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PL-18-2521r DIVISION OF •• Environmental Health Florida Health Miami -Dade County e�0 OSTDS/Well Division 11805 SW 26th Street - Miami, FL 33175 Date Address f -f� a �/ OSTDS # Comments: Signature tpz Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 III Issue Dates 03/18/2019 Location Address Parcel Number 152 NE 101ST ST, Miami Shores, FL 33138 1132060131980 Contacts Permit NO.: PL-09-18-2521 Permit Type: Plumbing - Residential Work Classification: Septic/Drainfield Permit Status: Approved Expiration: 09/ 16/2019 RICHARD AND JOSEPHINE CAMACHO Owner 152 NE 101 ST, MIAMI SHORES, FL 331382321 Other: 3057577057 ALFONSO SEPTIC CONTRACTOR INC Contractor JOSE BOLANOS 1391 W 36 ST, HIALEAH, FL 33012 Business: 7862514099 Description: SEPTIC TANK AND DRAINFIELD Valuation: $ 4,500.00 Inspection Requests: 1�05-762-494§ Total Sq Feet: 0.00 Fees Amount Application Fee - Other $50.00 CCF $3.00 DBPR Fee $2.36 DCA Fee $2.00 Education Surcharge $1.00 Notary Fee $5.00 Permit Fee $107.50 Scanning Fee $9.00 Technology Fee $3.94 Total: $183.80 Building Department Copy Payments Date Paid Amt Paid Total Fees $183.80 Credit Card 03/18/2019 $183.80 Amount Due: $0.00 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. Authorized Signature: Owner March 18, 2019 / Agent Date Page 2 of 2 t 1` Miami Shores Village g RECEIVED �Q Building Department SEP 24 2 18 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 F BC 2011 BUILDING Master Permit No?Ll �--252.1 PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: [ -S Z N 1D(- S City: Miami Shores County: Miami Dade Zip: `� `� (�0111- Folio/Parcel#: 1(^3 2D(o --© (3 — LR for Is the Building Historically Designated: Yes NO Occupancy Type: 8 � Load: Construction Type: Re !J Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): R VI ( rant (�A M a-c1J d Phone#: Address: j S 2. (1l --- I n( S City: ILI L A M r SNB A s State: Zip: Tenant/Lessee Name: Email: CONTRACTOR: Company Name: FCb IjGo S@{� f (C' (09 I r1aT n"4,C'Phone#: %gl, 25( Yo Cig Address: I Q( C!/'e S?- n S TdICnIe O City: State: R2-- Zip: 3 36/2� Qualifier Name: Off. (Z�0\k6 on1 Phone#: %F& IS /-C(D State Certification or Registration #: SR ©4 % { 22(p Certificate of Competency #: 1 :2 I el 5 ? DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $�'�'(Sa Square/Linear Footage of Work: 1 51) Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace ❑ Demolition Description of Work: ^ PAS fti�e2 °� �� Yli/L 141�i h 4 So Sfi, r,( -' 0f \-, Speciiy,color of c` ' forthru ple . �� .0 CCF Submittal Fee $ Permit°Fee $ - t. cr+n+w. w. •..,.R sr.:o..n_e� ram. -a_..,,.,,,..•. _.n^. ..... »CO/CC Scanning Fee $ Radon Fee $ DBPR $ Z - '3C� Notary $ Technology Fee $ Structural Reviews $. Training/Education Fee $ Double Fee $ Bond $ C-0 TOTAL FEE NOW DUE $ 1 c9 Eac� (Revised02/24/2014) (5CJB• 90 a Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip 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 W11- SignatureiyI� OWNER or AGENT The foregoing instrument was acknowledged before me this day of =LC2 ( t r , 20 ( ? by r ( /1 AA 1) rA kAe'140 , who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: TT oregoing instrument was acknowledged before me this �2 day1 of P ( � � 20 �J by t 1�t S wh''o,A, is personally known to me or who has produce V (,l.QUSFas identification and who did take an oath. NOTARY PUBLIC: APPROVED BY 911's�� Plans Examiner Structural Review SINDIA ALVAREZ MY COMMISSION # GG 238273 EXPIRES: September 3, 2= andea Tt n, Bolen Pain Undewh0i Zoning Clerk (Revised02/24/2014) Alfonso Septic Contractor, INC. 1391 West 36 Street Hialeah, FL 33012 Alfonsoseptic@gmail.com Date: September 3, 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: 152 NE 101 ST Miami Shores FLA. r,Signature Sworn tgl(or affirmed) and subscribed before me this by d Ianc)S Personally Know OR Produced Identification Type of Identification Produced t Nwom pr,16 ozz Print, Type or Stamp Name of Notary 21 day of 3 f—P-�-.20_8 �`""Y °''• MAHARAI K. GONZALEZ er MY COMMISSION # GG 044602 EXPIRES: November2,2020 e' "'��,°;„ ;°•' Bonded ihnr Notary Public Underwriters 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 Exem 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 BE OW YOU ACKNOWLEDGE 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 an day of A Q, , 20� By 'R, c o A 2 C►a iti P< H-Q who is personally known to me or has produced •� /` as identification. Notary: JOSE BOLANOS W COMMISSION 8 00 231457 EXPIRES: O*W 8, 2022 IN S RECEIVED -�`#9 �'d15•� l CEP 4 ?0?M ,.n s jores V ilac�P PLAN OF z(S:WRV - -- -- r r_ T TO CCMF lAlICE WI H ALL FFC'_P^,L '-•4c�x+� `(z' , :. . �� .� 4• ,.•.._,u mac' �tf�'p � Pa • t At 'iF�rl 30o Sal A t (�nr,Pocx lit & osct�( Drat 4 �3+Ilo'� DO � - A'3' t>11 - _ � •. $Las t Q ' t O41 r 1 tzcS, ca. 1SZ v '� 101 S-r 0 L • • 1, a ••• •• p 6 �.5 LMW 'I fVL • ��p� N A �.p �,.�• ma`s ' • N STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT FOR: OSTDS Repair APPLICANT: Richard Camacho PROPERTY ADDRESS: 152 NE 101 St Miami, FL 33138 LOT: 8 BLOCK PERMIT #:13-SC-1874642 APPLICATION # : AP 1362582 DATE PAID: 15 SUBDIVISION: Miami Shores Section 1 FEE PAID: RECEIPT #: DOCUMENT #: PR1153205 PROPERTY ID #: 11-3206-013-1980 [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 [ 900 ] GALLONS / GPD Existina Septic Tank CAPACITY REPAIR A [ 225 GALLONS / GPD .-Aevv Septic tank Laundry CAPACITY MIAMI-DADE COUNTY HEALTH DEPARTMENT N [ 0 ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS] K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ ] D [ 300 ] �sQuARE FEET Existing Drainfield Ned Con SYSTEM ."". R ( 150 SQUARE FEET ew Drainflel Bed Conf. SYSTEM • • • • A TYPE SYSTEM: [x] STANDARD [ ] FILLED [ ] MOUND [ ] • • ' • ' I CONFIGURATION: [ ] TRENCH [x] BED [ ] • F LOCATION OF BENCHMARK: FFE12 ' ' ' ' ' •••• • •• ••••• I ELEVATION OF PROPOSED SYSTEM SITE [ 14.40 ] [ INCHES FT ] [ ABOVE BELOW B211C"AA4RK/REFEMCE P01MY 0 E BOTTOM OF DRAINFIELD TO BE [ 42.40 ] [ INCHES FT ] [ ABOVE BELOW ••• •••• BF�jgF�RK/REFEPENCE •••••• POINT•' L • • • • •••••• D FILL REQUIRED: [ 0.001 INCHES EXCAVATION REQUIRED: r 28.001 INCHES• _'_ & !.... ! 0 T H E R 1.-EXISTING 900 septic tank with and approved filter and 300 sgft drainfield bed configuration TO RE"AINM 2.- Install 150 sf. of drainfield in ... BED.... configuration and a 225 gal septic laundry tank. 3.- Invert elevation and Bottom of drainfield to be no less than 8.97 ' & 8.47 ' NGVD respectively THIS PERMIT IS NOT FOR ANY ADDITIONS. The system is sized for 3 bedrooms with a maximum occupancy of 6 persons (2 per bedroom), for a total estimated flow of 300 gpd. The licensed contractor installing the system is responsible for installing the minimum category of tank in accordance with SPECIFICATIONS BY: S Th contractor (or designee) is required e�fArm a Alfonso 3Lt}SCant tU the dramfield excavation at the n Prior to Final Approval, tfie DOH APPROVED BY: C'�' ytjfC'$ theF-,�viFRaF p ialist II Dade CHD Erick Pere%U!tS to the Origi!lal Site aVa!llatlon suhrnitted. A DATE ISSUED: 09/12/2018 relnspection fee will be assessed if the contractor is not EXPIRATION DATE: 12/11/2018 DH 4016, 08/09 (Obsoletes all previonOsSeditions ��Adicti iemay not be used) Incorporated: 64E-6.003, FAC Page 1 of 3 v 1.1.4 AP1362582 SE1103193 DOCUMENT #: PR1153205 Required drainfield area based on rule 64E-6.015(6)(c)2. Install a new drainfield to achieve Drainfield size requirement. . . .... ...... ...... .... ...... .... .. . . . . .... . .. ..... ...... .... ..... .. .. .... ...... . • . . . . ...... . .. . .. . . . . 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. . . .... 9009V ...... .... ...... .... . .. ..... ...... .... ..... .. .. .... ...... . . . . ...... STATE OF FLORIDA DEPARTMENT OF HEALTH APPLICATION FOR CONSTRUCTION PERMIT Permit Application Number ---------------------------PART II-SITEPLAN--------------------------- Scale: Each block represents 10 feet and 1 inch = 40 feet Mon ■®■■ ■■i�__i�!�■■■■■■■■������■■■ M001-1.0 in. mill", M10.90HE ■■■■■_■m■■■■■■■■■■fTT IJ i';iit"Jti { i7 it t'E■®im {,..i1�T{{ Notes:.. 15 `2— N (2 101, 57, Mia g-t('5hk-,tz<! S ISM 33 i '..'. Site Plan submitted Plan Approved By / *JC35 - Not Approved i Date09 0 Y—/-�— County Health Department ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT DH 4015, 08/09 (Obsoletes previous editions which may not be used) Incorporated: 64E-6.001, FAC (Stock Number: 5744-002-4015-6) Page 2 of 4