PW-17-22011
Project Address
Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
869 NE 98 Street
Miami Shores, FL 33138-
Owner Information
Permit No. PW -8-17-2241
Permit Type: Public Works
Work Classification: Public Works
Permit Status: APPROVED
Issue Date: 8/31/2017
Expiration: 11/29/2017
Parcel Number
Applicant
Address
1132060142510
Block: Lot:
GEORGE SIDNEY PICKARD
Phone
Cell
GEORGE SIDNEY PICKARD
869 NE 98 Street
MIAMI SHORES FL 33138-2532
Contractor(s)
CHAMPION CONCRETE
Phone CeII Phone
(305)252-8055 (786)402-4802
Valuation:
Total Sq Feet:
$ 2,450.00
216
Scanning: 1
Fees Due
CCF
DBPR Fee
DCA Fee
Education Surcharge
Permit Fee
Scanning Fee
Technology Fee
Total:
Amount
$0.00
$0.00
$0.00
$0.20
$100.00
$3.00
$0.80
$104.00
Pay Date Pay Type Amt Paid Amt Due
Invoice # PW -8-17-65042
08/31/2017 Check #: 1951 $ 104.00 $ 0.00
Available Inspections:
Inspection Type:
Excavation
Final Public Works
Review Public Works
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, ROOFING and SWIMMING POOL work.
OWNERS AFFID IT: I - -ll the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
constructio - d zoni authoriz the above-named contractor to do the work stated.
uthermore,
g.
ized Signature: Owner / Applicant / Contractor / Agent
Building Department Copy
August 31, 2017
Date
August 31, 2017
Miami Shores Village
Public Works Department
(305)795-2210
Public works forms are available from the building department, 10050 NE 2nd Ave., Miami Shores, FL 33
RECEIVED
PUBLIC WORKS PERMIT APPLICATION
Permit Type: Work in the Right -of -Way on Miami Shores Village or Miami -Dade Property
Permit#:
AUG 3 12017
138
.5A j
Name of Applicant (if utility see below): v coed 2- . i vluey ,l rch-A4AM -n
Owner off the following described property:
Legal Description: Lot Block Subdivision
Folio #; 011-N 2-57 0,
Address: 4-6 ivo q d' S,y /7 d94(41 "I"Long 3.:N �r
30s—ico-4bS
UTILITY NAME:
Qualifier/Authorized Agent:
Address:
City: State: ZIP:
Telephone: Email:
State Certification or Registration #: Certificate of Competency #
CONTRACTOR NAME: x C114 Ai& . t zi5-1^t
Qualifier/Authorized Agent: -j -C- &445)L 1 D
Address: j O -d'fD /V W Co 3 `.7 t OS
City: '44-L State: . ZIP: 'a 37
Telephone:-? VS Email: --/1N1`ieehAit-po YA-114W,
State Certification or Registration #: Certificate of Competency #: CG US O03'?.
Requests permission to install (describe work, attach separate page if necessary) in the adjoining right of
way: (�k -err-C,, 'd// A -i' 4-4/-'1.
Type of Work: Paving 0 Utility ❑ Sidewalk 0 Electric ❑ Irrigation
❑ . Landscape ❑ Antenna ❑ Other:
DESIGNER: Architect/Engineer:
Address:
City: State: ZIP:
Telephone: Email:
Registration #:
Value of Work for this Permit: $ 2`150 Square/Lineal Footage of Work: 2 Igo
***** Fees *****
Permit Fee $ 100.00
Notary $ Training/Education $ 0.20 Technology Fee $ 0.80 Scanning $
Bond $ (if required) Total Fee Now Due $ 10L% - v�
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. 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, 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 pos ed at the job
site for the first inspection which occurs seven (7) days after the public works permit is ij. ued. In the
absence of such posted notice, the inspection will not be approved and a reinspection , ill be charged.
Signature]
plicant or Authorized Agent
The foregoing instrumen was acknowledged before
me this 1� day of 20 t 1 , by
�p f- S Pickc�+ alt who
iss-��er ally.kpown to me or wIWhas produced
riv-ev L `C'e N S ' as
identification.
NOTAR PUBL1:
Sign:
Print:
SEAL:
YANADY PRIETO
■, MY COMMISSION # FF 214031
y • a€ EXPIRES: March 25, 2019
'';;
;;oi 11t,• Bonded Thru Notary Public Underwriters v
•
****.********************
APPROVED BY:
2017-04-15
(1nature
Cor'pany/Utility `:ent
The foregoing instrument was acknowledged before
me this t8 day of �t'lY' .4. , 20 11 , by
N^Zt Qp►S;who
i ersonally known to me or who has produced
'Dr;.te tiNKs-e as
identification. $240 44z1 631011 0
afQAJ
U
NOTARY PU
Sign:
Print:
SEAL:
YANADY PRIETO
MY COMMISSION # FF 214031
EXPIRES: March 25, 2019
Bonded Thru Notary Public Underwriters
TrT.
, Public Works Director, or Designee
BLDG DFPT 1 15' A_ LEY "'N/AM/ SHORE
iR '1-C O COhhrL- TANLE WI IH ALL f" E P�BE�OOPG. .37
3cOo i's i
GAS LINE
OVERHEAD POWER LINE
WATER LINE
WOOD FENCE
SEWER LINE
CHAIN LINK FENCE
CENTER LINE
BENCH MARK
CONCRETE BLOCK AND STUCCO
ELEVATION
ID
IP
IRC
L.H.
NGVD
P.G.
R
R.O.W.
SOF
CAP OR DISK IDENTIFICATION
IRON PIPE
IRON REBAR 1 CAP
LICENSE OF BUSINESS
NATIONAL GEODETIC VERTICAL
PLAT BOOK
PAGE
RECORDED
RIGHT OF WAY
SQUARE FOOT
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BOUNDARY SURVEY
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OVERHEAD POWER LINE
WATER LINE
WOOD FENCE
SEWER LINE
CHAIN LINK FENCE
CENTER LINE
BENCH MARK
CONCRETE BLOCK AND STUCCO
ELEVATION
ID
IP
IRC
L.H.
NGVD
P.G.
R
R.O.W.
SOF
CAP OR DISK IDENTIFICATION
IRON PIPE
IRON REBAR 1 CAP
LICENSE OF BUSINESS
NATIONAL GEODETIC VERTICAL
PLAT BOOK
PAGE
RECORDED
RIGHT OF WAY
SQUARE FOOT
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BOUNDARY SURVEY
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APPOSSI
IIT GEO$OIIITION$
A LAND SURVCYNG COMPANY
14612 SW 02ND 6T. MIAMI FI. 33175
SURVEYOR NOTES
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•••... • • .
PROPERTY ADDRESS: 869 INE•98. ST, Miami Shores,
FL %3J 8 •
•
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LEGAL DESCRIPTION: •,... • • •
LOT 20 AND THE WES;1a OF LOT 211'8L83K
72, OF MIAMI SHORES SECTIO 3, PLAT BOQK 10
PAGE 37, PUBLIC RECBRDS• 0 MIAMI DACE • •
COUNTY, FLORIDA. ,
SUBJECT TO EASEMENiS7,RCIICTIONS AAA
RESERVATIONS OR EASEMENT OF %CORD.
• . a•••••
•
LEGAL NOTES: • • .
BEARING BASE ON AN ASSUMED MERtI iilF Da
S 89.47'59' E ALONG THE SOUTHERLY ow OF
SAID PROPERTY, DEFINED BY THE TWO FOUND
IRON PIPES,
EXAMINATION OF THE ABSTRACT OF TITLE WILL
HAVE TO BE MADE TO DETERMINE RECORDED
INSTRUMENTS, IF ANY, AFFECTING THE PROPERTY
LEGAL DESCRIPTIONS PROVIDED BY CLIENT.
UNDERGROUND ENCROACHMENTS, IF ANY, ARE NOT
SHOWN.
THIS FIRM HAS NOT ATTEMPTED TO LOCATE
FOOTING AND/OR FOUNDATIONS AND/OR
UNDERGROUND IMPROVEMENTS OF ANY NATURE.
THIS SURVEY IS NOT INTENDED FOR NEITHER
DESIGN NOR CONSTRUCTION PURPOSES, FOR
THOSE PURPOSES A TOPOGRAPHIC SURVEY IS
REQUIRED,
FENCE OWNERSHIP NOT DETERMINED
CERTIFY TOS GEORGE SIDNEY PICKARD JR
RAUL TIZA `J l' •
LAND SURVEYOR AND A - -;--- 942, LB 8129
STATE OF FLORIDA
14612 S.W. 32nd S -EET O I, FLORIDA "33175 ,
PHONE' 786-975-8588 0
NOT VALID WITHOUT THE SIGNATURE AND rHE
ELECTRONIC
SEAL OF A FLORIDA LICENSED SURVEYOR' AND
MAPPER
SCALE
SHEET NUMBER
1"=-20'
1 / 1
FIELD JOB DATE
AUG.22 2017
FILE NAME
869 NE 98 ST, MIAMI SHORES FL
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