PLC-19-2572Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
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issue Date:11/01/2019
Permit NO.: PLC-10-19-2672
Permit Type: Plumbing - Commercial
Work Classification: Septic
Permit Status: Approved
Expiration: 04/29/2020
Location Address Parcel Number Project
9999 NE 2 AVE, Miami Shores, FL 33138 1132060134490 NE 2 AVE SEWER CONNECTION
Contacts
CITY NATL BNK OF FLA TRU Owner CITY NATL BNK OF FLA TRU Applicant
25 W FLAGLER ST 711, MIAMI, FL 331301718 25 W FLAGLER ST 711, MIAMI, FL 331301718
SB ENGINEERING INC Contractor
SARIMA BATISTA
430 FLAGAMI BLVD, MIAMI, FL 33144
Business: 3052813771 SBENGINC@GMAIL.COM
Mobile: 3052813771
Description: SEPTIK TANK SYSTEM ABANDONMENT Valuation: $ 750.00 Requests:
Inspection 305-4949
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
10/29/2019 $50.00
Check # 708
11/01/2019 $60.30
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 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.
Authorized Signature: Owner / Applicant / Contractor / Agent Date
November 01, 2019 Page 2 of 2
T 11F'=1 TVED
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
OC 2 9 2019
BY: '
G J
FBC 20 14
BUILDING Master Permit No&51:�
PERMIT APPLICATION sub Permit No
OBUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION EXTENSION ❑RENEWAL
❑■ PLUMBING ❑ MECHANICAL PUBLIC WORKS ❑ CHANGE OF [:]CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 9999 NE 2nd Avenue
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: 11-3206-013-4490 Is the Building Historically Designated: Yes NO X
Occupancy Type: OFC BLDG Load: Construction Type: CBS Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): AHE REALTY ASSOC LLC DBA SHOREVIEW CENTER phone#: (305) 756-7747
Address: 9999 NE 2ND AVENUE, SUITE 305
City: MIAMI SHORES State: FL Zip: 33138
Tenant/Lessee Name: N/A Phone#:
Email: JULIOMARTINEZ@SHOREVIEWCENTER.COM
CONTRACTOR: Company Name: C1 l
Address: v _
City: tAN CLM I, State: 4—
Qualifier Name:
e#: 3Z 26r.2377.1
Phone#:
p:
State Certification or Registration M �U/ i'/ Y/yY/ di'/Certificate of Competency #:
DESIGNER: Architect/Engineer: SB ENGINEERING, INC. Phone#: (305) 281-3771
Address:430 FLAGANI BLVD L City: MIAMI State: FL
Value of Work for this Permit: $ Square/Linear Footage of Work:
Zip: 33144
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: SEPTIC TANK (SYSTEM) ABANDONMENT
Specify color of color thru the:
Submittal Fee $ Permit Fee $
Scanning Fee $ Radon Fee $
Technology Fee
Structural Reviews $
Training/Education Fee $
CCF $ CO/CC $ .
DBPR $ Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $ �b
(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
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 t attachment. Also, a certified copy of the recorded notice of commence e t must be posted at the job site
for the first inspection w ich oc seven (7) days after the building permit is issued. In th bs nce of such posted notice, the
inspection will not be appr vediand a reinspection fee will be charged.
The foregoing instrV
25 day of
JULIO MARTINEZ
me or who has produced
or AGENT
acknowledged before me this
R 20 9 by
who is personally known to
PERSONALLY KNOWN as
identification and who did take an oath.
NOTARY PUBLIC:
Sign.
Print:
Signature
The foregoing instrument was cknowledged before me this
day of 20 / , by
o is personally k to
me or who has produced as
identification and who / ! take an oath.
NOTARY PUBLIC:
Sign:
Print: WIC.CII-M MO4A-L,65
V" ' KELLYE.GALE Seal:
Seal: : :? = Commission # GG 137334
.: r,s WILLIAMMORALES
Ex res November 21, 2021 ?4, MY COMMISSION II GG 291605
�'.?,f`'P Bonded Thru Troy Fain kistx�nce 800 385 7019
A.
'e EXPIRES: January 15, 2023
***r**+►srr*•w*****r*:rss*******rrr*.*/*s*r*rrrrr*ss*rsrssrr****r *+i? rry •**rs**s
APPROVED BY Plans Examiner Zoning
Structural Review
Clerk
(Revised02/24/2014)
Y L(— — 2r • Vl 60 I
STATE OF FLORIDA
DZPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM
CONSTRUCTION PERMIT FOR: OSTDS Abandonment
APPLICANT: (AHE Realty Assoc, LLc)
PROPERTY ADDRESS: 9999 NE 2 Ave Miami, FL 33138
LOT: BLACK: SUBDIVISION:
PROPERTY ID if: 11-320E-013-4490
PERMIT #:13-SC-2008687
APPLICATION i : AP 1448433
DATE PAID:
FEE PAID:
RECEIPT M:
Domew # : PR1266763
[SECTION, TOWNSHIP, RANGE, PARCEL NM48ZRI
[OR TAX ID NUMBER)
as
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 MR166 OF TIM . 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 I 1 GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
K [ ] GALLONS DOSING TANK CAPACITY ( ]GALLONS @( ]DOSES PER 24 HRS 112umps [
D [ ] SQUARE FEET SYSTEM
R ( I SQUARE FEET SYSTEM
A TYPE SYSTEM: [ ] STANDARD I ] FILLED [ ] MOUND I ]
I CONFIGURATION: I ] TRENCH [ ] BED [ )
N
F LOCATION OF SENCHMARK:
I ELEVATION OF PROPOSED SYSTEM SITE I ]I / ][ABOVE/BELOW] BENCHMARK/REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE ( it / ](ABOVE/ BELOW]BENCHMARK/REFERENCE POINT
L
D I
O
T
H
E
R
ILL REQUIRED: [ V.UU ) INCHES EXCAVATION REWIRED: ► I munros
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 dean sand or other suitable material, and completely covered with soii.Have the system inspected
by the health department after it has been pumped, ruptured and filled with sand and,
-or �e;)tic Tank and/or drainfiei
SPECIFICATIONS BY: TITLE: _.._..i 1..f1 de eapiAg is rectnrpd,
APPROVED BY: TITLE: Environmental 8)peciali t II „ „,dw CHD
Mick Pe" & _r
DATE ISSUED: 10/16/2019 EXPIRATION DATE: 01/14/2020
DH 4016, 08/09 (Obsoletes all pravious editions which may not be used)
Incorporated: 64E-6.003, PAC Page 1 of 3
v 1 3 4 XP1449431 al-1