PW-18-86Project Address
Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
553 NE 101 Street
Miami Shores, FL 33138-
Owner Information
Pe
mit
issue Date: 218/2018
Permit NO. PW -1-18-86
Permit Type: Pudic Works
Work Classification: Public Works
Permit Status: APPROVED
Expiration: 05/09/2018
Parcel Number
Address '
1132060171120
Block: Lot:
553 NE 101 Street
MIAMI SHORES FL 33138-
553 NE 101 Street
MIAMI SHORES FL 33138-
Phone
Applicant
MICHAEL KNOLL KATHY GARCI
Cell
Contractor(s)
CHAMPION CONCRETE
Phone Cell Phone
(305)252-8055 (786)402-4802
Valuation:
Total Sq Feet:
$ 4,600.00
500
Scanning: 1
Fees Due
CCF
DBPR Fee
DCA Fee
Education Surcharge
Permit Fee
Scanning Fee
Technology Fee
Total:
Amount
$o.00
$0.00
$0.00
$0.20
$100.00
$3.00
$0.80
$104.00
Pay Date Pay Type
Invoice # PW -1-18-66105
01/11/2018 Check #: 2752 $ 50.00 $ 54.00
02/08/2018 Check #: 200 $ 54.00 $ 0.00
Amt Paid Amt Due
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 responsibi ty for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECT CAL, PLUMBING, M CHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNERS AFFI. IT: I certify that al e foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and z. in rmore thorize the above-named contractor to do the work stated.
February 08, 2018
Author. d Signature: O, . �� :p scant / Contractor / Agent
Buildin Departm - nt Copy
Date
February 08, 2018 1
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
JAN
2018
PUBLIC WORKS PERMIT APPLICATION
Permit Type: Work in the Right -of -Way on Miami Shores Village or Miami -Dade Property ad
Permit#: L S i S
Name of Applicant (if utility see below): /1VPJ / /IWV,
Pw
Owner off the following described property: -
Legal Description: Lot Block Subdivision
Folio #; //'• 3204-- 017 —// 2-0
Address: SO i l L2/ I ,G *4 7 -MA'S 53/7/
UTILITY NAME:
Qualifier/Authorized Agent:
Address:
,City: State: ZIP:
Telephone: Email:
State Certification or Registration #: Certificate of Competency #
CONTRACTOR NAME: (Jt }ON LO/V07`C) 0S ^ ?SZ— saA5�
Qualifier/Authorized Agent: J/97Mz 4. A5/1.4
Address: /024 - NV 1,3 rte -
City: _LOO State: ZIP: 33/7/
Telephone: Email: --%' ,, � oa 4,42.
State Certification or.Re`gistiation #:-, Certificate of Competency #eL1:25.$5,0106176
Requests permission to install (describe work, attach separate page if necessary) in the adjoining right of
.way: 1' ..&! ai e.r2 4011--
'553..le 10( /1441111 7r74 -9i-0` .x\:33170'
Type of Work: ❑ Paving- ❑ Utility [l Sidewalk ❑a Electric ❑- Irrigation i
❑ Landscape ❑ Antenna ❑ Other: (944/4-0 M L- llf p v0464, .
DESIGNER: Architect/Engineer:
Address:
City: • State: ZIP:
Telephone: Email:
Registration #:
Value of'Work for this�Permit: $ r �w Square/LineaI Footage of Work:''S00 S
11,
*****Fees*****
Permit Fee $ 100.00 SO pc\
Notary $ ) Training/Education $ 0.20 Technology Fee $ 0.80 Scanning $
Bond $ Z1X (if required) Total Fee Now Due $ 54
Ds IS -as
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 post -d at the job
site for the first inspection which occurs seven (7) days after the public works permit is is ed. In the
absence of such posted notice, the inspection will not be approved and a reirsection �I be charged._
-„,44/4r4116.,
Signature,
Applicant or Authorized Agent
The foregoing instrument was acknowledged,before
me this 7 day.of 20 /7 , by
Le//147 Ggel ,e",7 O/ who
is personally kn wn to major w_bjg,has prQduced
as
identification. •
1 .• <„ tf
NOTARY PUBLIC:
Sign:
Print:
SEAL:
�i
AOF
C.L
vi
A 7, 3h9-0'
AGALY LLAPUR
MY COMMISSION # FF213776
EXPIRES March 25, 2019
i3 Floridallou Se v. e.cc r
APPROVED BY:
2017-04-15
Signature
Com zany/Utility Agent
The foregoing instal' nt was acknowledged before
me this `7' day ofQO/77%,a/, 20 /? , by
who
_ is personally known tgrhe or who has produced
/02X//h/l0C-e--2/7 as
identification.
NOTARY PUBLIC:
Sign:
Print:
SEAL:
-arle-7::
SR. "iii _ M GALY LLAPUR
�;, •'c MY COMMISSION # FF213776
wtaw;, EXPIRES March 25. 2019
1007,398-0'53 , ForideNotryService.carr
, Public Works Director, or Designee
,Sy .1
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
COVENANT OF CONSTRUC ION ITH
Whereas, (owner) 4`lt7
"hereinafter referred to as the owner of thefollowing described
property (address): (S3 NE /0/5T" D`Lkiit 47)1#11
Legal -Description: Lot Block Subdivision
Folio # . /2-3106— r,i 7:- //
Requests permission to install (describe work): C)L 4-14/-60 i6 L1/
IIIIII EIIII IIIfI IIIA VIII VIII VIII IiII llll
._F irk 20178 )682774
OR BK 30780 Pg 4131 t1Fr'3si-
rt.GORIJ c 1-i/0,:..LHj,7 11;12e
HARVEY RUt Tri CLERK OF COURT
uIANI—L'HDr_ .i:{_U T'i`- FLORIDA
OF FLOR A, COUNTY OF DADS
Y CERT/FY Oat his is a f a.cDPY of the
din this office �av
G
Smyfai
WTht
N RIGHT OF WkYv
8v
ERIC STRINGER #172204
it
Within the public right of way of (address) XSJ 41e-jdi ,•T'
/14v i 0-1-104'0 tc. 3/7(
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 indemnifyand 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 removalanddisposal of the item(s).
14. 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
Owner or Agent
r
State of Florida
County of Miami Dade
The foregoi9g /ep%/%�,/;
,instrument was acknowledged before me this 7 day of 20 /7 , by
/ /thge J iC/70 /1 who is personally known, to me or who has produced
XS D_ 559-613 y0 agidentification.
NOTARY PUBLIC:
ign:
int: d'GiC,&
=s!"""'" MAGALY LLAPUR
MY COMMISSION # FF213776
•;ro.i, EXPIRES March 25, 2019
our'. B-0'53 FloridalloaryService.Arr.
SEAL: