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PW-16-1263174 16-1 26 3 1:117(1:t1 sF-a-c�it�n,11(1.7;c14;(1:12-"`"El--- Project Address Miami Shores Village 10050 N.E. 2nd Avenue NW Miami Shores, FL 33138-0000 Phone: (305)795-2204 165 NW 96 Street Miami Shores, FL 33138-0000 Owner Information Address Permit Permit NO. PW -5-16-1263 Permit Type: Public Works Work Classification: Public Works Permit Status: APPROVED Issue Date: 5113/2016 Expiration: 08/11/2016 Parcel Number 1131010250130 Block: Lot: 165 NW 96 MIAMI SHORES FL 33150-1714 Contractor(s) MASTEC NORTH AMERICA, INC Phone (305)232-3484 Cell Phone Phone Applicant Cell Valuation: Total Sq Feet: $ 6,000.00 310 Scanning: 3 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Total: Amount $3.60 $4.65 $4.65 $0.00 $0.00 $0.00 $0.00 $12.90 Pay Date Pay Type Invoice # PW -5-16-59729 05/13/2016 Money Order Amt Paid Amt Due $ 12.90 $ 0.00 Available Inspections: Inspection Type: Final Excavation Review Electrical 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 foregoing information is accurate construction and zoning. Futhermore, I authorize the above-named contractor t Authorized Signature: Owner / Applicant / Contractor Building Department Copy d that all work willjae done in compliance with all applicable laws regulating o the work st May 13, 2016 Date May 13, 2016 1 ow° Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC 206-1 BUILDING Master Permit No. w 1 ' 17 PERMIT APPLICATION Sub Permit No. 0BUILDING 0 ELECTRIC 0 ROOFING ❑ REVISION 0 EXTENSION 0RENEWAL PLUMBING El MECHANICAL JOB ADDRESS: City: IXIPUBLIC WORKS El CHANGE OF 0 CANCELLATION 0 SHOP CONTRACTOR DRAWINGS 165 NW 96th ST 1 COS° _ Z A:JK-- ^ reN I SG STz4.14.--T Miami Shores County: Miami Dade Zip: 33150 Folio/Parcel#: Is the Building Historically Designated: Yes NO X Occupancy Type: Load: Construction Type: Direct bore Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): AT&T Telecommunications Address: 9101 SW 24th ST Phone#: 305-222-8207 City: Miami Tenant/Lessee Name: Email: State: FI. Phone#: Zip: 33165 CONTRACTOR: Company Name: Mastec North America, Inc. Address: 2801 SW 46th AV Phone#: 954-587-4774 City: Davie State: FI. Qualifier Name:12-n-kjv 062 - State Certification or Registration #: E+G000 t 5 DESIGNER: Architect/Engineer: Jesus Castellanos Address: 9101 SW 24th ST Zip: 33314 Phone#: Certificate of Competency #: Phone#: 305-222-8207 City: Miami State: FI. Zip: 33165 Value of Work for this Permit: $ $6,000.00 Square/Linear Footage of Work: 310 ft Type of Work: ❑ Addition ❑ Alteration N-1 New ❑ Repair/Replace ❑ Demolition Description of Work: Direct bore along north R/W of NW 96th ST between 195 NW 96th ST and 153 NW 96th ST Specify color of color thru tile: Submittal Fee $ Permit Fee $ Scanning Fee $ Radon Fee $ Technology Fee $ Training/Education Fee $ Structural Reviews $ (Revised02/24/2014) CCF $ CO/CC $ DBPR $ Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage lender's Address City State Zip Application is hereby made to obtain a permit to do the work 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 regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, AIR CONDITIONERS, ETC OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. 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 building permit with an estimated value exceeding $2500, 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 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 building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. /+ Signature OWNER or AGENT The foregoing instrumentjway acknowledged before me this 1 --tt day of HAI -4--- t1 Li() d'ki71 personally known to me or who has produced identifications al did take an oath. NOTARY Pt7BUC Sign: P MY COS:V.!SSIO'1 f EE 37�s EXPIRES: May 3.201' 6:^41.4Mr, Novi P 1(lh+:�rlrel as 1 Signature CONTRACTOR The foregoing instrument was acknowledged before me this 5`day of 4 1'A -' , 20 \ O , by 1- e_rk QAC-+ who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: P S (iC71 398.0153 MY COMMISSION #FF071941 EXPIRES November 20, 2017 FIori1a1Not rySer.ice.com APPROVED BY (Revised02/24/2014) Plans Examiner Zoning Structural Review Clerk PROPERTY ADDRESS: 195 NW 96TH ST zlw w 0 PROPERTY ADDRESS: 185 NW 96TH ST 30' Prop. D�rect bore 5' CONC. SWK PROPERTY ADDRESS: 177 NW 96TH ST GRASS SWALE AREA 12 j�— MW PROPERTY ADDRESS: 165 NW 96TH ST PROPERTY ADDRESS: 153 NW 96TH ST EE)P COP 1 car 308' GRASS SWALLE AREA ror AERIAL SYMBOL LEGEND Proposed Existing Description BUREO CABLE —B AERIAL CABLE • 0 BST POLE * * POWER POLE ."< ' ANCHOR & GUY 4\ PUSH BRACE .II- PB —(--PB ......^....-...-• ✓-,------" AERIAL SVC WIRE 5,c SN• )I IV ' ') IH U.W SJ I' IF I AJN ',;)O CINV 11V,S IVF] .U_h 1 IV H11M =1JNVI IcU JOG 0110JI'41rI ; .?,,,(,9-4/z/ 20110 2 15.10 P 1d309010 1d3Q 9NINOZ 5' CONC. SWK R/W BURIED SYMBOL LEGEND Proposed Existing LJ scriplion BUREO CABLE —B B BUR JOINT -TRENCH BJ— — BJ .� ___A___ ENCLOSURE +..• ENCLOSURE MANHOLE �-1 PIPE/CONDUIT I I CA-MKR CA-MKR CABLE MARKER — — B — — — B — — BURIED SVC WIRE " —v— -' -- _a--- JOINT -TRENCH SVC N/A BORE j//// N/A CUT PAVEMENT I_ _ _ I N/A SPLICING PIT 2001)( 271 N/A TRENCH 1ENODEPTH 0 z cA X 0 0 m 13' J`. (t) I I I • • •• •••••• •• • ▪ • • • • ••• ••• •• ••• ••• ••• ••• ••• ••• • • ••� • • • • • ••• • •. • • • ••• •• • • • • •• •••• • PFRMI TS RFAIII RFO. uCC itt Mel .m. ❑F.D.O. T. El WOE COMM�y I:�CI In .._ Fs.. oo Ew ❑- A T TSE PROPOSED TELEPHONE FACILITIES ON RIGHT OF WAY OF MiomiShores NW 96 ST & ICT Exchongo: 305751 Designer: Costellonos,Jesus Phone: 305-887-9017 Authorization: 6MP05012N 000. 1 or 1 3iha A8 a3AOdddV CIBUIjif, S0,10t.{S ILUelul! �.GJ2 i - I met ••• • • • • A • • ••• • • • • • • • • • • • • • • • • .•. •.•. •• •: •• ••• ••