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EL-15-2435 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores,FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INS P-244181 Permit Number: EL-9-15-2435 Scheduled Inspection Date: December 23,2015 Permit Type: Electrical- Residential Inspector: Devaney, Michael Inspection Type: Final Owner: PERRA, OTTAVIA Work Classification: Pool - Private Job Address: 10659 NE 11 Avenue Miami Shores,FL 33138- Phone Number (305)322-8777 Parcel Number 1122320280320 Project: <NONE> Contractor: YORK ELECTRICAL CONTRACTOR CORP. Phone: (305)962-0759 Building Department Comments ELECTRICAL ROUGH Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed Failed Correction 77-7 w� Needed ❑ Re-Inspection Fee No Additional Inspections can be scheduled until re-inspection fee is paid. December 22,2015 For Inspections please call: (305)762-4949 Page 13 of 59 b T € -,y 3 3 h f 'z- y y 7. . Miami Shores Village 10050 N.E.2nd Avenue NE Miami Shores,FL 33138-0000 b � 1� Phone: (305)795-2204 , ' � z' Expiration: 04/16/2016 Project Address Parcel Number Applicant 10659 NE 11 Avenue 1122320280320 Miami Shores, FL 33138- Block: Lot: OTTAVIA PERRA Owner Information Address Phone Cell OTTAVIA PERRA 10659 NE 11 Avenue (305)322-8777 MIAMI SHORES FL 33138- 10659 NE 11 Avenue MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone Valuation: $ 2,000.00 YORK ELECTRICAL CONTRACTOR C, (305)962-0759 Total Sq Feet: 0 Type of Work:ELECTRICAL ROUGH Available Inspections: Additional Info: Inspection Type: Classification:Residential Final Scanning:3 Light Niche Bonding Review Electrical Alarms Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $1.20 DBPR Fee Invoice# EL-9-15-57200. $4.50 10/19/2015 Check#:13088 $321.20 $0.00 DCA Fee $4.50 Education Surcharge $0.40 Permit Fee-Additions/Alterations $300.00 Scanning Fee $9.00 Technology Fee $1.e0 Total: $321.20 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 ab a-nam tractor to do the work stated. v( October 19, 2015 Authorized Signature:Owner 1 Applicant / Contractor / Agent Date Building Department Copy October 19,2015 1 Miami Shores Village r _ TRE) Building Department SEP 2 4 20 5 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 -=__— INSPECTION LINE PHONE NUMBER:(305)762-4949 1511 FBC 201`4 BUILDING Master Permit No. 'W (S — 2 PERMIT APP CATION Sub Permit No. to - (5- 2 gas- ❑BUILDING ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL [PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: I C)(.Sq N City Miami Shores County: Miami Dade Zip: 3313 Folio/Parcel#: 1 A- 2 2-�L;ig <?ZaXq� > t:>fit: Is the Building Historically Designated:Yes- -.NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): n-Hezicx Phone#: Address: i C)CoSc-T K)F- City: P-✓f rami �'jfn®ceSState: �L Zip: Tenant/Lessee Name: 'Phone# Email: CONTRACTOR:Company Name: fl \ (2044ac� r Phone#: ��S -Oi(e Z- L7 SQi Address: k 0 G 4 t o m s,-+- #4 Z"3 City: 9 State: 5 Zip: ( S Qualifier Name: L-6-�►•`"7' ,V Phone#: 305 ' 054 State Certification or Registration#: 4(t 13 00 5(e �� Certificate of Competency#: DESIGNER:Architect/Engineer: fat(l 0.fn"7 06VWO (e-`Q 3 Lk Phone#: Address: 61 -1 --4-0 I as -Ave, City: M'%o.&,J State:Zip: Value of Work for this Permit:$ f,r)00 Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑1 New ❑ Repair/Replace ❑ Demolition Description of Work: T-Wet Lor Specify calor of color thru tile: Submittal Fee$-6D Permit Fee$ ��r�� CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ -2-0 (Revised02/24/2014) Bonding Company's Name(if applicable) I Bonding Company's Address �Ib1 City State Zip Mortgage Lender's Name(if applicable) t�J I A Mortgage Lender's Address IJ 1* 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$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property Is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Signature CkL OWNER or.AGENT CONTRACAR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this 07.3 day of 2 by 3 day of �✓ 20 by a�IG Pei-"Zx ,w o ersonally k to 1,®1'er-20 `✓e-�who i 'son ally known me or who has produced as me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign' 7A41A4JSign Print: vel AeZ— Print: 4a✓ 41�� Seal: gpPvro MARC Seal: �PxYPo C OS A.MARTINEZ i=* MARCOS Q =°' 5 MY COMMISSION dt F c :* MY COis M EXT IBES:tlryay 15F2017� fly° Bonded ON �0�8989 Bonded hruNotaryPublcUnderwriters i` B ded Thru Nota May 17 ry Public ka�#kkkxe�k&yak+Rskkke#�cok$+kkekMckkkk a:kakokatdhk�&kkskhkkk#k+sihkk�sk+kkkIc�eokh�k �� k��. APPROVED BY Z�/�Vl' , Plans Examiner Zoning Structural Review Clerk (Revised02j24/2014) J s STATE OF FLORIDA PERMIT NO. DEPARTb1ENT OF EMALTH DATE PAID: ONSITE T AM DXSPOSAL FEZ PAID: SYSTEM RECEIPT #: APPLICATION FOR CONSTRUCTION PERMIT APPLICATION FOR: [ ] New System [V ] Existing System [ ] Holding Tank [ ] Innovative E ] Repai.r [ J Abandonment [ ] Temporary [ ] APPLICANT: L_V-z_ AGENT: io��Y1-Cc �C3�31� TELEPHONE: 50&=i4&4P"_ 30� MAILING ADDRESS: 4 �p4� (L�a7 �(O Cf';tt slk® :Dorc 1�(:I �53i�o TO BE COMPLETED BY APPLICANT OR APPLICANT'S AUTHORIZED AGENT. SYSTEMS MUST BE CONSTRUCTED BY A PERSCli LICENSED PURSUANT TO 489.105(3) (m) OR 489.552, FLORIDA STATU'T'ES. IT IS THE AP'2LICA\'T' RESPONS=ILITY TO PROVIDE DOCtY NTATION OF THE DATE THE LOT WAS CREATED OR PL.XTTED (MM/DD/YY; IF REQUESTING CONSIDERATION OF STATUTORY GRANDFATHER PROVISIONS. PROPERTY INFORAA^a011 :.a-r: 4 BLOmc., 2 suBDivisYON: MIAMI SHORES ESTATES PLATTED: 1950 2a1JPERTY ID 0: 11.2232-028-0320 ZONING; RU I/M OR EQUIVALENT: [ No ] PROPERTY S%vE: _t3 _ ACRES WATER SUPPLY: [ ] PRIVATE PUBLIC [a( ]<=2000GPD [ ]>2000GPD IS SEWER A %AIIABLE AS PER 381.0065, FS? [ No I DISTANCE TO SEVER: N/A FT PROPERTY ADDRESS. 10659 T+ETE I 1 AVE MIAMI,FL 33138 f- DYRECTIONS TO PROPERTY: NE 103 ST TO I I AVE ,lid . BUILDING INFORMATION RESIDENTIAL �� IAL Unit Type of No. of g C er ' /Institutional System Design No Establishment Bedrooms S T 1. Chapter 64E-6, FAC 1 SFR 3 I ®a 'Q NOTE:CERTIFICATION FOR POOL. 2 3 [ l Floor/E ipment Drains [ J Other (Specify) SIGNATURE: 1 lt� '�� d°A-2-® DATE: 9/1/15 us editions which may not be used) DH 8015, 08/09 (Obs o ® s v' Incorporated 64E-6.001, C Page 1 of 4 r STATE OF FLORIDA DEPARTMENT OF HEALTH APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Permit Application Number -- --- ----- ----------------- PA -_ RT II -SITEPLAN - ________________________ Scale: Each block re resents 10 feet and 1 inch =4.0 feet. I � IND &o IPJ Banti .08 II ( ti t. DF 1 SIT 1 - LL r- )MWONCO SE AVAOMO I J (I( ,fFg• O C�,rr.—rr�u_y,_,d'RR e9 .._.u—a..—u—� �.r—..r 4'.>��; aQ Notes: THERE ARE NO PERTINENT FEATURES ON ADJACENT PROPERTIES AND OR ACROSa_ THE STREET THAT MAY AFFECT THE NEV SYSTEM INSTALLATION. Site Plan submitted by: ` 2l q I t Plan Approved Not roved Pp Date Ry County Health Department ALL CHANGES MUST BE APPROVED BY THE C®lJR4T4( HEATH DEPARTMENT DH 4015,10196(Replaces HRS-H Form 4016 which may be used) Page 2 of 4 (Stock Number. 5744-002-4015-6) rI''t),1;1 �sf:?Tea"ti1Ti1ENl`•'�''i _ , r° i . HE Charlie Crist Ana M.viamoute Kos,M.D. M.P.H. Governor State Surgeon Gcncral DOH# Chapter 64E-6.004(3)(a),1:.A.C.: A plan or plat of the lot or total site ownership drawn to scale, showing boundaries with dimensions, locations of any existing or proposed residences or buildings,swimming pools, recorded easements,the on-site sewage treatment and disposal system components and their location on the property,the slope of the property and any existing or proposed wells,potable and non-potable water lines,including valves, drainage features,filled areas,unobstructed areas, and surface`nater bodies. The site plan shall indicate the location of wells,on-site sewage treatment and disposal systems,surface waters and other pertinent facilities or features on contlauous or adjacent property. If the features are within 75 feet of the applicant lot,the estimated to .he feature must also be shown but need not be drawn to scale. The location of any pi..Llic drinking water well,as defined in Chapter 64E.-6.002(44)(b),within 200 feet of the applicant'` lt-t shall also be shown,,,with the distance indicated from the system to the well,and th�t location rif limited use public seater system or other public wells,as defined in Chapter 64E- 6.902(44)(t),-R'i°hin 100 feet of the applicant lot must also be shown,or as defined in Chapter C4E 6.002(R,";(a),F.A.C:.,within 75 feet from a private potable water well(well used only by one or two iE silences). Chanter 2,r-I2(i8), NEurni-Dade County Code: The-ninimurn separation between a well or swells and possible sources of contamination shall be a function of the drawdown radius of influence of the well or wells. In no case shall the well be located Iess than one hundred(100)horizontal feet from any source of contamination. I have read the above and to the best of any knowledge I have provided the Department with hill information regarding pertinent facilities and features on all adjacent properties. Furthermore,I understand that any on-site sewage treatment and disposal system permit issued on the basis of said facilities and feature as provided by me and found to be incorrect will be subject to revocation in accordance with the provisions of Chapter 120, Florida Statutes. Property Address: Q C1 Date: - ' ' 6 Signature: Samir Ehnir,PhD,PE,DEE,CEHP,Director Environmental Health and Engineering r�� ae+re Miami-Dadc County Health Department10 a,`~ 1725 AT.W. 167'h Street,Miami,Florida 33056 Tel:(305)623-3500 Fax: (305)623-3502 tmtna AUTHORIZATION LETTER Department of Health O.S.T.D.S. Corporate Park Office 7769 N.W.48 St. Suite 175 Miami, FI 33166 ReF• Permit No: Date: 9" Address: 56reet number/name City State Zip Code Property 22'YL ` 0 JA Fnd/7r Lega! Percrlption: ! ROSERTO RODRIGUEZ (Property owners full name or legal representative of the property) In representation oF: PlY5ELF (My self or property entity full name) As: SEPTIC CONTRACTOR (Owners or position into entity) Hereby authorize: (Property owners legally authorized agent or company name) To process and obtain the Septic System permit for this y located at the above referenced site- SI RE _ ♦5�x��s Grp i Miami shores Village all Building Department 10050 N.E.2nd Avenue LpR�A Miami Shores, Florida 33138 Tel: (305) 795.2204 Faux: (305) 756.8972 NOTICE OF REQUIREMENTS RESIDENTIAL SWIMMING POOL,SPA AND HOT TUB SAFETY ACT (We) acknowledge that a new swimming pool, spa or hot tub will be constructed or installed at ML,69 NJE i I -"e "#a,"Sharg.-,4 VL Miami Shores, FL, and hereby affirm-that one of the following methods will be used to meet the requirements of Chapter 515, ••••; Avnda•Statuep indtpe Florida Building Code R4101.17. SSSS •;•••• lease ilial iveilod(s)to be used: SSSS.. • •••• Tiee"will be equipped with an approved safety pool cover that comp lies with ASTM ••••• Re,;-91.(5u;mk anufacturer's Specifications). SSSS. . Soso ••••; .00.• • Ac@R*Tuous,one-piece(child)barrier meeting the requirements of Florida Building Code • RM.17.1,15% it protect the pool perimeter.The plans shall show the fence location and method of •••••• attBCbrtVnt,in&M111 one end that shall not be removable without the aid of tools.(Submit Manufacturer's SIlecific itions): .••. SSSS.. SSSS •••••• A combination of non-dwelling walls and fences(screen enclosure,child fence,masonry fence walls,chain rink or wood fence,etc.)will protect t he pool perimeter.The plans must specify t he type and location of all non dwelling walls. Florida Building Code, R4101.17,1 Any combination of protection which incorporates dwelling walls with openings directly into the pool perimeter and all windows and doors will be equipped with exit alarms complying with Florida Building Code, R4101.17.1.9(Submit Manufacturer's Specifications), Any combination of protection which incorporates dwelling walls with openings directly into the pool perimeter and all doors will be equipped with a self-latching device with positive mechanical latching/locking installed a min.54"above the threshold. If this option is selected,submit plans showing all types and location of all.perimeter protection.The plans must also show the location and type of all openings,and the hardware type for each location. (Submit Manufacturer's Specifications). In accordance with the Code,the pool may not be filled with water without compliance with the Private Swimming Pool Safety Requirements,and upon expiration of the permit,the pool shall be presumed to be unsafe.I understand that not having one of the above installed will constitute a violation of Chapter 515,F.S.,an d will be considered as committing a misdemeanor of the second degree,punishable as provided in Section 775.082 or Section 775.083 F.S.This form must be signed by thee pri a contractor. - zZ.—u—- CONTRACTOR'S SIGNATURE AND DATE OWNER'S SIGNATURE AND DATE CONTRA T R'SWIqAEPEASE PRIN OWNEra E PLEAS RI( T) Gi NOTARY PUBL NOTARY MARCOS A MARTINEZ =t��""f�,, MARCOS A MARTINEZ a` MY COMMISSION FF 008989 e3 MY COMMISSION#FF 0089159 r; { •*= EXPIRES:May 15,2017 EXPIRES:May 15,2017 Bonded Thru Notary Public Underwriters Bonded Thru Notary Public Underwritors i K0S Miami! Shores Village wilding Department Rte' 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 -SWIMMING POOL OWNER'S CERTIFICATION gate _ ",_._,• I a, �s 0000.. . . . 0000.. 0000. . . . . M. iami Shores V11499: 0.6006 0004 00 60 .••:oSuildig�Zon1AgOepartment 0060. .. 6000 . . . . s .0 sees 000600 Attentidn: SuiidfAWO'fficiai 666600 66:6 0000. e 00 0 . .. 0 060066 l•ce ify that r am 01he legal owner of the progrty described as M'S O M I s hQ<� - ��te� �8�--7-s 9 Lot ti , located at t oc� N I ► ► .oma . til i v,n i sin re-,S, L.L,3'.X13's In accordance with Section 33-12(f), Code of Metropolitan Dade County, I certify that I understand and agree that the swimming pool to be constructed at the above address cannot be used or filled with water until separate permit has been.obtained for an approved safety barrier, and such barrier erected, inspected and approved. I further understand that this certification, however, does not eliminate the need for obtaining a permit and erecting and approved barrier prior to final inspection and use of the pool. . Legal owner --u6�- Dote:This certification Is to be submitted with a swimming pool permit application In duplicate. S 5NOR9Es Lrt Miami Shores Village FIRE. ..... Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 RESTRICTIVE COVENANT PROTECTIVE POOL ENCLOSURE KNOW ALL MEN BY THESE PRESENTS: kVHEWS,the undersigned 0�'JVi e, is/are the fee . . • •••• simple owners)J thelollWng described property situated and being in Miami Shores Village,Florida: • •••• Address' 10S� felt Q ice.- M i o�n-,1 5 4�c4�S �l- X313$ •••••• WheTw,the un de*,adowner(s) o-4't �+ P.�✓�, ..... .... ...... `..:.. d�sjre to utilize said*6qt(*)as a single building site,and the undersigned owner(s)do(es)hereby declare and agree as follows: • . . ••••; • I. •••Wlthe property will not be used in violation of any ordinances of Miami Shores Village or Miami-Dade County now in effect or hereinafter enacted. • • • •••:`• II. ```•Valthe purpose of the covenant is to induce Miami Shores Village to issue a permit for a pool where the .` `` ` .�eNred enclosure is not on the subject property where the pool is located. .000000 III. ' That If any of our adjoining neighbors remove any portion of their fence or wall,or if our/my property shall fail 0866 to meet code requirements for pool barriers,we,as owners will immediately install a protective enclosure to meet code requirements and will obtain a permit for such fence. IV. That,Uwe,as owners)hold Miami Shores Village harmless for any negligence or injury that results from not having the enclosure. V. If enclosure belongs to said property,I agree to maintain&or replace said enclosure in the event that is damaged or removed by any case. NOW,THEREOF,for good and valuable consideration,the undersigned do(es)hereby declare that he/she will not convey or cause to be conveyed the title to the above property without requiring the successor in title to abide by all terms and conditions set forth herein. FURTHER,the undersigned declare(s)that this covenant is intended and shall constitute a restrictive covenant conceming the use,enjoyment and title to the above property and shall constitute a covenant running with the land and shall be binding upon the undersigned,his/her successors and assigns and may only be released by Miami Shores Village,or its successors,in accordance of said Village then in effect au �iiA�► OWNER SIGN& RINT OWNER SING&PRINT I Hereb Ce r h'fy that on this day personally appeared before me t>*,mV i- TE'..r�fc� and has produced ID # FIL t7L as identification and he/she acknowledge that he/she executed the foregoing,freely and voluntarily, for purposes there in expressed. SWORN TO AND SUBSCRIBED before me on this a�1 day of ` hj v5 .20155/ V' NO ARY P ORIDA (Revised 0512209 Ia1TMaRCos A MARTIN *: *' MY COMMISSION = #FF 008989 BondedXTpblrRuNo�teMay 15,2017 ry Public undeavMers ?C?i3-SR.FQ _ �..�il F.X02 /3Gi' • • ' ... 9999 .. 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F °�° _ ; . ish •t� net mii�N�dIDYt etl6bptF.0�31��dAm� :: •• a aM Wim• b '!►a.w�P�. i� � � ai cir4�e b t®ar�ae•tab�maor �, � • .. =,x -_,. +.;:. ,��.,y,•,'a.•• z, ., Via. 3 1 lad Safe Fool Net8,Ion hSoodI01104 pop P 25 t as+�sAetoetiwteq�e�+�syedrew6:gra�rtfat�pp3s¢BF ,ise�ae�aier �'s�oaSasaretLFiregorti►re�a�eQpeza rda .�,�.m�,. �ewd+as {�sa�maavt ` s§•we�seueggwoen�emaet are3dso@•�ndtiYc.la3S�•.�xaeea+apse.•s�e,erst «'�b* .aa,�mak. Y� APPS t RESEARCH LABdRATORM 6371 N.'i►+/.161dSteO wMa 1,FWid8 33014 • i �e•e�ete•+aa6e��teQa.�z•r�uas�rm - e ' 1 lQeaaoareB�IClf06'PLffiBlQppppyy�py�anaaraecar.A[!¢�,�jjpp +�'� .... :•• • 3 190•ed(wCar L�a6tWMY?�OMle�O.sed�9b '{�' y,� ��' �M'M �-r• f OYa{tilYOfi��AdSY17T.iR�lYi�il�OpYptp�$'FA�_�pG�np61(! • • m�O�mtM6Q9e�ABtltam�al�h�i 1(1�1.�'RWQ�: �6 73� iW��YQ �ptp�W��IIV•� - LQ•'di�itll�cWOC.olbKttaoitKCDa�Ea�alia0on pty,p04lppOgiml kldL. pt °° a` ° ,�,.. raawaaau:wiboa. . 1 i�d'fMFMr,j�Fb6t�!{7��y�,q-'694�.4rx�rOtt t• 4fOf8Q1D •�'��'�S�1R44116Yiftu3�16:� .V SSD;�o1�'�rf.adl4ra+emrite�0A�a0.�lh¢� ;.ti�9;� ' altC •• tn0avi �rrm0 '{"!�7 + +i�« aae �ai '07�$�► bN6tfwi� pu®mamyey�s . IcbORlMK4�li 01npasbao E 54 *add*"�.* ; F 2YVtlas fi►t tCriQypieQluvpLey p�.T�ep, �; :w7osa °tc�S�'°c6m�� r,samcasarma.xadst�. [�Y.e+�c,.�i.4�rr�aoaadana+wctsna.oaso��{, _. °taaKt.00R�tsiwa ' v. e� !bae�eaaees ,o°p!► a .•::.,::� • _ •�yy.e.,.' .• .. `� Y: - +• Ips Y � t L/N 3011 Kid Safe Pool Pets,lit. Lnuod101IO t4 Page P-26 �ss�adprottmoom�s.6�g#c�oesuk�.d+�cm�naof�is�@esurdbdocasaMe.+c.�eamfepeo{�egefdgpied8e�r�t�meiai;c , eaecismtaaysgs4aaarrs�+3o�de�fr+isna�P6�to.Y*�4sps}pv+aL 1tim..�,Ord4lTela'�tlwdYtme�s�k�dalu6�, ee�sdrdferir�pe�r,tesic tJekisamc�4s �d,QeesahndorEepi4attest�sx�aoetsdi�a' armraee�veaidxgcoifrofekebt!•aee+e5d�e'xan�gkMae4ksna.�d�raed�'ides�totarat�a•pro�er , w � STATE OF FLORIDA PERMIT NO. DEPARTHM OF HEALTH DATE PAID., ONSITE SEWAGE TREATMENT AND DISPOSAL FEE PAID: 4wa4.,-Ow SYSTEM RECEIPT #: APPLICATION FOR CONSTRUCTION PERbaT APPLICATION FOR: [ ] New System [,/ ] Existing System [ Holding Tank [ ] Innovative [ ] Repair [ ] Abandonment [ ] Temporary'' [ ] APPLICANT: N Liz, ile-1gana -An pc% AGENT: SebffiffiRN SEPTTC Vcc ' �>uC-AS TELIEPHONE: 306 599 o74ti FLING ADDRESS: QL0 3(a 5A,-zSIQ A-DO(Crl S(, ;J31(66 TO BE COMPLETED BY APPLICANT OR APPLICANT'S AUTHORIZED AGENT. SYSTEMS MUST BE CONSTRUCTED BY A PERSON LICENSED PURSUANT TO 489.105(3) (m) OR 489.552, FLORIDA STATUTES. IT IS THE APPLICANT'S RESPONSIBILITY TO PROVIDE DOCUMNTATION OF THE DATE THE LOT WAS CREATED OR PLATTED (bdM/DD/YY) IF REQUESTING CONSIDERATION OF STATUTORY GRANDFATHER PROVISIONS. PROPERTY INFORmTION • •LCV: 4: :• • BLOCK: •3— SUBDIVISION: MIAMI SHORES ESTATES PLATTED: 1950 •>3120PERTS�.iDe#: 161-223Z,028-0320 ZONING: RU I/M OR EQUIVALENT: [ No ] • .•..•• *see *see •••eR39OPER27.;1IZE: A" ACRES WATER SUPPLY: I ] PRIVATE PUBLIC [�/ ]<-20000PD [ ]>2000GPD ••••• •• • • IS SEW khIr-11-121A•1 PER 381.0065, FS? [ No ] DISTANCE TO SEWER: N/A FT ••••MOPER4;Y,VDRES j!:W59 NE 11 AVE MIAMI,FL 33138 • • • •• • •:..VARECT4944 TO P1FqFZ6R%VY: NE 103 ST TO 11 AVE • . BUILDING INFORMATION [ d ] RESIDENTIAL [ ] CObMERCIAL Unit Type of No. of Building Commercial/Institutional System Design No Establishment Bedrooms Area Sqft Table 1, Chapter 64E-6, FAC 1 SFR 3 1506 NOTE:CERTIFICATION FOR POOL. 2 3 4 [ I Floor/ ipment Drains [ ] Other (Specify) SIGNAT M: �kk-L DATE: 9/1/15 DR 4015, 08/09 (Obso e s . us editions which may not be used) Incorporated 649-6.001, Page 1 of 4 STATE OF FLORIDA DEPARTMENT OF HEALTH APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Permit Application Number ---------------------------PART II -SITEPLAN --------------------------- Scale: Each block re resents 10 feet and 1 inch =40 feet. d'M - � r �� Z51t DI` SlT,. 'I] Ul _ • • BddlB 8888• � .�� ►- :;:m�'st .;: • �` '6.•608• �'.a- • see* • a •••• 8888• 8888 q a VAIIII � ( . . :• 8888•• •JNOD 8888• • t • ;jp�y • d' 86:068 I 8888 � :; • • • j a— j i I :' • Z �i—u u_F --A. Notes: THERE ARE NO PERTINENT FEATURES ON ADJACENT PROPERTIES AND OR ACROSS THE STREET THAT MAY AFFECT THE NEW SYSTEM INSTALLATION. Site Plan.submitted by: /2.,0 ®2f 2 l Plan ApprovedN�tpp roved Date By County Health Department ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT DH 4015,10/96(Replaces HRS-H Form 4016 which may be used) page 2 of 4 (Stock Plumber. 5744002.4015-6) 0 ) l+X r J Charlie Crist Ana M.ViamOnte Ros,M.D.,M.P.H. Governor State Surgeon General DOH 0 Chapter 64E-6.004(3)(x),F.A.C.: A plan or plat of the lot or total site ownership drawn to scale, showing boundaries with dimensions,locations of any existing or proposed residences or buildings,swimming pools, recorded easements,the on-site sewage treatment and disposal system components and their location on the property,the slope of the property and any existing or proposed wells,.potable and non-potable water lines,including valves,drainage features,filled areas,unobstructed areas, and surface water bodies. The site plan shall indicate the location of wells,on-site sewage treatment and disposal systems,surface waters and other pertinent facilities or features on contiguous or adjacent property. If the features are within 75 feet of the applicant lot,the estimated to the feature must also be shown but need not be drawn to scale. The location of any public drinking water well,as defined in Chapter 64E.-6.002(44)(b),within 200 feet of the applicant's lot shall also be shown,with the distance indicated from the system to the well,and the location of limited use public water system or other public wells,as defined in Chapter 64E- ••• 6.W( 44)(b),within 100 feet of the applicant lot must also be shown,or as defined in Chapter +;4A-6.002Z44JCa1,F.A.C.,within 75 feet from a private potable water well(well used only by . 0000 •;Oris pr two residences). 0 sees** f'pter 24;0J,020(•1...8),Miami-Dade County Code: 0000• 0000 • • 0000.. ,0000: •Z'he.minim"M separation between a well or wells and possible sources of contamination shall be •; ••a&Actioi of Abd drawdown radius of influence of the well or wells. In no case shall the well be ` located less thin one hundred(100)horizontal feet from any source of contamination. e••.•• 0000 • 9*0 •• 0010 0 Gasses ••••• a hd've rez�,d�Above and to the best of my knowledge I have provided the Department with full •• Wermatioh regarding pertinent facilities and features on all adjacent properties. Furthermore,I ••widerstand that any on-site sewage treatment and disposal system permit issued on the basis of said facilities and feature as provided by me and found to be incorrect will be subject to revocation in accordance with the provisions of Chapter 120,Florida Statutes. Property Address: Qi �P'*' r- Date:. - 1 ! ' Signature: �. ..„ Samir Elmir,PhD,PE,DEE,CEHP,Director Environmental Health and Engineering Miami-Dade County Health Department 1725 N.W. 167h Street,Miami„Florida 33056 Tei:(305)623-3500 Fax: (305)623-3502 t I AUTHORIZATION LETTER Department of Health O.S.T.D.S. Corporate Park Office 7769 N.W.48 St. Suite 175 Miami, Fl 33166 Ref• Permit Alo: Date: -(- l d Address: 1 O bS � tom► L [ � �b L l� Street number/name City. State Zip Code Property /D: 22272 • Z.2S �7�° 0000•• ..• . • . And/Qr Gega��esaription: 00.00• 0000•• ' 5�.1�'�0 '!, 5 v�leS • 0000•• 0000•• 0960 •• •• •66•• 66.6 :00:00 : • • 9 9.66• •f • •60• :•.•6. ••/••• ••••.6 Romm RODRIWEZ • 6 66 (Propertyb&h:rs full name or legal representative of the property) 6 • 90000• • 09• • 000000 0•Ii!tlepresenb 614 of lny5fu •6 0 0 (Affy self or property entity full name) As: 5EP77C CONTRACTOR (Owners or position into entity) Hereby authorize Lug. —�rCic�pr� (Property owners legally authorized agent or company name) To process and obtain the Septic System permit for W y Located at the above referenced site- SIG RE Property Search Application-Miami-Dade County Page 1 of 1 OFFICE OF' THE PROPERTY' APPRAISER Summary Report Generated On:9/1/2015 Property Information � F 3 Folio: 11-2232-028-0320 Property Address: 10659 NE 11 AVE Owner ANDREW EASTON �RYk � ' z MaiOng Address JV 10659 NE 11 AVE MIAMI SHORES,FL 33138 - Primary Zone 1000 SGL FAMILY-2101-2300 SQ a ♦ Z P Z,: p( F Primary Land Use 0101 RESIDENTIAL-SINGLE 3 FAMILY:1 UNIT Beds/Baths/Half 3/1/0 K� ! `w i Floors 1 Living Units 1 AZ006 Ftctual Area Living Area 1,5WSq.Fi Adjusted Area 1,799 . Sq.Ft Rot size. :e; .• . 10,400 Sq.Ft Taxable Value Information dear Butt •e e e e i 1650 2015 2014 2013 esamant Information '••••• Cott ' Year.e• 000: :04.9015 2014 2013 Exemption Value $50,000 $0 $0 Taxab�Value Line blue � •4450 586 $208,087 $145,728 $359,075 $313,861 $222,101 No Value W5,278 $102,543 $102,543 School Board Exemption Value $25,000 $0 $0 tie •see$3,211 $3,251 $3,294 e e �_ _ ._..-- Taxable Value $384,075 $313,8#31 $251,565 Ma rlcet Value . O ft,075 $313,861 $251,565 Assessed Rote Veldt see• $409,075 $313.861 $222,101 City Exemption Valu® $50,000 $0 $p Benefttt;informatlon Taxable Value $359,0751 $313,861 $222,101 Benefit Type 2015 2014 2013 Regional Non-Homestead Cap Assessment Reduction $29, Exemption Value $50,000 $0 $0 Homestead Exemption $25,000 Taxable Value $359.075 $313,861 $222.101 Second Homestead Exemption $25,000 Sales Information Note:Not all benefits are applicable to all Taxable Values Q.e.County, School Board,City,Re glonaq. Previous Price OR Book- Qualification Description Sale Page Short Legal Description 07/23/2014 $485,000 29250-1500 Qual by exam of deed MIAMI SHORES ESTATES PB 47-58 03/14/2013 $180,500 28555-1302 Financial Inst or%n Lieu of Forclosunf LOT 4 BLK 3 LOT SIZE 80.000 X 130 08/01/2005 $550,000 837251846 2008 and prior year sales;Qua[by OR 20351-3822 04 2002 4 - exam of deed COC 23725.1646 08 20051 2008 and prior year sales;Qual by 01/01/2005 $ 4,000 2309 5-3i9 exam of deed The Office of the Property Appraiser is continually editing and updating the tax roll.This website may not reflect the most current information on record.The Property Appraiser and Miami-Dade County assumes no liability,see full disclaimer slid User/agreement at http:/hvww.miamidade.govfinfo/d'uclaimer.asp Version: http://www.Miainidade.gov/propertysearch/ 9/1/2015 ! r "E*T OF HOMELAND 8E uwg ELEVATION CERTIFICATE OMB No. 1=ate 60-0�8 r EMERGENCY MANAOENIENT AGENCY 9_9, Expiration Date:July 31,2015 Flood Insurance Program important: Real!the instructions on Pages FOR INSURANCE COMPANY USE SECTION A-PROPERTY INFORMATION Policy Number. Building Owner's Name OTTAWA PERRA Company MAIC Number. incl Apt,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. s udh»I Building Street Addres A2. B 9 10859 NE 11 AVE State FL ZIP Code 33138 City MIAMI SHORES A3. Property Description(Lot and etc•) Black Num bars Tax Parcell I'll U11,111:1 Elr,Legal Description, MIAMI SHORES ESTATES PB 47-58 LOT 4 BLK 3 MIAMI-DADE CO.FOLIO 11-2232-028.0320 A4. BuiWing Use(e.g.,Residential,Non-Residential,Addition,Accessory,etc.)RESIDE90A6 A5. Latitude/LongRude:Let.N25.873g Long.W .17 1 Horizontal Datum: F-1NAD1927 1@ WAD 1983 Ae. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood iruzuran�. A7. Building Diagram Number IA A9. For a building with an attached garage: ft A8. For a building with a crawtspace or encl losura): a) Square footage of attached garage 24 sq a) Square footage of crawispacs or enclosure{s) s b) Number of permanent flood openings in the attached garage b) Number of permanent flood openings in the crawlspacS within 1.0 foot above adjacent grade WA orenciosure(s)within 1.0 foot above adjacent grade NIA c) Total net area of flood openings in A9.b NIA sq in c) Total not area of flood openings in A8.b in nin s? [] yes ® No d) Engineered flood openings? ❑ Yes ta No Engineered flood ope 9 SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION B2.County Name 53.State • B1.NFIP CommCORP.1_2 Community Number M�l-DADE FL •• MSI-D�'� 1BB.Flood B9.Base Flood Elevations)(Zone • Map W-WApiOmber • B5;Suffix B6.FIRM Index Date B7.FIRM PaneDatel X ) AO,use base flood daft) • •�'' 12086 CC 0306 . OL 09h 1109E ve 11/09 ••i31D! Indicate*w-WurcO of Base Flood E�vatton(BFE)data or base flood depth entered in Item •••.• . • A FIRM �❑ Community Determined ❑ OthedSource: • • Fl�Profile .. • ® NGVD 1929 ❑ NAVO 1988 ❑ OthadSource: •�� Indic@aEftJovetion dahirvil for BFE in Item 89: No Coastal Barrier Resources System CBRS)area or Otherwise Protected Area(OPA}? ❑ Yes ••ii,Z• 10 Is the fDulidirig iocate'c�tQ p. �] CBRS ❑ OPA • Designation Date:WA • ••• • . . . ...... SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED) Building Under Construction' ® Finished Construction " • •Cf. Buildirignalavations ft based on: ❑ Construction Drawings' ❑ g "A new Elm►Certificate Gnit be required when construction of the budding Is complete. late Items C2.3-h C2. Elevations-Zones Al-AW,AE,AH,A(with BFE),VE,V1--V30,V(with BFE),AR,AWA,ARAE,ARIA?-A30,ARiAH,AR/AO.Come below according to the building diagram specified in Item A7.In Puerto Rico only,enter meters. Benchmark Utilized:BMS Vertical Datum: 1009'NGVD 1929 Indicate elevation datum used for the elevations in items a)through h)below. ®NGVD 1929 13 NAVD 1988 11 OtherlSour�: Datum used for building elevBWns must be the some as that used for the BFE. Check the measurement used. or enclosure floor) $. ®feet ❑meters a)Top of bottom floor(including basement,crawisPace, N� ❑feet ❑meters b)Top of the next higher floor ❑feet ❑met®rs C) Bottom of the lowest horizontal structural member N Zones only) ❑feet []meters d)Attached garage(top of slab) Icing 7 A ®feet ❑meters ®) sery (De�acriba type of equipment and locast elevation of machinery or tion in COMIftntsjre budding NA ®feet ❑meters f) Lowest adjacent(finished)grade next to building(LAG) �V- ❑feet ❑meters g)Highest adjacent(finished)grade next to building(HAG) 13feet 1:3 meters h)Lowest adjacent grade at lowest elevation of deck or stairs,including structural support WA. SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION r,or architect authorized by law to certify elevation This certification is to be signed and seated by a land surveyor,engines - Information.t certify+that the information on this Certificate represents my best effnt ortsinterpret� 1001. I understand that any false statement may be punishable by t7ne Wp ere latitude and longitude in Section A provided by a = . ® Check here ff comments are provided on back of forth. licensed land surveyor? ® Yes ❑ No 7 ® Check here ff attaehrrcerrt. Certifler's Name GUILLERMO A.GUERRERO License Number PSM 6453 - 2 Title PSM Company Name WA City HIALEAH -- - `� Address 882 E.21 State FL ZIP Coda 33013 Signature Date 07/2212015 Te�phone 305-3333328 '- - FE Farm 08&0-33(7112) See reverse side for continuation. Replaces alt previous edit 104PORTANT:In these spaces,copy the corresponding Intannation from Section A FOR INSURANCE COMPANY USE Building Street Address(including Apt.,Unit,Suite,and/or Bldg.Nq.)or P.O.Route and Box No. Policy Number NE 11 AVE City MiAMI SHORES State FL ZiP Code 33138 Company NAIC Number: SECTION D—SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION(CONTINUED) Copy both sides of this Elevation Certificate for(1)community official,(2)Insurance agent/company,and(3)building owner. Comments Equip or Mach on C2a Is AIC unit,located at BACK of house.Property located into 2 flood zones X/AE latitud and Longftud data was obtained by Internet GoogWYahoolrerrasever. Crown of road Eiev.m 7.80' Signature r Date 07/22!2015 SE TiON E—BUILDING ELEVATION INFORMATION(SURVEY NOT REQUIRED)FOR ZONE AO AND ZONE A(WITHOUT BFE) For Zones AO and A(without BFE),complete Items E1-E5.If the Certificate is intended to support a LOMA or LOMB-F request,complete Sections A.B. and C.For Items E1-E4,use natural grade,If available.Check the measurement used In Puerto Rico only,enter meters. E1. Provide elevation information for the following and check the appropriate bones to show whether the elevation Is above or below the highest adjacent grade(HAG)and the lowest adjacent grade(LAG). a)Top of bottom floor(including basement,kxawispace,or endure)is Q feet ❑meters ❑above or❑below the HAG. b)Top of bottom floor(including basement,crawlspace,or enclosure)Is ❑feet ❑meters ❑above or❑ below the LAG. E2. For Building Diagrams 8-9 with permanent flood openings provided in Section A Items 8 and/or 9(see pages 8-9 of Instructions),the next higher floor (elevation C2.b in the diagrams)of the building is ❑fent ❑meters 0 above or 0 below the HAG. E3. Attached garage(top of slab)is ❑feet ❑meters ❑above or ❑below the HAG. E4. Top of platfonn.of machinery and/or equipment servicing the builds is • • �9 n9 0 feet [3 meters ❑above or❑below the HAG. •�� ordinance? oyes Ef A EJ Unknown,The local official certify this Information in Section G with the community�s floodplain management SEV-QONNF-PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFICATION 'l tte pfwerry owntr grOwner's 111004W rePrasOntative who completes Sections A,B,and E for Zone A(without a FEMA-issued or community-Issued BFE) grAppt AO mVJ jVn here.The statements in Sections A,B and E are correct to the best of my knowledge aropG*Owned#lar Opener s,At$bgr fed RepresertStive's Name �Addr+ss�s .• •••• • • . @ s e e City State ZIP Code •�igmatere •• • ' Date Telephone •4vMnts •••e • • • ❑Check here N attachments, SECTION G-COMMUNITY INFORMATION(OPTIONAL) The local official who Is authorized by law or ordinance to administer the community's floodplain management ordinance can complete Sections A,B.C(or E),and G of this Elevation Certificate.Complete the applicable ften(s)and sign below.Check the measurement used In Items G8-010.in Puerto Rico only,enter meters. 01.[] The information in Section C was taken from other documentation that has been signed and seated by a licensed surveyor,engineer,or architect who is authorized by taw to certify elevation Information. (Indicate the scum and date of the elevation data In the Comments area below.) G2.❑ A kmmmunity official completed Section E for a building located In Zone A(without a FEMA4ssued or communhy4ssued BFE)or Zone AO. G3.Q The following information(Items G4-G10)is provided for community floodplain management purposes. G4.Permit Number G5. Date Permit Issued G8. Date Certificate Of Complianoaloocupancy Issued G7. This permit has been Issued for: 0 New Construction ❑Substantial Improvemenf 08. Elevation of as-built lowest floor(Including basement)of the building: ❑fent ❑meters Datum 139. BFE or(In Zone AO)depth of flooding at the building site: 0 feet ❑meters Datum 010.Community's design flood elevation: ❑feet ❑meters Datum Local Ofdioiars Name Title Community Name Telephone Signature Date Comments ❑Check here if attachments. FEMA Form 088-0-33(7/12) Replaces all previous editions. II ' 1 . CLevaTioN cl=_RTtFIcaTE,page 3Building Photographs See Instructions for Item A6. IMPORTANT:In these spaces,copy the corresponding Information from Section A. FOR INSURANCE COMPANY USE Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. Policy Number. 10658 NE 11 AVE City MIAMI SHORES State FL ZIP Code 33136 Company MAIC Number. If using the Elevation Certificate to obtain NFIP flood insurance,affix at least 2 building photographs below according to the instructions for Item A6• Identify all photographs with date taken;"Front View" and "Rear View°; and, If required, "Right Side View"and"Left Side View." When applicable, photographs must show the foundation with representative examples of the flood openings or vents, as Indicated in Section A8.If submitting more photographs than will fit on this page,use the Continuation Page. A a j . F •••• ''y. -"fid:., - t F„ 'i" k `si `R ,� :} k • •••• ,iw!!i' X11!}!!! . .•.. • �" FRONT • 6 ' j A BACK FEMA Form 086-0-33(7/12) Replaces all previous editions. it r rALst = a ur PROFESSIONAL SURVEYOR & MAPPER No.6453 ' '�"�'> z°`z BOUNDARY SURVEY PHONE-(305) 885-4603 J08 No. —15189 682 E. 21 SfREEf. HW.EAH, FL 33013 SCALE: 1 = 20' emafl:guerrempsmQaol.com PH: (305) 333-3328 YYOQD (AUL PP ;.g - . A8P4iALTP11VE1611E::'i::{:.::, : : FP Non I@ 4 WW.F �o1Q 1,00' LOTB LOr4 WL LOiB 6L=X3 /BLOZO BLOCK3 • • ••• ...... o fee so ••••• �• • i •••• • • j tL6, f..< AC law law r • • • • 1 �1tt� rb 1A0 rc QJR 1Bm ui z FDR FD RIW NOD NoD A A IDRW NOD BLOCK ASWALT :.1 ........... I&PAN&W CORNSt Z1'ABPHALTPAVEMBU'-:)::-'----•:.:...:.. ....:•::•::: i:::::::: :::.:::: ::::::: ................... .............................. •NR��lil•ea•R16®dl ea�•OiI•dFtU•D1•d�•IOI•p. 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