Loading...
RC-16-2935Ak INSPECTION RECORD r— Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138-0000 Phone: (305)795-2204 Fax: (305)756-8972 Permit NO. RC-10-16-2935 Issue Date: 6/6/2017 Perm# Type: Resideritiol'Con*uction Work Classification- Addition Expires: 12/03/2017 INSPECTION REQUESTS: (305)762-4949 or Log on at https://bldg.miamishoresvillage.comlcap REQUESTS ARE ACCEPTED DURING 8:30AM - 3:30PM FOR THE FOLLOWING: BUSINESS DAY. Requests must be received by 3 pm for following day inspections. Residential Construction Parcel:#A 122310130600 f Owner's Name: JORGE LUIS RIOS _ owners'Pho1 e: (786)202-6660 Job Address: Bond Number: 3420 HOME OWNER 47lCfZ/ eCklIR- Total Square Feet: 93 Total Job Valuation: $ 42,890.00 111K( WORK IS ALLOWED: C�7tr� MONDAY THROUGH FRIDAY, 8:OOAM - 7:OOPM. "n SATURDAY 8:00AM - 6:OOPM. ' n NO WORK IS ALLOWED ON SUNDAY OR HOLIDAYS. BUILDING AND ROOFING INSPECTIONS ARE DONE MONDAY THROUGH FRIDAY. 19 NO INSPECTION WILL BE MADE UNLESS THE PERMIT CARD IS DISPLAYED AND HAS BEEN APPROVED. PLANS ARE READLY AVAILABLE, IT IS L THE PERMIT APPLICANTS RESPONSIBILITY TO ENSURE THAT WORK IS, THE BUILDING OFFICIAL NOR THE CITY SHALL BE LIAOLE ACCESSIBLE AND EXPOSED FOR INSPECTION PURPOSES, WARNING TO OWNER; Y IMAL COMMENCEMENT MAY RESU OUR FAILURE TQ RECORD . TO YOUR QanDcn,-.. RESULT IN YOUR DA v,'..., _ _ _ A Nnr/rc .,,. lie Beam Tr ss/Rafters oof Sheathing ucks interior Framing Insulation eil' -Drywall Fir ire Lath P.DatSteel Poel-Becr Fi e Screen Eaglo&we Duue Dri se Tine ss Mop i7Progteg Fi Stn�tiars.A#i:achliient Fin Rails and ardrails AD e FINAL DOCUMENTS Soil Bearing Cert Soil Treatment Cert Floor Elevation Survey Reinf Unit Mas Cert Insulation Certificate Spot Survey Final Survey Truss Certification STRUCTURAL COMMENTS Nl' Miami Shores Village I' kOCT8 20 663 �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 20 l k4 BUILDING Master Permit No. c BCD - 35. PERMIT APPLICATION Sub Permit No. UILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: /D Occupancy Type: Load OWNER: Name (Fee Simple Titleholder): Address: /(,) A jx city: > [-Cl Tenant/Lessee Name: Email nstruction Type: '13 Iding Historically Designated: Yes NO Flood Zone: BFE: FFE: Phone#: M -zoz State: Zip: Phone#: CONTRACTOR: Company Name: Phone#: Address: City: State: Qualifier Name: ne#: State Certification or Registration #: Certificate of Competency #: DESIGNER: Architect/Engineer: ne#: Zip: Address: a I AOQ F City: State: Zip: �} Value of Work for this Permit: $ Square/Linear Footage of Work: t� Type of Work: d' i ter i New ❑ Repair/Replace ❑ Demolition Descri�rtio�i of or _ _� A ^ _ �-C n SpebIfy color of color thru tile: Submittal Fee $ I Permit Fee $ e •� CCF $ �� _ U CO/CC $� ' �� Scanning Fee $ 0 - c �Radon Fee $ I`� �d DBPR $ Notary $ Technology Fee $ ? �+ T[ Q Training/Education Fee $ Double Fee $ $0 co5u Structural Reviews • 120 w , Bond $ Sm • 00 (Revised02/24/2014) TOTAL FEE NOW DUE $ (C) 2I 0 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: condition to the issInce of a building permit with an estimated value exceeding $2500, the -applicant must promise in good f that a copy of the notof commencement and construction lien law brochure will be delivered to the person whose propert is subject to attachment. A/ o, a certified copy of the recorded notice of commencement must be posted at the job site for the firs inspection which occurs sev (7) days after the building permit is issued. In the absence of such posted notice, the inspectio wilkryot be approved and a re " spection fee will be charged. n R The foregoing instr ent day r e L i S me or who has produced identification and who did take NOTARY PUKIC\ Sign:_ Print: Seal: APPROVED BY h� (Revised02/24/2014) Signatu CONTRACTOR e e re me this The foregoing instrument was acknowledged before me this by day of 20 , by who is personally known to who is personally known to i v L i Ct( ns 'e. as me or who has produced as -Qa4V.--identification and who did take an oath. NOTARY PUBLIC: L Sign: { Print: YANADY PRIETO Seal: MY COMMISSION # FF 214031 EXPIRES: March 25, 2019 Bonded Th. Notary Public Underwriters ********************************************************************** Plans Examiner oning Structural Review Clerk Return to: Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138-0000 Bill To JORGE LUIS RIOS 10555 NE 2 Court MIAMI SHORES, FL 33138- Invoice Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138-0000 Phone: (305)795-2204 Fax: (305)756-8972 For Inspections please call: (305)762-4949 Permit Number: RC-10-16-2935 Invoice Date: October 28, 2016 Invoice Number: RC-10-16-61815 Bond Number: 3420 Comments: Permit Type: Residential Construction / Work Classification: Date Fee Name Fee Type Fee Amount 10/28/2016 DCA Fee Calculated $19.30 10/28/2016 Permit Fee Percentage $1,286.70 05/31/2017 CO/CC Fee Calculated $50.00 06/06/2017 Bond Type - Owners Bond Fixed $500.00 03/16/2017 Plan Review Fee (Engineer) Calculated $80.00 05/31/2017 Notary Fee Fixed $5.00 10/28/2016 CCF Calculated $25.80 10/28/2016 DBPR Fee Calculated $19.30 11/03/2016 Plan Review Fee (Engineer) Calculated $120.00 10/28/2016 Scanning Fee Calculated $60.00 10/28/2016 Technology Fee Calculated $34.40 10/28/2016 Education Surcharge Calculated $8.60 Total Fees Due: $2,209.10 a Tuesday, June 6, 2017 Return to: Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138-0000 Bill To JORGE LUIS RIOS 10555 NE 2 Court MIAMI SHORES, FL 33138- Permit Number: RC-10-16-2935 Invoice Date: October 28, 2016 Invoice Number: RC-10-16-61815 Bond Number: 3420 omments: Permit Type: Residential Construction / Work Classification: Date Fee Name Fee Type Fee Amount Payments Date Pay Type Check Number Amount Paid Change 10/28/2016 Credit Card $50.00 $0.00 06/06/2017 Credit Card $2,159.10 $0.00 Total Paid: $2,209.10 1 Total Due: $0.00 Tuesday, June 6, 2017 NAME: ADDRESS: Miami Shores Village Building Department R BUILUER DISCLOSURE STATEME I DATE: 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Do hereby petition the Village of Miami Sfiores to act as my own contractor pursuant to the laws of the State of Florida, F.S 489.103(7). And I have read and understood the following disclosure statement, which entitles me to work as my own contractor; I further understand that 1 as the owner must appear in person to complete all applications. State Law requires construction to be done by a licensed contractor. You have applied for a permit under an exception to the law. The exemption allows you, as the owner of your property, to act as your own contractor even though you do not have a license. You must supervise the construction yourself. You may build or improve a one -family or two-family residence. You may also build or improve a commercial building at a cost of $25,000.00 or less (The new form states 75,000). The building must be for your own use and occupancy. It may not be built for sale or lease. If you sell or lease a building you have built yourself within one year after the construction is complete, the law will presume that you built for sale or lease, which is a violation of this exemption. You may not hire an unlicensed person as a contractor. It is your responsibility to make sure the people employed by you have licenses required by state law and by county or municipal licensing ordinances. Any person working on your building who is not licensed must work under your supervision and must be employed by you, which means that you must deduct F.I.C.A and with -holdings tax and provide workers' compensation for that employee, all as prescribed by law. Your construction must comply with all applicable laws, ordinances, buildings codes and zoning regulations. Please read and initial each paragraph. 1. 1 understand that state law requires construction to be done by a licensed contractor and have applied f r an owner -builder permit under an exemption from the law. The exemption specifies that I, as the owner of the property listed, may act a y�own contractor with certain restrictions even though I do not have a license. /I j 2. 1 understand that building permits are not required to be signed by a property owner unless he or she responsible for the construction and is not hiring a licensed contractor to assume responsibility. I I 3. 1 understand that, as an owner builder, I am the responsible party of record on a permit. I understandyhbt I may protect myself from potential financial risk by hiring a licensed contractor and having the permit filed in his or her name instead of py own name. I also understand that the contractor is required by law to be licensed in Florida and to list his or license numbers on permits avo Ptracts. Initia 4. 1 understand that I may build or improve a one family or two-family residence or a farm outbuilding. rmay also build or improve a commercial building if the costs do not exceed $75,000. The building or residence must be for my use or occupan y. It may not be built or substantially improved for sale or lease. If a building or residence that I have built or substantially improved myself spId or leased within 1 year after the construction is complete, the law will presume that I built or substantially improved it for sale or lease ich,violates the exemption. S. I understand that, as the owner -builder, I must provide direct, onsite supervision of the construction. 6. 1 understand that I may not hire an unlicensed person to act as my contractor or to supervise persons r ' n my building or residence. It is my responsibility to ensure that the persons whom I employ have the license required by law and by u or municipal ordinance. Initial 7. 1 understand that it is frequent practices of unlicensed persons to have the property owner obtain an owner -builder permit that erroneously implies that the property owner is providing his or her own labor and materials. 1, as an owner- uilder, may be held liable and subjected to serious financial risk for any injuries sustained by an unlicensed person or his or employees whit working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an owner -builder nd�m aware of the limits of my insurance coverage for injuries to workers on my property. Initial RA 8. 1 understand that I may not delegate the responsibility for supervising work to be a licensed contr4to who is not licenses to perform the work being done. Any person working on my building who is not licensed must work under my dir s ervision and must be employed by me, which means that I must comply with laws requiring the withholding of federal income tax andN I security contributions under the Federal Insurance Contributions Act (FICA) and must provide workers compensation for the employunderstand that my failure to follow these may subject to serious financial risk. I agree that, as the party legally and financially responsible for this proposed Construction activity, I wig aJ { cle Icy all applicable laws and requirement that govern owner -builders as well as employers. I also understand that the ln\II / Construction must comply with all applicable laws, ordinances, building codes, and zoning regulations. 10. 1 understand that I may obtain more information regarding my obligations as an employer from the Int4Rea Service, the United States Small Business Administration, and the Florida Department of Revenues. I also understand that I may orida Construction Industry Licensing Board at 850.487.1395 or http://www.mvfioridalicense.com/dbpr/pro/cilb/index.html Initial 11. 1 am aware of, and consent to; an owner-builde wild' permit applied for in my name and understathe party le Ily andfins . Illly�@spponsiibble�for the r posed str lion activity at the following address: t vv Initial 12. 1 agree to notify Miami Shores Village immediately of any additions, deletions, or changes to any of the i Vmaion/at I have provided on this disclosure. Initial Licensed contractors are regulated by laws designed to protect the public. If you contract with a person who does not have a license, the Constr4uction Industry Licensing Board and Department of Business and Professional Regulation may be unable to assist you with any financial loss that you sustain as a result of contractor may be in civil court. It is also important for you to understand that, if an unlicensed contractor or employee of an individual or firm is injured while working on your property, you may be held liable for damages. If you obtain an owner -builder permit and wish to hire a licensed contractor, you will be responsible for verifying whether the contractor is properly licensed and the status of the contractor's workers compensation coverage. Before a building permit can be issued, this disclosure statement must be completed and signed by the property owner and returned to the local permitting agency responsible for issuing the permit. A copy of the property owner's driver license, the notarized signature of the property owner, or other type of verification acceptable to the local permitting agency is required when the permit is issued. 69 day IT Ull� rw or who has identification. JOB COST DETAIL BILL TO: JORGE L RIOS 10555 NE 2ND CT MIAMI SHORES, FL. 33138 7862026660 INVOICE DATE: March 12, 2017 INVOICE # 100 FOR: Project Description DESCRIPTION HOURS RATE AMOUNT ROOFING: GRAY FLAT TILE $ 15,000.00 WINDOWS: SLIDING GLASS DOORS AND WINDOWS 7,000.00 STRUCTUAL: EXAVATION, FOOTING, PILING, TRUSSES 30,000.00 MECHANICAL: AIR CONDITIONER 8,000.00 PLUMBING: CABANA BATHROOM 3,000.00 KITCHEN CABINETS 7,000.00 ELECTRICAL: LUTRON DIMMERS 6,400.00 WOOD FLOOR REFINISH .. ... .. 5,890.00 ..... .. .. .. .. ..... . . ...... SUBTOTAL $ 82,290.00 TAX RATE ' SALES TAX OTHER TOTAL $ 82,290.00 THANK YOU FOR YOUR BUSINESS! .. 0 0 0 . BEAST ENTERPRISE ALAIN J MILANES ECG-1522554 4690 WEST 8 PLACE HIALEAH FL 33012 MOBILE 305-799-4712 FAX 305-821-9571 JORGE RIOS 10555 NE 2 ND COURT MIAMI SHORES FL 33131 DESCRIPTION STRUCTURE AS PER BLUE PRINTS PROVIDED !NO PERMITS EXCAVATION FILLING FOOTING BLOCK SLAB TRUSSES PLY WOOD AND TRUSSES JOB TIME FRAME IS 45 DAYS WIT OUT PERMIT AND WEATHER DELAYS WORK4NG 5 DAYS A•YVIEEK AND EXCLUDING HOL.IO 45 RA1'S.13EGINJ 41 �DEPOSIT IS MADE 4 PAj&%NTS AS.F%) WWS TO 6TAF $10,010 pe- WHE ;;jOCKS ARE UP $10,000.00 TIE BEAM $5,000.00 PLYWOOD TO FINISH FINAL PAYMENT $5,000.00 INVOICE DATE: October 28. 2016 PO # 1028-2016 JOB ADDRESS: 1055 NE 2 ND COURT MIAMI SHORES FL 33138 AMOUNT I AN "/.. IV LESS PAYMENTS BALANCE DUE S 00,000.00 JOB COST DETAIL BILL TO: JORGE L RIOS 10555 NE 2ND CT MIAMI SHORES, FL. 33138 7862026660 INVOICE DATE: March 12, 2017 INVOICE # 100 FOR: Project Description DESCRIPTION HOURS RATE AMOUNT ROOFING: GRAY FLAT TILE $ 15,000.00 WINDOWS: SLIDING GLASS DOORS AND WINDOWS 7,000.00 STRUCTUAL: EXAVATION, FOOTING, PILING, TRUSSES 30,000.00 MECHANICAL: AIR CONDITIONER 8,000.00 PLUMBING: CABANA BATHROOM 3,000.00 KITGHEN eABINETS 7,000.00 "CTRICkL; .4JTRdN1U1IJMERS 6,400.00 WOOD FLOOR •REFI�J§H * 5,890.00 .. •••... .. .. SUBTOTAL $ 82,290.00 TAX RATE - SALES TAX OTHER TOTAL $ 82,290.00 THANK YOU FOR YOUR BUSINESS! BEAST ENTERPRISE INVOICE ALA/N J MILANES �CGC1� 4 4690 WEST 8 PLACE H IALEAH FL 33012 MOBILE 305-799-A712 FAX 305-821-9571 JORGE RIOS 10555 NE 2 ND COURT MIAMI SHORES FL 33131 DESCRIPTION (STRUCTURE AS PER BLUE PRINTS PROVIDED INO PERMITS (EXCAVATION FILLING FOOTING BLOCK SLAB TRUSSES !PLY WOOD AND TRUSSES JO"T.I&'FRAM%IIt 4$ DAYS WIT OUT PERIJIT AND WtA,THI;R DELAYS WOR16ING 5 �Y*§ P WEEK AND EXCLUDING HOLIC 45 �i4�'S BEGINS WREN DEPOSIT IS MADE 4 PAYMENTS AS FOLLOWS TO START $10,000.00 WHEN BLOCKS ARE UP $10.000,00 TIE BEAM $5,000,00 PLYWOOD TO FINISH FINAL PAYMENT $5,000.00 DATE: October 28, 2016 PO # 1028-2016 JOB ADDRESS: 1055 NE 2 ND COURT MIAMI SHORES FL 33138 AMOUNT I LESS PAYMENTS I BALANCE DUE I S 30,000.00 Water and Sewer PO Box 330316 • 3071 SW 38 Avenue MIAMI•DADE Miami, Florida 33233-0316 ® VERIFICATION FORM T 305-665-7471 VALID WITHOUT A PAID INVOICE AND EXPIRES ONE YEAR FROM THE DATE ON FORM ATWI@JFild9dP-90V E7-C INV#: / g1 f FORM M 201762255 DATE: 3/9/2017 NAME OF OWNER: 1PROPOSED REMODELING FOR RIOS RESIDENCE M2017005907 PROPERTY ADDRESS: 110555 NE 2 CT PROPOSED USAGE / NO. OF UNITS: REPLACES: PREVIOUS USAGE / NO. OF UNITS: PROPERTY LEGAL: INTERIOR REMODELING AND ADDITION TO EXISTING SFR EXISTING SFR CCB ACC 2462848337 FIRST ADD TO PASADENA PARK PB 6-82 LOT 14 & S1/2 LOT 13 BLK 14 FOLIO NUMBER: 11-2231-013-0600 GALLONS PER DAY INCREASE: PROPOSED FLOW: 220 PREVIOUS SQUARE FOOTAGE: 2,376 ❑ NEW CONSTRUCTION PREVIOUS FLOW: 220 PROPOSED SQUARE FOOTAGE: F___2,_4691 ❑d INTERIOR RENOVATION ADOPTED FLOW: 0] ❑ CRITICAL HABITAT ❑ SEWER ONLY THIS IS TO CERTIFY THAT THE MIAMI-DADE WATER AND SEWER DEPARTMENT DOES HAVE A(N) 2 INCH WATER MAIN ABUTTING THE SUBJECT LEGALLY DESCRIBED PROPERTY. WE ARE WILLING TO SERVE THE SUBJECT PROPERTY, (OR, IF "WILL HAVE", UPON PROPER CONVEYANCE AND PLACEMENT INTO SERVICE OF WATER FACILITIES BY THE DEVELOPER UNDER AGREEMENT WITH THE DEPARTMENT, (AGREEMENT ID # N/A) SUBJECT TO PROHIBITIONS OR RESTRICTIONS OF GOVERN NTAL ENCIES HAVING JURISDICTION OVER MATTERS OF WATER SUPPLY OR WITHDRAWAL. Jacqueline Rodriguez - New BY: Business Representative ENTATIVE AUTHORIZED BY NNI VF $30.00 PER PRESSURE TEST OK TO INSTALL A 5/8" METER **IF NEW SERV IS REQUIRED ALLOW 12 WEEKS FOR NEW INSTALL AT OWNER EXPENSES** SIR INSP 1854 THIS IS T6 CERTIFY THAT THE MIAMI-DADE WATER AND SEWER DEPARTMENT DOES NOT HAVE A(N) _— INCH GRAVI SEWER MAIN ABUTTING THE SUBJECT LEGALLY DESCRIBED PROPERTY. WE ARE WILLING TO SERVE THE BJECT PROPERTY, (OR, IF "WILL HAVE", UPON PROPER CONVEYANCE AND PLACEMENT INTO SERVICE OF SEWER SEW R FACILITIES BY THE DEVELOPER UNDER AGREEMENT WITH THE DEPARTMENT, (AGREEMENT ID # N/A ). SUBJECT TO PROHIBITIONS OR RESTRICTIONS OF GOVERNMENTAL AGENCIES HAVING JURISDICTION OVER MATTERS OF SEWAGE DISPOSAL. FURTHERMORE, APPROVAL OF ALL SEWAGE FLOWS INTO THE DEPARTMENT'S SYSTEM MUST BE OBTAINED FROM D.E.R.M. THE ANTICIPATED P&LY WATER AND/OR SEWAGE FLOW FOR THIS PROJECT WILL BE: NO GALLONS [01 GALLONS PER DAY INC WgAi9 NTS: ATIVE Jacqueline Rodriguez - New Business Representative AUTHORIZED BY Subject to RER terms & conditions set forth in Consent Decree (Case No.1:12-CV-24400-FAM) or DOH Onsite Sewer Treatment & Disposal Rules & Statutes THIS VERIFICATION LETTER CERTIFIES THE AVAILABILITY OF A WATER AND/OR SEWER MAIN ONLY, AND IT DOES NOT GUARANTEE THE EXISTENCE OF A WATER SERVICE LINE OR OF A SEWER LATERAL WITH SUFFICIENT DEPTH TO SERVE THE PROPERTY. FOR ADDITIONAL INFORMATION CALL 786-268-5360. SHOULD IT BECOME NECESSARY TO INSTALL A SERVICE LINE AND/OR A SEWER LATERAL WASD REQUIRES THAT THE DEVELOPER RETAINS SERVICES FROM DESIGNERS AND CONTRACTORS WITH SKILL SETS FOR DESIGNING, BUILDING AND CONNECTING TO PUBLIC WATER AND SEWER SYSTEMS. CONTACT NAME: JORGE RIOS Printed On: 3/10/2017 NB: Jacqueline Rodriguez CONTACT PHONE: 786 �66 9:04:12 AM PR: AUTHORIZED BY: Official Payments - Pay Taxes, Utility Bills, Tuition & More Online Page 1 of 1 This is a "printer friendly" page. Please use the "print' option in your browser to print this screen. OFFIC�IA 1111 I PAYMENTS Miami -Dade Water & Sewer Department New Business or Job Orders Kiosk Payments To print this page press CTRL + P or right click on your mouse and select Print from the menu. Confirmation Number: 069031935214 Payment Date: Friday, March 10, 2017 Payment Time: 09:20AM ET Payer Information Name: JORGE L RIOS Street Address: 4237 nw 37 ave miami, FL 33142 United States Daytime Phone (305) 638 - 8420 Number: E-mail Address: jorge@superiorstorm.com Invoice #: N00031918 Customer #: 00016735 Name: JORGE RIOS Location: KKMPIC Invoice Amount: $30.00 Card Information Card Type: American Express Card Number: ************7007 Card Verification **** Number: Payment Information Payment Type: New Business or Job Orders Kiosk Payments Payment Amount: $30.00 Convenience Fee: $0.71 Total Payment: $30.71 Thank you for using Official Payments. If you have a question regarding your payment, please call us toll free at 1-800-487-4567. To make payments in the future,, please visit our website at www.officialpayments.com. Copyright© 2017 Official Payments Corporation. All Rights Reserved. Official Payments Corporation is a licensed money transmitter in 44 states, the District of Columbia, and Puerto Rico. Official Payments is not required to be licensed as a money transmitter in Indiana, Massachusetts, Montana, New Mexico, South Carolina or Wisconsin. https://www.officialpayments.com/pc_step6_print.jsp 3/10/2017 7 COUNTY Water & Sewer Department New Business Office P.O. Box 330316 Miami, FL 33233-0316 Invoice Number Customer Number Invoice Date Business Process Number (X) Total Amount Due JORGE RIOS 10555 NE 2 CT MIAMI FL 33138 ATTN: JORGE RIOS Note: PAYING VF 201762255 NNI 10555 NE 2 CT FOLIO 1122310130600 VF Res (R-A) Water 1 EA 30.00 Total Standard Charges Total Invoice ER Water ER Sewer Agreement ID 30.00 Invoice N00031918 00016735 March 10, 2017 $30.00 0.00 30.00 $30.00 $30.00 Printed on 3/10/2017 by e78539 at WESTOFFICE STATE OF FLORIDA PERMIT NO. 1 DEPARTMENT OF HEALTH DATE PAID: ONSITE SEWAGE TREATMENT AND DISPOSAL FEE PAID: SYSTEM RECEIPT #: APPLICATION FOR CONSTRUCTION PERMIT APPLICATION FOR: [ ] New System Existing System [ ] Holding Tank [ ] Innovative [ ] Repair [ j Abandonment [ ] Temporary [ ] APPLICANT: AGENT: S. %Su�y �j C ' (� TELEPHONE : a 1 MAILING ADDRESS: ' S CA lJ�� 331 TO BE COMPLETED BY APPLICANT OR APPLICANT'S AUTHORIZED AGENT. SYSTEMS MUST BE CONSTRUCTED BY A PERSON LICENSED PURSUANT TO 489.105(3)(m) OR 489.552, FLORIDA STATUTES. IT IS THE APPLICANT'S RESPONSIBILITY TO PROVIDE DOCUMENTATION OF THE DATE THE LOT WAS CREATED OR PLATTED (MM/DD/YY) IF REQUESTING CONSIDERATION OF STATUTORY GRANDFATHER PROVISIONS. PROPERTY INFORMATION LOT: BLOCK: SUBDIVISION: ���A pGj %K PLATTED: PROPERTY ID #: CIQ31 013 V (Po ZONING: I/M OR EQUIVALENT: [ Y 01 PROPERTY SIZE: �� -1 ACRES WATER SUPPLY: [ ] PRIVATE PUBLIC X ]<=2000GPD [ ]>2000GPD IS SEWER AVAILABLE AS PER 381.0065, FS? [ Y ] DISTANCE TO SEWS �— FT PROPERTY ADDRESS: /V �` Of DIRECTIONS TO PROPERTY: BUILDING INFORMATION Unit No 1 2 3 4 • • RESIDENTIAL [�] [ ] COMMERCIAL � �• No. of Building Commercial/Instit;tio;al SyS1!At•Des1$n Bedrooms Area Sqf t Table 1, Chapter 6 }]r`- 6, FAQ,, a ; • • • • • 03--40 . • [ ] Floor/EquipmentXrainsZ[ ] Other (Specify) S DATE: laltz /1(, bH-4015, 08/ soletes previous editions which may not be used) Incorporat d 4E-6.001, FAC Page 1 of 4 STATE OF FLORIDA DEPARTMENT OF HEALTH APPLICATION FOR CONSTRUCTION PERMIT Permit Application Number ---------------------------PART II - SITEPLAN--------------------------- Scale: Each block represents 10 feet and 1 inch = 40 feet. ■■■■■ ■■■■■■■■■■■■■■■■■■■■ ■■■■■■ Notes: Site Plan submitted by: Plan Approved By ALL z Not Approved Date County Health Department GES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT DH 4015, 08/09 (Obsoletes previous editions which may not be used) Incorporated: 64E-6.001, FAC Page 2 of 4 (Stock Number: 5744-002-4015-6)