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.