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PL-06-22-1612 SepticMiami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Permit NO.: PL-06-22-1612 Permit Type: Plumbing - Residential Work Classification: Drainfield Permit Status: Approved Issue Date:06/27/2022 Expiration:12/27/2022 Location Address Parcel Number - 1269 NE 99TH ST, Miami Shores, FL 33138 1132050090130 Contacts SCOTT INDORF Owner ALFONSO SEPTIC SOLUTION Applicant 1269 NE 99 ST, MIAMI SHORES, FL 33138 SATURNINO ALFONSO 1391 W 36 ST, Hialeah, FL 33012 Business: 7867186460 Alfonsoseptic@gmail.com ALFONSO SEPTIC SOLUTION Contractor SATURNINO ALFONSO 1391 W 36 ST, Hialeah, FL 33012 Business: 7867186460 Alfonsoseptic@gmail.com Description: DRAIN -FIELD TO BE REPAIRED Fees Amount Application Fee - Other $50.00 CCF $4.80 DBPR Fee $3.94 DCA Fee $2.63 Education Surcharge $1.60 Permit Fee $212.50 Scanning Fee $9.00 Technology Fee 56.56 Total: $291.03 Building Department Copy Valuation: $ 7,500.00 Total Sci Feet: 0.00 Inspection Requests: 305-762-4949 Payments Date Paid Amt Paid Total Fees $291.03 Credit Card 06/24/2022 $50.00 Credit Card 06/27/2022 $241.03 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 a foregoing information is accurate and that all work will be done in compliance with all applicable laws regula ing c strudion and zoning. F h more, I authorize the above named contractor to do the work stated. Authorized Ignature: Owner licant / Contractor / Agent D to d�f�� -t2 June 27, 2022 Page 2 of 2 Ei TW,--W�ZD 41 BUILDING PERMIT APPLICATION Miami Shores Village JUN 24 �JLZ 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 FBC 20 Master Permit No. PZ —06 - 22 — Z ❑BUILDING ❑ ELECTRIC ❑ ROOFING �■ PLUMBING ❑ MECHANICAL [:]PUBLICWORKS JOB ADDRESS: 1269 Ne 99 St Sub Permit ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: 11 -3205-009-0110 Is the Building Historically Designated: Yes NO X Occupancy Type: R Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): Scoff A Indorf ,,,,A-, 1269 Ne 99 St City: Miami Shores State: Florida Tenant/Lessee Name: Email: CONTRACTOR: Company Name: Alfonso Septic Solution Address: 1391 W 36 St City: Hialeah State: FI Qualifier Name: Saturnln0 Alfonso Phone State Certification or Registration #: SR0221925 /Certificate of Competency #: DESIGNER: Architect/EnRlneer:.A /F9 vtSn S eo I L a l,' a, ( oo wi Phone 'ip: 33138 786-718-6460 Ip. 33012 786-718-6460 State: _Zip: Value of Work for this Permit: $ -73-00 Square/Linear Footage of Work: 2lb SP Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace ❑ Demolition Description of work: Drain -Field to be repaired Specify color of color thru Submittal Fee $ Permit Fee $ Scanning Fee $ . Technology Fee Structural Reviews $ Radon Fee $ Training/Education Fee $ CCF $ CO/CC $ DBPR$ Notary: Double Fee $ Bond $ (Revised02/24/2014) TOTAL FEE NOW DUE $ Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lenders 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. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature V `^' " �- . d 'P OWNER or AGENT The foregoing instrument was acknowledged before me this 6 day of r= 20 7.2- , by g601T A IV W4. who is personally known to me or who has produced s Lv s identification and who did ake an oath. NOTARY PUBLIC: + YOSDELGOMEZ • Notary PuhHe-Slab of Fldlda [/ C•mmlulon 9 GG 966894 Sign- [GQ,M 'Pt u.„ 0 onoa Print: Seal: Signature J'l CONTRACTOx The foregoing instrument was acknowledged before me this day of N 20 ZZ • by 00 IV -SO who is personally known to me or who has produced (aa identification and who did take an oath. NOTARY PUBLIC: YOSDEL GOMEZ �• Notary POO-.- Stow of Florida Sign: Commbalon • GG 966894 om s March 9, 2024 Print:*�J2,ki4MIL Seal APPROVEDBY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) Prope Search Application - Miami -Dade County Page 1 of 1 SL OFFICE OF THE PROPERTY APPRAISER Summary Report Property Information s Folio: Property Address: 11-3205-009-0110 1269 NE 99 ST Miami Shores, FL 33138-2642 Owner SCOTTA INDORF &W ANN MARIE Mailing Address 1269 NE 99 ST MIAMI SHORES, FL 33138-2642 PA Primary Zone 1400 SGL FAMILY - 3001-3250 SQ Primary Land Use 0101 RESIDENTIAL -SINGLE FAMILY: 1 UNIT Beds I Baths I Half 2/2/0 Floors 1 Living Units 1 Actual Area 2,790 Sq.Ft Living Area 2.526 Sq.Ft Adjusted Area 2,658 Sq.Ft Lot Size 9,537.5 Sq.Ft Year Built Multiple (See Building Info.) Assessment Information Year 2022 2021 2020 Land Value $563,156 $360,306 $360,306 Building Value $244,004 $199,350 $199,350 XF Value $20,694 $20,726 $20,757 Market Value $817,854 $580,382 $580,413 Assessed Value $329,905 $320,297 $315,875 Benefits Information Benefit Type 2022 2021 2020 Save Our Homes Assessment $487 949 $260.085 $264,538 Cap Reduction Homestead Exemption $25,000 $25,000 $25,000 Second Exemption $25.000 $25,000 $25,000 Homestead Note: Not all benefits are applicable to all Taxable Values (i.e. County, School Board, City, Regional). (Short Legal Description EARLETON SHORES PB 43-80 E1/2 LOT 14 & LOT 15 LESS E25FT BLK 1 LOT SIZE IRREGULAR OR 19014-0452 02 2000 1 Generated On: 6/24/2022 Taxable Value Information 2022� 2021 2020 County Exemption Value $50,000 $50,000 $50,000 Taxable Value $279.905 $270,297 $265,875 School Board Exemption Value 1 $25,000 $25,000 $25,000 Taxable Value 1 $304,905 $295,297 $290,875 city Exemption Value 1 $50,000 $50,000 $50,000 Taxable Value $279,9051 $270,297 $265,875 Regional Exemption Value 1 $50,000 $50,000 $50,000 Taxable Value 1 $279,905 $270,297 $265,875 Sales Information Previous OR Book- Price Qualification Description Sale Page 19014- 02/01/2000 $225,000 Sales which are qualified 0452 00000- Sales which are disqualified as a result 02/01/1992 $0 00000 of examination of the deed 12561 O6101/1985 $130,000 Sales which are qualified 0001 The Office of the Property Appraiser is continually editing and updating the tax roll. This website may not reflect the most current information on record. The Property Appraiser and Miami -Dade County assumes no liability, see full disclaimer and User Agreement at http://www.miamidade.gov/info/disclaimer.asp Version: https://www.miamidade.gov/Apps/PA/propertysearch/ N,YPzM Miami Shores Village Building Department Zoning Dept, Date Building Dept. Date J jd Subject to compliance with all Federal, STATEOF F r ' LO ROA State and County rules and regulations. JEPAR MIEr 11 OF HEALTH Permit#eL-'- APPLICATi0N rC R .;::S,TRUCTION PEFt:ei. 1 S: t i u• :. Permit Application Number____-_._.._.__. _ r' TY ? 7 9-- M!R'fv'i ^`►ytiR S ! L_ `:fir 3�} Site Plan submi ed t Plan Ap } X _ T s�asi+us :ol pp {:r-,d Date s !� ZOl2 BY � County Health Department ALL CHANGES MUST BE APPROVED SY THE COUNTY HFAL FH DEPARTMENT DH 4015, 08;Q9 46>bsoia?c-s Pi i. s'.I'd 11, ',. veveh may rot! a. (Stock Number. 5744.=-- 0 €i r,l E N T E R E D JUN�.�24 °,:G BY:� STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM APPLICATION FOR CONSTRUCTION PERMIT APPLICATION FOR: PERMIT NO. DATE PAID: FEE PAID: RECEIPT #: [ ] New System [ ] Existing System [ ] Holding Tank [ j Innovative [ ] Repair [ ] Abandonment [ I Temporary [ ] APPLICANT: AGENT: TELEPHONE: MAILING ADDRESS: 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: PLATTED: PROPERTY ID #: ZONING: I/M OR EQUIVALENT: [ Y/N PROPERTY SIZE: ACRES WATER SUPPLY: [ ] PRIVATE PUBLIC [ X]<=2000GPD [ 1>2000GPD IS SEWER AVAILABLE AS PER 381.0065, FS? [ Y/N ] DISTANCE TO SEWER: NIA PROPERTY ADDRESS: DIRECTIONS TO PROPERTY: BUILDING INFORMATION [ ] RESIDENTIAL [ ] COMMERCIAL Unit Type of No. of Building Commercial/Institutional System Design No Establishment Bedrooms Area Sqft Table 1, Chapter 64E-6, FAC 1 2 3 4 [ J Floor/Equipment Drains [ ] Other (Specify) SIGNATURE: 'on v DH 4015, 08/09 (Obsoletes previous editions which may not be used) Incorporated 64E-6.001, FAC DATE: Page 1 of 4 Mission: To protect promote&impmvc the healN ofall people in Floods through integrated li ��. N Ron D,Santis Guvcmor state, county & community efforts. Vision: To be the Healthiest State in the Nation WELLFORM Chapter 64E-6.004(3)(a), F.A.C.: l PLUMBING PLANS Date 2 A plan or plat of the lot or total site ownership drawn to scale, showing boundaries with dimensions, locations of any existing or proposed residences or buildings, swimming pools, recorded easements, the on -site sewage treatment and disposal system components and their location on the property, the slope of the property and any existing or proposed wells, potable and non -potable water lines, including valves, drainage features, filled areas, unobstructed areas, and surface water bodies. The site plan shall indicate the location of wells, on -site sewage treatment and disposal systems, surface waters and other pertinent facilities or features on contiguous or adjacent property. If the features are within 75 feet of the applicant lot, the estimated to the feature must also be shown but need not be drawn to scale. The location of any public drinking water well, as defined in Chapter 64E: 6.002(44)(b), within 200 feet of the applicant's lot shall also be shown, with the distance indicated from the system to the well, and the location of limited use public water system or other public wells, as defined in Chapter 64E-6.002(44) (b), within 100 feet of the applicant lot must also be shown, or as defined in Chapter 64E-6.002(44)(a), F.A.C., within 75 feet from a private potable water well (well used only by one or two residences). Chapter 24-12(18), Miami -Dade County Code: The minimum separation between a well or wells and possible sources of contamination shall be a function of the drawdown radius of influence of the well or wells. In no case shall the well be located less than one hundred (100) horizontal feet from any source of contamination. I have read the above and to the best of my knowledge I have provided the Department with full information regarding pertinent facilities and features on all adjacent properties. Furthermore, I understand that any on -site sewage treatment and disposal system permit issued on the basis of said facilities and feature as provided by me and found to be incorrect will be subject to revocation in accordance with the provisions of Chapter 120, Florida Statutes. Property Address: •• Sgto�er.d A/f�nSD Date: 2022 Signature: •r v} ��0221925 Florida Department of Health Division ofEnvironmenml Health and Engineering mumi-Dade County Acae&W Heafth Dep)8fhf1ent 1725 NE 305/62Jre500MmAX J t.: J53502 "iC Heafth Accreditation PHONE: 305 623-3 E N T E R E D Fbirldel JUN 24 9 %? BY: STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT FOR: OSTDS Repair APPLICANT: Scott Indore PROPERTY ADDRESS LOT: 1415 PROPERTY ID # 1269 NE 99 St Miami, FL 33138 PERMIT #:13-SM-2510674 APPLICATION #: AP1836423 DATE PAID: FEE PAID: RECEIPT #. DOCUMENT #: PR1789967 BLOCK: 1 SUBDIVISION: Eadeton Shores 11-3205-009-0110 [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 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 [ 750 ] GALLONS / GPD EXlstina Septic Tank to Remain CAPACITY A [ ] GALLONS / GPD CAPACITY N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS] K [ 300 ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ 1 1 D [ 216 ] SQUARE FEET New Dfainfleld. Bed Conf SYSTEM A [ ] SQUARE FEET SYSTEM A TYPE SYSTEM: [x] STANDARD [ ] FILLED [ ] MOUND [ ] I CONFIGURATION: ( J TRENCH [x] BED [ ] N F LOCATION OF BENCHMARK: Center Lot Crown Road 99th St. 5.14' NGVD I ELEVATION OF PROPOSED SYSTEM SITE ( 13.80] INCHES FT ][ ABOVE Pt,TOW]BENCHMARK/REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ 19.20It INCHES FT ][ABOVE BELOW BENCHMARK/REFERENCE POINT L D 0 T H E R L REQUIRED: [ U.UUI INCHES EXCAVATION REQUIRED: L 43.UU1 1NUft5 Invert elevation and Bottom of drainfield to be no less than 4.17' NGVD & 3.61, NGVD respectively. EXISTING 750 gal. septic tank with an approved filter certified by Alfonso Septic Solution on 5116/2022, TO REMAIN. EXISTING 300 gal. dosing tank TO REMAIN. Install 216 sf. of drainfield in BED configuration. Install 12" of slightly limited soil at the bottom of the drainfield. IS REPAIR PERMIT IS NOT FOR ANY ADDITIONS. (Comments Continued on Page 2.) SPECIFICATIONS BY: Sate VW- ^Alfonso TITLE: APPROVED BY TITLE: OPS Environmental Specialist II Jos divieaomera DATE ISSUED: 06 57 022 EXPIRATION DATE DH 4016, 08/09 (Obsoletes all previous editions which may not be used) Incorporated: 69E-6.003, FAC Dade CHD 09/06/2022 Page 1 of 3 Notice to Owner — Workers' 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' 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 rite 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 ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature: S w Owner State of Florida County of Miami -Dade The foregoing was acknowledge before me this _� day of 20 2Z, By (�—_07_r A _QVbDlL who is personally known to me or has produced as identifi a[ton. 1, Z �� Notary: Vb�Q©1t't� � """ YOSDEL GOMEZ SEAL: �r ruak • stab a FlwWa CommWlon = GG 999994 Comm.: oma March 9, 2024 FA 10 11 l� (786) 718-6466 ALFONSOSEPTIC@a GMAILCOM LICENSED & INSURED LIC.# SR0221925 Date: State of Florida County of Miami Dade Before me this day personally appeared Saturnino Alfonso Deposes and says: 9 INC who, being duly sworn, That he or she will be the only person working on the project located at: 1269 Ne 99 St Miami shores fl 33138 Sworn to (or affirmed) and ubscribed before me this ZI day of 0&6E 20 Z2 by A'7UkavlM� �ey�n�So Personally known OR Produced Identification Type of Identification Produced YOSDEL GOMEZ Nobly Pink - Sbb of . 202 gtt V Commission • GG 966994 ��\7/// �1 Comm.:. re• Much 9, 2044 L DA'Itz rint, Type or S a p Na of Notary