PW-17-2027Project Address
Miami Shores Village
• 10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Permit
Permit NO. PW -8-17-2027
Permit Type: Public Works
Work Classification: Public Works
Permit Status: APPROVED
Issue Date: 8/1012017
Expiration: 11/08/2017
Parcel Number
Applicant
1225 NE 92 Street
Miami Shores, FL 33138-2936
1132050270300
Block: Lot:
KAREN BLAIR PREDRAG STAR(
Owner Information
Address
Phone
CeII
KAREN BLAIR PREDRAG STARCEVIC 1225 NE 92 Street
MIAMI SHORES FL 33138-2936
(305)751-9333
1225 NE 92 Street
MIAMI SHORES FL 33138-2936
Contractor(s)
MIAMICRETE INC
Phone
(305) 790-4850
CeII Phone
Valuation:
Total Sq Feet:
$ 3,640.00
520
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 -8-17-64835
08/10/2017 Check #: 4555 $ 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 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 AFFIDAVIT: I certify that all the f.regoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction zonihg. Futhermore, I� uth;ize thabove-named cdQtractor to do the work stated.
Authorized Signature: Owner` / Applicantf'/ Contractor / Agent
Building Department Copy
August 10, 2017
Date
August 10, 2017 1
aa,e)(-5-) 79D - /A376-0
Public wor{cs for
PViS\OV'\
Miami Shores Village
Public Works Department
(305)795-2210
are available from the building departments 10050 NE 2"° Ave., Miami Shores, FL 33138
Permit T PUBLIC WORKS PERMIT APPLICATION
Ype: Work in the Right -of -Way on Miami Shores Village or Miami -Dade Property
/qv ze)z7
me of Applicant (if utility see below):
Owner off the following described prope
Legal Descri.tion: Lot Blo
Folio #; —.3 1-6--
";.'�, IN
Address: ,,�r
Permit#-,,
-pB Frei( a.01 01 E;41
y //: tS f>�7� �O
Subdivision
UTILITY NAME:
Qualifier/Authorized Agent:
Address:
City:
State:
Telephone: / ZIP:
Email:
State Certification or Registration #:
CONTRACTOR NAME: '--i-y),(0,
Qualifier/Au rized Agent:
Address: 79 (T' t.
City:
Telephone,9j) - nail:
State Certification or Registration #: Certificate of Competency #:
Requests pePla)-"t,
on to ins&wTh�t
(describe ork, atta separate page if necessa
way: ,o � J � (z�ry) in the adjoining right of
�� Lit
Q
(N€ -
Certificate of Competency #
State: //s- , ZIP:
Type of Work. ,' Paying 0 Utility
0 Sidewalk 0 Electric 0 Irrigation
' 0 landscape ❑ Antenna ❑ Other:
DESIGNER: Architect/Engineer:
Address:
City:
Telephone:
Registration #:
/ State: ZIP:
Email:
Value of Work for this Permit:
d _
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 $
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 Saws, regulation construction in
th.s 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 issued. In the
absence of such posted notice, the inspection will not be approved and a reinspection will be charged.
Signature
The foregoin
e this
is person
idem
NOTA
Sign:
Applicant or Authorized Agent
instrumen was acknowledged before
r C! who
o me or who has produced
Signa
The foregoi
me
Coma'' / tility
g instrument was acknowledge
day of O V , 20
efore
by
who
n hac produ etj,
is perso
Print:
SEAL:
identific
NOTAR
Sign:
Print:
SEAL:
Ro• s.
` MY COMMISSION • GG090533
ti
EXPIRES. - ;gym OS. 2u2 t
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APPROVED BY: , Public Works Director, or Designee
2017-04-15
vED
AUG 0 2017
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 33138
PUBLIC WORKS PERMIT APPLICATION
Permit Type: Work in the Right -of -Way on Miami Shores Village or Miami -Dade Property
Permit#:DS f7 202(7
uj 17- 2 0 27
Name of Applicant (if utility see below): re. A C 9-1--a_crop v j 0
Owner off the followi i de ribgd property:
Legal Description: Lot 4""r Block 2 Subdivision ce /_,21-4,
Folio #; 7 ocg�eo
Address: 1 2.� frE q 2 1 rot, ! 01 ;Q , aioa-si FC .
UTILITY NAME:
Qualifier/Authorized Agent:
Address:
City: State: ZIP:
Telephone:
State Certification or Registration #:
Email:
Certificate of Competency #
CONTRACTOR NAME: ,'11 r 1 Ij!/ii-Z_
`f
Qualifier/Authorized Agent: j / t tC-,e,
Address: Vei IQ S LO 44- G4 -1,,e, .l:
�
City: y) , �Sta : .
Telephone:(ZD5 'id T •ea`" 6nail: ade
State Certificatio or Registration #:
//%
ZIP: 55
Certificate of Competency #:
Requests permissio P to install (d crbe work, attach separ to pa:Q if necessary) in the adjoining right of
way: / i/1 % / /. 2 `z
41 VM
Type of Work: Paving ❑ Utility 0 Sidewalk ❑ Electric 0 Irrigation
0,1=1. Landscape ❑ Antenna ❑ Other:
' DESIGNER: Architect/Engineer:
Address:
City: State: ZIP:
Telephone:
Registration #:
Value of Work for this Permit: $
Email:
00 isCege-
Square/Lineal Footage of Work:
*****Fees*****
Permit Fee $ 100.00
Notary $ Training/Education $ 0.20 Technology Fee $ 0.80 Scanning $ 3 o,
Bond $ b (if required) Total Fee Now Due $ 10 4
• r
Bonding Company's Name (if ap licable): �.,.�
Bonding Company's Address: lq/b s Arm'
City: IniCVN, , State: ZIP: -5—
Application
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 regulati n const on in
this jurisdiction. I understand that separate permits must be secured for Ia"ff
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 $2,500, the applicant must promise in good faith that a copy of the notice of commencement
and construction lien law brochure will be delivered to the person whose property is subject to the
attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job
site for the first inspection which occurs seven (7) days after the public works permit is issued. In the
absence of such posted notice, the inspection will not be approved and a reinspection will be charged.
Signature
Applicant or Authorized Agent _
The foregoi instrument was acknowledged before The foregoing instrument was acknowledged before
r$his day ofikJ t15 t , 20 /7 , by me this day -of - 20 /7 , by
/gDA443 '573y/41//6 who erAi f 'f l/ who
is oerso ally known to me or who has produced is personally known to me or who has produced
as
Signature
Corfipany/Utility Agent
identification.
NOT
Sign:
Print:
SEAL:
as
identificism:.
ROD 0 ALVAREZ
NOTARY
Sign:
Print:
SEAL:
{ B • '`= MY C • M - • N # G000533
April 1 .,
........ ...................................
APPROVED BY: , Public Works Director, or Designee
2017-04-15
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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) PCPA (,Q T4�� �U i hereine
owner of the following described property ,(address): �'2 2,5 Nb
Legal Description
Folio # I\ - 3 2,05 -()2'7- 0 i7(--)
r
ferred
Lot ��� `� CBlock 2- Subdivision
Ain; )/IO(eS
' -e
)ci.0 x
Requests permis i n to install (describe work): qq:Id2.1 l2 (-1l r.-o+e
Gti v r
Within the public right of w y of (address V r a�.3 - C,
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, Florida by the
Village Manager o ai Shores Village (or his fully authorized representative).
Owner or Agent
he foregoinginstrument was acknowledged before me this _ day of,G vs� 20/7 . by
/'D tmq -110(.0//6_who is personally knownto me or who has produce
as idefftification an ••v,, • o did talo an--;Aath..__.___,_-.
( c\ j
cC1
NOTARY PUBLIC:
Sign:
Print:
ROOM
t4 MY COM
My Commission Expires:
AWARE
pp
E OF FLORID COUNTY OF DADE
R7 1'hhatt?'ithe
on
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EP'6' ST !DGER #172204