PW-18-1634Miami Shores Village
10050 N.E. 2nd Avenue NW
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Project Address
158 NW 94 Street
Miami Shores, FL
Owner Information
GUILUZ LLC
[6ontractor(s)
J
Address
,,Pertr)it NO. 'PW-6-1 8-1634
Perrnit Type: Public Works
Work Classification: Public Works
Pemiit Status: APPROVED
L'° tissue Date: 7/1.312018
Expiration: 10/11l2018
Parcel Number
1131010330790
Block: Lot:
158 NW 94 Street
MIAMI SHORES FL 33150-
158 NW 94 Street
MIAMI SHORES FL 33150-
Phone
AGER INSTERNATIONAL INC
Cell Phone
(305)926-P120
Applicant
Phone
Valuation:
Total Sq Feet:
Scanning: i
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-6-18-67929
07/13/2018 Check #: 1 101
Amt Paid Amt Due
$ 104.00 $ 0.00
Cell
(305)926-9129
$ 2,000.00
495
Available Inspections:
Inspection Type:
Excavation
Review Public Works
Final Public Works
In consideration of the issuance to me of this perrr. t, 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 ‘"ork done either myself, my age;it, _.....,_, cr employes. I understand that separate permits are
required for ELECTRICAL, PLUMBING. MECHANICA' WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNERS AFFIDAV 1 ertify that all the foregoinc information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zo uth more, I authorize the <.bove-named contractor to do the work stated.
4��
Authorize Sign ure: Owner / Applicant / Contractor / Agent
July 13, 2018
Date
Bu ding Department Cow;`,
July 13, 2018 1
s.
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
PUBLIC WORKS PERMIT APPLICATION
Permit Type: Work in the Right -of -Way on Miami Shores Village or Miami -Dade Property
Permit#: 17 — .:� •
Name of Applicant (if utility see below): : ' j 'Z t�
Owner off the following described property:
Legal Description: Lottg Block Subdivision
Folio #; 1,t-3�( - O.. 0761-0
Address:'„ Hvt/ 1.. T
_Apr_Apr5, .airribfe
RECEIVED
JUN 14 2018
UTILITY NAME:
Qualifier/Authorized Agent:
Address:
City: State: ZIP:
Telephone: Email:
State Certification or Registration #: Certificate of Competency #
CONTRACTOR NAME: t`Z toly .ubrc1U-k., We,
Qualifier/Authorized Agent: ...Mize &Ake:ea_
Address: 034,,SI l' 34 cam' /D/S
City: I S_L at et' I�o1s State: .4 ZIP: 3316,0
Telephone: it.6 9/2/' Email: su" . trk-er ornP:Al• Cqh
State Certification or Registration #: A Certificate of Competency #: Cr6C. i Z
Requests permission to ins II (des ibe work, attach separate page if necessary) in the adjoining right of
way: cam'►
T e of Work: �PavinUtilitySidewalk ElectricIrrigation
Yp g D ❑ ❑ 0 g
❑ Landscape ❑ Antenna ❑ Other:
DESIGNER: Architect/Engineer:
Address:
City: ' State: ZIP:
Telephoner - Email:
Registration #:• .
Value of Work for this Permit:
409
Square/Lineal.Footage.of Work:.._
***** Fees *****
Permit Fee $ 100.00
Notary $ Training/Education $ 0.20 Technology Fee $ 0.80 Scanning $
Bond $ (if required) Total Fee Now Due $ PLf • CO
f 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 $2,500, the applicant must promise in good faith that a copy of the notice of commencement
and construction lien law brochure will be delivered to the person whose property is subject to the
attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job
site for the first inspection which occurs seven (7) days after the public works per it is issued. In the
absence of such pos -d .tice, the inspection will not be approved an r:%nsp- ion will be charged.
Aft/ , /
Lift
Signature 4,L/ Signature 4111
A.. h . , t or Authorized Agent C./ palry/Utility Agent
The forego) in trument was ac nowledge efore The foregoing instrument was acknowledged [Afore
me this l d�tof 20(7,by me this (� day of-,20 l'by
J who poi surf a't'�li� who
is4erson Iy known to me or wo has produced
1 f as
identification.
pers T ally known to me or who has produced
`r
�'l 11 as
identification.
Sig
Print:
SEAL:
..................... K. GONZALEZ _
MY COMMISSION # GG 044602
EXPIRES: November 2, 2020
Bonded Thru Notary Public Undewriters
APPROVED BY:
A** *************************************
Sign:
Print:
SEAL:
MAHARAI K Gt7N7A1 F7
MY COMMISSION # GG 044602
EXPIRES: November 2, 2020
Bonded Thru Notary Public Underwriters
C$
, Public Works Director, or Designee
2017-04-15
111111111111111111111111111111111111)11111111
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 WAYI,
Whereas, (owner)H
hereinafter referred to as the owner of the following describe
property (address): 1E isl\N cm sr
Legal Description: Lot /Block 13 Subdivision
7�10
CFN 2c' 18R0344458
OR BK. 31010 P3 29101 (1Ps )
RECORDED A/12; 2ii13 Li?
i ,RVEY rt°Ifi71Nr CLERK OF COURT
NIANT--DADE CrOUNTYy FLORIDA
ATE OF FLORJDA, COUNTY OF DADE.
CERTIFY the thin is a true copy of 3
i inal fr'!ed i•<w this offii, o r ,cap
1^ A.D.•
w Lrr x , •unt Courts
inIVAPPAIlv
� : r'r�:�L 1 1 y c.
Requests permission to install (describe work): .L�i ,lexcD)1
Within the public right of way of (address)
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 D. se County, Florida by the Village Manager of Miami Shores Village
(or his fully auth j re • resentative).
Signature
State of Florida
County of Miami Dade
The foregoing instrument was nowtfl ged before me this % day of T U , 20
OY t C� '( SU o is`p onally known to me or who has produced
J IC �
r br Agent
NOTA UB IC:
Sign:
Print: ivio\rorac
s identification.
SEAL:
• +-. " `.. MAHA
•;� __ RAI K. GONZALEZ
MY COMMISSION # GG 044602
EXPIRES: November 2, 2020
Bonded Thru Notary Public Underwriters
y