REV-16-2757(61A(C)
BUILDING
PERMIT APPLICATION
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
RECETN73
Oi T 12 016 _
BY:
FBC201y
Master Permit NoT-01)- 12.510
Sub Permit No. REV 1 &`?c
BUILDING (l ELECTRIC n ROOFING n REVISION n EXTENSION (RENEWAL
PLUMBING n MECHANICAL
JOB ADDRESS: 5 ne 105 st
City:
(PUBLIC WORKS (- CHANGE OF CANCELLATION n SHOP
CONTRACTOR DRAWINGS
Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated: Yes NO no
Occupancy Type: SF Load: Construction Type: cbs Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): Group 10
Address: 1680 Michigan Ave
Phone#:
City: Miami Beach State: fl Zip: 33139
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: AJ Fulton Contractors Phone#: 3059708802
Address: 440 s dixie hwy
City: hollywood
Qualifier Name: Hugo Hernandez
State: fl
Phone#:
Zip: 33020
State Certification or Registration #: cgc1512815 Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $
Type of Work:
Addition n Alteration
Description of Work: revision to structural drawings
Square/Linear Footage of Work:
New
C Repair/Replace n Demolition
Specify color of color thru tile:
Submittal Fee $ 4 Permit Fee $ B ' `-v CCF $ CO/CC $
Scanning Fee $ 9 , (7,0 Radon Fee $ DBPR $ Notary $
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $Pl )• 03 Bond $ CD
TOTAL FEE NOW DUE$ 1 `c-�
(Revisedo2/24/2014)
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. 1 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 inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature
OWNER or AGENT
The foregoing instrument was acknowledged before me this
Signature
CONTRACTOR
The foregoing instrument was acknowledged before me this
12day of october 20 16 12 October 16
, by day of 20 by
sam sorierowho is personally known to Hugo Hernandez who is personally known to
me or who has produced as me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
kik
.107) 398-0153
CIA M PCLECRIN
ISSION #FF178894
p(RES November 23, 2018
`-FIoridallotaryService.com
********************************
APPROVED BY
(Revised02/24/2014)
i/4m1/4
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
a
AL,ICIA-TO PELEGRIN
!OMISSION #FF1788Q
;7)398-0153
r/s
IRES November 23, 2018
FloridallotaryService.com
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Plans Examiner
Structural Review
Zoning
Clerk
SIMPSON "HGAM10"
SIMPSON "H1OS"
CONCRETE BEAM
SECTION TYPICAL TRUSS ANCHORAGE
CONNECTION TYPE 1
ROOF TRUSS ANCHORAGE SCHEDULE
TYPE CONNECTOR CAPACITY NOA MFR. NAILS
2 ANCHORS
H1OS
1 AND
HGAM10
Ru 1065 Ib FL11478
Rh 0 Ib
SIMPSOM
8-10d STRAP
2-3/8"x4" TIDEN HD
Ru 850 Ib FL11473 SIMPSOM 4-1/4" TIDEN
Rh 1005 Ib 4-1/4" X 4" TAPCON
5 NE 105 ST
MIAMI SHORES, FL.
COMBINED ENGINEERING SCIENCES
CARLOS ENSENAT, PE 32566
CERTIFICATE OF AUTHORIZATION No, 9108
1214 SW 12 CT.
MIAMI, FL. 33135
( 305 ) 856-6345