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PL-19-855DIVISION OF Environmental Health Florida Health Miami -Dade County OSTDS/Well Division 11805 SW 26th Street • Miami, FL 33175 Inspector#t� /�l o,) j- �"o' Date 7 Address r 17 41'v //-- OSTDS # /Y Comments: Signature Location Address Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Issue Parcel Number 119 NW 110TH ST, Miami Shores, FL 33168 1121360030550 Contacts Permit NO.: PL -04-19-856 Permit Type: Plumbing - Residential Work Classification: Drainfield Permit status: Approved Expiration: 10/23/2019 Inspection Requests: Description: INSTALL DRAINFIELD Valuation: $ 3,000.00 305-3ti2 41149 TO REPLACE EXPIRED PERMIT PL -9-18-2441 Total Sq Feet: 0.00 Fees RICHARD HAISLEY Owner 119 NW 110 ST, MIAMI SHORES, FL 33168 Other: 9546485602 MR C'S PLUMBING & SEPTIC INC Contractor KEMBLE ETTRICK Business: 3056517859 Date Paid Amt Paid 50% Renewal Fee $52.50 Inspection Requests: Description: INSTALL DRAINFIELD Valuation: $ 3,000.00 305-3ti2 41149 TO REPLACE EXPIRED PERMIT PL -9-18-2441 Total Sq Feet: 0.00 Fees Amount Payments Date Paid Amt Paid 50% Renewal Fee $52.50 Total Fees $102.50 Application Fee - Other $50.00 Credit Card 04/26/2019 $102.50 Total: $102.50 Amount Due: $0.00 Building Department Copy In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In�quirt4cd g th ermit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits ar for ECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. O9 NERg�)Nc � I certify Q_ 9t�t all the foregoing information is accurate and that all work will be done in compliance with all applicable laws re ulatin t c o an z nin uthermore, I authorize the above named contractor to do the work stated. Signature: Owner / Applicant / Contractor / Agent Date April 26, 2019 Page 2 of 2 Miami Shores Village CEftFD \APR S 2 19 Building Department \ 19950 N,€,2nd Av@nu@, Miami Shor@s, Florida 33138 BY: � �! Tel; (395) 795--.2204 Fax; (395) 736=897 INSPECTION LINE PHONE NUMBER; (396) 762-4949 FBC 20 BUILDING Master hrmit Ng, L- - } PERMIT APPLICATION Sub Kermit No. 0131,11191NO M €€€ETM€ 0 ROOFING Ej REVISION [:] €XT€N51ON RENEWAL: OP€9MBING M M€CHANICA6 OPUBLIC WORKS M CHANGE OF M CANE€ELATION Q SHOP CONTRACTOR DRAWINGS JOB A9@R€55; 119 NW 110 Street City: Miami Shores County: Miami Dada zip: Folio/Parc@l#; Is th@ Building Historically ®@signat@d; Yes _ __-- NO X 9cEopancy Typ@: Load:._ Construction Typo: —Flood --Flood ?on@: sF€: FFE: OWNER; Name (F@@ 5impl@ Tiftholder): Richard Haisley Rhon@#: „a,4- 119 NW 110 Street City: Miami Shores State; FL zip: 33168 T@nant/6@w@ Nam@= NA Phon@#; €mail: CONTRACTOR; Company Nam@: Mr. C's Plumbing & Septic Phon@#: 305-651-7859 Add1 @S5: 19932 NW 2 Avenue my: Miami State; FL Qualifier Nam@: Kemble Ettrick Phon@#: State C@rti#ication or R@gistrAien M SR061536 Certificat@ of Competency it: DESIONER; Architect/€n$ine@r: NA Phone# ip: 33169 305-651-7859 Address: city: Stat@: Value of Work for this P@rmit; 3Q00o f 5qu@r@/€In@ar Feotag@ of Werk; Typ@ of Werk; 0 addition M Ascription of Work; N@w R@pair/Replace Ewpo Specify color of color thry tllw, Submittal F@@ 0 P@rmit F@@ CCF EO/C€ Scanning F@@ Radon F@@ $ Technology F@@ $ Training/Education Fee Structural R@vi@ws — (ftPv1§ 9?/?4/Z014) 9BPR $ Zip: 0 D@molition Notary @oobl@ F@@ 0 Bond 6 TOTAL FSE NAW ©UF $ 102 --SC) Bonding Cpmpany's Name (if appli€abl@) NA Bonding Company's Addr@ss city.Mato zip ._ Mortgage I•pnd@r'5 Name (if applicable) NA---- - ----- -- ---- Mortgage Lender's Address - city state -- -- - _ _ - - _ Zip - - ---- Application N her@by mad@ to obtain a p@rmit to do th@ work and installations a5 indicated: I certify that no work or installation has cPmm@nc@d prior to the issuance of a permit and that all work will b@ performed to meet th@ standards of all laws regulating cpn5truction in this jurisdiction: 1 and@rstand that a 5eparat@ permit mint be secured for ELECTRIC, PLUMBING, SIGNS, PO9L5, FURNACES, BOILE=RS, HEATERS, TANKS, AIR CONAITION€RS, ETC:::-: OWNE015 AFFIDAVIT- I certify that all the for@going information N accurate and that all work will b@ done in cemplianc@ with all applicable laws rquiating cpn5tructipn and ?oning: "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," NPti€o to Applicant; AS a €PnditiPn to the issuan€o of a Wilding permit with an estimatod NalNe exceeding $1500, the applicant must prP.mise in gPPd faith that a €Ppy Pf the notice Pf commencement and €Pnstruction lien law brp€hero will be delivered to the por5Pn whose property is 5Nbjo€t to attachment- Ahp, a €ert0ed copy of the recorded notice of commencement must be pasted at the job :situ far the first inspe€tiPn .which P€r ar3 Seven (Y) daY5 after the building permit is k5aed. in the abson€€ Pf Sd€h posted nPti€e, the inspo€tion will not bo approved and a roinspo€tipn. foo will be €barge Signator@__ __ OWNER or AGENT The for@gping instrument was a€know)@dQ@d before me this day of _ w ?Q- �°I by �� iL�cvel ��ISILH who is personally known to m@ Pr whp has produc@d P vt rS Cry n s a5 identificatipn and who did take an oath: NOTARY PUBLIC; sign; � CQ%`�.• ' Print; �az1�(d l�,tot✓�'r d: Signature CONTRACTOR The fpr@gping in5trum@nt was al=knpwl@dg@d b@fpr@ me this --- day of Thr%rrA. J by CA- who ES p@rspnally knQvn to me or who has produced as identification and who did take an oath: NOTARY PUBLIC; Sign! % l Pring (o( DONALD MARTIN Seal! : ,: DONALD MARTIN MY COMMISSION # GG102743 MY COMMISSION # GG102743 EXPIRES May 09, 2021 �',?d:EXPIRES May 09, 2021 APPROVFA BY -� y �� �/5 Plans Fgamin@r - - 79ning Structural R@vi@w 0@rk TL -q-19 - a-,5 5 BOUNDARY SURVF Mj SHORES VILLAGE _ j 1 For Septic Tank and jor drainfield, --FOUND 112' ON., M" 15 - 'A'S inspection until a d y IRON ROD A VV %,;n-nR j1pand NO ID. 75.00 scaping is restore r6s 4) TILE ICA sidewalk in wted and repa' d 0.4 o NDRIVEWAY 4C, 122' Existing90 LOT 22) 1 - gal S.T. Existing 300 s.f. BLOCK2-20 remain ae Drainfield to be Uj replaced in new b2Z 0 area. CD 221• kip- , • 190009 Cd 0.5W -j _12-5' 22 c" 15.1' c—'i 25.3' 12.1' FOUND 1)2- o FOUND M" BLM P IRON C� ; CORW? NO ID NO ID(P) IRON ROD 704.3• =620 . — Y CONCRETE SIDEWALK ;Z 24'PARKWAY Cn Cn EP 75'Rff.'�. EP 44 20 _T T7� By. NW 11 OTH STRE79T ----.'. ASPHALT PA4I4iNT- By. oti lr-etmc-, 1A IF #: PERMIT�-- Mlar-ni Shr(,esvinage CC��,f_r,f-Z��j"APPROVED BY DATE ZONING DEPT BLDG DEPT SU13JECT-l'0 C(-[,jpjjPNCE Vvi FH ALL FEDERAL STATE ANL) CU-Xt"t- L --ES AND RE-(3tjLAT10 I NS STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL, SYSTEM CONSTRUCTION PERMIT FOR: OSTDS Repair APPLICANT: RICHARD HAISLEY PERMIT #:13 -SM -1875614 APPLICATION #: AP1363xd7 DATE PAID: FEE PAID: RECEIPT #: DOCUMENT # : PR1163183 PROPERTY ADDRESS: 119 NW 110 St Miami, FL 33168 LOT: 23 BLOCK: 220 SUBDIVISION: M9 PROPERTY ID #: 11-2136-003-0550. [SECTION, TOWNSHIP, RANGE, PARCEL NUMBER) (OR TAX ID NUMBER] , ,1 SYSTEM DESIGN AND SPECIir'ICATIONS T [ 900 I GALLONS I GPD Existing Septic Tank to remain CAPACITY A ( 0 j GALLONS / GPD CAPACITY N [ 0 i GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS] K [ j GALLONS DOSING TANK CAPACITY [ )GALLONS @[ ]bOSEB PER 24 HRS #Pumps [ ]. D [ 300 ] SQUARE FEET New D F in Bed Conf. SYSTEM R [ 0 ] SQUARE FEET SYSTEM . A TYPE SYSTEM: [X] STANDARD [ ] FILLED [ ] MOUND [ ) I CONFIGURATION: [ ] TRENCH [x] BED [ ] N F LOCATION OF BENCHMARK: FFE 13.0' I ELEVATION OF PROPOSED SYSTEM SITE ['24.00 INCHES FT I ABOVE BELOW BENCHMARK/REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ 74.00 it ' FT If ABOVE SELC3W BENCHMARK/REFERENCE POINT L D FILL REQUIRED: I0.00_j INCHES EXCAVATION REQUIRED: [ 62.00) IN( I. -EXISTING 900 septic tank with and approved filter TO REMAIN. 0 2.- Install 300 sf. of drainfield in... BED...`.TRENCH... configuration,' T 3. -Install 12" of slightly limited soil at the bottom of the drainfield. H 5.- Invert elevation and Bottom of drainfield to be no less than 7.33' & 6.83' GVD respectively. THIS PERMIT IS NOT FOR ANY ADDITIONS. ( Cor,�rrients cont�ued"on 1page 2 )_ R I .,...... ...... SPECIFICATIONS BY. Mr Clr$ TITLE: APPROVED BY: _ TITLE: OPS ENVIRONMENTAL SPECIALIST III Dade CHI) DATE ISSUED: 09/17J;MB EXPIRATION DATE: 12/11/2018 DH 4016, 08/09 (Obsoletes all previous editions which may not be used) Incorporated: 64E-6.003, FAC v l.l.d AP1363207 SE1103174 Page 1 of 3 SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF SECTION 381.0065, F.S., AND CHAPTER 64E-6, F.A.C. bEPARTMENT 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 SPECIir'ICATIONS T [ 900 I GALLONS I GPD Existing Septic Tank to remain CAPACITY A ( 0 j GALLONS / GPD CAPACITY N [ 0 i GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS] K [ j GALLONS DOSING TANK CAPACITY [ )GALLONS @[ ]bOSEB PER 24 HRS #Pumps [ ]. D [ 300 ] SQUARE FEET New D F in Bed Conf. SYSTEM R [ 0 ] SQUARE FEET SYSTEM . A TYPE SYSTEM: [X] STANDARD [ ] FILLED [ ] MOUND [ ) I CONFIGURATION: [ ] TRENCH [x] BED [ ] N F LOCATION OF BENCHMARK: FFE 13.0' I ELEVATION OF PROPOSED SYSTEM SITE ['24.00 INCHES FT I ABOVE BELOW BENCHMARK/REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ 74.00 it ' FT If ABOVE SELC3W BENCHMARK/REFERENCE POINT L D FILL REQUIRED: I0.00_j INCHES EXCAVATION REQUIRED: [ 62.00) IN( I. -EXISTING 900 septic tank with and approved filter TO REMAIN. 0 2.- Install 300 sf. of drainfield in... BED...`.TRENCH... configuration,' T 3. -Install 12" of slightly limited soil at the bottom of the drainfield. H 5.- Invert elevation and Bottom of drainfield to be no less than 7.33' & 6.83' GVD respectively. THIS PERMIT IS NOT FOR ANY ADDITIONS. ( Cor,�rrients cont�ued"on 1page 2 )_ R I .,...... ...... SPECIFICATIONS BY. Mr Clr$ TITLE: APPROVED BY: _ TITLE: OPS ENVIRONMENTAL SPECIALIST III Dade CHI) DATE ISSUED: 09/17J;MB EXPIRATION DATE: 12/11/2018 DH 4016, 08/09 (Obsoletes all previous editions which may not be used) Incorporated: 64E-6.003, FAC v l.l.d AP1363207 SE1103174 Page 1 of 3 Property Search Application - Miami -Dade County Page 1 of 1 OFFICE OF THE PROPERTY APPRAISER Summary Report Property Information Folio: 11-2136-003-0550 Property Address: 119 NW 110 ST Miami Shores, FL 33168-4320 Owner RICHARD FRANK HAISLEY II PRISCILLA BRANCO HAISLEY Mailing Address ............. __ 119 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 2,016 Sq.Ft Living Area 1,185 Sq.Ft Adjusted Area 1,630 Sq.Ft Lot Size 9,150 Sq.Ft Year Built 1940 Assessment Information Year 2018 2017; 2016 Land Value $196,886 $196,886 $164,440 Building Value $140,702 $55,544 $55,592 XF Value $0 $0 $0 Market Value $337,588 $252,430 $220,032 Assessed Value $337,588 $144,828; $131,662 Benefits Information Benefit Non -Homestead Cap Type Assessment Reduction 2018 2017 2016 ............... __ $107,602 $88,370 Homestead Exemption $25,000 Taxable Value $287,588 Second Homestead Exemption $25,000 Note: Not all benefits are applicable to all Taxable Values (i.e. County, School Board, City, Regional). Exemption Value ......................................................._............._......_.. Taxable Value ®.®t..._®.. Short Legal Description 36 52 41 ._... ........ MIAMI SHORES EXT PB 43-40 LOT 23 BLK 220 LOT SIZE 75.000 X 122 75R 184001 Generated On : 9/14/2018 Taxable Value Information Previous Sale Price 10/13/2017 $418,000 OR Book -Page 30721-1182 Qualification Description Qual by exam of deed County 2018 20171 2016 Exemption Value 23685-2514 $0 $0 Taxable Value $287,588 $144,828 $131,662 School Board Exemption Value ......................................................._............._......_.. Taxable Value ®.®t..._®.. $25,000 $312,588 $0 _. _.._ $252,430 $0 _...._................_... _...................... . $220,032 City Exemption Value $50,000 $0 $0 Taxable Value ......._._____.__ ........................ .. Regional $287,588 $144,828 ___._.___._.._._..___......__ $131,662 _.........._ Exemption Value $50,000 $0 $0 Taxable Value $287,588 $144,828 $131,662 Sales Information Previous Sale Price 10/13/2017 $418,000 OR Book -Page 30721-1182 Qualification Description Qual by exam of deed 11/19/2012 $100,000 28368-4705 Qual by exam of deed 08/01/2005 $350,000 23685-2514 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 hftp://www.miamidade.gov/info/disclaimer.asp https://www.miamidade.gov/propertysearch/ 9/14/2018