PW-18-1551Miami Shores Village
10050 N.E. 2nd Avenue NW
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Project Address
Permit
Permit NO. PW-6-18-1551
Permit Type: Public Works
Work Classification: Public Works
Permit Status: APPROVED
Issue Date: 6/22/2018
Expiration: 09/20/2018
Parcel Number
Applicant
31 NW 92 Street
Miami Shores, FL 33150-
1131010170110
Block: Lot:
ROBERT BURLEIGH
Owner Information
Address
Phone
Cell
ROBERT BURLEIGH
31 NW 92 Street
MIAMI SHORES FL 33150-
31 NW 92 Street
MIAMI SHORES FL 33150-
Contractor(s) Phone
ANTHONY BOBCAT SERVICE INC (786)709-3622
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 Pay Type
Invoice # PW-6-18-67824
06/22/2018 Check #: 1197
Amt Paid Amt Due
$ 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 i accurate and that all work will be done in compliance with all applicable laws regulating
construction and zoning. Futhermore, I authorize the above-naontractor yd do the uyofk d.
Authorized Signature: Owner / Applicant T Contractor / Agent
June 22, 2018
Date
Building Department Copy
June 22, 2018 1
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
REC
JN
BY:
PUBLIC WORKS PERMIT APPLICATION
Permit Type: Work in the Right -of -Way on Miami Shores Village or'Miami-Dade Property
Name of Applicant (if utility see below):
Roo
Permit#:
be-Le-160,
Owner off the following described property: /�
Legal Description: Lot I I Block Subdivision Q' t b KtMS/013
Folio #; 1 I- 01- ! 11-010
Address: i!
2
•h31
UTILITY NAME:
Qualifier/Authorized Agent:
Address:
City: State: ZIP:
Telephone:
Email:
State Certification or Registration #: Certificate of Competency #
CONTRACTOR NAME:417l n
Qualifier/Authorized Agent:
Address: ?PT,
City:
Telephone
State Certification or'Registration #:
Reque is//per'
g/' issio(n}t�o ins 5J1`(des grrib�ee_ii,ork, attach s ra age if necessary)In the adjoi/n�ing.ri t of
way: Di�1,1k I �++ `�' ��r (um crp -1
Certificate o
ZIP:
Competency #: t400(NB
Type of Work: ❑ Paving ❑ Utility
❑ Landscape D Antenna
DESIGNER: Architect/Engineer:
Address: .. y t.
❑ Sidewalk 0 _Electric I ❑p Irrigation
❑ Other: Rlr.tn SgOarb /rel /tdTi!/1 .
City: • State: ZIP:
Telephone: Email:
Registration #:
Value of Work,forthis,permit
s
Fees
Square/Lineal Footage of Work Crar .,
Permit Fee $ 100.00
Notary $ Training/Education $ 0.20 Technology Fee $ 0.80 Scanning $
Bond $ (if required) Total Fee Now Due $ CO QD
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 viiiil 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 reinspection will be charged.
Signature Iyq
Apscant or Authorized Agent Company/Utility Agent
The for o' instrument was acknowledged before The foregoin nstrument was acknowledged before
his.day of 20 le , by me this drPillinay of C`hGs 1 , 20 �v , by
who ` ..���� Ontl.iX\- who
eorwfioas produc d is p�sonally kn• . me or who has produced
�. , as
Mt •
Mnally to
identification.
Sig
Print:
SEAL:
identification.
Lc�/y Sign: !'�iA 'U'/ �/�'�CLlfl Ilt/(�/1'/✓(.E
� Print:
.., OLORIASUSANALAM*IRT
* Comniselon N PF 9eoeu
Expire: January 14, ION
OFF,0 acederflwe NedINNOINYMMS4
APPROVED BY:
SEAL:
, nMUt, 0L0rItA WMNALAMBERT
* _ , - Commission / FF 950062
des January 14, 2020
'FOFne. BonNdllwuBudget NoWySwim
**********************************************
‘l-27d' , Public Works Director, or Designee
2017-04-15
Miami Shores Village
Building Department-
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 7,95.2204
Fax: (305) 756.8972
COVENANT OF CONSTRUCTION WITHIWRIGHT OF WAY
Whereas, -(owner) AOS -T O. 0G124 ?E,e4
hereinafter referred to as th'e owner of the following described
property•(address):... 3 / kIl J L-//' "fl' S4(O/U-S' 3/
Legal Description: Lot // Block = Subdivision C'92A i -3t//70N
Folio'# , //'3/C/- 0/ 2-O//O
Requests permission to install (describe work): (59'va L� �./ a
111111111111111111111111111111111111111111111
C F-N 201sRo31358o
OR BK 30991 P9 3719 (1P3s)
RECORDED 05/29/2013 09:37:5 ,
HARVEY RUVIN! C:LERY; Of COURT
MIAMI-DADE COUNTY. FLORIDA
Within the public right of way of (address) 3i 4,40 9.,9- 409/Y)i��CG G'tl ,a 31R)
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 br 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 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 canceled by an affidavit filed in
the Public Records of Dade County, F e rida by'the Village Manager of Miami Shores Village
(or his fully th zed presentativ
Signature
State of Florida
County of Miami Dade
he fRreg a ingjnstr me
Sig
Print:
wner or/Agent
was acknowledged before me this 3 day of I)1 f {I/ , 20
w o is personallyknown to me or who has produced I
on.
IEnfsopy��
B CERTIFY t
origineltleel in this on day of
A D 2A___--
el Seal.
%fi ERK, of Circuit and County
D.C.
, by
SEAL: ���` ���;°�, GLORIA SUSANA LAMBERT
• c • �€ * Commission # FF 950662
-7- . Expires January 14, 2020
OF pOPBeaded Pint Budget Notary Ser kes