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PL-17-1116RES Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138-0000 F�ORiDp' Phone: (305)795-2204 Project Address 10125 BISCAYNE Boulevard Miami Shores, FL 33138-2647 MDHI FOUR LLC Peet NO. PL-4-17-1116 Permit Type: Plumbing - Residential erlWork Classification: Septic Permit Status: APPROVED issue Bate: 511112017 Parcel Number 1132050190190 Block: Lot: 1680 MICHIGAN Avenue MIAMI FL 33139- 1680 MICHIGAN Avenue MIAMI FL 33139- Contractors) Phone Cell Phone EMPIRE ENGINEERING SERIVICES Cl (786)488-8657 Type of Work: SEPTIC TANK INSTALLATION Type of Piping: Additional Info: SEPTIC TANK INSTALLATION Bond Return Classification: Residential Scanning: 1 Fees Due Amount CCF $1.20 DBPR Fee $4.50 DCA Fee $4.50 Education Surcharge $0.40 Permit Fee $300.00 Scanning Fee $3.00 Technology Fee $1.60 Total: $315.20 Expiration: 11/07/2017 Valuation: $ 2,000.00 Total Scl Feet: 0 Pay Date Pay Type Amt Paid Amt Due Invoice # PL-4-17-63779 04/24/2017 Credit Card $ 50.00 $ 265.20 05/11/2017 Credit Card $ 265.20 $ 0.00 Available Inspections: Inspection Type: HRS Approval Final 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. _.Zuthermore, I authorize the above -named contractor to do the work stated. 11, 2017 Authorizakr ttfnature:Owner / Applicant / Contractor / Agent Building Department Copy May 11, 2017 1 AU co rv, q-S-2 G 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 BUILDING PERMIT APPLICATION ❑BUILDING ❑ ELECTRIC ❑ ROOFING FBC 20 Master Permit No.r _ k G — 6 3 y Sub Permit No. !E L 'Tl I ( C, ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 010 City: Miami Shores County: Miami Dade Zip: Z3 13 Folio/Parcel#: 11 _ - ©( ci - 013 D Is the Building Historically Designated: Yes NO _ Occupancy Type:,IzE Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): P--j li R Cr Phone#: Address: City: Tenant/Lessee Name: Email: State: Zip: Phone#: CONTRACTOR: Company Name: ,AA1 �^L —.� 1 N e- e r P n - Phone#: 9 �, C Address:2 w 1 U City: kAn. State: l Zip: Qualifier Name: \,C::){c—G � 4� 1/1 Phone#: S? 6 U g IR WC, State Certification or Registration #: S1k ©a rCertificate of Competency #: DESIGNER: Architect/Engineer: Address: City: Phone#: Zip: Value of Work for this Permit: $ ZCX70 Square/Linear Footage of Work: Type of Work: ❑ Addition ❑I Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: S 1'>i C 4o n k :1 4 c- •-i: ) �Ij -L ' —, Specify color of color thru tile: Submittal Fee $ Scanning Fee $ Technology Fee $_ Structural Reviews $ (Revised02/24/2014) Permit Fee $ Radon Fee $ Training/Education Fee $ CCF $ DBPR $ CO/CC $ _ Notary $ Double Fee $ _ Bond $ TOTAL FEE NOW DUE $ E 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. Signatu OWNER or AGENT The foregoing instrument was acknowledged before me this day of me or who has produced , 20 by who is personally known to as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Signature, CONTRACTOR The foregoing instrument was acknowledged before me this day of , 20 by who is personally known to me or who has produced identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: Seal: as ssssss.*.**::*:sssssss**r****sss***s*************s•*****************ssss*::ss.*********.**.*****r*********** APPROVED BY Plans Examiner Structural Review Zoning Clerk (Revised02/24/2014) Property Search Application - Miami -Dade County Page 1 of 1 fi ,►e-• n' OFFICE Summary Report Property Information Folio: 11-3205-019-0190 Property Address: 101� 25_BISCAY.NE,BLVD Miami Shores, FL 33138-2647 Owner BISCAYNE 10125 LLC Mailing Address 1680 MICHIGAN AVE 910 MIAMI BEACH, FL 33139 USA PA Primary Zone 1100 SGL FAMILY - 2301-2500 SQ Primary Land Use 0101 RESIDENTIAL -SINGLE FAMILY: 1 UNIT Beds / Baths / Half 2/2/0 Floors 1 Living Units 1 Actual Area 2,090 Sq.Ft Living Area 1,520 Sq.Ft Adjusted Area 1,801 Sq.Ft Lot Size 14,028 Sq.Ft Year Built 1957 Assessment Information Year 2016 2015 2014 Land Value $383,496 $349,076 $309,043 Building Value $7,921 $125,350 $122,108 XF Value $0 ................. $2,621 $2,656 _. Market Value $391,417 $477,0471 $433,807 Assessed Value $391,417 $477,047 $366,735 Benefits Information Benefit Type 2016 2015 2014 Non -Homestead Cap Assessment Reduction $67,072 Note: Not all benefits are applicable to all Taxable Values (i.e. County, School Board, City, Regional). Short Legal Description MIAMI SHORES SEC 8 REV PB 43-67 LOT 8 LESS BEG SW COR LOT 7 TH SWLY27.41FT NWLY120.59FT NELY52.35FT SELY128FT TO POB & LOT 9 LESS NWLY12FT FOR R/W Generated On : 4/24/2017 Taxable Value Information 2016 2015 2014 County Exemption Value $0 $0 $0 Taxable Value $391,417 $477,047 $366,735 School Board Exemption Value $0 ._Taxable $0 Value $39 d,4�7 $477,047 $433,807 City Exemption Value $0 $0 $0 Taxable Value $391,417 $477,047 $366,735 _..__._____._........_....__..______.... _____________..........__....... ._.._...........____.___._.....__...... ____.._._..... _._........ Regional Exemption Value j $0 __._...._.._____.._ Taxable Value $391,417 $0 .._._.._._._..... _._._....... _.__.. $477,047 $0 .... --._.................. ._.............. $366,735 Sales Information Previous OR Book - Price Qualification Description Sale Page 10/24/2015 $496,000 30280-0036 Qual by exam of deed 05/12/2015 $480,000 29632-1960 Affiliated parties ._.__.___.........._._____...... __..... _...... _..... _................... Financial inst or "In Lieu of 08/26/2014 $365,100 29292-0162 Forclosure" stated 05/01/2005 $550,000 23429-0866 Sales which are qualified 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/ 4/24/2017 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 FURNACES, BOILERS, HEATERS, TANKS, AIR CONDITIONERS, ETC.... permit must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS, 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 issu In the absence of such posted notice, the inspection will not be appr ed and a rei pection fee will be charged. r Signature Signature OW or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this 71 day of A pr � jt 120 Jq by e It i who is personally known to me or who has produced identification and who did take an oath. NOTARY PUBLIC: d1Q A Ar109M Alf 4%kAIL NOTARY PUBLIC Sign STATE OF FLORM Cam ,— GGOZM74 Print: Seal: as The foregoing instrument was acknowledged before me this — day of pp r, 2,n r N 20(9 E by T� ��rG QA la fiL/� who is personally known to me or who has produced as identification and who di o AMA pOTAFtY PUBLIC NOTARY PUBLIC: STATE OF FtORIDA Seal: APPROVED BY 0 6 ['7 Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) 2017 FLORIDA LIMITED LIABILITY COMPANY ANNUAL REPORT DOCUMENT# L16000156453 Entity Name `BISCAYNE 10125 � Current Principal Place of Business: 1680 MICHIGAN AVE SUITE 910 MIAMI BEACH, FL 33139 Current Mailing Address: 1680 MICHIGAN AVE SUITE 910 MIAMI BEACH, FL 33139 US FEI Number: 81-3643459 Name and Address of Current Registered Agent: SUNNY HOUSES CONS LLC 1680 MICHIGAN AVE STE 910 MIAMI BEACH, FL 33139 US FILED Mar 18, 2017 Secretary of State CC7793955685 Certificate of Status Desired: No The above named entity submits this statement for the purpose of changing its registered office or registered agent, or both, in the State of Florida. SIGNATURE: Electronic Signature of Registered Agent Authorized Person(s) Detail Title MGR Name bENEDETTI, CLAUDIO Address 1680 MICHIGAN AV STE 910 City -State -Zip: MIAMI BEACH FL 33139 Title MGR Name SANTINI, ANDREA Address 1680 MICHIGAN AVE, SUITE 910 City -State -Zip: MIAMI BEACH FL 33139 Date I hereby certify that the information indicated on this report or supplemental report is true and accurate and that my electronic signature shall have the same legal effect as if made under oath; that I am a managing member or manager of the limited liability company or the receiver or trustee empowered to execute this report as required by Chapter 605, Florida Statutes; and that my name appears above, or on an attachment with all other like empowered. SIGNATURE: CLAUDIO BENEDETTI MGR 03/18/2017 Electronic Signature of Signing Authorized Person(s) Detail Date I Miami shores Village tn- wilding Department 'tiA1 10050 N.E.2nd Avenue Miami Shores, Florida 33138 ...... _TI;y(3,Qa),795 220.4.—___.. .— Fax: (305) 756.8972 Notice to Owner — Workers' Comoensation Insurance Exe 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. ii Signature: State of Florida County of Miami -Dade The foregoing was acknowledge before me this 10 day of Mc /'c1--, , 20 BY C L4 U w Nr who is personally known to me or has produced as identification. Empire Engineering Services, Corp. 2423 SW 147 Ave. #344 Miami, Florida 33185 empireengineering@hotmail.com 3-20-2017 State of Florida County of Miami -Dade Before me this day personally appeared Jorge Millan who, being duly sworn, deposes and says: That he will be the only person working on the project located at 10125 Biscayne Blvd. Miami Shores, FI. 33178 Sworn to (or affirmed) and subscribed before me this 20 day of March, 2017, by Jorge Millan Personally know Or Produced Identification Type of Identification Produced Cna A. ArIeft d NOTARY PUBLIC UTEE OF FLORIDA Print, Type or Stamp�Vame oflVotary r STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT CONSTRUCTION PERMIT FOR: OSTDS New APPLICANT: (MDHI FOUR LLC) PROPERTY ADDRESS: 10125 biscayne Blvd Miami, FL 33138 LOT: 8-9 BLOCK: 176 SUBDIVISION: Miami Shores Sec. 8 PROPERTY ID #: 11-3205-019-0190 PERMIT # : 13-SM-1727265 APPLICATION # : AP 1267736 DATE PAID: FEE PAID: RECEIPT #: DOCUMENT #: PR1048508 [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 Seotic Tank CAPACITY A [ ] GALLONS / GPD N/A CAPACITY N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS] K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ ] D [ 500 ] SQUARE FEET Bed Conf. Drainfield SYSTEM R [ ] SQUARE FEET N/A SYSTEM A TYPE SYSTEM: [x] STANDARD [ ] FILLED [ ] MOUND I CONFIGURATION: [ ] TRENCH Cx] BED [ ] F LOCATION OF BENCHMARK: FFE: 10.45' NGVD I ELEVATION OF PROPOSED SYSTEM SITE [ 14.80][ INCHES FT ][ABOVE BELOW BENCHMARK/REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ 44.80][ INCHES FT ][ABOVE BELOW BENCHMARK/REFERENCE POINT L D FILL REQUIRED: [ 0.00] INCHES EXCAVATION REQUIRED: [ 72.001 INCHES O T H E R 1.- Install a 900 gal. septic tank with an approved filter 2.- The licensed contractor installing the system is responsible for installing the minimum category of tank in accordance with s. 64E-6.013(3)(0 FAC. 3.- Install 500 sf. of drainfield in BED configuration. 4.- Install 42" of slightly limited soil at the bottom of the drainfield. 5.- Perimeter of excavation area shall be at least 2 ft wider and longer than the proposed absorption bed or trench. (Comments Continued on Page 2.) SPECIFICATIONS BY: Jorae M Millan TITLE: APPROVED BY: TITLE: ENGINEERING SPECIALIST I vene Clermont DATE ISSUED: 02/09/2017 DH 4016, 08/09 (Obsoletes all previous editions which may not be used) Incorporated: 64E-6.003, FAC EXPIRATION DATE Dade CHD 08/07/2018 Page 1 of 3 v 1..1.4 ?,P1267736 SE1022122 DOCUMENT #: PR1048508 - Invert elevation of drainfield to be no less than 7.21' NGVD -Bottom of drainfield elevation to be no less than 6.71' NGVD system is sized for 3 bedrooms with a maximum occupancy of 6 persons (2 per bedroom), for a total estimated flow of 300 licensed contractor installing the system is responsible for installing the minimum category of tank in accordance with s. •6.013(3)(0, FAC. NOTICE OF RIGHTS A parry 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.