PW-17-2841Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Project Address
Parcel Number
Permit NO. PW-11-17-2841
Permit Type: Public Works
Work Classification: Public Works
Permit Status: APPROVED
Expiration: 02/28/2018
Applicant
10525 NE 2 Court
Miami Shores, FL
1122310130610
Block: Lot:
BENNY NEWBY
Owner Information
Address
Phone
Cell
BENNY NEWBY
10525 NE 2 Court
MIAMI SHORES FL 33138-
(305)336-0676
Contractor(s)
CRICKET PAVERS LLC
Phone Cell Phone
(786)518-1091
Valuation:
$ 6,000.00
Total Sq Feet: 1011
Scanning: 1
Fees Due
CCF
DBPR Fee
DCA Fee
Education Surcharge
Permit Fee
Scanning Fee
Technology Fee
Total:
Amount
$o.00
$o.00
$0.00
$0.20
$100.00
$3.00
$0.80
$104.00
Pay Date Pay Type
Invoice # PW-11-17-65789
11/30/2017 Check #: 2075
11/30/2017 Check #: 2076
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: I certify that all the foregoing information is accurate an t all wor -w+lI be done in compliance with all applicable laws regulating
construction and zoning. Futhermore, I authorize the above -named contractor to :. work ated.
Authorized Signature: Owner / Applicant / Contractor
Building Department Copy
gent
9vember 30, 2017
Date
November 30, 2017 1
Miami Shores Village
Public Works Department
CET VED
NOV 3 2017
BY: —alt-
(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 on Miami Shores Village
or Miami -Dade Property
Permit#:
Name of Applicant (if utility see below): fr\t' e. (\'y 1 \ D
Owner off the following described property:
Legal Description: Lot Block
Folio#; l(-2-23(— 013-0(0
Address: I13$ 9-5 Nf 2..- C4
Subdivision
UTILITY NAME:
Qualifier/Authorized Agent:
Address:
City: State: ZIP:
Telephone: Email:
State Certification or Registration #:!'� Certificate of Competency #
CONTRACTOR NAME: Cr-SCR-CATQVFCS
Qualifier/Authorized Agent: (\&A \1Y1 G (�I k CD
Address: I,37g5 Sup 1- ? 1
City: 't lAv"`\ C`
State: I ZIP: 3:3 19 C
Telephone: ?FrG •Slg''io4I Email: AVE1?3 P9'1 Ao;,1 • co► —
State Certification or Registration #: £I 600(206 . Certificate of Competency #:
Requests permission to install (describe work, attach separate page if necessary) in the adjoining right of
way: Timer -ale` 1C11�'`q S-Wewa i u d1&t r_`._T_Tr_64,eA -azA.,A .,Ai{'
A,vtJ Cov�c rete 6 c cam' �s
Type of Work: EPaving ❑ Utility ❑' Sidewalk ❑ Electric ❑
Irrigation,
❑ Landscape ❑ Antenna ❑ Other:
DESIGNER: Architect/Engineer:
Address:
City: State: ZIP:
Telephone: Email:
Registration #:...
Value of Work for this Permit:, $'paC� Square/Lineal Footage of Work: Tall
***** Fees *****
Permit Fee $ 100.00
Notary $ Training/Education $ 0.20 Technology Fee $ 0.80 Scanning $
Bond $ (if required) Total Fee Now Due $ Ski • GO
BondingCompany'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 specificallyconstruction in the
right-of-way. in,
"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 'reictiori will be charged.
anspe
Signature
uthorized Agent
The foregoing instrume j as acknowledged before
me this'L� day of ? •�.. + 20 �� by
1 ink/ / . r),ey 104
is aers naally,kr'Fown to me or who h s produced
• as
identification.
NOTARY PUBLIC:
Sign:
Print: 3 �� V\ 1 cs 'P5
SEAL:,
APPROVED BY:
John Rogues
NOTARY PUBLIC
iG STATE OF FLORIDA
;�v� Cam# FF946106
14110 , Public Works Director, or Designee
who
t 4,
Signature
Company/Utility Agent
The foregoin instrum-ntwas acknowledged Before
"me this day'of ,, �. •201' 7 , by ° r-,
as produced
as
identification.
NOTARY PUBLIC:
Sign: 11 11
Print: J c7 hv.
SEAL:
John Rogues
.t.r
NOTARY PUBLIC
STATE OF FLORIDA
I•l- aim* FF946106
Expires 4/17/2020
who
2017-04-15
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) d360-1 NE3
hereinafter referred to as the owner of the following described
property (address): /°S7 5 /46 2430 c4.-1 14A IM&I C•110..Af - tz 1
Legal Description: Lot ►s ;16 Block I L( Subdivision ?go,,,
Folio # I ( 223 I • at3 • V G to
Requests permission to install (describe work): Cov` CYe4E ?1 Avtt e \
ExTs+0.-n rtic c cl_ NAialkw
Within the public right of way of (address) I a525 r'tZ Cf
t i t skirmst '3'313fl
IN CONSIDERATION of the approval of this permit by the Village, the owner agrees as follows:
CFN: 20170647332 BOOK 30759 PAGE 1085
DATE:11/16/2017 04:15:52 PM
HARVEY RUVIN, CLERK OF COURT, MIA-DADE CTY
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 authc ized representative).
Signature
Owr er orAgent 13cinr'y tvewby-oW.n
State of Florida
County of Miami Dade r
The fore oing,instru�r�n}ent was acknowledged before me this I day of OC{o •e , 20 \-1
nn� l"e who is personally known to me or who has produced
L- as identification.
NOTARY PUBLI
Sign:
Print: i j a\-.\...-' .rEY SEAL:,. , I John Rogues
:, NOTARY PUBLIC
L- STATE OF FLORIDA
Comrrrlk FF946106
'''yc'E°i'' Expires 4/17/2020
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