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PL-13-642Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION 0 2t913 Ir--� FBC 20 Permit No. P I) 3 —coal)._ Master Permit No. Permit Type: PLUMBING JOB ADDRESS: 2610 1\1 6 Z S 1- " City: Miami Shores County: Miami Dade Zip: 351 3 Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple Titleholder): 1412`^ I a K 0'") S k Phone #: Address: Set O N\ c Gt. 2 . City: Nil 414-0 '1,.ro re i State: F. zip: 33139 Tenant/Lessee Name: Phone #: Email: CONTRACTOR: Company Name: 6-`-+-e Ev►q I A e en n j l Ca c p_ Phone #: 7 4s ??6S-1 J Address: 2.4 2-3 Sw IN-1 A■4 # 344 City: M t A w. t State: f l Zip: 3 3^ i g r Qualifier Name: Tole � , ( 14 " Phone #: �6 -1 ??-`8 b S" State Certification or Registration #: 5M DI 11 212- Certificate of Competency #: 1 II Contact Phone #: 7 1 ( 9 LIZ? S6 V I - Email Address: e wt r e - e " 1 tin eenK) 0 L 4 i^^ Ai 1 • CoLn-. DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ 2 ' OD ' Square/Linear Footage of Work: Type of Work: ❑Address °Alteration New t; URepair/Replace °Demolition Description of Work: laceJ e�uu,� n ri-ef 4 Submittal Fee $ Permit Fee $ /5 C1i : CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ Technology Fee $ TOTAL FEE NOW DUE $ S cCS 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 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 . commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is i ;;r. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature 6e/tit, •j Signature Owner or Agent The foregoing instrument was acknowledged before me this day of ,20_,by who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: �N11t1�GUOI11Ult /�j�� Print: 1 '' ir= o, • i9 •. tiled : 6s,;.- I I f g i 1111 O\ a`� APPROVED BY �m 3-7/3-14111"""‘%\ Plans Examiner Zoning My Commission Expires: �Cl_� `J * a..� Sz • #EE C Contractor The foregoing instrument was acknowledged before me this 7 day of At C,A-L-/i , 20 5 by JO1 L2 O t a '- who is personally known o tification and who did take an oath. NOTARY PUBLIC Print: My Commission Expir alp Structural Review Clerk (Revised3 /12/2012)(Revised 07 /10 /07XRevised 06 /10 /2009XRevised 3/15/09) FIRST -CLASS U.S. POSTAGE PAID MIAMI, FL PERMIT NO. 231 THIS IS NOT A BILL — DO'NOT PAY 695844 -2 RENEWAL BUSINESS NAME ILOCATION RECEIPTNO. 723397 -6 STATE* SM0971292 344 EMPIRE ENGINEERING 1 CORP 2423 SW 147 AVE 33185 UNIN DADE COUNTY OWNER EMPIRE ENGINEERING 1 CORP Sec. Type of Business is 6, 1CIALTY PLUMBING - CONTRACTOR SINESS TAX RECEIPT. IT ES NOT PERMIT THE LDER TO VIOLATE ANY ISTING REGULATORY OR NINE LAWS OP THE DEN OR CITE% NOR ES IT . EXEMPT THE LDER FROM ANY OT HER` RUM ' OR UCENSE OUIRED BY LAW THE T A CERTIPICAT OP E HOLDER'S GUAUi cA MEET RECEIVED WI-DADE COUNTY TAX i LECTOR:.. 09/21/2012 09010183001 000075.00- SEE OTHER SIDE WORKER /S 1 DO NOT FORWARD EMPIRE ENGINEERING 1 CORP JORGE M MILLAN 2423 SW 147 AVE 344 MIAMI FL. 33185 111111111111111011 1111!111111 1111111111 11111111tt1111114 , ` `r CERTIFICATE OF LIABILITY INSURANCE DATE ► 0401/13 . 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 poticy(Ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain pofctes may require an endorsement. A statement on this certificate does not copier rights to the certificate holder In lieu of such endorsement(s). PRODUCER Best Rate insurance Agency. � 8600 NW 17 St. Sub 170 DOrsi, FL 33126 Phone (866) 616 -0065 Fax (305) 403-0801 C• t ireAC'T rv�we'�� (> } S1 t • 1 403 -0801 N. not (305) , ; Rem amoreno@bestrate•Insurance.com INSURER(S) AFFORDING COVERAGE NM B INSuRER A: Preferred Contractors Insurance Company N INSURED Empire Engineering 1 Corp 2423 S,W.147 Ave. #344 Miami, FL 33185 (186) 488-8657 INSURER B : 03/08f2013 . INSURER C: EACH OCCURRENCE INSURER D: POfte nrs) INSURER E : • ❑ CLAIMS-MADE '® OCCUR ri INSURER 5: $ 5,000.00 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 COMMON 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 CONDmONS OF SUCH POLICIES. LINTS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TN TYPE OF INSURANCE !MR POLICY NUMBER IMM DI� (MMIDJ) LIMITS A GENERAL LIABILITY © COMMERCIAL GENERALUAB1LII'r N N PCIC5038- PCA95171 03/08f2013 0310812014. EACH OCCURRENCE S 1,000,x.04 POfte nrs) $ 60,000.00 • ❑ CLAIMS-MADE '® OCCUR ri raw E�W(Any� $ 5,000.00 PERSONAL & ADV INJURY $ 1.000,000.00 ❑ GENERAL AGGREGATE s 2,000;000.00 GEM. AGGREGATE LIMIT APPLIES P� ❑ POLICY ❑ JECT ❑ LOC PRODUCTS - COMPtOP AGG $ 1,000,x.00 BY Propetiy Damage $ 10,000,000.00 AUTOMOBILE LIABILITY El Amy Awn ❑ ALUFC a) ❑ AUTOS LE° ❑ HIRED AUTOS 0 A BD ❑ ❑ • COM tN DSINGLtr LIMVr• iBODILYINJURY(Perperson) $ INJURY (Per accident) $ pBODILY (Psr in� GE $ $ ❑ UMBRELLA LAB ❑ OCCUR Li EXCESS LAB ❑ CLAIMS-MADE EAC ii OCCURRENCE $ AGGREGATE S ❑ DED ❑ RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' Lamm Y1 N ANY PROPRIETORIPAR XECUTIVE NIA roc4TATudits- ❑si:114- EL- EACH ACCIDENT $ OFFICERIMEMBERt7CCWDED? (Mandatory In NN) iD CdesPTcONtibe0FeOr P EAIONSbelow EL DISEASE - EA EMPLOYE 5 EL DISEASE -POLICY t rf $ DESCRIPTION OF OPERATIONS, LOCATIONS( VEHICLES (Attach ACORD fez, AddlUonal Remarks Seheitute-If mere space Is requtrea) CERTIFICATE HOLDER CANCELLATION MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 ACORD 26 (2010105) QF SHOU}d? ANY OP THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE `© 1988-20.10 ACORD CORPORATION. All rights' reserved. The ACORD name and logo are registered marks of ACORD CFN: 20130177731 BOOK 28519 PAGE 1188 DATE:03 /07/2013 07:29:44 AM DEED DOC 1,950.00 HARVEY RUVIN, CLERK OF COURT, MIA -DADE CTY Prepared by: Jason B. Dubow, Esq. 215 N. Fed. Hwy. Dania Beach, FL 33004 Folio # 11- 3206 - 005-0130 TRUSTEE'S DEED THIS INDENTURE, Executed this day of cbI COOLA , 2013, by JASON B. DUBOW an DAVID J. WALLACE, as Co- Trustees of THE SOPHIE, CHARLES AND HELEN A. RAKOWSKY FAMILY REVOCABLE TRUST dated December 9, 2009, whose post office address is 215 North Federal Highway, Dania Beach, Florida 33004, GRANTOR, to MIGUEL R. ARRONTE and CARLINA T. ARROVTE, husband and wife, whose post office address is 890 NE 92 ST, Miami. Shores, fl 33138 GRANTEE, W I T N E S S E T H That the said GRANTOR, for and in consideration of the sum of $10.00, in hand paid by the said GRANTEE, the receipt whereof is hereby acknowledged, has granted, bargained and sold to the said GRANTEE, and GRANTEE'S heirs and assigns forever, the following described land, situate, lying and being in MIAMI -DADE County, Florida, to wit: Lots 1 & 2, of Block 2, GOLDEN GATE PARK ADDITION, A SUBDIVISION, according to the Plat thereof, as recorded in Plat Book 6, Page 130 of the Public Records of Miami - Dade County, Florida. This conveyance is subject to the following: 1. Taxes and assessments for the year 2013, and subsequent years. 2. Conditions, restrictions, limitations and easements of record, if any; but this provision shall not operate to reimpose the same. 3. Land use designation, zoning restrictions, prohibitions and other requirements imposed by governmental authority. 4. Utility easements of record. N.B. The subject property is not the homestead property of either the GRANTOR or the GRANTOR'S spouse or the GRANTOR'S minor children. and said GRANTOR does hereby fully warrant the title to said land, and will defend the same against the lawful claims of all persons claiming by through or under GRANTOR. IN WITNESS WHEREOF, the said GRANTOR has signed and sealed these presents the day and year first above written. Signed, sealed and delivered in presence of: (Witness #1 Sign) (Witness #1 Print) Connie f enm' ano (Witness 82 Sign (Witness #2 Print) STATE OF FLORIDA COUNTY OF BROWARD ON = DUBOW, Trustee 01 C(L2J 7 DA (SEAL) (SEAL) I HEREBY CERTIFY that on this day, before me, an officer duly authorized in the State aforesaid and in the County aforesaid to take acknowledgments, personally appeared JASON B. DUBOW and DAVID J. WALLACE, to me personally known to be the person(s) described herein or who produced as positive identification and who executed the foregoing instrument and who acknowledged before me under oath that the document was executed for the uses and purposes expressed therein. WITNESS my and and official seal in the County and State last aforesaid this $' day of g*Y`UC.c^l 2013. My commission expires: Notary Public CONSFANZACAOOIANO MYCOMWES1 N8EE18n20 EXPIRES Mae) 15, 2016 Bonded T at NataryP,6lIe Uader wes 1 STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT CONSTRUCTION PERMIT FOR: OSTDS Repair APPLICANT: Helen Rakowsky PERMIT #: 13-SC-1462333 APPLICATION #:AP1101594 DATE PAID: FEE PAID: RECEIPT #: DOCUMENT #: PR901273 PROPERTY ADDRESS: LOT: 1 PROPERTY ID #: 890 NE 92 St Miami, FL 33138 BLOCK: 2 11 -3206 -005 -0130 SUBDIVISION: Golden Gate Park Addn [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 [ 900 ] GALLONS / GPD septic tank CAPACITY ] GALLONS / GPD CAPACITY ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS] ] GALLONS DOSING TANK CAPACITY [ ]GALLONS 8[ ]DOSES PER 24 HRS #Pumps [ D 1 300 ] SQUARE FEET bed configuration drainfiel SYSTEM R [ ] SQUARE FEET SYSTEM A TYPE SYSTEM: [x] STANDARD [ ] FILLED [ ] MOUND [ ] I CONFIGURATION: [ ] TRENCH [x] BED [ ] N F LOCATION OF BENCHMARK: FFE 16.1' NGVD I ELEVATION OF PROPOSED SYSTEM SITE E BOTTOM OF DRAINFIELD TO BE L D FILL REQUIRED: O T H E R ] INCHES [ 27.60 ] [) INCHES 1 FT ] [ ABOVE , BELOW b BENCHMARK/REFERENCE POINT [ 49.56 ] 11 INCHES I FT ] [ ABOVE /) BELOW ' BENCHMARK /REFERENCE POINT EXCAVATION REQUIRED: [ 22.00] INCHES 1.- Existing 900 gal. septic tank, certified by Empire Engineering I, Corp on 3/20/2013 to remain. 2.- Install 300 sf of drainfield in bed configuration. 3.- Perimeter of excavation area shall be at least 2 ft wider and longer than the proposed absorption bed or drain trench. 4. -Invert elevation of drainfield to be no less than 12.47' NGVD. 5.-Bottom of drainfield elevation to be no Tess than 11.97' NGVD. The system is sized for 3 bedrooms with a maximum occupancy of 6 persons (2 per bedroom), for a total estimated sewage flow of 300 GPD. SPECIFICATIONS BY: Jorge Millan APPROVED BY: Erlande omisca DATE ISSUED: 03/26/2013 DH 4016, 08/09 (Obsoletes all previous Incorporated: 64E- 6.003, FAC v 1.1.4 TITLE: TITLE: Engineering Specialist II Dade CHD EXPIRATION DATE: 06/24/2013 editions which o be The contrac fur not C esi inWr equired to pertorrn a so I t_, nn; adjacent to the drainfield excavation at the time e Oft rinspection. Prior to FIR PA oval, the OOH inspector snail witness the soil boring and cornpare the results to the original site evaluation submitter:. A reinspeciicn fee will be assessed if the contractor is not at the jobsite at the arranged time Page 1 of 3 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 188339 Permit Number: PL -4 -13 -642 Scheduled Inspection Date: April 18, 2013 Inspector: Hernandez, Rafael Owner: ARRONTE, MIGUEL & CARLINA Job Address: 890 NE 92 Street Miami Shores, FL Project: <NONE> Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Drainfield Phone Number Parcel Number 1132060050130 Contractor: EMPIRE ENGINEERING, LLC. Phone: (305)8224765 Building Department Comments REPLACE DRAINFIELD WITH EXISTING SEPTIC TANK TO REMAIN Passed Failed Infractlo Passed Comments INSPECTOR COMMENTS • Inspector Comments hrs in file Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. False April 17, 2013 For Inspections please call: (305)762 -4949 Page 15 of 34 BELOW I APPLICANT: AGENT: Em, PROPERTY Ii" LOT: • SUBDIVISION: Golden Gate Park Addn ID#: 11- 3206 -005 -0130 CHECKED [X] ITEMS ARE NOT IN COMPLIANCE WITH STATUTE OR RULE AND MUST BE CORRECTED. TANK INSTALLATION [01] TANK SIZE [1] [02] TANK MATERIAL [03] OUTLET DEVICE [04] MULTI- CHAMBERED [. Y / N ] [05] OUTLET FILTER [06] LEGEND 1. [07] WATERTIGHT [08] LEVEL [09] DEPTH TO LID 900.00 [2] Concrete DRAINFIELD INSTALLATION [10] [11] [12] [13] [14] [15] [16] [17] [18] [19] [20] [21] AREA [1] 300 DISTRIBUTION BOX NUMBER OF DRAINLINES DRAINLINE SEPARATION DRAINLINE SLOPE DEPTH OF COVER ELEVATION [ ABOVE / SYSTEM LOCATION DOSING PUMPS AGGREGATE SIZE AGGREGATE EXCESSIVE FINES AGGREGATE DEPTH 2. [2] HEADER 1. 5.00 2. FILL / EXCAVATION MATERIAL ] [22] FILL AMOUNT ] [23] FILL TEXTURE ] [24] EXCAVATION DEPTH ] [25] AREA REPLACED [ ] [26] REPLACEMENT MATERIAL Comments: Comments are on page 2. CONSTRUCTION [ FINAL SYSTEM [ IAPPROVED I IAPPROVED I DISAPPROVED ]' / DISAPPROVED ]: (Explanation of Violations on following page) )H 4016, 08/09 (Obsoletes all previous edition :ncorporated: 64E- 6.003, FAC SQFT X ] BM 55.80 [ [ [ [ 1 SETBACKS [27] SURFACE WATER [28] DITCHES [29] PRIVATE WELLS [30] PUBLIC WELLS [31] IRRIGATION WELLS [32] POTABLE WATER [33] BUILDING FOUNDATIONS [34] PROPERTY LINES [35] OTHER FIT•T,FD / MOUND SYSTEM [36] [37] [38] FT FT FT FT FT 25 FT 5 FT 4 FT FT DRAINFIELD COVER SHOULDERS SLOPES ] [39] STABILIZATION ADDITIONAL INFORMATION [40] UNOBSTRUCTED AREA [41] STORMWATER RUNOFF [42] ALARMS [43] MAINTENANCE AGREEMENT [44] BUILDING AREA [45] LOCATION CONFORMS WITH SITE PLAN [46] FINAL SITE GRADING [47] CONTRACTOR A To Z Plumber (A To Z PIu [48] OTHER ADS ARC 24 ABANDONMENT [49] TANK PUMPED [50] TANK CRUSHED & FILLRD Dade CHD DATE: 04/11/2013 Piverger (Dade County Environmental Healt ich may not be used) Dade CHD DATE: 04/17/2013 ounty nv ronmental Hea Page 2 of 3