PL-16-1156 Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-257805 Permit Number: PL-4-16-1156
Scheduled Inspection Date: June 20,2016 Permit Type: Plumbing - Residential
Inspector: Hernandez, Rafael Inspection Type: Final
Owner: , Work Classification: Septic
Job Address: 175 NW 109 Street
Miami Shores,FL 33168-4316 Phone Number (786)444-2945
Parcel Number 1121360030170
Project: <NONE>
Contractor: STATEWIDE SEPTIC CONNECTIONS Phone: (954)963-0082
Building Department Comments
REPLACE SEPTIC TANK AND DRAINFIELD. Inbactio Passed Comments
INSPECTOR COMMENTS False
Inspector Comments
Passed HRS IN FILE
Failed
Correction
Needed
Re-Inspection a
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid.
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Miami Shores Villaget Type )t11 ?ii11 -Residential
10050 N.E.2nd Avenue NW
M I�fiac�a�s/� �5ep �
Miami Shores,FL 33138-0000
y� Phone: (305)795 2204 !ettf "SCIS:AII � ) I
�Lo � Expiration: 11/01/2016
Project Address Parcel Number Applicant
175 NW 109 Street 1121360030170
Miami Shores, FL 33168-4316 Block: Lot: JCAS FUND CORP
Owner Information Address Phone Cell
JCAS FUND CORP 5600 SW 135 Street (786)444-2945
FL
Contractor(s) Phone Cell Phone Valuation: $ 6,000.00
STATEWIDE SEPTIC CONNECTIONS (954)963-0082
Total Sq Feet:
_... . ._ _.. . ._. _.... 300
s
Type of Work:REPLACE SEPTIC TANK AND DRAINFIELD. Available Inspections:
Type of Piping: Inspection Type:
Additional Info:
Bond Return: HRS Approval
Final
Classification:Residential Scanning:3
Review Plumbing
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
Bond Type-Contractors Bond $500.00 Invoice# PL-4-16-59587
CCF $3.60 04/29/2016 Check#:6086 $50.00 $777.60
DBPR Fee $4.50
DCA Fee $4.50 05/05/2016 Check#:5064 $777.60 $0.00
Education Surcharge $1.20 Bond#:3073
Permit Fee $300.00
Scanning Fee $9.00
Technology Fee $4.80
Total: $827.60
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 abov - amed contractor do t e work stated.
May 05, 2016
Authorized Signature:Owner / Applican / ontractor / Agent Date
Building Department Copy
May 05,2016 1
Miami Shores Village - � -
Building Department PR 29 201151
1
10050 N.E.2nd Avenue, Miami Shores,Florida 33138
,BY
Tel:(305)795-2204 Fax:(305)756-8972 �4
"�
INSPECTION LINE PHONE NUMBER:(305)762-4949 L ( I
FBC 20 � `
BUILDING Master Permit No. , I`O_
PERMIT APPLICATION Sub Permit No.
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING ❑ MECHANICAL [-]PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
J i CONTRACTOR DRAWINGS
JOB ADDRESS: ,J C A S FU r1 Ch C-0 ` S N vel N o q St
City: iMiami Shores County' Miami Dade Zip' i a
Folio/Parcel#:_ _ LI - 21,�6—((1 ® 6- 01-7() Is the Building Historically Designated:Yes NO ✓
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name(Fee Simple Titleholder,):_-=,, �ri d Co r-p Phone#: �D S 3 L`2— 9S-37
Address:, (' 'NJ
City: S�'�®rr—,S State: Zip: 1 G
Tenant/Lessee Name: Phone#:
Email: C r� 166 CONTRACTOR:Comapany Name: ✓ r'+_-_ .� C .S I Phne#: (-6,4 .
Address: P `) 14-w 19 �Vc)
City: CDG Lac State: � Zip: 530S y
Qualifier Name: tj24-e Sc T'0 r®t'�f-j.gko Phone#: 661 .("63S
State Certification or Registration#: Z,(.-7 L Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ 00c) Square/Linear Footage of Work: _-_�)00
Type of Work: ❑ Addition ❑ Alteration ❑ New 'Repair/Replace ❑ Demolition
Description of Work: i K
�-'c0 "-) f 0
Specify color of color thru tile:
Submittal Fee$ Permit Fee$ ®� CCF$ CO/CC$
Scanning Fee$ �/I• OZ) Radon Fee$ DBPR$ NotaryNotary!)4
Technology Fee$ • 1�0 Training/Education Fee$ 0 Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$
(Revised02/24/2014)
Bonding Company's Name(if applicable)
Bonding Company's Address
City State d 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 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.
Signatur 12^ cdy� Signature
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
0 day of �(Jr1 .20 , by � day iiof I 20 IC ,by
UG Yl i�f1n Ch n C,� ,who is personally known to �QXCS J . �'o�,who is personally known to
me or who has produced r` l S7 as me or who has produced -Lft (P as
identification and who did take an oatf�`o4tiioo�aaa,ia identification and who did take an oath.
�e>�e`Q,p,GUEVgAp�`��.
NOTARY PUBLIC: w��G�. \SSION��°''__•� ®se,� NOTARY PUBLIC:
0 B • <_ J
Sign: ®'� FN : ®Sign:
sy°° # E1 •n��
Print: > N �eH�°off 10 Print:
Seal: ®isi>A!l^ ••®'°° •�4 "OZ/S020seuM s►ao
tIG.STR�E_, s Seal: Lepuou
sL dd u0m1wwoo An ; ,
' !ArrRY�PBP,�i\� 9"01 BIR Ueuj •
!o o4ins owed��N iu41►�
APPROVED BY e� �'t r Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
Clio
� A
14Ep&V DEPARTS"T PERMIT #:13-SC-1674511
STATE OF FLORIDA
APPLICATION #:AP1234409
DEPARTMENT OF HEALTH DATE PAID:
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM FEE PAID:
CONSTRUCTION PERMIT RECEIPT #:
DOCUMENT #:PR1014056
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: (JCAS Fund Corp)
PROPERTY ADDRESS: 175 NW 109 St Miami,FL 33168
LOT: 17 BLOCK: 219 SUBDIVISION: Miami Shores Ext
PROPERTY ID #: 11-2136-003-0170 [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 [ 900 ] GALLONS / GPD septic tank CAPACITY
A [ ] GALLONS / GPD CAPACITY
N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ ]
D [ 200 ] 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 12.3'NGVD
I ELEVATION OF PROPOSED SYSTEM SITE [ 16.80 ] [ INCHES FT ] [ABOVE BELOW BENCHMARK/REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 64.80 ] [ INCHES FT ] [ABOVE BELOW BENCHMARK/REFERENCE POINT
L
D FILL REQUIRED: [ ] INCHES EXCAVATION REQUIRED: [ 48.00 ] INCHES
"THIS REPAIR PERMIT IS NOT FOR ANY ADDITIONS"
0 1.-Install a 900 gal min.septic tank with an approved filter.
T 2.-The licensed contractor installing the system is responsible for installing the minimum category of tank in accordance
with s.64E-6.013(3)(f), FAC.
H 3.-Install 200 sf of drainfield in bed configuration.
E 4.-Perimeter of excavation area shall be at least 2 ft wider and longer than the proposed absorption bed or drain trench.
(Comments Continued on Page 2.)
R
SPECIFICATIONS BY: Teresa J Solomon TITLE: Master Septic Tank Contractor
/11
APPROVED BY: TITLE: Engineering Specialist II Dade CHD
Erlande omisca
DATE ISSUED: 04/15/2016 EXPIRATION DATE: 07/14/2016
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E-6.003, FAC ,�yye�9y"'I,ppp "t _y a 3 5=� kj? 1r' 4 5
V 1.1.4 AP1234405 �FLt b i�E'1 ='c s tr ty Cd •N� S U
{hn: is re :red to pw�o m b ng
The
x o t tine of ti ra
adj;;c27to �n2
:'��,nr ear
to sinal Aprrval. 0,,e FCCH InspOCtCr Shall
InSac'CaCn.
witness thesoiling and compare ttte resuits 10 the original
she evaluation submitted. A rainspec�ion fee" be assessed
if the contractor is not at the jobs to at the arranged time*
DOCUMENT #: PR1014056
5.-Invert elevation of drainfield to be no less than 7.40'NGVD.
6.-Bottom of drainfield elevation to be no less than 6.90'NGVD.
7.-This permit includes the abandonment of the existing septic tank.
The system is sized for 2 bedrooms with a maximum occupancy of 4 persons(2 per bedroom),for a total estimated flow of
300 gpd.
77 7
7-7,77
STATE OF FLORIDA
DEPARTMENT OF HEALTH
APPLICATION FOR CONSTRUCTION PERMIT
Permit Application Number
--------------------------- PARTII -SITEPLAN ------
- ----- ----------
Scale: Each block re resents 10 feet and 1 inch =40 feet. e Vk ,V/
O �
2
� s
2
Nqr
Notes: -° P` 9 RtS 331
"^ pSit
1 �, h
cP
Site Plan submitted by: t b G C. g� —
Plan Approved Not Approved Date
By County Health Department
ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
DH 4015,08109(Obsoletes previous editions which may not be used) Incorporated: 64E-6.001,FAC Page 2 of 4
(Stock Number: 5744-002-4015-6)
Property Search Application- Miami-Dade County Page 1 of 1
All'51ig
Summary Report
Generated On:4/29/2016
Property Information i � g
Qf
Folio: 11-2136-003-0170
fl
Property Address: Miami Shores,FL 33168-4316
Owner CAS FUND CORP]
Mailing Address 5600 SW 135 AV 109
MIAMI,FL 33183 USA
Primary Zone 0800 SGL FAMILY-1701-1900 SQ
Primary Land Use 0101 RESIDENTIAL-SINGLE
FAMILY: 1 UNIT r�
Beds/Baths/Half 2/1/0
t ;
Floors 1 � ,, ,
x .
Living Units 1 } E
Actual Area 1,846 Sq.Ft '
Living Area 1,450 Sq.Ft
Adjusted Area 1,648 Sq.Ft
Taxable Value Information
Lot Size 12,692.9 Sq.Ft
2015 2014 2013
Year Built 1938
County
Assessment Information Exemption Value $0 $0 $0
Year 2015 2014 2013 Taxable Value $274,733 $249,758 $227,053
Land Value $228,687 $136,392 $63,581 School Board
Building Value $149,111 $147,117 $148,979 Exemption Value $0 $0 $0
XF Value .....
..
$14,092 $14,293 $14,493 Taxable Value $391,890 $297,802 $227,053
...............
........... ..
._....... _..... ....11.1.1 _......
................................. ........_... ..............
Market Value $391,890 $297,802 $227,053 city
Assessed Value $274,733 $249,758 $227,053 Exemption Value $0 $0 $0
Taxable Value 1 $274,733 $249,758 $227,053
Benefits Information Regional
Benefit Type 2015 2014T2013 Exemption Value $0 $0 $0
Assessment Taxable Value $274,733 $249,758 $227,053
Non-Homestead Cap Reduction $117,157 $48,044
Note:Not all benefits are applicable to all Taxable Values(i.e.County, Sales Information
School Board,City,Regional). Previous OR Book-
Sale PricePaQualification Description
9e
Short Legal Description Financial inst or"In Lieu of
MIAMI SHORES EXT PB 43-40 10/12/2015 $285,600 29846-2556
Forclosure"stated
LOT 17 BLK 219 Financial inst or"In Lieu of
LOT SIZE 104.900 X 121 07/23/2015 $250,100 29717-2970
Forclosure"stated
OR 14622-1233 THRU 1238 0690 4 01/01/2005 $275,000 23046-2669 Other disqualified
COC 23046-2669 012005 6
11/01/2003 $177,500 21871-1593 Sales which are qualified
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 and User Agreement at http:/Avww.miamidade.gov/info/disclaimer.asp
Version:
http://www.miamidade.gov/propertysearch/ 4/29/2016
Detail by Entity Name Page 1 of 2
s
t
3
Detail by Entity
Florida Profit Corporation
JCAS FUND CORP 1
Filing Information
Document Number P15000047871
FEI/EIN Number 47-4184173
Date Filed 05/29/2015
Effective Date 05/29/2015
State FL
Status ACTIVE
Principal Address
5600 SW 135TH AVENUE
STE 109
MIAMI, FL 33183
Mailing Address
5600 SW 135TH AVENUE
STE 109
MIAMI, FL 33183
Registered Agent Name &Address
MULTI-BUSINESS CENTER CORP
8051 W 24TH AVE
STE 8
HIALEAH, FL 33016
Officer/Director Detail
Name &Address
Title P
ANNICOHIARICO, JUAN CD
5600 SW 135TH AVE STE 109
MIAMI, FL 33183
Annual Reports
Report Year Filed Date
2016 04/28/2016
Document Images
http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=Entity... 4/29/2016