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PL-10-672Project Address Owner Information Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Fees Due CCF Education Surcharge Permit Fee - Additions /Alterations Scanning Fee Technology Fee Total: Amount $6.00 $2.00 $300.00 $3.00 $8.00 $319.00 Building Department Copy Address Parcel Number Contractor(s) A.B.T. SEPTIC SERVICE, INC Phone (305)218 -8883 CeII Phone Authorized Signature: Owner / Applicant / Contractor / Agent Permit Permit NO. PL -4 -10 -672 Permit Type: Plumbing - Residential Work Classification: Septic Permit Status: APPROVED Issue Date: 4/26/2010 Expiration: 10/23/2010 Phone Type of Work: PLUMBING Type of Piping: ABANDONMENT & INSTALLATION Additional Info: NEW SEPTIC SYSTEM Bond Retum : Classification: Residential Pay Date Pay Type Amt Paid Amt Due Invoice # PL -4-10 -37641 04/21/2010 Check #: 1426 $ 319.00 $ 0.00 Applicant 9550 N BAYSHORE Drive Miami Shores, FL 33138- 1132060143860 Block: Lot: JORGE CABRERA 1 JORGE CABRERA 9550 N BAYSHORE DR MIAMI SHORES FL 33138 -3514 Valuation: Total Sq Feet: April 27, 2010 Date Cell $ 9,800.00 0 Available Inspections: Abandonment Inspection Type: HRS Approval Final Rough Landscaping 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. April 27, 2010 1 ����y Miami Shores Village � Building Department Job Address (where the work is being done) 5 City Miami Shores Village County FOLIO / PARCEL # BUILDING PERMIT APPLICATION FBC20 Permit Type: PLUMBING Owner's Name (Fee Simple Titleholder) 4q6 Cfeze62 nI- Phone # Owner's Address City State Zip Tenant/Lessee Name Email Is Building Historically Designated YES 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 rr� Permit No. l9 oZ Master Permit No. o Co '" V 3 I Contractor's Company Name 4, 6•7 Sep h -e-- f' +-rNe- Phone # /5-- y w Z. , o 1 City °vie , ec /� - J t / State - Zip 3 30 3 Qualifier Name 16 /b., / 4 44, °✓ Phone # State Certificate or Registration No. 0 9 5/ 2- Z 3 Certificate of Competency No. Contact Phone Contractor's Address 1. Architect/Engineer's Name (if applicable) Phone # Value of Work For this Permit $ Submittal Fee $ Permit Fee $ NO E -mail Double Fee $ Violation date: Structural Review. $ 94y5L Miami -Dade Square / Linear Footage Of Work: Type of Work: ❑Addition ❑Alteration ['New // ❑ Repair/Replace ❑ Demolition Describe Work: 2Gtno� f I'�/D a.� Z XiS t''zZ- � 7- ��i�5/ &// oyZe'v -vJ 4 T4 a �„oe-- T- 5 1-2- *************************************** ees * * * * * ** * * ** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Phone # idy 44.7 ce4444,e) CCF $ Notary $ Training/Education Fee $ 0'a0 Scanning $ 3 '00 Radon $ DPBR $ Zip Total Fee Now Due $ 3 3/36 Flood Zone tiT;(*ZVS AP 21 BY: -- 3� 2- (fTS ; z - , 8 4 3 See Reverse side -+ (0' CO /CC $ Technology Fee $ ° 00 Bond $ Bonding Company's Name (if 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. 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 ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and MR 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 Owner or Agent The foreg�in lnsYSt ument was ac; owledged befo e this {=t a day of , 20 f J, by . f!Je 3l' who is p rsonally known to me or who has produced C 1 1 1• NOT Sign: Print: My Commission Expires: APPROVED BY (Revised 07 /10 /07)(Revised 06/10/2009) entification and who did take an o .2 rThe fore day of .-who is pe aoa-, 1 Signature Oil Contractor trument was acknowl dg- befog- me thi ,20lQby onally known to me or who has produced tag l he tion and who did take an oath. My Commission Expires: Zoning V - 0 2 l ® Plans Examiner Engineer Clerk checked ALEX SINK STATE OF FLORIDA CHIEF FINANCIAL OFFICER DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW * CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: PERSON: FEIN: BUSINESS NAME AND ADDRESS: A 8 T SEPTIC SERVICE INC 15870 SW 250 STREET HOMESTEAD FL 33031 SCOPES OF BUSINESS OR TRADE: 1- SEPTIC TANKS DWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09 -06 06/09/2008 EXPIRATION DATE: 06/09/2010 MIRANDA ADALBERTO 200996759 PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE CUT HERE 04 -30 -2008 * Carry bottom portion on the job, keep upper portion for your records. DWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09-06 * IMPORTANT: Pursuant to Chapter 440. 05114), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election ender this section may not recover benefits or compensation under this chapter. Pursuant to Chapter 440.05112), F.S., Certificates of election to be exempt... apply only within the scope of the business or trade listed on the notice of election to be exempt Pursuant to Chapter 440.05113), F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shaft revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. QUESTIONS? (850) 413 - 1609 STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION CONSTRUCTION INDUSTRY CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW EFFECTIVE: 08 /09/2008 EXPIRATION DATE: 08/09/2010 PERSON: ADALBERTO MIRANDA FEIN: 200998759 BUSINESS NAME AND ADDRESS: A 8 T SEPTIC SERVICE INC 15870 SW 250 STREET HOMESTEAD, FL 33031 SCOPE OF BUSINESS OR TRADE: 1- SEPTIC TANKS IMPORTANT O Pursuant to Chapter 440.05(14), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election 1 - under this section may not recover benefits or compensation under this D chapter. Pursuant to Chapter 440.05(12), F.S., Certificates of election to be H exempt.. apply only within the scope of the business or trade listed on R the notice of election to be exempt. E Pursuant to Chapter 440.05(13), F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. QUESTIONS? (850) 413 -1609 L. OUSIIS TAX COUNTY STATE AIRES SEPT. 30, 2010 PLAYED AT PLACE OF,I USINE' BUSINESS NAME 1 LOCH ABT SEPTIC SE 15870 SW 250 33031 UNIN DADE-: RECEIPT NO. STATE* SM0951223 WORK ER /S R 1 ..r. t. ,.... I $ OWNER ABT SEPTIC SERVICE INC Sec. Type of Business 196 SPECIALTY PLUMBING CONTRACT IS ONLY A LOCAL ESS TAX RECEIPT. IT NOT PERMIT THE D ER TO VIOLATE ANY CISTING REGULATORY OR )NING LAWS OF = THE )LINTY OR CITIES NOR )ES IT EXEMPT THE )LDER FROM ANY OTHER IRMIT OR LICENSE EOUIRED SY LAW. THIS IS )T A CERTIFICATION OF IE HOLDER'S OUALIFICA. DNS. 'YMENT RECEIVED IAMFDADE COUNTY TAX )ELECTOR: 10/01/2009 09010251001 000082.50 SEE OTHER SIDE DO NOT FORWARD ABT SEPTIC SERVICE INC 15870 SW 250 ST MIAMI FL 33031 1UI11IIIIIII I„„ III), IIIIIIIi111I„l,IIII,1,1,I,1IIII 7I1 ERTO MIRA 15870 S.W. 25CTH STREET PRINCETON ` FL T, SEPTIC SERVICE INC. ess Autho €ixaftor►: SA0O41185 5 1..5122 Registration Exputation Date: September 0, 2010 Septic Tank Contractor ` LASS POSTAGE PAID MIAN, FL ERMIT -NO, 231 The Florida Department of Health hereby certifies the business or entity named below has satisfied the requirements of Part III, Chapter 489, Florida Statutes, for septic tank contracting and has been duly authorized by the department to provide septic tank contracting services under the name of Ana M Viamonte Ros, M.D., MPH. State Surgeon General This certifies*that the person named on the front of .' this card has satisfied t ftmquirements of Part M Chapter 489, Flori 1 sepbc tank contr II. registration y the as a Department of red a • . Programs, to p ite Sewage tank services. 0 • is I .... Report Uni ' . aiiii Contracting: 1488493::9813 CONSTRUCTION PERMIT FOR: OSTDS Abandonment APPLICANT: Jorge Cabrera STATE OF FLORIDA DEPARTMENT OF HEALTH DATE PAID: ONSITE SEWAGE TREATMENT AND DISPOSAL FEE PAID: SYSTEM RECEIPT #: PROPERTY ADDRESS: 9550 N Bayshore Dr Miami, FL 33138 LOT: 3 PROPERTY ID #: 11- 3206 - 014-3860 SYSTEM DESIGN AND SPECIFICATIONS D R A I N F I E L D 0 T H E R LOCATION OF BENCHMARK: ELEVATION OF PROPOSED SYSTEM SITE BOTTOM OF DRAINFIELD TO BE FILL REQUIRED: [ 0.00 ] INCHES BLOCK: 84 SUBDIVISION: PERMIT #: 13-SC-1 131608 APPLICATION #:AP961574 DOCUMENT #:PR807011 [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. T [ ] GALLONS / GPD CAPACITY A [ ] GALLONS / GPD CAPACITY N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS] K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ [ ] SQUARE FEET SYSTEM [ ] SQUARE FEET SYSTEM TYPE SYSTEM: [ ] STANDARD [ ] FILLED [ ] MOUND [ ] CONFIGURATION: [ ] TRENCH [ ] BED [ ] v 1.1.4 [ 3 / ][ ABOVE / BELOW ] BENCHMARK/REFERENCE POINT / ] [ABOVE/ BELOW ] BENCHMARK/REFERENCE POINT EXCAVATION REQUIRED: [ ] INCHES Have the tank abandoned in accordance with the following procedures:(a) The tank shall be pumped out.(b) The bottom of the tank shall be opened or ruptured, or the entire tank collapsed so as to prevent the tank from retaining water, and(c) The tank shall be filled with clean sand or other suitable material, and completely covered with soil.Have the system inspected by the health department after it has been pumped and ruptured but before it is filled with sand and covered. SPECIFICATIONS BY: Joseph R Piverger TITLE: Engineer Specialist II APPROVED BY: 1 i ■ TITLE: Engine = pecialist II Dade CHD J =... a..= DATE ISSUED: 04/16/ 0 EXPIRATION DATE: 07/15/2010 DH 4016, 10/97 (Previo Editions May Be Used) Page 1 of 3 AP961574 SE -1 -� l �LYI tL� STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT FOR: OSTDS New APPLICANT: Jorge Cabrera PROPERTY ADDRESS: 9550 N Bayshore Dr Miami, FL 33138 LOT: 3 PROPERTY ID #: 11- 3206- 014 -3860 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 [ 1,050 ] GALLONS / GPD Seotic CAPACITY A [ 275 ] GALLONS / GPD Laundry CAPACITY N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS] K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ ] D R A I N F I E L D 0 T H E R ELEVATION OF PROPOSED SYSTEM SITE [ 500 ] SQUARE FEET Drainfield SYSTEM [ 150 ] SQUARE FEET Laundry SYSTEM TYPE SYSTEM: [x] STANDARD [ ] FILLED [ ] MOUND [ ] CONFIGURATION: [ ] TRENCH [x] BED [ ] LOCATION OF BENCHMARK: CL Bayshore dr., 5.68' NGVD. BOTTOM OF DRAINFIELD TO BE FILL REQUIRED: DATE ISSUED: BLOCK: 84 SUBDIVISION: MiamiShores [ 0.00 ] INCHES The licensed contractor installing the system is responsible for installing the minimum category of tank in accordance with s. 64E- 6.013(3)(f), FAC. 1) Install 1050 gal septic tank equipped with an approved outlet filter device. 2) Install 500 sq. ft. of drainfield in bed configuration. 3) Install 42" of slightly limited soil beneath the bottom of the drainfield and 12" contiguous to the sides of the drainfield. 4) Invert elevation of drainfield to be no less than 5.5' NGVD. 5) Bottom of drainfield elevation to be no less than 5.0' NGVD. 6) Install a 275 gal capacity laundry tank with 125 sq. ft. (Comments Continued on Page 2.) SPECIFICATIONS BY: Adalberto Miranda APPROVED BY: TITLE: Engineer Supervisor III 1.1' as 04/ /20 PERMIT #: 13-SC- 1008348 APPLICATION #: AP941533 DATE PAID: FEE PAID: RECEIPT #: DOCUMENT #: PR800897 [SECTION, TOWNSHIP, RANGE, PARCEL NUMBER] [OR TAX ID NUMBER] [ 0.82 11 INCHES /) FT l [I ABOVE I BELOW 1 BENCBMARK /REFERENCE POINT [ 0.68 ] [ INCHES A FT P [ ABOVE /) BELOW b BENCHMARK /REFERENCE POINT EXCAVATION REQUIRED: [ 60.001 INCHES TITLE: Master Septic Tank Contractor DH 4016, 10/97 (Previous E. tions May Be Used) v 1.1.4 AP941533 SE809357 Dade CHD EXPIRATION DATE: 12/13/2011 Page 1 of 3 1 111:11 li ■■ e�elel rlelel■alalellailaal erwlaellfilre® e�le�fri�pltll�i�i1&n���et"wet rrtws r rr,r� m.raK � I ■ ■ ■ ■ ■ ■�� ■! ■! ■ ■ ■� ■■ lad O ■■I w■ ■■ It■! ■■■ ■■■ ■■■N■ ■ ■!■ ■ ■! ■ /■■■ ■fit ■■ >� ■I! ■ ■ ■■ ■ ■N■ ■■ IL! ■ ■w■ ! ■! ■ ■ ■ ■ ■� ® ■■®Milt■! ■ I ■:.' ■ •i. ■■ ■ ■■■II ■ ■ ■ ■ ■w ■■■ _ !D!N �ie ■w ■III■■ ■■ y 4 • mm • MOMMOMMM MOM mummummommi 11111 011311111 N�■■ ..,t. -. 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SITE ..r ., .... _..,,.,., Wm. MIMI _.MOM ME: MOD ,_ ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH D P,AR 4011,10010 Fonn-40i5 "Nth May be used) (Stoic Number:51444 24:4 ty Health Department Page 2of 4 Inspector DIVISION OF Environmental Health Florida Department of Health Miami -Dade County Health Department 9431 OSTDS /Well Division v4e 11805 SW 26 St: • Miami, FL 33175 Address '5 .' (D N. ...- 47.0_, JZOSTDS # ( 2 7/ cj5 Comments: '/_-. Signature Date e f`' ' 2 1 - 26/0 vl §3CEXVISH La APR 302010 BY: � -�