PW-18-859 r
Permit NO. PW-4-18;-859'
sµOREs Miami Shores Village M Permit Type:Public Works
10050 N.E.2nd Avenue NW
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Miami Shores,FL 33138-0000 Per r Ix Work Classification:Public Warks
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Permit Status:APPROVED Phone: (305)795-2204 i
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Issue Date:4/1012018 Expiration: 07/09/2018
Project Address Parcel Number Applicant
225 NW 91 Street 1131010331350
Miami Shores, FL 33150- Block: Lot: MARIE THERMITUS
Owner Information Address Phone Cell
MARIE THERMITUS 225 NW 91 ST
MIAMI FL 33150-2258
Contractor(s) Phone Cell Phone
Valuation:- $ 4,000.00
CHAMPION CONCRETE
(305)252-8055 (786)402-4802
Total Scl Feet: 600
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Scanning: 1 Available Inspections:
Inspection Type:
Excavation o
Review Public Works
Final Public Works
Fees Due jmnPay Date Pay Type Amt Paid Amt Due
CCF Invoice# PW-4-18-67021
DBPR Fee 04/10/2018 Check#:2836 $54.00 $50.00
DCAFee Education Surcharge 04/03/2018 Check#:2828 $50.00 $0.00
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.
1 April 10, 2018
Authorized Signature:Owner / Applicant / Contractor / Agent Date
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Building Department Copy
April 10,2018 1
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r+ Miami Shores Village
Public Works Department BY'
(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`
Permit Type:Work in the Right-of-Way on Miami Shores Village or Miami-Dade Property
Permit#:
# Name of Applicant(if utility see below): 60/9e44 1/yeti-I/7O..
I Owner off the following described property:
Legal Description: Lot i Block Subdivision
Folio 1t3 — 57
Address: -sty 64!✓
UTILITY NAME:
Qualifier/Authorized Agent:
Address:
City: State: ZIP:
Telephone: Email:
State Certification or Registration#: Certificate of Competency#
CONTRACTOR NAME: C Inti
Qualifier/Authoriz d A ent: /yTtC J `
Address: 0 Iz. &5 7—r/P .
City: State: ZIP: 3�
Telephone: GS 7fl Email: oE' 7A1A.,-
State Certification or Registration#: Certificate of Competency#:
Requests permission to install (describe work,attach separate page if necessary)in the adjoining right of
way: V 1A rel
t
Type of Work: ❑ Paving ❑ Utility ❑ Sidewalk ❑ Electric ❑ 1rrigation r
❑ Landscape ❑ Antenna ❑ Other:
DESIGNER:Architect/Engineer:
Address:
City: State: ZIP:
Telephone: Email:
Registration#:
Value of Work for this Permit: $ Square/Lineal Footage of`Work: (00s�
***** Fees *****
Permit Fee$ 100.00
Notary$ Training/Education$0.20 Technology Fee$0.80 Scanning$
Bond$ (if required) Total Fee Now Due$
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14, 9
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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 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 permtsu
' ed. In the
absence of such posted notice,the inspection will not be approved and a reinspectll be charged.
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Signature_l79't"}^A— �� �} Signature
Applicant or Authorized Agent mpariy/U ' ty Agent
The foregoing instrument was acknowledged before The foregoing instrument was a knowledged before
me this 23 day of IVIP rC�1 ,20�,by e this�day f >c� 20�by
�ro�ct�`i rr m i�.v s who o1i�-t qs" O who
isersonally known to me or who has produced is personally known to me or who has produced
-Dr i\�Qy � i M"4-.9, as i C'e -f as
identificatio identification.
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_'2Sign: Sign:
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Print: KA 1 Q 1110 Print:
SEAL: SEAL:
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Pµ•'P�' YANADY PRIETO
4Y PY'. YANADY PRIETO
MY COMMISSION#FF 214031
EXPIRES:March 25,2019 _'+; += M`'COMMISSION#FF 214031
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Bonded ThmNotary Public Underw(iters =;; ek.
�= EXPIRES:March 25,2019
-"°' Bonded�i hm Notary Pub!Ic Underwriters
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APPROVED BY: Public Works Director, or Designee
2017-04-15
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Miami Shores Village 86592
CFH2018RCR1"B= Building De artment
C+R` BK 0917 P9 392 ( Pas)
o�� 10050 N.E.2nd Avenue +, +_�ri:DED +l?
F�oRivA Miami Shores, Florida 33138 rF;r:;}�'r' ,,a�'-'zh}a `�a__"H, �:+F + +,1t!=
Tel: (305) 795.2204 -c.. cF
Fax: (305) 756.8972
COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY
Whereas, (owner)
hereinafter referred to as the owner of the'following de cribed
property (address):, ZZ3 tr lga .
Legal Description: Lot Block Subdivision
Folio # - /Oj" U 3
Requests permission to install (describe work):_(,O,Qa
Within the.public right of way of (address) Z —
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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 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 their facilities at their own expense,
within 60 days notice by the Villageto,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 an
assessed against the Owner for all costs incurred in the removal and disposal of-the item(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 representative).
STATE O42ECOOO ADE
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Signature o ' ~ , :r+gir►alon�leyp c°�HARVEYR CovetsOwner or Agent ,,,,State of Florida � ERRITT
County of Miami Dade 1Q22
The fore ing instrument was acknowledged before me this 2,3�`�day of 0// rck � , 20 (8 , by
Gw 0 cf n, 1 f rr;;�v s who is personally known to me or who has produced
as identification. +�
NOTARY PUB IC:
Sign: o _71
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NVPva;;- �F�1nDYPRIEio
Print:
SE f 41SSIGPv FF 214.031
-.,-K( EX°RES 'Nara+25,20"