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PW-17-1380
`i Permit'N Pw-5-'I -�138� Miami Shores Village _11-4,11 o Qr� 10050 N.E.2nd Avenue NWP� .... a Work Glassirrcotion. Public works Miami Shores,FL 33138-0000 P'e"Wt Status.APPROVED Phone: (305)795-2204 , toRmA Expiration: 09/17/2017 ��, Issue nate;6!19/ 01 P Project Address Parcel Number Applicant 17 NW 107 Street 1121360070470 Miami Shores, FL 33168-4306 Block: Lot: ARACELY BORGES Owner Information Address Phone Cell ARACELY BORGES 17 NW 107 Street (305)970-3289 MIAMI SHORES FL 33168- 17 NW 107 Street MIAMI SHORES FL 33168- Contractor(s) Phone Cell Phone STAR ISLAND CONCRETE DESIGN C( (305)776-7916 Valuation: $ 13,000.00 _._.. r._ .. Total Sq Feet: 506 Scanning:1 Available Inspections: Inspection Type: Excavation Review Planning Review Planning Review Public Works Review Public Works Final Public Works Fees Due AmountPay Date Pay Type Amt Paid Amt Due CCF $0.00 Invoice# PW-5-17-64079 DBPR Fee $0.00 06/19/2017 Credit Card $ 104.00 $0.00 DCA Fee $0.00 Education Surcharge $0.20 Permit Fee $100.00 Scanning Fee $3.00 Technology Fee $0.80 Total: $104.00 In consideration of the issuance to me of this permit pe rm the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity wi ans,drawings; atements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume re i ility.for all work done dher myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL,P CHAIdTCA Ov1/S,DOORS,ROOFING and SWIMMING POOL work. OWNERS AFF IT' €foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating constructio d z "` ore,I authorize the above-named contractor to do the work stated. June 19,2017 orized Signature:Owner / Applicant / Contractor / Agent Date uilding Department Copy June 19,2017 1 RECEIVED MAY 2 31011 Miami Shores VillageAt rr Public Works Department �� l (305)795-2210 Public works forms are available from the building department,10050 NE 2"d Ave.,Miami Shores,FL 33138 PUBLIC WORKS PERMIT APPLICATION Permit Type:Work in the Right-of-Way on Miami Shores Village or Miami-Dade Property {� Permit#• P V,4 Name of Applicant(if utility see below): A aAC-E64 1-?0t26-e,5 Owner off the following described property: Legal Description:Lot /S- Block 2(0 Subdivision 0",-? �e"mss �� -5/4/c-� 1*d 1V13 Folio#, -C70'2 0Cj2o e M.' l Address: UTILITY NAME: Qualifier/Authorized Agent: Address: City: State: ZIP: Telephone: Email: State Certification or Registration#: Certificate of Competency# CONTRACTOR NAME: S+1n Qualifier/Authorized Agent: rm Address: /090- /�� /Ly-A1-t% 66 33/.S> City ; M' State: ZIP•33/!gD Telephone: 0S- �- _�Email: /2EA1,L e1?- AA a1--,1%,L.e State Certification or Aegist6tilon#: Certificate of Competency#: 20/ d` Requests permission to install(describe work,attach separate page if necessary)in the adjoining right of way: A Z.Dfvc 2 ETA= �L � b6'1,cue�ccer �AA�c"� A e3Ds�c,o �/ AI X27" Type of Work: R. Paving ❑ Utility ❑ Sidewalk ❑ Electric ❑ Irrigation ❑ Landscape ❑ Antenna ❑ Other: DESIGNER:Architect/Engineer: Address: City: State: ZIP: Telephone: Email: Registration#: Value of Work for this Permit: $ /✓� Square/Lineal Footage of Work: ***** Fees***** Permit Fee$100.00 Notary$ Training/Education$0.20 Technology Fee$0.80 Scanning$ Bond$ (if required) Total Fee Now Due$ 1 5 Bonding Company's Name(if applicable): Bonding Company's Address: City' State: ZIP: Application is hereby made to obtain a public works permit to do the work in the right of way and installations as indicated.l 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,regulation construction in this jurisdiction. I understand that separate permits must be secured for APPLICANT'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with applicable laws regulating construction and specifically construction in the right-of-way. "WARNING TO APPLICANT:YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO THE RIGHT-OF-WAY.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 public works 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 property is subject to the 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 public wjaAks permit is issued. In the absence of such posted notice,the inspection will not be approve and inspection will be charged. Signature cam` Signature A (cantor orized Agent Com ny/Util y Agent The foregg in�instrum t as kn wledged ore The foregoi ginstru e t wa cknowledged efore me this day of 20 by met is day Z0 by u ciz s who f is personally know me oY who has rso I known to o has prod e 1,• [dent] RI ntlfication H4U CARLOS RAUL a aW 1 y COR •_ NOTA _ U Com: MY COMMISSION#GGOIi I NOTARYPUB * MY tS13SION#GG017733 EXPIRES:August 16,2020 RES:August 16,2020 F ;°• Bonded Thru Notary Public Uraierwriiem j ons" Notary Public Sign: Sign: unde"whore Print: r"6,5 /L"L/ Print: SEAL: SEAL, APPROVED BY: Public Works Director,or Designee 2017-04-15 - • • {ill{i{�!{il{iffi i�{i{i[��{•i�i�{lilii{�i{ill{ ,. OR BK •30542 Pss 4611-.4613 (3F'ss) RECORDED 05122/2017 11:13:76 D 0 CUMENT COVERPAGE' HARVEY RMt INN CLERK OF COURT MAMI-DADE COUNTY7 rLORTDA Por those documents not providing the regd•ed 3 x 3 in . !� spars on tb-o first page,this coyer page must be atfached. An additionatrwzrdmg fee for this pagD must be remitted. . ---------------------------- • - (S�am abcye Eds rma T=4Ytd`b L=+Tm6 mfffCC V56) 7JoeumentTifle: �t/-Q -+-r,�•••� �J Lc�-�•_S�IZ�G�a-. Wmtgap,Deed,EtG.) Ref am D o mm ent To///Prepared Bg:- ti , Hale 2520(d)0a an—,,dom=mh prepmed_v nh are in be recorded inihe pnblic retards of my comcy•,.a S. spaceaEfbetopzigh hand cozyonfaefMpapend al-mcbbyS-inch spacaa±-hetopHg�EEhandro=Or onearh snI7sP1�fFagesbaIlbel bTR„t��„�,�e edfnr use by 4n dirk of rpt CL CLKCF 156 Rev.03m6 Clws Web aodm=www.m(amkdadeci Q 9� b coo WE TFusr 0 �qoF coin S I-C. 13 Miami shores Village :illi oil ,,,,,t" Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 alp tipA Tel: (305) 795.2204 Fax: (305) 756.8972 COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY Whereas, (owner) /A�t�/ J_4�j hereinafter referred to as the owner of the following described property(address): /7 /U k/ /O 7 J� /� � ✓!h'r' �� U144" g t 4 rew4�.n ti / No3 Legal Descri tion ` �� 5[Jo-ra.� ExT Lot IS- Block 2 f[ Subdivision P13 6-2.-33 Folio# Requests permission to install (describe work): A- COWC_057-A 00.'Vec.�ce-N Within the public right of way of(address) 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. CLERK 1F -7.fr N G Ydi TRUST 0 COUe ' OR BK 30542 PG 4613 LAST PAGE= 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 the land and shall remain in full force and effect and be binding on the undersigned,their heirs and assigns, until such time as this obligations has been canceled by an affidavit filed in the Public Records of Dade County, Florida by the Village Manager of Miami Shores Village (or his fully authorized representative). SIGNED, SEALED, EXECUTED AND ACKNOWLEDGE on this f" y of 2017 Ignature) SIGNED, SEALED, AND DELIVERED in th presence of: 4 � � ••AyP � ��n °j%;-, LINA FIGUEROA BET*Florida rY4°�z Notary Public-State of My Comm.Expires Jul 1Commission#FF 14 E OF FLORJDA,COJNTY OF DADE: �c©e�,j� �} DY CERTIFY tF:taf the is a true Copy Of ffae &P CLE'ax c F. v wce on A C 20 day of Wf ry and and ®f Seel u►fs 4A V LIVIN.C of C v� tF SHAKIERRA BRA , �GLL ti 2