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PW-18-527 Permit No. P-W-3-18-527 Miami Shores Village Permit Type: Public Works �0 10050 N.E.2nd Avenue NE ' WorkGlaSsifrcation:Public Works Miami Shores,FL 33138-0000 Permit Status:APPROVED Phone: (305)795-2204 CORLDi'' Issue crate:3/212018 Expiration: 05/31/2018 Project Address Parcel Number Applicant 925 NE 95 Street 1132060143100 Miami Shores, FL 33138- Block: Lot: JUDITH H LEFFERDINK Owner Information Address Phone Cell JUDITH H LEFFERDINK 925 NE 95 Street (847)975-8540 MIAMI SHORES FL 33138- 925 NE 95 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone Valuation: $ 1,764.00 ARTISTIC CONCRETE GROUP INC (305)888-9095 —� .. Total Sq Feet: 252 Scanning: 1 Available Inspections: Inspection Type: Excavation Review Public Works Final Public Works i Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $0.00 Invoice# PW-3-18-66620 DBPR Fee $0.00 DCA Fee $0.00 03/01/2018 Check* 1189 $50.00 $54.00 Education Surcharge $0.20 03/02/2018 Check#: 1190 $54.00 $0.00 Permit Fee $100.00 Scanning Fee $3.00 Technology Fee $0.80 Total: $104.00 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 FIDA : I certify t all a foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating constr o d o ing. Futh ore, I uthorize theabove-named contractor to do the work stated. March 02, 2018 uthoriz ignature:O ner / Applicant / Contractor / Agent Date 1 Building Department Copy March 02, 2018 1 K-ex-vIV\��- �o�reS R t l Miami Shores Village ARO 1 261 r. R Public Works Department (305)795-2210 BX3138 Public works forms are available from the building department, 10050 NE 2"d Ave., Miami Shore PUBLIC WORKS PERMIT APPLICATION Permit Type:Work in the Right-of-Way on Miami Shores Village or Miami-Dade Property Permit#: �� — ZG Name of Applicant(if utility see below): —J lCailfh Owner off the following described property: Legal Description: Lot Block Subdivision Folio#; - 2 b- oil- 3 100 Address: qZS Ne S5- IV UTILITY NAME: Qualifier/Authorized Agent: Address: City: State: ZIP: Telephone: Email: State Certification or Registration#: Certificate of Competency# CONTRACTOR NAME: AV115 C 1r-OA Qualifier/Authorized Ag t: H e CA CK ,\I6I,, Address: 6 ,5- IOW fev City: ki&& state: IL ZIP: Teleph ne• Email: State Certification or Registration#: Certificate of Competency#: eQq0cog Requests permission to ins all(describe work,attach separate page if necessary)in the adjoining right of way:_ N� h Type of Work: 5?(Paving ❑ Utility ❑ Sidewalk ❑ Electric ❑ Irrigation ❑ Landscape ❑ Antenna ❑ Other: DESIGNER:Architect/Engineer: Address: City: State: ZIP: Telephone: ` Email: Registration#: i Value of Work for this Permit: $; " `•,1 fP� Square/Lineal Footage'of Wor`k�` 52� ***** Fees****`* -�.;n,rsE. .�+- :„n.«i'S"Y•,+e.• =,..wr ?"''�,. Permit Fee$ 100.00 ' Notary$ Training/Education$0.20 Technology Fee$0.80 Scann_in $ t Bond$ (if required) Total Fee Now Due$ _i T7 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. �L "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 commencemenCmust be posted at the job site for the first inspection which occurs`seven(7) days"after the public woks permit is issued. In the absence of such posted notice,the inspection will not be approved and a reinspection will•be charged. WA Signature Signature Applicant or Aut6fized Agent Co pany/Utility Agent The foregoing instrumeRt was acknowledged before The foregoing instrument fwas acknowledged efore ' m this a'day of_Jif)WWAA_7 20 f B .by me this��day of J a,: 20 l by 1' Jw-91 Lo-i2�b1! lam- who L= a-<- Zty a < who is personally known to me or who has produced is personally known to me or who has produced as r as identification. identification. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Gf/ Sign: 'Print: S'h>✓01 fir! G� Print: J o Ve'S SEAL: SEAL: wa.ery SHELLIELFULFORD John Roques Notary Public-State ofFloddaNOTARY PUBLIC CommissionA00075t1ti4STATE OF FLORIDA , MY Comm.Expires Feb T8 2021 ? Comm#FF946106 *** X res 4/17/2020 APPROVED BY: Public Works Director,or Designee 2017-04-15 CFN: 20180045812 BOOK 30837 PAGE 4457 ♦ DATE:01/22/2018 03:45:18 PM RI �p� HARVEY RUVINIW" 6&4g'llf j2AU CTY Building Department , 10050 N.E.2nd Avenue Miami Shores, Florida 33138 i Tet.:(305)795.2204 Fax: (30 5)756.8972 COVENANT OF C©NSTRUCTION 'IWITNIN RIGHT OF WAY- - a Whereas,(owner} r hereinafter referred to as the owner of the following es ti d propert (address): Legal De rri tion r � g .._ Lot IBJ Bloa Subdivision Folio# j` p y 31 .--y ,r^ Requests permission to install (describe work): allsK14P'. Within the public right of way of(address) IN CONSIDERATION of the approval of this permit by the Village, the owner agrees as follows: E 1, To maintain and repair, when necessary, the above-mentioned Item(s) installed within the dedicated right of way. If it becomes nece6sary 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 cif permitting the installation of these items within the public right of way. 4 3. The Owner does hereby agree to remove or relocate their facilities at their own'expense, r within 6 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 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 canceledby an affidavit filed in the Public Records of Dade Country, Florida by the Village Manager of Miami Shores Village(or his fully authorized representative). E Signature vy OwneiL&Agent oin f The or instrument was acknowledged � � foregoing instrume � ged before me this day of � , 20 t� , by �r who is personalty known to me or who has produced *.V 4,P 5 as identification and who did take an oath. a NOTARY PUBLIC Sign: Print: My Commission Expires: 4, "Mq Pw&-Stsm►of i ; CommNsim•GG 031072 { 'Comm. � f41 Sep 10.2020