REV-19-1599BUILDING
PERMIT APPLICATION
❑BUILDING ❑ ELECTRIC
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
'C I ED
JUL 1 1 20 9
BY: 1�1.
FBC 20
Master Permit No .j-'—A) 1] AQ
Sub Permit No. �4V— — IS11
XREVISION
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF
CONTRACTOR
JOB ADDRESS:
❑ EXTENSION ❑RENEWAL
❑ CANCELLATION ❑ SHOP
DRAWINGS
uc J live AC/
City: Miami Shores ✓ County: Miami Dade Zip: > 3131
Folio/Parcel#:
Occupancy Type: Load
Is the Building Historically Designated: Yes NO
Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): �� flu 4�d Phone#: q-I (, a
Address: 7j -2— / v C ��C_42,�k
City: Q 1 �A 0!!e1 State: Zip:
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name:
Address:
c
City: State:
Qualifier Name: / v
State Certification or RegistrMion #:
DESIGNER: Architect/Engineer:
hone#: W-2_6 q �
Phone#:
Certificate of Competency #:
hone#:
Address: City: State: Zip:
Value of Work for this Permit: $lAft clap—Square/Linear Footage of Work: ZYj R ,�pn rr��
Type of Work: ❑ Addit' ❑ Alteration ❑ New El Rep it/Replace ❑ Demolition
Description of W,prk: ' �
_U .. «
Specif ,,;color of color"tlirurtile::
Submittal,Fee Permit Fee $ CCF $ NCO/CC $
Scanning Fee,$ ,Radon Fee $ DBPR $ Notary $
r -
Technology (Fee $' F Training/Education Fee $ Double Fee $
Structural Reviews $
Bond $
(Revised02/24/2014)
TOTAL FEE NOW DUE $ 4ci • CA
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City State
Zip
Zi
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 inspection which occurs seven (7) days after the building permit is issued 1 the absence ofch po to notice, the
inspection will not be approved and a reinspection fee will be charged. � �\ 1
Si nature [-Alwj.
gSignature_
NER or 4GENT CONTI
The foregoing instrument was acknowledged before me this
da of V 120 �� by
who is personally known to
me or who has produced as
on and who did take an oath.
NOTARY P BLIC:
Sign:
Seal:
*******************
APPROVED BY
y
SINDIA ALVAREZ
MY COMMISSION # GG 238273
EXPIRES: September 3, 2022
The foregoing ihstrunn w s ac/�inowledged before me this
d y of �U ( 20 by
1/5I J� (*DI rxY5 who is personally known to
me or who has produced ) as
identification and who did take an oath.
NOTARY PUBLIC:
Print:
! Plans Examiner
Structural Review
TVNotary Public State of Florida
My Commission GG 200800
Expires 09/21/2022
1 Zoning
Clerk
(Revised02/24/2014)
PREPARED BY:
Land Surveyors, Inc.
www.exactaland.com ''
Toll Free 866-735-1916 • F 866-744-2882
PROPERTY ADDRESS: 9632 NE 5TH AVE STREET, MIAMI SHORES, FLORIDA 33138
FIELDWORK DATE: 1/15/2018 REVISION DATE 16/2018)
17121827
BOUNDARY SU,BJlGY--'''�
MIAMh•19ADE COU
IAIN FLO .9 1
PPER FLOOR 20.9 _
ADDLE RO = 9.45
ACK KO \ = 9.2
}� 7 I
v `
G A,LO
BLK 86 i
SURVEY NUMBER: 1712.1827-01
v'"vi
,\ �,
DVq?. ,0 TABLE:
LI 5 44°49'42' W 31 .99' (M)
L2 5 O'29'233 W 22.58' (M)
I" FIP 17� �C�'°'� �•`� e�� S �, fir`
NO ID
°,
LOT 22
�s BLK 8G
0 1 I' FIP
ID
2�
@ P.C.
9y
'CO3Ff 2 (#9(; RES 9632
X_,rtCCrf S,
FIP
I" NIP` NO ID `r
w ' @ ANGLE POINT 1,
8.55
@STONE PATH
�T1i
7 ' ,ALVY / / i`. / / . / /_ s=: /. Z TBM l
NO 10 205 90 (P) 0 @ W UNE
N 89-31'43" W 204.38' (M)
NOTES:
LOT APPEARS TO BE SERVICED BY CITY WATER AND SEWER
FENCE AND WALL OWNERSHIP NOT DETERMINED • • ; ^
• ) THE ELEVATIONS SHOWN HEREON WERE OBTAINED USING GPS IN t�
CONJUNCTION WITH REAL TIME NETWORK L-NET NAVD 88 DATUM • • "�{> ` \ "" •'
AND CONVERTED TO NGVD 1929 DATUM WITH A CONVERSION FACTOR OF + 1 .54' • s '• • • • �— •
�OTE5 FISTING ELEVATION IN NGVD 1929 DATUM lll��� • •
I hereby certify that ary Survey of the ;--' •• .f y •
hereon described en made under �,� h • ... "� . • • • • • • • • • •
my direction, on oYtht 4I'D49st�know/edge 3 Pj, ...... ..:..'
and belief, it is a t e and acc to representation - 'J
of a survey tha fiA rds of Practice *sees* •
set forth by the /orida Board w rofessional •
Surveyors &Map s irk;ipte P J-17 of the 4�� I i o 20 :...:4p
Florida Administrab ode. � � �/ 0 - -
RONALD W. WALLING GRAPHIC SCALE (In FA-e
rcc.�
State of Florida Professional Surveyor and Mapper 1 inch = 40' ft.
License No. 6473 SLCy'Url
Use ofThis Surveyfor Purposes other than Intended, Without Written Verification, will be at the User's Sole Risk and Without Liability to the Surveyor.
Nothing hereon shall be Construed to Give ANY Rights or Benefits to Anyone Other than those Certified.
FLOOD INFORMATION: POINTS OF INTEREST
BY PERFORMING A SEARCH WITH THE LOCAL GOVERNING NONE VISIBLE
MUNICIPALITY OR WWW.FEMA.GOV, THE PROPERTY APPEARS TO BE
LOCATED IN ZONE X. THIS PROPERTY WAS FOUND IN THE VILLAGE
OF MIAMI SHORES, COMMUNITY NUMBER 120652, DATED 09/11/09,
CLIENT NUMBER: DATE: 1/16/2018
BUYER: David Halabu
SELLER: ESTATE OF MARY ALICE BLAKE
CERTIFIED TO: DAVID HALABU; LEXIUM PLLC
AFFILIATE
MEMBERS
This is page 1 of 2 and is not valid without all pages.
REPORT OF SURVEY 1712.1827-01 1 This is page 2 of 2 and is not valid without all pages.
LEGAL DESCRIPTION:
LOT 21, BLOCK 86, AMENDED PLAT OF MIAMI SHORES SECTION 4, ACCORDING TO THE PLAT THEREOF, AS RECORDED IN PLAT BOOK 15,
PAGE 14, OF THE PUBLIC RECORDS OF MIAMI-DADE COUNTY, FLORIDA.
i E I
77,
l;
JOB SPECIFIC SURVEYOR NOTES:
THE BEARING REFERENCE OF SOUTH 45 DEGREES 00' 00" W IS BASED ON THE NORTHWESTERLY RIGHT-OF-WAY LINE OF NE 5TH AVENUE
EAST LOCATED IN AMENDED PLAT OF MIAMI SHORES SECTION 4, ACCORDING TO THE PLAT THEREOF, AS RECORDED IN PLAT BOOK 15,
PAGE 14, OF THE PUBLIC RECORDS OF MIAMI-DADE COUNTY, FLORIDA.
1
GENERAL SURVEYOR NOTES:
1. The Legal Description used to perform this survey was supplied by others. This survey does not determine or imply ownership.
2. This survey only shows improvements found above ground. Underground footings, utilities and encroachments are not located on this survey map. i
3. If there is a septic tank, or drain field shown on this survey, the location is approximate as the location was either shown to Exacta by a third party or it was estimated by metal detection, I
probing rods, and visual above ground inspection only. No excavation was performed in order to determine the exact and accurate location. I
4. This survey is exclusively for the use of the parties to whom it is certified.
S. Additions or deletions to this survey map and report by other than the signing party or parties is prohibited without written consent of the signing party or parties.
6. Dimensions are in feet and decimals thereof. i
7. Due to varying construction standards, house dimensions are approximate.
8. Any FEMA flood zone data contained on this survey is for informational purposes only. Research to obtain such data was performed at www.fema.gov.
9. All corners marked as set are at a minimum a %z"diameter,18" iron rebar with a cap stamped LB#7337. I i
10. If you are reading this survey in an electronic format, the information contained on this document is only valid if this document is electronically signed as specified in
Chapter 51-17.062 (3) of the Florida Administrative Code and Florida Statute 472.025. The Electronic Signature File related to this document is prominently displayed on the invoice for this survey which is
sent under separate cover. Manually signed and sealed logs of all survey signature files are kept in the office of the performing surveyor. If this document is in paper format, 13
it is not valid without the signature and original raised seal of a Florida Licensed Surveyor.
11. Unless otherwise noted, an examination of the abstract of title was NOT performed by the signing surveyor to determine which instruments, if any, are affecting this property. i
12. The symbols reflected in the legend and on this survey may have been enlarged or reduced for clarity. The symbols have been plotted at the center of the field
location, and may not represent the actual shape or size of the feature. ( i
13. Points of Interest (POI's) are selected above -ground improvements which may be in conflict with boundary, building setback or easement lines,
as defined by the parameters of this survey. There maybe additional POI's which are not shown, not called -out as PON, or which are otherwise
unknown to the surveyor. These POI's may not represent all items of interest to the viewer.
14. Utilities shown on the subject property may or may not indicate the existence of recorded or unrecorded utility easements. i
15. The information contained on this survey has been performed exclusively, and is the sole responsibility, of Exacta Surveyors. Additional logo or references to third party firms are for
informational purposes only.
16. Pursuant to F.S. 558.0035, an individual employee or agent may not be held individually liable for negligence. i
17. House measurements should not be used for new construction or planning. Measurements should be verified prior to such activity.
LEGEND:
uNL�rPEs: iv�spp�rbrm,
SURVEYOR'S LEGEND
Pi4�7'Bp'rl�•�•1 IRON PENCE SYMBOLS: (actinomeaee- *f
r..:."�"w"+i��..1 SURFACE TYPES: tw;na omeave w;m, ® �A
OVERHEAD LINES BENCH MARK PND HYDRANT
BTRUL�RE�,q,ic� ( CENTERLINE • PND OR SET MONUMENT
CENTERLINE_ _ SURVEY TIE LINE ASPHALT L BRICK 0 E_ GUYWIRE OR ANCHOR I
FILE CENTRAL ANGLE a DELTA 1
CHAIN -LINK or WIRE FENCE COVERED �r COMMON OWNERSHIP 0 MANHOLE
WALL OR PARK WALL CONCRETE AREA v '1y1j TREE
• CONTROL POINT
EASEMENT ........ WOOD FENCE WATER ® �T UTILITY OR LIGHT POLE
WOOD ■ CONCRETEATBA MONUMENT O WELL
EDGE OF WATER --__- VINYL FENCE � CATCH BASIN I
�-� ELEVATION I
I
i
(C) CALCULATED E.O.W. EDGE OF WATER N.T.S. NOTTO SCALE R.P. RADIUS POINT A.E. ACCESS EASEMENT
(D) DEED ELEV. ELEVATION NAVD88 NORTH AMERICAN VERTICAL R/W RIGHTOF WAY AN.E. ANCHOR EASEMENT
(F) FIELD EM ELECTRIC METER DATUM OF 1988 RES. RESIDENCE C.M.E. CANAL MAINTENANCE ESMT.
(M) MEASURED ENCL. ENCLOSURE NGVD29 NATIONAL GEODETIC RGE. RANGE C.U.E. COUNTY UTILITY ESMT '
(P) PLAT ENT. ENTRANCE VERTICAL DATUM OF 1929 S.B.L. SET BACK LINE D,E. DRAINAGE EASEMENT
IR) RECORD EUB ELECTRIC UTILITY BOX O.C.S. ON CONCRETE SLAB S.C.L. SURVEY CLOSURE LINE D.U.E. DRAINAGE AND UTILITY ESMT.
(5) SURVEY F.F. FINISHED FLOOR O.G. ON GROUND S.T.L. SURVEY TIE LINE ESMT. EASEMENT
A.S.B.L. ACCESSORY SETBACK LINE P.O.P. EDGE OF PAVEMENT O.R.8 OFFICIAL RECORD BOOK S.W. SEAWALL I.E./E.E. INGRESS/EGRESS ESMT
A/C AIR CONDITIONING F/DH FOUND DRILL HOLE O.R.V. OFFICIAL RECORD VOLUME S/GD SET GLUE DISC IRR.E. IRRIGATION EASEMENT r I
FCM FND. CONCRETE MONUMENT O/A OVERALL Still SIDEWALK L.A.E. LIMITED ACCESS ESMT.
B.C. BLOCK CORNER I
B.F.P. BACKFLOW PREVENTOR FIP FOUND IRON PIPE O/S OFFSET SCR. SCREEN L.B.E. LANDSCAPE BUFFER ESMT
B.R. BEARING REFERENCE FIPC FOUND IRON PIPE &CAP OFF OUTSIDE OF SUBJECT PARCEL SEC. SECTION L.E. LANDSCAPE ESMT.
B.R.L. BUILDING RESTRICTION LINE FIR FOUND IRON ROD OH. OVERHANG SEP. SEPTICTANK L.M.E. LAKE Of Ml#)GCAPE
B/W BAY/BOXWINDOW FIRC FOUND IRON ROD &CAP OHL OVERHEAD LINES SEW. SEWER MAINTENANCEEASEMENT
BLDG. BUILDING FN FOUND NAIL ON INSIDE OF SUBJECT PARCEL SIRC SET IRON ROD &CAP • M.E. MAINTRJANILEASEMENT • • • • • •
BLK BLOCK FN&D FOUND NAIL AND DISC P.B. PLAT BOOK SN&D SET NAIL & DISC • • P.L. PUBLIC UTILITY EASEMENT
BENCHMARK •
FND. FOUND P.C. POI CURVATURE SQ.FT. SQUARE FEET • • RAPE. ROCIP&AHAN SMT.
8S • y
•
MT. BASEMENT FPKN FOUND PARKER-KALON NAIL P.C.C. POINT OF COMPOUND STY STORY I� Vj(E. SIDEWALK EtNT
C CURVE FPKN&D FOUND PK NAIL &DISC P.C.P. CURVATURE SV SEWERVALVE • • • S.%M.E. STORMWATER AGEMENT• • • • • • ",�
C.B. CONCRETE BLOCK FRRSPK FOUND RAILROAD SPIKE PERMANENT CONTROL POINT T.O.B. TOP OF BANK • • • • • • EASEMENT • • • I
C.LF. CHAIN LINK FENCE GAR. GARAGE P.I. POINT OF INTERSECTION TBM TEMPORARY BENCHMARK T.U.E. TECHNOLOGICAL UTILITY ESMT • • • • • I
C.O. CLEAN OUT GM GAS METER P.O.B. POINT OF BEGINNING TEL. TELEPHONE FACILITIES • • • Y.E. UTILOY EASEM NT • • i
C.V.G. CONCRETE VALLEY GUTTER ID. IDENTIFICATION P.O.C. POINT OF COMMENCEMENT TWP. TOWNSHIP • • • • • • • •
CIL CENTER LINE ILL. ILLEGIBLE PP. PINCHED PIPE TX TRANSFORMERC/P COVERED PORCH • • • • • • • • • • . INST. INSTRUMENT P.R.C. POINT OF REVERSE CURVATURE TYP. TYPICAL • • q
CIS CONCRETE SLAB INT. INTERSECTION P.R.M. PERMANENT REFERENCE U.R. UTILITY RISER ,
• • • • • • • • l ;
CAN CABLE TV RISER L LENGTH MONUMENT UG UNDERGROUND • • • • • • • • • • •
CH CHORD BEARING LB# LICENSER - BUSINESS P.T. POINTOFTANGENCY UR UTILITY RISER • I i
CHIM. CHIMNEY LS# LICENSER - SURVEYOR P/E POOL EQUIPMENT V.F. VINYL FENCE • • • • • • • • I
.B. MAP BOOK PG. PAGE W.F. WOODEN FENCE
CO CONCRETE • • • • y))
COR. M
CORNER M.E.S. MITERED END SECTION PLS PROFESSIONAL LAND SURVEYOR W/C WITNESS CORNER • • • • • • • • • • � '?
CS/W CONCRETE SIDEWALK M.F. METAL FENCE PLT PLANTER W/F WATER FILTER • • • • • • tt
D.F. DRAIN FIELD MES MITERED END SECTION PSM PROFESSIONAL SURVEYOR AND WM WATER METERNALVE BOX • • • • • I I
D.H. DRILL HOLE MH MANHOLE MAPPER WV WATERVALVE • • • • • • • • • i
D/W DRIVEWAY N.R. NON RADIAL R RADIUS or RADIAL • • • • • • • • • ! I
k
ELECTRONIC SIGNATURE: PRINTING INSTRUCTIONS: OFFER VALID ONLY FOR:
David Halabu
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