RC-17-1000 ;t
G
sNOs�, Miami Shores Village Resldntial"rtction
10050 N.E.2nd Avenue NE
workGlasslflcattttnr Repair
Miami Shores,FL 33138-0000
Phone: (305)795 2204 Pem*Status:APPROVED
FCORiD4'
Issueiaal¢ „4121/2E1 i Expiration: 10/18/2017
Project Address Parcel Number Applicant
92 NE 95 Street 1132060130450
HAYDEE&DOUGLAS ROMANIK
Miami Shores, FL Block: Lot:
Owner Information Address Phone Cell
HAYDEE&DOUGLAS ROMANIK 92 NE 95 Street
MIAMI SHORES FL 33138-2707
92 NE 95 Street
MIAMI SHORES FL 33138-2707
Contractor(s) Phone Cell Phone Valuation: $ 500.00
SLUYTER CONSTRUCTION (970)379-9730 Total Sq Feet: 100
3
Approved:In Review Available Inspections:
Comments:
Inspection Type:
Date Approved::In Review Final
Date Denied:
Type of Construction:DRYWALL REPAIR Occupancy:Single Family
Stories: Exterior:
Front Setback: Rear Setback:
Left Setback: Right Setback:
Bedrooms: Bathrooms:
Plans Submitted:Yes Certificate Status:
Certificate Date: Additional Info:
Bond Return: Classification:Residential
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $0.60 Invoice# RC-4-17-63657
DBPR Fee $2.00
DCA Fee $2.00 04/11/2017 Credit Card $50.00 $64.60
Education Surcharge $0.20 04/21/2017 Credit Card $64.60 $0.00
Permit Fee $100.00
Scanning Fee $9.00
Technology Fee $0.80
Total: $114.60
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 AFFIDAV T: 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 zo i g. Futh ,I authori4e the above-named contractor to do the work stated.
April 21, 2017
Authorized Si tures Owner Applicant / Contractor / Agent Date
Building Department Copy
April 21,2017 1
'0 AY, Midl111 JIIUICJ VIIIdge
400, Building Department RECEivE®
\ 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 APR 10 2017
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 2014
BUILDING Master Permit No. 1?c,I `�-
PERMIT APPLICATION Sub Permit No.
BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP
n CONTRACTOR DRAWINGS
JOB ADDRESS: �� .� S
City: Miami Shores L . County: Miami Dade Zip: 3 3, 38
Folio/Parcel#: I _ 3 106 " b 1 3- L3 Z ,5-D Is the Building Historically Designated:Yes NO
Occupancy Type:_C,�ad: Construction Type: U 5 Flood Zone: BFE: FFE:
OWNER: Name(Fee Simple Titleholder): L-70 o %l\ Phone#:
Address: q7- NrC-, !J-57 's (
City: �"' (► Nd - S tf"A_ -,-_S State: Zip: 3 3
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: 5 4=AC C4 U�A,'ST'"�-f'`"C�� Phone#:
Address: 2-37 N I 5T
City: VU 1 A-r'L I Co HJyt c c / State:�_( Zip: 33 I :
Qualifier Name: l Phone#:
State Certification or Registrati n#:Ca-c- l 3 3112 11 Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ 5-00 Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New M�Repair/Replace ❑ Demolition
Description of Work: k-,L-
Specify color of color thru tile:
Submittal Fee$ Permit Fee$ CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fe $
Structural Reviews$ Bond$_bf,
TOTAL FEE NOW DUE S
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.
.o
Signature _ - Signature
OWNER or AGENT -CONTRACTCff
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of 1 ,by , day of r� I ,20 ` by
1 ,
&i who is personally nown to � � -Ir ,who is ona ley owp to
me or who has produced 1 as me or who has produced r as
identification and wh identification and who did take an o gt�is111a1III
NOTARY PUBLIC: y0. " D ISSIOb. #FF 16 NOTARY PUBLIC:EXPI �a`` A l g/S��i
?.. r MY COMMISSION+FF 167297 vIQ
1,
RTtnNabreWe�milm _`��,�•°• arch i°r��%
„". ea• may:�'_
Sign: C-- Sign:
1 °
Print: �a �• • �cou�J�t. Print: sD
"'•,
DALE C. II
Seal: .- ' Seal: P
.: ..x MY COMMISSION Y FF 167297 �;�llO I I IN��O�
; ro EXPIRES:December 2,201S '
char Bonded ThN Notary PuNk UndeA-*e*
APPROVED BY ( Plans Examiner Zoning
Structural Review Clerk
A j
741
1
s �
ce ( �
• ... 0.60.0
• � 0
000000 �•
•• •0000•
•..: •.. • 0000:
RECEIVED .,.. .
*Geese .08900 .9..9
APR 1 �017 '
. 0000.
0000.. 000.0 .
• • ..s...
t • •
I 0000.• s
• • • 9000.•
•
099
V '
_ (� _ F UAJ 1Or V � /-�I L FFn- �,L 1 �-