PW-17-2884 1 1
Permit NO. PW-12-17-2884
`yeoRes i,� Miami Shores Village Permit Type:Public Works
10050 N.E.2ndvenue NW
APer '
't
-2204 Work Classification:Public Works
- Miami Shores,FL 33138-0000 Permit Status:APPROVED
Phone: (305)795 2204
�ORtDp' 03/11/2018
Issue este: 12/11/2017 Expiration:
Project Address Parcel Number Applicant
93 NW 97 Street 1131010330250
Miami Shores, FL 33150- Block: Lot: BARBARA DELGADO
Owner Information Address Phone Cell
BARBARA DELGADO 93 NW 97 Street (786)499-7389
MIAMI SHORES FL 33150-
93 NW 97 Street
MIAMI SHORES FL 33150-
Contractor(s) Phone Cell Phone Valuation: $ 1.00
DECO CONCRETE INC (305)828-5158 (305)345-4740
Total Sq Feet: 0
Scanning: 1 Available Inspections:
Inspection Type:
Excavation
Review Public Works
Final Public Works
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $0.00
Invoice# PW-12-17-65840
DBPR Fee $0.00
DCA Fee $0.00 12/07/2017 Credit Card $50.00 $59.00
Education Surcharge $0.20 12/11/2017 Credit Card $59.00 $0.00
Notary Fee $5.00
Permit Fee $100.00
Scanning Fee $3.00
Technology Fee $0.80
Total: $109.00
In consideration of the is ane to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in ict nformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this permit s responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRI P MBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: I fy that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zonin I authorize the above-named contractor to do the work stated.
December 11, 2017
Authori Signat re:Owner / Applicant / Contractor / Agent Date
Building rtment Copy
December 11,2017 1
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-►�- Miami Shores Village _( _
{ Public Works Department
(305)795-2210 i
Public works forms are available from the building department,10050 NE 2nd Ave.,Miami Shores,FL 33138 .E ;
- - PUBLIC WORKS PERMIT APPLICATION
Permit Type:Work in the Right-of-Way on Miami Shores Village or Miami=Dade Property {+
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Permit#,. DJ i-] — 3
Name of Applicantl(if utility see be _`.."I`//a��-�f ' rul �'J�!u0 �'' ,`d , 'sal ` �}
Owner off the following described property:
Legal'Description:Lot-7 /-�!C_ 13 1 o c WA-2,` ubdivision
Folio#;
' Address: !21 AAL)
ILITY NAME:' i s - " 'e- ";s. .,`r " , 43i }
Qu lifier/Authorized Agent:'; a f Y V ., " .,. 'e`
Addss:
City: State: ZIP: '
TelepC�rtifi6atidn`br
ne: Email:
State Registration#:° ' f Y` Certificate of Competency It
.CONTRACTOR NAME:`" _Ct����i" -Lce
.�.
Qualifier/Au &iiedAgent-'-!
Address: r �:
City: M) State: " ;`'�;`} ZIP:^•331 2-1
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Telephone: 3%_bn,S15S Email:, fms 0=560 In6 r ly) '
State Certification or Registration#: Certificate of Competency'#:
Requests pe�rmissio to install describe work,attach separate page if,necessary)in the adjoining right of
way: lCA I Vl' �Yti� � ��s C azy-,
Y f• S
j �� ... ..... « • .. .., +'f — ..A..— .. ,y�,F r t.l t �; `} a ��-:
Type of Work:'`❑'Paving` � `•❑' Utility' ❑'Sidewalk CT�Electric ❑ 'Irrigation -
r ZL }
Landscape [] AntennIa ''Other:
SIGNER:Architect/Engineer: i
Ad ess:
City: State: ZIP:
Telephon .Email:
Registration
� r �
Value of Work for this Permit: $ 'Square/Lineal Footage of Work
***** Fees**«**
Permit Fee$`100.00 - 50 •Pct;
Notary$�_ Training/Education$0.20 Technology Fee$'0.80 Scanning$
Bond$ Y(if required) , I s,v - Total Fee Now,Due'.$
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Bo ing Company's Narri'e'(If applicable): -`
Bon ' g Company's Address:
City: State: ,ZIP:
" a
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:L- ' certify that all the foregoing information ls.accurate'ahcl jhat�all work will be
done iri compliance with applicable laws regulating construction and,specifically construction in the
right-of-way; � .-' J . r
"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 Westimated value,
exceeding$2,506,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,, 1_,
attachment.Also;a certified co notice
,6f of the-recorded nonce•of commencement must be posted at the;job
site for the first inspection which occurs'seven(7)daysi afterthe public works permit is issued!In the'-.av
absence of such posted notice,the inspectioin:will not"be approvea-and a reinspection,will,be'cherged..•
Signature Signature- t. y
'~ Applicanto Authorized Agent
The foregoing instrument was acknowledged before --The'foregoing instrument was acknowledged before+
me this 10 day of dirlibeI! .20 /iL by- me this dayof DLC(,_tM)Ctv20_�Z,by
C E 00,121 n fJL= who C r who
is p ally known to me or who has produced is pets�nally.known to me%r who has produced ,
vf- as
identification. identification.
NOTARY PUBLIC_ NOTARY P ELIC:
Sign' Sign:.
Print: Print: U r
SEA SEAL:
FO'.OF
MARIA M.AGUILAR
tary Public-State of-Florida t;�•1,�' ;� �' * $ f YANADY PRIETOComm:Expires Jul 15,2018 ' Ml'COMMISSION#FF 214031
_Commission # FF 142170 s. :a EXPIRES:March 25 2,010
d Through National Not Assn. rt 9 h ' Beaded Thru Notary Public UmlBrufiipf6 ,
rc4y
l
APPROVED BY:� t, r r t Public Works Director,or Designee' _-
2017-04-15
CFN:20170657562 BOOK 30765 PAGE 1114
DATE:11/22/2017 08:39:56 AM
} HARVEY RUVIN,CLERK OF COURT,MIA-DADE CTY
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
a Miami Shores,Florida 33138
Tel:(305)795.2204
Fax:(305)756.8972
COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY
Whereas,(owner) Y6r1V-,•? De► twr iinafter referred to as the
owner of the following described property( ddress): T lc1 9� StYz�,�—
Legal DescriptionI�i ID-3�Lot /S- Bloch Subdivision
R! ugrsts permission to install(describe work): 1r3+n FJncl (�i/�(�
Within the publiafight of way of(address) S
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 Village to do so. Failure to comply with this notice will result
In the Village causing the items)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 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).
Signature �F
iwnefr ge t'D
he foregoincl instrument was acknowledged before me this day of 2At�'t!z0 by
RYR who is personally known to me or who has produced ;t/e✓C fl�r�c is p,
as identification nd wh did take an oath.
NOTARY PUBLIC:
Sign:
Print: 4M; - .
My Commission n MARIA M.AGUItAR
¢: Notary Public•State of Florida
My Comm.Expires Jul 15,2018
Commission 8 FF 142170
n.
Bonded P=0 National Notary Ass