PW-17-2001Project Address
Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Permit
Permit NO. PW -8-17-2001
Permit Type: Public Works
Work Classification: Public Works
Perrnit Status: APPROVED
Issue Date: 9/2812017
Expiration: 12/27/2017
Parcel Number
Applicant
1226 NE 100 Street
Miami Shores, FL 33138-2604
1132050090060
Block: Lot:
VALDIVIA HOLDINGS LLC c/o M
Owner Information
Address
Phone
CeII
VALDIVIA HOLDINGS LLC c/o MELLAW 2601 S BAYHORE Drive
--- - -- -- - COCONUT GROVE FL 33133-
2601 S BAYHORE Drive
COCONUT GROVE FL 33133-
Contractor(s)
MIAMICRETE INC
Phone
(305)790-4850
CeII Phone
Valuation:
$ 2,000.00
Total Sq Feet: 250
Scanning: 1
Fees Due
CCF
DBPR Fee
DCA Fee
Education Surcharge
Notary Fee
Permit Fee
Scanning Fee
Technology Fee
Total:
Amount
$0.00
$0.00
$0.00
$0.20
$5.00
$100.00
$3.00
$0.80
$109.00
Pay Date
Invoice #
09/28/2017
Pay Type
PW -8-17-64805
Credit Card
Amt Paid
$ 109.00
Amt Due
$ 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 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
require for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNERS
constructio
VIT: I certify that all th
ning. Futhermore, I aylho
ion is accurate and that all work will be done in compliance with all applicable laws regulating
ed contractor to do the work stated.
uthorized Signatre: Owner / Applicant / Contractor /
Building Department Copy
September 28, 2017
Date
September 28, 2017 1
Miami Shores Village
Public Works Department
(305)795-2210
Public works forms are available from the building department, 10050 NE 2"d Ave., Miami Shores, FL-33.1-313—
PUBLIC
L 33138—
PUBLIC WORKS PERMIT APPLICATION
Permit Type: Work in the Right -of -Way on Miami Shores Village
Name of Applicant (if utility see below):
Owner off the following described property:
Legal Description: Lot Block
Folio #;
Address: 122.4. Nie. £OO ST
or Miami -Dade Property
Permit#: ,V S 11 -2000
Pw17-Z OIt
VA- LDIV iA- i-i-o/LGD/hi (Pr LLG
Subdivision
4141 Si+u LCS F [, 33 /s8
UTILITY NAME:
Qualifier/Authorized Agent:
Address:
City: State: ZIP:
Telephone: Email:
State Certification or Registration #: Certificate of Competency #
CONTRACTOR NAME: 111/ ,4411 c &ErC.
Qualifier/Authorized Agent: +iG N/Li Q t/C /vU/Vr 2 -
Address:
Address: l g i G SCA) top tr.
City: 1.q,i km t State: tC' L ZIP: 331 !'S'
Telephone: 766,. 963 .-746Y' Email:
State Certification or Registration #: Certificate of Competency #:
Requests permission to install (describe work, attach separate page if necessary) in the adjoining right of
way: i.EMO1E" 1 R CiocA-c E,x.1 rTrNG tecre-
Da-oD Q -t rciAi y
Type of Work: ❑ Paving 0 Utility ❑ Sidewalk ❑ Electric 0 Irrigation
❑ Landscape ❑ Antenna Other: C014/C.-/e-CTC pac /& W.4r
DESIGNER: Architect/Engineer:
Address:
City: State: ZIP:
Telephone: Email:
Registration #: �
Value of Work for this Permit:
$ 410/ Square/Lineal Footage of Work:
*****Fees*****
250
Permit Fee $ 100.00
Notary $ Training/Education $ 0.20 Technology Fee $ 0.80 Scanning $
Bond $ (if required) Total Fee Now Due $
101
oa)
0
Bonding Company's Name (if applicable): Me-Lk/267g
Bonding Company's Address: 7//O 6"w /6 s7
City: "L7/A.Gc/' State: f/ ZIP: 3 j/Sy-
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 t
attachment. Also, a certified copyof the recorded notice of commencement must be poste
site for the rst inspection which occurs seven (7) days after the public works permit is iss
absence osuch posted notice, the i pe ill not be approved,: • a reinspe ion w' I
Signa • ihki. t's*Signature
AM\
Applicant .r Auth.rize. Agent omp _ ny/Utility Aa!
The foregoing instrument was acknowledged before The foregoing instrmen I was ackno •►•
me this 210 day of 30 , 20 17 , by me this 71 day of
MOr Srni-4 who
is personally known to me or who has produced is personall known to me or who has produced
1'V'(1 i C-ehS-e as as
identification.
e
t the job
ed. In the
be charged.
ed before
,201z ,by
who
NOTARY PU:
Print:
•
;�Y dye•. YA•i Y PRIETO V
- m
MY COMMISSION # FF 214031
EXPIRES: March 25, 2019
ARA . 0. Bonded Thru Notary Public Underwriters
APPROVED BY:
2017-04-15
identification.
NOTARY PUB
Sign:
Print:
SEAL:
1 ALVAREZ
ISStON # 00090533
05, 2021
*4,4, *********************************
, 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
I IIlIII!lIII IIIA VIII VIII VIII VIII II I ilii
C fr [moi 201 7R04-4 ,, J
OR BK 30640 P9 3047 (1Pis)
RECORDED OVH/2017 101'12,
HARVEY 'U IH: CLEC OF _SOUR
HIAri-..DAi' : COUNTY_ FLORIDA
COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY
Whereas, (owner) VAL Ai VIA /AL6//U
hereinafter referred to as the owner of the following described
property (address): 12240 NE- loo ST
Legal Description: Lot 42 Block / Subdivision Eke L TO' PB 143•80
Folio # t I • 3 20 3 • cool
Requests permission to install (describe work): ft L P'4 cE zziST[ Iv G 6DAllpti6 ED�
Die/ V CLJAI
Within the public right of way of (address) 1224 NE 10' S?'.
lel( A141 Sf*'P( 3,313'
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.
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, V FI a_b the Villa a Manager of Miami Shores Village
(or I silly authorized re reser . ' e). BYC 19E! CO,aUNTY OF D cou,
original on fife in this off.. t 2
Signature
State of Florida
County of Miami Dade
The foregoing instrument was acknowledged before me this 2t day of of , 20 11 , by
who is personally known to me or who has pro ce
as identification.
Owner or Agent
JES E MERRITT #310229
MO n►cusr
7rl�Y iic�enS-
NOTARY UBLI
Sign:
Print: car\ck Pr 0
SEAL
,,, ei,; YANADY PRIETO
=
_,: .k ,.. .,, MY COMMISSION # FF 214031
%a•.r-..,a= EXPIRES: March 25, 2019
�;
oF F4, Bonded Thru Notary Public Underwriters