PL-18-3576Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address
122 NW 110TH ST, Miami Shores, FL 33168
Contacts
issue Date:12/03/2018
Parcel Number
1121360030100
Permit NO.: PL 12-18-3576
Permit Type: Plumbing - Residential
Work Classification: Drainfield
Permit Status: Approved
Expiration: 06/03/2019
KATE J & SEAN T ALBEE
122 NW 110 ST, MIAMI SHORES, FL 33168
Other: 5618279779
Owner
Description: DRAIN FIELD REPAIR
Fees
Amount
Application Fee - Other
CCF
DBPR Fee
DCA Fee
Education Surcharge
Permit Fee
Scanning Fee
Technology Fee
$50.00
$4.20
$3.61
$2.41
$1.40
$190.63
$9.00
$6.02
Total: $267.27
A SUPER SEPTIC & DRAIN FIELD INC
BRYAN K ZERO
7701 W 18 LN, HIALEAH, FL 33014
Contractor
Valuation: $ 6,875.00
Total Sq Feet: 0.00
Inspection Requests:
305-762-4949
Payments
Total Fees
Credit Card
Credit Card
Amount Due:
Date Paid
12/03/2018
12/03/2018
Amt Paid
$267.27
$50.00
$217.27
$0.00
Building Department Copy
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 c9nstruction and zoning. Futhermore, I authorize the above named contractor to do the work stated.
A horized Sig ure: Owner / Applicant / Contractor / Agent Date
December 03, 2018
Page 2 of 2
BUILDING
PERMIT APPLICATION
❑ BUILDING ❑ ELECTRIC
ELUMBING ❑ MECHANICAL
JOB ADDRESS: i Ia ►U O
City: Miami Shores
❑ ROOFING ❑ REVISION
❑ PUBLIC WORKS ❑ CHANGE OF
CONTRACTOR
Countvfl W d[ Miami Dade
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
RECEIVED
DEC 0 3 2010
ms►
Master Permit No.°121 iLgj - 4-(0
Sub Permit No.
❑ EXTENSION ERENEWAL
❑ CANCELLATION
❑ SHOP
DRAWINGS
Zip:Jj/6 8
Folio/Parcel#: // v�/ 36.. (30.i• 0100 Is the Building Historically Designated: Yes
Occupancy Type Load: Construction Type:
OWNER: Name (Fee Simple Titleholder):
Address: )d 1, i1) rwi //Oil'
Flood Zone:
City: 01i`4ti111. State: i.
NO
BFE: FFE:
Phone#:
Zip: 33// &
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name t,. ST�(L DK4f a/ 6e t1 • ..+h[�.
Address: %7d:/ .iv . /'S'"'��i AO4--- c /
City: y � //d4/2 . State: T 7OR/diq Zip: 330 / y
Qualifier Name: R M%)
State Certification or Regis4ation #:.34.e1 b f T7 a. Certificate of Competency #:` ) O / 6J 9.149,
Phone#:30.5'• 36 lc G/L
Phone#:3 • 9 G y 0ii
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $4,
Type of Work: ❑ Addition ❑ Alteration
Description of Work: f P 1 . 12.4 pd. it,
Square/Linear Footage of Work: N O 6 se). ice' •
New
Q Repair/Replace ❑ Demolition
Specify color of color thru tile:
Submittal Fee $ Permit Fee $
Scanning Fee $ Radon Fee $
CCF $ CO/CC $
DBPR $ Notary $
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ Bond $ 5 V(J
TOTAL FEE NOW DUE$ 41• 2:
(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 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.
Signature
7
eke
OWIVR or AGENT
Signature
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
Ai day of IV twen i /1' , 20 I 0 , by 2- k day of , 20 (V , by
6 A -ee, , who is personally known to T).Q.`(AT 2A fZ , who is pe�csenalty' moll to
me or who has produced I oevis4 as me or who has produced as
identificatio and ho did takean oath.
NOT
Sign:
Print:
Seal:
`ZANY PVd'(. YANADY PRI:��•
MY ►1MISSION # FF 214031
EXPIRES: March 25, 2019
'',,„?;; .§, Bonded Thru Notary Public Underwriters
********************** **
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Print:
1Eg6a�� "' o�=
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Seal: � �PUB,
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identification and who did take an oath.
NOTARY PUBLIC:
****************************************************************
APPROVED BY (2734 Plans Examiner
Zoning
(Revised02/24/2014)
Structural Review Clerk
Property Search Application - Miami -Dade County
Summary Report
Property Information
Folio:
11-2136-003-0100
Property Address:
122 NW 110 ST
Miami Shores, FL 33168-4321
Owner
KATE J ALBEE
SEAN T ALBEE
Mailing Address
122 NW 110 ST
MIAMI SHORES, FL 33168 USA
PA Primary Zone
0800 SGL FAMILY - 1701-1900 SQ
Primary Land Use
0101 RESIDENTIAL - SINGLE
FAMILY : 1 UNIT
Beds / Baths / Half
3/2/0
Floors
1
Living Units
1
Actual Area
Sq.Ft
Living Area
Sq.Ft
Adjusted Area
1,863 Sq.Ft
Lot Size
9,150 Sq.Ft
Year Built
1938
Assessment Information
Year
2018
2017
2016
Land Value
$196,886
$196,886
$164,440
Building Value
$132,907
$133,431
$133,955
XF Value
$1,613
$1,634
$1,655
Market Value
$331,406
$331,951
$300,050
Assessed Value
$312,784
$306,351
$300,050
Benefits Information
Benefit
Type
2018
2017
2016
Save Our Homes Cap
Assessment Reduction
$18,622
$25,600
Homestead
Exemption
$25,000
$25,000
$25,000
Second Homestead
Exemption
$25,000
$25,000
$25,000
Note: Not all benefits are applicable to all Taxable Values (i.e. County, School
Board, City, Regional).
Short Legal Description
MIAMI SHORES EXT PB 43-40
LOT 10 BLK 219
LOT SIZE 75.000 X 122
OR 19131-4988 05 2000 4
COC 26165-3773 01 2008 3
Generated On : 12/3/2018
Taxable Value Information
2018
2017
2016
County
Exemption Value
$50,000
$50,000
$50,000
Taxable Value
$262,784
$256,351
$250,050
School Board
Exemption Value
$25,000
$25,000
$25,000
Taxable Value
$287,784
$281,351
$275,050
City
Exemption Value
$50,000
$50,000
$50,000
Taxable Value
$262,784
$256,351
$250,050
Regional
Exemption Value
$50,000
$50,000
$50,000
Taxable Value
$262,784
$256,351
$250,050
Sales Information
Previous
Sale
Price
OR Book -
Page
Qualification Description
09/24/2014
$420,000
29327-0001
Qual by exam of deed
01/30/2014
$220,000
29014-1373
Qual by exam of deed
11/06/2009
$152,000
27079-2474
Financial inst or "In Lieu of Forcbsure"
stated
02/13/2009
$100
26774-1238
Financial inst or "In Lieu of Forcbsure"
stated
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:
iami 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 YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS
CONTENTS.
Signature:
State of Florida
County of Miami -Dade The foregoing was acknowledge before me this 2 b day of t\ ovO1'4n
, 20 ( .
By
Aikia
Notary:
SEAL:
who is personally known to me or has produced
as identification.
•tF�Y'P•y•ftet% YANADY PRIETO
:,,, ��� ••,.__ MY COMMISSION # FF 214031
••. '" . • ` EXPIRES: March 25, 2019
-...► .. `„
cR - Banded Tine Notary Puq:ic Undervaners }
A SUPER SEPTIC & DRAIN FIELD INC.
CC: SR0161772 7701 WEST 18 LANE
HIALEAH, FLORIDA 33014
Licensed and Insured
PHONE: 305-364-0113 E-MAIL: ASUPERSEPTIC@GMAIL.COM FAX: 305-364-0349
WWW.ASUPERSEPTIC.COM
DATE: i(^ai'i
STATE OF FLORIDA
COUNTY OF MIAMI-DADE
BEFORE ME THIS DAY PERSONALLY APPEARED, /7%2--cA-V ZOIQ--1)
BEING DULY SWORN, DEPOSES AND SAYS:
THAT HE OR SHE WILL BE THE ONLY PERSON WORKING ON THE PROJECT AT:
1 a) �. IV l i o st, 3 16 f(
liyContractor Signature: ,e4,14 rt iztrO
WHO
SWORN TO (OR AFFIRMED) AND SUBSCRIBED TO ME THIS a( DAY OF NOp -r1(3 rz
7 , 2018, BY:
PERSONALLY KNOWN
OR PRODUCED IDENTIFICATION
TYPE OF INFORMATION PRODUCED
PRINT, TYPE, OR STAMP
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISpOSAL
SYSTEM
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: kate J Albee
PROPERTY ADDRESS:
LOT: 10
PROPERTY ID #:
4
122 NW 110 St Miami, FL 3316'8
PERMIT # :13-SC-1892201
APPLICATION #: AP1373396
DATE PAID:
FEE PAID:
RECEIPT #•
DOCUMENT # : PR1181388
. • • •
.• •
• •
••••••
•
BLOCK: 219 SUBDIVISIOW: Miami Shores Ext-.•-�_. •
1[SEC'J.'IQN,, TOWNSHIP, IRANC ,•4iitCEL NJFdR]
11-2136-003-01 OO [O R TAX ID NUMBER] • • • • : • .0•• • ir•
•
i • • _• '•
•
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••••••
• •
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• •
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SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE •WITH SPECIFICATIONS AND 4,8EDATl7ARDS OF SECTION •
381.0065, F.S. , AND CHAPTER 64E-6, F.A.C. DEPARTMENT • APPROVAL OF SYS'!EM • dOES JOT • GUARANTE2
SATISFACTORY PERFORMANCE FOR ANY SPECIFIC PERIOD OF TIME. AN�tr CHANFE eN M VERTAL FA% ••
WHICH SERVED AS A BASIS FOR 'ISSUANCE OF THIS PERMIT, REQUIRE TEE -APPLICANT Tg• MODIFY i8'i$ty:
PERMIT APPLICATION. SUCH MODIFICATIONS MAY RESULT IN THIS PERMIT BEING MADE NaLL.•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 I GALLONS / GPD Existing Septic Tank CAPACITY
A i 0 ] GALLONS / GPD CAPACITY
N [ 0 ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
K ( ] GALLONS DOSING TANK CAPACITY [ ]GALLONS 8( ]DOSES PER 24 HRS #Pumps [
D [ 225 ) SQUARE FEET New Drainfield Trench Con SYSTEM
R [ 0 ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [x] STANDARD [ ] FILLED [ ] MOUND
I CONFIGURATION: [x] TRENCH [ ] BED [ j
N
F LOCATION OF BENCHMARK: FFE 12.9
I ELEVATION OF PROPOSED SYSTEM SITE
E BOTTOM OF DRAINFIELD TO BE
L
D FILL REQUIRED: '
R
REPAIR
[ 24.00 ] 11 INCHES / FT ] [ ABOVE A BELOW U BENCHMARK/REFERENCE POINT
[ 59.00 I 1 INCHES r FT ] [ ABOVE /) BELOW b BENCHMARK/REFERENCE POINT
[ 0.00 ] INCHES EXCAVATION REQUIRED: [ 47.00) INCHES
1.-EXISTING 900 gal septic tank with and approved filter TO REMAIN.
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.
3.- Install 225 sf. of drainfield in....TRENCH... configuration.
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 8.48 ' & 7.98' NGVD respectively
THIS PERMIT IS NOT FOR ANY ADDITIONS.
CONTRACTOR •SOIL 6RRId�C
SPECIFICATIONS BY:
APPROVED BY:
A `APR#
11,1
Pt: #4P desterrw�el is retlu'riNt to o orm aassoii boring
aoj'cen o the drain:101a excavation at the time of Th!
42 rero l igl4+WErmiftilMSntwk!ditps iialist II
ErYtiYte:Def a' OiI bonng and compare t.e resut;s to ::ia crxg na'
DATE ISSUED: 11/1 g
S ?cation submitted. A rt nspecticn fee will be assessec
eePt'a.+:vr is not at the jobsite at Me a-raneed ti,rr
DE'4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E-6.003, FAC
Dade CHD
EXPIRATION DATE: 02/17/2019
Page 1 of 3
v 1.1.4 AP1373396 5E1131307
STATE OF FLORIDA
DEPARTMENT OF HEALTH
APPLICATION FOR CONSTRUCTION PERMIT
Permit Application Number
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Notes: REPAIR REPLACING EXISTING 30 ....,�A/��!!!! �� 0 S.F BED WITH 225 S.F IN TRENCH CONFIGURATION ��
Site Plan submitted b
Plan Approved
By
t ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPART
DH 4015. 08/09 (Obsoletes previous editions which may not be used) Incorporated: 64E-6.001. FAC MENT
(Stock Number: 5744-002-4015-6)
Not Approved
vac,_ o •
C2018011105
CONTRACTOR
Date 11-14-18
County Health Department
Page 2 of 4
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This oroperLy doscribp
Lot 10, Block 219,
MIAll SHORES EXTPSION,
ac::ording tc: the Plat
thereof, sr(!corc!eir
Plat gook 43,
o the Public Records c,1
Dade County, Florida.
Mitial & Gervais, 122 r.w. 110th Street, Miami Shores, Floridc.
A BOUT
SURVEY
a k so' also. a. of, Lou. •••••hrs.
LANNES and GARCIA, INC.
Inspector
Address
Comments:
Signature
DIVISION OF
Environmental Health
Florida Health
Miami -Dade County
OSTDS/Well Division
11805 SW 26th Street • Miami, FL 33175
PPM11- -74 itIC(nitt
24/ ( 7&
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