PW-18-331Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Project Address
Permit
Issue Date: 2/14/2018
Permit NO. PW-2-1 8-331
Permit Type: Public Works
Work Classification: Public Works
Permit Status: APPROVED
Expiration: 05/15/2018
Parcel Number
Applicant
9280 NE 12 Avenue
Miami Shores, FL 33138-
1132050070172
Block: Lot:
DANIEL MCFADDEN
Owner Information
Address
Phone
Cell
DANIEL MCFADDEN
9280 NE 12 Avenue
MIAMI SHORES FL 33138-2929
(305)762-6519
9280 NE 12 Avenue
MIAMI SHORES FL 33138-2929
Contractor(s)
ONE STOP PAVING
Phone
(786)299-1354
Cell Phone
Valuation:
Total Sq Feet:
$ 1,000.00
30
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-2-18-66392
02/14/2018 Check #: 1885
02/08/2018 Check #: 1881
Amt Paid Amt Due
$ 54.00 $ 50.00
$ 50.00 $ 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: ertify that
construction and zo thermore,
Authorized Si
nature:0 r / Applicant /
the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
uthorize the above -named contractor to do the work stated.
Contractor / Agent
February 14, 2018
Date
Building Department Copy
February 14, 2018 1
3ctrirJafp Sdon/Lc�
R-8(e 09 15e/
V
RECEIVE.
FEB 0 8 ' IR
Miami Shores Village
Public Works Department
(305)795-2210
Public works forms are available from the building department, 10050 NE 2"d Ave., Miami Shores, FL 33138
PUBLIC WORKS PERMIT APPLICATION
Permit Type: Work in the Right -of -Way oh Miami Shores Village or Miami -Dade Property
Name of Applicant (if utility see below): Do �► �- l
Owner off the following desribed property:
Legal Description: Lot ',roil la✓ Block
Folio#; tt 32 05 00'1 Oi `T Z
Address: 92,o N& 12 Ave-
Permit#•GCS
�w 8 7 6s'
Subdivision Ft o T Gov t . .
M. s L-a ^e. 5 fit_ 3 t 3 8
UTILITY NAME:
Qualifier/Authorized Agent:
Address:
City: State: ZIP:
Telephone: Email:
State Certification or Registration#: Certificate of Competency #
CONTRACTOR NAME: Ov►Sfbr Pay i "1` TM -a
Qualifier/Authorized Agent: Co..io s QL-c.o r4
Address: k,4(g3 tJE t1'? • 11.
City: L. 4-e.oe k State: - ZIP: 3 3 l L Z ,
Telephone: )$. 299 1354 Email:. C¢.•ta s w, o. c.
State Certification or. Registration it: C6c t 5 t3'119 Certificate of Competency #: . Z3 l CV b
'Requests per ission to install (describe work, attach separate page if'neces ry) in the adjoining right of
way: c4 ' oo-c d 6r,Zlc-- 'otJ.e' s
9. ;C
Type of Work: [r Paving ❑ Utility ❑ Sidewalk 0 Electric 0 Irrigation
❑ Landscape ❑ Antenna ❑ Other:
DESIGNER: Architect/Engineer:
Address:
City: State: ZIP:
Telephone: - .. . • Email: . ► .E,
Registration#:
Value of Work for this Permit:
Permit Fee $ 100.00
$ t.O C C0 • `".3) Square/Lineal Footage of Work:
*****Fees*****
b
f
Notary $ Training/Education $ 0.20 Technology Fee $ 0.80 Scanning $
Bond $ (if required) Total Fee Now Due $
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
4
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. r t; . Ft.
"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.
Applicant or Authorized Agent
The foregoing instrument was ac nowledged before'
me this 1;3 day o -c zp / / v, by
Pc / e / f o/h '1 who
is personally known to me or who as produced
identification.
Sign:
Print:
SEAL:
1 A nvd
as
BARBARO SOBRINO
MY COMMISSION # FF 195634
EXPIRES: February 3, 2019
Bondad Thu Notary Public Underwriters
***
APPROVED BY:
r.
Signature
Company/Utility Agent
The foregoing instumentwas acknowledged before
20 1a,by
6 $* (.(tp 0 who
is personally known to me or who has produced
as
me this.aday of
identification.
Sign:
Print:
SEAL:
soectk Iv
BARBARO SOBRINO
• MY COMMISSION # FF 195634
� bit
9
'4 Bo.14 nded EXPIRES; u Notary Public ebruaryU denC,dtter
* *********************************
Public Works Director, or Designee
2017-04-15
I 1 dill III 1111 1111 11(1 lilt
CFh1 2O18R =i0687 5 1
OR EK. • 30°50 P3 1737 (1P3s)
Rr_r:ORCLF) 02/0? 2tll° 0 :1;.:-
ARVEY RUVIN, CLERK. OF COURT
MIAMI—DADE COUNTY; FLORID
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores,' Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
• COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY
Whereas, (owner) Eats i e-) J. Qdcl a ✓► hereinafter referred to as the
owner of the following described property (adress): g2So pie .slw es 3313s
Legal Description l,, 4. Grou-r Lot IBlock ' treS) (ef. Subdivision
Folio# 1( .t Z.O5 O i o I `J 2.
Requests permission to install (describe work): c--c- -Pa cm, [>_� v-¢w
Within the public"right of way of (address) rl) F t2. d Jra
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 or 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, Florida by the
Village Manager of Miami Shores Village (or his fully authorized representative).
ignature
Owner or Agent
.The foregoing instrument was acknowledgedbefore me this �J� day of ,Sa
DvNi.:1 J )Qc inwho is personally known to me or who has produced
as identificaticM and who did take an oath.
NOTARY PUBLIC:
Sign: ``
Print: .,0-40.G6u
My Commission Expires.
STATE OF FLORIDA, COUNTY OF DP,DE
HEREBY CE�Rt IFYthat this is a true copy ofth of , J
snort
icialSeal. � '�4T/
of Circuit anti County Courts , L, n`�
D.C.
A�--
I 13AR ?.PQ SOF...R PM
} MY C(r: MiSS!OU # FF 195634
EXPIRES: Feb r,3.ry 3; 2019
Ocithd Thre: Notary pudic Underwriter,
,20L , by