PW-17-2521Project Address
Miami Shores Village
10050 N.E. 2nd Avenue NW
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Permit
Permit NO. PW -10-17-2521
Permit Type: Public Works
Work Classification: Public Works
Permit Status: APPROVED
Issue Date: 10/31/2017
Expiration: 01/29/2018
Parcel Number
Applicant
41 NW 102 Street
Miami Shores, FL
1131010180110
Block: Lot:
KATHLEEN VILLAVICENCIO
Owner Information
Address
Phone
CeII
KATHLEEN VILLAVICENCIO
41 NW 102 Street
MIAMI SHORES FL 33150-
(512)709-0056
Contractor(s)
DECO CONCRETE INC
Phone CeII Phone
(305)828-5158 (305)345-4740
Valuation:
Total Sq Feet:
$ 5,000.00
250
Scanning: 1
Fees Due
Bond Type - Contractors Bond
CCF
DBPR Fee
DCA Fee
Education Surcharge
Permit Fee
Scanning Fee
Technology Fee
Total:
Amount
$500.00
$0.00
$0.00
$0.00
$0.20
$100.00
$3.00
$0.80
$604.00
Pay Date
Invoice #
10/31/2017
10/24/2017
Bond #: 3542
Pay Type
PW -10-17-65435
Credit Card
Credit Card
Amt Paid Amt Due
$ 554.00 $ 50.00
$ 50.00 $ 0.00
Available Inspections:
Inspection Type:
Excavation
Review Public Works
Review Public Works
Final Public Works
In consideration of the iss
pertaining thereto and in s
accepting this permit I as
required for ELECTRICAL,
ance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
onformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In
sibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: I
construction and zoning. F
I the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
I authorize the above-named contractor to do the work stated.
AuthoTried S
Buildin
October 31,
October 31, 2017
e: Owner / Applicant / Contractor / Agent
rtment Copy
Date
1
fnekri0
02J\Z \1
Miami Shores Village
Public Works Department
(305)795-2210 \ BY. _ IM
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#: P� `7 _ 251
6-44A(12-e}
\VU
Name of Applicant (if utility see below): ` 4 CP -A& U d
Owner off the followin d scrib d property:
Legal Description: Lot �/ 2, Z%Iock / Subdivision kieni -
Folio #; 1/- 3/2/- Dl $",/ / O
Address: 9/ A11) /D2 5 6/12Y 6 . ??).0
RE(_T"-')X'! D
OCT6 2017
UTILITY NAME:
Qualifier/Authorized Agent:
Address:
City: State: ZIP:
Telephone: Email:
State Certification or Registration #: Certificate of Competency #
CONTRACTOR NAME: - ric).e,C./p (DO Gr e. •
4
Qualifier/A orized Agent:
Address: �p It5X
City: (Y1. i/i
Telephone: ,c15432$ 5(S$ Email: fiarr6.- a decp(ot-,a�-f� inc- _Dm
State Certification or Registration #: C ?ZS Certificate of Competency #:
Requests ermission to install describe work, attach separate page if necessary) in the adjoining right q
way: ck YlveAiva,i (l Y7 \i -e O p- .
0\!-e i/t -m" 1
State: . ZIP: I t Zi
Type of Work: 0 Paving 0 Utility 0 Sidewalk 0 Electric . 0 irrigation,
❑ Landscape ❑ Antenna ❑ Other:
DESIGNER: Architect/Engineer:
Address:
City: State: ZIP:
Telephone: Email:
Registration #:
Value of Work for this Permit: $ •SJi JOU' � � Square/Lineal Footage of Work: 2 �
Permit Fee $ 100.00 50-PC3 i d
Notary $ Training/Education $ 0.20 Technology Fee $ 0.80 Scannin_g. $ 3
Bond $ -N (if required) Total Fee Now Due $ 4 .
***** Fees*****
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
APPLICANTS 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 foregoin instrument wa ac nowledged before
me this iv? day of I. 20 Ile by
LAG -TQC / Jf I who
is personally known to me or who has produced
• p,�--it eY (,ic61. e.-
as
identification.
NOTARY PUBLIC:
Sign:
//,�,�
ir4gA ivt l.AF%. t,
Print:
SENA
L^^? Notal y Public
'• • , _ ; • My Comm. Expires Jul 15, 2018
,• Commission # FF 142170
• `,nm,P` ▪ °P F`°Q`' Banded Through National Notary Assn.
y,. ..
APPROVED BY:"
2017-04-15
Signature
Company/
The forego'n�instrumen
me this 4Ljday of�
edged before
by
who
is personall
identification.
own to me or who has produced
as
NOTARY PUBLIC:
.►
Sign: .41""�.fr.-
Print:/ it frXeri"‘° ;i 04;7°4
SEAL:?z°, �;`"� ; Notary Public - ' tate of Florida
• My Comm. Expires Jul 15, 2018
Commission # FF 142170
" ,,„,„ Bonded Through National Notary Assn.
********* ** *********************s**********
, Public Works Director, or Designee
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
OCT z4 2017
PUBLIC WORKS PERMIT APPLICATION
Permit Type: Work in the Right -of -Way on Miami Shores Village or Miami -Dade Property 1
Permit#: PO.) ' - al
Name of Applicant (if utility see below): Ka-±k(-e_eY\ v) 110uCell U O
Owner off the following described property:
Legal Description: Lot Block Subdivision
Folio#; II i 3101 6 S_0110 3315
Address: -i A.)GO I 5-/r -el' M iap1.4! oeS
UTILITY NAME:
Qualifier/Authorized Agent:
Address:
City: State:
Telephone: Email:
State Certification or Registration #: Certificate of Competency #
ZIP:
CONTRACTOR NAME:
Qualifier/Authorized Agent:
Address:
City:
Telephone:
46 OvonP�+2
Stat. r'' ZIP:
State Certification or Registration #:
Requests permission to install (describ
way: ri-pAk-e�
Type of Work: ❑ Paving
e of Competency #:
e page if necessary) in the adjoining right of
vi VP, O p -roc t Ct..
❑ Sidewalk 0 Electric ❑ Irrigation
0 Landscape tenna ❑ Other:
DESIGNER: Architect/Engineer:
Address:
City: State: ZIP:
Telephone: Email:
Registration #:
Value of Work for this Permit: $ 5000 - (50 Square/Lineal Footage of Work: 4 Z50
***** Fees *****
Permit Fee $ 100.00
Notary $ , Training/Education $ 0.20 Technology Fee $ 0.80 Scanning $
Bond $ (if required) Total Fee Now Due $
50 pc d
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 pu lic works permit is issued. In the
absence of such posted notice, the inspection will not be approved and a reinspection will be charged.
Signature
7410/,/'crA4GIU
Signature
Applicant or Authorized Agent Company/Utility Agent
The foregoing instrument wa acknowledg d before The foregoing instrument was acknowledged before
2
me this — dayy,,of J1%QUC 20i, , by me this day of , 20 , by
i�iai-hte €rt Vi tV W;Cien Ci 0 who who
is personally known to me or who has produced is personally known to me or who has produced
7TI V•Q( 1 IC4 1S'Q as as
identification. identification.
NOTARY PUBLIC:
_ + Sign:
4.
net CI r.
gam/
NOTARY P
Sign:
Print:
SEAL:
•,'"•'-Py''-- Y- ADYPRIETO
,,R 4 MY COMMISSION # FF 214031
Bonded Thar Not March Public Underwriters
Print:
SEAL:
**********************************************
APPROVED BY: , Public Works Director, or Designee
2017-04-15
CFN: 20170575618 BOOK 30716 PAGE 614
HHARDATE:EYRUV NO .�s�L9ItPr�Mfd Q CTY
Building Department
. 10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 758.8972
COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY
Whereas, (owner) 14Mhig6ti t'/�
�UiCf� D hereinafter referred to as the
owner of the following described property (ddr ss): ill Atti Itc2 s1jr
Legal Description Lot ��� 2 Bock Subdivision liguthot
Folio # f/ / /- �/R - (9///)-�
Requests permission to install (describe work): rt't .12 Uep
Within the public right of way of (address)
r 10,01-77
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 rightof 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 representative).
Signature 4
Owner or Agent
.The foregoing ins m t was acknowledged before me this 1/ day of ,�� 20 1 by
- � 1411 A rra�ea4�ho is personally known to me or who has produced L) rLeV dGA-rost identification and who did take an oath.
NOTARY PUBLIC: Ai /
Sign: _
-yin
Print: r'tA gin. .r-1 "M9L
My Commission Expir
:11 /"'.,, MARIA M. AGUILAR
V+ b
It = Notary Public - State of Florida
s;Sr • My Comm. Expires JuI 15. 2018-4P Commission M FF 142170
�.�OFR�`,
�14A-' Bonded Through National Notary Assn.
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