PW-17-2113Project Address
Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Parcel Number
445 NE 94 Street
Miami Shores, FL
Owner Information
Darren Ockert
1132060140520
Block: Lot:
Address
445 NE 94th Street
Miami Shores FL 33138
Phone
NO. PW -8-17-2113
Permit Type: Public Works
Classification: Public Works
Permit Status: APPROVED
Expiration: 11/30/2017
Darren Ockert
Cell
917 573-9022
Contractor(s) Phone
TRI STATE ROOFING & GENERAL CO (561)337-7718
Cell Phone
Valuation:
Total Sq Feet:
Scanning: 1
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
$3.00
$0.80
$104.00
Pay Date Pay Type Amt Paid Amt Due
Invoice # PW -8-17-64944
09/01/2017 Credit Card $ 104.00 $ 0.00
$ 1,400.00
0
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 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 an. zon' •'. Futhermore, I a horize the above-named contractor to do the work stated.
September 01, 2017
Autho d Signature: Owner / Ap. a t / Contractor / Agent
Building Department Copy
Date
September 01, 2017 1
Miami Shores Village RECEtV ED
Public Works Department
(305)795-2210
Public works forms are available from the building department, 10050 NE 2'd Ave., Miami Shores, FL 33138 G 2 1
PUBLIC WORKS PERMIT APPLICATION
Permit Type: Work in the Right -of -Way on Miami Shores Village or Miami -Dade Property
Permit#:QL 1qt '
Name of Applicant (if utility see below): bArt(LE Cx �E�zT
Owner off the following described property:
Legal Description: Lot Block Subdivision
Folio #;
Address: 4-4 t 94T" ST. rvi 4.4in�i FL 3 313`i:
UTILITY NAME:
Qualifier/Authorized Agent:
Address:
City: State: ZIP:
Telephone: Email:
State Certification or Registration #: Certificate of Competency #
CONTRACTOR NAME:
Qualifier/Authorize e t: / 1i� (-1.44,A
Address: glK 1 -P (.a, Ai
City:
Telephone: C6 Email:
State Certification or Registration #:
ZIP: 4 �(
livvlw('ti� • C v
Certificate of Competency #:
Requests erm ssion to install escri le work, attJ� ch se�pparate page i ryecessary) in the adjoining right of
way: C.A�-< c �yv U ../t; G' L �� (-1/L. — CCr C
v
Type of Work: 0 Paving
❑ Landscape
DESIGNER: Architect/Engineer:
Address:
Utility 0 Sidewalk 0 Electric 0 Irrigation
❑ Antenna
❑ Other:
City: State: ZIP:
Telephone: Email:
Rcigistration #t:, . •..,b.
V4Iue of Work for this Permit: $ (4 Square/Lineal Footage of Work:
*****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 $2,500, the applicant must promise in good faith that a copy of the notice of commencement
and construction lien law brochure will be delivered to the person whose property is subject to the
attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job
site for the first inspection which occurs seven (7) days after the public works permit is issued. In the
absence of such posted notice, the inspection will not be approved and a reinspection will be charged.
Signature
Applicant or Authorized Agent
The fore oin instrument was a nowledged ore The foreg
me thisday of U J 20 by me this
rr�X�,hc�-4" who
is personally known to me or who has produced
Signature
identification.
NOTARY PUBLIC:
Sign: �!:!
Print:
SEAL:
t Cc Y L_ as
MAHARAI K. GONZALEZ
MY COMMISSION # GG 044602
EXPIRES: November 2, 2020
Bonded Tru Notary Public Underwriters
Company/Utility t
instrument as ackn wl" dged before
day of 20 )1, by
O L I / ea -u6r4. who
is personally known to me or who has produced
fiLCNc,- as
identification.
NOTARY P
Sign:
Print:
SEAL:
:s
%�f,OFf •'s My Comm. Expires Nov 30, 2020
•
,*urn,,,'
s„.0%14;,,, RAPHAELA ST. /WOE
: Notary Public - State of Florida
Commission # GG 051820
APPROVED BY: ,=�� 1L1�� , Public Works Director, or Designee
2017-04-15
FPL.
Overhead to Unda'rgi-o#.irfct poiv$rsion Sketch Form
CIT
POWFRINC TOOAV FMPOWFRING TOMORROW.'
Customer Name:
•
• • • • • • • •• • •
.
• •- - • •
• • • , • •• •• •
Armando Ortiz & Darfefi Ockert • • D?ytutie Contact
•: Phone:
Service Address: 445 NE 94th Street
••• : • '•*••• •••
• ••. : :
•
• • • 0 • • • •11
•
Example Instructions:
#5
(60)
#2
#3
#4
ADDRESS
(ex. 123)
#1
1. Building address
2. Pole location
3. Indicate existing meter location on your home
4. Existing overhead wire to property
(Indicate with solid line)
5. Cable route for new underground conduit
6. Street name
7. Indicate how many underground risers
are on pole: 0 (see FAQ #10 for detail)
'Rv4 A -21%3
PERMIT #:
#6 Street name (ex. First St.)
APPROVED
RECEIV
ED
AUG 2 1 7017
CL1
Miami Shcres Village
ZONING DEPT
BY _ DATE
445 NE 94TH STREET
MIAMI SHORES, FL 33138
Current
Temporary
Pole
#3
#1
Instructions:
1. Building address
2. Pole location
3. Indicate existing meter location on your home
4. Existing overhead wire to property
(Indicate with solid line)
5. Cable route for new underground conduit
New (Indicate with dashed line, show cable route footage)
#
M3eter6. Street name
7. Indicate how many underground risers
are on pole: ° (See FAQ #10 for detail))
T--- `0.
STATE AHu CCUN' Y IMAM AND REGULATIONS
i
/ #5
/ (48')
/ #6 ALLEY BETWEEN NE 94TH STREET & NE 95TH STREET
#2
Rev. 11/07
1
N •