PW-17-1994Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Project Address
Permit NO. PW-8-17-1994
p is Permit Type: Public Works
Work Classification: Public Works
Permit Status: APPROVED
issue Date: 811412017
Expiration: 11/12/2017
Parcel Number
Applicant
9190 BISCAYNE Boulevard
Miami Shores, FL
1132060100030
Block: Lot:
BRITE STONE INVESTMENT LLC
Owner Information
Address
Phone
Cell
BRITE STONE INVESTMENT LLC
1160 KANE Concourse
BAY HARBOR'ISLANDS FL 33154-
(786)340-7513
1160 KANE Concourse
BAY HARBOR ISLANDS FL 33154-
Contractor(s) Phone
G & G EQUIPMENT RENTALS INC (305)716-3311
Cell Phone
Valuation:
$ 1,000.00
Total Sq Feet: 1200
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 Pay Type Amt Paid Amt Due
Invoice # PW-8-17-64797
08/14/2017 Credit Card $ 104.00 $ 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 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 aurize the above -named contractor to do the work stated.
Et_
Authorized SiE ngture: Owner / Applicant / Contractor / Agent
August 14, 2017
Date
Building Department Copy
August 14, 2017 1
Miami Shores Village
Public Works Department
(305)795-2210 Pi, r,.
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
RECEIVED
AUG 07 217
� ll_
Permit#: DS 11 — �SO
V.\ 11-- 199 g
Name of Applicant (if utility see below): BIZ ITE STONE_ )NVESTmEN
Owner off the following described property:
Legal Description: Lot Block Subdivision
Folio#; II- (;)- 0/l) - O403C)
Address: R/ / I.Sc.rIVA/E SL_VD, mlAmi siiaiS rt._ 331.3
UTILITY NAME: N / A
Qualifier/Authorized Agent:
jJ �A Address:
City: State: ZIP:
Telephone: Email:
State Certification or Registration #: Certificate of Competency #
G G EQVIPMENT R2,NTALS, INC.
CONTRACTOR NAME: DBA PAVE THE.. vJAY ENGIG
Qualifier/Authorized Agent: LAJ I L/C l A/ G. N-F_, AJAN D E Z
Address: 8311 ARA) 70 ST
City: i'>7 c A-m ► State: / - L- ZIP: 33 / (a (o
Telephone: ,305-71(o-33/I Email: 60TASP)4A-LT- a-QIa--@ Y ff00, c ni
State Certification or Registration #: N A Certificate of Competency #: E l (o 00 0 4 J
N I A
Requests permission to install (describe work, attach separate page if necessaryYin the adjoining right of
way: SEALCA /--TIAI 6 .4— /2. S 024 P)AJG
Type of Work: X. Paving ❑ Utility ❑ Sidewalk ❑ Electric ❑ Irrigation
❑ Landscape ❑ Antenna ❑ Other: ,
DESIGNER: Architect/Engineer: N IA
Address:
City: State: ZIP:
Telephone: Email:
Registration #:
Value of Work for this Permit: $ L, OOO, 00
Square/Lineal Footage of Work: I a,00 3 CR F7
*****Fees*****
Permit Fee $ 100.00
Notary $ Sec Training/Education $ 0.20 Technology Fee $ 0.80 Scanning $ 3 .c7�
Bond $ (if required) Total Fee Now Due $ 1(*k. c R.
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 permit is issued. In the
absence of such posted notice, the inspection will not be approved and a reinspec 'on will be charged.
Signature ( /'"�"
Applicant or Auth !zed Agent
The foregoln lnstrume t was cknowledged before
me this day of 161.v 20 17 , by
'i` fileSwho
is personally known to mP or who has produced
as
identification.
NOTARY PUBLIC:
Sign:
SE •-L:
;arR•
ra�e Boris Borukhov
Signature
Company/Utility Agent
The foregoing instrume t was acknowledged before
me this elk day of 20 ( , by
\NUI,i P • HeArY(a who
is personally known to me or who has produced
S ti`ac
identification.
?•
;c•:Commission # FF 164392
.�` Expires: SEP 30, 2018 NOTARY PUBLIC:
OF''''' BONDED THRU
1ST FLORIDA NOTARY, LLC Sign:
bt 5
APPROVED BY:
ki1* ***************************************
�1
%� , Public Works Director, or Designee
Print: N I UYVQ
SEAL:
as
1411311NAANRAICAETA
Notary Public • Stars o1 Florida
• _ Commission N GG 031740
My Comm. Expires Sep 19, 2020
%,, °,, ,, Bonded through National Notary Assn.
�11111Poilip-w�'
2017-04-15