PW-17-2374Project Address
Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
151 NE 101 Street
Miami Shores, FL 33138-
Owner Information
Permit
Permit NO. PW -10-17-2374
Penult Type: Public Works
Work Classification: Public Works
Permit Status: APPROVED
Issue Date: 10/6/2017
Expiration: 01/0412018
Address
Parcel Number
1132060131950
Block: Lot:
Applicant
SHARON HELD
Phone
Cell
SHARON HELD
151 N. E. 101 ST.
MIAMI SHORES FL
Contractor(s)
CHAMPION CONCRETE
Phone Cell Phone
(305)252-8055 (786)402-4802
Valuation:
Total Sq Feet:
$ 3,000.00
500
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
Invoice # PW -10-17-65241
10/06/2017 Check #: 2673
Amt Paid Amt Due
$ 104.00 $ 0.00
Available Inspections:
Inspection Type:
Excavation
Review Public Works
Final 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 csnformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this permit I assum:lresponsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL, PL 1' BING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNERS AFFIDAV 1 ce ( that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zo ing. Fut. ermore, I - horize the above-named contractor to do the work stated.
Authorize' Sig . .?8 Owner / Applicant / Contractor / Agent
Building Department Copy
October 06, 2017
Date
October 06, 2017 1
c23 Gly d'— k 33�
��G
1,g2 4--(0, 7
Miami Shores Village j VED
Public Works Department OCT ®�2��%
(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
Name of Applicant (if utility see below): 55/7/9/0/v i/*
Permit#: 11 23-62_
Pw 1i -x.314
Owner off the following described property:
Legal Description: Lot Block Subdivision
Folio #;
Address: /5/ /tie- /0/ 5f /f J A (5) 7 5'3/7)
UTILITY NAME:
Qualifier/Authorized Agent:
Address:
City: State: ZIP:
Telephone: Email:
State Certification or Registration #: ` Certificate of Competency #
CONTRACTOR NAME: (49 / 2/00 4,baiyi.
Qualifier/Authorized Agent: i LC.— i,4
Address: / 0 /3 ›"Cir,"--
City: State: ZIP: 337)'
Telephone: S05, 76-W-
'Z Email:J1,%�Cs 7'479/W •- Y411t7t� '
State Certification or Registration #: Certificate of Competency #:CG4251.4541S
Requests permissionrninstall' describe work, attach separate page if necessary) in the adjoining right of
way: /) `V/ 57- / 44'f r�V! /a✓'ir iia
.oma 1 13 /1/0 1-1/47
Type of Work: ['Paving 0 Utility 0 Sidewalk ❑ Electric ❑ Irrigation
❑ Landscape ❑ Antenna ❑ Other:
DESIGNER: Architect/Engineer:
Address:
City: State: ZIP:
Telephone: Email:
Registration #: ..
Value of Work for. this Permit: $ ,Pc5D•
jay{,
,.ti ..a`a
Square/LineafFootage of Work: —0700 5F
Fees*****
Permit Fee $ 100.00
Notary $ Training/Education $ 0.20 Technology Fee $ 0.80 Scanning $
Bond $ (if required) Total Fee Now Due $ tC 4 ,
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 posted at the job
site for the first inspection which occurs seven (7) days after the public works permit is i.sued. In the
absence of such posted notice, the inspection will not be approved and a reinspection ° ill be charged.
Signature
Appli or Authorized Agent
The foregoing in rument was acknowledged before
me this a / day of 20 /5 , by
B7—% e who
is personally known to me or who has produced
pLRAt763.71)-W1,-C7 as
identification.
NOTARY PUBLIC:
Sign:
aA►;�r✓.ar.
AGALY L PUR
MY COMMISSION !F FF213776
EXPIRES March 25. 2019
�.7 399{ • 5J Noridallo a Ssrviti.Gom
APPROVED BY:
2017-04-15
Signature
Company/Utility Agent
The foregoing instrumenntt wadacknowledged before
me this a ( day of 5. %/54%, 20 /7 , by
,� 2 1e %rim///� who
is personally known to me or who has produced
as
identification.
NOTARY PUBLIC:
Sign:
Print:
SEAL:
AGALY LAPUR
MY COMMISSION i! FF213776
IN'
;'';;.' EXPIRES March 25, 2019
407.398-C' 53 :loridallola Svvioa.com
***************************
Public Works Director, or Designee
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY
Whereas, (owner) $/f,9,z t) /
hereinafter referred to as the owner of the following described
property (address):%SIN %0/ SakiliS/7
Legal Description: Lot Block Subdivision
Folio # 11-52-04- 0/.37 -1q -Su
Requests permission to install (describe work): imikeito
11111H11111 Mil 11111 11111 11MIRE
tiAtIVEY
C: N 2O 17 .o5 5922_6
OR BK ?1J706 F'Q2514 (1F'3s)
FtECORDFD 10/04/2017 .L5: _ . `o
HARVEY RiJVIH1 CLERK OF COURT
I.L iN I -L'i-li i;. C UNTY y f' LAR T DA
Within the public right of way of (address) /1/ i /0/Sr
IN CONSIDERATION of the approval of this permit by the Village, the owner 6drees 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.
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 repress ative).
Signature
1. ner or Agent
State of Florida '�'''�r‘c:
County of Miami Dade �/
T fore�oyngi i�tst�nent was acknowledged before me this 7" day of
who is personally known to me or who has produced
as identification.
NOTA
Sign:
Print:
LUCIA ESTRELLA
Apr` EXPIRES: July 4, 2021
N Bonded Thru Notary Public Underwriters
SEAL:
, 20/1, by