PW-18-1Project Address
Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Permit
Issue Date: 1/212018
Permit NO. PW -1-18-1
Permit Type: Public Works
Work Classification: Public Works
Permit Status: APPROVED
Expiration: 04/03/2018
Parcel Number
Applicant
10400 NE 4 Avenue
Miami Shores, FL 33138-2013
1121360130150
Block: Lot:
EDELMAN LOPEZ JR
Owner Information
Address
Phone
Cell
EDELMAN LOPEZ JR
10400 NE 4 Avenue
MIAMI SHORES FL 33138-2013
2209-500 SHERBOURNE Street
TORONTO ON
Contractor(s)
R2 BUILDERS INC
Phone
(305)231-3113
Cell Phone
Valuation:
Total Sq Feet:
$ 1,000.00
145
Scanning: 3
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
$9.00
$0.80
$110.00
Pay Date Pay Type
Invoice # PW -1-18-66020
01/02/2018 Credit Card
Amt Paid Amt Due
$ 110.00 $ 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 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 and t all work will be do in compliance with all applicable laws regulating
construction and zoning. Futhermore, I authorize the above-named contrac o t he work stated.
Authorized Signature: Owner / Applicant / Contractor / Agent
Building Department Copy
January 02, 2018
Date
January 02, 2018 1
\\A\e5 A L -
Miami Shores Village
Public Works Department
(305)795-2210
Public works forms are available from the building department, 10050 NE 2nd 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#: I 8 `•ice
Name of Applicant (if utility see below): (2ll-e /7 /51-"/Z_
Owner off the following derib d propert:
Legal Description: Lot ascYe/Z.-Block • /f Subdivision
Folio #; //- 2/ �G--O / 3-0(.S ) ,
Address: / O VOD ,V 01113rn i / Pe- 3 3/ 3,
UTILITY NAME: 99( G( 8e)S'( T.D-r 1
Qualifier/Authorized Agent:
Address:
City: State: ZIP:
Telephone: Email:
State Certification or Registration #: Certificate of Competency #
_�•
CONTRACTOR NAME: R c2---1 /�� • /
Qualifier/Authorized Agent: i2. �p/_/2/
Address: �` l /�%L!J / _Sy7 •i-� l �y .
City: m,i541 i• Lig-/Les State: /4.L.— ZIP: 31 3Q
Telephone: ?i'S 7C-4. ?j"7 l Email: f2.2... gvtiJ(przg
State Certification or Registration #:CGL 1316,7 q Certificate of Competency #:
Requests permission to install (describe work, attach separate page if necessary) in the adjoining right of
way:
ft9)
Type of Work: ❑ Paving ❑ Utility /6 Sidewalk 0 Electric 0 Irrigation
Landscape ❑ Antenna ❑ Other:
DESIGNER: Architect/Engineer:
Address:
City: State: ZIP:
Teleptione :, • ;•� Email:
A•
Registration #: , h 1'
4
Value of Work for.thisMPermit:,, $ `=-// -�a a • a v
Square/Lineal, Footage. of Work:Wsp
***** Fees *****
Permit Fee $ 100.00
Notary $ Training/Education $ 0.20 Technology Fee $ 0.80 Scanning $
Bond $ (if required) Total Fee Now Due $ 1 (b •
r r
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 issued. In the
absence of such posted notice, the inspe tion will not be approved and a rei ion will be charged.
Signature
--
Applicant or Authofd Agent
The foreg g instrument was a.' owledge efore
g.e t is d r") I 20 by
tnGTca. who
is personally known to isoi who has produced
T t l fox)
as
identification.
,,, 'c* MY COMMISSION # GO 044602
`* EXPIRES: November 2, 2020
sh'A• oi F,°'' Bonded Thru Notary Public Underwriters
APPROVED BY:
2017-04-15
Signature
_....„; , 7 4
cliff'
. . ' tility Agent
The foregoing instrum n was acknowledged efore
mhis ..260 day of 20 y
VCO e[ Aiu gpe.? �� who
is p onally known to me who has produced
YL I., ( c€ vv v.)2.__ as
identification.
NOTARY P BLIC:
Sign:
Print:
SEAL:
e"""s•
JULISSA RODRIGUEZ
?;fni ;-
02.1, , 4
Commission # FF 98800
My Commission Expires
� . Ofisii
March 05, 2018
****************************************
, 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 CONSTRUCTIONWITHIN RIGHT OF WAY
Whereas, (owner) 6-el-e-imod
hereinafter referred to as the owner of the following described
property (address):
Legal Description: Lot Ie Block [ 11- Subdivision
Folio# 11-21-31,0—Oi3--'016
Requests permission to install (describe work): (te -t Ci g e_IL 2
Within the public right of way of (address) 10 9 0 o —r`) E
muni ,FL 3 1278"
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 of Miami Shores Village
(or his fully authorized rep es tative).
IIIIIIIIIIII IIIIIIOIIIIilllllll!IIII IIIIIIII
C FN 2017E _'727721
OR Br, 308108 F'9 3532 (1F'9s)
REGARDED 12/2E2/2017 14231:43
HARVEY RUVl6 CLERK OF COURT
MIAMI -DADS COUNTY, FLORIDA
Signaturedg244-,-�?')
Ownef�br Agent �°/L/, Lori
State of Florida
County of Miami Dade
The foregoing instrument was acknowledged before me this Z day of Dc C,
fY1G tO �" who is personally known to me or who has produced
x-1 l iC21
NOTARY PUBLIC:
Si
Pn
s identification.
SEAL:
COUNTY OF DADE
Y CERTIFY that this is elm copy ofthe
DECWilk'sS " L ;A.D. 20 dayot
Wf1NESSmyhand i Official8WI.
V) i �+ C •� Itand County Cowts
.C.
NICOLE
11AVIS # -r."44
,20 ` by
•§061c."-°'‘. STREET. SUITE 202
MAMI, FLORIDA 33126
'EL EPROM, (305) 220 3171
Ax (305) 554-7822
aim nrinuors calttr.
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