PL-12-1130Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
i
I ,,, 96 a ..... INSPECTION'S PHONE NUMBER: (305) 762.4949
VJCP I 4—
Yr ii, ING Permit No.
fiti@MEWM-ril
la JUN 2 25i2 o
BY: ...........
PE IT APPLICATION
FBC 20
Master Permit No.
Permit Type: PLUMBING
US Eon -No ono I ASSa_tabonj
ui
RASt91 t Q-1k, -3-)- e (9 6
OWNER: Name (Fee Simple Titleholder) :0GTrLIve
viorcpc3e_ phonet Xsto Ee - . - I
Address: j,-c&a ".. Pg........a.-
City: ae...c fri-4.4"Ans,a State: TO Zip:
Tenant/Lessee Name: A Phone#: N 1 A
Email: Oh I F) ic s, con-)
JOB ADDRESS: (b PE 1014 S+
City: Miami Shores
County:
Miami Dade
Zip: 3 3 1 3g
Folio/Parcel#: H -
Is the Building Historically Designated: Yes NO Flood Zone:
CONTRACTOR: Company Name:
. C 15 -PI t-4 Se Q (K .Phone: () 01 — 7 35?
Address: qq1/43a NW .,— ed
City: HOrY I State: a Zip: 33 (PCI
Qualifier Name: Ke.4,...,....M t ---6" it,r-icL Phone: 3c&---.6,s-t res-
State Certification or Registration #: Certificate of Competency #:
Contact Phone#: Email Address:
DESIGNER: Architect/Engineer: Phone#:
Square/Linear Footage of Work: 21.1)\I
Value of Work for this Permit: $ 3 in) /SO
Type of Work: LIAddress °Alteration °New 4air/Replace °Demolition
Description of Work: 1
Submittal Fee $ Permit Fee $ 07Ct° CU* $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $
oO
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
I v I State
A
N A-
Zip
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no v,_ork 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 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 he delivered to the person
whose property is subject to attachment. : Iso, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occur even (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approver a einspection fee will be charged.
Signature
Owner or Agent
The foregoing instrument was acknowledged before me this cQI The foregoing instrument was acknowledged before me this 11
day of -TU. ) 6 . 20 12_, by K(tin4 eVr,(.Z fr
Signature
Contractor
day of t , 20 by 01. ktt.4 VOUn — .
who • ersgtt y known to mE r who has produced weho is personally awn tom )or who has produced
as identification and who did take an oath.
PUBLIC:
As identification a
NOTARY PUBLIC:
Sign:~ T pG i'
Print:
My Commission Expire
NANCY M. FITZGERWMAR
NOTARY PUBLIC
TATE OF COLORAD
1 or
APPROVED BY
A. 1 ��
A`Z2—
Z-- Plans Examiner
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Notary Poltllk State of Florida
. Sheryl A Mendes
weemsnisskerseemn 4%.%
OF a Expires 10/23/2014
ing
Structural Review Clerk
(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09)
,JAN. 5. 2012 10:56AM
NO. 2745 P. 1
WELLS FARGO BANK, N.A.
Written Authorization of Designated Signer(s)
The duly appointed Executive Officer or Senior Officer of Wells Fargo Bank, N.A. (the "Bank "),
hereby appoints the following individual(s) as Designated Signer(s) pursuant to Article VIII of
Resolution I of the General Signature Resolution, issued by Mortgage Banking Committee I of
the Board of Directors of the Bank, whereby an Executive Officer or Senior Officer of the Bank
is authorized to appoint such "Designated Signer(s)" the authority to create the following herein. The of
Designated Signer(s) named below shall have
documents on behalf of the Bank:
P1ame of I�adividual s
Baloun, David
Branson, Stephanie
Connally, Candice
Crocker, Pamela
Dawson, Gary
Dudgeon, Norma
Esealera, Theresa
Farrell, William
Herndon, Pamela
Kaneta, Ashley
Kneeland, Gail
Mousseau, Paul
Channel, Cory
Neary, Jason
Otte, David
Sanchez, Holly
Sanchez, Jennifer
Shepherd, Red
Transactions Authorized to Execute
Listing agreements, list reductions, HUD 1
settlement statements, Purchase Contracts,
addenda to purchase contracts and permit
applications for repairs.
The Bank hereby acknowledges that the persons named above are employees of LPS Asset
Management Solutions, Inc., an affiliate of LPS Property Tax Solutions, Inc., with its principal
office located at 601 Riverside Avenue, Jacksonville, Florida 32204, and that they may, from
time to time, be named as agents by other corporations for purposes similar to that set forth in
this authorization.
Such appointment as Designated Signer(s) of the Bank is at the eonveniennce and desire of the
Bank and is revocable upon the earlier occurrence of revocation by the Bank, in writing delivered
to LPS Asset Management Solutions, Inc.; or expiration of the Statement of Work #8.1, executed
by and between the Bank and LPS Asset Management Solutions, Inc., dated as of June 3, 2010.
An individual's appointment shall terminate automatically upon termination of such individual
from employment with LPS Asset Management Solutions, Inc,
The authorization of the above individuals to serve as Designated Signer(s) is undertaken for the
exclusive purposes set forth herein and shall not entitle any such individual to status as an
employee or officer of the Bank, including, without limitation, any participation in employee
benefit plans or insurance protection otherwise available to officers or employees of the Bank.
Any person shall be entitled to rely on any action taken within the scope of this authorization by
any such Designated Signer(s). The Designated Signer(s) shall have the strict authority to
execute the documents described above on behalf of the Bank, but shall not have the authority to
negotiate any terms and conditions of any Authorized Transactions, or further delegate the
powers designated herein.
This Written Authorization of Designated Signer(s) shall be certified by any Secretary or
Assistant Secretary of the Bank, by either fax, stamped or original signature, and placed on file
with the Bank. Said Written Authorization shall be in full force and effect and binding upon the
01/05/2012 10:10AM (GMT- 07:00)
JAN. 5. 2012 10:56AM
NO. 2745 P. 2
'bank until written notice of its rescission is delivered to the Secretary or Assistant Secretary of
the Bank, signed by an authorized officer (Executive Officer or Senior Officer), and the Bank has
been afforded a reasonable opportunity to act on such notice.
SECRETARY'S CERTIFICATION
I, Deidre A. Messenger, Assistant Secretary of Wells Fargo Bank, N.A., a national banking
association do hereby certify that the foregoing is a frill, tme and correct copy of the Written
Authorization of Designated Signer executed by a duly authorized officer of Wells Fargo Bank,
N.A., on January 4, 2012; that said authorization has not been amended or revoked and that the
same is on the date of this certification, in full force and effect.
WITNESS MY HAND AND THE SEAL OF THE BANK., this 4th day of January, 2012.
(SEAL)
Deidre A. Messenger, Assistant Secr
01/05/2012 10:10AM (GMT- 07:00)
MAY. 17. 2007 10:34AM PREMIERE ASSET SERVS
WHEN RECORDED MAIL TO:
Na 353 P. 2
LIMITED POWER OF ATTORNEY
U.S Bank National Assodation ("U.S. Bank"), a national banking association organized and existing
under the laws of the United States of America, 1 Federal St., Corporate Trust, 3rd Floor, Boston, MA
02110, hereby constitutes and appoints Wells Fargo Bank, N.A., successor by merger to Wells Fargo
Home Mortgage, Inc. and in its name, aforesaid Attorney In -Fact, by and through any officer appointed
by the Board of Directors of Wells Fargo Bank, NA, to execute and acknowledge in writing or by facsimile
stamp all documents customarily and reasonably necessary and appropriate for the tasks described in the
items (1) through (4) below; provided however, that the documents described below may only be
executed and delivered by such Attorneys -In -Fact if such documents are required or permitted under the
terms of the related servicing agreements and no power is granted hereunder to take any action that
would be adverse to the interests of the Trustee of the Holder. This Power of Attorney is being issued in
connection with Wells Fargo Bank, N.A., successor by merger to Wells Fargo Home Mortgage, Inc.`s,
responsibilities to service certain mortgage loans (the "Loans") held by U.S. Bank in its capacity as
Trustee. These Loans are comprised of Mortgages, Deeds of Trust, Deeds to Secure Debt and other
forms of Security instruments (collectively the "Security Instruments") and the Notes secured thereby.
1. Demand, sure for, recover, collect and receive each and every sum of money, debt, account and
interest (which now is, or hereafter shall become due and payable) belonging to or daimed by U.S.
Bank National Association, and to use or take any lawful means for recovery by legal process or
otherwise.
2. Transact business of any kind regarding the Loans, and obtain an interest therein and/or building
thereon, as U.S. Bank National Association's act and deed, to contact for, purchase, receive and
take possession and evidence of title in and to the property and /or to secure payment of a
promissory note or performance of any obligation or agreement.
MAY.17.2007 10 34A PREMIERE ASSET SERVS
NO. 353 P 3
3. Execute bonds, notes, mortgages, deeds of trust and other contracts, agreements and instruments
regarding the Borrowers and /or the Property, including but not limited to the execution of releases,
satisfactions, assignments, and other instruments pertaining to mortgages or deeds of trust, and
execution of deeds and associated instruments, if any, conveying the Property, in the interest of
U.S. Bank National Association.
4. Endorse on behalf of the undersigned all checks, drafts and /or other negotiable instruments made
payable to the undersigned.
Witness my hand and seal this 2nd day of April, 2007.
U.S. Bank National Association, as Trustee
By:
Witness.: Matthew F Karen R. Beard, Vice President
Attest r odi Scully, As ,: nt Vice P 'dent
FOR CORPORATE ACKNOWLEDGMENT
Commonwealth of Massachusetts
By:
County of Suffolk
On this 2"d day of April, 2007, before me, the undersigned, a Notary Public in and for said County and
State, personally appeared Jodi Scully, Karen R. Beard and Veneta I. Bernard personally known to me (or
proved to me on the basis of satisfactory evidence) to be the persons who executed the within
instrument as Assistant Vice President, Vice President and Vice President, respectively of U.S, Bank
National Association, and known to me to be the person who executed the within instrument on behalf of
the corporation therein named, and acknowledge to me that such corporation executed the within
instrument pursuant to its by -laws or a resolution of its Board of Directors.
WITNESS my hand and official seal.
Signature:
Christopher J. Twardzick
My commission expires: 2/18/2011,
(SFAL f')
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM
CONSTRUCTION PERMIT
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: (Keller Williams Realty)
PROPERTY ADDRESS: 60 NE 104 St Miami, FL 33138
LOT: 4
PERMIT #: 13 -SC- 1415407
APPLICATION # : AP 1074887
DATE PAID:
FEE PAID:
RECEIPT #:
DOCUMENT #: PR878118
BLOCK: 123 SUBDIVISION:
PROPERTY ID #: 11- 2136- 013 -0880
[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 [
A [
N [
K [
1,050 ] GALLONS / GPD Septic CAPACITY
0 ] GALLONS / GPD CAPACITY
0 ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ ]
D [ 400 ] SQUARE FEET SYSTEM
R [ 0 ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [x] STANDARD [ ] FILLED [ ] MOUND [ ]
I CONFIGURATION: [ ] TRENCH [x] BED [ ]
N
F LOCATION OF BENCHMARK: FFE: 13.3'NGVD
I ELEVATION OF PROPOSED SYSTEM SITE
E BOTTOM OF DRAINFIELD TO BE
L
D FILL REQUIRED:
O
T
H
E
R
[ 0.00 ] INCHES
[ 31.20 ] [I INCHES I FT ] [ ABOVE / BELOW h BENCHMARK /REFERENCE POINT
[ 61.20 ] [I INCHES r FT ] [ ABOVE 4 BELOW li BENCHMARK /REFERENCE POINT
EXCAVATION REQUIRED: [ 42.00] INCHES
- Install 1050 g septic tank.
- Install 400 sq ft drainfield.
- Install 12" of slightly limited soil under bottom of drainfield.
- Elevation of bottom of drainfield to be no less than 8.20' NGVD.
- The system is sized for 4 bedrooms with a maximum occupancy of 8 persons,
for a total estimated sewage flow of 400 g /d.
- Not for additions
SPECIFICATIONS BY:
APPROVED BY:
DATE ISSUED:
Kemble Ettrick
Joseph R Piverger
06/18/2012
TITLE:
TITLE: Engineer Specialist II
Dade CHD
EXPIRATION DATE: 09/16/2012
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E- 6.003, FAC
v 1.1.4 AP1074887 SE872748
Page 1 of 3
•
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 4052 Bald Cypress Way, BIN # A02, Tallahassee, Florida 32399 -1703. The
Agency Clerk's facsimile number is 850 - 410 -1448.
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, a party who is adversely affected by it is
entitled to judicial review pursuant to Section 120.68, Florida 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 Health 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 filed within 30
days of rendition of the final order.
Invoice
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138 -0000 39VIllA S31710HS 0 l
Phone: (305)795 -2204 Fax: (305)756 -8972
For Inspections please call: (305)762 -4949
pteturn to:
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138 -0000
Bill To
US BANK NATL ASSOC. AS TRUSTEE FOR (
60 NE 104 Street
, FL 33138-
FT. MILL, SC 29715-
Date
Fee Name.
Invoice Number: _424gia
Invoice Date: June 20, 2012
Permit Number: PL -6 -12 -1130
Bond Number:
Comments:
07/02/2012 Bond Type - Owners Bond
Fee Type
Fixed
Fee Amount
$500.00
Sandra Dee Williams P.A.
700 NE 90th Street.
Miami, FL 33138
ORDER OFE MlAjvMl StI-OReS y lLI ACHE;
00
-FtV 'ttUN i4 ANA- /100
FOR' A F IC O14 6 af\l'?'
(90 Ne i D s-T.
01334C
Bank of America
' 63 -4/830
sI.NoIla
$ SO 0. 00
DOLLARS
1►'O L 3 340111 1:06 300004 71: 8980 200 39 ? L 3111
THISDOQCMENr.gaNTAIN8 A COLO3 D BAC (�D,R(LyHo QH WHITE EAPSR. MIC OPRINT IS LOC47ED_SEL2W •HJB WARNj60 BAND
07/02/2012
Check 13340 $500.00 $0.00
Total Paid:
$500.00
Total Due: $316.80 II
Monday, July 2, 2012
Invoice
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138 -0000
Phone: (305)795 -2204 Fax: (305)756 -8972
For Inspections please call: (305)762 -4949
eturn to:
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138 -0000
Bill To
US BANK NATL ASSOC. AS TRUSTEE FOR (
60 NE 104 Street
, FL 33138-
FT. MILL, SC 29715-
Date
07/02/2012
06/20/2012
06/20/2012
06/20/2012
06/20/2012
06/20/2012
06/20/2012
06/20/2012
Fee Name
Bond Type - Owners Bond
CCF
Technology Fee
DBPR Fee
Scanning Fee
DCA Fee
Permit Fee
Education Surcharge
Invoice Number: PL -6 -12 -44558
Invoice Date: June 20, 2012
Permit Number: PL -6 -12 -1130
Bond Number:
Comments:
Fee Type
Fixed
Calculated
Calculated
Calculated
Calculated
Calculated
Percentage
Calculated
Fee Amount
$500.00
$1.80
$2.40
$4.50
$3.00
$4.50
$300.00
$0.60
Total Fees Due:
$816.80
Payments
Date Pay Type
Check Number Amount Paid Change
07/02/2012 Check
13340 $500.00
$0.00
Total Paid:
$500.00
Total Due: $316.80 II
Monday, July 2, 2012
(c0 oNIc*r 10f51-
;1,4 lronmental Health
Pa Department of Health
Miami-Dade f:-.N-al ty #«Q|h Ue#GQmeM
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