The URL can be used to link to this page

PW-17-1861Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Permit Permit NO. PW -7-17-1861 Permit Type: Public Works Work Classification: Public Works Permit Status: APPROVED Issue Date: 8/9/2017 Expiration: 11/07/2017 Parcel Number Applicant 905 NE 92 Street Miami Shores, FL 33138- 1132060050010 Block: Lot: PAUL GOLDENBERG Owner Information Address Phone Cell PAUL GOLDENBERG 16445 COLLINS Avenue SUNNY ISLES FL 33160- 16445 COLLINS Avenue SUNNY ISLES FL 33160- Contractor(s) Phone Cell Phone CHAMPION CONCRETE (305)252-8055 (786)402-4802 Valuation: $ 3,200.00 Total Sq Feet: 600 Scanning: 1 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Work without a Permit Fee Amount $0.00 $0.00 $0.00 $0.20 $100.00 $3.00 $0.80 $100.00 Total: $204.00 Pay Date Pay Type Amt Paid Amt Due Invoice # PW -7-17-64637 08/09/2017 Check* 2592 $ 204.00 $ 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 self, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOO' ., ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing information construction and zoning. Futhermore, I authorize the above -nam ate and that all work will be done in compliance with all applicable laws regulating ctor to do the work stated. August 09, 2017 Authorized Signature: Owner / Applicant / ' ontractor / Agent Building Department Copy Date August 09, 2017 1 ULMiami 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 8 J L 20,2017 PUBLIC WORKS PERMIT APPLICATION Permit Type: Work in the Right -of -Way on Miami Shores Village or Miami -Dade Property Permit#: t (-) — g2' Name of Applicant (if utility see below): t91/L— 64a, 4 / A a G Owner off the following described property: Legal Description: Lot Block Folio #; Address: l'as //E 672,7 Subdivision UTILITY NAME: Qualifier/Authorized Agent: Address: City: State: ZIP: Telephone: Email: State Certification or Registration #: Certificate of Competency # CONTRACTOR NAME: r'7A /4) 6A,ape-pe Qualifier/Authorized Agent: Address: /02 -it) NC I/ 1,3 Z 4t_ /7)5 City:__0O 1'L State: r- ZIP: -3/17, Telephone: Email: State Certification or Registration #: Certificate of Competency #: Z O esao s Requests permsion to install (describe work, attach separate page if necessary) in the adjoining right of way: (©r.O 97t12-- 5, Type of Work: 0 Paving 0 Utility ❑ Sidewalk 0 Electric 0 Irrigation ❑ Landscape ❑ Antenna ❑ Other: 401/8.14,7-&- )0,05' DESIGNER: Architect/Engineer: Address: City: State: ZIP: Telephone: - Email: Registration #: $ Value of Work for this Permit: Square/Lineal Footage of Work: 600' ***** Fees***** Permit Fee $ 100.00 4- c. Ito (Pt -3t2 N (% FRA.4.1 (&\\ Notary $ Training/Education $ 0.20 Technology Fee 0.80 Scannin $ Bond $ (if required) Total Fee Now Due $ 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 besecured 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 tdthe person whose property is subject to the attachment. Also, a certified copy of the recorded notice�of co`m enc m�ent1must be poste.j•t the job r.,4, -"v.-% 4r.1. site for the first inspection which occurs seven(7)'days after the public'works permit is iss •. In the absence of such i• notice, the inspection will not bye approved and a reins. -ction wil F e charged. "--\ II- `/� Signature 4 Ai 1 W.cant or Autho ized Agent The foregoumerxt /' knowledgedIbtlore m :ph- .� _ ii',[[-,=',' • 20 //, by 'IL S e / arUIRUr who is pe so Ily kn n to me or who s produced as identificati• NOTARY Sign: Print: SEAL: 2o,"RY'°Be% LUCIA ESTRELLA * MY COMMISSION # EE 880165 FXPIRFS• ,hdy 99017 e`O Bonded Thru Budget Notary Services APPROVED BY: 2017-04-15 Signature The fo'r m Com 'f ny U ility AA t g instru nt "k` o"wledged/ore , 20 by • who is personally .. to me6,t has produced �/ as identific NOTA Sign: Print: SEAL: P0.Y•Pue(,C LUCIA ESTRELLA 880165 * 1 EXPIRES: July 2, 2017 .Thru Budget NotaryServices OF F- ********************************* , Public Works Director, or Designee