PW-18-79 i.
Permit NO. PWA-18-79
�sw°REs.y� Miami Shores Village Permit Tyrie:Public Works
10050 N.E.2nd Avenue NE - � Work Classification:Public Works
Miami Shores,FL 33138-0000 "P e
Phone: (305)795-2204 Permit Status:,APPROVED
FCORiDp`
Issue Date: 1/1212018 Expiration: 04/12/2018
Project Address Parcel Number Applicant
652 NE 105 Street 1122310120140
Miami Shores, FL Block: Lot: KILUAN, INC
Owner Information Address Phone Cell
KILUAN, INC 652 NE 105 Street I
MIAMI SHORES FL 33138-
150 SE 2 Avenue
MIAMI FL 33131-
Contractor(s) Phone Cell Phone Valuation: $ 1,000.00
JOSEPH S. ROBBIO INC (954)663-6743
Total Scl Feet: 400
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-1-18-66098
DBPR Fee $0.00
DCA Fee $0.00 01/12/2018 Credit Card $ 154.00 $50.00
Education Surcharge $0.20 01/11/2018 Credit Card $50.00 $0.00
Permit Fee $100.00
Scanning Fee $3.00
Technology Fee $0.80
Work without a Permit Fee $100.00
Total: $204.00
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 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. Futher ,,I authorize the above-named contractor to do the work stated.
January 12, 2018
Authorized ' ture:Owner / Applicant / Contractor / Agent Date
Buildin apartment Copy
January 12, 2018 1
Miami Shores Village RECEIVED
Public Works Department
(305)795-2210 JAN 11 2018
Public works forms are available from the building department, 10050 NE 2n"Ave.,Miami Shores,FL 33138 �y
PUBLIC WORKS PERMIT APPLICATION
Permit Type:Work in the Right-of-Way on Miami Shores Village or Miami-Dade Property
Permit#:bs ( —
Name of Applicant(if utility see below): Klluan Inc.
Owner off the following described property:
Legal Description:Lot Block Subdivision Golf View Estates
Folio#; . 11-2231-012-0140
Address: 652 NE 105 St. Miami Shores Fl. 33138
UTILITY NAME: I
Qualifier/Authorized Agent:
Address:
} City: State: ZIP:
Telephone: . Email:
State Certification or Registration#: Certificate of Competency#
CONTRACTOR NAME: Joseph S. Robbio, Inc
Qualifier/Authorized Agent: Joseph S Robbio
Address:9400 S. Meadows Circle
city: Miramar Stater Florida ZIP: 33025
Telephone:(954) 663-6743 Email: josephsro5bioinc@a6Ecom
State Certification or Registration#: CBC 059462 Certificate of Competency#:
Requests permission to install (describe work, attach separate page if necessary)in the adjoining right of
way: Install 1" asphalt cap over existing asphalt driveway
r ,
Type of Work: ® Paving ❑ Utility ❑ Sidewalk ❑ Electric ❑ Irrigation
❑ Landscape ❑ Antenna ❑ Other:
DESIGNER:Architect/Engineer:
Address:
City: State: ZIP:
Telephone: Email:
Registration#:
Value of Work,for this Permit:.. $ Square/Lineal Footage of Work: Sq: Ft.
Fees
Permit Fee$ 100.00~
Notary$ Training/Education$0.20 Technology Fee$0.80 Scanning$
Bond$ (if required) Total Fee NOW Due$ 15Y. CK)
—DLQek " Etc:: I W• 00
a
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 Or COMMENCEMENT MAY RESULT IN
YOUR PAYING TWICE FOR IMPROVEMENTS TO THE RIGHT-OF-WAY. 1F 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 publiciworks permit is issued. In the
absence of such posted notice,the inspection will not be approved and a reinspection will be charged.
M co B zi Joseph S obbio -
Signature Signature
Applicant orTAuthorized Agent Company/Utility Agent'
The foregoing instrument was acknowledged before The fo oing instrument was acknowledged before
me this_M day of J0y1UQy20 _)8_,by me this_(:a__day of ,by
M&MA2�—who _ /O who
is pe ovally kno to me or who has produced is p sonaily kno o me or who has produced
as as
identification. identification.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: Sign:
Print ( oGCI G. I3GS1 Print: (_L6Q G''1. JG51
SEAL: SEAL:
'5.... °t►pr°�
:'o�- -.�;•• - LUCIA G ISASI
LUCIA G ISASI
'€ MY COMMISSION#FF182628 iy;. i .MY COMMISSION#FF182628
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°•..,'ttid!�,. EXPIRES December 10,201F3 !rd!: EXPIRES December 10,2018
(407)398-0153 idallotaryServicexom L(4_07)398-0153 FloridallotaryServlce.com
******* *************************************
APPROVED BY , Public Works Director, or Designee
2017-04-15
i
`'5 CI, S
Miami Shores Village
mole €�j ,�,.� Building Department - , -30822 - -
10050 N.E.2nd Avenue ijy
-O51Ny° Miami Shores;'Florida 33138 r' ' ` J ° ° '
RIDp' t,
Tel: (305)795.2204
Fax: (305) 756.8972
COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY
Whereas, `(owner) Kiluan, Inc.
-hereinafter referred Was the owner of the following described
property (address): 652 NE 105 St. Miami Shores, Fl.
Legal Description: ,Lot Block Subdivision Golf View Estates Corrected Plat
Folio # 11-2231-012-0140 -
Requests permission.to install (describe.work): Install 1" asphalt cap over existing '
asphalt driveway
Within the public right of way of (address) 652 NE 105 St. �
Miami Shores, F1.33138
IN CONSIDERATION of the approval of this permit by the Village, the owner agree-" 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
I 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.
12. The owner does hereby agree to indemnify and hold Miami Shores Village.or,Dade. County 1.
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 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 suchAime 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
f
(or his fully authorized representative).
*Mte:(Ar KO+fi VA,COUtft:Y OFill"
M c Br i ( Kiluan, Inc.) rHEAMYCER�y�+et"Ar etre at"
Signature
snl lelaedIn0*2 •
A D 7Q .
caner or Agent + JWY of
080W ON*
State of Florida I _„_pF
County of Miami Dade
The foregoing instrument was acknowl me this meq_day of uay 20V 1B , by
2Co lam! who is ersonally know to me' or who,has produced -
asAide tification.
NOTARY PU IC: a` j
°4��P„„... LUCIA G 1
V
Sign: � _::” ��= SASI
Print: SEAL: , MY COMMISSION#FF182628
°•''ors�d°='' EXPIRES December 10,2018
(407)399-0153 Floridallotaryservice.com
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