RC-16-986 £ F�
"%-44
Miami Shores Village kt � ftM� l1,
10050 N.E.2nd Avenue NE
Miami Shores,FL 33138-0000
r
hv � Phone: (305)795-2204
J'1501-��Ilx "Pate;�CORtD4'
Expiration: 10/2312 1
Project Address Parcel Number Applicant
5 NE 102 Street 1132060131640
Miami Shores, FL Block: Lot: ROBERT SAKI
Owner Information Address Phone Celt
ROBERT SAKZ 5 NE 102 ST
MIAMI SHORES FL 33138-2322
Contractor(s) Phone Cell Phone Valuation: $ 8,000.00
SLUYTER CONSTRUCTION (970)379-9730
Total Sq Feet: 0
Approved:In Review Available Inspections:
Comments: Inspection Type:
Date Approved::In Review Final PE Certification
Date Denied: Window Door Attachment
Type of Construction:RENOVATE BATHROOM. Occupancy:Single Family Framing
Stories: Exterior: Insulation
Front Setback: Rear Setback: Drywall Screw
Left Setback: Right Setback: Fill Cells Columns
Bedrooms: Bathrooms: Window and Door Buck
Plans Submitted:Yes Certificate Status: Review Planning
Certificate Date:
Additional Info: Review Plumbing
Review Building
Bond Return: Classification:Residential Review Electrical
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due Review Mechanical
CCF $4.80 Review Structural
Invoice# RC-4-16-59390
DBPR Fee $3.60
DCA Fee $3.60 04/12/2016 Credit Card $50.00 $234.00
Education Surcharge $1.60 04/26/2016 Credit Card $234.00 $0.00
Permit Fee $240.00
Scanning Fee $24.00
Technology Fee $6.40
Total: $284.00
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 authorize the above-na ed contr or to do the work stated.
April 26,2016
Authorized Signature:Owner / Applicant / on or / 'Agent Date
Building ®epairtment Copy
April 26,2016 1
Miami Shores Village _
® Building Department PR 12 2096
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972 BJY.
INSPECTION LINE PHONE NUMBER:(305)762-4949 �T14
FBC 2014
BUILDING Master Permit Noel —,::T 9
PERMIT APPLICATION Sub Permit No.
[dBUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION [—]RENEWAL
❑PLUMBING ❑ MECHANICAL PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION SHOP
/ o CONTRACTOR DRAWINGS
JOB ADDRESS:
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: CO.Astruction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): a / +L/ �i Phone#:
Address:^� �� /6��G7
City: �1 1i� 1 v,5/'J/2/zi State: Zip:J U J;
lam^
Tenant/Less a Name: / �"� J95 Phone#:
Email:
CONTRACTOR:Company Name: � tsil �y•���� �� �L� Phone#:
Address:
City: M'A✓ : �1`���L'�'� State• Zi p: f �—
/' f �
Qualifier Name: C7''���j i--���• Phone#: S�
State Certification or Registration#r: Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: 114 60 f� ,pC= /e- City: i�l,,g4 L tate:J�<Zip: 3 I
Value of Work for this Permit:$ t�. o& C� Square/Linear Footage of Work:
Type of Work: ❑ Addition [+Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: i m
Specify color of color thru tile:
Submittal Fee$ G� Permit Fee$ 2(40 CCF$ e CO/CC$
Scanning Fee$ *-�-9 (�)O Radon Fee$ � ' 1:�)® DBPR$ 0 Notary$ CTS
Technology Fee$ b e �0 Training/Education Fee$ Double Fee$ 0
Structural Reviews$ Bond$ P I
TOTAL FEE NOW DUE$ �#
(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 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 Signature
OWNER or AGENT ONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
d� ay of 112, 20 by / da f
le� who is personally known to Z: o is personally known to
me or who has produced as me or who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: Sign:
Print: Print:
Seal: .y GAfi l WANDA FIGUEROA Seal: 0Notary pUM State of FWda
:.� MY cotMSSION Y FF 13UM C Rodriguez
Bonded Ttn Notary Public Underwriters of w EXPIRES:september 7,2018 ' MEIP6es 2aO/2018 881704
�I �b
APPROVED BY 2 Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
Greg Sluyter, Owner
1'I SLUYT�—�--- 970-379-9730
CONSTRUCTION,LLC.
SluyterConsLruction@gmail.com
Date:
State of�u LA Wy, Q)L A
County o
Before me this day personally appeared Pla who,being duly sworn,
deposes and says:
That he or she will be the only person worldng on the project located
at: ,S Aia 102- S7 i�}�r, f/�n,� �,r C. 3.?13 6
worn to (or affi ed) and subscribed before me this day of i . 20L(4,by
Personally Imow
V
Or Produced Identification
Type of Identification Produced
Print,Type or Stamp Name
�d Notary Public State of Florida
. C Rodriguez
s1� My Commission EE 861704
ora Expires 12MW2016
Licensed and Insured
d
`CJk� R
Miami shores Village
A Building Department
�ORt� 10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305)795.2204
Fax: (305) 756.8972
Notice to Owner— Workers' Compensation Insurance Exemption
Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05
allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to
obtaining a building permit. Pursuant to the Florida Division of Workers'Compensation Employer Facts Brochure:
An employer in the construction industry who employs one or more part-time or full-time
employees,including the owner,must obtain workers'compensation coverage. Corporate officers
or members of a limited liability company (LLC) in the construction industry may elect to be
exempt if
1. The officer owns at least 10 percent of the stock of the corporation,or in the case of
an LLC,a statement attesting to the minimum 10 percent ownership;
2. The officer is listed as an officer of the corporation in the records of the Florida
Department of State,Division of Corporations;and
3. The corporation is registered and listed as active with the Florida Department of
State,Division of Corporations.
No more than three corporate officers per corporation or limited liability company members are
allowed to be exempt. Construction exemptions are valid for a period of two years or until a
voluntary revocation is filed or the exemption is revoked by the Division.
Your contractor is requesting a permit under this workers'compensation exemption and has acknowledge that he or she will not use
day labor,part-time employees or subcontractors for your project.The contractor has provided an affidavit stating that he or she will
be the only person allowed to work on your project.In these circumstances,Miami Shores Village does not require verification of
workers'compensation insurance coverage from the contractor's company for day labor,part-time employees or subcontractors.
BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS
CONTENTS.
Signature:
Owner
State of Florida
County of Miami-Dade
The foregoin /e who is
ore me this day of ,20�
B ®bf 6?&
y personally known to me or has produced
as identification.
Notary:
SEAL:
Notary Putdic Stet.of Florida
C Rodriguez
M)GeffiffilmW EE Be
asE.Om 12130/2016