PW-17-2655Pen
t NO. PW-1 17-2655
Miami Shores Village
10050 N.E. 2nd Avenue NW
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Project Address
Permit
Issue Date: 11/20/2017
Permit Type: Public Works
Work Classification: Public Works
Permit Status: APPROVED
Expiration: 02/18/2018
Parcel Number
Applicant
49 NW 98 Street
Miami Shores, FL
1131010330140
Block: Lot:
BRADLEY & KELLY SOUTHARD
Owner Information
Address
Phone
Cell
BRADLEY & KELLY SOUTHARD
49 NW 98 Street
MIAMI SHORES FL 33150-
(305)218-0119
49 NW 98 Street
MIAMI SHORES FL 33150-
Contractor(s) Phone
TRUE STAMP CONCRETE LLC (305)494-4465
CeII Phone
Valuation:
$ 1,000.00
Total Sq Feet: 900
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-11-17-65589
11/07/2017 Credit Card
11/20/2017 Credit Card
Amt Paid Amt Due
$ 50.00 $ 54.00
$ 54.00 $ 0.00
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 information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zoning. Futhermore, I authorize the above -named contractor to do the work stated.
November 20, 2017
Authorized Signature: Owner / Applicant / Contractor / Agent Date
Building Department Copy
November 20, 2017
1
RECEIVED
Miami Shores Village NOV 0 7 2017
Public Works Department
(305)795-2210
Public works forms are available from the building department, 10050 NE 2' 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
Permitt 1 R -2.Co55
Name of Applicant (if utility see below): K2 -(!/
Owner off the following described property: /9 tiw Q S 57' «i e; 54o et 4 cG 33i�D
Legal Description: Lotto —Z/ Block 12_ f Subdivision "Ai( -.,, �( 5-X497e.of
Folio#; //J/Co/ 0z,3 O/c/O
Address: 49.E-c.- If ' 54oito( ,( _rO
UTILITY NAME:
Qualifier/Authorized Agent:
Address:
City: State: ZIP:
Telephone: Email:
State Certification or Registration #: Certificate of Competency #
CONTRACTOR NAME: l cAl % /01pd (m„-- C/eP fp 2GC•
Qualifier/Authorized Agent: ,' /Lr:v., •Tit-,.,Ob -�
Address: 1 3 2-,? 5 ' """) 17 47
City: Ail e ,1 / State: ,c' C ZIP: 15 -27 / 5-5-
Telephone: 30SC/4e,f ci(/6S Email: ca7.7z. 4.. /s-1c,� . e �-.,--
State Certification or Registration #:Eolf 0O 7,'' Certificate of Competency #:
Requests permission to install (describe work, attach separate page if necessary) in the adjoining right of
way: ,a - i+— olil (ere. cc.v44/ ry�.20,5z_ ai '
Type of Work: ❑ Paving ❑ Utility ❑ Sidewalk D Electric ❑ Irrigation
0 Landscape ❑ Antenna [Other: Z9/1-c G ._, y
DESIGNER: Architect/Engineer:
Address:
City: State: ZIP:
Telephone: Email:
Registration #: '"
Value of Work for this Permit: $ '!•q0 0
Square/Lineal Footage of Work:',1, *too
*****Fees*****
Permit Fee $ 100.00
Notary $ Training/Education $ 0.20 Technology Fee $ 0.80 Scanning $
Bond $ (if required) ,,,Total Fee Now Due $ 51-P • CO
: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
A. p icant or thorized 'Agent
The foregoing instrument w. ' acknowledged before
me this 0 S day of /L�Uv lti 4 , 20 / 7 , by
/<? (iv Set,]`G, �a who
is personally known to me or who has produced
as
identification. '
NOTARY PUBLIC:
Sign:
Print:
SEAL:
APPROVED BY:
Ccx‘--7- c �>
-Sign:
,• • " ARANEUS GONZALEZ
(. . ' MY COMMISSION # FF 913306
•.��� a' EXPIRES: September 18,' 2019
:thy`' Bonded This Notary Public linden/tars
Print:
SEAL:
Signature
Company/Utility Agent
The foregoing instrument was acknowledged before
me this 9 S day of 4.0i/•1ti/404, 20 (7 , by
4-1/ j r, .., 7:20> -e 4 -9- who
i .ersona y nown o r or who has produced
as
identification.
NOTARY PUBLIC_,
ARANELIS GONZALEZ
.• = MY COMMISSION # FF 913306
EXPIRES: September 18, 2019
Bonded This Notary Public Undernriters
*********************************
1t\\I,V' , Public Works Director, or Designee
2017-04-15
hores ' ' illage
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.6972
COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY
Whereas, (owner) P 111 SOUx j-- h cord hereinafter referred to as the owner of
the following described property (address): 9 cl A 1 lei q l V ,C) -f--
Legal Description Lot 52i> j;)/ Block / 0-� Subdivision �J
jj ' \ � _- r J �i .r-1 /, c ;� ,i:� C.
Folio # L 3 J 6 1 0. 3 al y V/} n
Requests permission to install (describework): -/ B r� P �,
Within the public right of way of (address)
AJ J C ' (f—
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.an
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) z ?
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
y
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).
c?
n
SIGNED, SEALED, EXECUTED AND ACKNOWLEDGE on th's
SIGNED, SEALED, AND DELIVERED in the presence of:
€.� `'' ' ARANELIS GONZALEZ
MY COMMISSION # FF 9133C6
EXPIRES: September 18, 2019
Bonded Thru Notary Public Underwriters
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