PW-17-1838Miami Shores Village
Public Works Department
(305)795-2210
Public works forms are available from the building department, 10050 NE 21' Ave., Miami Shores, FL 33138
1'
RECEIVED
l/1.1 8 2017
PUBLIC WORKS PERMIT APPLICATION
Permit Type: Work in the Right -of -Way on Miami Shores Village or Miami -Dade Property
Permit#:" t 338
Name of Applicant (if utility see below): \ '&1 1 elecommunications
Owner off the following described property:
Legal Description: Lot - Block Subdivision
Folio #; 11-3206-013-3760
Address: 9499 NE 2nd AVE. Miami Shores. FL. 33138
UTILITY NAME: ' 1-&1 t elecommunications
Qualifier/Authorized Agent: 'Michael Perez
Address: 9101 s'v 24th 5"1
City: Miami State: FL ZIP: 33165
Telephone: 305-222-8218 Email: rnp9544ii;att.com
State Certification or Registration #: Certificate of Competency #
CONTRACTOR NAME:
Mastec North America INC
Qualifier/Authorized Agent: Robert 11crnande,
Address: 2801 SVk 46th AVE
City: i r,,
Telephone: Email:
State: 1-1. ZIP: I
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 rench to place 5ft of conduit in the alley located east Of 9499 NE 2nd Ave
Type of Work: 0 Paving 0 Utility 0 Sidewalk 0 Electric 0 Irrigation
❑ Landscape ❑ Antenna ❑ Other:
DESIGNER: Architect/Engineer: \lu h,i, 1 fere,
Address: 9101 sw 24th ST
City: Miami
Telephone: 305-222-8218
State: I-1_ 1
Email: mp9544( att.coni
ZIP: 33165
Registration #:
Value of Work for this Permit: $ 6000.00 Square/Lineal Footage of Work: 674
*****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 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 inspection will not be approved and a reinspection will be charged.
Signature
Applica t or Authorized Agent
The foregoing instrum t was acknowledged before
me this I ei day of --.11)l—Vi, 2Q 17 , by
(Nlt A-tAS i( �, who
is personally known to me or who has produced
identification.
NOTARY !BLIC:
Sign:
as
Signature
k
Company/Utility Agent
The foregoing instrument was acknowledged before
me this I s day cLf , 20 ,- . by
{-Uf 7j1_ , 1>I ez
is personally known -to me or who has produced
identification.
APPROVED BY:
2017-04-15
SEAL:,
L
as
MAYLIN EXPOSITO
yCGrTirllJJfufV'Fr /1G41
EXPIPES N3 -..'ember 20, 2017
Service corn
, Public Works Director, or Designee
who
Project Address
Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
9475 NE 2 Avenue
Miami Shores, FL 33138 -
Owner Information
BANK OF AMERICA NA
Permit
Permit NO. CW -7-17-1838
Permit Type: Public Works
Work Classification: Public Works
Permit Status: APPROVED
Issue Date: 7/21/2017
Expiration: 10/19/2017
Address
Parcel Number
1132060133760
Block: Lot:
Phone
Applicant
BANK OF AMERICA NA
13510 BALLANTYNE CORP Place
CHARLOTTE NC 28277 -
9475 NE 2 Avenue
MIAMI SHORES FL 33138-
Contractor(s)
MASTEC NORTH AMERICA, INC
Phone
(305)232-3484
Cell Phone
Valuation:
Total Sq Feet:
$ 6,000.00
5
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
$0.00
$0.00
$0.00
$0.00
$0.00
Pay Date Pay Type Amt Paid Amt Due
Invoice # PW -7-17-64612
$ 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 AFFID ce
that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction . d zoni F erm
re, I authorize the above-named contractor to do the work stated.
:Owner / Applicant / Contractor / Agent
Building Department Copy
July 21, 2017
Date
July 21, 2017 1
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
nspection Number: INSP-286212
Inspection Date: January 19, 2018
Inspector: Miranda, Chris
Owner
Jcb Address: 9475 NE 2 Avenue
Miami Shores, FL 33138 -
Project <NONE>
Contractor: MASTEC NORTH AMERICA, INC
Permit Number: PW -7-17-1828
Permit Type: Public Works
Inspection Type: Final Public Works
Work Classification: Public Works
Phone Number
Parcel Number 1132060133760
Phone: (305)232-1484
Building Department Comments
TRENCH TO PLACE 5 FT OF CONDUIT IN THE ALLEY
LOCATED EAST OF 9499 NE 2 AVE
Passed
Failed
Correction
Needed
Fie-IliiEpection
Fee
No Additional Inspections can be scheduled until
re -inspection fee is paid.
Inspector Comments
SE CORNER OF DRIVETHRU
SCOTT FERRINGTON
305-322-5109
For Inspections please call: (305)762-4949
January 18, 2018 page 1 of 1
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P/L
SIDEWALK
-P/I 7
BANK OF AMERICA
9499 NE 2ND AV
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PARKING LOT
RECEIVED
JUL 1 8 2017
P/L
ATM DR1 VE-THRU
5'
J
IZ
180'
Existing
ATT Manhole
J
EL
AERIAL & BURIED
SYMBOL LEGEND
Proposed
Existing
Description
AERIAL CABLE
BURED CABLE
$
D
•
Q
BST PULE
*
*
POWER POLE
ANCHOR & GUY
MANHOLE
r I
PIPE/COP/UT
I
I I
I 1
N/A
BORE
V/Z/Z/
N/A
CUT PAVEMENT
1 I
N/A
SPLICING PIT
200'o(24')
N/A
TRENCH LENOOEPTH
PROPOSED 4" CONDUIT
TRENCH 3' WIDE 3' DEEP
Ph1 -1838
MIT #
Miami Shoe, Village
APFROVED
BY
DATE
ZONING DEP[
BLFA DEPT
SUBJECT nii 10 CCAI INCE WI EH ALL
STATE ANu Lr IjN , 7 HULL'S AND REGULATIONS
/
/
ATTSE
PROPOSED TELEPHONE FACILITIES
ON RIGHT OF WAY OF
Exchange:
305751
Designer:
Perez,Michael
Phone:
305-222-8218
Authorization:
7MP05334N
Dwg. 1 of 1
6/29/2017 8: 56: 28 AM