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PW-18-366Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Project Address Permit Issue Date:.. 2/13/2018 Permit NO. PAW-2-18-366 Permit Type: Public Works Work Classification: Public Works Permit Status: APPROVED Expiration: 05/14/2018 Parcel Number Applicant 1441 NE 101 Street Miami Shores, FL 33138- 1132050240270 Block: Lot: PAUL BENJAMIN Owner Information Address Phone Cell PAUL BENJAMIN 1441 NE 101 ST MIAMI SHORES FL 33138-2612 (305)757-5351 Contractor(s) DRIVEWAYS BY DESIGN INC Phone (305)776-7916 Cell Phone Valuation: Total Sq Feet: $ 100.00 0 Scanning: 1 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Total: Amount $0.00 $0.00 $0.00 $0.20 $100.00 $3.00 $0.80 $104.00 Pay Date Invoice # 02/13/2018 02/13/2018 Pay Type PW-2-18-66432 Check #: 3024 Check #: 3026 Amt Paid Amt Due $ 50.00 $ 54.00 $ 54.00 $ 0.00 Available Inspections: Inspection Type: Excavation Review Public Works Final Public Works 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 AFFID h re nformation is accurate and that all work will be done in compliance with all applicable laws regulating construction ut ore I.auth nze�e-named contractor to do the work stated. uthorized Signature: Owner / Applicant / Contractor / Agent uilding Department Copy February 13, 2018, Date February 13, 2018 1 If• '�n4 I5I47t5 vlDESIGNER. Architect/Engineer. Miami Shores Village 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 PER 13 2018 -3Y: Permit#: Name of Applicant (if utility see below): a-(4-e-<S )G -._ �-- Owner off the following described property: V Legal Description: Lot / E' Block 3 Subdivision /l-;4"6t -.P Say, �� et14M� Folio #; /(- 3-2- -cS ©2.6(o2?a J Address:,/c(q, me 1p( S{ Kitt-6f, 3fy'o v-5 , fJ 33(3g UTILITY NAME: Qualifier/Authorized Agent: Address: City: State: ZIP: Telephone: Email: State Certification or Registration #: Certificate of Competency # CONTRACTOR NAME: /2: (/EI !! S Lcy /O Qualifier/Authorized Agent: /�z. �,� ✓ Address: 2:2-2 ke ,(S ,sa' City: /4YA t-tState: F . ZIP: 33(30 : Telephone: 3c'S -??6 ?T Email: 26/v6 0 fief e S /a v-. State Certification or Registration #. C - __ -. Certificate of Competency #: (7c7 336 Requests permission to install (describe work, attach separate page if necessary) in the adjoining right of way: A O024-44,2 - - - Type of Work: Paving ❑ Utility ❑ Sidewalk ❑ Electric ❑ Irrigation ,,.:....f�.,, y ...r...,r.xa:aw�..s.wc^'u �a-..w.wF •.sWr,h. L.; a^a.-a ew7gw.'�w,✓sa�.>...rn..vr w.w...rr.W�a 0 , Landscape q❑ lAntenna 0 Other: St Il= v1 y ,.�.. i. City: ,,=7.. • State: Telephone: Email: Registration #: Value of Work for this Permit: $ Square/Lineal Footage of Work: ***** Fees***** Permit Fee $ 100.00 Notary $ Training/Education $ 0.20 Technology Fee $ 0.80 Scanning $ Bond $ (if required) Total Fee Now Due $ lat -03 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 workwill 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 cor`npliance 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 permit is issued. I s absence of.such posted notice, the inspection will not be approved and a reins' - Signature A plic or Aut orized Agent The foregoing instrument was acknowledged before day of meths / is ersonally kno identifica . NOTARY Sign: Print: SEAL: APPROVED BY:. , 20 /8 . by who to"rhe or who has produced ll�S� as KOMORNIK a- ary Public 128031 n Expires 2021 Signat Company/Utility Agent Th - . -going instrument was acknowledgeefore mgthis �� day of� , 20 (d , by 7� Q who is perso to me or who has produced as identification. NOTARY PUBLIC: Sign: Print: SEAL: �`i' OP "III' MA. v • 0M1RNIK Strida-Not,ry Public ssion # G'. 128031 ommis Expires u y25,,• 1 ************************************** 711-3( Public Works Director, or Designee 2017-04-15