BPP-18-1317BUILDING
PERMIT APPLICATION
*BUILDING ❑ ELECTRIC
El PLUMBING ❑ MECHANICAL
Miami Shores Village
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
MAY 118
FBC 2011
Master Permit No. 6.P1is --1St 1
Sub Permit No.
❑ ROOFING ❑ REVISION ❑ EXTENSION ❑ RENEWAL
❑PUBLIC WORKS CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 9929 NE 4th Ave Rd.
City: Miami Shores
Folio/Parcel#:11-3206-017-1280
County:
Occupancy Type:
Load: Construction Type:
Miami Dade
Zip: 33138
Is the Building Historically Designated: Yes
Flood Zone: BFE:
OWNER: Name (Fee Simple Titleholder): Marvin R List / Maria T Manerba
Address: 9929 NE 4th Ave Rd.
Phone#:
NO X
FFE:
City: Miami Shore State: FL Zip: 33138
Tenant/Lessee Name:
Email:
Phone#:
CONTRACTOR: Company Name: Regency Pool and Spa of FI Inc
Address: 6507 NW 13th CT
Phone#: 954-583-7373
City: Plantation State: FL
Qualifier Name: Rafael Imbert
State Certification or Registration #: CPC056811
DESIGNER: Architect/Engineer: Aquadynamics Design
Zip: 33313
Phone#:
Certificate of Competency #:
Address: 5000 SW 75th Ave Suite 103 City: Miami
Phone#:
State: FL Zip: 33155
Value of Work for this Permit: $ WOO,. ' Square/Linear Footage of Work:
7
Type of Work: ❑ Addition Alteration . New ❑ Repair/Replace ❑ Demolition
New Swimming Pool itl(Vfi /zL(..Cr/1446/27;"1.&—jil-40,)
Description of Work:
Specify color of color tiru tile:
Submittal Fee $ Permit Fee $ 10 S O
Scanning Fee $ Radon Fee $ 10 . S 0 DBPR $ I S. -4S Notary $
Technology Fee $ Training/Education Fee $
Structural Reviews $
Double Fee $
Bond $
CCF $ 2 I CO/CC $ 15 + 122-E ✓�
500 2S
tOLIS•
(Revised02/24/2014)
TOTAL FEE NOW DUE $
SAS. 13
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 such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature
OWNER or AGENT
•
CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
1 J.— day of Poi , 20 % g , by br day of i(_Lel , 20 l ! , by
/1Qrd!A) Itsf known
, who is personally own to % 6e! ..rrriber, who is personally known to
m.e or who has produced as me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print: �)�� �Allanys Gonzalez
Seal: ;aq ,r; f'= Commission # FF969034
"' Expires: March 8, 2020
; rilg • Bonded thru Aaron Notary
APPROVED BY
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
kOd7 Plans Examiner
fir
Structural Review
,;gay'e�;;,, Alianys Gonzalez
Commission # FF969034
; Expires: March 8, 2020
�;° Bonded thru Aaron Notary
Zoning
Clerk
(Revised02/24/2014)
iami Shores Viiiage
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
SWIMMING POOL OWNER'S CERTIFICATION
Date -��T/ 2U/i'
Miami Shores Village
Building & Zoning Department
Attention: Building Official
I certify that I am the legal owner of the property described as
Marvin R List/Maria T Manerba
FL, 33138
, located at 9929 NE 4th Ave.Rd. Miami Shore
In accordance with Section 33-12(f), Code of Metropolitan Dade County, I certify that I
understand and agree that the swimming pool to be constructed at the above address cannot
be used or filled with water until separate permit has been obtained for an approved safety
barrier, and such barrier erected, inspected and approved.
I further understand that this certification, however, does not eliminate the need for
obtaining a permit and erecting and approved barrier prior to final inspection and use of the
pool.
Legal Owner
Note: This certification is to be submitted with a swimming pool permit application in duplicate.
Miami Shores Viiiage
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
RESTRICTIVE COVENANT PROTECTIVE POOL ENCLOSURE
KNOW ALL MEN BY THESE PRESENTS:
WHEREAS, the undersigned Marvin R List/Maria T Manerba is/are the fee
simple owner(s) of the following described property situated and being in Miami Shores Village, Florida:
Address: 9929 NE 4th Ave. Rd. Miami Shore, FL 33138
Whereas, the undersigned owner(s) Marvin R List/Maria T Manerba
desire to utilize said Lot(s) as a single building site, and the undersigned owner(s) do(es) hereby declare
and agree as follows:
That the property will not be used in violation of any ordinances of Miami Shores Village
or Miami -Dade County now in effect or hereinafter enacted.
II. That the purpose of the covenant is to induce Miami Shores Village to issue a permit for a
pool where the required enclosure is not on the subject property where the pool is located.
III. That if any of our adjoining neighbors remove any portion of their fence or wall, or if
our/my property shall fail to meet code requirements for pool barriers, we, as owners will
immediately installs a protective enclosure to meet code requirements and will obtain a
permit for such fence.
IV. That, I/we, as owner(s) hold Miami Shores Village harmless for any negligence or injury
that results from not having the enclosure.
V. If enclosure belongs to said property, I agree to maintain & or replace said enclosure in
the event that is damaged or removed by any case.
NOW, THEREOF, for good and valuable consideration, the undersigned do(es) hereby declare that
he/she will not convey or cause to be conveyed the title to the above property without requiring the
successor in title to abide by all terms and conditions set forth herein.
FURTHER, the undersigned declare(s) that this covenant is intended and shall constitute a
restrictive covenant concerning the use, enjoyment and title to the above property and shall constitute a
covenant running with the land and shall be binding upon the undersigned, his/her successors and assigns
and may only be released by Miami Shores Village, or its successors in accordance of said Village then in
ffect.
0
Mav`viii J.
OWNER SIGN & PRINT/
I, Hereby Certify that on this day personally appeared before me 'arw� �✓i{ / l '/,'f,A 7 Alebu&213 ‘9 •
and has produced ID # as identification and he/she acknowledge that he/she
executed the foregoing, freely and voluntarily, for purposes there in expressed.
SWORN TO AND SUBSCRIBED before me on this /5 day of , 20 / c
I
F L RID
NER SI
(Revised 05/2209
& PRINT
�`"�RY1P������ Allan Gonzalez
=2� 'i1 ••`�'= Commission # FF969034
.���; Qs Expires: March 8, 2020
• FAO Bonded thru Aaron Notary NOTARY Pi;BLIC STAT O 0 A