MC-14-2037 Permit No. MC-'9-14-2037
�seO1rS r, Miami Shores Village M Penn#NX. Metha leal-Rwidentia)
10050 N.E.2nd Avenue NE it
Wc>rtsCfassTfication.•Poral Heater
'• ""'"' Miami Shores,FL 33138-0000 perPermit StahJ3'APPRC3VE®
_d" Phone: (305)795-2204
fcOR
bow Dates 6/2/2015 Expiration: 11/29/2015
Project Address Parcel Number Applicant
912 NE 95 Street 1132060010010
Miami Shores, FL Block: Lot: RICHARD EFFS BARCLAY GRAI
Owner Information Address Phone Cell
t
RICHARD EFFS BARCLAY GRAEBNER 912 NE 95 Street (305)490-3299
MIAMI SHORES FL 3338- i
912 NE 95 Street
MIAMI SHORES FL 3338-
Contractor(s) Phone Cell Phone
CUSTOM POOLS 305 255-5315 Valuation: $ 5,000.00
( ) (305)218-3861
Total Sq Feet: 0
Tons: Available Inspections:
Additional Info:NEW HEAT PUMP FOR SWIMMING POOL. Inspection Type:
Classification:Residential
Final
Approved:In Review Review Mechanical
Comments: Date Approved::In Review
Date Denied: Type of Work:
Scanning:1
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $3.00
DBPR Fee $2.63 Invoice# MC-9-14-52981
DCA Fee $2.63 09/18/2014 Credit Card $50.00 $141.26
Education Surcharge $1.00 06/02/2015 Credit Card $ 141.26 $0.00
Permit Fee $175.00
Scanning Fee $3.00
Technology Fee $4.00
Total: $191.26
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-named cont ctor o the work stated.
June 02, 2015
Authorized Signature:Owner / Applicant 7 Ageof Date
Building Department Copy
June 02,2015 1
Bonding Company's Name(if applicable) &A
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. 1 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$2500,the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment Also,a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued in the absence of such posted notice, the
inspection will be approved and o inspection fee will be charged.
LAf
1;�0
Signature Signature � / &
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foreg instrument was acknowledged before me this
11:7 day of Gds/ 20✓tf by �day of P 20�by
re({( i/l/ULwho is personally known to W,y ! is who is personally known to
me or who has produced as me or who has produced as
identification and who did take an oath, identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: Sign:
Print: Print:
Seal: �1'C (411SSIONN Seal: ' YN
Ry
EXPIRES:January 10,016O' EE
Rf�I4" Bended 11tra Netmy pok Undenw ltwS :gr,, �S r to,
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rs$rsssssrrrrssrsrssrsrrrrrrrrssrrsa rrsrrrrsrsrrrrrerrrrrrrrrrrrrrrrrrrrrrsrs � rsssssrsss
APPROVED BY IPI ns Examiner Zoning
Structural Review Clerk
(Rev1sed02/24/2014)
•
,F
Miami Shores Village
SEP 8
Building Department BY: _
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION UNE PHONE NUMBER:(305)762-4949
FBC 20
BUILDING (waster Permit No. B?P-S -I`t"-111&
PERMIT APPLICATION Sub Permit No. 1w' & 14~ ` O�
❑BUILDING ❑ELECTRIC ❑ ROOFING ❑ REVISION ❑EXTENSION ❑RENEWAL
❑PLUMBING Q MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑SHOP
CONTRACTOR DRAWINGS
ADB ADDRESS: 912 NE 95 St
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: !1 -3 ao6+awl - ZQ/y Is the Building Historically Designated:Yes NO
Occupancy Type: load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): ?I I aA&4 V- -AEpgs Phone#-
Address: l a, N E
City: MI&6&) sues State: Zip: 333 k
Tenant/Lessee Name: Phone#:
Email: �s
CONTRACTOR:Company Name: 6a
,SMA Phone# 305 a75 5 65/5
Address: /.3d,50 Sr ) /3/ $7 2d4-- 100
City: IM 14M r t state: F�- Zip:.--3 31 t�►
Qualifier Name: �B►leu �ie- 0 Phone#::45,
Q55 -53 13
In_
State Certification or Registration#: 1 (L 05(64M(- Certificate of Competency#:
DESIGNER:Architect/Engineer: Int _�=(GtJIJG� Phone#: 3 cz-/-3 0S cJ(,3 1
Address: 10 a 7 60 Al(k) kf WK AS City: "I State: Zip: 17
Value of Work for this Permit:$ SOD Ow Square/Unear Footage of Woric
Type of Work: ❑ Addition ❑ •'Alteration � New ❑ Repair/Replace El Demolition
Description of Work: )PA Q 9 eAl-7 f i M A 404L S,01 m M 1 A 9 OOL
Specify color of color thru tile:
Submittal Fee$�Fb M_ Permit Fee$ ® CCF$_R , 0Q) CO/CC$
Scanning Fee$ r���� Radon Fee$ 1 DBPR$0 . G3 Notary$
Technology Fee$ '-4• QK:) TrainhWEducatlon Fee$ 6 Double Fee$
Structural Reviews$� Bond$ M
TOTAL FEE NOW DUE$
(Revised02/24/2014)
RICK SCOTT, GOVERNOR KEN LAWSON, SECRETARY
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
CONSTRUCTION INDUSTRY LICENSING BOARD
CPC056434
The RESIDENTIAL POOL/SPA CONTRACTOR
Named below IS CERTIFIED
Under the provisions of Chapter 439 FS.
Expiration date: AUG 31, 2016
PIEKLO, JOHN MICHAEL
CUSTOM POOLS
13250 SW 131 ST ST#100
MIAMI FL 33136
OEM -
ISSUED:
06/29/2014 DISPLAY AS REQUIRED BY LAW SEQ# L1406290001686
006484
Local Business Tax Receipt
Miami—Dade County, State of Florida
-THIS IS NOTA BILL - DO NOT PAY
2962844 LBT
�/
BUSINESS NAME&OCATION RECEIPT NO.
EXPIRES
CUSTOM POOLS RENEWAL SEPTEMBER 30, 2®15
13250 SW 131 ST 100 309'7649
MIAMI FL 33186 Must be displayed at place of business
Pursuant to County Code
Chapter 9A-Art.9&10
OWNER SEC.TYPE OF BUSINESS PAYMENT RECEIVED
CERTIFIED GUNITE COMPANY 196 SPECIALTY BUILDING CONTRACTOR BY TAX COLLECTOR
Worker(s) 6 CPC056434 $75.00 07/18/2014
CHECK21-14-025136
This Local Business Tax Receipt only confirms payment of the local Business Tax. The Receipt is not a license,
permit ora certification of the holder's qualifications,to do business. Holder must comply with any governmental
or nongovernmental regulatory laws and requirements which apply to the business.
The RECEIPT NO.above must be displayed on all commercial vehicles-Miami-Dade Code Sec ga-276.
For more information,visit wwW miomidade uo z o I ctor