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PL-07-23-1830Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Location Address Parcel Number 10610 NE SOTH PL, Miami Shores, FL 33138 1122320280820 Contacts Permit NO.: PL-07-23-1830 Permit Type: Plumbing - Residential Work Classification: Septic Permit5mtus: Applied Issue Date: Expiration: 01/21/2024 TR DEVELOPERS LLC Owner JESUS TORRES Mobile: 9792564427 jcremierz@mndesigngroup.com EMPIRE ENGINEERING SERIVICES CORP Contractor JORGE MILLAN 2423 SW 147 AVE, MIAMI, FL 33185 Business: 7864888657 Description: SEPTIC SYSTEM REPAIR Valuation: $ 5,800.00 Inspection Re uests: Total Sq Feet: 0.00 Fees Amount Application Fee - Other $50.00 CCF $3.60 DBPR Fee $3.05 DCA Fee $2.03 Education Surcharge $1.80 Permit Fee $153.00 Scanning Fee $9.00 Technology Fee 520.30 Total: $242.78 Building Department Copy Payments Date Paid Amt Paid Total Fees $242.78 Credit Card 07/25/2023 $50.00 Credit Card 08/15/2023 $192.78 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 n accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permo arellnequired for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws and zoning. Futhermore, I authorize the above named contractor to do the work stated. arge tAIAC-... <3 15I23 Owner / Applicant / Contractor / Agent Date August 15, 2023 Page 2 of 2 Miami Shores Village [J2 2 5 2T023 Building Department J4M10050 N.E.2nd Avenue. Miami Shores. Florida 33138 Tel:(305) 795-2204 Fax: 1305) 7S6.8972 INSPECTION LINE PHONE NUMBER: (305) 762d949 FBC 2^02E� �w1 BUILDING Master Permit No.?L--C)IT PERMIT APPLICATION Sub Permit No. []BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ]PLUMBING ❑ MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP / CONTRACTOR DRAWINGS JOB ADDRESS: -1 0& 10 T S 4 O Pi _City: Miami Shores County Miami Dade Zip: 33 13 i Folio/Parcel#:_11-222. 32-0 2-F— Q o Is the Building Historically Designated: Yes_ NO - --Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder(: T R 32 y e 1 w rs 4-L C Phone#: Address: f 6 4 0e- � -.�.2 vy P jl !� City: CO Y-al or7, Ulu State: FL zip: 331y6 Tenant/Lessee Name: phone* Email: CONTRACTOR: Company Name: rA '! Address: "1'3'40 EW �72 S SU& City: 'M i dm i State: F/ Qualifier Name: State Certification or RegistYation #: 511O Q 4 41 Q 2 Certificate of Competency 0: _ DESIGNER: Architect/Engineer: N1Q Phone#: Address: City: y Value of Work for this Permit: $ ,D 5 t 0000 _Square/linea�Irrt �FFttootage of Work: Typeof Work: ❑ Addition ❑ Alteration El New 19 Repair/Replace Description of Work: 305- PA1s-5253' Zip: 33 1 Zip: ❑ Demolition Specify color of color thru tile: �[ Submittal Fee $ 'm . Permit Fee $ 1 iJ cT CCF $ i. (;,C CO/CC $ Scanning Fee $ ' - u' Radon Fee $ ? DBPR $ (' > Notary $ Technology Fee $ Z ° 7 c Training/Education Fee $ i 9,� Double Fee $ Structural Reviews S (eemsed02/24/20141 Bond $ TOTAL FEE NOW DUE $ I L 7d Bonding Company's Name lit applicable) Bonding Company's Address City State zip 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. 1 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 CONDITIONE0., 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 low brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice c mencement must be posted at the lob site for the first inspection which occurs seven (7) days after the building permit is ed. n the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature � H'' Signature CQ-MAl�- NERor AGENT ONTRACTOR The foregoing ins rument was acknowledged before me this The foregoing instrument was acknowledged before me this ZO'r` day of ,T„ v , 20 Z 5 . by P ,, day of i s+ / 20 'Z , by who is personally kna rn to yes �-{s i(cw who Is personally own to me or who has produced �>l as me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC :7�'baA,�� Sign: — Sign: rh!%2 Print: G.e..— Prin Seal: :''✓'.c:, ADIANEZ POSAOA : :¢,t}s,+ S e�£�!' MYCOMMISSION#HH134793 CRUZ A. ARISTIZABBAL EXPIRES: Jbne 4, 2025 ''`r J) 4 .t1Y ('OA11115510ti vIIII1JJ1'� i1 i;4'' punded Thry Notary Wblk Waen..gers }J)jj}� ExPIRfS AuK))m��'�2? Ia2J i N-n_/ t22, (i2 _— •HMNH�H�H•e IWMA:�g V •NH�N OH��H�HOp t�iv.,s Gil r APPROVED ByI '7 r�-z,�J Plans Examiner Structural Review (Aeruea02/24/20141 Clerk 7/25/23, 1:50 PM Detail by Entity Name DmSION OF COP.f ORATION i ti`' � Jr t i tray i uJ ,off 1or'0"f u7. law £lurrcttr ;redcdt?• Dgearlment of Stafe / Division of Cor i r / Search Records / Search by Entity / Detail by Entity Name Florida Limited Liability Company TR DEVELOPERS LLC FJjjpg Information Document Number L23000065651 FEI/EIN Number NONE Date Filed 02/06/2023 Effective Date 02/06/2023 State FL Status ACTIVE Principal Address 8200 NW 41 ST 200 DORAL, FL 33166 Mailing Address 8200 NW 41 ST 200 DORAL, FL 33166 Rggistered Agent Name & Address POSADA, ADIANEZ 8200 NW 41 ST 200 DORAL, FL 33166 Authorized Person(5) Detail Name & Address Title AMBR RAMIREZ, JUAN CARLOS 8200 NW 41 ST DORAL, FL 33166 Title AMBR TORRES, JESUS M 8200 NW 41 ST DORAL, FL 33166 pT9�0T JUL 2 5 2023 I By � 1 https://search.sunbiz.org/Inquiry/CorporationSearch/SearchResu[tDetail7inquirytype=EntityName&directionType=l nitial&seamhNameOrder--TRDEVEL... 1 /2 JrJUL L0�9 2 5 Z02; .1�I}'- PERMIT #: STATE OF FLORIDA 73SC-2742583 By •1" \ PLICATION s:AP1975431 DEPARTMENT OF HEALTH DATE PAID: ONSITE SEWAGE TREATMENT AND DISPC I 101y FEE PAID: SYSTEM RECEIPT #: DOCUMENT #: PR1978476 CONSTRUCTION PERMIT FOR: OSTDS Repair --Copy APPLICANT: (TR DEVELOPERS LLC) PROPERTY ADDRESS: 10610 NE 10 PI Miami, FL 33138 LOT: 11 BLOCK: 5 SUBDIVISION: PROPERTY ID #: 11-2232-028-0820 [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 [ 900 ] GALLONS / GPD New Seotic Tank CAPACITY A [ 0 ] GALLONS / GPD CAPACITY N [ 0 ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS] K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HAS #Pumps D [ 300 ] SQUARE FEET Existin0 Bed DF SYSTEM R [ 0 ] SQUARE FEET SYSTEM A TYPE SYSTEM: [ ] STANDARD [ ] FILLED [X] MOUND [ ] I CONFIGURATION: [ ] THENCE [XI BED [] N F LOCATION OF BENCHMARK: F.F.E. 6.0' NGVD. I ELEVATION OF PROPOSED SYSTEM SITE [ 24.001 INCHES FT ][ ABOVE BELOW BENCHMARK/REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ 16.00][ INCAES FT ][ABOVE BELOW BENCHMARK/REFERENCE POINT L D 0 T H E R LL RGQU1Rtil: tLD.VVJ INCSE5 EXCAVATION REQUIRED: L J INURES he system is sized for 3 bedrooms with a maximum occupancy of 6 persons (2 per bedroom), for a total estimated flow of 00 gpd. The EXISTING 300 sf. BED drainfleld, certified by Empire Engineering may remain if the system was previously ermitted and approved, and not currently in failure, and meets the setback requirements of Table V, 62-6.015(6)(a), FAG. (Comments Continued on Page 2.) SPECIFICATIONS BY: Jorg Mi n TITLE: MASTER SEPTIC TANK CONTRACTOR, SM0971292 APPROVED BY: TITLE: Environmental Specialist II Guido V Gallo DATE ISSUED: 07/14/2023 US 4016, 08/09 (Obsoletes all previous editions which may not be used) Incorporated: 64E-6.003, FAC v 1.1.4 AP1975431 Dade CHD EXPIRATION DATE: 10/12/2023 SE1876860 Page 1 of 3 DOCUMENT # : PR1978476 The four comers of the drainfield shall be exposed so that the DOH inspector can verify the size as specified in the existing system evaluation. 3: Install a 900 gal. septic tank with an approved filter. THIS REPAIR PERMIT IS NOT FOR ANY ADDITIONS. 4: The licensed contractor installing the system is responsible for installing the minimum category of tank in accordance with s. 62-6.013(3)(f), FAC. 5: This permit includes the abandonment of the existing septic tank if any. I 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, n party who is adversely affected by it is entitled to judicial review pursuant to Section 120.68, Flurida 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 fled within 30 days of rendition of the final order. MASTER SEPTIC TANK CONTRACTOR s_ JORGE M. MILLAN 9370 SW 7 MIA I, FL EMPIRE ENGINEERING SERVICES, ri EMPIRE O GINE�IO NGSCORP 196 PECtAL Y PLUMBING CONTRACTOR ratFSWVMS s�tvEt► C/O JORGE M MILIAN SM0971282 s�txxrrat�s $75.00 07/25/2022 Warker(s) I INT 22-374742 This lacd Radom Slot Racoi ady coat%"" Ott ttaa local Bucksss Tait. ibe Et "I" la act a ll am, PQm%ar a Ica of tLe� � s to da .. How" W att com* x� aatr gorett stttat or nooawraraatsatal repay 0"Tatw sio.tb+1button. The F= f' $10. above mul be fttgw oe"at1 cmmwdd VSWCWS « AlLdd- Dade Cads Sec 6a-m. ftr more iaforaedion. rW ACCMDr CERTIFICATE OF LIABILITY INSURANCE F-ATEIO/2612022(MMIDDIYYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the poiicy(les) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NA l:: LETICIA RODRIGUEZ Leticia Insurance Agency PHONE ExtI: (305) 631-2094 AI No : (305) 631-2184 5538 SW 8th ST -ADDRESS&leticiainsuranceagency@hotmail.com INSURERS AFFORDING COVERAGE NAIC if Coral Gables, FL 33134 INSURER A : KINSALE INSURANCE COMPANY Phone (305) 631-2094 Fax (786) 703-6435 INSURED INSURER B : INSURER C : EMPIRE ENGINEERING SERVICES CORP INSURER D : 9370 SW 72 ST A-107 INSURER E : MIAMI FL 33173 INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADO INSR UBR POLICY NUMBER POLICY EFF MMIDDNYYY POLICY EXP MMIDDNYYY LIMITS A ❑ COMMERCIAL GENERAL LIABILITY ❑ CLAIMS -MADE © OCCUR ❑ ❑ GEN'L AGGREGATE LIMIT APPLIES PER: ❑ POLICY © JET ❑ LOC ❑ OTHER Y Y SUB 03527860 10/26/2022 10/26/2023 EACH OCCURRENCE ` S 1,000,000.00 DAMAGE TO RENTED PREMISES (Ea occurrence $ 100-000 MED EXP (Any one person) $ EXCLUDED PERSONAL & ADV INJURY $ 1,000,000.00 GENERAL AGGREGATE $ 2,000,000.00 PRODUCTS - COMP/OP AGG $ 2,000,000 $ AUTOMOBILE LIABILITY ❑ ANY AUTO OWNED ❑ AUTOS ULED ❑ AUTOS ONLY HIRED ❑ NON -OWNED ❑ AUTOS ONLY AUTOS ONLY ❑ Ea accident) SINGLE LIMIT $ BODILY INJURY (Per person) S BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ $ ❑ UMBRELLA UAB ❑ OCCUR EXCESS LIAB _) CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ ❑ DED ❑ RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' UABIUTY Y I N ANY OFFICERRIMEM ER EXCLU ED? ECUTNE❑ (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA ❑ PERTUTE ^t OTH- E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE S E.L. DISEASE -POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Excavation, Sewer/Water Line and Septic Contractor CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE MIAMI SHORES VILLAGE BLDG DEPT THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 10050 NE Znd AVE ACCORDANCE WITH THE POLICY PROVISIONS. MIAMI SHORES FL 33138 AUTHORIZED REP ESENTATIVE LETICIA RODRIGUEZ LIC#DW7160 t% � 01988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) OF The ACORD name and logo are registered marks of ACORD ti. DEPAmSEMCES MEW DIVISION OF WORKERT COMPENSATION CERTIFICATE OF ELECTION To Be EXEMPT PROM FLORIDAN WORKERTCOMPENSAT*N LAW PERSON: JORGE M MfLA-AN EMAIL JUPiREENGINC-CRINGGHOTMAIL-COM Miami Shores Village - BUILDING DEPARTMENT 10050 NE 2 Ave Miami Shores, FL 33138 305 - 795 -2204 www.msvfi.aov 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 1 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:yi;r:, 'Iy2rLa5— '"Ci-rt rA LL G 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- fime employees or subcontractors. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature: — Address: I061'0 i-A 16"' ' I, rIQA ' 56o,5fL ,3313X Owner State of Florida County of Miami -Dade The foregoing was acknowledge before me this Zb day of �, , 201,s-. By. tJ nwho is personally known // to me or has produced as identification. Notasa�-- Fnrl ADIANEZ POSADA SEAL: MY COMMISSIONIM 134793 •,: o.' EXPIRES: June 4, 2025 •,M"Poc FY:P" BCfld¢d ThN NWBfY Public Un(13NRII¢l6 ev Notice to Owner Page 1 of 1 COMPANY LETTER HEAD Date: 07/25/2023 State of Florida County: Miami Dade County. Before me this day personally appeared WL'110AK who, being duly sworn, deposes and says: 0 That he or she will be the only person working on the project located at: 10610 NE 10 PI, Miami Shores FL 33138 Signature Sworn to (or'affirmed) and subscribed before me this 2-S- day of 20 L by ,N o r r- Personally known OR Produced Identification Type of Identification Produced �oft.� CRUz A. , �e n1�� coti�,�i�ss(oy.�IZAC3AL RES: Aug ust 22. 2024 l; Print, Type or Stamp Name of Notary