PL-16-1506 f
Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-260065 Permit Number: PL-6-16-1506
Scheduled Inspection Date: July 07,2016 Permit Type: Plumbing - Residential
Inspector: Hernandez, Rafael Inspection Type: Final
Owner: BELTRAMINI, CIRO Work Classification: Septic
Job Address: 1170 NE 97 Street
Miami Shores, FL 33138- Phone Number
Parcel Number 1132050170150
Project: <NONE>
Contractor: MIAMI DADE ENVIROMENTAL Phone: 786-251-4099
Building Department Comments
INSTALL A 900 GALLONS SEPTIC TANK AND 300 OF infractio Passed Comments
DRAINFIELD. INSPECTOR COMMENTS False
Inspector Comments
Passed HRS IN FILE
Failed
Correction ❑
Needed
Re-Inspection ❑
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid
July 06,2016 For Inspections please call: (305)762-4949 Page 10 of 30
L �
DIVISION OF
Environmental Health
`` Florida Health
wO Miami:Dade County
Q�O OSTDS/Weil Division
h, 11805 SW 26th street•Miami,FL 33175 //;?/,�
�►' / 1 j 46
Inspector 1;`G' Date
Address
Comments:
Signature
01S 3 �}
3fl jj
�sKK°c L' Miami Shores Village M �Il1gt
10050 N.E.2nd Avenue NE 3 m
Miami Shores,FL 33138-0000 " ' '
N
Phone: (305)795-220401
COR1Dp'
Ex Iratlon: 12/04/2016
p.
Project Address Parcel Number Applicant
1170 NE 97 Street 1132050170150
CIRO BELTRAMINI
Miami Shores, FL 33138- Block: Lot:
Owner Information Address Phone Cell
CIRO BELTRAMINI 1170 NE 97 Street
MIAMI SHORES FL 33138-2558
Contractor(s) Phone Cell Phone Valuatio=Feet: 1
MIAMI DADE ENVIROMENTAL 786-251-4099
Total Sq
Type of Work:INSTALL A 900 GALLONS SEPTIC TANK A Available Inspections:
Type of Piping: Inspection Type:
Additional Info: HRS Approval
Bond Return: Final
Classification:Residential Scanning:3 Review Plumbing
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
Bond Type-Contractors Bond $500.00
CCF Invoice# PL-6-16-59996
$4.20 06/07/2016 Credit Card $784.20 $50.00
DBPR Fee $4.50
DCA Fee $4.50 06/01/2016 Credit Card $50.00 $0.00
Education Surcharge $1.40 Bond*3105
Notary Fee $5.00
Permit Fee, $300.00
Scanning Fee $9.00
Technology:Fee $5.60
Total: $834.20
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 above-name ntr ctor to do the work stated.
June 07, 2016
Authorized Signature:Owner / Applica / Contra or / Agent Date
Building Department C y
June 07,2016 1
t Miami Shores Village
Building Department jui 0 '1''V-
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949 e '
—R
BUILDING
BUILDING Master Permit No. I"-k '/0— Q
PERMIT APPLICATION Sub Permit No.
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑EXTENSION ❑RENEWAL
PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF [:]CANCELLATION ❑ SHOP
} n CONTRACTOR DRAWINGS
JOB ADDRESS:
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load:�F e®L-- 'o frp Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titlpholder): tCjj 110 e! l 6(�Mtk
- Y U I, Phone#:Ise I? f '�
Address: _I!47C' IBJ if _ !�j I c_�Z
City: / iaj4 j I !lam State: l Zip:
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: "! 0 4 0 e F_L20iA&4,1 MAR Phone#: /_r' L/C 9
Address: !Sq 3;k
City: 141 11 U4 1 State' Zip'
Qualifier Name: Phone#: /��• ;/S/, (fo %1
State Certification or Registration#: nq-1 Cj_�jt Certificate of Competency#: SR,00 q l to cl
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ Square/Lip:ear Footage of Work: p'
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: l ksC'i� �r �� ��'J '�C <23., PI-L CT A,iU�A' 1 0 "
�Soo n&l"ra f f)n (7,
Specify color of color thru tile:
f
Submittal Fee$ 60 `(Z Permit Fee$ �� CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$ CPS
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$ 0-9 4 °20
(Revised02/24/2014)
J
}
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
whoseproperty-is-sut jest-ta attachment-Also,a-certifred
copy oftherecarded7rutice of cammerrcerttent-mrrsi-be-p s�teat fhote 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 ���v G�(1
Signature
OWNER or AGENT ONTRACTOR
The foregoing instrument was acknowledged before me this The regoing instrument
�wass acknowledged before me this
��day of d -1 20 ,by day of �1�A ilk '20 I by
l 3 94(A q who is personally known toft 0
� who is personally known to
me or who has produced as me or who has produced �� W�as
identification and w identification and who did take an oath.
JOSE NOTARY PUBLIC: r 1. MY CMUSS 0NNFFFF 16=2 NOTARY LIC:
eordod Th�d giber abk ,gole e
Sign: Sign:
Pri til Print:
eal: Seal:
oio�r°�eG Notary Public State of Florida
? Sindia Alvarez
cg My commission FF 156750
o� xpires 09!0312018
************************************************************** ***4r> *** * * * * • ************
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
5/31/2016 Detail by Entity Name
w
X
Detail by Entity Nairne
Florida Limited Partnership
INOLTRA, LLLP
Filing_Information
Document Number A09000000823
FEI/EIN Number 27-1455217
Date Filed 11/25/2009
Effective Date 11/25/2009
State FL
Status ACTIVE
Principal Address
21860 REFLECTION LANE
BOCA RATON, FL 33428
Mailing Address
21860 REFLECTION LANE
BOCA RATON, FL 33428
Registered Agent Name &Address
QUINONES, JACOBO
20166 OCEAN KEY DR
BOCA RATON, FL 33498
Address Changed: 02/27/2013
General Partner Detail
Name &Address
BELTRAMINI, CIRO OTRUSTEE
21860 REFLECTION LANE
BOCA RATON, FL 33428
ALIBERTON, MARIA CTRUSTEE
21860 REFLECTION LANE
BOCA RATON, FL 33428
Annual Reports
Report Year Filed Date
STATE OF FLORIDA APPLICATION #:AP9240399
-
DEPAR'TbOW OF HEALTH m DATE PAID:
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM FEE PAID:
CONSTRUCTION PERMIT ; RECEIPT #-
�° DOCUMENT #:PRI 019415
CONSTRUCTION PERMIT FOR: OSTDS Repair•'
APPLICANT: Ciro Beltramini
PROPERTY ADDRESS: 1170 NE 97 St Miami,FL 33138
LOT: 2 BLOCK: 181 SUBDIVISION:
PROPERTY ID #: 11-3205-017-0150 [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 l GALLONS ! GPD Septic(Now Tank) CAPACITY
A [ 0 l GALLONS / GPD CAPACITY
N [ 0 l GALLONS GREASE INTERCEPTOR CAPACITY EMAX33M CAPACITY SINGLE TANx:1250 GALLONS]
H I l GALLONS DOSING TANK CAPACITY [ IGALLONS @I IDOSES PER 24 HRS #Pumps [ ]
D [ 300 l SQUARE FEET Bed Drainfield SYSTEM
R [ 0 l SQUARE FEET SYSTEM
A TYPE SYSTEM: [xl STANDARD I I FILLED I I MOUND [ I
I CONFIGURATION: [ I TRENCH [xI BED t l
N
F LOCATION OF BENCHMARK: FFE12.3
I ELEVATION OF PROPOSED SYSTEM SITE [ 24.00] INCHES FT I[ABOVE BELOW BENCHMARK/REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE 146.001[ INCHE3 FT I[ABOVE�B2NCHMARK/REFERENCE POINT
L
D FILL REQUIRED: [ 0.00 I INCHES FJ=VATION REQUIRED: [ 22.001 INCHES
"THIS PERMIT IS NOT FOR ADDITIONS"
O *Perimeter of excavation area shall be at least 2 ft wider and longer than the proposed absorption bed.
T 'Invert elevation of drainfield to be no less than 8.9T NGVD.
H *Bottom of drainfield elevation to be no less than 8.4T NGVD.
*The licensed contractor installing the system is responsible for installing the minimum category of tank in accordance
E with s.64E-6.013{3)(f),FAC.
*This permit includes the ab on of the existing septic tank.
R A- I
SPECIFICATIONS BY: TITLE:
APPROVED BY: V TITLE: EngineeringSpecialist II Dade CHI)
Nicole s
DATE ISSUED: 05/24/2016 EXPIRATION DATE: O8r2=16
DE 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 642-6.003, FAC Page 1 of 3
1.1.4 AP1240399 SE996711
STATE OF FLORIDA
DEPARTMENT OF HEALTH
APPLICATION FOR CONSTRUCTION PERMIT
Permit Application Number
------------- ---- ---------- PART II -SITEPLAN --------------- ------------
Scale: Each block re resents 10 feet and 1 inch =40 feet.
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Notes: (1Z0 W E -- q—I ST /1-ll 4LL"(
Site Plan submitted by: S
Plan Approved Not Approved Date DS- [S-1�2
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)
fast 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
MAIN
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 lt
B who is personally known to me or has produced
as identification.
Notary-
SEAL:
JOSE 8"06
W COMUSSION 0 FF 150202
EXPIRES:OctoWr 6,20 1 a
Miami-Dade Environmental Services, INC.
8290 Lake Drive Suite 334
Miami, Florida 33166
Phone: (786) 251-4099 l Fax: (305) 513-9200
MiamiDadeEnvironmental@msn.com
May 31, 2016
State of / 110A( Q A
County of t)Q.b y
Before me this day personally appeared who, being duly
sworn, deposes and says:
That he or she will be the only person working on the project located at:
Sworn to (or affirmed) and subscribed before me this (31 day of 4 0t-,� . 20 1
by a "e>6�tg 0-C
Personally know
OR Produced Identification
Type of Identification Producedr
Print, T or Stamp Name of Notary
E
Public State of Florida
Alvarezmmission FF 156750
09103!2018