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PL-17-2272
Miami Shores VillageLY:_ 017 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 FBc 201 q Ste' BUILDING Master Permit No.?U1 — Z PERMIT APPLICATION Sub Permit No. BUI ING ELECTRIC ROOFING REVISION EXTENSION [:]RENEWAL PLUMBING MECHANICAL [--]PUBLIC WORKS CHANGE OF CANCELLATISHOP CONTRACTOR RAWINGS JOB ADDRESS: L&Qf P_ Folio/ Parcel#: C/ i_36 ©O 0 3 Is the Building Historically Designated: Yes _ , Nam_ Occupancy Type: Load: construction Type / Flood Zone: BFE: — FFE: OWNER: Name (Fee Simple Titleholder): Address: City: L° State: Tenant/ Lessee Name: Phone#: Email: CONTRACTOR: Company Name: APhone#: Address: w h City: / h- / Aa7 ' State: Zip: Qualifier Name: 0 Phone#: State Certification or gistration #:AA 61 do Z Certificate of Competency #: S 131) 1 /n ( '%% DESIGNER: Architect/Engineer: / Phone#: - City: , / State:_ Zip: -- Value of Work for this Permit: $t% Square/Linear Footage of Work: ao7 S S 6) 1:7 Type of Work: Addition Alteration El New Repair/Replace Demolition Description of Work: Specify color of color thru tile: Submittal Fee $ '50 V-*—1 i Permit Fee $ , CCF $ CO/CC $ Scanning Fee $ Technology Fee $ Structural Reviews $ Radon Fee $ Training/ Education Fee $ DBPR $ Notary $ Double Fee $ Bond $ i;M Revised02/ 24/2014) TOTAL FEE NOW DUE $ I 1 V ` 6119- 30 Bonding Company's Name (if applicable) Bonding Company's Address City / State Mortgage Lender's Name (if applicable) _ Mortgage Lender's Address City State l 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 000— O NER or ENT The foregoing 7instrume t was acknowledged before me this 20- day of CCYC; Y )C*r , 20 by i n 'who is personally known to me or who has produced 1C` nSf as identification and who did take an oath. NOTARY UBLIC. Sign: Print: Seal: r APPROVED BY Revised02/24/2014) MY COMMISSION # FF 214031 EXPIRES: March 25, 2019 Bonded Thru Notary Public Underwri1cr5 Signature C RACTOR The foregoing instrument was acknowledged before me this day of VCQttmlr7cY , 20 11 by CV1QY1 i 1 Z=Y who is personally known to me or who has produced Dr VtV Lic`Qhs as identification and who did take an oath. NOTARY P Sign: O Print: Seal: ss*r**er*•s******** Plans Examiner Structural Review AJY PRIE 0 i:`;SION#FF214031 i.: ':parch 25, 2019 c Tt;u m ::y Public Underwriters Zoning Clerk 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: State of Fl County of The foregoing was acknowledge before me this ZQ"day of 'e YYt%r 120 1- By who is personally known to me or has produced C'ir -'Q '2 as identification. YANADY PRIETO MY COMMISSION # FF 214031 Notary:=+; +__ EXPIRES: March 25, 2019 Bonded Thru Notary Public Underwrbr$ SEAL: Sep 20 17 02;07p A Super Septic & Drain 3053640349 p.1 A SUPER SEPTIC & DRAIN FIELD INC. CC: SR0161772 7701 WEST 18 LANE HIALEAH, FLORIDA 33014 Licensed and Insured PHONE: 305-364-0113 E-MIAIL: ASUPERSEPTIC GMAIL.COM FAX: 30S-364-0349 WWW.ASUPERSEPTIC.COM September 20, 2017 STATE OF FLORIDA COUNTY OF MIAMI-DADE BEFORE ME THIS DAY PERSONALLY APPEARED, Bryan Zero, President OF UQ'rr a D{qj hIF WHO BEING DULY SWORN, DEPOSES ANDSAYS: I AM AUTHORIZING A SUPER SEPTIC AND DRAIN FIELD INC., TO MAKE THE NECESESSARY REPAIRTOMYSYSTEMASSOSTATEDONTHEPERMITFROMTHEDEPARTMENTOFHEALTH. PERMIT NUMBER: AP1305511 THAT HE OR SHE WILL BE THEONLY PERSON WORKING ON THE PROJECT LOCATED AT. 161 NE 106 Street Miami, Florida 33138 SWORN TO (OR AFFIRMED) AND SUBSCRIBED TO ME THIS DAY OF ty'}t V 20 I . BY: PERSONALLY KNOWN OR PRODUCED IDENTIFICATION 'briytr qE; RMATI O@ :D: C7_ PRINT, TYPE, OR STAMP NAME OF NOTARY L yva& ?v -,'t <, V+ f1k1. YANADY PRIEW MY COh1MISSION FF 214031 f;•;a' EXPIRES: March 25, 2019 Bonded Thru Notary Public Underv+riters 001052 Excal Business Tax Receipt Miami -Dade County, State of Florida THIS IS NOT A BILL - DO NOT PAY 3820314 LBT BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES A SUPER SEPTIC & DRAIN FIELD INC RENEWAL SEPTEMBER 30, 20187701W18LA3988772MustbedisplayedatplaceofbusinessHIALEAHFL33014PursuanttoCountyCode Chapter 8A - Art, 9 & 10 OWNER SEC. TYPE OF BUSINESS PAYMENT RECEIVEDASUPERSEPTIC & DRAIN FIELD INC 196 SPECIALTY PLUMBING CONTRACTOR BY TAX COLLECTORC/O BRYAN ZERO PRIES SEP0161772 " Worker(s) 1 $45.00 08/30/2017 CREDITCARD-17-056586 This Local Business Tax Receipt only confirms payment of the Local Business Tax. The Receipt is not a license, permit, or a certification of the holder's qualifications, to do business. Holder must comply with any governmentalornongovernmentalregulatorylawsandrequirementswhichapplytothebusiness. The RECEIPT NO. above must be displayed on all commercial vehicles - Miami -Dade Code Sec 8a-276. For more information, visit www.miamidade.govRaxcollector Property Information Folio: 11-2136-006-0380 Property Address: 161 NE 106 ST Miami Shores, FL 33138-2036 Owner JEAN LUC ROY Mailing Address 161 NE 106 ST MIAMI SHORES, FL 33138 USA PA Primary Zone 1000 SGL FAMILY - 2101-2300 SQ Primary Land Use 0101 RESIDENTIAL -SINGLE FAMILY: 1 UNIT Beds / Baths / Half 3/2/0 Floors 1 Living Units 1 Actual Area 2,442 Sq.Ft Living Area 1,628 Sq.Ft Adjusted Area 1,854 Sq.Ft Lot Size 9,225 Sq.Ft Year Built 1941 Assessment Information Year 2017 2016 2015 Land Value 230,638 198,007. 110,700 Building Value 116,290 116,330 116,370 XF Value 960 972 738 Market Value 347,888 315,309 227,808 Assessed Value 275,646 250,588: 227,808 Benefits Information Benefit Type 2017 2016 2015 Non -Homestead Cap Assessment Reduction 72,242 64,721 Note: Not all benefits are applicable to all Taxable Values (i.e. County, School Board, City, Regional). Short Legal Description DUNNINGS MIAMI SHORES EXT NO 2 PB 41-78 14 BLK 208 SIZE 75.000 X 123 20535-4401 07 2002 1 Generated On : 9/20/2017 Taxable Value Information 2017 2016, 2015 County Exemption Value 0 0 0 Taxable Value 275,646 250,588 227,808 School Board Exemption Value $0 0 0 Taxable Value 1 $347,888 315,309 227,808 City Exemption Value $0 0 SO Taxable Value $275,6461 250,588 227,808 Regional Exemption Value $0 Taxable Value $275,646 0 250,588 0 227,808 Sales Information Previous Price APBook- Qualification Description Sale 9e 03/31/2017 600,000 30509-1796 Qual by exam of deed Corrective, tax or QCD; min 03/29/2017 0 304814996 consideration Corrective, tax or QCD; min 11/18/2014 270,400 29397-0850 consideration 07/01/2002 286,000 20535-4401 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 Version http://www.miamidade.gov/propertysearch/ 9/20/2017 STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT CONSTRUCTION PERMIT FOR: OSTDS Repair APPLICANT: ,Jean Luc Roy PROPERTY ADDRESS: 161 NE 106 St Miami, FL 33138 LOT: 14 BLOCK: 208 SUBDIVISION: PROPERTY ID #: 11-2136-006-0380 PERMIT #: 13-SM-1786683 APPLICATION # : AP 1305511 DATE PAID: FEE PAID: RECEIPT #: DOCUMENT #: PR1074949 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 TO REMIAN CAPACITY A [ 0 ] GALLONS / GPD CAPACITY N [ 0 ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS] K [ ) GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ ] D ( 225 J SQUARE FEET NEW DF IN TRENCH CON SYSTEM R [ 0 ] SQUARE FEET SYSTEM A TYPE SYSTEM: [x] STANDARD [ ] FILLED [ ] MOUND [ ] I CONFIGURATION: (x] TRENCH [ ] BED [ ] N F LOCATION OF BENCHMARK: F.F.E 12.4 I ELEVATION OF PROPOSED SYSTEM SITE [ 21.60][ INCHES FT ][ ABOVE BELOW BENCHMARK/REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE ( 63.60]f INCHES FT ][ABOVE BELOW BENCHMARK/REFERENCE POINT L D FILL REQUIRED: [ 0.00] INCHES EXCAVATION REQUIRED: [ ] INCHES O T H E R 1-EXISTING 900gal. septic tank with and approved filter TO REMAIN. 2.- Install 225 sf. of drainfield in ... TRENCH.... configuration. 3.- Install 12" of slightly limited soil at the bottom of the drainfield. 4.- 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: A Super Septic TITLE: APPROVED BY: TITLE: Engineering Specialist II Loanis X nza ez DATE ISSUED: 09/05/2017 DH 4016, 08/09 (Obsoletes all previous editions which may not be used) Incorporated: 64E-6.003, FAC EXPIRATION DATE Dade CHD 12/04/2017 Page 1 of 3 v 1.1.4 AP1305511 SE1046498 R-1 b'- 35s6 DIVISION OF 44>00<0>Environmental Health Florida Health O Miami -Dade County OSTDS/ Well Division 11805 SW 26th Street - Miami, FL 33175 Inspector Date Address 6 C W /04 t OSTDS #Af I . -, -g Comments: