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DS-16-3382 (2) Permit No. DS-12-16-3382 `SHORES t�� Miami Shores Village Permit Type:Driveways/Sidewalks/Slabs 10050 N.E.2nd Avenue N it Work Classification:Addition/Alteration Miami Shores,FL 33138-0000 Per Permit Status:APPROVED Phone: (305)795-2204 toRioA Issue Date: 12/28/2016 Expiration: 06/26/2017 Project Address Parcel Number Applicant 9301 N BAYSHORE Drive 1132050270560 Miami Shores, FL Block: Lot: GUY&SELIN KURLANDSKI Owner Information Address Phone Cell GUY&SELIN KURLANDSKI 9301 N BAYSHORE Drive MIAMI SHORES FL 33138- 15811 COLLINS Avenue SUNNY ISLES FL 33160- Contractor(s) Phone Cell Phone Valuation: $ 4,000.00 CONSTRUSERVE CORP (786)380-0619 Total Sq Feet: 4618 Approved: In Review Available Inspections: Comments: Inspection Type: Date Approved: :In Review Final Date Denied: Foundation Type of Work:DRIVEWAY Additional Info:DRIVEWAY Review Building Bond Return: Classification:Residential Review Planning Scanning:4 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $2.40 DBPR Fee Invoice# DS-12-16-62368 $4.87 12/28/2016 Check#:8259 $353.14 $0.00 DCA Fee $4.87 Education Surcharge $0.80 Permit Fee $325.00 Scanning Fee $12.00 Technology Fee $3.20 Total: $353.14 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 aut rize the above-named contractor to do the work stated. December 28, 2016 Authorized Signature:Owner / Applicant / Contractor / Agent Date Building Department Copy December 28,2016 1 { Miami Shores Village 7Y: ,T\7FD 0• Building DepartmentEC 14 2016 10050 N.E.2nd Avenue, Miami Shores, Florida 33138Tel:(305)795-2204 Fax:(305) 756-8972 _ INSPECTION LINE PHONE NUMBER:(305)762-4949 C5 FBC 201(4 BUILDING Master Permit No. /PG -)1, �s 3�aZ7 PERMIT APPLICATION Sub Permit No. C)S 1 l0- :S?�� Z EZ-BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION 16 CONTRACTOR DRAWINGS JOB ADDRESS: q19011Z CAli2ry 0/10` City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: p - 3),65 - 827— o s60 Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name(Fee Simple Titleholder):/ V /pe7 *e!7 L, /J 965",�f'i • Phone#: Address: ( �� O 'C _ O/^ City: 1221�M/• f��d�S State: E-4 Zip: 3 13 Tenant/Lessee Name: Phone#: Email: /- CONTRACTOR:Company Name: Phone#: r Address: 6/4 5�2 S h, City: kol'4rhl / / State: aov��i Zip: •� l C46 Ll Qualifier Name: L�'6bler /�/!� !`Ct/rG_9� Phone#: State Certification or Registration#: ` cJ1✓ �J��yCertificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: Stat/e: Zip: Value of Work for this Permit:$ L� 0 r`� 7 _Square/Linear Footage of Work: /W/,/16 G Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: h O Specify color of color thru tile: Submittal Fee$ Permit Fee$ CCF$ 2 �© CO/CC$ ScanningFee$ Nota Radon Fee$ �•�1 DBPR$ Notary$ Technology Fee$ � C) —Training/Education Fee$ • �lJ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ • Iq (Revised02/24/2014) ti 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 rIff D,4,4 4J Signature WNER or AGENT CONTRACTOR She going instrument was acknowledged before me this The foregoing instrument was acknowledged before me this er� day of JpCb 611-611- 1 20 16 by (. day of -_D9-L 120 16 by = A- qd ki who is personally known to —f' CJ V'314�0�,who is personally know= Peho has produced as me or who has produced as f ation and who did take an oath. identification and who did take an oath. NO PUBLIC: NOTARY PUBLIC: , ..t.� y ANT Cyf' .t� 4 pnal o =c Q co W '••� Sign: a oar Print: �A�CPi C ��//'!� Print: �' �� >w A 0 m Seal: Seal: ....... APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014)