PL-07-22-1922Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Permit NO.: PL-07-22-1922
Permit Type: Plumbing - Residential
Work Classification: Septic/Drainfield
Permit Status: Approved
Issue Date: 08/05/2022 1 Expiration:02/06/2023
Location Address Parcel Number
246 NE 101ST ST, Miami Shores, FL 33138 1132060134630
Contacts
DAVID SPIRT Owner MIAMI DADE ENVIROMENTAL Applicant
246 NE 101 ST, MIAMI SHORES, FL 33138 JOSE BOLANOS
Mobile: 3053059898 davidpspirt@gmail.com 8290 LAKE DR, DORAL, FL 33166
Business: 7862514099 miamidadees@gmail.com
MIAMI DADE ENVIROMENTAL Contractor
JOSE BOLANOS
8290 LAKE DR, CORAL, FL 33166
Business:7862514099 miamidadees@gmail.com
Description: INSTALL A 900 GALLON SEPTIC TANK AND 300 SO Valuation: Ins eMon Re nests
P $ 11,050.00 x .. "- r 1F"ry,E'hSa�y.-.
FTDRAINFIELDrOf ljt P
Total Sq Feet: 0.00
Fees
Amount
Application Fee - Other
$50.00
CCF
$7.20
DBPR Fee
$5.80
DCA Fee
$3.87
Education Surcharge
$3.60
Notary Fee
$5.00
Permit Fee
$336.75
Scanning Fee
$9.00
Technology Fee
$38.67
Total:
$459.89
Payments
Date Paid Amt Paid
Total Fees
$459.89
Credit Card
08/05/2022 $409.89
Credit Card
07/29/2022 $50.00
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 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 accurate and that all work will be done in compliance with all applicable laws
regulating constructi2iiand zoning. Futhennore, I authorize the above named contractor to do the work stated.
Owner / Applicant / Contractor / Agent Date
August 05, 2022 Page 2 of 2
Miami Shores Village EXTER•IE;D
JUL 2 � 2Q?.2
Building Department BY.
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949 7-µt
FBC 20Z0"
BUILDING Master Permit No. PL-67-2-67Z2
PERMIT APPLICATION sub Permit No.
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION [—]RENEWAL
PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 1 11 d2. IV 6 IO /. ST
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: 2 n& —0I _V-� —4(4 3to Is the Building Historically Designated: Yes NO
Occupancy Type:,_ Load: Construction Type:Repw &_ Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): 9 \ ALA\ S' R1I 1 j /4Vbl/c j S'/9a29: •kone#:
City: U/ f4 Im 0' 64o III e � State:
Tenant/Lessee Name:
Email: J'9'j1A
CONTRACTOR: Company Name: RIA141 PA be FAAJIIDA106eA� I S. Phone#:
Address: V,zcm Iojs S�r1 S li.�3ts
City: ffl A F4 ( State: 10 /A Zip: `3 s I6(0
Qualifier Name: �r )So �n ��i�1Cat Phone#:
State Certification or Registration #: SI1050 t� Certificate of Competency M C A.02 2i I Ra--
DESIGNER: Architect/Engineer: V a Phone#:
Address: �) �a City: State: Zip:
Value of Work for this Permit: $_L4C S0 Square igeay Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New j Repair/Replace ❑ Demolition
Specify color of color thru tile:
Submittal Fee $ rJG CT-2 Permit Fee $ 'VA3 (p 15 CCF $ 7- 2-0 CO/CC $
Scanning Fee $ 4A•00 Radon Fee $ .3 • 2;, DBPR Notary$_5 • GO
Technology Fee $ 3 5 • (a Training/Education Fee $ i . too Double Fee $
Structural Reviews $
Bond $ p Q
TOTAL FEE NOW DUE$ 9O C•,—1
(Revised02/2412014)
Bonding Company's Name (if applicable)
Bonding Company's
City
State
MortgageLender'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, 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. /n the absence of such posted notice, the
inspection will not be app?Dyep�6N aiteinspection fee will be charged.
or AGENT
The foregoing instru}rrWntwas acknowledged before me this
2 day of V4 , 20 72 . by
h14UAf, '%PNI' ' who is personally known to
me or who has produced as
identification and who did take an oath.
NOTARYPUBLI ;•.,, Jr.�SEBC4ANOS
�t MYCOMMISSIOtJ#00931467
'a`,.` EXPIRES:Ootdbar3,2022
Sign: ...Ro.;.
Pri& , %r!i16-V)A-11TJ
BY
CONTRACTOR
The creeggoing instrument was acknowledged before me this
261 day of \o�i)I�JT 20 2-2—by
JO � 3n A 4V� O S , who is personally known to
me or who has produced PL. Dv-� Vev�, ✓1'c� as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:y �1-
Print: V 1f L I "# e,,N l
`�011,PY Pps�' � Y1Pfa11110'�ee
Seal: cr Comm.:HH222410
Expires: Jan. 31,2026
NoteryPublic • State ofFlorida
Plans Examiner
Structural Review
Zoning
Clerk
(Revised02/24/2014)
NOTICE OF COMMENCEMENT 11l1111 H11111111111111I a ill 1�1111111111111111
I II L lta:� „aa ail Hill tall
E C U
A RECORD D OP, InST BE POSTED ON Inc JOB SITE Al TIME OF FIRST INSPECTION C F ht 21D 22 R 0 5 9 221 I
OR By, 33305 Ps 3042 (1Pss)
PERMIT NO. TAX FOLIO NO. RECORDED 1i7/26/2102< 1.112=i0
HARVEY RUVIN, fi.G;g f.
MIAMI-DARE COUWIY ii
STATE OF FLORIDA:
COUNTY OF MIAMI-DADE:
THE UNDERSIGNED hereby gives notice that improvements will be made to certain real
property, and in accordance with Chapter 713, Florida Statutes, the following information
is provided in this Notice of Commencement.
Space above reserved for use of recording office
Legal description of property and street/address: _- tLLL r2 A1C" 1QLST AtIAM 15 nAPS &P 12A% %k�
2. Description of Improvement:
3. Owner(s) name and address:
Interest In property:
Name and address of fee simple tiNeholder: _
4. Contractor's name, address and phone number:
5. Surety: (Payment bond required by owner from contractor, if any)
Name, address and phone number:
Amount of bond $
6. Lender's name and address:
7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided by
Section 713.13(1)(a)7., Florida Statutes,
Name, address and phone number:
B. in addition to himself, Owners designates the following person(s) to receive a copy of the Lienor's Notice as provided in Section
713.13(1)(b), Florida Statutes.
Name, address and phone number: ._
9. Expiration date of this Notice of Commencement:
(the expiration date is 1 year from the date of recording unless a different date Is specified)
WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED
IMPROPER PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713.13. FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING CE FOR
IMPROVEMENTS TO YOUR PROPERTY A NOTICE OF COMMENCEMENT ���t� p����ryYry`��tB PdjkIQB SI E
FIRST INSPECTION. IF YOU INTEND TO OBTAIN OR RECORDING YOUR NOTICE OF OMMENCEMENT. FINANCING, CONSULT WIRtlEt1lhafthls iyQ�O R o
Slgnature(s) of Owner(s) or Owner(s)' Authorized Officer/Director/Partnerl
Prepared By `i
PnepaM
Print Name
Print PM
Title/Office
Titlegr'
STATE OF F ORIDA
COUNTY OF MIAMI-DADE
The foregoing instrument was acknowledged before me this "yLday
By lLub SPA it
❑ Individually, or ❑ as
for
Personally known, or ❑ produced the following type of identification:
that the
filed in
AD
of
Signature of Notary Public:
Print Name: S OS
(SEAL)
TO SECTION 92.525. FLORIDA STATUTE At!!'l:^tie; JOSE BOUINOS
declare that I have read the foregoing an „ MYCOMMISSION # OG 231457
true, to the best of my knowledge and belief. ,, EXPIRES: October 8, 2022
)wner(s)'sAuthorized Of6cer/Director/Partner/Mana '' ThmNa18n'p'b`u'de'ftm
r• �
INSTRUMENT PREPARED BY:
SKETCH AND LEGAL DESCRIPTION
��ov�o�Nr FOR EASEMENT
LB# 7282 FNTERED
PHONE: 305-822-6062 e FAX: 305-827-96 9
6175 NW 153rd STREET SUITE 321
MIAMI LAKE FL. 33014 JUL 2 9 2022
JOB NUMBER: RP22-1188
ADDRESS:246 NE By.
FOLIO # 1011 3206 E013 I4630 SHORES, FLORIDA 33138 PLITMBING PLANS ::::Date
LEGAL DESCRIPTION: Arr— --Date__
r-tl „_
The South 21 feet of the North 23 feet, LESS the East 2 feet thereof and LESS the West 2 feet
thereof, of the following described parcel of land:
Lot 7 and the East 1/2 of Lot 8, in Block 34 of "MIAMI SHORES SECTION 1", according to the plat
thereof, as recorded in Plat Book 10, at Page 70, of the Public Records of Miami -Dade County,
Florida.
SURVEYOR'S CERTIFICATE:
1) This is not a BOUNDARY SURVEY, but only a GRAPHIC DEPICTION of the description shown hereon.
2) Bearings hereon are refered to Plot Book 10 at Page 70 of the Public Records of Miami -Dade
County, Florida.
3) Not valid without the signature and the original raised seal of a Florida Licensed Surveyor and
Mapper. Additions or deletions to survey maps or reports by other than the signing party or
parties are prohibited without written consent of the signing party or parties.
4) There may be additional Restrictions not shown on this survey that may be found in the Public
Records of this County, Examination of ABSTRACT OF TITLE will have to be made to determine
recorded instruments, if any affecting this property.
5) No Title search has been performed to determine if there are any conflict existing or arising out
of the creation of the Easements, Right of Ways, Parcel Descriptions, or any other type of
encumbrances that the herein described legal may be utilized for.
CITY N.E. 101st. STREET
75' RIGHT-OF-WAY
COPY
22-0'
SCALE: 1" = 30' 10.0'52"
I Fr.FNr)
--— —Centerline
=ONSITE SEWAGE TREATMENT AND
DISPOSAL SYSTEM EASEMENT
Miami Shores Village Building Department
Zoning Dept. Date
Building Dept. Date
Subject to compliance with all Federal,
State and County rules and regulations.
Perm it# R_-O /-zZ- I�IzZ
75.00' ice- — — —
2.0'
I
I
EASt 1/2 LOT-7 I
BLOCK-34
LO F-8 I CD
BLO K-34 o LOT-6
Ln BLOCK-34
I
III L--J
JI
I II
I I
,7" 89'52'10"
75.00
15' ALLEY PER PLAT
SURVEYOR'S CERTIFICATE: F
I Hereby Certify to the best of my knowledge and belief that
this drawing is a true and correct representation of the SKETCH
AND LEGAL DESCIRIPTION of the real property described hereon. 4.e
omis o
1 further certify that this survey was prepared in accordance ional Surveyor & Mapper
with the applicable provisions of Chapter 5J-17, Florida f Florida Reg. No. 6231 N
Administrative Code. July 21, 2022
ur,rnnIr Lli ur na n
ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM
CONSTRUCTION PERMIT
`°:.ae NTERED
JUL 2 9 2022
CONSTRUCTION
BY -PERMIT FOR:p/. OSTDS Repair
APPLICANT: (DAVID SPIRT & MONIKA SLODOWNIK)
PROPERTY ADDRESS: 246 NE 101 St Miami, FL 33138
LOT: 7 BLOCK: 34 SUBDIVISION:
PROPERTY ID #: 11-3206-013-4630
DATE PAID:
FEE PAID:
RECEIPT #:
DOCUMENT #: PR1799054
[SECTION, TOWNSHIP, RANGE, PARCEL NUMBER]
rOR 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 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 CAPACITY
A [
0 ]
GALLONS / GPD CAPACITY
N [
0 ]
GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:I250 GALLONS]
K [
]
GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ ]
D [ 300 ] SQUARE FEET
R [ 0 ] SQUARE FEET
A TYPE SYSTEM: [x]
I CONFIGURATION: [ ]
N
F LOCATION OF BENCHMARK:
New Drainfield. Bed Conf. SYSTEM
SYSTEM
STANDARD [ ] FILLED [] MOUND
TRENCH [x] BED [ ]
COR Front Door 10.20' NGVD
I ELEVATION OF PROPOSED SYSTEM SITE
E BOTTOM OF DRAINFIELD TO BE
L
D FILL REQUIRED: [ 0.001 INCHES
O
T
H
E
R
[ 4.80 1 [L INCHES FT ][ABOVE A BELOW BENCHMARK/REFERENCE POINT
[ 40.80 ] [INCHES FT ] [ ABOVE BELOW BENCHMARK/REFERENCE POINT
EXCAVATION REQUIRED: [ 36.001 INCHES
I: Invert elevation and Bottom of drainfield to be no less than 7.30' NGVD & 6.80' NGVD respectively.
?.- Install a 900 gal. septic tank with an approved filter.
3: Install 300 sf. of drainfield in BED configuration.
3.- Existing SAND at the bottom of the drainfield to remain. Any spoil material UNDERNEATH THE DRAIN FIELD within
?4" vertically that has visible signs of effluent shall be removed as part of the repair.
rHIS REPAIR PERMIT IS NOT FOR ANY ADDITIONS.
(Comments Continued on Page 2.)
BY: Jose Bolanos
TITLE: Registered Septic Tank Contractor
APPROVED BY: TITLE: Engineering Specialist II Dade CHU
ua o as i o are o
DATE ISSUED: 07/27/2022
EXPIRATION DATE: 10/25/2022
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E-6.003, FAC
v 1.1.4 AP1855783 SP•: 0730]
Page 1 of 3
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NOTICE OF RIGHTS
A party whose substantial interest is affected by this order may petition for an
administrative hearing pursuant to sections 120.569 and 120.57, Florida Statutes. Such
proceedings are governed by Rule 28-106, Florida Administrative Code. A petition for
administrative hearing must be in writing and must be received by the Agency Clerk for the
Department, within twenty-one (21) days from the receipt of this order. The address of the
Agency Clerk is 3900 Commonwealth Boulevard, Mail Station 35, Tallahassee, Florida 32399-
3000. The Agency Clerk's email is agency_clerk@FloridaDEP.gov.
Mediation is not available as an alternative remedy.
Your failure to submit a petition for hearing within 21 days from receipt of this order will
constitute a waiver of your right to an administrative hearing, and this order shall become a 'final
order.
Should this order become a final order, a party who is adversely affected by it is entitled
to judicial review pursuant to Section 120.68, Florida Statutes. Review proceedings are
governed by the Florida Rules of Appellate Procedure. Such proceedings may be commenced
by filing one copy of a Notice of Appeal with the Agency Clerk of the Department of
Environmental Protection and a second copy, accompanied by the filing fees required by law,
with the Court of Appeal in the appropriate District Court. The notice must be filed within 30
days of rendition of the final order.
�?�A8 , 4e1V8
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 Fled 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 insuratweNverage from the contractor's company for day labor, part-time employees or subcontractors.
BY SIGNING OW U J(NOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS
CONTENTS. /I
Signature:
Owner
State of Florida
County of Miami -Dade
The foregoing was acknowledge before me this _2 _ day of J C, 202 -
By [)?AU tO S i�A�r who is personally known to me or has produced
IL!
Notary:
BOLANOS
odows,2022
as identification.
ENTERED
JUL 2 9 2022
MIAMI-DADE ENVIRONMENTAL SERVICES INCBy; 2&A-
8290 LAKE DRIVE #334
Miami, FL 33166
miamidadees@gmail.com
Date: January.9.2022
State of Florida
County of Dade
Before me this day personally appeared _Jose Bolanos who, being sworn,
Deposes and says:
That he or she will be the only person working on the project located at 246 NE 101 ST Miami
Shores FLA.
ctorSignature
Sworn to (or affirmed) and subscribed before me this day of J 0 .20J
by . �,- .-P�" �C!'-ems
Personally Know
VOR Produced Identification I �n ✓� L, c
Type of Identification Produced
U L-�
V 1 vi -e_r7 "�'/CLO
Print, Type or Stamp Name of Notary
YrvienneYao
oumnup,,
:�4rPY' PUBI
-
<�
Comm:HH222410
Expires: Jan. 31,2026
Notary Public- State of Florida