PL-18-1318BUILDING
PERMIT APPLICATION
El BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION
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
RP-7C _: YE.D
FBC
Master Permit NotjnP
Y1
20V1
tg-1311
Sub Permit No. f L
•PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF
CONTRACTOR
JOB ADDRESS: 9929 NE 4th Ave Rd.
--1318
❑ EXTENSION ❑ RENEWAL
❑ CANCELLATION ❑ SHOP
DRAWINGS
City: Miami Shores
Folio/Parcel#:11-3206-017-1280
County:
Occupancy Type: Load:
Construction Type:
Miami Dade Zip:
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#:
33138
NO X
FFE:
City: Miami Shore State: FL
Tenant/Lessee Name:
Email:
Phone#:
zip: 33138
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
Address: 5000 SW 75th Ave Suite 103
Phone#:
zip: 33313
Certificate of Competency #:
Phone#:
State: FL zip: 33155
Value of Work for this Permit: $ / £,t
Type of Work: ❑ Addition Ef] Alteration
Description of Work: Pool Piping
City: Miami
Square/Linear Footage of Work:
New ❑ Repair/Replace
❑ Demolition
Specify color of color thru tile:
Submittal Fee $ So Pa) d Permit Fee $ CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $
Technology Fee $ Training/Education Fee $
Structural Reviews $
Notary $
Double Fee $
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 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 AGEN
Signature
CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
-r day of /LeGCy
A -Part: #.) f tSf //
,20 i� ,by
, who is personally known to
i r day of
ot-,01 ,20 /e ,by
-1+-71.6Pti, who is personally known to
me or who has produced as me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
<--7e
pWup,-
,2o�aaxp�a�, Allanys Gomel€?
�•� • Commission # FF969034
*• _��. Expires: March 8, 2020
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APPROVED BY
6/2-5-be
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
Plans Examiner
Structural Review
a.1aa'1/Ga� Allanys Gonzalez
•
= Commission # FF969034
.-':��o� Expires: March 8, 2020
Bonded thru Aaron Notary
Zoning
Clerk
(Revised02/24/2014)
CO
CONT
NOTARY Pd16CIC
iami Shores Viiiage
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
NOTICE OF REQUIREMENTS
RESIDENTIAL SWIMMING POOL, SPA AND HOT TUB SAFETY ACT
I (We) acknowledge that a new swimming pool, spa or hot tub will be constructed or installed at
9929 NE 4th Ave. RD. Miami Shores, FL, and hereby
affirm that one of the following methods will be used to meet the requirements of Chapter 515,
Florida Statues and the Florida Building Code R4101.17.
Please initial the method(s) to be used:
The pool will be equipped with an approved safety pool cover that complies with ASTM
F1346-91. (Submit Manufacturer's Specifications).
A continuous, one-piece (child) barrier meeting the requirements of Florida Building Code
R4101.17.1.15 will protect the pool perimeter. The plans shall show the fence location and method of
attachment, including one end that shall not be removable without the aid of tools. (Submit Manufacturer's
Specifications).
A combination of non -dwelling walls and fences (screen enclosure, child fence, masonry
fence walls, chain link or wood fence, etc.) will protect the pool perimeter. The plans must specify the type
and location of all non dwelling walls. Florida Building Code, R4101.17.1
V Any combination of protection which incorporates dwelling walls with openings directly into the
pool perimeter and all windows and doors will be equipped with exit alarms complying with Florida Building
Code, R4101.17.1.9 (Submit Manufacturer's Specifications).
Any combination of protection which incorporates dwelling walls with openings directly into the
pool perimeter and all doors will be equipped with a self -latching device with positive mechanical
latching/locking installed a min. 54" above the threshold. If this option is selected, submit plans showing all
types and location of all perimeter protection. The plans must also show the location and type of all
openings, and the hardware type for each location. (Submit Manufacturer's Specifications).
In accordance with the Code, the pool may not be filled with water without compliance with the
Private Swimming Pool Safety Requirements, and upon expiration of the permit, the pool shall be
presumed to be unsafe. I understand that not having one of the above installed will constitute a
violation of Chapter 515, F.S ., an d will be considered as committing a misdemeanor of the second
degree, punislt@ble as provided in Section 775.082 or Section 775.083 F.S . This form must be signed
by the owner/,and the prime contractor.
v Af; 1l'17
SIGNATURE AND DATE
NAME (PLEASE PRINT)
WNER'S SIGNATURE AND DATE
J�1�J'✓► �l L(S
OWNEE (PLEASE PRINT)
Allanys Gonzalez
Commission # FF969034
Pq Expires: March 8, 2020
Bonded thru Aaron Notary
OTARYIPUBLI
Allarlys Gonzalez
? '•1' Commission # FF969034
▪ .%�., Expires: March 8, 2020
% 0f...� O Bonded thru Aaron Notary