PL-07-23-1685 SepticMiami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Permit NO.: PL-07-23-1685
Permit Type: Plumbing - Residential
Work Classification: Septic/Drainfield
Permit Status: Approved
Issue Date:07/13/2023 Expiration: 01/15/2024
Location Address Parcel Number
68 NW 92ND ST, Miami Shores, FL 33150 1131010170170 �
Contacts
David Canut Owner
68 NW 92ND, Miami, FL 33150
yunnnox2@gmail.com
ALFONSO SEPTIC SOLUTION Contractor
SATURNINO ALFONSO
1391 W 36 ST, Hialeah, FL 33012
Business: 7867186460 Alfonsoseptic@gmail.com
I
Description: SEPTIC TANK AND DRAIN -FIELD Valuation: $ 8,500.00 inspection Re uests
Total Sq Feet: 0.00
Fees
Amount
Application Fee -Other
$50.00
CCF
$5.40
DBPR Fee
$4.46
DCA Fee
$2.98
Education Surcharge
$2.70
Permit Fee
$247.50
Scanning Fee
$6.00
Technology Fee
$29.75
Total:
$348.79
Payments
Date Paid
Amt Paid
Total Fees
$348.79
Credit Card
07/06/2023
$50.00
Credit Card
07/13/2023
$298.79
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 ctstruction and zoning. uthermore, I authorize the above named contractor to do the work stated.
L,(Cy/A ,/A, Ii Safi ('0o'141/lop�rz--,
Authorized Signature: Owner / Applicant / Contractor / Agent Date
July 13, 2023 Page 2 of 2
iRECEIVED
Miami Shores Village JUL062023
Building Department B`-':
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 20Z-�
o - "►
BUILDING Master Permit No. PL-0-7— Z3- NoE—S
PERMIT APPLICATION sub Permit No.
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑■ PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 68 NW 92 St
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: 11-3101-017-0170 Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type:
Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): David M Canut Phone#:
68 NW 92 St
Citv: Miami Shores
Tenant/Lessee Name:.
Email:
State: FI
33150
CONTRACTOR: Company Name: Alfonso Septic Solution Phone#: 786-718-6460
Address: 1391 W 36 St
City: Hialeah State: FI Zip: 33012
Qualifier Name: Saturnino Alfonso Phone#: 786-718-6460
State Certification or Registration #: SR0221925
of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Value of Work for this Permit:
Type of Work: ❑ Addition ❑ Alteration ❑ New
Description of work: Septic tank and Drain -field
Specify color of color thru tile:
Submittal Fee
Scanning Fee $
Technology Fee
Structural Reviews $
Permit Fee $
Radon Fee $
Training/Education Fee $
State: Zip:
Footage of Work: _:�I` C=1111
❑■ Repair/Replace ❑ Demolition
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 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.
'r
Signature IVY Signature
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this
Not day of / J UNE 20 Z3 by
1f^ of 1 arIOAD CJQ who is p�e�rs/on�,ally known to
me or who has produced. tj� as
identification and who did take an oath.
NOTARY PUBLIC:
The foregoing instrument was acknowledged before me this
,12:7 day of VN*F 20 ?-3 by
YHiVJe1Q/No SO who is personally(!29A to
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
as
Sign: Va, y Sign:
Print: Print:YOSDEL MEZ
Seal: +, ,•YOSDELGOMEZ Seal: Notivy
Pubfic - State of
• N4tW Pubib- Stelednodae CemmWloni GG 99aIIIIIIIIIIIIr
# Comn"slon 0 GG 9M54 WCOMM.: 0" Muds 9, 2924
Ctxem.: Ores Mamb 9, 2024
/ ii qa�,
VEDBY APPROUVW Plans Examiner Zoning
Structural Review
(Revised02/24/2014)
Clerk
RIFICEIVrID
Site Plan submitted by
Plan Approved XX Not Approved Date 6/21/2023
+,g fia tR:sd .jiibnSt7
ey aLCARDD CASTTLLO of
County Health Department
-llltlf'2/f�S
ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
DEP 4015, 06-21-2022 (Obsoletes previous editions which may not be used)
Incorporated: 62-6.004,F.A.C. Page 2 of 4
R-E,CEIV7ED
JUL 062023
STATE OF FLORIDA RV:_
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM
CONSTRUCTION PERMIT FOR: OSTOS Repair
APPLICANT: (DAVID M CANUT BARRACHINA CARMEN RABANAL DE LA CAGIGA)
PROPERTY ADDRESS: 68 NW 92 St Miami, FL 33150
LOT: 17 BLOCK:
PROPERTY ID #: 11-3101-017-0170
SUBDIVISION:
PERMIT #:13-SC-2739750
APPLICATION #:AP1973531
DATE PAID:
FEE PAID:
RECEIPT #:
DOCUMENT #: PR1965471
[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 SeDtic 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 HRS #Pumps [ ]
D [ 200 1 SQUARE FEET New Drainfield. Bed Cont SYSTEM
R [ 0 ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [x] STANDARD [ ] FILLED [ ] MOUND [ ]
[x] RED [ ]
I CONFIGURATION: [ ] TRENCH
N
F LOCATION OF BENCHMARK: Center pn
I ELEVATION OF PROPOSED SYSTEM SITE
E BOTTOM OF DRAINFIELD TO BE
L
D FILL REQUIRED: [ 0.00 ] INCHES
0
T
H
E
R
line 11.58' NGVD
[ 0.96 ] INCHES FT ] [ ABOVE
[ 42.96 ] [INCHES FT ] [ ABOVE
"This permit must not exempt applicant from meeting other federal, state, and local jurisdictional requirements including
permitting."
1: Invert elevation and Bottom of drainfield to be no less than 8.50' NGVD & 8.00' NGVD respectively.
2 - Install a 900 gal. septic tank with an approved filter. (Comments Continued on Page 2.)
SPECIFICATIONS BY: SATURNINO ALFONSO
TITLE:
APPROVED BY: TITLE: Engineering Specialist II
Eduardo CastilloSaloedo
DATE ISSUED: 06/26/2023 EXPIRATION DATE
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E-6.003, FAC
POINT
POINT
Dade CHD
09/24/2023
Page 1 of 3
v 1,1.4 AP19'353: SE1873641
ACOREF CERTIFICATE OF LIABILITY INSURANCE
�fti
DATE(MMIDD/YYYIr)
07/10/2023
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 policy(ies) 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
co Monica Escobar
PHONE _ (305) 558-2062 1 T(AAIXC No . (305) 826-4835
Centurion Insurance
AIL
ADDRESS- mescobar@centurionfl.com
3904 W 12 Ave
INSURERS AFFORDING COVERAGE
NAIC t/
INSURER A: NAUTILUS INSURANCE COMPANY
17370
Hialeah FL 33012
INSURED
INSURER B
INSURER C :
ALFONSO SEPTIC SOLUTION INC
INSURER D .
1391 W 36th St
INSURER E :
INSURERF:
Hialeah FL 33012
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
ADDL
SUER
POLICY NUMBER
POLICY EFF MM
PIOIDDMnM EXP
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE FX OCCUR
NN1542083
07/01/2023
07/01/2024
EACH OCCURRENCE
$ 1,000,000
DAMAGE TO RENTED
PREMISES tEa occurre
$ 100,E
MED EXP oneperson)
S 5,000
PERSONAL & ADV INJURY
$ 1,000,000
GENL
X
AGGREGATE LIMIT APPLIES PER:
POLICY JEC LOC
OTHER:
GENERAL AGGREGATE
$ 2,000,000
PRODUCTS - COMP/OP AGG
$ 2,000,000
$
AUTOMOBILE
LIABILITY
ANY AUTO
OWNED SCHEDULED
AUTOS ONLY AUTOS
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
CEOMBINEDD SINGLE LIMIT a accident)
$
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
Per accident
$
$
UMBRELLA LIAB
EXCESS LIAB
OCCUR
CLAIMS -MADE
EACH OCCURRENCE
$
AGGREGATE
$
DED I I RETENTION $
$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
It a describe under
DESCRIPTION OF OPERATIONS below
N / A
PER I OTH-
STATUTE I I ER
E.L. EACH ACCIDENT
$
E.L. DISEASE - EA EMPLOYE
$
E.L. DISEASE - POLICY LIMIT
$
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required)
LICENSE NUMBER SR0221925 SEPTIC TANK CONTRACTOR
Village of Miami Shores
10050 NE 2nd Ave
Miami Shores
FL 33138
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
01988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD