PL-16-2956 (2)1
BUILDING
PERMIT APPLICATION
BUILDING ❑ ELECTRIC
El PLUMBING ❑ MECHANICAL
JOB ADDRESS: 170 NW 97 ST
Miami Shores Village RECET ..-
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
❑ ROOFING
PUBLIC WORKS
Master Permit No.
OCT 31 2016
FBC 2014
9aPPI6-2ss
Sub Permit No. P t. 10 - (6' [9 l5
❑ REVISION ❑ EXTENSION ❑RENEWAL
❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
City: Miami Shores
Folio/Parcel#:11-3101-025-0030
Occupancy Type:
County:
Load: Construction Type:
Miami Dade Zip:
Is the Building Historically Designated: Yes NO X
OWNER: Name (Fee Simple Titleholder): Robert F Rosenwald Jr
Address: 170 NW 97 Street
Flood Zone:
BFE: FFE:
Phone#: 305-790-8449
City: Miami Shores State: FL
Tenant/Lessee Name:
Email: robertrosenwald@aim.com
zip: 33150
Phone#:
CONTRACTOR: Company Name: Miami Custom Swimming Pool Corp.
Address: 1065 Bass Point Road
Phone#: (305)592-8066,
i
City: Miami Springs
Qualifier Name: Jose Quinones
State: FL
State Certification or Registration #: CPC1458439
DESIGNER: Architect/Engineer: Kenneth Pfeiffer
Address: 8754 S.W. 206th Lane
zip: 33166
Phone#: (305)592-8066
Certificate of Competency #: 000018565
Phone#: (786)235-2494
City: Miami State: FL
Value.of Work'for this Permit: .$ <Square/Linear_Foot�ag of-W" ork
Type of Work: ❑ "Addition ❑ Alteration ElNew
• /
,k-Description oof,Work S • PeeoL-
zip: 33189
❑ Repair/Replace ❑ Demolition
Specify color of color thru tile:
Submittal Fee $ 5 0 1 d Permit Fee $ 7
Scanning Fee $ Radon Fee $ . 36'
Technology Fee $ % ,.. ,
111,/. Training/Education Fee $ ' 2-0 Double Fee $
Structural Reviews $ Bond $
CCF$ •WQ
DBPR $ 3- a
CO/CC $
Notary $
(Revised02/24/2014)
TOTAL FEE NOW DUE $
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
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 su _ osted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature
OWNER or AGENT
The foregoing instrument was acknowledged before me this
d 7of day � , 20 /cP , by
KO beck ge/(Gfk Wwho is personally known to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
Jo Mt' t''' Ap
It_ mow!
n
ORALES
rkai w = ' o ary • up tate of Florida �—
an/ `17 Print:
P��' Commission # EE 875428
.,,oFen,.o Seal: * •.
������" Bonded Through National Nof'-
Signature
CTOR
The foregoing instrument was acknowledged before me this
31 day of . -o6 ( , 20
`1c vtetc.
n.ts
by
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
( c
F LAMM
* MY COMMISSION If FF 018011
EXPIRES: May 14,2017
J'4,s Fte�e Bonded T ru Budget Notary Services
*******************************************************************************##***************************
APPROVED BY
Plans Examiner
Zoning
(Revised02/24/2014)
Structural Review Clerk