PL-17-1966Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Project Address
Permit
Permit : NO. P L-8-17-1966
Pennit Type: Plumbing - Residential
Work Classification: Pont - Private
Permit Status: APPROVED
Issue Date: 12/5/2017
Expiration: 06/03/2018
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
FORTIS CONSTRUCTION GROUP LLC (786)252-3770 (786)226-4264
Valuation:
Total Sq Feet:
$ 8,000.00
500
Type of Work: PLUMBING SUB PERMIT 02-1/2 BATHROOM
Type of Piping:
Additional Info: PLUMBING SUB PERMIT 02-1/2 BATHROOM
Bond Return :
Classification: Residential
Scanning: 1
Fees Due
CCF
DBPR Fee
DCA Fee
Education Surcharge
Permit Fee
Scanning Fee
Technology Fee
Total:
Amount
$4.80
$3.38
$2.25
$1.60
$225.00
$3.00
$6.40
$246.43
Pay Date Pay Type
Invoice # PL-8-17-64753
12/05/2017 Check #: 105
08/01/2017 Credit Card
Amt Paid Amt Due
$ 196.43 $ 50.00
$ 50.00 $ 0.00
Available Inspections:
Inspection Type:
Main Drain
Final
Rough
Review Plumbing
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 ELECTR PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNERS AFFIDAV
construction and zo
rtify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
hermore, I authorize the above -named contractor to do the work stated.
December 05, 2017
Date
Authorized Sign ure: •wner / Applicant / Contractor / Agent
Building Department Copy
December 05, 2017 1
Miami Shores Village
BUILDING
PERMIT APPLICATION
BUILDING ❑ ELECTRIC
0PLUMBING ❑ MECHANICAL
JOB ADDRESS: 1050 NE 107 ST
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
RECEIVED
AUG 001 1017
1-7
C 20 ILA
Master Permit No. BPP-7-17-1904
Sub Permit No. I VR —1G
REVISION ❑ EXTENSION ❑ RENEWAL
CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
City: Miami Shores
Folio/Parcel#:11-2232-028-0520
Occupancy Type: RES Load:
County:
Miami Dade Zip:
Is the Building Historically Designated: Yes
NO X
Construction Type: NEW CONS Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): GABRIEL MARTIN KUSKUNOV
Address: 1050 NE 107 ST
Phone#: 786-488-8315
City: MIAMI SHORES
Tenant/Lessee Name: N/A
State: FL Zip: 33161
Email: GABRIEL@NATURALISTONE.COM
Phone#:
CONTRACTOR: Company Name: SUNSET ppo\ L c.)('k
Address: S3�S
City: '` C\* ' State: 1-" t O'(1 Ck°1
Qualifier Name: "...v'CCe, \ • GON AzZ.
State Certification or Registration #: CGC1523422
Phone#:
Zip: ' 115
Phone#: i5c4- i0(o
Certificate of Competency #: CPC O }O$q
DESIGNER: Architect/Engineer: JUAN FERNANDEZ BARQUIN P.E
Phone#: 786-336-0881
Address:2520,NW 97TH AVE_ City: DORAL State: FL zip: 33172
8000
Value of Work for this •Permit: $ ,,
Square/Linear Footage of Work: 500 SF
Type of Work: ❑ Addition 0 Alteration ❑ New
Description of Work: NEW POOL PLUMBING WORK (renuew permit expired)
Q Repair/Replace ❑ Demolition
Specify color of color thru tile:
Submittal Fee $ Permit Fee $ V-25- CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Notary $
Technology Fee $ Training/Education Fee $ Double Fee $
Bond $
TOTAL FEE NOW DUE $ Fn • Gro
Structural Reviews $
(Revised02/24/2014)
Bonding Company's Name (if applicable)
Bonding Company's Address
City tr Et' State Zip
Mortgage Lender's Name (if applicable) r
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
I' t. . A tit
' • •
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 FORaIMPROVEMENTS 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 lnw 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 bpprovecl and a reinsp ion fee will be charged.
Signature
OWNER or AGENT
The foregoing instrument was acknowledged before me this
2...G _ n day of JU't y , 20 1. �—• , by
6 11 PX VI r k-US I l, who ' personally kn to
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC: -
Sign:
Print:
Seal: -
i
as
Notary - State of Florida
Cornmiaaiun # FF 191910
cpA: My Comm. Expires Jan 21, 2019
, , wBonded throto!tNational Notary Assn.
APPROVED BY
Signature-
-f.
CONTRACTOR
The foregoing instrument was acknowledged before me this
i -day of 4-(161' ,20 /7 `,'by
J,1r5,e 4 60✓1 z k2- F` ;Who is personally kriownito
me or who has produced --IV/A as'
identification and who did t nwoat LBIA MANDULEY
NOTARY PUBLIC:" ' y *:-MYCOMMISSION 4 FF95997r
EXPIRES_February 19. 2020
kat SotvYx.w 1
Sign:.
iket
Print: . ®/•lry/4,
-Seal: --,- .
Plans Examiner Zoning
(Revised02/24/2014)
Structural Review
z'
Clerk