WS-18-2333Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address
Issue Date : 09/27/2018 I
Parcel Number
Permit NO.: WS-8-18-2333
Permit Type: Windows/Shutters
Work Classification: Shutters
Per+it Status: Approved
Expiration: 03/13/2019
126 NW 104 ST, Miami Shores, FL
1121360131450
I
Contacts
JOHN & DALE OSTROWSKI
Owner
DEPENDABLE SHUTTER SERVICE
7042 NW 49 ST, LAUDERHILL, LA 33319
(954)583-1411 www.dependableshutter.com
Contractor
Description: ACCORDION SHUTTERS 6
Fees
Amount
CCF
DBPR Fee
DCA Fee
Education Surcharge
Permit Fee
Scanning Fee
Technology Fee
$4.80
$2.46
$2.00
$1.60
$160.00
$9.00
$6.40
Total: $186.20
JOHN & DALE OSTROWSKI
Applicant
Valuation: $ 7,164.00
Total Sq Feet:
0.00
Payments
Total Fees
Credit Card
Check # 3523
Amt Paid
$186.20
$136.20
$50.00
Amount Due: $0.00
Permit Received By
Inspection Requests:
305-762-4949
Inspections:
Inspection Type
Building Final
Review Building
Date
Building Department Copy
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 -rtify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws
regulzoning. Futhermore, I authorize the above named contractor to do the work stated.
Authorized Signat e: Owner / Applicant / Contractor / Agent Date
September 27, 2018
Page 2 of 4
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BUILDING
PERMIT APPLICATION
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
Cfin
RECEIVED
AUG 3 0 2018
FBC 201 Master Permit No. t `23 2 ✓ a
Sub Permit No.
BUILDING 0 ELECTRIC 0 ROOFING E REVISION E EXTENSION//��RENEWAL
PLUMBING ❑ MECHANICAL PUBLIC WORKS E CHANGE OF ❑ CANOE
CONTRACTOR ��//
JOB ADDRESS: /024, Pia / 0 tip S?zEET
City: Miami Shores County: Miami Dade Zip: 33/57)
Folio/Parcel#: //-0?/3(0 —0/3 —'/i(50 Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: ---� Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): DSTIeo w/Sk/ , 3 $-A( sill' L.)416CPhone#:
Address: /a?(0, /1%l,tJ l0 SFr ST2EFT r
City: /.1iA*ii SHoAFS State: /'L
Tenant/Lessee Name:lr NCELIED
Email: .➢ A
Phone#:
I Pl;i •+ CQHOP
if E WOG G S
LLLLV 1�v�7i�l
Zip:
CONTRACTOR: Company Name: l a4113 6&" 5•/iu77P2 S&,¢.dlc.6 Phon WY-583 /P/ lc
Address: I/74/ D/eANCE DRl tit
City: 7)A-0/E State:
Qualifier Name:
10 y, iE T/e/npsoI
State Certification or Registration #: ooafdao R) Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Zip: S /�
Value of Work for this Permit: $ 7, �(o `/ • oO
Phone#:
Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration I 1 New ❑ Repair/Replacee ❑ Demolition •
.i1Viliket-'17Px/- C O <P94,1/ 9a bx5'
Description of Work:
6C)
Specify color of color thru tile: /,�
Submittal Fee $ Permit Fee $ 0 W CCF $ CO/CC $
Scanning Fee $ Radon Fee $ 2- ' DBPR $ • '4 6 Notary $
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ Bond $
TOTAL FEE NOW DUE $ l3 6 •6
(Revised02/24/2014)