PL-02-20-273Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address
274 NW 93RD ST, Miami Shores, FL 33150
Contacts
MATTHEW CITRIGUA Owner
274
Permit NO.: PL-02-20-273
Permit Type: Plumbing - Residential
Work Classification: Septic/Drainfield
Permit5tatus: Approved
Issue Date: 11/19/2021 Expiration: 05/19/2022
Parcel Number
1131010331120
Bryan Zero
7701 W 18 LN, HIALEAH, FL 33014
Business: 3053640113
asuperseptic@gmail.com
Description: REPAIR SEPTIC TANK AND DRAIN FIELD Valuation: $ 7,525.00 Inspecton Requests:
305-762 4949'
Total Sq Feet: 0.00
Fees
Amount
Application Fee - Other
$50.00
CCF
$4.80
DBPR Fee
$3.95
DCA Fee
$2.63
Education Surcharge
$1.60
Notary Fee
$5.00
Permit Fee
$213.38
Scanning Fee
$9.00
Technology Fee
$6.58
Total:
$296.94
Building Department Copy
Payments Date Paid Amt Paid
Total Fees $296.94
Credit Card 11/19/2021 $296.94
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 AFFID I th all the foregoing information is accurate and that all work will be done in compliance with all applicable laws
regulatin o i rr r g Futhermore, I authorize the above named contractor to do the work stated.
nit
Applicant / Contractor / Agent
Date
November 19, 2021 Page 2 of 2
Miami Shores Village ---:Ag
�rr�r �En Building Department 010190 83J
10050N.E.2nd Avenue, TeL (3 5) 795-2204'Fax: (305) 756 8972ami Shores, Florida 33138 Cr a w a J. Ara
FES 0 6 202o INSPECTION LINE PHONE NUMBER: (305) 762-4949
sy�_._ FBC 2014'1
BUILDING Master Permit No. PC-02-20- 2"43
PERMIT APPLICATION Sub Permit
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
2�FLUMBING ❑ MECHANICAL [—]PUBLIC WORKS [:]CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS:4,/'y N k/ 93 -g%Rec--i'
City: Miami Shores County: Miami Dade Zip: 33s0
Folio/Parcel#: //- � 0/-623 • MP d Is the Building Historically Designated: Yes NO
Occupancy Type: � Load: Construction Type: '-� Flood Zone: i BFE: FFE:
OWNER: Name (Fee Simple Titleholder): / � r77f/Pit/ "q 62z'ellA Phone#:
City: 4/Xf0/
Tenant/Lessee Name:
Email:
CONTRACTOR: Company
State: zip:.�3/SU
Phone#:
Address: %'/0/ ii/ J8
City: ///A/e✓- H State: �� zip: 93 01,61
Qualifier Name:
State Certification or Rja istration #% Sqo 1 b I r77a Certificate of Competency #:
DESIGNER: Architect/Engineer: �i Phone#:-gAOlbITeaa
Address: City: State: _Zip;
Value of Work for this Permit: $ 'I h oZ� Square/Linear Fgotage of Work: 30 0 S4, EL
Type of Work: ❑
Description of Work:
❑ Alteration ❑ New I_I Repair/Replace ❑ Demolition
Specify color of color thru tile:
Submittal Fee
Scanning Fee S.
Technology Fee
Structural Reviews $
Permit Fee $
Radon Fee $
Training/Education Fee $
CCF $ CO/CC $
DBPR$ Notary
Double Fee $
Bond $ S C)0' oci /
TOTAL FEE NOW DUE $ Z i6 - � Y
(Rev1sed02/24/2014)
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
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, ertified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven da after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a rei s ctio fee will be charged.
OWNEor AGENT
The foregoing instrument �Jaas acknowledged before me this
0� dayof �20 2—Cs by
r'4nkTT4L. 4__���DTI�kfilh personally known to
me or who has produced-T�L -rO il,� WCXlM as
identification and who did take an oath.
NOTARY PUBLIC:
Sig
_ �-
r--
$INDIA ALVAREZ
MY COMMISSION N GG 238273
APPROVED BY
Signature
G CTOR
The foregoing instrument was acknowledged before me this
lb+n day of 'F((kJD 20 2 . by
Y!AaV) Z Pr0 who is personally known to
me or who has pp)du_ced -D% as
who diiKtake an oath.
Print:
Seal:
Y PR
n,oac
Plans Examiner Zoning
(Revised02/24/2014)
Structural Review Clerk
_ 7Y
a' to* 20,
1 loch = 20' ft.
F.LP.
^.I
B.C. 75.00'
F.L.P. 112- (BASIS OF BEARING
PER PLAT)
REMAINDER OF
LOT 11
BLOCK 135 d
ri
04
a
.. i. STAMPED
OCOwNC .
N.. '
STEPS
Lo" I-
x-ru
70' C.E
I
e
WALL
o
Y,
I
a
ry
ONESTORY
n
RESIDENCE
11.30'
4.20'
a 274
17.6D'
I
80
IPNI
r4
£
' OF LOT 10
L
T11 BLOCK 13'LO 135rI
t
jA
�1
'Raw...
•••.•.
• •�•
LOT 9
658 BLOCK.W
&-
cl
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DINTS OFPTtN651:
j OVER °ROPERTY LIN
j
MAP OF BOUNDARY SURVEY
cIESM RfPRESEN]W KASIIST PRFPARFOINmERN ]MS
BYMES
CQNFLIES WITN MEYNYWN RGXAL ETAMYROS /•S SETF0.4M8Y rME 5TA]EOF
C
Property Address:
0.0.P1.1' 4BOM06PMIPSSIMML9tlM1EV"Vi$.Vq YY4ERM CMMTEN Sll)OSI. ROFM
AUYIY[Ir4rNE coaE� rosEc ,)zPn.aoww sr"n)Es
274 NW 93 ST
MIAMI SHORES, FL 33150
nlineLand
/ SLIRVEYORS,INC.
15271 NW 60 AVE. Suite 206
Miami Lakes, FL 33014
www.OnGnel-andSurveyors.Com
SIGNED �'., r�.anv `� FOR THE FIRM
MIGUEL ESPINOSA No. S10T
AD
STAVorAMING IPL,MV�7_
Survey Date:4/1812018 Survey Code:0-02318 Page 1 of 2 Not valid without all pages.
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: (Matthew A. Citriglla)
PROPERTY ADDRESS: 274 NW 93 St Miami, FL 33150
LOT: 10/11 BLOCK: 135 SUBDIVISION:
PERMIT #:13-SC-2034076
APPLICATION #:AP1464421
DATE PAID:
FEE PAID:
RECEIPT #:
DOCUMENT #: PR1301329
[SECTION, TOWNSHIP, RANGE, PARCEL NUMBER)
PROPERTY ID #: 11-3101-033-1120
[OR TAX ID NUMBER]
SYSTEM MUST HE 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
Mj+�S'ERi4L FACTS,
WHICH SERVED AS A BASIS FOR ISSUANCE OF
THIS PERMIT, REQUIRE THE APPSIIGANT
Th" NODIFY "TI-a-
PERMIT APPLICATION. SUCH MODIFICATIONS MAY
RESULT IN THIS PERMIT BEING MADE
t{IfL 'JWD VOID
ISSUANCE OF THIS PERMIT DOES NOT EXEMPT
THE APPLICANT FROM COMPLIANCE:WITH
••�
OTHIZU FEDSRA:,J-
STATE, OR LOCAL PERMITTING REQUIRED FOR DEVELOPMENT OF THIS PROPERTY.
a
••••
SYSTEM DESIGN AND SPECIFICATIONS
•�••
T [ 900 ] GALLONS / GPD New Septic Tank CAPACITY •• ••
• ••••�•
A ( 0 ] GALLONS / GPD
CAPACITY .
•
N ( 0 ] GALLONS GREASE INTERCEPTOR CAPACITY
[MAXIMUM CAPACITY SINGLE TANK:12500GALL4ft • ••••%
K ( ] GALLONS DOSING TANK CAPACITY (
)GALLONS 8[ ]DOSES PER•]A1•HRS
fi9UMPG [�•�•�•
D ( 225 ] SQUARE FEET New Drainfield Trench Con
SYSTEM
R [ 0 ] SQUARE FEET
SYSTEM
A TYPE SYSTEM: [XI STANDARD [ ] FILLED
[ ] MOUND [ 1
I CONFIGURATION: [x] TRENCH [ ] BED
N
F LOCATION OF BENCHMARK: 12.6' NGVD BACK SLIDING DOOR.
I ELEVATION OF PROPOSED SYSTEM SITE
E BOTTOM OF DRAINFIELD TO BE
L
I,
0
T
H
E
R
[ 26.40 ] [INCHES FT ] [ ABOVE
161.32 ] ( INCHES ' FT ] [ ABOVE
POINT
BENCHMARK/REFERENCE POINT
'ILL REQUIRED: I U.UV J INCHES ZAi VA'1'1vN I
1: Invert elevation and Bottom of drainfield to be no less than 7.99 & 7.49' NGVD, respectively.
2 : Install a 900 gal. septic tank with an approved filter
3.- Install 225 sf. of drainfield in TRENCH configuration.
4.- Existing SAND at the bottom of the drainfield to remain. Any spoil material UNDERNEATH THE DRAIN FIELD within 24"
vertically that has visible signs of effluent shall be removed as part of the repair.
THIS REPAIR PERMIT IS NOT FOR ANY ADDITIONS. REPAIR PERMIT
(Comments Continued on Page 2.) FLORIDA HEALTH MIAMI DADE COUNTY
FOR A001TIONS
SPECIFICATIONS
BY: Isabe!4B Per
TITLE: OPS Engineering Specialist
II
APPROVED BY:
TITLE: Engineering Specialist II
Dade CHD
arts rza+
DATE ISSUED:
2/04/2020
EXPIRATION DATE: r
05/04/2020
DH 4016, OB/09
(Obsoletes all previous
editions which may 19py L6.Y4gTNG PT ANq
Incorporated:
64E-6.003, FAC
Page 1 of 3
v 1.1.4
Approved S1
AP1�6C421 Approved Se1250792_
`__
DOCUMENT R: PR1301329
5 - Perimeter of excavation area shall be at least 2 ft wider and longer than the proposed absorption bed or trench.
6- 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.
-The system is sized for 3 bedrooms with a maximum occupancy of 6 persons (2 per bedroom), for a total estimated flow of 300
ad drainfield area based on rule 64E-6.015(6)(c)2.
a new drainfield to achieve Drainfield size requirement.
....
......
B,��G pLAN5
pL
ApprO�ed e`l..
D»appt�
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. Star. § 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 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 ACI DGE 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 GS day of� 20 2-0.
By �q-T- tqj^! -V'—RK\ Niv bT24 Gv who is personally known to me or has produced
C ,-�--�C4 1 V;E2 lkas identification.
Notary:
SEAL:
i:!11,SINDIA ALVAREZ
MY COMMISSION # GG 236273
Public nnderAtere
A SUPER SEPTIC & DRAIN FIELD INC.
CC: SR0161772 7701 WEST 18 LANE
HIALEAH, FLORIDA 33014
Licensed and Insured
PHONE: 305-364-0113
= =- FAX: 305-364-0349
DATE:
STATE OF FLORIDA
COUNTY OF MIAMI-DADE
BEFORE ME THIS DAY PERSONALLY APPEARED, 6f2"•A/ 2_1=r_0 WHO
BEING DULY SWORN, DEPOSES AND SAYS:
THAT HE OR SHE WILL BE THE ONLY PERSON WORKING ON THE PROJECT AT:
a--( y- Al- w fl s + , 3 3i.;-0
Contractor Signature:q
SWO N yT�O, (OR AFFIRMED)'AND SUBSC BED TO ME THIS 5 DAY OF
CJIUO,r zom, BY: I&A kerp
PERSONALLY KNOWN
OR PRODUCED IDENTIFICATION
TYPE OF INFORMATION PRODUCED
�\` - `Lr�M15SI0N� � •����
VO GH 26,
Z ;• u #GG 287268 h:
09 • dyp°titled lbl° C�0
�'Pp�•• �blic Unde�G�O``��
PRINT, TYPE, OR STAMP NAME OF NOTARY