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PL-19-1004STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM PERMIT #:13-SC-1943706 APPLICATION #: AP141 0486 DATE PAID: FEE PAID: RECEIPT #: DOCUMENT # : PR1214146 CONSTRUCTION PERMIT FOR: OSTDS Repair •• • APPLICANT: Hugo Santillan ___. __. _______ • • • �' • • • • • i ... • • PROPERTY ADDRESS: 1482 NE 104 Miami, FL 33138 : • LOT: 12 BLOCK: 4 SUBDIVISION: [ SECTION, TOWNSHIP, RA%E*,* PARCEL *&JMBER] • • • • • PROPERTY ID #: 11-2232-032-0330 •••••• •• [OR TAX ID NUMBER] • • • • • SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND "STANDARDS •GF SEM01A: 381.0065, F.S., AND CHAPTER 64E-6, F.A.C. DEPARTMENT APPROVAL OF SYSTEM DOES'AWS • 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 NEW SEPTIC TANK TO INSTALL CAPACITY A [ 0 ] GALLONS / GPD CAPACITY N [ 0 ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS] K [ 300 ]-GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ 1 ] D [ 200 ] SQUARE FEET NEW DF IN BED CONFIG SYSTEMr%pN � R [ 0 ] SQUARE FEET SYSTEM G..E A TYPE SYSTEM: [XI STANDARD ( ] FILLED [I MOUND P1ct]R1j,)A i- r.,M�4 T _._ _ I CONFIGURATION: [ ] TRENCH [x] BED [ ] '" +rv�rT$Tr— F LOCATION OF BENCHMARK: FFE 6.0' GNVD. I ELEVATION OF PROPOSED SYSTEM SITE [ 15.20][ INCHES FT ]( ABOVE BELOW BENCHMARK/REFERENCE-POINT E BOTTOM OF DRAINFIELD TO BE [ 30.2011 INCHES FT II ABOVE BELOW BENCHMARK/REFERENCE POINT L D 1 O T H -E R -1LL 1graWU1KriLj; 1 J.VV J 1M-otI ZI CiliI:HVATl VN KNWUlKPBJ: L 40.1V J 1Nla1L'ab 1.- Install a 900 gal. septic tank with an approved filter AND 300 GAL DOSING TANK 2.- Install 200 sf, of drainfield in BED configuration. 3.- Install 12" of slightly limited soil at the bottom of the drainfield. 4.- Invert elevation and Bottom of drainfield to be no less than 4.00 ' & 3.50 ' NGVD respectively THIS PERMIT IS NOT FOR ANY ADDITIONS. .......................... I ............................ (Comments Continued on Page 2.) SPECIFICATIONS BY: Empi TITLE: APPROVED BY: TITLE: Environmental Manager Dade CHD rard q Philizaire DATE ISSUED: 05/01/2019 EXPIRATION DATE: DH-4016, 08/09 (Obsoletes all previous editions which may not be used) Incorporated: 64E-6.003, FAC v 1.1.4 AP1410486 SE1163731 07/30/2019 Page 1 of 3 • • • • ••• ••• • • • ... . . . . . ... . . . . . . . . . ... . . . . ... 01 DIVISION OF ° Environmental Health A Florida Health qj�p Miami -Dade County*R, OSTDS/Well Division �O 11805 SW 26th reet • Miami, FL33175 Inspector /�/+�� 4�/ �✓ Date0 Address �t T3 2- �� �� a S #' - � � �' Comments: - Signature 4 0: >`1 IBC LI y STATE OF FLORIDA DEPARTMENT OF HEALTH APPLICATION FOR CONSTRUCTION PERMIT Permit Application Number --------------------------- PART 1I SITEPLAN --------------------------- Srp)p,- FAQ hhr_k feet ■■■■■Nl41 ■■ON '�■!s ■■�■■ E■■ ■ ■ ■V" ■■■■■E��iN si'E i■■■■■■EEEI■■■■■■ Dow ■ENNENLKE■ ■C©NSO123SSMHNNEENAMMMEZ ■■■■■■�'1ls�J■■■■■■■■■■■®N!�■■■Sid■■■ ■■■■■■■IY�'ii■��i�■■■■■,�■■■■■■■■■■■■■■ ■ ■iII�NEENNINF.-I■ !"' MEME■ONEEEE .; MMMME ■■r''Si�t■■■■■I�-■■�■■■■■ONES■ ■SSS���ESSNOii�OSSNEE■Sf■■■■NEE ■■■■■■■WE■EEr■■■■■EMNON■■■■■■■■, Notes: ��y T.� ��-a y:a-! s �.ar�� -.�r�� 94-&-, Jos C !ter `' S G o< <� �� � e �vy�r>� >'- 2 �� s �,,,v,-=,►srl�t'. Sa,,D �r- , 7-i'�', 2srrz- -u-� aZe G �z�..� O�.�olci e.. * i a.q -e Site Plan submitted Plan Approved1_4 Not Approved Date County Heaith'Department ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT DH 4018, 08108 (Obscletes previous editions which may not be used) Incorporated: 64E-6.001, FAC Page 2 of 4 (Stock Number. 674"024016-6) Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Location Address Issue Date: 05/08/2019 Parcel Number 1482 NE 104TH ST, Miami Shores, FL 33138 1122320320330 Contacts Permit No.: PL-05-19-1004 Permit Type: Plumbing - Residential Work Classification: Septic/Drainfield Permit Status: Approved Expiration: 11/04/2019 HUGO SANTILLAN Owner 916 NE 96 ST, MIAMI SHORES, FL 33138 Mobile: 7863996633 PULLES PLUMBING COMPANY Contractor CARLOS PULLES 8541 SW 133 PL, MIAMI, FL 33183 Business: 7862950256 Inspection Description: INSTALL DRAINFIELD AND SEPTIC TANK RELOCATE Valuation: $ 8,500.00 Inspection Requests: DRAIN 4949 TotalSq Feet: 0.00 Fees Amount Application Fee - Other $50.00 CCF $5.40 DBPR Fee $4.46 DCA Fee $2.98 Education Surcharge $1.80 Permit Fee $247.50 Scanning Fee $9.00 Technology Fee $7.44 Tota I : $328.58 Building Department Copy Payments Date Paid Amt Paid Total Fees $328.58 Check # 20515 05/08/2019 $278.58 Check # 20492 05/06/2019 $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 foregoing information is accurat d, that all work will be done in compliance with all ap icable laws regulating constructs oning. futhermore, I authorize the above name contr for to do the work stated. Authorized Signature: Owner / Applicant / Contractor / Agent Date May 08, 2019 Page 2 of 2 Miami Shores Village R E C':-; Building Department MAY 06 2019 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 P Tel: (305) 795-2204 Fax: (305) 756-8972 U INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC 20P-U BUILDING Master Permit No.9I_0c _ 1 - (� I-1� PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL Z"PLUMBING ❑ MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: /,�0�2_ 01 5- City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Zl',QZ3�' -B3� - S3 o Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): / / V ��'`�� Phone#: Address: City: S!�/ Tenant/Lessee Name: Email State: `y Zip: g ne#: CONTRACTOR: Company Name: / ll��S // ��J � Cd Phone#: Address:? l -� G%• City: /%%�¢�t�t State: Zip: Qualifier Name: �i¢� /G_5- �/���s Phone#: State Certification or Registration #: C F C Qom!° c F­7 Certificate of Competency #: 3gs 'ut' -© I'Z0 DESIGNER: Architect/Engineer: Address: City: Phone#: _State: Zip: Value of Work for this Permit: $ O� Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace ❑.Demoliti Description of Work:—/�STA��ic� `�i /316 Specify color of color thru tile: . Submittal Fee $ Permit Fee $ Scanning Fee $ Radon Fee $ Technology Fee $ Training/Education Fee $ Structural Reviews $ _ (Revised02/24/2014) CCF $ CO/CC $ DBPR $ Notary $ Double Fee $ Bond $ ' TOTAL FEE NOW DUE $ �� E3 `7LJ 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 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 ngt'�a approved and a reinspection fee will be charged. Sig ER or AGENT The foregoi g tnstrumentwas acknowledged before me this i 1 � da of 0-k � 20 , by �lVIn �N-O An ` 41� ar� _ , who is personally known to me or who has produced as identification and who did take an oath. NOTARY P 15ZNotary Public State of Fbride Loren Laje Mr Cogrission GG 2E0457 Sign:_ Print: Seal: Signature CONTRACTOR Thing instru�was acknowledged before me this daypof 20 �l1 by ' " 'E tos 6 t� `1 �S who is personally known to me or who has produced identification and who did take an oath. NOTARY PUBLI Print: Seal: Notary Public State or Florida Loren Laje My Commission GG 2e0457 Expires 09/20/2022 r1y ************************************************************************************************************ APPROVED B)(� 5' /1 Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) 5/6/2019 Property Search Application - Miami -Dade County OFFICE '6F THE PROPERTY APPKF*AA Is'" E R u U Summary Report Property Information Folio: 11-2232-032-0330 Property Address: 1482 NE 104 ST Miami Shores, FL 33138-2664 Owner HUGO SANTILLAN Mailing Address 1424 NE 133 RD NORTH MIAMI, FL 33161 USA PA Primary Zone 1100 SGL FAMILY- 2301-2500 SQ Primary Land Use 0101 RESIDENTIAL -SINGLE FAMILY: 1 UNIT Beds / Baths / Half 2/2/1 Floors 1 Living Units 1 Actual Area 2,722 Sq.Ft Living Area 2,602 Sq.Ft Adjusted Area 2,662 Sq.Ft Lot Size 8,850 Sq.Ft Year Built 1954 Assessment Information Year 2018 2017 2016 Land Value $309,729 $309,729 $309,729 Building Value $213,066 $214,610 $216,154 XF Value $28,460 $28,625 $28,791 Market Value $551,255 $552,964 $554,674 Assessed Value $551,255 $552,964 $554,674 Benefits Information Benefit Type 2018 2017 2016 Note: Not all benefits are applicable to all Taxable Values (i.e. County, School Board, City, Regional). Short Legal Description RIVER BAY PARK ADDN PB 40-72 LOT 12 BLK 4 LOT SIZE 75.000 X 118 OR 18274-4985 0498 4 COC 25420-0435 02 2007 1 Generated On : 5/6/2019 Taxable Value Information 2018 2017 2016 County Exemption Value $0 $0 $0 Taxable Value $551,255 $552,964 $554,674 School Board Exemption Value $0 $0 $0 Taxable Value $551,255 $552,964 $554,674 City Exemption Value $0 $0 $0 Taxable Value 1 $551,2551 $552,964 $554,674 Regional Exemption Value $0 $0 $0 Taxable Value $551,255 $552,964 5554,674 Sales Information OR Previous Price Book- Qualification Description Sale Page 29274- Non -market financing or assumption of 08/11/2014 $345,000 2882 lease 02/01/2007 $860,000 25420- Sales which are qualified 0435 05/01/2006 $760,000 24540- Sales which are qualified 3159 18274- Sales which are disqualified as a result of 04/01/1998 $0 4985 examination of the deed 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 http://www.miamidade.gov/info/disclaimer.asp Version PULLES PLUMBING CO. 8541 S.W 133 PL. MIAMI, FLORIDA 33183 PH: (305)-558-0410 FAX: (305) 382-8914 CFC056693 Date: STATE OF FLORIDA COUNTY OF DADE BEFORE ME THIS DAY PERSONALLY APPEARED CARLOS PULLES WHO, BEING DULY SWORN, DEPOSES AND SAYS: THAT HE OR SHE WILL BE THE ONLY PERSON WORKING ON THE PROJECT LOCATED AT: 1482 N.E. 104 ST MIAMI SHORES, FLORIDA 33138 CONTRACTOR SIGNATURE SWORN TO (OR AFFIRMED) AND SUBSCRIBED BEFORE ME THIS 6 DAY OF A� .20c1, BY Personally Know OR Produced Identification -:IF(.— DL Type of Identification Produced 6-52-0"'�2-v aggyAMerly Gonzalez Velazquez ! o NOTARY PUBLIC a STATE OF FLORIDA Print, Type or Stamp Name of Notary o Comm#GG059602 Explroo 1/4/2021 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 su ontractors for your project. The contractor has provided an affidavit stating that he or she will be the only person allowed to workbp your project. In these circumstances, Miami Shores Village does not require verification of workers' compensation insurance erage from the contractor's company for day labor, part-time employees or subcontractors. BY SIGNING BELOW YOUR CKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature: State of Florida County of Miami -Dade The foregoing was acknowledge before me this . day of H , 20 ' — ` By M Q,Q sc�(M\a n ' who is personally known to me or has produced as identification. Notary: SEAL: Notary a JState of Florlde tj t.orena LaLa C11 Expinst�l2t1/2022 2EW57 RECEIVED MAY 0 6 20J' 7210 SW 126th cart, Aniano J. Garcia, PLSM Ph (305) 856-4566 Miami, Florida 33183 Land Surveyor & Planner Fax (305) 595-1454 Property Address: 1482 NE 104th Street, Miami Shores, Florida 33138 Record Surve Legal Description: Lot 12, Block 4, of "RIVER BAY PARK ADDITION", according Scale V= 20' to the Plat thereof, as recorded in Plat Book 40, at Page 72, of the Public Records of Miami -Dade County, Florida. REPLAT OF TRACT "C" MIAMI SHORES BAY PARK ESTATES (Pb 64. Pg 97) Not o Port of this Plot :-- .50' Wide Alley (Not Improved) —------------------- FIP(oea o � N 90e00'00" E 75.00' 0.45' d Cone ^� CI cone i 6'x34' v Swimming N Pool ro Cone 0.15' 18.9' CI o I; Resident Lot 13, w l ACl ��� # 1482 Block 4 C� �J o o 0.1 o' Cl cv 10' 19. i Step Con 00 w 00 0 0 CD 0 t --UP at • i Property • Corner —N90'00'00'E — Ad 0.70• cl • mod... U 0 00 •••• 7:g 0.06' Q 0 ay ( Lot 11, P alock 4 - a _ U.1 Lo 0 0i E C' co t !_ I n LL n fl There may be easements and/or other instruments affecting this — property, recorded in the Public Records not shown on this survey. The purpose of this survey is for — use in obtaining title insurance and financing and should not be used f construction purposes or plans. cl x.J cl -�WeCn 2 11 M ~ m GtlrkdtAo Pavers Driveway FIP FIP 01, 9d rBOB d ., Sidewalk N 90'00'00" E 75.00' WM Parkway n CB a N N Asphalt Pavement NE — 104th Street (50' total A/W) Visual Encroachments Noted: None O W J J W tL rI z n n Lu U y -C a Z 1 ) 'J 2 fry CJ U Q 1 LEGAL NOTES .0atK of Field wort; 02-12-•2013j Natonalo Title nln Older R epublic This Survey dots not reflect or determine ownership; E.sominotion of the Abstract of Title w•]f Ir/ have to be mode to determine Recorded Instruments, if any, affecting the property, This -' Company Aybor Londrau & Survey is subject to dedications, limitations, restrictions, reservations & easements of rec AcigLSM 5105 Nizio, P.L.; NWL 2016 Legal Deser,ption provided by client:The Liabifity, of this Survey is limited to the cost of th �- r Survey; Underground Encroachments. if any, are not shown; This firm has not atlerrpted ' Not-V.60 w„hout theJSignaf•ure Evergreen LP its SUCCBSSOFS Wale fooling and/or fomdatians and/or underground improvements of any nature; If shrm_1pnd ffhe.Ori i-rAL-rtSisea seal and/Or assigns, OtimO Bearings are retorted to m Assumed Meridian; If shown, aevoliom are referred to Natiaral Ot a FiCn Iicen:e0 Surveyor Order No 13-0045 Geodetic vertical Datum of 1929 (NGYD 1929) •and mapper _ A . ALonglh; AC Air Conditioner; AE - Anchor Easement BC - Black Coiicr; BM.. Baneh Mnrk; boB - Basis Of Bearings; (C) - Calculated Dimension; CB Care ton Booin; CBS • Concrete Block Structure; CFW - Concrete Fence Wca; CH . Cnrd u 1%th: CHB - Chord Bearing; CI - Clear, CML . City Monument Line; ZCUE - Carol Maintenance Easement: Cone - Concrete; DE - drainage Easement; OVE - Dfs;mtge & Maintenance Easement: Or - Drive; E East; Dow, - Z O Qevatfon; ENCR = Encroached; ErP - Electric Transformer, FOH - Found D 7 Hale; FM •. Fmmd Iron Rod; FIFE .finished Floor Elevation; FH - flre Hydrant; FIP Q f- - Found Iron Pipe; FN - Found Nail; Fr - Feet: LME - Lake Maintenance Easement; :9 - Ucmtsed Bus;ness: LFE - Lowest Floor Elevation: UP - Light Pole: (M) o G - Measured Dimansion; ME - Maintenance Eosemenl; MON - Monument; N - North; NGVD 1929 - National Geodetic vertical Datum of 1929: NTS - Not To Scale; Z 5; CE - Overhead Cables; OH - Over Hong; ORB - Official Record Book; O/S - Off Set; Pb - Plat Book; PC - Paint of Curvature: PCC - Point Of Compound Lu LU Curvature; POOR - Property Comer. PCP . Permonent Central Po1nl: Pg - Poge; PL - Planter or Property Line; PLS - Professional Land S.—yor. PLSM - LD of Professional Land Surveyor and Mapper; POS - Point Of Beginning: Poe - Point 01 Commencement; PRC - Point Of Reverse Curve; PRM - Permanent Reference ui CO m Maart en; PT - Point Of Tangency; R = Radius; (R) - Recorded Dimension; RLS - Registered Land Surveyor end Mapper; R/R - Rail Road; R/W - fight Of 11 Way; Be. - Section; T - Tangent; S - S- SIP . Set Iron Pipe With Cap Stamped PLS 5105: UE - Utility Easement; UP - Utility Pale; UTY - Utility; W West; WF - Wood Fence: WM - Water Meter, WV - Water Valve; - Cent.�m : -x- - Chain Link Fence: f=. Concrete Won; - Degrees; .l . Central Ingle; 0 - Diameter, - Ewisting Elava Gon; - Minulee; - - 5.eonde; �.-- Wood Fence