PW-18-2203Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Project Address
Permit
Permit No. PW-8-1 8-2203
Permit Type: Public Works
WorkClassificationn: Public Works
Permit Status: APPROVED
ss ue =Date: 8/3Q/2018
Expiration: 11/28/2018
Parcel Number
Applicant
671 NE 105 Street
Miami Shores, FL 33138-2053
1122310120100
Block: Lot:
CAROL INVEST USA INC
Owner Information
Address
Phone
Cell
CAROL INVEST USA INC
671 NE 105 Street
MIAMI SHORES FL 33138-
(305)747-3098
671 NE 105 Street
MIAMI SHORES FL 33138-
Contractor(s)
JOSEPH S. ROBBIO INC
Phone
(954)663-6743
CeII Phone
Valuation:
Total Sq Feet:
$ 1,000.00
18
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-8-18-68596
08/30/2018 Credit Card
08/20/2018 Credit Card
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 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.
August 30, 2018
Authorized •'Ti: Owner ._—Applicant / Contractor / Agent
Date
Build' r'Department Copy
August 30, 2018 1
Miami Shores Village
Public Works Department
(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#: EL 1 D ^ ZZO Z
Name of Applicant (if utility see below): Carol Invest USA
Owner off the following described property:
Legal Description: Lot Block
Folio #; 11-2231-012-0100
Address: 671 NE 105 St.
Subdivision
UTILITY NAME:
Qualifier/Authorized Agent:
Address:
City: State: ZIP:
Telephone: Email:
State Certification or Registration #: Certificate of Competency #
CONTRACTOR NAME: Joseph S. Robbio, Inc
Qualifier/Authorized Agent: Joseph S. Robbio
Address: 9400 S. Meadows Circle
City: Miramar
State: FI. ZIP: 33025
Telephone: (954) 663-6743 Email: josephsrobbioinc@aol.com
State Certification or Registration #: CBC 059462 Certificate of Competency #:
Requests permission to install (describe work, attach separate page if necessary) in the adjoining right of
way: Cut and dig 8' wide, 12" deep trench across cul-de-sac to install pvc pipe for phone and data
lines to connect to telephone pole in center of cul-de-sac. Repair with hot asphalt as required
12" on each side of trench
Type of Work: EX Paving ❑ Utility ❑ Sidewalk LR1 Electric ❑ Irrigation
❑ Landscape ❑ Antenna ❑ Other:
DESIGNER: Architect/Engineer:
Address:
City: State: ZIP:
Telephone: Email:
Registration #:
Value of Work for this Permit: $ 1,000 Square/Lineal Footage of Work: 18 OF
***** Fees*****
Permit Fee 5 100.00
Notary $ Training/Education S 0.20 Technology Fee $ 0.80 Scanning
Bond $ (if required) Total Fee Now Due $ . s4 .°'
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. 1 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 APPL ICA.NT: 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
Signature
Applicant o uthorized Agent ompany/Utility Agent
The foregoing instrument was acknowledged before The fore g instrument was acknowledged before
day of A)( 05-r 20 t (/ by r-r,Q t •is d . , f 1 u u t 20 1 , by
Joseph S. Robbio
mn this
ersenally
to me or who has produced
as
identification.
n.
__NOTARY_PUBLIC:-
Sign:
Print: LUC40
SEA
LUCIA G ISASI
MY COMMISSION #FF182628
`•oFnd"-` EXPIRES December 10, 2018
(407) 398-0153 Floridallotary ice.com
who who
n to me or who has produced
as
identification.
NOTARY -PUBLIC:
Sign:
Print: LUCIQ C7.
SEAL:
3c45I
ot'µr n�o"•.
LUCIA G ISASI
MY COMMISSION #FF182628
aF :••` EXPIRES December 10, 2018
(407) 398-0153 FloridallotaryService.com
APPROVED BY: `1,- ` , Public.Works Director, or Designee
2017-04-15
uiimiiiiummiii 11111 11111 11111 1111 1111
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
COVENANT OF C9VSTIVCTION WITHIN RIGHT OF WAY
Whereas, (owner) LAR oiki Yesf" (i S J
hereinafter referred to as the owner of the following described
property (address): 6/1 (13 (Os' Si• M14rtSi-}on-CS
1-N 21113RC51_4175
OR BK 311:6 Ps 1708 (1Pss)
'RECORDED IV /201/2i:01 11: 41
H AUV RVEY RIN CLERK OF. COURT
h11AMiI--GLADE i:OUNTY ¢ FLORIDA
Legal Description: Lot Block Subdivision
Folio# //- Z S/-D/a2-D/Do
Requests permission to install (describe work): %REnic/) AcfoSs C`J1-.tom-SAC
7 7-Als7A!/ P '.
Within the public right of way of (address) 6 /) Me. ) Ds" S t »iAM .` s Hc✓vs
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 Da County, Florida by the Village Manager of Miami Shores Village
(or his fully authorizrep esentative).
Signature
Oar % 2-21/J6S7 OS4 vOwner or A ent •
State of Florida
NiViCr O/ldz2/ CArvr
County of Miami Dade
The foregoing instrument was acknowledged-befor-
MGV(x P)vO7,21 who is p rsonally know
IZA ,as identification.
NOTARI( PUBLIC: L
f
711
Sign:
Print�
STATk OF IDA, COUNTY OF DADE
me this I day of r),1(a1,) ,20by
to me or who has produced
t HEREBY CERTIFY filet this N e title copy oftl*
origloal filed In this office on dey of
AUG 2 n 2nia ,A.D.20
WITNESS my ha s and Official Seal.
flIAR UV 'f ircuit and County Courts
Bye `s'. D.C.
SEAL
LUCIA G ISASI
MY COMMISSION #FF182628
EXPIRES December 10, 2018
(407) 398-0153 FloridallotaryService.com