PL-02-22-270Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address
Permit NO.: PL-02-22-270
Permit Type: Plumbing- Residential
Work Classification: Drainfield
Permit Status: Approved
Issue Date:02/01/2022 Expiration: 08/01/2022
Parcel Number
53 NW 93RD ST, Miami Shores, FL 33150 1131010340260
........
Contacts
MICHAELCHATMAN Owner Yosdel Gomez Applicant
53 NW 93 ST, MIAMI SHORES, FL 331502232 14713 Sw 22 ter, Miami, FL 33185
Mobile: 7864399698 yosdelalfonsoseptic@gmail.com
ALFONSO SEPTIC CONTRACTOR INC Contractor
JOSE BOLANOS
1391 W 36 ST, HIALEAH, FL 33012
Business: 7862514099
Description: INSTALL A NEW DRAINFIELD TO REPLACE PERMIT Valuation: $ 4,800.00 Ins ection Requests:
PL-06-20-1184 305-762-4949
Total Sq Feet: 0.00
Fees Amount Payments Date Paid Amt Paid
100% Permit Renewal Fee $168.00 Total Fees $168.00
Total: $168.00 Credit Card 02/01/2022 $168.00
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 construction and zoning. Futhermore, I authorize the above named contractor to do the work stated.
Authorized Signature: Owner /
Contractor / Agent
Date
February OS, 2022 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
EB 01 2022
By n' A.0
FBC 20 ZO
BUILDING Master Permit No.���-�ro�
PERMIT APPLICATION Sub Permit No. liz-62- Z2-Z�0
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION 2-6TENSION ❑RENEWAL
PLUMBING ❑ MECHANICAL [-]PUBLICWORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: '�; .3 �j (I )Q ':� c;r _
City: Miami Shores County: Miami Dade Zip: 3 i E-50
Folio/Parcel#: 11-� j 01- 0 3 y - 0 „ . 4 Q Is the Building Historically Designated: Yes . NO
Occupancy Type: -R— Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (FeeSimpleTitleholder): 141r14 AA- C[)A-rM A 1Li,jSA UajX_k Phone#: 30-5- y a d -oMo q
Address: Ida ,S- u - t la V1, \oci (� C e
City: Cli /Je coital - State: /-�/n- Zip:,
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: h I. (buSuSe-PTi-Phone#: 7 96 •-251�Ioq 9
Address:
City: 9/ /1- o a LJ- State: //lA Zip: 3 -80/ 2.
Qualifier Name: Ao&(-1r) IA om Phone#: Z96-2S/- qQ
State Certification or Registration #: C Q 129-7 12 -26 Certificate of Competency M 94 01719-t;
DESIGNER: Architect/Engineer:
Address: City: _ _ Statee: __ Zip:.__
Value of Work for this Permit: $ tl zipv Square/Linear—Footage of Work: so 0
Type of Work: ❑ Addition Alteration ❑ & New Repair/Replace ❑ Demolition
Description of Work:
L--a6-26 -
Specify color of color thru tile:.
Submittal Fee
Scanning Fee $
Technology Fee
Structural Reviews $
Permit Fee $ CCF $ Co/cc $-
Radon Fee $ DBPR $ Notary;
Training/Education Fee $
Double Fee $
Bond $
TOTALFEENOWDUE$ 16n- w
(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
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.
5
r N Signature (, Signature
G
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this a foregoing instrument was acknowledged before me this
10 day of i0CT(71ht ON 20ZO L by day of L . 20 2,n I • by
S wt, "ik a C "T`Me, who is personally known to P, a who is personally known to
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
JOSEBOLANOS
MY COMMISSION M GO 231457
EXPIRES: October S, 2o22
APPROVED BY
as me or who has produced
identification and who did take an oath.
as
NOTARY PUBLIC:
,
Sign:
_ Print:
Seal: / YOSDEL GOMEZ
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Comm EYON 11rdi 96 pal
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Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
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06/11/2020 12:41:57
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: Micheal D. Sandra Chatman
PROPERTY ADDRESS: 53 NW 93 St Miami, FL 33150
LOT: 19 BLOCK: 20 SUBDIVISION:
PROPERTY ID #: 11-3101-034-0260
PERMIT 8:13-'Ji.'lUtSEi3'L/
APPLICATION #:AP1506522
��TFJ�22
FEE PAID:
RECEIPT #
DOCUMENT #: PR1361477
[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 1 GALLONS / GPD Existing Septic Tank CAPACITY
A [ O ] GALLONS / GPD CAPACZTY
N [ 0 j GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
K [ ] GALLONS DOSING TANK CAPACITY I ]GALLONS @[ ]DOSES PER 24 HRS #Pumps I ]
D [ 300 1 SQUARE FEET New Drainfield Bed Conf. SYSTEM
R [ 0 1 SQUARE FEET SYSTEM
A TYPE SYSTEM: IX] STANDARD [ 1 FILLED I ) MOUND I ]
I CONFIGURATION: I ) TRENCH [xj BED I 1
N
F LOCATION OF BENCHMARK: Crown of the road center of house @ 10.70' NGVD.
I ELEVATION OF PROPOSED SYSTEM SITE 11.20 )I INCHES � FT ]I ABOVE BELOW]BENCHMARK/REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 28.803[ INCBES FT [ABC:'E BELO BENCHMARK/REFERENCE POINT
L
u
0
T
H
E
R
Invert elevation and Bottom of drainfield to be no less than 8.89 & 8.30' NGVD, respectively.
EXISTING 750 gal, septic tank with an approved filter certified by ALFONSO SEPTIC CONTRACTOR on 05/21/2020, TO
Install 300 sf. of drainfield in BED configuration.
Existing SAND at the bottom of the drainfield to remain. Any spoil material UNDERNEATH THE DRAIN FIELD within 24"
tically that has visible signs of effluent shall be removed as part of the repair.
IS REPAIR PERMIT IS NOT FOR ANY ADDITIONS.
SPECIFICATIONS BY: Jo,.se,, ,.Bolanos TITLE: Registered Septic Tank contractor
V
APPROVED BY: / Ua*i / Serer TITLE: Engineering Specialist II Dade CHU
Yliene serre
06/O3/2020 EXPIRATION DATE: 09/01/2020
DATE ISSUED:
DH 4016, 08/09 (Obsoletes all previous editions which may not be used] Paqe 1 of 3
Incorporated: 64E-6.003, FAC
. i_i.i /.?15G65s2-.n.25a EG4
DOCUMENT #: PR1351477
The system is sized for 2 bedrooms with a maximum occupancy of 4 persons (2 per bedroom), for a total estimated flow of 300
9pd,
Required drainfeld area based on rule 64E-6.015(6)(c)2.
Install a new drainfield to achieve Drainfield size requirement.
STATE OF FL DA
DEPARTMENT OF HEALTH
APPLICATION FOR CONSTRUCTION PERMI T
Pemlh AppOcation Number
-------------------- PART'it- SITEPLAN----------- -----------
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site Plan ���Y 0
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S-u-- ti R 0921 Z T 6 County Heegh Deparbeat
ALL cHAt4GES IWCiST 8E APPROVED By THE COUNTY HEALTH
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06/03/2020
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 Exem
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
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.
Owner
State of Florida
County of Miami -Dade
The foregoing was acknowledge before me this _L O day of CC, To be -,' , 202&__:
By S Ay a i C�) •1 q K'N AT V Akl— who is personally known to me or has produced
as identification.
Notary:
SEAL: / T-t 4tY00AtL1M1S _
�; •�1SS10tIfGGT31457
tx• :e EXPIRE8:Odober8 2M2
��,.r.,:yc_a� �=i-r css��ii�t'si�.e�s •>� ssti. -' .
- - ' �'!:".i1�4!1}b.y ��.�'�`{�e��wtl�l±l �'T1�Y7 •��r �;Jl 9�?���� ---- --
Alfonso Septic Contractor, INC.
1391 West 36 Street
Hialeah, FL 33012
Alfonsoseptic@gmail.com
Date: November.14.2021,
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 53 NW 93 ST Miami
Shores FLA.
Contractor Signature t�
Sworn to (or armed) and subscribed before me this;'p day of l-JO20_2?j
bvAQ&
Personally Know t/
OR Produced Identification
Type of Identification Produced
YOSDEL GOMEZ
Nab" ruek • air. r naa.
CarnarMon 0 00 gou"
Conn. LV&n Hirar 0. 2=
Print, Type or Stamp Name of Notary
y �Me7z