PL-14-1797 Miami Shores Village F1 N�F��
Building Department auG
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 sF y
Tel:(305)795.2204 Fag:(305)756.8972
INSPECTION'S PHONE NUMBER:(305)762.4949
]SBC 20JO a '
Permit No.�l-- � �- 1-�9
BUILDING
PERMIT APPLICATION Master Permit No.� d L-���
Permit Type:PLUMBING
JOB ADDRESS: tJ C Miami Dade Zip: 1"�
City:
Miami Sho County:
Folio/Parcel#: - -" d
ted:Yes N® Flood Zone:
Is the Building Historically Designs
OWNER:Name(Fee Simple Titleholder):
"►'� a�a R 6�c F�i�EE, - Phone#:
Address: C
City: 9y1��Vi i Sid ts�z�S
State: i=L- Zip: am
Phone#:
TenautlLessee Name:
Email:
CONTRACTOR:Company
Name: (^Al`� y �e�t>t Phone#: 3Q__4 5
Address i
►� 1�OlA 1 State: 1=�. Zi
City p:
Qualifier Name:
Phone#:�.�.�.
�
c Certificate of Competency#:
State Certification or Registration#: C"P&° t,5-b q �_ - I
Contact Phone#: rJ i � r Email Address: dt 6 11 Stat°+' ° a ed
DESIGNER:Architect/Engineer: V i L r 1 t Phone#: "`�/
ear
Value of Work for this Permit:$ 15gj�!�� Squarell in Footage of Work: 011emolition
Type of Work: OAddress OAlteration view ORepair/Replace
Description of Work: L �•
V 0 Permit Fee$ 12�� f CCF$ CO/CC$
Submittal Fee$ ; . - 3 Bond$
Scanning Fee$ Radon Fee$ DBPR$ P
Notary$
Tra!Wng/Education Fee$C)- -46 Tecbnologg Fee$ W
Double Fee$ Structural Review$
TOTAL FEE NOW DUE$_,,,
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores,FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-218049 Permit Number: PL-8-14-1797
Scheduled Inspection Date: October 22,2015 Permit Type: Plumbing - Residential
Inspector: Diaz, Osvaldo Inspection Type: Final
Owner: BARCLAY GRAEBNER,RICHARD EFFS Work Classification: New
Job Address:912 NE 95 Street
Miami Shores,FL Phone Number (305)490-3299
Parcel Number 1132060010010
Project: <NONE>
Contractor: CUSTOM POOLS Phone: (305)255-5315
Building Department Comments
POOL PIPING Infractio Passed Comments
INSPECTOR COMMENTS False
Inspector Comments
Passed 1.
C)
Failed
Correction ❑
Needed
Re-Inspection ❑
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid
October 21,2015 For Inspections please call: (305)762-4949 Page 1 of 55
Pefmit Na PL-$-14-17 7
`5i! R rys q� Miami Shores VillagePermit Type'
-Residential 10050 N.E.2nd Avenue NE WorkCfaS51fic8han;
Now
Miami Shores,FL 33138-0000 ' e-l"N'd'N&dj'& It
Phone: (305)795 2204 A It Statu$,APPROVED
I ra ► ;6t21 01, Expiration: 11/29/2015
Project Address Parcel Number Applicant
912 NE 95 Street 1132060010010
Miami Shores, FL Block: Lot: RICHARD EFFS BARCLAY GRAS
Owner Information Address Phone Cell
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 Valuation: $ 1,500.00
CUSTOM POOLS (305)255-5315 (305)218-3861 Total Sq Feet: 0
Type of Work:POOL PIPING Available Inspections:
Type of Piping:
Inspection Type:
Additional Info:
Top Out
Bond Return: Final
Classification:Residential Scanning:3 Water Main
Underground
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $1.20 Invoice# PL-8-14-52655
DBPR Fee $3.38 08/18/2014 Credit Card $50.00 $193.96
DCA Fee $3.38
Education Surcharge $0.40 06/02/2015 Credit Card $ 193.96 $0.00
Permit Fee $225.00
Scanning Fee $9.00
Technology Fee $1.60
Total: $243.96
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 inform ion is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zoning. Futhermore,I autilprize thVabc394jrnW co tractor to do the work stated.
June 02, 2015
Authorized Signature:Owner / Applicant Co act / Agent Date
Building Department Copy
June 02,2015 1
s Qi►
Bonding Company's Name(if applicable) ,gid/6:
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 ELECTRICAL WORK,PLUMBING,SIGNS,
WELLS,POOLS,FURNACES,BOILERS,HEATERS,TANKS and 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 pproved and a •nspection fee will be charged.
Signature � Signature
Owner or Ag t Contractor
The foregoing instrument was acknowledged before me this The foregininstrument was acknowledged beforel/me>>th//isiday of z ° ,208 ,by' C!r_�, ��4Q31Vk day of " ,20 ,by �c-h�re �✓�/'iCK/ ,
who is personally known to me or who has produced who is personally known to me or who has produced
As identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: . SCHWfRER Sign:
Print: T S va RES:January 10,2016 r�
rs Print: ' L A) l N#EE 129586
'RY,^ PIRES:January 10,2016
My Commission Expires: /�C My Commission Expi Vii,;R >t a rnm Notary Pubis Underwriters
a
APPROVED BY �- 8 Zt Plans Examiner Zoning
Structural Review Clerk
(Revised3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)