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PW-18-3050Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Location Address Issue Date:11/06/2018 Permit NO.: PW-10-18-3050 Permit Type: Public Works Work Classrfication: Public Works Permit Status: Approved Expiration: 04/01/2019 Parcel Number 1286 NE 95TH ST, Miami Shores, FL 33138 Contacts MANUEL RIVERO 1286 NE 95 ST, MIAMI SHORES, FL 33138 Other: 3057627851 Owner Description: REPAIR DRIVEWAY - REMOVE DRIVEWAY AND REPLACE WITH SAME OLD BRICKS TO REPLACE DS18-857 Fees Amount Education Surcharge Public Works Permit Fee Scanning Fee Technology Fee Total: $0.40 $100.00 $3.00 $2.50 $105.90 CHAMPION CONCRETE JAIME BASILIO 10280 NW 63 TER 105, DORAL, FL 33178 Business: 3052528055 Other: 7864024802 Contractor Valuation: $ 1,800.00 Total Sq Feet: 400.00 Inspection Requests: 305-762-4949 Payments Total Fees Check # 2997 Amount Due: Date Paid 11/06/2018 Amt Paid $105.90 $105.90 $0.00 Building Department Copy 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, drawins statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all woj done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANIC , , WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoi • infor tion is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore, I aut orize thJabove i_-_cqme..c1 contractor to do the work stated. Authorized Signature: Owner / Applicant tor / Agent Date November 06, 2018 Page 2 of 2 Miami Shores Village Public Works Department (305)795-2210 Public works forms are available from the building department, 10050 NE 2' Ave., Miami Shores, FL 331 RECEIVED OL 032018 PUBLIC WORKS PERMIT APPLICATION Permit Type: Work in the Right -of -Way on Miami Shores Village or Miami -Dade Property /��r--�� Permit#: Ig "�SL.J Name of Applicant (if utility see below): r%A,V . i t.z Owner off the following described property: Legal Description: Lot Block Folio #; l — 3206 0l k LI;{2,—V Address: '( (45/} l-0.42 Subdivision UTILITY NAME: Qualifier/Authorized Agent: Address: City: State: ZIP: Telephone: State Certification or Registration #: Email: Certificate of Competency # CONTRACTOR NAME: �y�/�ip14U Ceci'1X39to. Qualifier/Authorized Agent: ,Ni - j, -I-e_ 112A SL 0 Address: Iw_eo M) &3 •-i 14i- 105' City: 9C/iLVLA State: 11_ ZIP: 3 %7i' Telephone: 31.15 47f-LIV3> Email: State Certification or Registration #: Certificate of Competency #: a 0 sosoo Requests permission to install (describe work, attach separate page if necessary) in the adjoining right of way: Type of Work: ❑ Paving ❑ Utility ❑ Sidewalk ❑ Electric ❑ Irrigation ❑ Landscape ❑ Antenna ❑ Other: DESIGNER: Architect/Engineer: Address: City: State: Telephone: Email! Registration #: Value of1111orkforthjsPermitn$ ���� v°0 _.t Permit Fee $ 100.00 Notary $ Training/Education $ 0.20 Bond $ (if required) ZIP: Squa a/Lineal F4otaidbf Work lf4Y Fees Technology Fee $ 0.80 Scannin $ Total Fee Now Due $ U 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 comma cement must be posted at the job site for the first inspection which occurs seven (7) days after the publifc works permit is issued. In the absence.of such posted notice, the inspection will not be approved and a`reinspection I be charged. v, vcr^ _, , Signature The foregoi me this Jf MAAue� is : n or Authorize • , ge strume t was acknowledged before daa of C5 Ctbe v , 20 , by KU. (a who issersonally known to me or who has produced ,J(.\12('S as identification. Print: SEAL: r- Signature Com.any/Utility Agent The foregoing instrument. was acknowledged before me histr� day`of t t e r , 20 19 , by CAMP 1`• As1 c' who is,gssonally known to me or who has produced as itification. I NOTARY IC: Print: SEAL: Mk M- 1)3 i 14 ♦r MARVAM. WIWAMS MY COMMISSION i FF 203592 EXPIRES: February 25, 2019 Banded Thru Notary Pubic WJndenders ******************************* Public Works Director, or Designee 2017-04-15 111111111111111111111111111111111111111111111 (Apieh NOTARYP1BU! Sign: Print: 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) D(JW--) " 1110 hereinafter referred to as the owner of the following described property (address): / 2 '6 Ng- 15 Legal Description: Lot Block Subdivision Folio# l/ 3Z 06 o>i'o.s Requests permission to install (describe work): •/7 ia() C FN 2O18RO6O71 1 3 OR BK 31168 Fa 1665 t.1F si R C:-'.F 1; ill1-/NJF 09;1.910A H( VEY RU •1 is C:LF•R.I` OF COURT MIAP1I--DADF (0LNT'f s FLORIDA Within the public right of way of (address) 2 e /!ice '9 ) 5I57 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 thi obligations has been canceled by an affidavit filed in the Public Record of Dade County ' Iorida by the Village Manager of Miami Shores Village (or his fully author -ed)ei present. ' e). Signature caner or Agent State of Frida County of Miami Dade , 1 The foregoing' instrument w.: acknowledged before me this �) gvl day of 01-(4 , 20 /1 , by who is personally known to me or who has produced J / of -ntification. �• �.o`c EXPIRES: June 12, 2022 Boded Thru Notary Pubic thrdemllili EB a that thrs rs a s office on 2018 F DADE rue cop, of the day of , AD20 WIT SS m, ha d a . Officral Seal. H ` i Y RUVIIJ, ' RK of Circuit and County Courts y D.C.