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PL-16-1232 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores,FL Phone:(305)795-2204 Fax:(305)756-8972 Inspection Number INSP-258381 Permit Number: PL-5-16-1232 Scheduled Inspection Dater June 15,2016 Permit Type: Plumbing- Residential Inspector. Hernandez,Rafael Inspection Type: Final Owner , Work Classification: Drainfield Job Address.1030 NE 105 Street Miami Shores,FL 33138-2106 Phone Number (300-6611 Parcel Number 1122320280040 Project <NONE> Contractor. PULLES PLUMBING COMPANY Phone:(786)2514234 Building Department Comments INSTALL 300 FEET DRAINFIELD Intracdo pas-W! menta INSPECTOR COMMENTS False Inspector Comments Passed Itz HRS IN FILE Failed Correction Needed Re-Inspection Fee No Additional Inspections can be scheduled until re4nspection fee is paid � (-eo 2, lw V 70 A4 Qom© Miami Shores Village h 10050 N.E.2nd Avenue NE Miami Shores,FL 33138-0000 Phone: (305)795-2204 ' Expiration: 1111912016 w, Project Address Parcel Number Applicant 1030 NE 105 Street 1122320280040 105 INVEST LLC Miami Shores, FL 33138-2106 Block: Lot: Owner Information Address Phone Cell 105 INVEST LLC 44 W FLAGLER Street (305)420-6611 MIAMI FL 33130- 44 W FLAGLER Street MIAMI FL 33130- Contractor(s) Phone Cell Phone Valuation: $ 8,700.00 PULLES PLUMBING COMPANY (786)251-1234 Total Sq Feet: 300 Type of Work:INSTALL 300 FEET DRAINFIELD Available Inspections: Type of Piping: Inspection Type: Additional Info: HRS Approval Bond Retum: Final Classification:Residential Scanning:3 Review Plumbing Fees Due Amount Pay Date Pay Type Amt Paid Amt Due Bond Type-Owners Bond $500.00 Invoice# PL-6-16-69697 CCF $5.40 05/20/2016 Credit Card $500.00 $337.40 DBPR Fee $4.50 DCA Fee $4.50 05/23/2016 Credit Card $287.40 $60.00 Education Surcharge $1.80 05/06/2016 Check*17169 $50.00 $0.00 Notary Fee $5.00 Bond*3094 Permit Fee $300.00 Scanning Fee $9.00 Technology Fee $7.20 Total: $837.40 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 accurateand all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore,I authorize the above-named r o work stated. May 23,2016 Authorized Signature:Owner / Appii / ntr / Agent Date Building Department Copy May 23,2016 1 Miami Shores VillageM Y ® g�t6 - � Building Department � g p 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20 ,k4 BUILDING Master Permit No. f W 6— 1 22, PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION E]RENEWAL PLUMBING ❑ MECHANICAL PUBLIC WORKS ❑ CHANGE OF F-1 CANCELLATION F-1 SHOP ,y CONTRACTOR DRAWINGS JOB ADDRESS:City: Miami Shores County: Miami Dade Zi Folio/Parcel#: of v 22 J 2 d®fy Is the Building Historically Designated:Yes NO Occupancy Type:4'0J4�t Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titip-holder): Q 15'10412 L L C Phone#: ZiC 2b,9- f)In� Address: /./_ U I,C jQ� 1—C Q City: TC\r t State: L Zip: qR1.3 n Tenant/Lessee Name: Phone#: Email:_ aIDS 1 Lmc- `4 Fl L _ rn1l, 1 4f CONTRACTOR:Company Name: �L� ��y �/' Phone#: Address: b1 S'tJ 133 City: jq I fico State: �`G Zip: Qualifier Name: Phone#:JQC_ '°q''®yd® State Certification or Registration#: �'/ C ®��� `�� Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: a Value of Work for this Permit:$ 4 d d• Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New `f Repair/Replace ❑ Demolition Description of Work: Specify color of color thru tile: F Submittal Fee$ ' � Permit Fee$ S ® � CCF$ 5 4 0 CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ ' Technology Fee$ 9. 2-0 Training/Education Fee$ I ' Double Fee—$ jo Structural Reviews$ 0 Bond$ bI.JL)77yy�� • M TOTAL FEE NOW DUE$ � (Revised02/24/2014) 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 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 -whoseXoperty-issubject-to,attachment.-Also;v-certftdcopy oftirerecordedrro- -ofcammerrci."nentmastbepast`eVwMirlo sbt---- - 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. ASignature Signature �owor AGENT CONTRACTOR The foregoing instr nt as acknowledged before me this The foregoing instrument was acknowledged beforemethis day of 201,6 .by vs-�_da'y6of M� �1 20 h .by n who is personally known to 1 F- -CS H � a;-r� gi�personally known to me :�a as me or who has produced -WN_111-- as identification and who did take an oath. identificati nd who did take an oath. NOTARY PUBLIC: NOTARY BL Sign: 2� Sign: Print: Print• (�- t� oupek?C' Seal: DIES:November 14,2017 Seal: `✓ ° Bated TitNdmyPu*ihut s �p5Y°eb Notary Public State of Florida Sindia Alvarez % ea My Commission FF 156750 cop iF ire 09/03 018 ************************************************************** ***AF * '�'* **** * * * * * ************ APPROVED BY Plans Examiner Zoning Structural Review Clerk (Rev1sed02/24/2014) Prope Search Application-Miami-Dade County Page 1 of 1 OFFICE OF THE PROPERTY APPRAISER Summary Report Generated On:5/6/2016 Property Information Folio: 11-2232-028-0040 v. Property Address: � Miami Shores,FL 33138-2106 Owner � 44 W FLAGLER ST#2300 Mailing Address MIAMI,FL 33130 USA Primary Zone 1100 SGL FAMILY-2301-2500 SQ . Primary Land Use 0101 RESIDENTIAL-SINGLE o FAMILY:1 UNIT Beds/Baths/Half 3/2/0 Floors 1 Living Units 1 Actual Area 2,821 Sq.Ft Living Area 1,948 Sq.Ft Adjusted Area 2,308 Sq.Ft Taxable Value Information Lot Size 11,250 Sq.Ft 2015 2014 2013 Year Built 1963 County Assessment Information Exemption Value $0 $0 $0 Year 2015 2014 2013 Taxable Value $522,802 $519,969 $493,859 Land Value $309,172 $309,172 $281,426 School Board Building Value $200,969 $198,026 $199,550 Exemption Value $0 $0 $0 XF Value $12,661 $12,771 $12,883 Taxable Value 1 $522,802 $519,969 $493,859 Market Value `$522,802 ~ $519,969 $493,859 City Assessed Value $522,802 $519,969 $493,859 Exemption Value $0 $01 11 $0 Taxable Value $522,802 $519,969 $493,859 Benefits Information Regional Benefit Type 1 2015 2014 2013 Exemption Value $0 $0 $0 Note Not all benefits are applicable to all Taxable Values(i.e.County, Taxable Value $522,8021 $519,969 $493,859 School Board,City,Regional). Sales Information Short Legal Description Previous OR Book- MIAMI SHORES ESTATES PB 47-58 Sale PriceORQualification Description LOT 4 BLK 1 Financial inst or"In Lieu of LOT SIZE 75.000 X 150 01/02/2014 $643,000 28992-4120 Forclosure"stated OR 15944-0065 06931 COC 21627-4133 07 2003 6 11/01/2013 $0 28992-4115 Financial Inst or Lieu of Forclosure"stated 10/11/2012 $380,200 28334-3791 Financial inst or"In Lieu of Forclosure"stated 07/01/2003 $477,500121627-4133 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://www.miamidade.gov/infoldisclaimer.asp Version: http://www.miamidade.gov/propertysearch/ 5/6/2016 Detail by Entity Name Page 1 of 2 i Detail by Entitye Florida Limited Liability Company Filing Information Document Number L13000119186 FEI/EIN Number 41-2282671 Date Filed 08/22/2013 Effective Date 08/22/2013 State FL Status ACTIVE Principal Address 44 W FLAGLER STREET SUITE 2300 MIAMI, FL 33130 Changed: 04/07/2016 Mailing Address 44 W FLAGLER STREET SUITE 2300 MIAMI, FL 33130 Changed: 04/07/2016 Registered Agent Name&Address ATRIUM CPA 44 W FLAGLER STREET SUITE 2300 MIAMI, FL 33130 Name Changed: 04/07/2016 Address Changed: 04/07/2016 Authorized Persons) Detail Name&Address Title MGRM http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=Entity... 5/6/2016 Detail by Entity Name Page 2 of 2 44 W FLAGLER STREET SUITE 2300 MIAMI, FL 33130 Title MBRM SUTTON, RICHARD 44 W FLAGLER STREET SUITE 2300 MIAMI, FL 33130 Annual Regorts Report Year Filed Date 2014 04/22/2014 2015 04/20/2015 2016 04/07/2016 Document Images 04/07/2016--ANNUAL REPORT View image in PDF format 04/20/2015--ANNUAL REPORT View image in PDF for 04/22/2014--ANNUAL REPORT View image in PDF for 08/22/2013-- Florida Limited Liability View image in PDF format yr.iaand Privacy Policies State of Florida,Department of State http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirAype--Entity... 5/6/2016 PRINT, TYPE OR STAMP NAME OF NOTARY 8541 S.W. 133 PL MIAMI, FLORIDA 33183 305-558-0410 305-382-8914 FAX LISCENSE CFC056693 May 2,2016 STATE OF FLORIDA COUNTY OF DADE BEFORE ME THIS DAY PERSONALLY APPEARED CARLOS PULLES WHO, BEING DULY SWORN, DESPOSE AND SAYS:THAT HE OR SHE WILL BE THE ONLY PERSON WORKING ON THE PROJECT LOCATED AT:1030 N.E. 105 ST. MIAMI, FLORIDA 33138. SWORN TO(AFFIRMED)AND SUSCRIBED BEFORE ME DAY OF h6d .20�, BY MAW)& `CVIZP PERSONALLY KNOW PRODUCE IDENTIFICATION DL TYPE OF IDENTIFICATION 2,424— Q9-S2 Z 2--0 PRINT,TYPE OR STAMP NAME OF NOTARY ArvA 1640(;. AIda?orm ?� Expires:Mgrch 1,2020 s Bonded thru P On Notary Miami shores Village Building Department 10050 N.E.2nd Avenue fi R1t�y� Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Notice to Owner- Workers' Compensation Insurance Exemption 77777 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. Signature: Owner State of Florida County of Miami-Dade The foregoing was acknowledge before me this day of ,20_IZ__. B� �_(? �� �J air who is personally lown to me orhaTredueed- as identification. Notary: SEAL: t WCOWU IiFf048617 EXPIRES:Nove ow 14,2017 r A PERMIT #:13-SC-1672194 STATE OF FLORIDA APPLIcATION #:AP1232870 DEPARTMENT OF HEALTH DATE PAID: ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM FEE PAID: CONSTRUCTION PERMIT RECEIPT #: D@cUMsNT #:PRI 015076 CONSTRUCTION PERMIT FOR: OSTDS Repair APPLICANT: (105 Invest LLC) PROPERTY ADDRESS: 1030 NE 105 St Miami,FL 33138 LOT: 4 BLOCK: 1 SUBDIVISION: PROPERTY ID #: 11-2232-028-0040 [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 E=MPT THE APPLICANT FROM COMPLIANCE WITH OTHER FEDERAL, STATE, OR LOCAL PERMITTING REQUIRED FOR DEVELOPMENT OF THIS PROPERTY. SYSTEM DESIGN AND SPECIFICATIONS T [ 1,050 ] GALLONS / GPD Septic(Existinct) CAPACITY A [ 0 ) GALLONS / GPD CAPACITY N [ 0 ) GALLONS GREASE INTERCEPTOR CAPACITY DOXIM0K CAPACITY SINGLE TANK:1250 GALLONS) K [ 225 ] GALLONS DOSING TANK CAPACITY [50.00 ]GALLONS @[ 6 ]DOSES PER 24 HRS #Pumps [ 1 ] D [ 300 7 SQUARE FEET Bed Drainfield SYSTEM R [ 0 l SQUARE FEET SYSTEM A TYPE SYSTEM: [x] STANDARD [ I FILLED [ ] NOUND [ I I CONFIGURATION: [ ] TRENCH [xI BED [ I N F LOCATION OF BENCHMARK: Garage Floor.5.12 ngvd I ELEVATION OF PROPOSED SYSTEM SITE [ 4.32 1 INCHES FT ] [ABOVE BELOW BENCHMARK/REFERENCE POINT E BOTTOM 08 DRAINFIELD TO BE [ 19.32][ INCHES FT I[ABOVE BELOW BENCHMARK/REFERENCE POINT L D FILL REQUIRED: [ 3.00] INCHES EXCAVATION REQUIRED: [ 15,103 INCHES **THIS PERMIT IS NOT FOR ADDITIONS" 0 **FILL SYSTEM-This is a fill system and must comply with all the requirements of Chapter 64E-6.009(4)."* T *Perimeter of excavation area shall be at least 2 ft wider and longer than the proposed absorption bed. H *Invert elevation of drainfield to be no less than 4.50'NGVD. *Bottom of drainfield elevation to be no less than 3.50'NGVD. E *The licensed contractor installing the system Is responsible for installing the minimum category of tank In accordance R with s.64E-6.013(3)(f),FAC. SPECIFICATIONS BY: jalI M1 3Y&gkn TITLE: APPROVED BY: TITLE: Engineering Specialist II Dade CHD gabs DATE ISSUED: 04/21/2016 EXPIRATION DATE,: 07/2012016 DB 4016, 08/09 (Obsoletes all previous editions which may not be used) Incorporated: 642-6.003, PAC Page 1 of 3 v 1.1.4 AP1232870 88993173 ■ttt�`�sst'■Stsstst�tttst■ttti■■■■ ■■■■11■■t■■■■t r ■t■■■■■■■■N I■■■■ ■■■■if iii ■■■■■■t r ■t■■■■■■■OU■MEN Erdolloomm ■■■ ■ mom hismalmomm ■!�■■11�■fit��■�■■�����■■■■■■■mmmomimm FIRE WIN ■�■■ ■■�■��■www■w��wQ�a�a��wr�■�z��=Gr����.■ ■■■MEMO■■■Nii �iiOOl�■ % ■■■■■■■'!l���� ■■■■■■■■ 'r ■r■■■��MEMOS■MEMOS ■■ ■■■�■■■�■fit■■■■■■■■■■■■■■INI■t■■■ l ?91 < MM AdW, _ .:. •- :::s •, nye_ ;1 _... ry