The URL can be used to link to this page

PL-15-725�1 Miami Shores Village 10050 N.E. 2nd Avenue NW Bond Type - Owners Bond Miami Shores, FL 33138-0000 CCF Phone: (305)795-2204 Project Address Parcel Number Applicant 190 NW 101 Street 1131010230170 Miami Shores, FL Block: Lot: RICARD PROPHETE Owner Information Address Phone Cell RICARD PROPHETE 190 NW 101 ST MIAMI FL 33150-1214 Contractor(s) Phone Cell Phone AFFORDABLE SEPTIC SOLUTIONS LI (305)726-8022 Type of Work: REPAIR DRAINFIELD Type of Piping: Additional Info: Bond Retum : Classification: Residential Scanning: 1 Fees Due Amount Bond Type - Owners Bond $500.00 CCF $3.00 DBPR Fee $2.25 DCA Fee $2.25 Education Surcharge $1.00 Permit Fee $150.00 Scanning Fee $3.00 Technology Fee $4.00 Total: $665.50 Valuation: $ 4,200.00 Total Sq Feet: 0 Pay Date Pay Type Amt Paid Amt Due Invoice # PL -3-15-54999 03/31/2015 Credit Card $ 50.00 $ 615.50 03/31/2015 Check* 170 $ 500.00 $ 115.50 04/03/2015 Credit Card $ 115.50 $ 0.00 Bond *: 2653 Available Inspections: Inspection Type: HRS Approval Final Review Plumbing 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 AFFIDAVH --f cerci ha ll the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction zoning. , ermore. I Authorize therabove-named contractor to do the work stated. / Contractor / Agent Buildiffg Department Copy April 03, 2015 April 03, 2015 1 Q.►off DIVISION OF Environmental Health Florida Health lho Miami -Dade County AQQ OSTDS/Well Division sl �.� 11805 SW 26th Street • Miami, FL 33175 InspectorRico ie 6rJ m bs Date . C'21 I?-' 20% S Address M NW Ldl K,i- OSTD5 # P&1=10-79, Comments: 19 fl Signature Z, / ` 12-1 I -G Miami Shores Village - ---- i L! M Building Department MARa� z, 10050 N.E.2nd Avenue, Miami Shores, Florida 33138, Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION UNE PHONE NUMBER: (30S) 762-4949 FBc 20 BUILDING Master Permit NoPL- IS— J®PERMIT PERMIT APPLICATION Sub Permit No. BUILDING ❑ ELECTRIC ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL XPLUMBING ❑ MECHANICAL ❑PUBLIC WORKS [:]CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS (� (y � JOB ADDRESS: 1 -I 1 o 1 SA City: Miami Shores County Miami Dade Zip: FoliolParoal#: Is the Building Historically Designated: Yes NO _/N, Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: r- =C)r®pe. e OWNER: Name (Fee Simple_ Titleholder): Phane#: Address: • WY > ®� s'. -ro I 1 rO 1 State: L Tenant/Lessee Name: Phone Email: CONTRACTOR: Company Name: Address: /60/ ni. wi City: MI LQ nqi A Glee Qualifier Name: State Certification or Registration #: M rel Pt • Zip: 3 ! lD l of Competency #. DESIGNER: Architect/Engineer. �"-*, Phone#: c Value of Work for this Permit: $ Type of Work: ❑ Addition ❑ Alteration Description of Work: _____State: Zip: _ Square/Unear Footage of Work. New II Repair/Replace - it ❑ Demolition "oeci f y color of color thm We: ,ittai Fee $ Permit Fee $ CCF $ CO/CC $ Fee $ Radon Fee $ Fee $ TraininglEducation Fee $ DBPR $ Notary $ Double Fee $ — IDOLiaD low $ Bond $ TOTAL FEE NOW DUE $ ° Bonding Company's Name (if applicable) Bonding Company's Address city P17M Mortgage Lender's Name (if applicable) Mortgage Lender's Address Zip 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 $25DQ 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 certijired copy of the recorded notice of commencement must be posted at the job site for the f rst inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the Inspection will not he aaaroved and a reinsnection fee will be charaAd. Signature OWNER or AG NT The foregoing instrument was ack owledged before me this day of � p , MCJs� 20�, by lll:�frr�) IJ I j (®� CAt._wih•�or is /plersonally/known to m or o has produ Iced c®f 3 /ZV6� 1630 as Identification and who did take an oath. NOTARY PUBUQ - • � ° ` : � ..: /!!�i!%!�'!..''/moi Signature CONTRACTOR The foregoing instrument was acknowledged before me this day of 40A 20by um who Is personally known to m or ho has produced P416531 U I ��® as identification and who did take an oath. NOTARY PUBUG Print: 8�41�{RAA HE(�pN Seal: W 088 #FFP08D21' � 23, Me eT+w�t as*s******ss*ssssssss*s**sass******ss*****ss***ass*s***s*s****sass**s***sss****ss**sssss***sass*********sass APPROVED BY Plans Examiner Zoning Structural Review Clerk (Re0-,ed02/24/2014) 31 VAJ. • ,• M• 4 4'{I • :lj 4,1'01 cx>NSTRQCTIc�a PERMIT FCR: OSTDS Repair APPLICANT: Richard Phosphate PROPERTY ADDRESS: 180 NW 101 St Miami, Fl. 33150 LOT: 14 BLOCK: 3 ABDIVISICN: PROPERTY ID #: 11-3101-023-0170 PERMrT #:13 -SC -1593008 APPLICATION #: API 180107 DATE PAID: � FS�E�.ryBAID: i�O4Y' IPT#: a4= =us= #: PR967678 LSECTION, TOWNSM, RAS, PARCEL N[PMRI [OR TAX ID NONBER] SYSTEM MAST BE IN ACcoBDANCE WITS SPECIFICATIONS AND 87ANDARDS OF SECTION 381.0065, F.S., AND CHAPTER 64E-6, F.A.C. DEPARMONT APPROVAL OF SYSTEM DOES NOT C,[JARANTEE SATISFACTORY PERNICEMANCE FOR ANY SPECIFIC PERIOD OF Tna. ANY CHANGE IN twnmpntM FACTS, WSICH SERVED AS A BASIS FOR ISSUMME OF TUB P&RMZT, REQUIRE TBE APPLICANT TO Mpm THE PERMIT APPLICATION. OWS MWIFICATIONS MAY RESULT IN THIS PERMIT BEING MADE NULL AND VOID. ISSUANCE OF THIS PERMIT DOES .NOT ElMeT TBE APPLICANT FROM C016LTANCE WITH OTffiR FEDERAL, STATS, ORS -LOCAL BETTING ReQUIRED FOR DEVIMOPAMT OF THIS PROPERTY. SYSTEM DESIGN AMID T [ 650 l GALLONS / GPD existing septic tank to remain CAPACITY A [ O I GALLONS / GPD CAPACITY N I 0 l cATJAMS GREASE INTERCEPTOR CAPACITY Reumcm chnac Y sn;= TAW:1250 GALLONS] K [ I GALLONS DOSIIqa 22M CAPACITY [ I GALLS 6 [ IDOBES PER 24 =a #Pampa [ D t 200 I s» FEET new bad contig. drat ftW SYSTEM R t 0 l Samum FEET SYSTEM A TYPE SYSTEM: [sI STANDARD [ ] FnJM I I HOM [ I I CONFIGURATICBi: [ I TRENCH [z] BED t I N F LOCATION OF Bim: FFE 12.51' NOW I ELEVATION OF PROPOSED SYSTEM SITE [ 30.10 ] INCHES FT I [ ABOVE JBEIAW Rimmiucz Boni E BOTTOM OF DRAIIw,D To BE. [ 70.08 ] FT I [ ABOVE RK/ POIIST L D FILL Rzaun ED: [ 0.00 3 Imcass ESCAVATION REQUIRED: [ 40.00 I IWCHES O T H E R 1: Existing 650 gal. septic tank, certified by "Statewide Septic" on 3/11/2015 to resin. 2. -Install 2W sf of dratntield in bail configuration. 3.-Pefteftr of excavation area shall to at least 2 ft wider and IoWr than the proposed almrption bad or draln trenck 4.4nvert elevation of drainfletd to be no less tion 7.17' NGVD. 5. -Bottom of drainfiekl elevation to be no less #w 6.67' NGVD. The system is sized for 2 bedrooms with a maximum ocmpm cy of 4 persons (2 per bedroom), for a total estimated flow of 200 gpd. THIS PERMIT IS NOT FOR ANY ADDITIONS. BY: Affordable Sept TITLE: DATE ISSUED: 03/1612015 EXPIRATION DATE: 08/14/2015 DH 4016, 08/09 (Obsoletes all previous editions wbich MAY not bs used) Iaaorporated: 64E-6.003, FAC „ 1.1.4 AP3.180107 sEssaiyz Page 1 of 3 c., REGISTERED SEPTIC TANK CONTRACTOR t DURA D. BRYANT 1601 NW 175 ST MIAMI, FL 33196 - AFFORDABLE SEPTIC SOLUTIONS LLC Business Authorization: SA0141879 SR0141734 Registration Expires on September 30, 2015 Local Business Tax Receipt Miami—Dade County, State of Florida -THISIS NOTA BILL -DO NOT PAY 7173903 BUSINESS NAME/LOCATHM AFFORDABLE SEPTIC SOLUTIONS LLC 14261 NW 24 AVE OPA LOCKA, FL 33054 OVIt11IER AFFORDABLE SEPTIC SOLUTIONS LLC rin n11RA RRVANT M( -4R Workegs) 1 RECEIPT NO. RENEWAL 7453077 LBT M-1) EXPIRES SEPTEMBER 30, 2015 Must be displayed at place of business Pursuant to County Code Chapter 8A -Art 8 & 10 SEC. TYPE OF BUSINESS 198 SPECIAVY PLUMBING CONTRACTOR SE0141855 PAYMENT RECEIVED BY TAX COLLECTOR 45.00 08/07/2014 0224-14-008409 This Local Bushm"Tax Receipt only worn psyment of the local BaslnessTaLThe Receipt is eat a Haeme, permi4 or a cerd8ceden of the hohlefs gaeli8oadons, to do business. Holder aria samply witb my governmental or noagsvermaeami regulatory lava end requirements which apply to the haminess. The RECEIPT N0. above man be displayed on all commeratal vehicles- Mismf-Dade Code Sea Se -27L ® For more information, visit ymmndandda This Is to certify that card his satisfied #w 489, Florida Staty" contractor and is to provide conte listed. Report on the front of this Oft Hk Chapter A:*eptic tank 0 of Health W�islness Warne MAR -27-2015 13:16 From: 9549653999 To:9546531456 Pase:111 CERTIFICATE OF LIABILITY INSURANCEM-MO'MM " TYPROPOiSURANIX WWII Iss TNf$ CERTIFICATE IS MUED AS A RAATR R OF INFORMATION ONLY AND CONFERS NO UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES) NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. TWS CERTIFICATE OF IN$URANCE DOES NOY CONSTITUTE A CONTRACT BEMEEN THE I=MG INSUM M), AWTHORM0 REPRESIMATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER MNMTAt11T: If file cal@aate holder b an ADDITIONAL QI.9UREM Idle IWii+fies) must he emwwd. If SU8RIXlATM WAMW su*wt m the UM and conditions of the poflty, tadidn popda mtyr mgtft an sidoMentaft A etata hant on ihb cm fife OM not Confer d9& to the cWtIlude holder In HSU of such endonsmmr t(s} P uG� BRENDA V SCI.( 80N AM* Irides= Grasp 6106 Mramar P 9S4) IMS 3B� 886.65 m.net Mhamar. FL 330'23 PNS" 9MM Fax 683.1455 INSUREIRA, WESTERNWORLD INSURANCs I amm Al ambits le SWC SCI rs 1,000,000.00 C : INSLW48 Q: ISIM NW 178TH STREET � a MIAMI GARDENS, FL 33169 (305) 726-M au AUTOMOBILE LUUMMIEI�ED ❑ ANY AUTO ❑ A ❑ ❑ 11REDAITOS ❑ AUfos NEO ❑ ,M vv.r%p V=10 uelturiuAItNUInLiM REVISION NUMBER: THIS 15 TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN IS8U6D TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NO'SWl MISTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OYHOR DOCUMENT WITH RESPECT TO WHICH THIS CP, 79MATE MAY EL�EE ISSUEb OR MAY PERTAIN, THE.SMRANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN is SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMrTS SHOWN MAY HAVE BEEN REDUCED Sy PAID CLAIAgS, TYPROPOiSURANIX AO 07/0.9P101$ LamGENERALNABLITY A ® COMMERMAL01314 RALI.FI IRM Q ® CLAIMS MADE ❑ OCCUR ❑ 004LA(}OMOATELWTAPPLIESPrtW Elcy❑ IO JWFLZ-14-10503 07f 1014 rs 1,000,000.00 RNwjn=0w s 100,OOQ00 dm ew WN one 6 6,ODO.QO PIUMONAL&AMMMW S 1,OOO,U00,00 GENERAL AGGREGATE s 2XVIA O.UO E522M-comPwAGG s 1.01M .00 AUTOMOBILE LUUMMIEI�ED ❑ ANY AUTO ❑ A ❑ ❑ 11REDAITOS ❑ AUfos NEO ❑ I LIMIT BO)?Il Y INJURY (F� per) ti SLY INJURY p sntJ B a s ❑ Uw3 a" LIAR M951JAB CKX= 0011 OOCURREMM 8 Awnmu $ DED ANY PROPRBsI T 1 N 1:1 INION of OPERATifl NIA ATLL EL taACM ACCIDENT $ EL D48EAN - EA EMPLOYS S EL DISEASE. LIMIT s A GENIAL. UABLL.ITY JWFLZ-14-IOSM 071092014 laymawfi DEDUCTIBLES 500MOO P=FWMNOF0PERA=r4SILOCA=N81YEJIlaLEI; (Apsg1AWRD761,Ad�io�l SCrieOu�,B e�Cals�gsd�lj STATE OF FLORIDA - SEPTIC SOW11ONS "a. MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI, FLORIDA 33139 OF THE ABOVE DESCRIBED POLICIES BE CANOILLEA BEFORE ON DATE THBREOP, NOTICE WILL BE DELIVERED IN��... 1 WITH THE POLICY PROVISIONS. -� - ACORD CORPORATION. All rhd is r@Swred_ AWN,ID X§ (Ap'ITJM; QF The ACORD nam and lqp an tegiwed muft If ACORD JEFF ATWATER CHIEF FINANCIAL OFFICER STATE OF FLORIDA 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 Ill) be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: 8/7/2014 EXPIRATION DATE: 8/612016 PERSON: BRYANT DURA FEIN: 471498592 BUSINESS NAME AND ADDRESS: AFFORDABLE SEPTIC SOLUTI 14281 NW 24TH AVENUE OPA LOCKA FL 33054 SCOPES OF BUSINESS OR TRADE: SEWER CONSTRUCTION ALL OPERATI Pursuant to Chapter 440.05(14), F.S., an officer of a corporation who elects exemption from thk chapter by filing a certificate of ern under Oils section my rat recover traneft or compensation under this chapter, Pursuant to Chapter "0 05(12), F.S., CeRBtcates of election to be exempt.. apply only within the scope of the busine&a or bade listed on the notice of election W be exempt Pursuant to Chapter 440.0413), F.S., Notices of election to be exempt and certificates of election to be exempt shag be subjecit to revocation if, at any thne 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 eerlifioats to meet the requirements of this section. DFS-F2-DWC•252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 07-12 QUESTIONS? (850)413-1609 Miami shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 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 3. 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 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-time employees or subcontractors. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. State of Florida County of Miami -Dade The foregoing was acknowloZe before, me this S / day of 20 15 . By CIO URP7,tc who is personally known to ffor has roduce 13 055 �% as identification. Notary: �//K�P/%�'_ MMY /• f �� '.: CAMPJISSION � FF 208027 SEAL: EXPIRES: May 23, 2919 �R, �� Bondad'Fhni kct8r� FubHC U�eiwrltelB AFFORDABLE SEPTIC SOLUTIONS (305) ?26-8022 Date: March 30, 2015 County of aft Before me this day personally appeared who, being swom, deposes and says: That he or she will be the only person worift on the project located at: 190 N• W Swom to (or rmed) apd subscribed before me this = day of AftML201& by Or Produced Idendfleaiion Type of Identification Produc d_3 - Sb � 4r��lliZ�� Seal: BARBARA A.HWERSMI MY COMMISSION # FF 20862% EXPIRES: May 23, 2019 B=d TAru tomry Pubo Undmdw