PL-19-1065Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Issue Date:,OS/ {2019
Location Address Parcel Number
410 NE 94TH ST, Miami Shores, FL 33138 1132060140360
Contacts
Permit No.: PL -05-19-1065`:''
Permit Type:: Plumbing - Residential
Work Classification: Septic/Drainfteld
Permit Status: Approved'''
Expiration: 11/25/2019
DANIEL CUBES Owner A SUPER SEPTIC & DRAIN FIELD INC Contractor
410 NE 94 ST BRYAN K ZERO
Mobile: 9176125104 DANIELCUBES@MAC.COM 7701 W 18 LN, HIALEAH, FL 33014
asuperseptic@gmail.com
Description: NEW SEPTIC AND DRAIN FIELD Valuation: $ 6,500.00 Inspection Requests:
305-752-4049
Total Sq Feet: 0.00
Fees
Amount
Application Fee - Other
$50.00
CCF
$4.20
DBPR Fee
$3.41
DCA Fee
$2.28
Education Surcharge
$1.40
Permit Fee
$177.50
Scanning Fee
$9.00
Technology Fee
$5.69
Total:
$253.48
Payments
Date Paid Amt Paid
Total Fees
$253.48
Credit Card
05/29/2019 $203.48
Credit Card
05/10/2019 $50.00
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 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.
Signature: Owner
/ Applicant / Contractor / Agent
Date
May 29, 2019 Page 2 of 2
BUILDING
PERMIT APPLICATION
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
F�BC 20� �
Master Permit No. jr bo ,� —1 G I — t 06 S
Sub Permit No.
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION 7RENEWAL
PLUMBING ❑ MECHANICAL ❑PUBLICWORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
o' %() /A � WL 106ADDRE55: `� " qT
City: Miami Shores �1 County: Miami Dade Zip:
Folio/Parcel#: ��� -D/T - Is the Building Historically Designated: Yes NO
Occupancy Type: —6 N
Load: Construction Type: Flood Zone: 'A- BFE: N% FFE: N /�
OWNER: Name (Fee Simple Titleholder): Phone#:
Address: 'L(a q Y � r
City: H^1 �Ayi-� State: Zip: 37113 8
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: Fc Wo- ��Ci Wr� fieri Afc- Phone#: 305- 3/ 01/3
Address: 1 1Q% L47q�
City: i 7 Aim State: -fL Zip: 3�61
Qualifier Name: Phone#:
State Certification or Registration #: `� �`-� ��`' Z" Certificate of Competency #: Z L
DESIGNER: Architect/Engineer: Phone#: /
Address: �� City: /" State: Zip:
Value of Work for this Permit: $ wl �� Square/Linear Footage of Work: 30o a'!2�
Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace ❑ Demolition
Description of Work: D 9-/X- i rJ �I Ea -i) PAI -V I -'14"l
Specify color of color thru tile:
Submittal Fee
Scanning Fee $
Permit Fee $
Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $
(Revised02/24/2014)
CCF $ CO/CC $
DBPR $
Notary
Double Fee /$
Bond $ 5V0-
TOTAL FEE NOW DUE $203. Cl
-? 63 - e-40
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 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 4
OWNER or AGENT
The foregoing instrument was acknowledged before /me this
! Q day o 20� IJ by
n �e l s ii who is personally known to
me or y�io has produced 1 t(� ✓ ICS h S as
Signature&V
I /' C ACTOR
The foregoing instrument was acknowledged before me this n
day of r ' `a V 120 by
{ h ,--e1'Owho is pe sonally known to
me or who has Mduced rl � y � f ct ns`g as
identi icat n a d o did take an oath. identif ca n Id w o did take an oat ���`" y p "/�j1N111111//ry". �F10//OTA Y P BLI ay PRtErO////�A OTA Y P
.1 AvIl
Sign: _ '* Z Sign: L>
Print: * '' ' < Print: IAG1' ' ice. ••� Ona.d'�``J `�•
Seal:0 A, ��� •'ti8 u�a •• Q,\�� Seal: /i////// °UC •SfA� �\```
/�j 1C, .1 1111111NN����
**:********srs***ss*******r**r*s**s*s***s�*r**s*********#******ss**s*****rr****:**•***:**.**#*:*sss*****sss*
APPROVED BY �� �3�9 Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
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: `V
( Owner
State of Florida
County of Miami -Dade
The foregoing was acknowledge before me this In day of 20 1� .
By JX.`lfli-e' CV S who is personally known to me or has produced
ntification.aWNN"y PRIE70
WJC.StaA
A SUPER SEPTIC & DRAIN FIELD INC.
CC: SR0161772
PHONE: 305-364-0113
DATE. S- 4-i M
STATE OF FLORIDA
COUNTY OF MIAMI-DADE
7701 WEST 18 LANE
HIALEAH, FLORIDA 33014
Licensed and Insured
E-MAIL: ASUPERSEPTIC aOGitriAiL.COM
WWW.ASUPERSEPTIC.COM
FAX: 305-364-0349
BEFORE ME THIS DAY PERSONALLY APPEARED, WHO
BEING DULY SWORN, DEPOSES AND SAYS:
THAT HE OR SHE WILL BE THE ONLY PERSON WORKING ON THE PROJECT AT:
410 r j� sl- 7317�
Contractor Signature:
SWORN TO (OR AFFIRMED) AND SUBSCRIBED TOME THIS 6q DAY OF
l� �A 2019, BY:2:--2t-0
PERSONALLY KNOWN
OR PRODUCED IDENTIFICATION ✓
TYPE OF INFORMATION PRODUCED (l*QV Ikq
D
PRINT, TYPE, OR STAMP NAME OF
' Y PR/FTO /iii//�
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LOT I I AND 12, BLOCK 51 OF MIAMI SHORES /i.00DZOJIESIJ)'iDla•IATION:
SECTION TWO ACCORDING TO THE PLAT THEREOF, AS
RECORDED IN PLAT BOOK 10, PAGE 37 OF THE PUBLIC TIEMFAaoofwN�oE••ATmnl�sToom•®wsTBEfn1TmR
RECORDS OP MIAMI -DADS COUNTY. FLORJDA sxWOODRn�meFwnaa wi
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4
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM
j4
PERMIT #:13 -SC -1946098
APPLICATION # : AP 1412070
DATE PAID:
FEE PAID:
RECEIPT #:
DOCUMENT #: PR1226292
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: Gregory A Haile a
PROPERTY ADDRESS: 410 NE 94 St Miami FL 3338
LOT: 11 12 BLOCK: 51 sUBDIVISION: Miami Shores Sec 2
[SECTION, TOWNSHIP, RANGE, PARCEL NUMBER]
PROPERTY ID #: 11-3206-014-0360 [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 CgMPLIANCE WITH OTHER FEDERAL,
STATE, OR LOCAL;PERMITTING REQUIRED FOR DEVELOPMENT OF THIS PROPERTY.
SYSTEM DESIGN AND SPECIFICATIONS
T [ 1,050 1 GALLONS / GPD NEW Septic Tank CAPACITY
A [ 0 1 GALLONS / GPD, CAPACITY
N [ 0 1 GALLONS GREASE INTERCEPTOR CAPACITY [M]LILMKUM CAPACITY SINGLE TANK:1250 GALLONS]
K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps
n [ 300 ] SQUARE FEET NEW Drain Field in TRENC SYSTEM
R [ 0 ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [XI STANDARD [ ] FILLID [ ] MOUND ( 2 RAM
A 9 e-� P- E R hA 1`1
B�W..r M ZAY � a..rr pr u
I CONFIGURATION: [x] TRENCH I l BED I ]
N
F LOCATION OF BENCHMARK: FFE 12.5' } in c o n Jai D I) IT # C1 N I C,
I ELEVATION OF PROPOSED SYSTEM SITE [ 33.60] INCHES][RABOVE BEaO"d BENCHMARK/REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE 168.64] INCHES FT I[ABOVE BELOW BENCHMARK/REFERENCE POINT
L
D FILL REQUIRED: [ 0.00] INCHES EXCAVATION REQUIRED: [ 35.00] INCHES
I.- Invert elevation and Bottom of drain field to be no less than 7.28' & 6.78'- NGVD respectively.
O 2- Install a NEW 1050 gal. septic tank with an approved filter
T 3- Install a NEW 300 sf. of drain field in TRENCH... configuration.
H 4- The licensed contractor installing the system is responsible for i stalling the minimu[n category of tank in accordance
with s. 64E-6.013(3)(0
E 5.- THIS PERMIT IS NOT FOR ANY ADDITIONS.
R 6.- Perimeter of excavation area shall be at least 2 der and longer t e proposed absorption trench.
SPECIFICATIONS BY: A Super Sep'
APPROVED BY:
DATE ISSUED:
DH 4016, 08/09 (Obsoletes
Incorporated: 64E-6.003,
ENGINEERING SPECIALIST II Dade CHD
editions which may not be used)
v 1.1.4 "1412070
EXPIRATION DATE
SE1174809
08/05/2019
Page 1 of 3
Anthony ottguez, Esq.
7950 NW ISS Siren Lille 208
Miami Lakes, FL33016
3F
Tran"tattTitit insurance Agency, LLC
113205 owaynt Blvd. Suite 2241.
Aventors, FL 33160
1
Page 1 of 3
N: 20 W251151 BOOK 31414 PAGE 648
DATE:0412412019 12:00-.16 PM
Iia DOC 3,99x.00
HARVEY RWN, CLERK OF COURT, MIA-DADE CTY
This Warranty need made Ni 15th day of April, 2014 between Ortgary A Haile and Chat L Halle, Husband sod
`Fife vvhw post offixt address is 2756 AVE 30 .'stagy#, lFort Landerds* Fl. 33306, grwftr, and 0saa l v Cubes, a single
man and Brandon L Conrad, a single roan as joint tenants with right of savivondsip whow pop office address is 410
NE " Strect. Miami Shorts, FL 33138,
VwgcA—
(Wkwtm wg4 katin ft : amts ,vwA*e hwsrae ter an + sum or
wAivi&Aft, arta ft iaieaeAM aroxwowm trans OW votm)
1 itn 1s, that said grantar, fcu and in eansidazion of the sum of TEN AND N(XIM DOLLAPS (SIO.OD) and other
tood and vakAble msiderttions to said pamor in hand paid by said pootec, the receipt whoraof Is hereby oci3towltsiged,
has granted. bargained, and sold to the saidrt , and 'S r, the fallovOng described lazed,
situate, lying and being in hiiarn de County, ids€ to-*
Lot 11 and 12, eek 51, Miami Shorts Section 2, according to the flat ftre4 recorded in Plat
Book 10, Page 37, of the Public Records of Miami -fit County, lUdds.
410 NE 94 Stret4 Miami Shorts, PL3 138
Parcel l4todilestloo Number. 11-3206-014-0360
Together with all the tenernew, heredhamcau mul apportentam tlmvo belonging or in any Wng
To Have and to Hold, the mat in fft, shVik forever.
And the grantor bereby coveneft with said grantee that ft Vuntor is lawNly selzed of said land in fee sirup&, that d
mento has pod right and hrwrul authority w sell and ca" said land; that the tally warrants the tit* to said
land and will defend the sum against the lawwfut claims of all persons whomwever and that said land is ftee of all
cocumbranees, exxtpi taxes scoviiis subsequent to t?eccanber 31, 21110,
In Witness Wh +eaf, grantor has hemoto set grantwl haul and seal the day and year E'trst above vnitum.
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Page 3 of 3
CFN° 20190251151 BOOK 31414 PAGE 6503
No my Lilo&
State of F
County orMimi-Dada
The fixe ` ittstru-ment was ed before me this f .at 3l< 2019 by Chu L tWk. who U
pe rwal ey kttrrwa or fXI tm produced a ' er's lictose gas ilets4iivation,
WOUNY sal]
Printed Nom:
My Commi3sion Expires:.
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Er +o Do
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