PL-04-21-1035- 453 NE 99 STMiami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address
453 NE 99TH ST, Miami Shores, FL 33138
Permit NO.: PL-04-21-1035
Permit Type: Plumbing - Residential
Work Classification: Septic/Drainfield
Permit Stotus: Approved
Issue Date.05/03/2021 Expiration:11/03/2021
Parcel Number
1132060170410
Contacts
ROMAIN BRETON Owner PULLES PLUMBING COMPANY Contractor
453 NE 99 ST, MIAMI SHORES, FL 33138 CARLOS PULLES
8541 SW 133 PL, MIAMI, FL 33183
Business: 7862950256 CPU LLES@BELLSOUTH.NET
Description: INSTALLATION DRAINFIELD & SEPTIC TANK
Fees
Amount
Application Fee - Other
$50.00
CCF
$6.60
DBPR Fee
$5.51
DCA Fee
$3.68
Education Surcharge
$2.20
Permit Fee
$317.50
Scanning Fee
$9.00
Technology Fee
$9.19
Total:
$403.68
Building Department Copy
Ins action Requests.,
FValuation: $10,500.00tal Sq Feet: 0.00
Payments
Date Paid Amt Paid
Total Fees
$403.68
Check # 22089
05/03/2021 $403.68
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 accurst and that all work will be done in compliance with all applicable laws
regulating construction and zoning. Futhermore, I authorize the abvvg arn=tractvr to do the work stated.
Authorized Signature: Owner / Applicant / Contractor / Agent
Date
May 03, 2021
Page 2 of 2
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
BUILDING
PERMIT APPLICATION
❑BUILDING ❑ ELECTRIC ❑ ROOFING
FZE�{ C-4 IVE
AP1
BY:
FBC 20 ZO
Master Permit No.?L- 0y - 21" WS
Sub Permit No.
❑ REVISION ❑ EXTENSION ❑RENEWAL
F71PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS [:]CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS:
City! Miami Shores
Count
Miami Dade
Zip:
Folio/Parcel#1:_Z/ "-
3,/<w - _-' 7 -
Is the Building Historically Designated: Yes NO /
Occupancy Type:
Load:
Construction Type:/ Flood Zone:
BFE:y FFE:
(
OWNER: Name (Fee Simple Titleholder).
Phone#:
Address:
City:�f�£.!
Jam- �'o'���
State:
��
Zip:
Tenant/Lessee Name:
Phone#:
Email
CONTRACTOR: Company Name:
Address:
city:
Qualifier Name:
-1 �Ie�-t57
State Certification or Registration #:
DESIGNER: Architect/Engineer:
Phone#:
Zip: -3-3
Phone#: 70e'l`�2S 'o2S-6
e t ficate of Competency #:
hone#:
Address: City: State:
Value of Work for this Permit: $����' Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New u repair/Replace
Description of Work: - `' '� 'L �iCC� K
Specify color of color thru the:
Submittal Fee $
Scanning Fee $
Technology Fee $_
Structural Reviews $
(Revised02/24/2014)
Permit Fee $
Radon Fee $
Training/Education Fee $
CCF $_
DBPR $
I
Zip:
❑ Demolition
`CO/CC $
Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $ `'' ��' �`-✓
-1 CD "3
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 not be approved and a reinspection fee will be charged.
Signature
71� �
O NER or AGENT
The foregoing instrument was acknowledged before me this
Z day of &rA 20 2 i by
r►&ra4o n who is personally known to
me or who has produced RI.-v;>L as
identification and who did take an oath.
NOTARY PUBLIC:
Si
Print: s1"As.4 -t2 °
crxr =tlic
ASSeal: of Florida
078607
My Comm. Expires Jan 7, 2025
Signature,
CONTRACTOR
The foregoing instrument was acknowledged before me this
'2 day of ?f 5 20 •� 9 by
;�U�e �1•i= who is personally known to
me or who has produced !V4- OC--` rrf�Z`1-jOb
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
11 Merry Gonzalez Velasquez
Print:`:'`:
— State of Florida
Seal: Comm# HH105281
ref 1g�� Expires 3/16/2025
APPROVED BY �� �� ,E Plans Examiner
Zoning
Structural Review Clerk
Environmental Health
Florida I-lealth
Nilarni-Dade County
OS UDS;WC11 Mvi.,ii4;fI
PULLES PLUMBING CO.
8541 S.W. 133 PL.
MIAMI, FLORIDA 33183
305-558-0410 305-382-8914 FAX
LISCENCE CFC056693
April 21, 2021
STATE OF FLORIDA
COUNTY OF DADE
BEFORE ME THIS DAY PERSONALLY APPEARED CARLOS PULLES WHO, BEING DULY SWORN, DESPOSE AND
SAYS: THAT HE OR SHE WILL BE THE ONLY PERSON WORKING ON THE PROJECT LOCATED AT: 453 N.E. 99 ST
MIAMI SHORES, FLORIDA 33138
SWORN TO (AFFIRMED) AND SUSCRIBED BEFORE ME Z3 DAY OF . , .202A BY
PERSONALLY KNOW PRODUCE IDENTIFICATION _ TYPE OF
IDENTIFICATION'Tt DL �4Z —_ l]� &- ---
Marty Gonzalez Velasquez
Notary Public
*- State of Florida
PRINT, TYPE OR STAMP NAME OF NOTARY. Comm#HH105281
Expires 3/16/2025 &Ze--
Miami shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
Notice to UWner — WorKers• compensation insurance txemotion
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:
l . 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.
P
Signature:
Owner
State of Florida
County of Miami -Dade
The foregoing was acknowledge before me this. -2,2 day of Lam_ , 20 Z l .
By - aNc^ who is personally known to me or has produced
L as identification.
yP� MICHAELROJAS
Notary._ , Notary Public - State of Florida
SEAL: aF r4..•r
Commission p HH 078607
My Comm, Expires Jan 7, 2025
IERAL LEGEND:
= AIR CONDITIONER
= ALUMINUM FENCE
= BROWARD COUNTY RECORDS
=BENCHMARK
= CATCH BASIN
= CANAL MAINTENANCE EASEMENT
= CENTERLINE
= CHAIN LINK FENCE
= CONCRETE BLOCK STRUCTURE
T=CHATTAHOOCHEE
=CONCRETE
= CLEAN OUT
= DELTA (CENTRAL ANGLE)
= DRAINAGE EASEMENT
= EAST
= ELECTRIC BOX
= ELEVATION
Y = ELEVATION
= EDGE OF PAVEMENT
= EDGE OF WATER
= FINISHED FLOOR
= FOUND DRILLHOLE
= FIRE HYDRANT
= FOUND NAIL • +
-FOUND .�
= IRON ROD
= FOUND NAIL & DISC
-INVERT
= ARC LENGTH -
= LIGHT POLE
= LAKE MAINTENANCE EASEMENT
= NORTH
• = NO IDENTITY
= METAL FENCE
= MAN HOLE
= OVERHEAD CABLES
= OFFICIAL RECORD BOOK
= OFFSET
= PLAT BOOK
= PALM BEACH COUNTY RECORDS
= POINT OF CURVATURE
-PAGE
= PLANTER
= POINT OF BEGINNING
= POINT nF COMMENCEMtNT
=POOLPUMP
= PLAT AND MEASURED
= POLYVINYL CHLORIDE FENCE
= RADIUE
= RIGH , OF WAY
= SOUTH
= SIDE.V, ,LX
= SET j"'Rnrl ROD #6677
= SET NAIL & DISC
FND 1/2" IF
NO I.D.
3'X2'
A/C
9.9'
U
10' ASPHALT ROADWAY
85.00'
FNE
NN
4' CBS WALL a
`l-
`
X
X� 03 x�
b 17 6' -q
ONE STORY
SHED
� 'It
GUEST HOUSE
y •
•
}
^^
XC xc X
/i O
CD
_'•
''
WEST 40' OF
J
J
"t � v
•-
LOT 18, BLOCK 89 �
C
20.0
�' . �.
h
onJ
••4CONLr•
Z'T
C X� 'A
U
�7
CO �NC
?
Il
PLANTER
•.STEPS.
18.9' o
g,
33.5'
`l� C° ,
ONE STORY
4'X4' CBS RESIDENCE 4.0' 9
A/C Zo #453
FF ELEV = 13.06' i
34.2' ; r
p •• O
12.8' `6 ILE ,.: co 14.2' 13.
9.9'
EAST 45' OF
= UT"' ITYLEASEMENT
Lu
I
LOT 17, BLOCK 89 '_�
CONIC
= WEST
= WUQO FENCE
cp
�a
.. WALK �o
= WATEF' METER
O�
Lo
,
�
= WATER VALVE
N
dam+
FND 1/2" I
o^
e�s�)
NO I.D.
��
45.0' •'•'• 40.0'
'VINYL C ORIDE FENCE (PVCF)
5,
i :
•
_
♦
IV LINK FENCE (CLF)
.• •
255.00' :
~
o:,•'r, ..;:: A "+l
BLOCK
��
_
1KFENCE (VW)
_
--0013[WE� t' d3
4LFE
l�l�l�7il �hiviik?S 1/l�I��rn
��
•.. ASPHALT
-
GREE SYMBOL
NATER METER �`( LIGHT i9P
4T&TBOX C-0 UTILITY POLE];•.';"`,�<'_.;
L7
". t? G DEPT
OUNDARY SURVEY
ROPERTY ADDRESS:
3 NE 99th STREET,
AMI SHORES, FL. 33138
I DR4VEW
DA,T.
23' PARKWAY M
N.E. 99TH STRE I: `•
22' ASPHALT ROAD Y -
�+75RIW (TOTAL,Vf'FUI!•Clf A) -� ...... 9.75
11
n �z•,nnlf� r7l-(- 11 A f
FLOOD ZONE DATA: DATE OF SURVEY: W
ZONE: X N/A FIELD LOCATION OF IMPROVEMEN 2fi12017
COMMUNITY #: 120652 UPDATED SURVEY FOR POOL811,512020
PANEL $ SUFFIX: 0302 L
DATE OF FIRM: 9/11/2009
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM
CONSTRUCTION PERMIT FOR:
APPLICANT: Romain A Breton
OSTDS Repair
PROPERTY ADDRESS: 453 NE 99 St Miami, FL 33138
LOT: 17 BLOCK: 89 SUBDIVISION: Min miShnres Sec
PROPERTY ID #: 11-3206-017-0410
PERMIT # :13-SC-2272189
APPLICATION #:AP1656044
DATE PAID:
FEE PAID:
RECEIPT #:
DOCUMENT #: PR1548889
[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, E.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.
.31j-22M DESIGN AND SP. CIFICATIONS
1,050 ] GALLONS / t.PD Septic Tank TO BE REPLACED CAPACITY
0 1 GALLONS / GPD
') GP,LLONP GPEASE INTERCEPTOR CAPACITY
] GALLONS DOSING TANK CAPACITY [
CAPACITY
[MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
]GALLONS @[ ]DOSES PER 24 HRS #Pumps [
il [ 300 1 SQUARE FEET Bed TO BE REPLACED SYSTEM
R [ 0 1 SQUARE n-FT SYSTEM
A TYPE SYS'"FM: [xI STANDARD [ ] FILLED [I MOUND [ ]
I :INFIGURPT7C`N: ] TRENCH [x] BED [ ]
N
F LOCATION OF BENCHMARK: Crown of the road Of ne 99 st 9.70' NGVD
I ELEVATION OF PROPOSED SYSTEM SITE [ 2.16 ][INCHES FT ILABOVE BELOW BENCHMARK/REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 38.16 ] _-4c yr? SELOW BENCHMARK/REFERENCE POINT
L
D FILL REQUIRED: 112.001 INCHES EXCAVATION REQUIRED: [ 48.00] INCHES
1.- Invert elevation and Bottom of drainfield to be no less than 7.02' & 6,52' NGVD respectively.
0 2.- Install a 105D gal, septic tank with an approved filter. I
T 3.- The licensed contractor installing the system is responsible for installing the minimum category of tank in accordance
H with s. 64E-6.013(3)(f) FAC. �l
4.- Install 300 sf. of drainfield in BED configuration. +-
cti
E 5: Install 12" of slightly limited soil at the bottom of the drainfield. Q
R
THIS PERMIT IS NOT FOR ANY ADDITIONS. (Comments Continued on Page 2.)
f
SPECIFICATIONS BY- Ca os H Pullen (jTITLE:
APPROVED BY: 31W91SHO � ciYAWA ,�
ns A Davis ,,11 DATE ISSUED: For Septic Tank andjor UlaNT-- I" DATE:
DH 4016, 08/09 (Obsoletes all pre taus edi nsfi ch r�ays�ti b� used 1�f i
Incorporated: 64E-6.003, FAC
and landscaping is resTd w+1;-
sidewalk inspected and reDaI ,E;� -
CHD
U 07M9/2021
Maq 1 of 3
Q
STATE OF FLORIDA
DEPARTMENT OF HEALTH
APPLICATION FOR CONSTRUCTION PERMIT
Permit Application Nurrtbpr,
--------------------------- PARTII- SiTEPLAN---------------------------
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Notes:o� P.�.cy"-�r+#a�"!�-F'�R �� o ���c�e i fi►ei r
o re as a-i.rr
, � . ' mac- -r4r •►�_. rsAl �.
Mow! -or ! � ��
Sins PLan submitted I
Plan Approved
ey
ALL
e
pH 4 W S, catoo pbaoWea pmvieus adiNons which may not be
(Stock Numbor. 1.1)44-002a0'5-3)
Not Approves!
Elate
County Health Department
VE D elf TAM l4W"6kFVV T; k GE
incorporated: EPTA. Wic Tank PayP a of4
no final inspection dor d�airtfie,d,
and landscaping until ya; u
is restored,
sidewalk inspected and repaired