PW-18-170 Permit NO. PW-1-18-170
Miami Shores Village Permit Type:Public Works
10050 N.E.2nd Avenue NEPer Work Ciassifrcation:Public Works
Miami Shores,FL 33138-0000 Permit'Status::'APPROVED
Phone: (305)795-2204
F�oRio�
T$guieDate:1!25/2018 Expiration: 04/25/2018
Project Address Parcel Number Applicant
10666 NE 10 Court 1122320280910
Miami Shores, FL 33138- Block: Lot: F-1 PERFORMANCE LLC
Owner Information Address Phone Cell
F-1 PERFORMANCE LLC 530 N SHORE Drive (786)302-8768
MIAMI BEACH FL 33141-
530 N SHORE Drive
MIAMI BEACH FL 33141-
Contractor(s) Phone Cell Phone Valuation: $ 1,000.00
SFL (786)356-8806
_. Total Sq Feet: 375
Scanning: 1 Available Inspections:
Inspection Type:
Excavation
Review Public Works
Review Public Works
Final Public Works
Fees Due jmnPay Date Pay Type Amt Paid Amt Due
CCF
CCF Fee Invoice# PW-1-18-66198
D�P01/25/2018 Credit Card $ 104.00 $0.00
DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Total:
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 and zoning. Futhermore,I authorize the above-named contractor to do the work stated.
January 25, 2018
Aut oriz d Signature:Owner / Applicant / Contractor / Agent Date
Building Department Copy
January 25, 2018 1
R, CEI ID
Miami Shores Village JA 2 2018
Public Works Department
(305)795-2210 BY.
Public works forms are available from the building department, 10050 NE 2nd 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 I
Permit#: ,JJ - l�
Name of Applicant(if utility see below): -Jf),.rAI Rdw9,5� r-1 ��e� ,•,7,q-../G� '( L r
Owner off the following described property:
Legal Description: Lot I Block _Subdivision -
Folio#; 1/- 0232 - 02 �j/(�
Address: /62 6z 1a L AJ t_ /d
UTILITY NAME:
Qualifier/Authorized Agent:
Address:
City: State: ZIP:
Telephone: Email:
State Certification or Registration#: Certificate of Competency#
CONTRACTOR NAME: Sb L ,0
Qualifier/Authorized Agent: • t F-X): ' RAnA .
Address:_ '2T35 ::54-A) 7(a -5-1—
City: WIState: a11- ZIP: 3a17 R
Telephone: 71?Q6Email: 10m).--LA
State Certification or Registration#: (l,A I�fQ/5' Certificate of Competency#:
Requests permission to install (describe work,attach separate page if necessary)in the adjoining right of
way: AgA w _r d<AV L 1—Aer,6A/277-1 , Aze
•721 / ,4 U}_/[' �6� �l�%
T ,...�.,
Type of Work: ❑ Paving ❑ Utility, �: E] Sidewalk ❑ Electric El Irrigation
❑ Landscape ❑ Antenna N�'Other: �ig,/�e be1Vf l
DESIGNER:Architect/Engineer:
Address:
City: State: ZIP:
Telephone +<:Em_
•� , ail: x
Registration# , ` w
Value of:Workfor,,this Permit: $`a.z �oon. Square/Lineal Footage of Work: Y•
***** Fees
V,+,,;.r.'i:;M'.'�'9T44•t...W'c+wr_u a�ceq... y..�y r...y,,,, - a f,
Permit Fee$ 100.00
Notary$ Training/Education$0.20 Technology Fee$0.80 Scanning$
Bond$ (if required) Total Fee Now Due$ 10y . CC)
t .
i
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 publiCworks permit is issued. In the
absence of such posted notice,the inspection will not be approved and a reinspection wil a charged.
CSigna� Signature'
A plicant or Authorized Agent Com ny/Utility Agent
The foregoi strument was acknowledged before The foregoing instrument ' acknowledged before
me this day of i JtfAA 20 Tt ,by me this day of 26 by
_1 t`N� G�k Ow. S who who
is persgnally known to me or who has produced is per onally known to me or who has produced
A-PL as as
identification. identification.
rN TARY-PUBL'IC:D iNOTARY'PUB-1
ign: Sign:
1 2J t. L��c J
Print: Print:
SEAL: ,►�'.' G OFFREY CHAN `
MY C MMISSION#GG136185
� PEDRO E LACAU -
_;`l•. Notary Public-Stateof Florida EXPIRES August 20,2021
• _ .
Commission#GG 097404
'E W* My Comm.Expires Apr 24,2021
r
** *** * **********************************
APPROVED BY: Oa Public Works Director,or Designee
2017-04-15
R
I llll11 �II �fllI �1 it
C.
�Sg
Miami Shores Village
0 OR BK '70825 F's :11204 (IP9s)
Building Department 5 Ij I
oil RECARCUi 01/11/2018 11-:5--f-D
10050 N.E.2nd Avenue H(iRYEY RUVIN? ��_LERIK% OF 0 T
A I E: Of LON I OA,ice' FLO
_LOk'OA F,_ ! - C110
'Miami Shores, Florida 33138 a s
0 '"ER his s a true c,oOy of the CLINK
r 1 0
Tel: (305) 795.2204 .1riginal filed in this f 0 day of
Fax: (305) 756.8972 AN 1 18 AD 20 U
NITN y he"
SS my hand d ficial Sea/.
ARAYTN C C', 06 am W1 am
N.C R of Circuit and County courts
COVENANT,OF CONSTRUCTION WITHIN RIGHT 6FwM--- D.C. .COO
Whereas, (owner) Joj4K RA1'4bjC_r—_ LL47WSHINARNOLD#201144
hereinafter'referred to as the'owner of thefollowing,d e-scribe*d
property (address): 10(A� ur-*. in e;r
Legal Description: Lot� Block Subdivision -mi"I SH0(4!5_-5 . Tony
Folio
Requests permission to install (describe work): T)F
- 6 _fLjjcF_ kPt4XLX
ini 4' yi2�� !Rft& 9S - L&4 p j2T
AS. �}
Within the publicrightof way of (address) [ r-
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 descdbed 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 theiir facilities at their own expense,e� se,
within 60'days notice by the Village to do so. Failure to comply with this-notice will result in the
,,Village causing the item(§) 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. conditiohs 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).
Signatyr d o
Owner or Agent
State of Florida -
County of Miami Dade
Th�I eforegoinginstrument was acknowl6dged before me this day of AAXI 20 IJ by
6�w '15,0toleir )0--U' who-is personally known to me or whd has produced
/PLV as identification.
-
NOTARY
Sign:
Print: SEAL:EAL:
PEDRO E LACAU
Notary Public-State of Florida
404
0
Commission#GG 097404
My Comm.Expires Apr 24,2021
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