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PLC-18-3360
Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Location Address Issue `Date: 11106 111002018 Permit NO.: PLC-11-18-3360 a. Permit Type: Plumbing - Commercial Work Classification: Drainfieid Permit Status: Approved Expiration: 05/06/2019 Parcel Number 9823 NE 4TH AVE, Miami Shores, FL 33138 1132060170330 I Contacts MIAMI SHORES COMM CHURCH INC 9823 NE 4 AVE, MIAMI, FL 331382402 Owner ALFONSO SEPTIC CONTRACTOR INC JOSE BOLANOS 1391 W 36 ST, HIALEAH, FL 33012 Business: 7862514099 Contractor Description: INSTALL A 947 SQFT OF DRAINFIELD Fees Amount Application Fee - Other CCF DBPR(Fee I DCA Fee Education Surcharge Permit Fee (Manual) Scanning Fee Technology Fee (Manual) Total: $50.00 $6.00 $2.00 $2.00 $2.00 $100.00 $9.00 $3.75 $174.75 Valuation: $ 10,000.00 TotalSq Feet: 0.00 Inspection Requests: 305-762.4949 Payments Total Fees Cash Credit Card Amount Due: Date Paid 11/06/2018 11/05/2018 Amt Paid $174.75 $124.75 $50.00 $0.00 Building Department Copy In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I •-rtify that all the fore•-•ing information is accurate and that all work will be done in compliance with all applicable laws regulating,, onstr ;,; . jn•. Futhermore, .uthorize the above named contractor to do the work stated. Authdrized Signature: Owner / A;blicant / Contractor / Agent (19 Date November 06, 2018 Page 2 of 2 , is v FBC 20 + BUILDING Master Permit No. 2 1 C a -g3(00 PERMIT APPLICATION Sub Permit No. BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑ RENEWAL Miami Shores Village RECEIVE 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Building Department (�\Tel: (305) 795-2204 Fax: (305) 756-8972 NOV 0.52018 NAVO4" INSPECTION LINE PHONE NUMBER: (305) 762-4949 PLUMBING ❑ MECHANICAL ❑ PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: Q' 2 3 Li - 41 C City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: 11-3l04-O (1 -©_ -S Is the Building Historically Designated: Yes NO PS Occupancy Type: ( Load: Construction Type: 1 le1'V-l_ Flood Zone: On BFE: FFE: /t/t/2 OWNER: Name (Fee Simple Titleholder): 14( iA IP(I Stvoke S CCOU'1q.C'yU/tat Phone#: Address: 9 3 i.) F - LI t4U 2 City:' 04 tA I/4) SI%o neS State: 1 (►'— Zip: 1-3&--- 1 Tenant/Lessee Name:. Phone#: CONTRACTOR: Company Na'me:.IA (_ , &T e 62� 1 ttA6TD& ($.4 Phone#: 7& 25(.D P 9 ; Address`: Lag) V%e S l ciG sr - City: M t t/4 4 State: r(a Zip: '3 ©/ ` L Qualifier Name: A a IRO( bkhgrr Phone#:7a 25/_YO99 State Certification or Registration #:'.S(ZDeel 12Z Certificate of Competency#:'A -or?! Q 5 1 DESIGNER: Architect/Engineer: N( Phone#: Address: City: State:nnZip: Value of Work for this Permit: $ 10 006 Square/Linear Footage of Work:.,.,. `7..�(.�. Type of Work: ❑ Addition ❑ Alteration s i �i i e ❑ New � +2� Repair�Replace »' '' Description of Work: (1'JS'TA IV A `IA( `1.. SC1 pT o r IQif� (k..j�r 0 0 i I f Specify color of color thrustile: Submittal Fee $ Permit Fee $ CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ q-� Structural Reviews $ Bond $ ' CO i (Revised02/24/2014) TOTAL FEE NOW DUE $,ZT •S �2 + �5 Bonding Company's Name (if applicable) Bonding Company's Address v ' (r'" City ' State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address a.... .* .2 _.. ti City, r '. , , 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 • h .osted notice, the inspection will not be approved and a reinspection fee will be charged. Signature V OWNER or AGENT The foregoing instrument was acknowledged before me this day of VW 401 c, , 20 I - , by ovklTt5 (,Ji& o—, who is personally known to me or who has produced as identification and who did take an oath. NOTARY PU Sign: Prin al: c ';. JOSE BOLANOS MY COMMISSION # OG 231457 ctobor e, 2Zi22 r 04 Thru Ho!, Pu'Ti; ' H . a.`r• 4 Signature CSNTRACTOR MAHARAI K. GONZALEZ MY COMMISSION # GG 044602 EXPIRES: November2, Y020 Bonded Thru Notary Public Undenw. T - foregoing instrument was acknowledged before me this S day of NM_ , 20 J by 1' c''nj rct who is personally k own to 4 or who has produced as identification and who did take an oath. NOTARY PUBLIC: S Print: Seal: .r MY :,;(1 EXPIRES: Nover.':v:r: +• eP •' Bonded TM, N ************************************************************************************************ APPROVED BY ' P / /'j /// Plans Examiner Zoning 1. (Revised02/24/2014) Structural Review Clerk 11/5/2018 Property Search Application - Miami -Dade County Summary Report Property Information Folio: 11-3206-017-0330 Property Address: 9823 NE 4 AVE Miami Shores, FL 33138-2402 Owner MIAMI SHORES COMM CHURCH INC Mailing Address 9823 NE 4 AVE MIAMI, FL 33138-2402 PA Primary Zone 1200 SGL FAMILY - 2501-2800 SQ Primary Land Use 7144 RELIGIOUS - EXEMPT : RELIGIOUS Beds / Baths / Half 0/0/0 Floors 2 Living Units 0 Actual Area Sq.Ft Living Area Sq.Ft Adjusted Area 22,482 Sq.Ft Lot Size 37,121.2 Sq.Ft Year Built 1930 Assessment Information Year 2018 2017 2016 Land Value $1,115,070 $1,115,070 $927,142 Building Value $974,864 $974,864 $928,440 XF Value $28,613 $29,007 $29,401 Market Value $2,118,547 $2,118,941 $1,884,983 Assessed Value $2,118,547 $2,030,308 $1,845,735 Benefits Information Benefit Type 2018 2017 2016 Non -Homestead Cap Assessment Reduction $88,633 $39,248 Religious Exemption $2,118,547 $2,030,308 $1,845,735 Note: Not all benefits are applicable to all Taxable Values (Le. County, School Board, City, Regional). Short Legal Description MIAMI SHORES SEC 4 PB 15-14 LOTS 1 TO 6 INC & ALL OF ALLEY BLK 88 AS VACATED PER CITY ORDINANCE NO 237 BLK 88 LOT SIZE IRREGULAR Generated On : 11/5/2018 Taxable Value Information 2018 2017 2016 County Exemption Value $2,118,547 $2,030,308 $1,845,735 Taxable Value $0 $0 $0 School Board Exemption Value $2,118,547 $2,118,941 $1,884,983 Taxable Value $0 $0 $0 City Exemption Value $2,118,547 $2,030,308 $1,845,735 Taxable Value $0 $0 $0 Regional Exemption Value $2,118,547' $2,030,308 $1,845,735 Taxable Value $0 $0 $0 Sales Information Previous Sale ? Price OR Book -Page Qualification Description 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: 11/5/2018 Detail by Entity Name Department of State / Division of Corporations / Search Records / Detail By Document Number / Detail by Entity Name Florida Not For Profit Corporation MIAMI SHORES COMMUNITY CHURCH, INC. filing Information Document Number N49539 FEI/EIN Number 59-0657328 Date Filed 06/24/1992 State FL Status ACTIVE Last Event AMENDMENT Event Date Filed 10/25/2018 Event Effective Date NONE Principal Address 9823 NE 4TH AVE. MIAMI SHORES, FL 33138 Changed: 03/18/2009 Mailing Address 9823 NE 4TH AVE. MIAMI SHORES, FL 33138 Changed: 03/18/2009 Registered Agent Name & Address SASTRE, MICHAEL A 2 SOUTH BISCAYNE BLVD. SUITE 3050 MIAMI, FL 33131 Name Changed: 05/20/2009 Address Changed: 05/20/2009 Officer/Director Detail Name & Address Title P LANGFORD, DRACE 720 NE 69 STREET http://search.Sunbiz.org/Inqui ry/CorporationSearch/SearchResultDetail?i nqui rytype=EntityName&directionType=Initial&searchNameOrder=M IAM ISHORESC.. 1/3 11/5/2018 #8 MIAMI, FL 33138 Detail by Entity Name Title Treasurer Snyder, Clint 5401 Collins Ave #137, Miami Beach, FL 33140 Title V MERRILL, BRENDA 5929 NE 6TH AVE MIAMI, FL 33137 Title MINISTER AND CAO WATSON, MARGARET, REV 386 NE 99 STREET MIAMI SHORES, FL 33138 Annual Reports Report Year Filed Date 2016 03/29/2016 2017 03/02/2017 2018 03/27/2018 Document Images 10/25/2018 — Amendment 03/27/2018 — ANNUAL REPORT 03/02/2017 — ANNUAL REPORT View image in PDF format View image in PDF format View image in PDF format 03/29/2016 — ANNUAL REPORT View image in PDF format 04/08/2015 — ANNUAL REPORT View image in PDF format 06/27/2014 — AMENDED ANNUAL REPORT View image in PDF format 03/03/2014 —ANNUAL REPORT 03/19/2013 — ANNUAL REPORT 03/20/2012 — ANNUAL REPORT 05/11/2011 — ANNUAL REPORT View image in PDF format View image in PDF format View image in PDF format View image in PDF format 03/02/2010 — ANNUAL REPORT View image in PDF format 05/2Q/2009 — Reg. Agent Change View image in PDF format 03/18/2009 — ANNUAL REPORT 03/14/2008 —ANNUAL REPORT Q4/02/2007 — ANNUAL REPORT View image in PDF format View image in PDF format View image in PDF format 07/05/2006 — ANNUAL REPORT View image in PDF format 04/14/2005 — ANNUAL REPORT View image in PDF format 02/27/2004 — ANNUAL REPORT View image in PDF format 05/05/2003 — ANNUAL REPORT View image in PDF format 05/21/2002 —ANNUAL REPORT View image in PDF format ndl7zl9nnl _. 6t\I111I IGI P 0ilPT Vin+u imnnn in or)G fmmnn+ http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?i nqui rytype=EntityName&directionType=lnitial&searchNameOrder=M IAM ISH ORESC.. 2/3 Alfonso Septic Contractor, INC. 1391 West 36 Street Hialeah, FL 33012 Alfonsoseptic@gmail.com Date: November 2, 2018 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: 98 23 NE 4 AVE Miami Shores FLA. Contractor Signature `' jQ Sworn to (or affi er d) and subscbed before me this 5 day of Nb V .20 1,6 by Personally Know OR Produced Identification Type of Identification Produc MAHARAI K. GONZALEZ MY COMMISSION # GG 044602 EXPIRES: November 2, 2020 Bonded Thru Notary Public Underwriters Print, Type or Stamp Na e of Notary 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 YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature: 0 ner State of Florida County of Miami -Dade The foregoing was acknowledge before me this day of (1JD(?eIr1 }rat., , 20 I g/ ByRe0-111 Lt1 go t..4%t (J -Q's0 I'✓ who is personally known to me or has produced as identification. Notary. SEAL . JOSE eOI ANDS MY C EM ISSIO GO 23i,�S7; i• 'Bt O. 2022 ••onged MR)Ata,, 11c DIVISION OF Environmental Health Florida Health Miami -Dade County OSTDS/We11 Division 11805 SW 26th Street • Miami, FL 33175 Inspector /?i#vT (041, g e Address i 42 1 ''�- Comments: Date rr—(c - (g - (34O7i.a-R OSTDS # Signature SUBJECT CCCMPLIPNCE O VVI All FEDERAL - STATE ANo CGUN tY AND RE6OLATIONS 5 r- 3. I • • • • • • • • • • • • • ftC etoular..wel • .• • •' • s as:•• • As .• • *Am. • ow&• • • DETAIL SDI r 26er RECEIVED NOV 0 6 2018 • • • • • • • • • • • • • • STATE OF FLORIDA DEPARTMENT OF ,HEALTH ONSITE SEWAGETREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT FOR: OSTDS Repair APPLICANT: (Miami Shores Comm Church) PERMIT #: 13-SC-1888148 APPLICATION #: AP1370927 DATE PAID: FEE PAID' RECEIPT #: DOCUMENT #: PR1169532 PROPERTY ADDRESS: 9823 NE 4 Ave Miami, FL 33138 LOT: 106 BLOCK: 88 PROPERTY ID #: 11-3706-017-0330g' SUBDIVISION: [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 A64E-6, F.A.C. DEPARTMENT APPROVAL OF SYSTEM DOES • NOT. GUARANTEE SATISFACTORY PERFORMANCE FOR ' ANY SPECIFIC PERIOD OF TIME. ANY CHANGE • IN MASPitIAL MEWS.. WHICH SERVED AS A BASIS FOR ISSUANCE OF THIS PERMIT, REQUIRE THE AHHLICk NT CO ?MODIFY TW PERMIT APPLICATION. SUCH MODIFICATIONS MAY RESULT IN THIS PERMIT BEIN60••)ADE NULL • AND WOID.• ISSUANCE OF THIS PERMIT DOES NOT EXEMPT THE APPLICANT FROM COMPLIAtfCIB•••9iITH OTHER FEDERAL • • ••••L• STATE, OR LOCAL PERMITTING REQUIRED FOR DEVELOPMENT OF THIS PROPERTY. •••• •••• • • • • • • SYSTEM DESIGN AND SPECIFICATIONS' T A N K D R A I N F I E L D 0 T H E R SPECIFICATIONS BY: APPROVED BY: 1,600 ] GALLONS / GPD Existina Septic TANK TO REMAIN CAPACITY 0 ] GALLONS / GPD ;, CAPACITY 0 ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:12%0•GALLONS] ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER••24 ARS ••'#rbgips [• ]• 947 ] SQUARE FEET New Drainfield in Trench co SYSTEM 0 ] SQUARE FEET SYSTEM • • •• •• • ••• • • • •• • • • • • • • • • • • TYPE SYSTEM: CONFIGURATION: [x] STANDARD [x] TRENCH [ ] FILLED [ ] BED [ LOCATION OF BENCHMARK: FFE 10.8 NGVD [l • • • • • •• • MOUND [ ] ELEVATION OF PROPOSED SYSTEM SITE BOTTOM OF DRAINFIELD TO BE FILL REQUIRED: [ 0.00 ] INCHES [ 7.20 ] (I INCHES [ 45.20 ] [I INCHES FT ][ ABOVE A BELOW 1] BENCHMARK/REFERENCE POINT FT ]( ABOVE/+ BELOW ]BENCHMARK/REFERENCE POINT EXCAVATION REQUIRED: [ 38.00] INCHES 1.-EXISTING 1600 GAL. septic tank with and approved filter TO REMAIN. 2.- Install 947 sf. of drainfield in..........TRENCH.... configuration. 3.- Existing SAND at the bottom of the drainfield to remain. Any spoil material UNDERNEATH THE DRAIN FIELD within 24" vertically that has visible signs of effluent shall be removed as part of the repair. 4.- Invert elevation and Bottom of drainfield to be no less than 7.13' & 7.03 ' NGVD respectively THIS PERMIT IS NOT FOR ANY ADDITIONS._ (Comments Continued on Page 2.) REPAIR FLORIDA DEPARTMENT OF HEALTI{1 IN MIAMI-DADE CmUNTY Jose ccrecre-ar DATE ISSUED: 11/01/ .18 anos .lizaire TITLE: Registered Septic Tank Contractor TITLE: Engineering Specialist II Dade EXPIRATION DATE: DH 4016, 08/09 (Obsoletes all previous editions which may not be used) Incorporated: 64E-6.003, FAC v 1.1.4 AP1370927 SE1119457 01/30/2019 CHD Page 1 of 3 DOCUMENT # : P R 1169532 _ ( Comments continued on page 2 ) 3.. ........................................................................................................................................................................... 4 ........ ......... .......... .................. ......... ....:............. ............ ...... ............ ...... ......... ..................... ............ ............ ...... ... ..................................................................................................................... 5.- Perimeter of excavation area shall be at least 2 ft wider and longer than the proposed absorption trench. The licensed contractor installing the systernlis responsible for installing the minimum category of tank in accordance with s. 64E-6.013(3)(f), FAC. Required drainfield area based on rule 64E-6.015(6)(d)2.b. Install a new drainfield to achieve Drainfield size requirement. • • • •• • • •••• •••• •••• •••• • ••• • • •• •• 1• • • • • • • • • • • • • •• • •• • • • • •• • • • 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 firial order.. .• . . . . . . . . .. . . • .... .... . .• .. . . .• ..• .. •• • . •..• . • • • • • • •• • •• • • • • STATE OF FLORIDA DEPARTMENT OF HEALTH APPLICATION FOR CONSTRUCTION PERMIT Permit Application Number PART 11- SITEPLAN Scale: Each block represents 10 feet and 1 inch = A., IQ.; 1, ,c` Ilere ar a nent /eag.r es,on Nom • p opedies and across he t that may . , - ,off evt it sytsten ilk. 1II off. • . ..... •. • • • • • r • •• 4 !nor • .•• r.• { & Sic ,,c9,0..... cc3 • i` • •.. . �.. p � II II F t -IT 04. 4 (.xat•.► rr•e fl n"r s: t� k •.rr•• • 1 • c-► '�ilQCi� P arts.' J iC, 6i f — rJ Notes: 9g).2 IU E - Ll VDU° -(t lM i S �)o�e 5 �� ! 3 ` 3 ti r‘. o / to o rt Ee. P(al e R O I t n i IUS j l..- (J+TC 14 5-r•C) ice % P n.:U r CP Site Plan submitted y: Plan Approved pp � Not Approved Date /0:994.9-- By CountyHealth Department O1.k'5 A F !t ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT n� .no/nn ......ta:.,.., ..d.i.4, ...o., nett hn ..cori\ Inrnrnnrofoi• R4F-fi lfYl FAf: Paae 2 of 4