PL-16-651 Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores,FL
Phone:(305)795.2204 Fax: (305)756.8972
Inspection Number: INSP-254540 PermitNumber. PL-3-16451
Scheduled Inspection Date:August 15,2016 Permit Type: Plumbing -Residential
Inspector:Hernandez,Rafael
Inspection Type final
Owner. Work Classification: Septic
Job Address:500 NE 92 Street
i
Miami Shores,FL Phone Number
Parcel Number 1132060141200
Project <NONE> —'—
Contractor. ALLSTATE DIVERSIFIED ENGINEERING INC Phone:(305)256-0306
BuUnq Department Comments
REPLACE SEPTIC TANK AND DRAINFIELD. Infractio Pawed marts
INSPECTOR COMMENTS False
Inspector Comments
Passed 1Z HRS APPROVAL IN FILE
Failed El
Correction ❑
Needed
Re-Inspection
Fee
No AddWonal Inspedtons can be sdieduled untfl
re-inspedion The is paid.
DIVISION OF
Environmentat Heatth
Q Florida Health •
I ilami-Dade County I.RA'a OS'TDS/Well Division
1180$SW 26th Street•Miand FL 33173
_ Lxspector � F%' / I 0,19 1010- Date
Address $''Q o /rf .� CSTDS
Comments:
Signaturecs
:
� 16- �
Miami Shores Village
10050 N.E.2nd Avenue NE i
.s
Miami Shores,FL 33138-0000
Phone: (305)795-2204
55:`. CtM.#..t..,. ...sr.: -.. .... •••..3, tE E,:v
Expiration: Q /14l2016
Project Address Parcel Number Applicant
500 NE 92 Street 1132060141200 PORTO CABRAL LLC
Miami Shores, FL Block: Lot:
Owner Information Address Phone Cell
PORTO CABRAL LLC 500 NE 92 Street
MIAMI SHORES FL 33138-3157
500 NE 92 Street
MIAMI SHORES FL 33138-3157
Contractor(s) Phone Cell Phone Valuation: $ 2,000.00
ALLSTATE DIVERSIFIED ENGINEERIP (305)256-0306 (305)258-7797
----------_ Total Sq Feet: 1275
Type of Work:REPLACE SEPTIC TANK AND 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
CCF $1.20 Invoice# PL-3-16-58990
DBPR Fee $2.25 03/11/2016 Check#:5333 $50.00 $116.70
DCA Fee $2.25
Education Surcharge $0.40 03/18/2016 Check#:5352 $116.70 $0.00
Permit Fee $150.00
Scanning Fee $9.00
Technology Fee $1.60
Total: $166.70
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,ROOEINGand SWIMMING POOL work.
OWNERS AFFIDAVIT: I certify that all the foregoing inform on is ccur e a that a rk will be done in compliance with all applicable taws regulating
construction and zoning. Futhermore,I authorize the abov am ntr or d the ork ted.
March 18,2016
Authorized Signature:Owner / Applicant Date
Building Department Copy
March 18,2016 1
Miami Shores e Villa
rte g
Building Department � �
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 M 1 2016
Tel:(305)795-2204 Fax:(305)756-8972 BY:
INSPECTION LINE PHONE NUMBER:(305)762-4949
BC 20(tAi S
BUILDING Master Permit No.-PC
PERMIT APPLICATION Sub Permit No.
BUILDING ❑ ELECTRIC ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP
/� CONTRACTOR DRAWINGS
JOB ADDRESS: = Nom" 7 z 4
City: Miami Shores County: Miami Dade Zia: .35 17r
Folio/Parcel#: 113?4?p 0// -lea Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: ( /' Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titlehold r): 01 C l.t�M% _� Z`0 050-1
Address: 600 MC Q.Z
City:_1&M I Slte�L@S State: Zip: A3/79+
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: Mitt
t t 610 6A Phone#: on i Z-$$
Address: S 1
City: 136c 1 a L a._101:� State: E") Zip: .
Qualifier Name: ll" Phone#:
S M C 47C 14k.) W341-
DESIGNER:
34 T'.DESIGNER:Architect/Engineer: Phone#:
Address: City: State: _ Zip:
Value of Work for this Permit:$ D600 Square/Linear Footage of Work: `"i f T S215
Type of Work: E� Addition--�r❑l Alteration �❑ New 4 ❑ Repair/Replace ❑ Demolition
Description of Work: sL. �rJ Ca
Specify color of color thru tile: r�7�
Submittal Fee$ CAD Permit Fee$ �1�/r CCF$ Gam_. CO/CC$
to
Scanning Fee$ '�V Radon Fee$ °�S DBPRR'\$ Notary$
Technology Fee$ ' Training/Education Fee$ ()' 4 y Double Fee$
Structural Reviews$ P Bond$
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 ,livered to the person
whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement ust be osted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the abs ce of su h posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature Signature
OWNER or AGENT NT OR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of �Q b►� a ✓`� ,20 .by aQ�day of /��t'Ly ,20 t,1O .by
a�' p tt I Of .who is personally known to (t)� I MCM QMD4 6 .who own to
me or who has produced r i,4D L- as me or who has produced as
MR .identification and who did take an oath. identification and who did take a3''' MIMBATISTA
MY COMMISSION#EE 873354
NOTA PUBLIC: NOTARY PUBLIC: r EXPIRES:May 11,2017
Borated Thm Notmy PubdC urdrs
Sign: Sign:
Print' Print: SARIMABATISTA
dAVW BElfit _*: ;v, MY COMMISSIO #FT 67K.7
Seal d '"= Nary Public•SNfe of Florida Seal: ' EXPIRES:May 11,2017
' i Bonded Thru Notary Pobfic underwam.-
o, My Comm.Expires Mar 31,2017
'.9. p.. Commission 8 EE 870357
" Bono-O Through National Notary Assn
**************** * **********************************************************
APPROVED BY kd, .3*-(V—tC Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
Detail by Entity Name Page 1 of 2
3
R P
Detail by Entity Name
Florida Limited Liability Company
PORTO CABRAL LLC
Filing Information
Document Number L14000186436
FEI/EIN Number 47-2578765
Date Filed 12/05/2014
State FL
Status ACTIVE
Principal Address
1 SE 3RD AVENUE
2900
MIAMI, FL 33131
Mailing Address
1 SE 3RD AVENUE
2900
MIAMI, FL 33131
Registered Agent Name&Address
MARX& FRANKEL PA
1 SE 3RD AVENUE
2900
MIAMI, FL 33131
Authorized Person(s) Detail
Name&Address
Title MGR
HENARES PORTO, RICARDO
1 SE 3RD AVENUE, SUITE 2900
MIAMI, FL 33131
Annual Reports
Report Year Filed Date
2015 03/26/2015
Document Document Images
http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=Entity... 3/3/2016
Detail by Entity Name Page 2 of 2
03/26/2015--ANNUAL REPORT View image in PDF format
12/05/2014-- Florida Limited Liability View image in PDF format
Conyriubt t7 and Privacy Policies
State of Florida,Department of State
http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=Entity... 3/3/2016
ACO O® DA78
C40 CERTIFICATE OF LIABILITY INSURANCE 1/14/2016
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: N the certificate holder Is an ADDITIONAL INSURED,the policy(les)must be endorsed. K SUBROGATION IS WAIVED,subject to
the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endo s.
PRODUCER David N. Lopes
Eastern Insurance Group, Inc. PHONE (303)595-3323 (303)393-7133
9570 SN 107 Avenueamanda@as
etesninsurance.not
Suite 104 MURERM AFFORDING COVERAGE NAtC A
Miami 8'L 33176 MUM A:ColOa Insurance Company
INSURED =ww s:Torus National insurance Company
Allstate Diversified Engineering, Inc. mum c-aridaefield Mmlovers Insuranc
25525 SN 141 Ave DIIURERD:
Homestead n 33032
COVERAGN CERTIFICATE NUMBER:Master 16/17 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 CONDITION 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 CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
am FJML im TYPE OF ORKIRAN0e Lam
X CONVAERCIAL GENERAL Lman nY EACH OCCURRENCE $ 1,000,000
DAVAGE TO RENTED
A a m%-w E []x OCCUR $ 100,000
103WA007204-01 11/13/2015 11/13/2016 MED EV one $ 5,000
PERSONAL 8 ADV KIURY $ 1,000,000
GEM AGGREGATE UdIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
x PoLw F],M 7 Loc PRODUCTS-COMPIOP AM $ 2,000,000
AUTONOME LIASUM COMBINED
ffia1 $
ANY AUTO ODDLY INJURY(Per person) $
ALL OWNED CHHEDULED BODI.Y INJURY(Pwaw $
AUTOSHIRED AUTOS AUTOS
I�A�NON-OWNED PROPERTY $
$
UNSREL.LA W1BOCCUR EACH OCCURRENCE 8 11000,000
IS x EXCESS LIAR HCLAIMS-VADE AGGREGATE $ 11000,000
8900M30AL1 4/20/2013 4/20/2016 1
WORKERS COMPENSATION X
AND EMPLOYERS'LL41KM
ANY PR TORIPA�T�E YIN E.L.EACH ACCIDENT $ 11000,000
C (OFRCERIMEMBER EXCLUDED? EIN t o
bndd y In NMI 530-50170 1/27/2016 1/27/2017 EL DISEASE-EA EMPLOYE $ 11000,000
y dearXtbe tpKlBf
E.L.DISEASE-POLICY UWT S 2,000,000
DESCRIPTION OF OPERATIONS t LOCATIONS 1 VEHICLES(ACORD 101,Adc9dond ReMwM Bdw*d,may be alfeetred I n we apace Is requilsd)
Septic tank installation, drainage installation
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Miami Shores Village THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED M
Building Deptartment: ACCORDANCE WITH THE POLICY PROVISIONS.
10080 N>g 2 Avenue Aun o REPRESENTATIVE
Miami Shores, SL 33138
David Lopez/DAVID = - -
01988 2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
INSa4SMA01%
STM OF FLORIDA PERMIT #: 13-SC-1645129
DZPARMOM OF MMLTH APPLICATION #:AP1214338
ONSITE SZNAW TRMTMM AND DISPOSAL DATE PAID:
SYSTEK FEE PAID:
CONSTRUCTION PZMUT
RECEIPT #•
•�� Docm=T #: PR1005997
CONSTRUCTION PERMIT FOR: OSTDS Existing New
APPLICANT: (Porto Cabral LLC)
PROPERTY ADDRESS: 500 NE 92 St Miami,FL 33175
LOT: 6 BLOCK: 58 SUBDIVISION:
PROPERTY ID #: 11-3206-014-1200 [SECTION, TOWNSHIP, RANGE, PARCEL NUMBER]
IOR TAR 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 CHAFE 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 WMMPT 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(New Tank) CAPACITY
A [ ] GALLONS / GPD WA CAPACITY
N I ] GALLONS GREASE INTERCEPTOR CAPACITY IM»QUM CAPACITY SINGLE TANK:1250 GALLONS]
K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @I JDOSES PER 24 HAS #Pumps [ ]
D I 375 ] SQUARE FEET Trench Draintield SYSTEM
R [ ] SQUARE FEET WA SYSTEM
A TYPE SYSTEM: [x] STANDARD [ ] FILLED ( ] MOUND [ ]
I CONFIGURATION: [x] TRENCH [ ] KED [ ]
N
F LOCATION OF BENCHMARK: CROWN OF ROAD 9.74'NGVD
I ELEVATION OF PROPOSED SYSTEM SITE I 1.13 ][ INCHES' a rj I ABOVE �HENCNNA=/ POINT
E BOTTOM OF DRAINFIELD TO BE [ 3.13 ]I INCHES [ABOVE/ BENCHMARK/REFERENCE POINT
L
D FILL REQUIRED: 10.00] INCHES EBCAVATION REQUIROD: [ 72.001 INCHES
0 *Instap 42°of slightly limited soil at the bottom of the drainfieki.
*Perimeter of excavation area shall be at least 2 ft wider and"or than the proposed absorption bed.
T *Invert elevation of drainfleki to be no less then 6.61'NGVD.
H Bottom of drainfield elevation to be no less than 6.11'NGVD.
E *The licensed contractor installing the system Is responsible for installing the minimum category of tank in accordance
with s.64E-6.013(3Xf),FAC.
R *This permit includes the abandonment of the existing septic tank.
(Comments Continued on Page 2.)
SPECIFICATIONS BY: GUILLERMO SUAREZ TITLE:
APPROVED BY: TITLE: Engineering Specialist iI Dade CHD
DATE ISSUED: 02/22/2016 EXPIRATION DATE: 08/22/2017
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E-6.003, FAC Page 1 of 3
v 1.1.4 AP1214338 SE986100
DOCUUM fl; PR1005997
The system is sized for 3 bedrooms with a maximum occupancy of 6 persons(2 per bedroom),for a total estimated flow of
300 gpd.
NOTICE OF RIGHTS
A parry whose substantial interest is affected by this order may petition for an
administrative hearing pursuant to sections 120.569 and 120.57, Florida Statutes. Such
proceedings are governed by Rule 28-106, Florida Administrative Code. A petition for
administrative hearing must be in writing and must be received by the Agency Clerk for the
Department,within twenty-one(21)days from the receipt of this order. The address of the
Agency Clerk is 4052 Said Cypress Way, BIN#A02,Tallahassee, Florida 32399-1703. The
Agency Clerk's facsimile number is 850-410-1448.
Mediation is not available as an alternative remedy.
Your failure to submit a petition for hearing within 21 days from receipt of this order
will constitute a waiver of your right to an administrative hearing,and this order shall become
a'final order'.
Should this order become a final order,a party who is adversely affected by it Is
entitled to Judicial review pursuant to Section 120.68, Florida Statutes. Review proceedings
are governed by the Florida Rules of Appellate Procedure. Such proceedings may be
commenced by filing one copy of a Notice of Appeal with the Agency Clerk of the
Department of Health and a second copy,accompanied by the filing fees required by law,
with the Court of Appeal in the appropriate District Court. The notice must be filed within 30
days of rendition of the final order.