PW-18-564 I
Permit NO. PW-3-18-564
r,� Miami Shores Village Permit Type,'Public Works
10050 N.E.2nd Avenue NE Pen ' Work Classification.-Public Warks
Miami Shores,FL 33138-0000 Permit Status::APPROVED
Phone: (305)795-2204
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Issue Date:3011201$ Expiration: 06/05/2018
Project Address Parcel Number Applicant
1130 NE 91 Terrace 1132050010410
Miami Shores, FL Block: Lot: BARBARA TER HORST
Owner Information Address Phone Cell
BARBARA TER HORST 1130 NE 91 Terrace (305)432-1775
MIAMI SHORES FL 33138-
1130 NE 91 Street
MIAMI SHORES FL 33138-
Contractor(s) Phone Cell Phone Valuation: $ 800.00
DRIVEWAYS BY DESIGN INC (305)776-7916
Total Sq Feet: 300
]�
Scanning: 1 Available Inspections:
Inspection Type:
Excavation
Review Public Works
Final Public Works "
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due t
CCF $0.60
DBPR Fee Invoice# PW-3-18-66679 �
$0.00 03/06/2018 Credit Card $50.00 $54.60
DCA Fee $0.00
Education Surcharge $0.20 03/07/2018 Credit Card $54.60 $0.00
Permit Fee $100.00
Scanning Fee $3.00
Technology Fee $0.80
Total: $104.60
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.
March 07, 2018 a
Authorized Signature:Owner / Applicant / Contractor / Agent Date
Building Department Copy
March 07,2018 1
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RECEIVED
Miami shores village MAR 0 6 2118j
Public Works Department
(305)795-2210
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 c(�
Permit#: ` '� 'lJ t `�
Name of Applicant(if utility see below): _/3AP-OA 12A _AL 116-0-511
Owner off the following described property:
Legal Description: Lot /0/9,c.-, I block 2 Subdivision
Folio#; // - 3265-- oa/
Address: (/ 30 tVig !T(
UTILITY NAME:
Qualifier/Authorized Agent:
Address:
City: State: ZIP:
Telephone: Email:
State Certification or Registration#: Certificate of Competency#
CONTRACTOR NAME: 0 &.y�4X�-YS �✓-t �9c, `,G l
Qualifier/Authorized Agent:/1-4! vt AA r—
Address:-22-2- /VE 65_5-7 _
City: /AM,. State: )C-/, zIP: 33(3i�
Telephone:3o5- "2' -71/6 Email:. C1,5;>
'State Certification or Registration# � Certificate of Co petency#:ri 2 33-6/'
Requests permission to install (describe work,at ach separate page if necessary)in the adjoining right of
way:-_I-,.,r
Type of Work: C!fPaving ,❑ Utility: ❑ Sidewalk ❑ Electric Irrigation , r
❑, Landscape ❑ Antenna Other:
DESIGNER:Architect/Engineer• k
Address4vr��� ^` �"i I .I .` ,� •, �-i" .}
ani .Caty �.Stete:F'
".� Telephone: .,.. �� t Email: - ;
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Value of Work for this Permit: $ lJ 01:59 Square/Lineal Footage of'Work 30„0
***** Fees*****
Permit Fee$ 100.00 +
Notary$ Training/Education$0.20 Technology Fee$0.80 Scanning$
Bond$ (if required) Total Fee Now Due$ i
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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 co - ` `-"g .!4
copy of the recorded•notice of commencement,must be posted at the job
site for the first inspection which occurs seven (7) days after�th`e public works permit is issued. In,the
absence of such posted notice,the inspection will not be approved and a reinspection ifl-be
4 ' �arg4
Signature Signature
pplicant or Authorized ent % Company/Utility Agent_
The foreinstrument was acknowledged_before The r ing instrument was acknowledged fore•
P;
this day ofr�,20 ,by is--a day of �r�20AqeJ
by
CA who _�x� UGZr—� U Y G1GZ-t who
ZsonallY C1?xknown to me gjwho has produced ispersonallyknown oyyvho has produced
1 �sas ;� i as
identification. identification.
EZ
MAHA�1 K•GONGL044602
Sig Sign. •:?°A4.; MYM►SSION#
r 2,2020
�ARPd K.G� 044802 3 �hru Notary public Und
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Print: .,, "" r, N Print: �''�oif�?p: Bow
SEAL: o, . pIRENO rypublicUndervm�n SEAL: -
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APPROVED BY:
Public Works Director;or Designee
2017-04-15
a i ii�lll!IIlI if!I!Bill l!!li!llff I!I!I IIII I!!I
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018R 1271-j-73
1y�OREs tC
OR'BK 320992 P9 38b1((1P95)
Miami Shores Village - 11(:13I1i5/;?lli8 1`11-i' )-
we! BIG ,.,..� Building Department- HARVEY f UVINr CLER1 Of
GUIJf;7
I�:EAIII IiAOE COUNTY? FLORIDA
10050 N.E.2nd Avenue
L ~� Miami Shores, Florida 33138
Tel: (305) 795.2204 7C:t?f FLORI{�A COUNTY OF L1Ar o coot
Fax: (305) 756.8972 i R1=�'r`cERrr,�Y r.��t��a trs+e���
ori incl r`,eY'roof":.*an
�ii�lAR 0_ 101�.AD a
WAKI
County CamCOVENANT OF CONSTRUCTION WITHIN IGIIJT O WAY ac J_
Whereas, (owner) ;124ge2 a
hereinafter referred to as the ow er f the following describedA IL#162583 -
property (address): 1130 /�/ ��% G �3�
tZ
Legal Description: Lot►6gw'l lock 2 Subdivision t,✓A-re" fLWre--
-Folio #- 11320'5610*10 a
Requests permission to install (describe work): �Pf eA�l� Oy `� ��STj4Gl;
Within thepublic right of way of (address) / ? ,
F-(, _--5i 5:
IN CONSIDERATION of the dpproval 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 indemnify and hold,Miami Shores Village orDade 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 removal and disposal of thelitem(s).
4. 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,repres ntativ )).
Signature
Owner Agent
State of Florida.
County of.Miami Dade ^ �`
T e foregoing instrumentTUR7is
�► owledged before me this �_day of 1" `a Cj �, 20 $, by
_bay personally known to me or who has produced
as identification.
NO LIC:
� �o
�g � ,�,..•.:�;; MAHARAI K.GONZALEZ
Print: SEA MY COMMISSION#GG 044602
eN *
EXPIRES:,November 2,2020
"'FOF FqP Bonded Thru Notary Public Underwriters