PL-15-2258 C �4
Miami Shores Village SEP 0 3 2015
Building Department
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972 �1
INSPECTION LINE PHONE NUMBER:(305)762-4949 S
FBC 20 lq
BUILDING Master Permit N `1:___.)_
__ ?OR
PERMIT APPLICATION Sub Permit No. %-4
BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION RENEWAL
PLUMBING ❑ MECHANICAL PUBLIC WORKS ❑ CHANGE OF [:]CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 310 NE 99 Street
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#:11-3206-013-5580 Is the Building Historically Designated:Yes NO X
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder):Donald HaydenaffilfteS IriftPhone#:
Address:310 NE 99 Street VMtiCLLrU
city: Miami Shores State: FL Zip: 33128
Tenant/Lessee Name: Phone#: —:5-15T
Email: tv®t,��
CONTRACTOR:Company Name: Miami Custom Swimming Pool Corp. Phone#: (305) 592-8066
Address: 1065 Bass Point Road
city. Miami Springs State: Florida Zip. 33166
Qualifier Name: Jose Quinones Phone#: (305)725-4765
State Certification or Registration#: CPC1458439 Certificate of Competency#:
DESIGNER:Architect/Engineer: Kenneth Pfeiffer Phone#: (786)235-2435
Address:8754 SW 206 Lane City: Miami State: FL Zip; 33189
Value of Work -
_for this Permit:$ 1�6® Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration M New ❑ Repair/Replace ❑ Demolition
-Description of Work: /U o w A
Specify color of colo(rtrthru tile:
Submittal Fee$ ®' �' " Permit Fee$ CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$ 109 = I
(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 buildk►g•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. I
/K�Signature Signature
OWNER or A L' iNTRACTOR
The foregoing instrument was acknowl dged before methis The foregoing instrument was acknowledged before me this
t`I day of (-4e,,-., A 20 J �by day of y 20 �s .by
whhoo is personally known to
) e ��.n r�-�s-who i personally to
me or who has produced FL�j D150-kk- me or who has produced as
identification and who did take an oath. identification and who did take an oath.
NOT _liCs NOTARY PUBLIC:
Sign: Sign:
Print: Print:
'0o�•••.••��" A INONES
►"r h+i
Seal: * * MI C ISSI 1 EE 845938 Seal: ,�•.•••.• JOHN P COELLO
EXPIRES: anuary12,2017 * * MY COMMISSION#FF 018011
Baxd Tlw Nalry Snta �� r EXPIRES:May 14,2D17
************************************************************************************************************
APPROVED BY 9 t S Plans Examiner Zoning
Structural Review Clerk
(Revieed02/24/2014)