EL-18-1371Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Project Address
1050 NE 107 Street
Miami Shores, FL 33161-7374
Owner Information
Address
Permit
Permit NO. EL-5-18-137f
Permit Type: Electrical - Residential
Work Classification: Low Voltage
Permit Status: APPROVED
Mile Date: 5/23/201' 8
Expiration: 11/19/2018
Parcel Number
1122320280520
Block: Lot:
Phone
Applicant
GABRIEL MARTIN KUSKUNOV
CeII
GABRIEL MARTIN KUSKUNOV
1050 NE 107 Street
MIAMI SHORES FL 33161-7374
1050 NE 107 Street
MIAMI SHORES FL 33161-7374
Contractor(s) Phone CeII 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
Fees Due
CCF
DBPR Fee
DCA Fee
Education Surcharge
Permit Fee - Additions/Alterations
Scanning Fee
Technology Fee
Total:
Amount
$0.00
$0.00
$0.00
$0.00
$150.00
$0.00
$0.00
$150.00
Pay Date Pay Type
Invoice # EL-5-18-67622
05/18/2018 Credit Card
05/23/2018 Credit Card
Amt Paid Amt Due
$ 50.00 $ 100.00
$ 100.00 $ 0.00
Available Inspections:
Inspection Type:
Review Electrical
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:
construction and zo ing.
information is .ccurate and that all work will be done in compliance with all applicable laws regulating
above -named c. ntractor to do the stated.
ed Sig atur ; ner ., :.. icant / Contractor / Agent
Z May 23, 2018
Date
Building Department Copy
May 23, 2018 1
BUILDING
PERMIT APPLICATION
'El BUILDING ❑ ELECTRIC
❑PLUMBING ❑ MECHANICAL
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
❑ ROOFING
PUBLIC WORKS
JOB ADDRESS: 10S0 1O) Sr
City:
Miami Shores County:
Folio/Parcel#: I I — 223,2 - 008 " OS Q-0
Occupancy Type: Load:
OWNER: Name (Fee Simple Titleholder):
Address: 10S0 NE LO3 �[
City:
FBC 201 4
Master Permit NOT " 1c 4 \
Sub Permit No.
❑ REVISION ❑ EXTENSION ',RENEWAL
❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
Miami Dade Zip:
Is the Building Historically Designated: Yes NO
Construction Type: Flood Zone:
BFE: FFE:
rye 2.f 4*z Q:44- N0V Phone#: (-4E0 `-i& g3
State: Zip: 33161.
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name:R ^,u e) /c31, 4 ../f.( e)/ Co Phone#: 3 zT —0/O
Address: //3S l S(.(.1 l S% # 2.)C)c
/ Z c
City: i r) ,c fir i / State: - /� /- �' (/) Zip: �, t� �� /
Qualifier Name: A>)4,r��)/�A , (j�,, Lei Phone#:
State Certification or Registration #: /5 OOC)O5-7 /11Zaertificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
ter\
Address: t1 SCE City: /'Y e9,u-r , State: /7 Zip:
Value of Work for this Permitr$ Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace
(Description of.Work: 1,0�+)
CJ€'— -1\ it EL_ 1C-1Las
❑ Demolition
Specify color of color thru tile:
Submittal Fee $ Permit Fee $ 6155, ao CCF $ CO/CC $
Scanning Fee $ _ Radon Fee $ DBPR $ Notary $
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ Bond $
TOTAL FEE NOW DUE $
(Revised02/24/2014)
2
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 i s • ction which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will of 'e approved and a reinspection fee will be charged.
fLSignature
)1:
The foregoing instrument was acknowledged before me this
I t) ' _ UNy of I\VAy , 20 /, by
IG_Sk_U IJQ' / who is personally known to
[me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
I� Sign:
I' Print:
I Seal:
WNER or AGENT
.+ tE Notary Public State of Ronda
Catherine Petit
My Commission FF r.57875
IS'or. Expires 02/07/202( 1
—� -
Signature__ Z
The foregoing instrument, was acknowledged before me this
20 i 15 , by
, day of
CONTRACTOR
l Q , who is personally known to
.me or who has produced as
identification and who did take an 1,j11111I1101%
NOTARY PUBLIC:
Sign:
Print:
Seal:
**************************************************************
APPROVED BY t/-C%Z-!t-fl} y )flans Examiner
Zoning
Structural Review
(Revised02/24/2014)
Clerk