DGT-17-69 (2) Miami Shores Village FRECF
Building Department j 12017
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972 BY: _C"l
INSPECTION LINE PHONE NUMBER:(305)762-4949 �fih
FBC 2014
BUILDING Master Permit No. PS 'IZ')5' 3% ?;-
PERMIT APPLICATION Sub Permit No. )GT I- I-1- 69
®BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL F-1 PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
p�,� CONTRACTOR DRAWINGS
JOB ADDRESS: q2-)01 0 C`10 r`Q pr
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: )\ - 3205- O 2:� - OS b O Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name(Fee Simple Tittllehoo'ld"er):1� �� Ct 00(S ILS Phone#:
Address: I �"1 S I z� ( (�
City: W, ilA.c^ State: '�'1 zip: 33 13CS
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: Phone#:
Address: 1 1 b k 1 C llw A%k-
City: L,k' c4j-1 State: TL Zip: 3 3i M
Qualifier Name: N V Cis 0 Ina rra Phone#:
State Certification or Registration#: Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ �J��� Square/Linear Footage of Work: �no
Type of Work: ❑ Addition 0 Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: P,0X1Cr0j G
Specify color of color thru tile: C (��"�
Submittal Fee$ 5 A i Permit Fee$ fZS� CCF$ 3• `0v CO/CC$
Scanning Fee$ Radon Fee$ `, �S DBPR$ S '�S Notary$
Technology Fee$ �1 . g Training/Education Fee$ I Z Double Fee$
Structural Reviews$ 0 Bond$ q
TOTAL FEE NOW DUE$ I
(Revised02/24/2014)
i .
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
0 NER or AGENT CONTRACTOR
The foregoing instru ent was acknowledged before me this The foregoing instrument was acknowledged before me this
U day of 0ZCQ.iM,6t-( 20 1 ( by 915 day of 9k UA10 bi2-r 120 IG by
bULA �'N^l�s)L� ,who is personally known to d 0 \J) 10A\1y44 who is personally known to
ho has produced as me or who has produced as
Jide i ation and who did take an oath. identification and who did take an oath. ��" ';•,
Y PUBLIC: NOTARY PUBLIC: "
0a S
m�
Sign: 8
it's,
1i Pr GK COC Print: N
I: Seal: 93
*************** ***********************************************************************)********
/Z-2
APPROVED BY �� Plans Examiner / Zoning
CG Structural Review Clerk
(Revised 02/24/2014)
Permit NO. DGT-1-17-69
Miami Shores Village Permit Type:Decks/Gazebos(Trellises
10050 N.E.2nd Avenue N ' Work Classification:Pergola
Miami Shores, FL 33138-0000 Per Permit Status:APPROVED
'F— Phone: (305)795-2204
It Oak
Issue Date: 1/24/2017 Expiration: 07/23/2017
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: $ 6,000.00
CONSTRUSERVE CORP (786)380-0619
Total Sq Feet: 100
Approved: In Review Available Inspections:
Comments: Inspection Type:
Date Approved::In Review Slab
Date Denied: Final
Type Const:Pergolas Additional Info:ALTERATION TO A PERGOLA Framing
Classification: Residential Scanning: 1 Footing
Scanning: 1_ Review Planning
Review Building
Review Structural
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $3.60
DBPR Fee Invoice# DGT-1-17-62580
$3.75 01/11/2017 Check#:8279 $50.00 $309.10
DCA Fee $3.75
Education Surcharge $1.20 01/24/2017 Check#:8299 $309.10 $0.00
Permit Fee $50.00
Permit Fee-GazebolTrellise/Pergola $200.00
Plan Review Fee(Engineer) $80.00
Scanning Fee $12.00
Technology Fee $4.80
Total: $359.10
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
constructio and zoning. Futhermore, I authorize the above-named contractor to do the work stated.
January 24, 2017
Authorized Signature:Owner / Applicant / Contractor / Agent Date
Building Department Copy
January 24, 2017 1
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