PW-17-2978Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Project Address
r475 NE 91 Street
Miami Shores, FL 33138-3150
Owner Information
AVANT PLACE , LLC
Parcel Number
Address
Permit NO. PW-12-17-2978
Permit Type: Public Works
Work Classification Public Works
Permit Status: APPROVED
Expiration:03/20/2018
Applicant
1132060140142
Block: Lot:
7845 W 2 Court
HIALEAH FL 33014-
7845 W 2 Court
HIALEAH FL 33014-
Contractor(s) Phone Cell Phone
CONWELL & ASSOCIATES CONSULT (305)962-5673 (305)926-5673
AVANT PLACE , LLC
Phone
(786)566-2454
Valuation:
Total Sq Feet:
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-12-17-65952
12/20/2017 Check #: 1710 $ 104.00 $ 0.00
Cell
$ 600.00
150
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 ce hat all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zonin./ the or authorize the above -named contractor to do the work stated.
Authorize / Applicant / Contractor / Agent
December 20, 2017
Date
Building Depa ment Copy
December 20, 2017 1
Miami Shores Village
Public Works Department
(305)795-2210
Public works forms are available from the building department, 10050 NE 2nd
PUBLIC WORKS PERMIT APPLICATION
Permit Type: Work in the Right -of -Way on Miami Shores Village
Name of Applicant (if utility see below):
Owner off the following described property:
Legal Description: Lot Block
EC 9 2017
Ave., Miami Shores, FL 3 138
BY
or Miami -Dade Property Permit##71)S (- 2-90 lG
I )J T5
Subdivision
Folio #; r
Address: • 2= Trr ( 4/1 � I
UTILITY NAME:
Qualifier/Authorized Agent:
Address:
S-'1740�
City: State:
Telephone: Email:
State Certification or Registration #: Certificate of Competency #
CONTRACTOR NAME: GOM III ssoc l'otictr hu14 r
Qualifier/Authorized Agent: e ii r 1C �ONwf C
Address: (t l? I S W " /"'N C
City: ___ t Q N. r' State:
Telephone: 30SAA6 S 6'7) Email: Kee ,,t)er-C.-q cc h 54 yr irCJ. Ce co Pi,
State Certification or Registration #:CGCl4/513C Certificate of Competency #:
ZIP:
Requests permission to install (describe work, attach separate page if necessary) in the adjoining right of
way:
Type of Work: ❑ Paving ❑ Utility QrSidewalk ❑ Electric ❑ Irrigation
❑ Landscape ❑ Antenna Other: "4-6'4(
DESIGNER: Architect/Engineer:
Address:
City: State: ZIP:
Telephone: Email:
Registration #:
Value of Work for this Permit: $ 600
Square/Lineal Footage of Work: / 0
***** Fees *****
Permit Fee $ 100.00
Notary $ Training/Education $ 0.20 Technology Fee $ 0.80 Scanning $
Bond $ (if required) Total Fee Now Due $ ICY-F. (`1�j
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 reinspection will be charged.
Signature
Applicant or • orized Agent
The foregoing instrument was acknowledged before
me this l ` day of '.,f" IF_3' 20 11 , by
\ t\1O`Cf, who
js personally known to me or who has produced
Lt 7 - (kC NSt as
identification.
NOTARY PUBLI
Sign:
Print: �1
SEAL:
r°er °�e�� Notary Public State of Florida
Sindia Alvarez
a My Commission FF 156750
oFi,° Expires 09/0312018
..d...r, ,...sx..,_s..+►..w_A r,A"hh11.,>+ys^
APPROVED BY:
Signature
The foregoing
met es I cj
k PNNt
is personally)y
ompany/Utility Agent
instrument as acknowledged before
ay of e 20 (7 , by
eft. F. AL a C,1lwho
own to me or who has produced
identification.
NOTARY PURL C:
Sign:
Print:
SEAL:
,
as
Carolyn M. Conwell
tF Cotnmibsion # 6C001091
' Expires: October 7, 2020
r'i'�= Bonded thru Aaron Notary pf iti ���`�
o+rnm���
_******_ m***********************************
IL( '7 -7 , Public Works Director, or Designee
2017-04-15
I IHIlI IIIII!IIII IIIII illll IIIII IIIII IIII IIII
CFN 2 17Ro71 925
OR BK 7,0800 P9 660 (1.P'aa)
RECORDED 12/20/.2017 14:3; g5
rRVEY RUV].Ns CLERK OF COURj
NIANI-DADE COCIN.f } FLORIDA t�
COVENANTOFCONSTRUCTION WITHIN RIGHT OF WAY
Whereas, (owner) L-s1 3(��% here nafter fer d to as th
owner of the following described property (address): _ N-� `�—/�-C (,11I 7_
Legal Description Lot Block Subdivision
Folio #
Requests permission to install (describe work): t�, 1J 1r-)4\—/ Pte-074eC-j
Within the public right of way of (address) tom_ ��-�-� (/�
IN CONSIDERATION of the approval of this permit by the Village, the owner agrees as follows:
To maintain and repair, when necessary, the above -mentioned item(s) installed within the
edicated right of way. If it becomes necessary for Miami Shores Village or Dade County
o make repairs or maintain said items within public right of way including restoration of
treet by reason of the Owner's failure to do so, such expense shall be paid by the Owner
r shall constitute a lien against the above described property until paid.
he owner does hereby agree to indemnify and hold Miami Shores Village or Dade
ounty harmless from any and all liability, which may rise by virtue of permitting the
nstallation of these items within the public right of way.
he 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
rr the Village causing the item(s) to be removed and a lien being placed on the property
77 nd/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
ndersigned, their heirs and assigns, until such time as this obligations has been
anceled by an affidavit filed in the Public Records of Dade County, Florida by the
illage ; nagores Village (or his fully authorized representative).
Signature
Owner or gent
The foregoing instrument was ackn
,e47--LiD0,1- wh
as identification and who di
NOTARY PUBL
Sign:
Print: 7
My Commission
personally
ath.
ed before me this k7day of - , 20 / 7, by
wn to me or who has produced
$ Y: Zettie Jones
COMMISSION # FF209081
%`, ;F' 77. •EXPIRES: March 14, 2019
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