FW-13-2124BUILDING
Miai-r,i Shores Village -- --
Building Department SEP 19 7
-013
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972';
INSPECTION'S PHONE NUMBER: (305) 762.4949
FBC 210 n
PermitNo.
PERMIT APPLICATION
Master Permit
Permit Type: BUILDING ROOFING
JOB ADDRESS: 979K Xai
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: // 3.Z a- 0/ - / '�' R ®
Is the Building Historically Designated: Yes NO Flood Zone:
OWNER: Name (Fee Simple Titleholder): advo 7-12
Address: OW ��' V
/� Phone#:
cL
City: oho State: Zip: _3V'39
Tenantaxssee Name: Phone#:
Email:
CONTRACTOR: Company Name: `71C 540PIV P10171W &OP Phone#: /Z
Address: 6-1
/�'a°�/� dd,,
City: f� State: � Zip: /I /
Qualifier Name: d�e Phone#: 01'7 -�✓�/
State Certification or Registration #: Certificate of Competency #:* ®�.8�a®o
Contact Phone#: Email Address: L1C_&2A1,-f F1* * P
DESIGNER: Architect/Engineer: Phone#:
ov
Value of Work for this Permit: $' Square/Linear Footage of Work: ��1160 11;,&p1jV
Type of Work: DAddition DAlteration ONew ❑Repair/Replace ODemolition
Description of Work: ��� �� ��/� C��/l!?7 7�
Color thru tile:
Submittal Fee $ Permit Fee $131-126 CCF $ CO/CC $
Scanning Fee $ j . Radon Fee $ e 60 DBPR $ • 0 Bond $
Notary $ Training/Education Fee $ Technology Fee $ 0
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $ 11 / •
Bonding Company'%Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
State
zip
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 Iaws regulating
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS. FURNACES, BOILERS, HEATERS, TANKS and 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 t
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."
Nonce to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2.500. 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 properly 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
Owner oagent
The foregoing instrument was acknowledged lidfciif''' e this/
day of 20 by /h
who is personally known to me or who has produced"
J)0J 41� As identification and who did take an oath.
NOTARY
oil 0 %. A
'signature �Y�i2 � d �® i��
/ Contractor
The foregoing 'upstrgirient was acknowledged before me this i
day of , 20 a, by
w y me or who has produced
r as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print: Vv�-s
MMISS10N f DD W103
My CO RES: February 2, 2014
'9rxOF c•�OP Bordw Thru Baiget Noy Se cee
Structural Review Clerk
(Revised 3/12/2012)(Revised 07/11/07)(Revised 06f lOr 009)(Revised 3/15/09)
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6' fl.,
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4.00" Connections
(Max) fillet weld
CLEARANCE (trna I I
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fillet weld (typ.)
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2500 PSI min. 2500 PSI min.
CONCRETE CONCRETE
24" 24"
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--- 12" dia. 12" dia. ---0'
NOTE:
NOTE: 'f*#Aalg g'
rences Gooa Me 001. ine 77tica er:"_ zonta
supporting members of a :e shF." the C+Tp
interior of the plot on whir a fe,, ::. is located SK/�L�
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and the finished side sl' y. SURVEY the DIARY
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S('ALE: 1 INCH = 20 FEET '�02
A. R. TOUSSAINT & ASSOCIATES, INC.
LAND SURVEYORS
FLORIDA CERTIFICATE OF AUTHORIZATION NO. LB -273
620 N.E. 126 ST. NORTH MIAMI, FLORIDA 33161
FB: 515 PGS: 65-67 DATE: APRIL 14,:2006
A v E N TJ E ORDER No. 13953 SCALE: " = 20'
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LEGEND:
A.C. - AIR CONDITIONER
- PROPERTY LINE
LS - REGISTERED LAND SURVEYOR No.
WM - WATER METER
B.S. - 026"BLOCK STUCCO
CONC - CONCRETE
ENC. - ENCROACHMENT
1 5-31-13 13953-1 1 UPDATE—REVISED NO CHANGES
40. DATE I ORDER REVISION DESCRIPTION
\J
N
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A
• 70'
SCALE: 1"= 100'
LEGAL DESCRIPTION:
SURVEY OF LOTS 21 AND 22, BLOCK 97, AMMENDED PLAT
OF "MIAMI SHORES SECTION NO. 4", ACCORDING TO THE
PLAT THEREOF AS RECORDED IN PLAT BOOK 15 AT PAGE
14 OF THE PUBLIC RECORDS OF MIAMI-DADE COUNTY, FLORIDA.
SURVEYOR'S CERTIFICATION:
WE HEREBY CERTIFY THAT THIS SURVEY IS TRUE AND CORRECT
TO THE BEST OF OUR KNOWLEDGE AND BELIEF AS RECENTLY
SURVEYED AND PLATTED UNDER OUR DIRECTION AND THAT TMS
SURVEY COMPLIES WITH THE MINIMUM TECHNICAL STANDARDS
FOR LAND SURVEYING IN THE STATE OF FLORIDA, UNDER
CHAPTER 61G17-6 FLORIDA ADMINISTRATIVE CODE, CHAPTER
472.027 FLORIDA STATUTES.
NOT VALID WITHOUT THE SIGNATURE AND RAISED SEAL OF THE
REGISTERED LAND SURVEYOR SHOWN HEREON.
A. R. T A YTA& ASSO IAtES, INC.
BY: ' PRES.
DATE:
APRIL 14, 2006
SCALE: 1" = 20'
WT AT DRAWING NUMBER
BY CKO
ALBERT R. TOUSSAINT
REGISTERED ENGINEER NO. 8939
REGISTERED LAND SURVEYOR NO. 907
STATE OF FLORIDA
AZ1
TITLE MELBOURNE & VERNA TEIGLAND
9780 N.E. 5th AVENUE ROAD
MIAMI SHORES, FLORIDA 33138
SHEET DRAWN BY:
13953 1 OF 1 RS
FD -
FOUND
DH -
ORILL HOLE
IP -
IRON PIPE
1 5-31-13 13953-1 1 UPDATE—REVISED NO CHANGES
40. DATE I ORDER REVISION DESCRIPTION
\J
N
' o
� � W
A
• 70'
SCALE: 1"= 100'
LEGAL DESCRIPTION:
SURVEY OF LOTS 21 AND 22, BLOCK 97, AMMENDED PLAT
OF "MIAMI SHORES SECTION NO. 4", ACCORDING TO THE
PLAT THEREOF AS RECORDED IN PLAT BOOK 15 AT PAGE
14 OF THE PUBLIC RECORDS OF MIAMI-DADE COUNTY, FLORIDA.
SURVEYOR'S CERTIFICATION:
WE HEREBY CERTIFY THAT THIS SURVEY IS TRUE AND CORRECT
TO THE BEST OF OUR KNOWLEDGE AND BELIEF AS RECENTLY
SURVEYED AND PLATTED UNDER OUR DIRECTION AND THAT TMS
SURVEY COMPLIES WITH THE MINIMUM TECHNICAL STANDARDS
FOR LAND SURVEYING IN THE STATE OF FLORIDA, UNDER
CHAPTER 61G17-6 FLORIDA ADMINISTRATIVE CODE, CHAPTER
472.027 FLORIDA STATUTES.
NOT VALID WITHOUT THE SIGNATURE AND RAISED SEAL OF THE
REGISTERED LAND SURVEYOR SHOWN HEREON.
A. R. T A YTA& ASSO IAtES, INC.
BY: ' PRES.
DATE:
APRIL 14, 2006
SCALE: 1" = 20'
WT AT DRAWING NUMBER
BY CKO
ALBERT R. TOUSSAINT
REGISTERED ENGINEER NO. 8939
REGISTERED LAND SURVEYOR NO. 907
STATE OF FLORIDA
AZ1
TITLE MELBOURNE & VERNA TEIGLAND
9780 N.E. 5th AVENUE ROAD
MIAMI SHORES, FLORIDA 33138
SHEET DRAWN BY:
13953 1 OF 1 RS