identification and who did take an oath.
NOTARY PUBLIC:
Sig .'
Print:
Seal:
MAHARAI K. GONZALEZ
MY COMMISSION # GG 044602
EXPIRES• November2: 2020 t
oa; Bonded Thru Notary Public Underwriters
**************
APPROVED BY',
' F t;i r
Signature
••.+ � II4' tdc
CONTRACTORfoa
.
The foregoing instrument was acknowledged before me this
7. day of „/ ,20 /a ,by
, who is personally known to
me or who has produced as
identification and who did take an oath.
♦ ,. . _Yv
NOTARY PUBLIC:.
Sign:
A :‘
Print:
Seal:
Debra 5rrydert
=., COMMlbSrt)N .0ff916Ti1•
''EXPIRES: September8,2019`"
� WWW,AARONNOUIRY.COM
*******************************************************************************************
?74-4/0 Plans Examiner
Zoning
Structural Review Clerk
(Revised02/24/2014)
r.
STATE OF FLORIDA
DEPARTMENT OF HEALTH APPLICATION #: AP1348996
ONSITE SEWAGE TREATMENT AND DISPOSAL DATE PAID:
SYSTEM
FEE PAID:
CONSTRUCTION PERMIT
RECEIPT #:
PERMIT #: 13-SM-1853804
DOCUMENT #: PR1120740
CONSTRUCTION PERMIT FOR: OSTDS Abandonment
APPLICANT: (Miami Shores Village)
PROPERTY ADDRESS: 9301 NE 2 Ave Miami, FL 33138
LOT: 10-11
BLOCK: 27 SUBDIVISION: Miami Shores Sec 1 Amd
PROPERTY ID #: 11-3206-013-3650
[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 [ ] GALLONS / GPD CAPACITY
A [ ] GALLONS / GPD CAPACITY
N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ ]
D
R
A
I
N
F
I
E
L
D
0
T
H
E
R
SPECIFICATIONS BY:
APPROVED BY:
[ ] SQUARE FEET
[ ] SQUARE FEET
SYSTEM
SYSTEM
TYPE SYSTEM: [ ] STANDARD [ ] FILLED [ ] MOUND [ ]
CONFIGURATION: [ ] TRENCH [ ] BED [ ]
LOCATION OF BENCHMARK:
ELEVATION OF PROPOSED SYSTEM SITE
BOTTOM OF DRAINFIELD TO BE
FILL REQUIRED:
[ 0.00] INCHES
][ / ] [ ABOVE/ BELOW ]BENCHMARK/REFERENCE POINT
][ / ][ ABOVE/ BELOW ]BENCHMARK/REFERENCE POINT
EXCAVATION REQUIRED: [
] INCHES
Have the tank abandoned in accordance with the following procedures: (a) The tank shall be pumped out. (b) The bottom of
the tank shall be opened or ruptured, or the entire tank collapsed so as to prevent the tank from retaining water, and (c)
The tank shall be filled with clean sand or other suitable material, and completely covered with soil. Have the system
inspected by the health department after it has been pumped, ruptured and filled with sand and covered.
DATE ISSUED:
Erlande Om.sca
06/11/2018
TITLE:
TITLE: Engineering Specialist II
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E-6.003, FAC
Dade
EXPIRATION DATE: 09/09/2018
CHD
Page 1 of 3
1.1.4
AP']. 3ai3 <r
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.