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Location Address
Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
9534 NE 2 AVE, Miami Shores, FL 33138
Contacts
Issue
Parcel Number
1132060132630
Permit NO.: PLC -11-18-3367
Permit Type: Plumbing - Commercial
Work Classification. Alteration
Permit Status: Approved
Expiration: 09/25/2019
Project
NE 2 AVE SEWER CONNECTION
LEOCAVA LLC Owner LEOCAVA LLC Applicant
LEOCAVA LLC LEOCAVA LLC
EDWARD ROJAS PLUMBING CORP Contractor
EDWARDO ROJAS
880 NE 111 ST, BISCAYNE PARK, FL 33161
Business: 3059446788 EDDIE.ROJAS@HOTMAIL.COM
Home: 7864439846
Description: SEPTIC TANK ABANDONMENT Valuation: $ 750.00 Ins ection Requests:
305-762-4949
Total Sq Feet: 0.00
Fees
Amount
Application Fee - Other
$50.00
CCF
$0.60
DBPR Fee
$2.00
DCA Fee
$2.00
Education Surcharge
$0.20
Permit Fee
$50.00
Scanning Fee
$3.00
Technology Fee
$2.50
Total:
$110.30
Building Department Copy
Payments
Date Paid Amt Paid
Total Fees
$110.30
Credit Card
03/29/2019 $60.30
Credit Card
11/06/2018 $50.00
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
regulating construction and zoning. Futhermo
nformation is accurate and that all work will be done in compliance with all applicable laws
:e the above named contractor to do the work stated. /2
Authorized Signature: Owner / Applicant / Contractor / Agent I Date
March 29, 2019 Page 2 of 2
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
.—I -I
INSPECTION LINE PHONE NUMBER: (305) 762-4949 �
�F jB (C� 20
BUILDING Master Permit No.
PERMIT APPLICATION Sub Permit No`P} L110 `33G0 ?
❑BUILDING ❑ ELECTRIC ❑ ROOFING REVISION ❑ EXTENSION RENEWAL
14PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS [:]CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 153 y NF?, "l /1��-
City: Miami Shores County: Miami Dade zip:
Folio/Parcel#: I 1 " 520b-013 -26 3 c-> Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: X, BFE: FFE:
OWNER: Na,�na (Fee Simple Titleholder): LI1.000-�1 c—LLC.. Phone#: ✓�J ' �o • // �' �sj�
Address: iVD 60x 5g/ -?03
City: IViami State: f7L.-- Zip: 3Z2>00
Tenant/Lessee Name:
Email
Phone#:
CONTRACTOR:
�pCompany Name: Oyjr-J Phone#: T��Q•-1�i�.����
Address: 71 b C) /vc 'l // ;i' d � •
City: . co., .� 1"c�rL State: c _ Zip: 3.3(6
Qualifier Name: dL Jc / A of as Phone#: �D . �1�'�
State Certification or Registration #: CFC- - 01-11 L/3 / Certificate of Competency #:
DESIGNER: Architect/Engineer:
Phone#:
Address: City: State:
Value of Work for this Permit: $ J Square/Linear Footage of Work:
Zip:
Type of Work: ❑ Addition ❑ (Alteration ❑ New ❑ Repair/Replace Demolition
Description of Work: � Z- �d-ey- coo o'j a" to
Specify color of color thru tile:
Submittal Fee $ S("q) , w Permit Fee $
Scanning Fee $
Technology Fee $
Structural Reviews $
(Revised02/24/2014)
Radon Fee $
Training/Education Fee $
CCF $
DBPR $
CO/CC $ _
Notary $,
Double Fee $ _
Bond $
TOTAL FEE NOW DUE $
Bonding Cornpany'.s'Name (if applicable)
Bonding Company's Address _. F
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 Signature 4206, U;,x
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this
330 day of 061
, 20 �� by
who is personally known to
Me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign: V�
Print:
The foregoing instrument was acknowledged before me this
770 day of 194-7 20 �8 by
DW+,Cb 90ja S , who is personally known to
as �p or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign: L U. a
Print:
as
Seal: � VOGEL Seal: ANDREW VT5,2019
EL
MY COMMISSION # FF919683 MY COMMISSION #19683
�° EXPIRES: November 25, 2019
EXPIRES: Novembe
****************
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
1
•STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM
CONSTRUCTION PERMIT FOR: OSTDS Abandonment
APPLICANT: (Leocava LLC)
PROPERTY ADDRESS: 9534 NE 2 Ave Miami, FL 33138
LOT: 1-3 BLOCK: 20
PROPERTY ID #: 11-3206-013-2630
SUBDIVISION
PERMIT #:13 -SC -1889919
APPLICATION #:AP1371979
DATE PAID:
FEE PAID:
RECEIPT #:
DOCUMENT #: PR1169979
Miami Shores Sec 1 Amd
[SECTION, TOWNSHIP, RANGE, PARCEL NUMBER]
[OR TAX ID NUMBER]
SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF SECTION
381.006 5, 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 [ ] GALLONS / GPD CAPACITY
A [ ] GALLONS / GPD CAPACITY
N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ ]
D [ ] SQUARE FEET
R [ ] SQUARE FEET
A TYPE SYSTEM: [ ] STANDARD
I CONFIGURATION: [ ] TRENCH
N
F LOCATION OF BENCHMARK:
I ELEVATION OF PROPOSED SYSTEM SITE
E BOTTOM OF DRAINFIELD TO BE
L
D E
O
T
H
E
R
SYSTEM
SYSTEM
[ ] FILLED [ ] MOUND
[ ] BED [ ]
][ABOVE / BELOW] BENCHMARK/REFERENCE POINT
ABOVE/ BELOW] BENCHMARK/REFERENCE POINT
ILL REQUIRED: [ U.UU ] INCHES EXCAVATION REQUINZIJ: L J LVt'nzb
Have the tank abandoned in accordance with the following procedures: (a) The tank shall be pumped out. (b) The bottom of
the tank shall be opened or ruptured, or the entire tank collapsed so as to prevent the tank from retaining water, and (c) The
tank shall be filled with clean sand or other suitable material, and completely covered with soil. Have the system inspected
by the health department after it has been pumped, ruptured and filled with sand and covered.
SPECIFICATIONS BY: TITLE:
APPROVED BY: TITLE: Engineering Specialist II
Erlande OnIsca
DATE ISSUED: 11/06/2018 EXPIRATION DATE
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E-6.003, FAC
v 1.1.4 AP1371979 SE -1
Dade CHD
02/04/2019
Page 1 of 3
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.
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM
CONSTRUCTION PERMIT FOR: OSTDS Abandonment
APPLICANT: (Leocava LLC)
PROPERTY ADDRESS: 9534 NE 2 Ave Miami, FL 33138
PERMIT #:13 -SC -1889918
APPLICATION #:AP1371978
DATE PAID:
FEE PAID:
RECEIPT #:
DOCUMENT #: PR1169980
LOT: 1-3 BLOCK: 20 SUBDIVISION: MIAMI SHORES SEC 1 AMD
PROPERTY ID #: 11-3206-013-2630 [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 [ ] GALLONS / GPD CAPACITY
A [ ] GALLONS / GPD CAPACITY
N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ ]
D [ ] SQUARE FEET SYSTEM
R [ ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [ ] STANDARD [ ] FILLED [ ] MOUND
I CONFIGURATION: [ ] TRENCH [ ] BED [ ]
N
F LOCATION OF BENCHMARK:
I ELEVATION OF PROPOSED SYSTEM SITE
E BOTTOM OF DRAINFIELD TO BE
L
D F
O
T
H
E
R
][ ABOVE/BELOW] BENCHMARK/REFERENCE POINT
][ABOVE/ BELOW] BENCHMARK/REFERENCE POINT
ILL REQUIRED: [ U.UU J INCHES EXCAVATION REQUIRED: L j LNla1Eb
Have the tank abandoned in accordance with the following procedures: (a) The tank shall be pumped out. (b) The bottom of
the tank shall be opened or ruptured, or the entire tank collapsed so as to prevent the tank from retaining water, and (c) The
tank shall be filled with clean sand or other suitable material, and completely covered with soil. Have the system inspected
by the health department after it has been pumped, ruptured and filled with sand and covered.
SPECIFICATIONS BY: TITLE:
APPROVED BY: TITLE: Engineering Specialist II
Erlande Omisca
DATE ISSUED: 11/06/2018 EXPIRATION DATE:
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E-6.003, FAC
v 1.1.4 AP1371978 SE -1
Dade CHD
02/04/2019
Page 1 of 3
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.
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:
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;
The officer is listed as an officer of the corporation in the records of the Florida
Department of State, Division of Corporations; and
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 inAurance coverage from the contractor's company for day labor, part-time employees or subcontractors.
BY SIGNING BELO , YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS
CONTENTS. /
Signature:
State of Florida
Owner
County of Miami -Dade
11q
The foregoing was acknowledge before me this A � day of 11 20 I 1
LIZ
Notary
-1-m Wlbril
SEAL: 0 "°" ANDREW VOGEL
MY cOMMISSION # FF91%83
,4i EXPIRES: November 25, 2019
who is personally known to me or has produced
as identification.