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EL-16-1453Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Project Address Permit NO. EL-5-16-1453 Permit Type: Metrical,- Residential Work Classification: Low Voltage Permit Status: AP1?ROVED Issue Date: 6/2412616- Expiration: 12/21/2016 Parcel Number Applicant 1050 NE 107 Street Miami Shores, FL 33161-7374 1122320280520 Block: Lot: GABRIEL MARTIN KUSKUNOV Owner Information Address Phone Cell GABRIEL MARTIN KUSKUNOV 1050 NE 107 Street MIAMI SHORES FL 33161-7374 1050 NE 107 Street MIAMI SHORES FL 33161-7374 Contractor(s) Phone Cell Phone RAMALEX ELECTRICAL CONTRACTC (786)329-0101 (786)315-3586 Valuation: Total Sq Feet: $ 1,500.00 0 Type of Work: LOW VOLTAGE TV Additional Info: Classification: Residential Scanning: 1 o Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee - Additions/Alterations Scanning Fee Technology Fee Total: Amount $1.20 $2.25 $2.25- $0.40 $150.00 $3.00 $1.60 $160.70 Si I�Iglnspections: ins Snro p:� Pay Date Invoice # 06/24/2016 05/25/2016 Pay Type EL-5-16-59935 Credit Card $ 110.70 $ 50.00 CreAd E1IEO $ 0.00 L ED Amt Paid Amt Due Review 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 AFFIDA 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 ar`zo 1' . Futher Vie, I authorize the above -named contractor to do the work stated. Authorized Signatu Building Departm Applicant / Contractor / Agent nt Copy June 24, 2016 Date June 24, 2016 1 (0\MP 00\ 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 BUILDING PERMIT APPLICATION ❑BUILDING 2 ELECTRIC ❑ ROOFING RECE1 T—,` McpY252016 FBC 20'`'( STU- Master Permit No.?C / 5 — (z �z Sub Permit No. -E,1 (Co- i (t5 3 ❑ REVISION ❑ EXTENSION ❑RENEWAL PLUMBING ❑ MECHANICAL 0 PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION AlCONTRACTOR l ; JOB ADDRESS: / O c Al City: Miami Shores County: Miami Dade Folio/Parcel#: Is theei is,'t ii I esignated: Yes NO ,Occupancy Type: Load: Construction Type: ' �IddQ� BFE: ❑ SHOP DRAWINGS zip: ,33 l6 /— 7��37 ( FFE: ;OWNER- N me (Fee Simple Titleholder): - p ' kc., 5 [%v 1--0 L) P oh ne#:� 3 05 - _i J % - r FZ9 47: e'ss:1 d / , tJ 7( ,y Cit Tenant/Lessee Name: Email: CONTRACTOR: Company Name: AA -Le) ([�� e/Nci7 y-0,0) ;� t yC.e ,Phone#: T7— .� /s. 5.©g /5e Address: // ,3 /S / (,(� l �T '5t'5 City: �ZQ [,Lc State: F2 Zip: 6,2) / Civalifier Name: of u Ost i re9 Zr • pow I Pr.Phone#: State Certification.orRegistration #: Ef7- /30 (ifi _! L.Certificate of Competency #: DESIGNER: Architect/Engineer: Address: City: State: Zip: Phone#: Value of Work for this Permit: $ / JO - Type of Work: ❑ Addition ❑ Alteration Phone#: Square/Linear Footage of Work: �El New ❑ Repair/Replace Description of Work: / a ((ivU<// - 00 —00 7,��y ❑ Demolition .• Specify color,of color tliru file: �` Submittal Fee $ `t_,.._ e_e.._�.-.— .Permit Fee'$ --;'/.S2Orr>v CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ TOTAL FEE NOW DUE $ t 0 - o (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 OBTAINFINANCING, CONSULTWITH 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.—Aiso,-a-certified copy of the -recorded notice-of.commenc m irt-must-b-e posted at the job-gites—� Arsibed. _for the first inspection which occurs seven (7) days after the building per iItIn; the ab a ce of such posted notice, the inspection wi iot be a ov- d and a reinspection fee will be charged. Signature WNER r,rAGENT i1LLA.LL The foregoin instrument was .cknowledged before me this The foregoing instrument was acknowledged before me this L " 1, da, of % , 20 t 6 , by day of t Q / , 20 \ ( , by ' r r a- r+ �1 � �jy 5��;;,nVt,�,ho personally known �,�,�,,, el)] �bc cr, ,who is personally known to me or who has produced identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: *************** APPROVED BY 4*** as as me or who has produced identification and who did take an oath. NOTARY PUBLIC: Sign: Print: C. e..o ; .0.-- Seal: � : i3EOROIINA' SALVATORE •. •'z MY COMMISSION # FF911140 ,x•� ; . EXPIRES August 19, 2019 (407) 3R8-01s3 Fb4dallotory5eiw a com Plans Examiner Zoning (Revised02/24/2014) Structural Review Clerk