PL-20-589¢y \ : � � DIVISION OF
Environmental Health
` Florida Health
Miami -Dade County
eQ� OSTDS/Well Division
U 805 SNI' 26th Street • Miami, FL 33175 �O
Inspector_ �7��j�r ��n A /o Date 5",
Address S 7 r 5 / -! S/ OSTDS # 7/
Comments:
Signature`'
Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
�r'`sltlf'fi'I it
Issue Date: 03-/23-/ 20
Location Address Parcel Number
541 NE 94TH ST, Miami Shores, FL 33138 1132060140870
Contacts
Permit NO.: PL - 09
Permit Type:
Work Classification Se
PermitStaftsrAPPOM
Expiration: 09/14/2020
JOHN J MENNES Owner PULLES PLUMBING COMPANY Contractor
JOHN & MARIE MENNES CARLOS PULLES
1700 NE 105 ST #214, MIAMI SHORES, FL 33138 8541 SW 133 PL, MIAMI, FL 33183
Other: 3058954480 Business: 7862950256 CPU LLES@ BELLSO UTH. N ET
Description: INSTALL SEPTIC TANK AND DRAINFIELD Valuation: $ 6,200.00 Inspection Requests:
uests:
4-9
Total Sq Feet: 0.00
mi -
Fees
Amount
CCF
$4.20
DBPR Fee
$3.26
DCA Fee
$2.17
Education Surcharge
$1.40
Permit Fee
$217.00
Scanning Fee
$9.00
Technology Fee
$5.43
Total:
$242.46
Payments
Date Paid Amt Paid
Total Fees
$242.46
Check # 21248
03/23/2020 $242.46
Amount Due:
$0•00
Building Department Copy
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 1 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
Page 2 of 2
March 23, 2020
BUILDING
PERMIT APPLICATION
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
Master Permit No
Sub Permit No.
RECEIVED
MA 17 2020
BY: TT
FBC 20
i L-43 - iD -��'�'
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
dPLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: ��L �L 4 5�
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: /<ia- 3 -2-6 6 - 0l - V 7 Z� Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): �/ �1r2.,l �-P��✓eS Phone#36�-s�J
Address:
S' 1C7yz_ 's State: Zip:3� /✓2
City: ��
Tenant/Lessee Name:
T [ Email:
L. L e_57 (53 .eel f ,Sd e_-,>ez�. AJ 2 7`
hone#:
CONTRACTOR: Company Name: �� �o S'/jf Phone#:3
Address:
City: State: Zip: --; 23'� lo� g-j
Qualifier Name: _ <a-2 �0 �' E✓ .44 �- S Phone#: M4 - Z `7S"0Z-f-6
State Certification or Registration #: 4- P C - OS �-& '?3 Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#: -
Address: City: State
Value of Work for this Permit: $ Z d d
Square/Linear Footage of Work:
M
Type of Work: ❑ Addition ❑ Alteration ❑ New LJ Repair/Replace ❑ Demolition
Description of Work: ,Sim-G 7 sQfl� %��✓% q-
Specify color of color thru the:
Submittal Fee $ - `Permit Fee $
Scanning Fee $
Technology Fee $
Structural Reviews $
Radon Fee $
Training/Education Fee $
CCF $
DBPR $
CO/CC $
Notary $
Double Fee $
Bond $'i �d� C-10-11T-2
TOTAL FEE NOW DUE $ ��
(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
WE
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
OWNER o AGENT
The foregoing instrument was acknowledged before me this
177 day of ` %Jt� M 6A N 6-3, 20 X.) by
?--'�who is personally known to
me or who has produced ( �^7 ��— as
identification and who did take an oath.
NOTARY PUB
Sign: ✓
Print: N
Seal:
APPROVED BY
(Revised02/24/2014)
SINDIA ALVAREEZ
MY COMMISSION # GG 238273
EXPIRES: September 3, 2022
Signature /
CONTRACTOR
The foregoing instrumen was acknowledged before me this
day of 20 by
S 4-5who is personally known to
me or who has produced �� �`-�
y— a�
identification and who did take an oath.
NOTARY P BLI .
Sig
Print: ,(1�cl
`•'��P`•: SINDIA A:#GG
Z
Seal: MY COMMISSIO2382'3EXPIRES: Sept3, 2022Bondd Thru Notary ndervvrilers
Plans Examiner Zoning
Structural Review Clerk
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:
541 N.E. 94 ST. MIAMI SHORES, FLORIDA 33138
CONTRACTOR SIGNATURE
SWORN TO (OR AFFIRMED) AND SUBSCRIBED BEFORE ME THIS /%DAY OF
MlWe- c . 20 LG,
BY
Personally Know
OR Produced Identification 47L__D
Type of Identification Produced V424-- k Q 8' ` 2- Q"-_12-Q
Print, Type or Stamp Name of Notary
ARy l Medy Gonzalez Velazquez
NOTARY PUBLIC
+STATE OF FLORIDA
Coma# GG059602
E l0� Expires 1/4/2021
Notice to Owner - Workers' Corn
Miami shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
nsation Insurance Exemption
Florida. Law requires. Workers' C.Quapensatian invixam= wverage under Chapter 44Q of the Ftarida Sta.butes. 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:
I . 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:
Owner
State of Florida
Caunty of Miami -Dade
The foregoing was acknowledge before me this �3
By �V ' `(y 11n ri
day of Y1-�P
120 1--7
who i ersonally known to me or has produced
as identification.
Notary:
SEAL: CA#CA
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SIDE 2 OF 2
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: (John Mennes)
PROPERTY ADDRESS: 541 NE 94 St Miami, FL 33138
LOT: BLOCK: SUBDIVISION:
PROPERTY ID #: 11-3206-014-0870
PERMIT #:13-SC-2044770
APPLICATION #: AP1471386
DATE PAID:
FEE PAID:
RECEIPT #:
DOCUMENT #: PR1316940
[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 APPL41"TION. SUCH MODIFICATIONS MAY RESULT IN THIS PERMIT BEING MADE NULL AND VOID.
:;j%1j;pCE OTi••RHIS PEWT DOES NOT EXEMPT THE APPLICANT FROM COMPLIANCE WITH OTHER FEDERAL,
'STATE', OR •7ACAI,:PERMJI%INGrREQUIRED FOR DEVELOPMENT OF THIS PROPERTY.
•
SYSTEM DESI* AND SPLCrR'r!>,TIONS
•••••• • •• ••
�'1 • • 90i ] • • CALLOI� f• AFD New Seotic Tank CAPACITY
A't'• go 1 CALLONS•% ,GPD CAPACITY
a.(.: O']•GALLONS C4WJ1E INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
' K [ ' GALLONSPCO VG TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ l
•••••• •• •• ••••••
•
•D ( 30b ] %QUARE,0FFy r • New Drainfield Bed conf. SYSTEM
.••.•• •.••
R [ -0 ] SQUARE ?EET ' SYSTEM
A TYPE SYSTEM [x] STANDARD [ ] FILLED [ ] MOUND [ ]
I CONFIGURATION: [ ] TRENCH [x] BED [ ]
N
F LOCATION OF BENCHMARK:' CROWN OF THE ROAD 9.20' NGVD. NAIL POINT NE LINE PROPERTY.
I ELEVATION OF PROPOSED SYSTEM SITE [ 2.16 ][ INCHES FT ][ ABOVE BELOW BENCHMARK/REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 38.163[ INCHES FT ][ ABOVE BELOW BENCHMARK/REFERENCE POINT
L
D
O
T
H
E
R
FILL REQUIRED: [ 0.00] INCHES EXCAVATION REQUIRED: [ 46.UU] INCHES
1.- Invert elevation and Bottom of drainfield to be no less than 6.57' & 6.07' NGVD respectively.
2.- Install a 900 gal. septic tank with an approved filter.
3.- The licensed contractor installing the system is responsible for installing the minimum category of tank in accordance
with s. 64E-6.013(3)(f) FAC. R E PA i R PERM 1 NTY
4.- Install 300 sf. of drainfield In BED configuration. FLORIDA HEALTH MIAMI DADE COUN
5.- Install 12" of slightly limited soil at the bottom of the drainfield. NOT VALID FOR ADDITIONS
THIS REPAIR PERMIT IS NOT FOR ANY ADDITIONS.
SPECIFICATIONS BY: Jor lan TITLE:
APPROVED BY:
TITLE: Engineering Specialist II Dade CHD
Yli a Aerra7
DATE ISSUED: 03/13/ EXPIRATION DATE
IF
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E-6.003, FAC
v 1.1.4 AP1471386 SE1266439
06/11 /2020
Page 1 of 3
DOCUMENT # :
PR1316940
'The system is sized for 3 bedrooms with a maximum occupancy of 6 persons (2 per bedroom), for a total estimated flow of 300
-Install a new drainfield to achieve Drainfield size requirement.
-Required drainfield area based on rule 64E-6.015(6)(c)2.
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STATE OF FLORIDA
DEPARTMENT OF HEALTH
APPLICATION FOR CONSTRUCTION PERMIT
Permit Application Number
---------------------------PART II-SITEPLAN---------------------------
Scale: Each block rPnrPcentc in twatn ad 9 ln,.h - AO f--+ _ 11)ai W^"
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ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
Not Approved
DH 4015, 08109 (Obsoletes previous editions which may not be used) incorporated: 64E-6.001, FAC
(Stock Number: 5744-002-4015-6)
Page 2 of 4