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PL-18-245Permit NO. PL-1-18-246 Miami Shores Village o Permit Type: Plumbing - Residential " 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Perl"111 Work Classification: Septic yam. Phone: (305)795 2204 Pait'Status: APPROVED FtoRtoA Issue Date: 2/2812018 Expiration: 08/27/2018 Project Address Parcel Number Applicant 114 NE 106 Street 1121360050070 Miami Shores, FL 33138-2037 Block: Lot: JACQUELINE IRWIN Owner Information Address Phone Cell JACQUELINE IRWIN 114 NE 106 Street MIAMI SHORES FL 33138- 114 NE 106 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone ALFONSO SEPTIC CONTRACTOR INC (786)251-4099 Type of Work: PUMP AND ABANDONMENT OF SEPTIC TANK Type of Piping: Additional Info: PUMP AND ABANDONMENT OF SEPTIC TANK Bond Return : Classification: Residential Scanning: 1 Fees Due Amount CCF $5.40 DBPR Fee $4.50 DCA Fee $3.00 Education Surcharge $1.80 Notary Fee $5.00 Permit Fee $300.00 Scanning Fee $3.00 Technology Fee $7.20 Total: $329.90 Valuation: $ 8,500.00 Total Sq Feet: 500 Pay Date Pay Type Amt Paid Amt Due Invoice # PL-1-18-66286 02/28/2018 Credit Card $ 279.90 $ 50.00 01/31/2018 Credit Card $ 50.00 $ 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. _Futhermore I a„thorize the above -named contractor to do the work stated. February 28, 2018 Owner / Applicant / Contractor / Agent Building Department Copy February 28, 2018 1 �dSe(3010 NaS Miami Shores Village RECEIVED �� l Building Department JAN 31 018 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 ol Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 51-1 FBC 20M BUILDING Master Permit No. ' 1 4^C1 5 _T PERMIT APPLICATION Sub Permit No.�l N8r ZU S ❑ BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑ RENEWAL PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: / / t - L) C — /y & se - City: /Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: �_ Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder)- Ucye(! Il.r tV/!t/ Phone#: Address: 1 /9- V15 1D6sr City: jq/A 1.4I s !lollga j State: 1-,In— Zip: Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: A l Fooso 1' I (e (D UTA roc I ©/' Phone#: 7?6 2Sf-L/69r, Address: _13%1�- City: / State: 012 Zip: 3 � V l Qualifier Name: Phone#: State Certification or Registration #:QZ =QRM 9 %/a Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ j!soa Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration New ❑ Repair/Replace ❑ Demolition Description of Work: Er)"(' A dJ le�s'�'�1r1 ��� io���_�IaN-�Pc�� ����<< a►�o �c���a, ot�Q�a-r.�.� Specify color of.color thrutile:' ' g Submittal Fee $ Permit Fee $ ��t� CCF $ CO/CC $ Scanning Fee $ Technology Fee $ Structural Reviews $ Radon Fee $ 3 • O7 DBPR $ Notary $ Training/Education Fee $ Double Fee $ Bond $ Z� �� q`T� p/ rS7� TOTAL FEE NOW DUE $ (Revised02/24/2014) 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 Zi 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 on 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 OWNER or AGENT The foregoing instrument was acknowledged before me this Z4 day of v` 20 X. a by '1; EGG V�� �rV w �+►. who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: C�GJ2.L1C� `t C^ «'y Seal: LAURAFARLEY My wMIu1issa # FF 188027 * * EXPIRES: March 16, 2019 p`�tF Boeded Thru Budget Nobry Services 'Pew Signature COfTRACTOR e foregoing instrument was acknowledged before me this _ day of 20J by who is personally known to me or who has produced -�' �(U1JI �� as identification and who did take an oath. NOTARY P Sign'. '* MAHARAIK. GONZA-- EZ Print: L— Seal: ";Fo F`oP; . SIRES: November2, 2020 2 Bonded Thru Notary Public Underwriters APPROVED BY ® Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT CONSTRUCTION PERMIT FOR: OSTDS New APPLICANT: Jacqueline Irwin PROPERTY ADDRESS: 114 NE 106 St Miami, FL 33136 LOT: 70 BLOCK: 201 SUBDIVISION: PROPERTY iD #: 11-2136-005-0070 PERMIT #: 13-SC-1754918 APPLICATION #: AP1285828 DATE PAID: FEE PAID: RECEIPT #: DOCUMENT #: PR1065277 [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 [ 1,050 ] GALLONS / GPD Sentic 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 trench confiauration SYSTEM R [ ] SQUARE FEET N/A SYSTEM A TYPE SYSTEM: (X] STANDARD [ ] FILLED [ ] MOUND [ ] I CONFIGURATION: [X] TRENCH [ ] BED [ ] N F LOCATION OF BENCHMARK: CL NE 106 st., 10.98' NGVD I ELEVATION OF PROPOSED SYSTEM SITE ( 6.96 ) INCHES FT ][ABOVE BELOW BENCHMARK/REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ 36.96][ INCHES FT ][ABOVE/ BENCHMARK/REFERENCE POINT L D FILL REQUIRED: ( 0.001 INCHES EXCAVATION REQUIRED: [ 72.001 INCHES 0 T H E R Invert elevation of drainfield to be no less than 8.40' NGVD. 'Bottom of drainfield elevation to be no less than 7.90' NGVD. Install 42" of slightly limited soil under the bottom of drainfield. -Perimeter of excavation area shall be at least 2 ft. wider and longer than the proposed absorption bed or drain trench. The system is sized for 4 bedrooms with a maximum occupancy of 8 persons (2 per bedroom), for a total estimated flow of 400 gpd. 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. BY: Teresa J Solomon APPROVED BY: TITLE: Carlos H leaza DATE ISSUED: 06/13/2017 TITLE: Master Septic Tank Contractor Dade CHD EXPIRATION DATE: 12/13/2018 DH 4016, 08/09 (Obsoletes all previous editions which may not be used) 4 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. Alfonso Septic Contractor, INC. 1391 West 36 Street Hialeah, FL 33012 Alfonsoseptic@gmail.com Date: January 24, 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: 144 NE 106 Street Miami, Shores, FL 33136 �e ractor Sigofature Sworn to (or affirmed) and subscribed before me this day of .20 by Personally Know OR Produced Identification ,(31�dS32o20 Type of Identification Produced or gta3hp Name of Notary IDANIA GONZALEZ * MY COMMISSION i FF 900745 EXPIRES: September 30, 2019 Bonded Thru Budget Notary Services Notice to Owner - Workers' Corn Miami shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 nsation 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: l . 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. **1 �Signature: �� Owner State of Florida County of Miami -Dade ` / t The foregoing was acknowledge before me this � Y day of 20�b By. . 3CAC Ca n i W t who is personally known to me or has produced identification. Notary: '47'o LAUf�1FARLEr— * * OFF 189027 SEAL: EXPIRES: Mertz 16, 2019 �''ra►�.�'t�" Raided Thm Nohry SerMcee