PW-17-2982Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Project Address
Per
mit
Parcel Number
Permit NO. PW-12-17-2982
Permit Type: Public Works
Womclassification: Public Works
Permit Status: APPROVED
Issue Oats: 1131/2018
Expiration: 05/01/2018
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:
$ 5,800.00
Total Sq Feet: 150
Scanning: 1
Fees Due
CCF
DBPR Fee
DCA Fee
Education Surcharge
Permit Fee
Scanning Fee
Technology Fee
Total:
Amount
$o.00
$o.00
$0.00
$0.20
$100.00
$3.00
$0.80
$104.00
Pay Date Pay Type Amt Paid Amt Due
Invoice # PW-12-17-65957
01/31/2018 Check #: 1593 $ 104.00 $ 0.00
Available Inspections:
Inspection Type:
Excavation
Review Public Works
Review Public Works
Final Public Works
II I
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 PLUMB! 4., MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNERS AF
construction a
and
_f :�io • -
•
1.', in n
utho ed " n" ur=: ')wner / Applicant / Contractor / Agent
II the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
I authorize the above -named contractor to do the work stated.
January 31, 2018
Date
Building Department Copy
January 31, 2018 1
BUILDING
"PERMIT APPLICATION
QBUILDING ❑ ELECTRIC
QPLUMBING D MECHANICAL
.ia :F • Shores Village.
.Bu Ming Department
10050EN1E.2nd Avenue, Miami`'Shores, Florida:33138'
Tel: (305} 795-2204 Fax: (305)`756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
❑ ROOFING
PUBLLC WORKS
C E l ;1:
OE..; 2 0
FBC 2019 5411
Master Permit No. RC-7-17-1901
Sub Permit No 12W l� 2. 1 &Z
❑ REVISION ❑ EXTENSION ❑ RENEWAL
❑ CHANGE OF CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 1'050 NE 107 ST
City: M+iai F Shores
Folio/Parcel#:11-2232-028-0520
Occupancy Type: RES Load:
County:
il✓Iiam brace Zip:
Is the Building Historically Designated: Yes
Construction Type: REMODEL Fiood2one:
OWNER: Name (Fee Simple Titiehoider'j: GABRIEL MARTIN'IWSKUNOV
Atfdress:.11)5°`' E 1°7 ST
NO X
BFE: FFE:
Phone#: 786- 488-8315
City:'MIA'M1 SHORES
Tenant/Lessee Name: N/A
State: — zip: 33161
Phone#:
Email: GABRIEL@NATURALISTONE.COM
CONTRACTOR: Company Name: FORTIS CONSTRUCTfON GROUP
Address: 8725 NW thTF* TER; STE 3088`
Rom: 786-252-3770
City: M IAM I State: FL zip: 33172
Qualifier Name: AGUSTIN MORALES
Phone#: 786-226-4264
State)Gertification>or Registration #: CGC 1523422 Certificate of Competency #:
'::oEseGNER: Air i'tett/Engineer: ,,IUAN FERNANDEZ BARQUIN PE Rhone#: 786-336-0881
Address_.2520 NW 97TY 1 AVE city. DORAL State: FL zip: 33172
Value of WodkXor:kbis,Pemrrrit: $5' 8O0 Squarefteiriearfootage of wor " ' DD I - tS-a0 SCIPi
Type of Work: ❑ Addition ❑ Alteration New ❑ Repair/Replace ❑ Demolition
Description of Work: NEW CONCRETE DRIVE WAY (DESIGN AS PER PLAN)
Specify color of c thru :
Submittal Fee $ Permit Fee $ CCF $ CO/CC $
Scanning .Fee .$ Radon .Fee .$ DaPJt.$ Notary ,$
Technology Fee $ Trainiing/Education'Fee $ D+ le Fee $
'Structural Reviews $ Bond $
TOTAL/FEE N i'W I3'LfE $ I OM ' QJ
(Revised02/24/2014)
Print:
Seal:
Bonding Company's Name (if applicable)
Bonding Company's Address
J.
City ..sate Zip
Mortgage Lender'sitilamektf applicable.)
Mortgage Lender's Address'
City ' State Zip
t 6 r
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 prioeto the issuance of a'permit anancr thati alt wank "wiltbe perfoiimech to meet the standdandss oft allt,kiws iiegutattimg'
construction in this jfiirisdittien. I°, understand:that a' separate permit must be secured;.lot; ELECTRIC, PL'UJMEFNG7, SJGNNs PO€ Ss
FURNACES, BOILERS, HEATERS, TANKS, AIR CONDITIONERS, ETC
h1
OWNER'S_AFFrDAVIT: IF certify thataltthe.foregoirik,jnformatioi<r,is.accrsrate.and'thatalt,woik,will'lie:drone,i'i_rompliance.wrt -aW .
applicable laws regulating construction and zoning. • , _ 1
"WARNING TO OWNER:., YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY
RESULT IN YOUR 'PAYING MICE 'FOR *MOVEMENTS TS TO YOUR PROPERTY, . IF "YOU -INTEND
r .
TO OBTAHLF1NA,N+GNG,,CONSULT ,WITH' YOUR LENDDER OR AN ATTORNEY BEFORE RECORDING
Y UR iOT10EtiF 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 bedelivered 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•
thefirst ins ction which} occurs severe 7
� � 1 days after the 4uefding..permit is issceed in the absence- of suer 'gaited : notice,,the
inspection will not be approved and a reinspectian fee wine charged — !
Signature
OWNER or AGENT
The foregoing instrument was acknowiedgedbefore me this
ton flayof ,'20
Ci(s _X 1,c0St/v'0 , ho.ispersorially'knq Tito
CONTRACTOR
The foregoing instrument was acknowledged before me this
' ;flay Of, » , 20 -• by
MOB
.-.trie:or Who t is ProduCeb ;as Anne or taltm has produced
` of
identification and who did take an oath.
NOTARY PUBLIC:
Sign:. 1 q,�I� JULIAII A Cr'R1➢ONA
Jilm hs • Yi /saur�reaissi011 4 FF 191910„r
Tx'It a fay Comm Expues .roar 2.. 23'"`
r', ::.:'` B�iirk L"r *ItstislalWW1Via.
*
APPROVED.IBY
*
***
o ispersonally ° known t
identification and who did take an oatti:—
NOTARY PUBLIC:
� r
Sign:
PPrint:
Seal:
si1aryIitlu - Stale of FloridaMy '}
rr
Comm.
al 21, l"sd n&sary Assn.
,. -- — .. .,`t .a- t.
***, *****************************
Plans Examiner
` ` ": -Stru.ctural Review
as
*******************'_
--
Zoning
.,
Clerk
(Revised02/24/2014)
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY
Whereas, (owner) cAb12-h'EL Kugte—/NoV'
thereinafter referred to as the owner of the following described
property (address): 110 50 ni E (n- G i
mmuiiuimuuiimiiummmiiiim
C-FN 2018R0031342
OR BK 30829 Ps 4411 (1F'ss)
RECORDED 01i 16/2018 13:35:11
HARVEY RUVIN, CLERK OF COURT
1IIAIII-DADE COUNT'r'r FLORIDA
Legal Description: Lot 1. Block 9 Subdivision hrl s1401€.€S £677ire3 'CS g` )
Folio # (1--2232-026 -O6-2O
Requests permission to install (describe work): 1JF,w Cora .Jre4T-o j J Sw .1c t ve
kit) -I )40--Clo I2A-0 ty /1;rti2
Within the public right of way of (address) .o7-24 h/mac `f •g ,i lit`
IN CONSIDERATION of the approval of this permit by the Village, the owner agrees as follows:
1. To maintain and repair, when necessary, the above -mentioned item(s) installed within the
dedicated right of way. If it becomes necessary for Miami Shores Village or Dade County to
make repairs or maintain said items within public right of way including restoration of street by
reason of the Owner's failure to do so, such expense shall be paid by the Owner or shall
constitute a lien against the above described property until paid.
2. The owner does hereby agree to indemnify and hold Miami Shores Village or Dade County
harmless from any and all liability, which may rise by virtue of permitting the installation of
these items within the public right of way.
3. The Owner does hereby agree to remove or relocate their facilities at their own expense,
within 60 days notice by the Village to do so. Failure to comply with this notice will result in the
Village causing the item(s) to be removed and a lien being placed on the property and/or
assessed against the Owner for all costs incurred in the removal and disposal of the item(s).
4. The undersigned further agrees that these conditions shall be deemed a covenant running
with t land and shall remain in full force and effect and be binding on the undersigned, their
heirs n assign, until su h time a this obli ations has been canceled by an affidavit filed in
the Public ec rds of ,Da Count , Florida b the Village Manager of Miami Shores Village
(or his\fully ut orized r pr ':;entativ ).
Signature
viner or Agent
grosE OF FLORIDA: .COUNTY OF DADg
1'HERESY CERTIFYd►sor,., 1s A�recopyofMe
�16 In thise is
j
AC28J (�
iM extend Off;t�t,seal
tiAR UVII f, CLERIKI oO�Crrcuit end C Courts
of
State of Florida \ � vd. `./ F ✓, / ,
County of Miami Dade
The foregoing instrument \as acknowledged before me this P- day of ArtVA , 20 le , by
GA 62tei2 iwS Vort0 V who is personally knownnoor who has p oduced
as identification.
NOTARY PUBLIC:
Sign:
Print: _.1-0 'CAYLoo r -
JULCANlA CARDONA
Notary Public - State of r`. ;wis;a
LO'rrrrtti'SSr6rt. ' FF 19'191.
tryty Corrirn. Expires,,Jars 21, 2t 19;
- ,"t Boodett'tbres7l."r N'a:iocal Pittary Awl. 1.