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RC-17-1901
Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Project Address �m i� Parcel Number Permit NO. RC-7-1 7-1 901 Permit Type: Residential Construction Work Classification: Alteration Permit Status: APPROVED Issue Date: 10/19/2017 Expiration: 04/17/2018 Applicant 1050 NE 107 Street Miami Shores, FL 33161-7374 1122320280520 Block: Lot: GABRIEL MARTIN KUSKUNOV Owner Information Address Phone 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 FORTIS CONSTRUCTION GROUP LLC (786)252-3770 (786)226-4264 Valuation: Total Sq Feet: $ 54,446.00 2344 Approved: In Review Comments: Date Approved: : In Review Date Denied: Type of Construction: INTERIOR Stories: Front Setback: Left Setback: Bedrooms: Plans Submitted: Yes Certificate Date: Bond Return : RENOVATION, NEW INT Occupancy: Single Family Exterior: Rear Setback: Right Setback: Bathrooms: Certificate Status: Additional Info: Classification: Residential Fees Due Bond Type - Owners Bond CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Total: Amount $500.00 $33.00 $24.50 $16.34 $11.00 $1, 633.38 $3.00 $44.00 $2,265.22 Pay Date Invoice # 10/19/2017 07/26/2017 Bond #: 3535 Pay Type RC-7-17-64681 Check #: 101 Check #: 102 Amt Paid Amt Due $ 2,215.22 $ 50.00 $ 50.00 $ 0.00 Available Inspections: Inspection Type: Window Door Attachment Framing Insulation Drywall Screw Final PE Certification Window and Door Buck Fill Cells Columns Review Building Review Planning Review Electrical Review Plumbing Review Structural Review Mechanical 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, R.OFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing informatin is i and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore, I authorize the above- a o do the work stated. October 19, 2017 Authorized Signature: Owner / Applicant / .ntractor / Agent Date Building Department Copy October 19, 2017 1 442-1A ally lip :BUILDING PERMIT APPLICATION DBUILDING ❑ ELECTRIC PLUMBING ❑ MECHANICAL JOBADDRESs 1050 NE 107 ST Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shares, Florida' 33138- Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC20(LI Master Permit No. - - 2•C0'i901 Sub Permit No. ROOFING 0 REVISION 0 EXTENSION 0 RENEWAL PUBLIC WORKS Q:CHANGE-OF ❑ CANCELLATION = SHOP CONTRACTOR DRAWINGS City: Miami Shores Folio/Parcel#:11-2232-028-0520 County: Occupancy Type: RES Load: Miami: Dade Zia:: Is the Building Historically Designated: Yes Construction Type: REMODEL Flood Zone: -OWNER: Name (Fee Simple Titleholder): GABRIEL MARTIN KUSKUNOV Address: 1050 NE 107 ST NO X BFE: FFE: P h o n e#:78 6-488- 8315 aty: MIAMI:SHORES State:. FL Tenant/Lessee Name: N/A Email: GABRIEL@NATURALISTONE.COM Phone#: •, 33161 CONTRACTOR- Company Name F TI S CONSTRUCTION GROUP Address: 8725 NW 18TH TER STE 308 Ph o n e#: 786-252=3770 City: MIAMI State: FL Zip: 33132 Qualifier Name: AGUSTIN MORALES State Certification or Registration #: CGC1523422 • Phone#: 786-226-4264 Certificate of Competency #: ,DESIGNER: Architect/Engineer: UAN FERNANDEZ BARQUIN P:E Phare#: 786-336-0881 Addrress:2520 NW 97TH:AVE City: DORAL state: FL Zip: 33172 ;Value of.Work for this Permit:'$ k65 E?°0 �, '`� `� (a - uaree/kinear Footage of Work: 2,344 SF Type of Work: ❑ Addition ❑� ei w ❑■ Repair/Replace El Demolition Description of Work: NEW WINDOWS NEW DOORS, NEW POO , INTERIOR REMODELING, NEW LAYOUT, NEW 2-1/2 BATHS NEW m- ' :I f FLOOR, NEW ELECTRICAL WIRING NEW Arc-odeTS & HAIR.HA A c, W KITCHEN, CABIN ETS:ANDAPPLIANCES: NEW POO ,• NEW PERGOLA (BACK OF THE: HO NEWALUMINUM FEN ecify color of color thru tile: 2 Submittal Fee $ V - Permit Fee $ �/ G3- .38 Scanning Fee $ Radon Fee $ (i, . `f DBPR $ 2-4-1- Notary Technolggy,Fee'$ Training/Education Fee'$ Double Fee StructurakRev evws $ CCF $ CO/CC $ ,Bond (Revised02/24/2014) TOTAL, FEE,N:OWDUE$ _ i IJ - — 2( ZL_ I • - Bonding Company's Naive (if applicable) Bonding Company's Address City State lip 'Mortgage Lender's Name (ifapplica.ble) �t/lartgage -beride rs Ad d rest 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 cop enced;'prior'to-,tlr'e issuance of a, permit' and that alk, work, wr#;lae perfer to.:txreet:the standards, of aEk laws' iegulatmg construction in, this' jurisdiction I° understand that. a..separate permit must be secured f©r`.:ELECTRIC, PLUMBING-i SIGNS, POOLS FURNACES, BOILERS, HEATERS TANKS, AIR -CONIi1i1dNERS ETC:.... 1 .. OWNER'S AFFIDAVIT: I certify that all the foregoing, informationis accurate and'thatall' work will, be donein 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'IIMPROVEMENTS 'O YOUR PROPERI'Yf •'IF YOU INTEND TO OBTAIN" FINANCING, CONSULT WITH YOUR-LENDER'OR AN'ATTORNEV BEFORE RECORDING -you R NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a.building permit with an estimated value exceeding'$2500,' the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment: Also, a certified copy of the recorded notice of commencement must be posted at the job Site for the first inspection which .occurs seven (7j days after the building permit is issued- Iry the absence of suckposted 'notice; the inspection wil it be approved meta reinspe+ctiorrfee wiWfle Charged, Signature OW RorAGE T The foregoing instru • ent was acknowledged before me this .47 ,dayTof l. , 20 / .. y by • GA/je/ z A ,5Xvs' k ,•who is personally known to me or who has produced _ . as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: 4,`,0 ,,,A''' ° y`c'c Notary Public - State of Florida •. * :"__ Commission # FF 191910 �f� My Comm. Expires Jan 21, 2019 ' pp,. �,,,0 ;;,,,,` Bonded through National Notary Assn. APPROVED BY Signature CONTRACTOR The foregoing instrument was acknowledged before me this ,,day o f 7v 20 . / , by it i/SY/fyy✓ 4-101Zf�'%$ J , who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print:-virildrr.6G1,OSS7= f Seal:E ... JULIAN A CARDO;17NA �;n� FAN,,, _ � ^ Notary Public - State of Florida E. * ��`1 * • _ Commission,# FF 191910 ' . N ;9rp° Y. My Comm. Expires Jan 21, 2019 ;FPF ; ` o ed rou h National Notary Assn.' ., .`Plans Exathfriei :Zoning 1Revised02/24/2014) structural Review 'Clerk SENDER'`COMPLETE THIS SECTION • Complete items 1, 2, and 3. ■ Print your name and address on the reverse so that we can return the card to you. • Attach this card to the back of the mailpiece, or on the front if space permits. 1. Article Addressed to: COMPLETE THIS SECTION ON'DELIVERY• A. Signature X B. ReceJ.y (Printed Name) ❑ Agent ❑ Addressee C. Date of Delivery eA1 / c-ly (c rT :�-ems .-s- ).4))7►'4nzd4 S re CC yylm1.1m/ rz_. 33r ,16 I II U I IIi IllUl l 1O i� IIII I II I I91111i 9590 9402 2512 6306 0210 24 D. Is delivery address different from item 1? ❑ Yes YES, enter delivery address below: ❑ No 1areiS 2. Article Number (Transfer from service label) 7016 3010 0000 7902 3915 3. Service Type ❑ Adult Signature ❑ Adult Signature Restricted Delivery ❑ Certified Mail@ O Certified Mail Restricted Delivery ❑ Collect on Delivery ❑ Collect on Delivery Restricted Delivery ' ired Mail ired Mail Restricted Delivery r $500) ❑ Priority Mail Express@ ❑ Registered Mail'"' ❑ Registered Mail Restricted Delivery O Return Receipt for Merchandise ❑ Signature ConfirmationTPA ❑ Signature Confirmation Restricted Delivery PS Form 381 1, July 2015 PSN 7530-02-000-9053 Domestic Return Receipt United States Postai Service USPS y�CKt#i#G # , 1111 9590 9402 2512 6306 �210 24 • Sender: Please print your name,Address, and ZIP4® in this box• • OBEFER CONSULTING LLC 40 NW 111TH STREET MIAMI SHORES, FL 33168 First -Class Mail Postage & Fees Paid USPS Permit No. G-10 ? i i ?i ,'( Iii Sign: Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel. (305) 795.2204 Fax: (305) 756.8972 CHANGE Of CONTRACTOR / ARCHITECT Permit N. PL-11-15-2922 Owner's Name (Fee Simple Title Halder}aGABRIEL MARTIN KUSKUNOV Pilo/ #. 786-488-8315 Owner's Address: 1050 NE 107 ST City. MIAMI SHORES. Job Address (Of where work is being done): 1050 NE 107 ST State : FL Zip,Code: 33.161 City: Miami Shores State: Florida Zip Code: 33161 Contractor's Company Name: 'GALLOWAY CONTRACTORS:;& BUILDERS INC Phone #: 305-796'2239 Address:.?920 SW:97 TERR 'City: MIAMI State: FL Zip Code: 156 Qualifier's Name DAMIAN FERNANDEZ tic. Number: 'CC01509461 Architect/ Engineer of Record Name: JUAN FERNANDEZ BARQUIN P.E Address: 2520 NW 97TH AVE Phone #: 786-336-0881 City: DORAL State: FL Zip Cod 331'72 Describe Work; IN THR1OR REIVOCELJNIG, NEWPOOL, El./PERGOLAfi NE4u'HrrCHEN.NEwFLO R. NEW ELECTRICAL LICHT: NEW F1£ MTh; NEW AC hereby certify that the work has been abandoned and/or the contractor/architect plete the contract. I hold the Building Official and the s harmless of all legal involvement. Signature _ - .Signature 0 r or Agent Contractor or Architect The foregoing ins ru ent was aknowledged before me The foregoing' instrument was aknowledged before me this a day of .. kilt' ,2dt by 644 1,Cust,a3Ao ✓r this day of , 20 by Who is personally known to me or who has produced who is personally known to me or who has produced to WI 9.M 3 — 61-- 31' _ 0 ' as imdentificationc as indentificationc Notary Public:. .1 d ' JULIAN A CAROONA '- Notary runt - State of Florida Seal: f ""» •= Commission # FF 191910 F _ C-Q,,=` My Comm. Expires Jan 21, 2019 . Bonded through National Notary Assn. Notary Public:, Sign: Seak Change o'F Contractor!Arc'hitect or Engineer Y • . Miami Sh o res: V i l lag e Building Department 0050. N E.; 2" Avenue'`" Miami: Shores;, Florida 33'.138, Tel (305) 795.2204'f* Fax: (305) 756.8472 )r. A -change of contractor, architect or engineer must be —done under a permit number. There is a $75.00 charge for a change of contractor. The owner will -submit a Change of Contractor Form.: completed withnotarized signatures: If the signature of the previous, contractor cannot be obtained "thee owner must send a certified letter/return; receiptnotifying the; previous. contractor; architect or engineer the reason for the. change The owner must -allow 10 busi'ness days for the contractor; architect or, engineer to respond A'perrnit:application:. must accompany the change -.of contractor form, with the information and. signature 'of the- new' contractor. The new contractor must be, registered with the Village or must submit the required documents to register with the Village.' I . •Change of Contractor form completed, signed andrnotarized. 2. Permit application by_riew contractor. i 3. Required fees. . ., . 4. Copy of original letter sent via certified mail along with the returned receipt. In addition to the.requirements. above the architect or engineer of.record must-authorized the;new.architec or engineer to,reprocluce'his documents. The authorizationmust be in writing and.must be signed and sealed. c Miami, July 7th, 2017 GALLOVVAY CONTRACTORS:V BUILDERS Mc. Damian, Javier_. Fernandez 7920 SW 97 TERRACE Miami, FL 33156 Re: Change Genaral Contractor Address: 1050 NE 107 ST, Miami, FL 331.61 DearMr. Damian J. Fernandez I, Gabriel Martin Kuskunov, (Owner) of the property at 1050 NE 107 ST, am notifying you, that we are re -activating the job and decide to change the General Contractor, therefore your company will be no longer work at my property. The new responsible for Electrical work will be:. Company. : FORTIS CONSTRUCTION GROUP LLC Qualifier : AGUSTIN MORALES License No. : CGC1523422 Address : 8725 NW 18 TERR SUITE 308, DORAL, FL 33172 GABRI MA IN KUSKUNOV ner STATE OF FLORIDA COUNTY OF DADE Sworn, to and subscribed before me this o day of ..%vzy , 2017 by: [irsonally known to me; or [ ] Produced Identification SG G Sgt f Notary Public (Seal) Please hand -deliver this letter toAdministration. 6,, JULIAN A CARDONA •.•. „v rV Notary Public - State of Florida Commission # FF 191910 My Comm. Expires Jan 21, 2019 ; `' Bonded through National Notary Assn. Property Search Application - Miami -Dade County Page 1 of 1 Summary Report Property Information Folio: 11-2232-028-0520 Property Address: 1050 NE 107 ST Miami Shores, FL 33161-7374 Owner GABRIEL MARTIN KUSKUNOV Mailing Address 1050 NE 10 ST MIAMI SHORES, FL 33161 USA PA Primary Zone 1000 SGL FAMILY - 2101-2300 SQ Primary Land Use 0101 RESIDENTIAL - SINGLE FAMILY : 1 UNIT Beds / Baths / Half 2/2/0 Floors 1 Living Units 1 Actual Area 2,344 Sq.Ft Living Area 2,344 Sq.Ft Adjusted Area 2,249 Sq.Ft Lot Size 10,752.3 Sq.Ft Year Built 1950 Assessment Information Year 2017 2016 2015 Land Value $263,663 $195,864 $155,687 Building Value $143,204 $143,849: $144,493 XF Value $396 $396 $317 Market Value $407,263 $340,109 $300,497 Assessed Value $363,600 $330,546 $300,497 Benefits Information Benefit Type 2017 2016 2015 Non -Homestead Cap Assessment Reduction $43,663 $9,563 Note: Not all benefits are applicable to all Taxable Values (i.e. County, School Board, City, Regional). Short Legal Description MIAMI SHORES ESTATES PB 47-58 LOT 1 BLK 4 LOT SIZE 82.710 X 130 OR 20730-1094 10 2002 1 COC 25669-4474 08 2006 1 Generated On : 7/26/2017 Taxable Value Information 20171 2016> 2015 County Exemption Value $0 $0 $0 Taxable Value $363,600 $330,546 $300,497 School Board Exemption Value $0 $0 $0 Taxable Value -1 ! $407,263 $340,109 $300,497 City Exemption Value I $0 $0 $0 Taxable Value $363,600 $330,546 $300,497 Regional Exemption Value Taxable Value i $0 $0 $0 $300,497 $363,600 $330,546 Sales Information Previous Sale Price OR Book - Pa a 9 Qualification Description 05/12/2014 $360,000 29198 4300 Qual by exam of deed 06/26/2009 $187,900 26948- 1151 Financial inst or "In Lieu of Forclosure" stated 12/03/2008 $100 26694- 3702 Sales which are disqualified as a result of examination of the deed 08/01/2006 $650,000 25669- 4474 Sales which are qualified The Office of the Property Appraiser is continually editing and updating the tax roll. This website may not reflect the most current information on record. The Property Appraiser and Miami -Dade County assumes no liability, see full disclaimer and User Agreement at http://www.miamidade.gov/info/disclaimer.asp Version: http://www.miamidade.gov/propertysearch/ 7/26/2017 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 MORALES, AGUSTIN E FORTIS CONSTRUCTION GROUP LLC 8725 NW 1'8TH TERRACE STE 308 DORAL FL 33172 Congratulations! With this license you become one of the nearly one million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range from architects to yacht brokers, from boxers to barbeque restaurants, and they keep Florida's economy strong. Every day we work to improve the way we do business in order to serve you better. For information about our services, please log onto vnvw.myfloridalicense.com. There you can find more information about our divisions and the regulations that impact you. subscribe to department newsletters and team more about the Department's initiatives. Our mission at the Department is: License Efficiently, Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, and congratulations on your new license! DETACH HERE RICK SCOTT, GOVERNOR STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CGC1523422 ISSUED: 07/16/2015 CERTIFfED GENERAL CONTRACTOR MORALES, AGUSTIN E FORTIS CONSTRUCTION GROUP LLC iS CERTIFIED under the provisons of CA.4439 FS. Expiration date AUG 31, 2016 L1507160000241 KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD LICENSE NUMBER CGC1523422 The GENERAL CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2016 MORALES, AGUSTIN E FORTIS CONSTRUCTION GR 8725 NW 18TH TERRAC8`48 DORAL Ft4e412:, ISSUED: 07/16/2015 DISPLAYAS REQUIRED BY LAW SEQ # L1507160000241 Local Bus i ness Tax Recei pt Miami -Dade County, State of Florida THIS S NOT A St L liOT PAX 1188129 ?VSINESS NAM CC TO FORTIS CONSTRUCTION GROUP LLC 8725 NW 18 TER SUITE 308 DORAL, FL 33172 OWNER FORTIS CONSTRUCTION GROUP LLC r.K1 ISTIIN NICIPAI FS klif4R VVaker(s) 1 RECE'PT CZOWNVAL 746209 EX PRES SEPTEMBER 30, 2017 r.5 ediserlayel an place of basarrew. 4V15437,1 'VD `Caourity CAM Ciarzer - zurr A7,1 EEC T ?";RE OE at[stnEss 196 GFJ4ERAL BUILDING CONTRACTOR CGC1523422 PA 'IV En 7 RECEIVED at:1,a EC fTOR 45.00 00222016 9224-16-005967 Tris Local Business Tax Rucept arty curl paperrers of ire Lecai Bizo:ess ear 7.Ve Recap ,srea 2rcelse perm t or a cert "Galion al be Wider's gat "caroms rb lazarem m. amply irt,b an/ graferiebouou a norigovurrtereal regulatory laws arxj regrararrentswhicl appil tartieb.s.raaA The RECEIPT Pi0 abrwe ',rust be rtsel.apethzyr =inionerata vehrots 0,6am -Cork Gude Sec 8a-276 ar rise r .4$ crt Asr way: r,arkrelj.fLass_ DA E( 07/18/2017 Act:,Ref CERTIFICATE OF ILA INSURANCE a THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(Sl, AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Florida Bankers Insurance 6874 SW 8, ST Miami, FL 3314* Phone. (305) 266-6493 Fax (305) 262,0679 CONTACT MARTA ALONSO NAME: PHONE : (305)266-6493 II.0 Rod, (305)262-0679 AD s4 martafforodabenkersinsemeice.co 1r INSURER(S), AFFORDING COYERAGE. NAIC#. INSURER A.:. FEDERATED NATIONAL INSURANCE CO. INSURED FORTIS CONSTRUCTION GROUP LLC. 8725 NW 18 Terr #308 DORAL FL 33172 INSURER B : INSURER : INSURER D : INSURER E : INSURER f,: COVERAGES CERTIFICATE NUMBER REVISION NUMBER THIS IS TO;CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY -REQUIREMENT, TERM OR CONDITION OF ANY>CONTRACTOR'OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY -PERTAIN; THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN ISSUBJECT TO ALL THE TERMS, EXCLUSIONS ANDCONDITIONS OF SUCH POLICIES. LIMITS SHOWN MA',t' HAVE BEEN REDUCED BY PAID CLAIMS. ,INSR LTR - 'TYPEOF INSURANCE ADDLSUBR INSR 'WVD POLICY NUMBER POLICY EFF (MWDD/YYYY) POLICY,EXP 1MM/DDIYYYY) ,LIMn'S A n COMMERCIAL GENERAL LIABILITY N N GL-0504013678-01 08/13/2016 08/13/2017 EACH OCCURRENCE $ 1,000,000.00 ❑ CLAIMS -MADE V' OCCUR DAMAGE TO PREMISES (Ea oNccu ence) $ 100,000.00 MED EXP (Any one person) $ 5,000.00 ❑ PERSONAL SADVINJURY, $ 1,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: ❑ PRO - POLICY JECT ❑ LOC ❑ OTHER GENERAL AGGREGATE S 2;000,000.00 PRODUCTS-CONP/OPAGG $,: 2,000,000.00 $ AUTOMOBILE LIABILITY D ANY AUTO ALL OWNED SCHEDULED ❑ AUTOS ❑ AUTOS NON -OWNED ❑ HIRED AUTOS ❑ AUTOS ❑ COMBINED'SINGLE LIMIT (Ea,accident): , BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ ❑ UMBRBLIA`UAa ❑ OCCUR ❑ ,EXCESS LIAB ❑'CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ ❑ 'DED ❑ RETENTION:$ WORKERS/COMPENSATION AND EMPLOYERS'LIABILITY Y 1 N ANY.PROPRETORIPARINER/EXECUSIN OFFICER/MEMBER EXCLUDED? �❑ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A PER ❑ OT i- ❑ STATUTE ER E>L. EAOM ACCIDENT'$ E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OFOPERATIONS, Ir'll-etTIONS r VEHICLES (Attach ACORE/101, Additional Remarks Schedule, If mere space Is required), General Contractor CGC1523422 CERTIFICATE HOLDER CANCELLATION MIAMI SHORES VILLAGE BUILDING DEPARTMENT IAM NE 2nd , F MIAMI SHORES, 33138 SHOULD AYDFTNE'ABOVEDESCRIBBW?OLLOIESIBE CANGELLEDOEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. nAUTHORIZEDIrwmrE �� y+f ' • ACRID 75 (2Dt4IO11t$ O19 1` 4AGORDCORPORA'RO .> Mint/hes reserved. The ACORD name andlogo are registered' marks of ACORD T'.®: `o,RL CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDOIYYYY). 7l18r2017 THIS; CERTIFICATE IS ISSUED AS "A MATTER OF -INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE -HOLDER. THIS`. CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND, OR ALTER THE. COVERAGE. AFFORDED BY THE POLICIES BELOW. mIS CERTIFICATE OF INSURANCE DOES: NOT CONSTITUTE A CONTRACT BETWEEN:.THE`ISSUING INSUFIER(S) AUTHORIZED REPRESENTATIVE OR'PRODUCER, A AND THE CEI TIF'iCATE blaDER - IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements). PRODUCER SUNZ Insurance_1SoLutions, LLC. ID: (TLR) ‘clo TLR,of Bonita, Inc 700 Central Ave, Suite 500 St. Petersburg, FL 33701 NAMtEhCT Workers' 'Comp Department PHONE FAX 4A/C,No:"Ekt)=- 727-520-7676 -X 3 :(ANC, NO: n7-.525-3862 E-MAIL ADDRESS: •certsigencDrehr.eom INSURERS) AFPORDI NG COVERAGE NAIC A INSURER;A:SUNZ Insurance Company 34762 INSURED TLR of Bonita, Inc EnterpriseH R 700 Central Avenue Suite 500 St. Petersburg FL 33701 INSURER B : INSURER C : INSURER D : INSURERS: INSURER F VERAGES CERTIFICATE NUMBER:. 36728998: REVISION NUMBER: - THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED-BELOW,HAVE: BEEN ISSUED `TO<THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED: NOTWITHSTANDINGANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT -WITH RESPECT TO W14ICH THIS' CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBE() HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILICY NSR LTR OF INSURANCE ADDLTYPE INSD INSD WVDSUBR POLICY NUMBER WVD EFF (MPM/ D/YYYY) (MLICY EXP M/ DIIYYYY) LIMITS COMMERCIAL GENERAL LIABILITY EA(CkHi,,(d�OCCURRENCE I $ GE TO RENTED PREMISES (Ea ,occurrence) =CLAIMS-MADEOCCUR 'MED EXP (Arty one person) $ PERSONALE,ADV INJURY '$ GENERAL AGGREGATE $ GENT AGGREGATE POLICY OTHER: LIMIT APPLIES PRO - JECT PER: LOC PRODUCTS -'COMP'OPAGG '$ $ AUTOMOBILE LIABILITY ANY AUTO OWNED AUTOS. ONLY HIRED AUTOS ONLY SCHEDULED AUTOS, NON -OWNED AUTOS ONLY COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per aacidenf) $ PROPERTY DAMAGE (Per aocIdent), $ $. UMBRELLA LIAO. EXCESS'LIAB. O OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ $ DED 1 RETENTION $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED1 ..;� Mandatory iri NH) If yes, describe under DESCRIPTION' OF OPERATIONS below NIA WCPE00000001 13 WCPE00000001 12 6/1/2017 6/1 /2016 6/1/2018 6/1/2017 / STATUTE I ERH E.L. EACH ACCIDENT $ 1,000,000.00 'EL'DISEASE -'EA EMPLOYEE >$ 1,000,000.00 EL DISEASE - POLICY LIMIT '$ 1,000,000.00 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) Coverage Provided for all leased employees but not subcontractors of: Fortis Construction Group LLC Client Effective: 6/12/2017 General Contractor CGC1523422 .1-Ini r7FR` CANCELLATION 2184 Miami Shores Village BuildingDepartment 9 P 10050 NE 2nd Ave. Miami Shores FL-331.38 r - '... . SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 'AUTHORIZED REPRESENTATIVE -Glen J Distefano A;988-2015:ACORDCORPDRATION. ',AII_rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 36728998 1 Master Certificate- Current 2017 I Kathleen Wilkes 17/18/2017 1:04:52 PM (CDT) I Page 1 of 1 ,(LC-5 - IS -12‘2 Juan Fernandez-Barquin, P.E. Structural Engineers 40114 2520 N.W. 97th Avenue, Suite #240 Threshold Inspectors 0947 Doral, Florida 33172 c State Plans Examiner PX 1305 PH: 786-336-0881 Fax: 786-336-0884 State Building Inspector BN 3318 Email: jfbeng@bellsouth.net www.juanferoandezbarqulope.com SEPTEMBER 21, 2016 CITY OF MIAMI SHORES VILLAGE BUILDING DEPARTMENT 10050 N.E. 2ND AVENUE MIAMI SHORES, FLORIDA 33138 ATTN: BUILDING OFFICIAL RE: 1050 NE 107th STREET, MIAMI, FLORIDA LETTER FOR THE CORNER BARS. This letter is to verify that the corner bars were installed at the rear portion of the house, near the new columns, at each corner. Please note that the masonry block on top of beam B-1 was previously changed to structural concrete with #5 @24" c/c. Horizontal and vertical minimum. This is where the corner bars were installed and needed. If you have any questions, please call. Respectfully rquin, P.E. 212016 Structural Registration No.. 40114 Threshold Inspector No. ... 0947 State Building Inspector No.. BN3318 Plans Examiner No... PX1305 \DOCS\PAULA CORREA\LETTERS\LETTER FOR BEAM-1.DOCX g-C-S--15-1261_ Inspection Worksheet ; \\Z, Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-266349 Permit Number: RC-5-15-1262 Scheduled Inspection Date: ember 302016 Permit Type: Residential Construction Inspector: e. _TO,,#C\ Inspection Type:Aindow Door Attachment Owner: KUSKUNOV, GABRIEL MARTIN Work Classification: Alteration Job Address:,T050'NE 107 Street Miami Shores, FL 33161-7374 Project: <NONE> Contractor: GALLOWAY CONTRACTORS & BUILDERS INC Phone Number Parcel Number 1122320280520 Phone: (305)972-8150 Building Department Comments INTERIOR RENOVATION, NEW INTERIOR DISTRIBUTION, NEW BATHROOM, NEW KITCHEN. Infractio Passed Comments INSPECTOR COMMENTS False Passed Failed Correction Needed Re -Inspection Fee No Additional Inspections can be scheduled until re -inspection fee is paid. Inspector Comments CREATED AS REINSPECTION FOR INSP-255143. CREATED AS REINSPECTION FOR INSP-254881. CREATED AS REINSPECTION FOR INSP-254732. CREATED AS REINSPECTION FOR INSP-235459. Need complete window/ door package No gaps> 1/4" Supply letter from Engl Arch for structural attachment with 2 X if not spelled out on NOA Missing letter 03/17/2016 CANCEL BY YURI FERNANDEZ 8-30-16 LETTER STILL PENDING. September 29, 2016 For Inspections please call: (305)762-4949 Page 11 of 32 Juan Fernandez-Barquin, P.E. 2520 N.W. 97th Avenue, Suite #240 Doral, Florida 33172 PH: 786-336-0881 Fax: 786-336-0884 Stivctural Eneincers 40114 Threshold Inspectors 0947 State Plaits Examiner PX 1305 State Building Inspector BN 3318 Email: jlhene(abellsouth.net www.juanfernandezbarquinpe.com MARCH 24, 2016 VILLAGE OF MIAMI SHORES BUILDING DEPARTMENT 10050 N.E. 2ND AVENUE MIAMI SHORES, FLORIDA 33138 ATTN: BUILDING OFFICIAL RE: 1050 NE 107th STREET MIAMI SHORES, FLORIDA INSTALLATION OF WINDOWS. Dear Sir, this letter is to verify that this office completed the examination of the installation of the wood bucks and windows and are approved. If you have any questions, please call. Respectfully, MAR 2 4 201& Structural Registration No.. 40114 Threshold Inspector No. ... 0947 State Building Inspector No.. BN3318 Plans Examiner No... PX1305 DOCS\PAULA CORREA\LETTERS \G LASS DOORS.DOCX h� Q1 .11.13.. STATE OF fit, . 1-i/i �S /O N A1 " .` `,,,PNP .. • eq is �9 �•'��E SF�' ,p ,er'•. No 40114 ' Z it : it Juan Fernandez-Barquin, P.E. Structural Engineers 40114 2520 N.W. 97th Avenue, Suite #240 Threshold Inspectors 0947 Doral, Florida 33172 State Plans Examiner PX 1305 PH: 786-336-0881 Fax: 786-336-0884 i State Building InspectorBN 3318 Email: jlbeng@bellsouth.net www.juanternandezbarqulope.com MARCH 18, 2016 VILLAGE OF MIAMI SHORES BUILDING DEPARTMENT 10050 N.E. 2ND AVENUE MIAMI SHORES, FLORIDA 33138 ATTN: BUILDING OFFICIAL RE: 1050 NE 107th STREET MIAMI SHORES, FLORIDA INSTALLATION OF FRENCH DOORS AND FRENCH DOOR PANELS. Dear Sir, this letter is to verify that the French doors and the French door panels, at the rear of the residence, may be installed directly to the steel columns. The installation of the frame may be completed with %" diameter metal screws connecting the frame directly to the steel column. If you have any questions, please call. Respectfully, Juan Structural Regist tion No.. 40114 Threshold Inspector No. ... 0947 State Building inspector No.. BN3318 Plans Examiner No... PX1305 DOCS\PAULA CORREA\LETTERS \GLASS DOORS. DOCX