PW-17-1124 Permit NO. PW-4-17-1124
Miami Shores Village Permit Type:Public Works
10050 N.E.2nd Avenue NW Work Clas.5ification:Public Works
Miami Shores,FL 33138-0000 Per It Permit Status:APPROVED
Phone: (305)795-2204
DID Issue Date:412812017 r Expiration: 07/27/201
Project Address Parcel Number Applicant
166 NW 93 Street 1131010330950
Miami Shores, FL 33138- Block: Lot: STEVEN SHAER
Owner Information Address Phone Cell
,STEVEN SHAER 166 NW 93 Street (305)395-7171
MIAMI SHORES FL 33150-
Contractor(s) Phone Cell Phone Valuation: $ 2,000.00
HOME OWNER
Total Sq Feet: 25
Scanning:3 Available Inspections:
Inspection Type:
Excavation
Review Public Works
Final Public Works
Fees Due Amount Pay Date Pay Type Amt Paid AmtDue
—
CCF $1.20 Invoice# PW-4-17-63789
DBPR Fee $0.00 04/28/2017 Credit Card $62.20 $50.00
DCA Fee $0.00
Education Surcharge $0.40 04/25/2017 Credit Card $50.00 $0.00
Permit Fee $100.00
Scanning Fee $9.00
Technology Fee $1.60
Total: $112.20
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.
OWNERSAFFID : I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
constructionand on(T'Nuthermore, I authorize the above-named contractor to do the work stated.
7 April 28, 2017
Authorized SijKat- :Owner / Applicant / Contractor / Agent Date
Building Department Copy
April 28, 2017
ve ✓. � �� RE�EI V
Miami Shores Village APR 10,�
Public Works Department
(305)795-2210
Public works forms are available from the building department, 10050 NE 2"d Ave., Miami Shores, FL 33138
PUBLIC WORKS PERMIT APPLICATION a
Permit Type:Work in the Right-of-Way on Miami Shores Village or Miami-Dade Property
Permit#:
Name of Applicant(if utility see below):
Owner off the following described property:
Legal Description: Lot Block Subdivision
Folio#; 11 31 a 1 0'33 OCIS t-D
AddressJ6 C Al W q 3;,.4 ,s*
UTILITY NAME:
Qualifier/Authorized Agent:
Address:
City: State: ZIP:
Telephone: Email:
State Certification or Registration#: Certificate of Competency#
CONTRACTOR NAME:
Qualifier/Authorized Agent:
Address:
City: State: ZIP:
Telephone: Email:
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''C by�✓ S'��.-s
Type of Work: ❑ Paving ❑ Utility Sidewalk ❑ Electric ❑ Irrigation
r
' ❑ Landscape ❑ Antenna ❑ Other:
DESIGNER: Architect/Engineer:
Address:
City: State: ZIP:
Telephone: Email:
Registration #:
i
Value of Work for this Permit: $ ''ZOO c:;, Square/Lineal Footage of Work: 2
***** Fees *****
Permit Fee$ 100.00
Notary$ Training/Education $0.20 Technology Fee$0.80 Scanning$
Bond $ (if required) Total Fee Now Due$ 2
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.
SignaturvIlle 01A.1 Signature
Applicant or Authorized Agent Company/Utility Agent
The foregoing instrument was acknowledged before - The foregoing instrument was acknowledged before
me this'ZS day of ZIC_ ,20 c'1 by me this day of 20 , by
S-7iE 1LX-3 -14,— who who
is personally known to me or who has produced is personally known to me or who has produced
-fx-- as as
identification. identification.
NOTARY PUBLI NOTARY PUBLIC:
\\\\\`� 1111111 *%iii ,
Sign: b Sign:
Cj
co
Print: =Z.� `�' •�-: Print:
SEAL: _�;� SEAL:
NOT
�
1
APPROVED BY: a1 , Public Works Director, or Designee
2017-04-15
RECEIVED
APR 2 o
Miami Shores 'pillage n
Public Works Department
10050 N.W.2"d Avenue,Miami Shores,Florida 33139
Tel:(305)795.22-04 Fax: (305)7513.8972
Public Works Permit No.
Perinit Application
FSC 2004 i
alt T-yOK Publlc.Works R S�cK"• Ik
Owner's Name (Fee Simple Titleholder). Phone if:30
Owner's Address Ac
City WIt 4.�.` `�"�'. State L Zip
Tenant/Lessee Name y Phone
Job Address(where the work is being done) t(` A0411-34 0
City_ .- Miami Shores Village County Miami-Dade Zip 33 1,5-0
is Building Historically Designated: Yes No t/
Utility's
Gentrasto?s Company Name r�( Phone#:
Utility's
Gentraster-'s Address
City: State: Zip:
Architect/Engineer's Name(if applicable) Phone;<R:
Value of Work For this Permit: l Lineal Footage Of Work:
Type of Work: ❑ Addition El Alteration El New 1 tai RepalrlReplace El Demolition
Describe Work: ' Rt e cc 10 0 hfrl SJt 4/•,f`( Rc( -*a
l�ilfRi{4illtlf�lll��Fees tlli!***A*A*kAAAAAi!
SubmiUal Fee$ Permit Fee$ CCF$ CO/CC _
Notary$ Training/Education Fee$ Technology Fee$
Scanning$ Radon$ Zoning Bond$
Code Enforcement$ Structural Plan Review $
Total Fee Now Due$
(Continued on opposite side)
Bonding Company's Name (if applicable)
Bonding Company's Address NIA
City Slate Zip
Mortgage Lender's Name. (if applicable) NIA
Mortgage Lender's Address
City Slate Zip
Application is hereby made to obtain a permit to do the work 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 regulating construction in
this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK,PLUMBING,SIGNS,WELLS,POOLS,
FURNACES,BOILERS,HEATERS,TANKS and AIR CONDITIONERS,ETC.....
OWNER'S 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 and zoning.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE
FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING,CONSULT WITH YOUR LENDER OR AN
ATTORNEY BEFORE RECORDiNG YOUR NOTICE OF COMMENCEMENT."
d.
Notice to Applicant: As a condition to this issuance of a Public Works permit with an estimated value exceeding$2500,the applicant must
promise in good faith that a copy of Ilia notice of conrnrencenient and construction lien la►y brochure will be delivered to Iha person whose
property is subject to atlachnient. Also,a certirled copy of Ilia recorded notice of commencement must be posted at Ilia Job site for Iiia first
fispeclion which occurs seven(7)days after the buildtiig pomrll Is issued. in the absence of such posted notice,the inspection Wit not be
approved and a r ' peclion les w Ge charged.
Signature Signature
Owner orAgent Utility Representative 1-Genlraetor
The foregoing instrument was acknowledged before me this day of 120 - by
who Is personalty known to me er-who•h"reduc-ed NIA as
identification,and who•didldid not take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: Sigir
Print: Print:
My Commission Expires: My Commission Expires
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APPLICATION APPROVED BY: ?7 I Public Works Director or
his designee.
I flu 7/2005