PW-18-529Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Project Address
Permit
Parcel Number
Permit NO. PW-3-18-529
Permit Type: Public Works
Work Classification: Public Works
Permit Status: APPROVED
Expiration: 06/07/2018
Applicant
935 NE 95 Street
Miami Shores, FL 33138-
1132060143110
Block: Lot:
RUTH KETTANEH LE
Owner Information
Address
Phone
Cell
RUTH KETTANEH LE
935 NE 95 Street
MIAMI SHORES FL 33138-2517
(786)521-1243
i
Contractor(s) Phone
ARTISTIC CONCRETE GROUP INC (305)888-9095
Cell Phone
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-3-18-66622
03/09/2018 Credit Card $ 54.00 $ 50.00
03/01/2018 Check #: 1189 $ 50.00 $ 0.00
Amt Paid Amt Due 1
Available Inspections:
Inspection Type:
Excavation '
Review Public Works
Review Public Works
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 informa ion is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zoning. Futhermore, I authorize the above-n,. ed contractor to do the work stated.
a.-=--_ _ March 09, 2018
Authorized Signature: Owner / Applicant / Contractor / Agent
Date
Building Department Copy
March 09, 2018
1
1
Miami Shores Village
Public Works Department F
(305)795-2210
Public works forms are available from the building department, 10050 NE 2nd Ave., Miami Shores, 138
0 2018
PUBLIC WORKS PERMIT APPLICATION
Permit Type: Work in the Right -of -Way on Miami Shores Village or Miami -Dade Property
Permit#:( 9
Name of Applicant (if utility see below): nc T
Owner off the following described property:
Legal Description: Lot Block Subdivision
Folio #; 1 -3206 - GIH -3I U
Address: q35 NE q5 iAiwMr, 4^0v15, r - 3313R
UTILITY NAME:
Qualifier/Authorized Agent:
Address:
City: State: ZIP:
Telephone: Email:
State Certification or Registration #: Certificate of Competency #
CONTRACTOR NAME: ri51IC: c cQualifier/Authorized AgINA
t: i'( lfo(t- 7.,,I bra
Address: 015 N'.l 53 ,} (✓
City: iwi State: - ZIP: 13166
Telep one:wF Email:
State Certification or Registration #: eogooO61 Certificate of Competency #:
._ f 4 F
Requests permission to insall (,describe work, attac�i separate page if necessary) in the adjoining right of
way: Ne 1 r5 Co,0Cv6 } e p,(OVS .
GANI
Type of Work: ❑ Paving ❑ Utility ❑ Sidewalk ❑ Electric ❑ Irrigation
❑ Landscape ❑ Antenna ❑ Other:
DESIGNER: Architect/Engineer:
Address:
City: 'State: ZIP:
Telephone: Email:. .
Registration #: •-
i` F
Value of Work for this Permit:=.;,$'
Square/Lineal Footage of Woric t1` {
•
***** Fees *****
Permit Fee $ 100.00 iry' """"
Notary $ Training/Education $ 0.20 Technology Fee $0.80 Scanning $ .
Bond $ (if required) Total Fee Now Due $ �`-'\
City:
Bonding Company's Name (if applicable): ,
Bonding Company's Address:
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. kf
"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 willbecharged.
Signature Pla k's?1-1--a
Applicant or Authorized Agent
The foregoing instrum nt was acknowledged before
me this c day of W14 7 , 20 , by
Icac7'T M r 1-1who
is personally known to me or who has produced
as
identification.
NOTARY PUBLIC:
Sign:
Print: S'!ielf,t T ij
SEAL:
APPROVED BY:
SHELLIE L FULFORD
Notary Public- State of Florida
Commission tl GG 075064
My Comm. Expires Feb 28, 2021
LIVA.
Signature
to/Utilit an Agent'
p Y Y A g
The foregoing instrumenf was acknowledged
me this 2-1 ' day of Ja,\ , 20
(-1 E c a c .•.e.r s`
efore
by
who
o me or who has produced
as
identification.
NOTARY PUBLIC:
Sign:
Print:
SEAL:
�.SPR
96 NOTARY PUBLIC
o f STATE OF FLORIDA!
0"t Comm*FF
946106
4ICE 1.1e Expires 4/17/2020
**************************
John Rogues
Public Works Director, or Designee
2017-04-15
Miami Shores Village
Building Department
10050 N.E,2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 766.8972
Folio # It _ 32, - vet 31/0— Subdivision
Requests permission to install (describe wort): (j, rr r 44405
COVENANT OF CONSTRUTIO►N 'WI IN flIGHT OF WAY
Whereas, (owner) .-Rui 114
hereinafter referred to as the owner of fol wring described
property (address): 135 WE q
Legal Description: Lot Block
CFN: 20180069444 BOOK 30850 PAGE 3664
DATE:02/02/2018 12:32:32 PM
HARVEY RUVIN, CLERK OF COURT, MIA-DADE CTY
Within the public right of way of (address) tie 5
etc0Ce
IN CONSIDERATION of the approval of this PP 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 80 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).
Signature .11( t,1 h
Owner or Agent
State of Florida
County of Miami Dade
The foregoing instrument
was Icknowiedged before me this 3 3-- day of - _ t .., 20 l3 , by
who is personally known to me or who has produced
e• ,,ree• 5 . e t_ as iden
NOTARY P _ C._�
Sign. .
Print;