PL-16-2309 Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores,FL
Phone: (305)795-2204 Fax: (305)756.8972
Inspection Number: INSP-265585 Permit Number: PL-8-16-2309
Scheduled Inspection Date: October 20,2016 Permit Type: Plumbing - Residential
Inspector: Hernandez, Rafael
Inspection Type: Final
Owner: Work Classification: Septic
Job Address:652 NE 105 Street
Miami Shores,FL Phone Number
Parcel Number 1122310120140
Project: <NONE>
Contractor: STATEWIDE SEPTIC CONNECTIONS Phone: (954)963-0082
Building Department Comments
INSTALL NEW 1200 GAL. SEPTIC TANK AND A 375 SQ Infiactio Passed comments
FT DRAINFIELD. INSPECTOR COMMENTS False
Inspector Comments
Passed HRS TAG ON FILE
Failed a
Correction B
Needed
Re-inspection 0
Fee
No Additional Inspections can be scheduled until
reinspection fee is paid
►• DIVISION 01
°i Environmental Health
�--" ``0Q Florida Health
Miami-Dade County
�Q OSTDS/Well Division QG
11805;S#26th Street•Miami,FL 33175
Inspector/f� Date
Address[!��. r�i QLj�
Comments: C
TO Lf4 , G6-ice.
Signature
it I
J
c
Permit N I L -"l - " :
Miami Shores Village '' Pe1T/'!1€Tyke yrs ing- � �
10050 N.E.2nd Avenue NEsopfic
Miami Shores,FL 33138-0000 Stents:
h g Phone: (305)795-2204
Expiration: 03/ /2017
Project Address Parcel Number Applicant
652 NE 105 Street 1122310120140
Miami Shores, FL Block: Lot: KILUAN, INC
Owner Information Address Phone Cell
KILUAN, INC 652 NE 105 Street
MIAMI SHORES FL 33138-
150 SE 2 Avenue
MIAMI FL 33131-
Contractor(s) Phone Cell Phone Valuation: $ 6,800.00
STATEWIDE SEPTIC CONNECTIONS (954)963-0082
.. .,.._. , _._..... ...._ Total Sq Feet: 375
Type of Work:INSTALL NEW 1200 GAL.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
CCF $4.20 Invoice# PL-8-16-61007
DBPR Fee $4.50 08/16/2016 Check#:6141 $50.00 $279.20
DCA Fee $4.50
Education Surcharge $1.40 09/30/2016 Check#:5156 $279.20 $0.00
Permit Fee $300.00
Scanning Fee $9.00
Technology Fee $5.60
Total: $329.20
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 AFFID IT: ify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and ni Fut ermo ,I rize the above-named contractor to do the work stated.
September 30, 2016
Aut orized nature:Owner / Applicant / Contractor / Agent Date
Building Department Copy
September 30,2016 1
• � Miami Shores Village A-e , 2_ T �
�C
Building Department A G 1 zoic
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972 Ll�y°
INSPECTION LINE PHONE NUMBER:(305)762-4949
FC 2014 ��-�
BUILDING Master Permit No.V_L(. — 236 1
PERMIT APPLICATION Sura Permit No.
F-]BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
FX_JPLUMBING ❑ MECHANICAL PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION F-1 SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 652 N. E. 105 St.
City: Miami Shores County: Miami Dade Zip:33138
Folio/Parcel#: 11-2231-012-0140 Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): Kiluan, Inc. Phone#:
Address: 652 N.E. 105 St.
City: Miami Shores State: Florida Zip: 33138
Tenant/Lessee Name: N/A Phone#:
Email:
CONTRACTOR:Company Name: Statewide Septic Connections, Inc Phone#: 786-359-4980
Address: 13680 NW 19th.Ave. Bay#10
city: O alocka �,,, State: Florida zip:33054
Qualifier Name: T®e`-O`° Phone#: a05- (-6633
9
State Certification or Registration#: M®?-7 (26 z Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$6,800.00 square/linear Footage of Work: 375 SQ. Ft.
Type of Work: ❑ Addition ❑ Alteration ❑ New X❑ Repair/Replace ❑ Demolition
Description of Work: Install new 1200 gal septic tank and a 375 Sq Ft drainfield
.. Lily
Specify c for caior�fhm tile:
Submittal F e "^�� imr'+a:Fern* ®� CCF$ CO/CC$
11.
Scanning Fe "T ' �O DBPR$ � Notary$
Technology Fee Training/Education Fees ! ` q® Double Fee$
Structural Reviews$ Bond$ KQ-.15-23 8
TOTAL FEE NOW DUE$ 2 7z) I•' 2_0
tRevised02/24/2014)
Bonding Company's Name(if applicable) N/A
Bonding Company's Address
City State Zip
Mortgage Lender's Name(if applicable) N/A
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.
Kiluan, Inc
Signature NI 1 .1ASignature
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
ra day of 2G, (, by I `� day of IN-v,!n • ,20 )6 by
H( �°ft3 2z t who is p rsonally know to ,�•f S�f-f'�^*
,l .who is personally known to
me or who has produced as me or who has produced rif4— (ID as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: Sign:
Print: t!X 'Q C� `JCtSi Print S
Seal: oe;r..�r, LUCIA G ISASI Seal: •••���
.•. " JERRICA L.ARNSTROM
;� MY COMMISSION#FF182828 =+° N .>�d/10ft
+•.'s ,a EXPIRES December 10,2018 ;`
sx� i s'<&:�# KlTldiil9wwwyR�.' a.
APPROVED BY i ® Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
Property Search Application- Miami-Dade County Page 1 of 2
OFFICE OF THE PROPERTY APPRAISER
Summary Report
Generated On:8/16/
Property Information
Folio: 11-2231-012-0140
Properly Address: 652 NE 105 ST
Miami Shores,FL 33138-2054 - - 4.
Owner KILUA
150 SE 2 AVE#1010
Mailing Address MIAMI, FL 33131 USA
Primary Zone 1100 SGL FAMILY-2301-2500 SQ 3
0101 RESIDENTIAL-SINGLE
Primary Land Use
FAMILY: 1 UNIT
�3
A
Beds/Baths I Half 5/4/0
$ `y
a
Floors 2 Q '
Living Units 1
Actual Area 4,209 Sq.Ft
Living Area 3,117 Sq.Ft `' _
Adjusted Area 3,381 Sq.Ft Taxable Value Information
Lot Size 14,600 Sq.Ft 2016 2015 2
Year Built 1949
County
Assessment Information Exemption Value $0 $0 $50
Year 2016 2015 2014 Taxable Value $848,130 $771,028 $197
Land Value $501,539 $401,231 $195,935 School Board
Building Value $366,838 $369,797 $240,693 Exemption Value $0 $0 $25
XF Value $0 $0 $0 Taxable Value $868,377 $771,028 $222
Market Value $868,377 $771,028 $436,628 City
Assessed Value $848,130 $771,028 $248,204 Exemption Value $0 $0 $50
Taxable Value $848,130 $771,028
Benefits Information Regional
Benefit Type 2016 2015 2014 Exemption Value $0 $0 $50.
Save Our Homes Assessment Taxable Value $848,130 $771,028 $197
Cap Reduction $188,424
Non-Homestead Cap
Assessment $20,247 Sales Information
Reduction Previous Sale Price OR Book-Page Qualification Descriptic
Homestead Exemption $25,000 12/02/2014 $975,000 29422-3732 Qual by exam of deed
Second Homestead Exemption $25,000 03/01/1973 $100,000 00000-00000 Sales which are qualified
Widow Exemption i $500
Note: Not all benefits are applicable to all Taxable Values(i.e.County,
School Board,City, Regional).
Short Legal Description
GOLF VIEW EST CORR PL PB 41-58
LOT 16
LOT SIZE IRREGULAR
CF 73R70125
4ttp://www.miamidade.goy/propertysearch/ 8/16/2016
........... .. - _._...........
Detail by Entity Name Page 1 of 2
E
5
Detail
Florida Profit Corporation
KILUANzIN_C.1
Filing Information
Document Number P14000001904
FEI/EIN Number 30-0805814
Date Filed 01/08/2014
State FL
Status ACTIVE
Principal Address
990 Biscayne Blvd
Suite 801, MB 16
MIAMI, FL 33132
Changed: 04/21/2015
Mailing Address
990 Biscayne Blvd
Suite 801, MB 16
MIAMI, FL 33132
Changed: 04/21/2015
Registered Agent Name &Address
BOLOGNA, STEFANIA, ESQ.
150 S.E. 2ND AVENUE
SUITE 1010
MIAMI, FL 33131
Officer/Director Detail
Name &Address
Title D, President, Secretary
BRUZZI, M_A_RCO
10433 NE 6th AVE
MIAMI SHORES, FL 33138
Title D, VP, Treasurer
MELOTTI, MONICA
http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=Entity... 8/16/2016
ZA - "O— �8(�
PERMIT #:13-SC-1700239
STATE of ARIDA APPLICATION e:AP1,;i
DEPARTMENT OF HEALTH
ONSITE SES DATE Pte` F51 2-84
a
CONSTRUCTION PE�TNT AND DISPOSAL SYSTEM FEE PAID:
RECEIPT #:
DOCUMENT $:PR1028808
CCNSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: (Man Inc)
PROPERTY ADDRESS: 652 NE 105 St Miami,FL 33138
IAT: 16 BLOCK: no SUBDIVISION:
PROPERTY ID #: 11-2231-012-0140 (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 O)MPLIANCE WITH OTHER FEDERAL,
STATE, OR LOCAL PERMITTING REQUIRED FOR DEVELOPMENT OF THIS PROPERTY.
SYSTEM DESIGN AND SPECIFICATIONS
T [ 1,200 1 GALLONS / GPD NEW SeDdc TANK CAPACITY a
A [ 0 1 GALLONS / GPD CAPACITY
N I 0 1 GALLONS GREASE INTERCEPTOR CAPACITY EMAX Mies CAPACITY SINGLE TANK:1250 GALLONS].,ed�O�
K I l GALLONS DOSING TANK CAPACITY ( (GALLONS 8I IDOSES PER 24 HRscl`S
D [ 375 l SQUARE FEET DF BED CONFIGURATIO SYSTEM
A TYKE SYSTEM SQUARE FEET STANDARD [ ] mnrc!n SYSTEM MO0>ID [ ] O°0��``N�a5 °SSS
iCONFIGURATION: Is] TRENCH I l BED I l \'L OC
N V °\�-1 „
F LOCATION OF BENCHMARK: FFE..........15.7VNGVD ` Q `0�0�`� �'`a``r�a�
I ELEVATION OF PROPOSED SYSTEM SITE 145.401I�' FT ]I ABOVE BELOW /REFERENCE POINT
aai�l
E BOTTOM OF DRAINFIELD TO BE 193.40] INCHES FT IIABOVE/ &CHMARK/REFEREHCE POn4T
L
D FILL REQUIRED: 10.00] INCHES MM&NATION REQUIRED: 160.00 l INCHES
1-Install a 1200 gal.septic tank with an approved filter
O 2.-The licensed contractor installing the system is responsible for installing the minimum category of tank in ac Gordan
T with s.64E-6.013(3)(0 FAC.
3.-Install 375 sfof drainfield In bed configuration.
H 4:Install 12°of slightly limited soil at the bottom of the drainfiekl.
E 5:Perimeter of excavation area shall be at least 2 ft wider and longer than the proposed absorption bed or
(Comments Continued on Page 2.)
R
SPECIFICATIONS BY: G'arspa Philizai • TITLE: Engineering Specialist II
APPROVED BY: L TITLE: Engineer Supervisor III Dade CED
trid V Edwards
DATE ISSUED: 08/10/2016 EXPIRATION HATE: 1110812016
3H 4016, 08/09 (Obsoletes all previous Oditions Which may not be used)
rnoorporated: 64E-6.003, FAC Page 1 of 3
v 1.1.4 AP1251284 681004546
Scanned by CamScanner
STATE OF FLORIDA
DEPARTMENT OF HEALTH
.�� .
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permit Application Number _
------------------ ART 11 -SITE PLAN-----------------
kale: Each block represents 5 fleet and t inch=50 feet.
y�
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There are no petisnent feetw .across
r the.street or adjacent.to the property
that t may affect septic system
oteS: f'� 9 Y �J r?!,' '1 ,-� 4��.'"n..7 �a°'�(_ - --��-1 �. � I'— _-6 ,� ..t .pip1/__ ,'� /g-_i _� _�a--✓._ _..�-_w...J,._.. .. _._._._
I
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to Plan submitted by: --Q :�k' � ,� .� � �`�_ �; 1 „�':g�J; �,r-,��:f/3
Si Inature Title
an Approved Not Approved Date
County Health Department
ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
t015,10/98(Replaces HRS-H Form 4015 which maybe used)
*Number:5744-002-4015.81