PW-18-1998Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Project Address
Permit
Issue Da
Permit NO. PW-7-18-1998
Permit Type: Public Works
Work Classification: Public Works
Pennit Status: APPROVED
3/2018
Expiration: 11/01/2018
Parcel Number
Applicant
10618 NE 11 Court
Miami Shores, FL
1122320280420
Block: Lot:
ARTURO RODRIGUEZ
Owner Information
Address
Phone
CeII
ARTURO RODRIGUEZ
10618 NE 11 Court
MIAMI SHORES FL 33138-
(305)877-0897
10618 NE 11 Court
MIAMI SHORES FL 33138-
Contractor(s)
M.A.M BUILDERS
Phone CeII Phone
(305)527-1089
Valuation:
Total Sq Feet:
$ 6,000.00
1200
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 Amt Paid Amt Due
Invoice # PW-7-18-68341
08/03/2018 Credit Card $ 104.00 $ 0.00
Available Inspections:
Inspection Type:
Excavation
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 AFFI AVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction an zq 1ing. Futhermorr ,-Leathorize the above -named contractor to do the work stated.
Aut(iorizeid Signature: Owner / Applicant / Contractor / Agent
August 03, 2018
Date
Building Department Copy
August 03,
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
PUBLIC WORKS PERMIT APPLICATION
Permit Type: Work in the Right -of -Way on Miami Shores Village or Miami -Dade Property C I�
Permit#: P le ' (e T✓
Name of Applicant (if utility see below): /A% . /)43/.24.Z/6Z
Owner off the following described property:
Legal Description: Lot /f Block ,3 Subdivision ,fg4( L /6 S � S
Folio #; 6.172e2
Address: 0/,i /VE //r y/4&?
UTILITY NAME:
Qualifier/Authorized Agent:
Address:
City: State: ZIP:
Telephone: Email:
State Certification or Registration #: Certificate of Competency #
'—CONTR CTA OR NAME / ►l/1Wl 60 1 /
Qualifier/Authorized Agent: Pax led, itief4 02q
Address: 106 6 7,A)6 )) 4 �e 1
City: N(i A en 1 S Lis State: ri_ ZIP: 3 3 (36
Telephone: 305 5a7-OS 6f Email: LJi101ev-IAJc M 30e 9 mgi(• Cd 4
State Certification or Registration #: Certificate ofvCompetency #:
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:' bed �i�%y'//\- Lit/1/t4,
DESIGNER: Architect/Engineer:
Address:
City: State:- ZIP:
Telephone: Email:
Registration #
Value of Work for`this Permit 'iot0
Permit Fee $ 100.00
Notary $ Training/Education $ 0.20 Technology Fee $ 0.80 Scanning $
Bond $ (if required) Total Fee Now Due $'
o_ o'
Square/Lineal Footrage of Work:•; ,. /�O0 S,�T
***** Fees*****
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 ATTORNEYBEFORERECORDING 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.
X lSignatureOK/
Applicant or Authorized Agent
The foregoing instrument was acknowledged before
me this (i day of t�U €` , 20 (_ , by
4:1(.1 jZ-aa(Ztc who
is personally known to me or who has produced
T--'Das
identification.
ti
NOTARY PgBLIC:
Sign:
Print: SI (\1DI (, [SWAQ
SEAL:
APPROVED BY:
Notary Public State of Florida
Sindia Alvarez
My Commission FF 156750
Expires 09103/2018
Signature
Company/Ufility A(ent
The foregoing instrument was cknowledged before
me this 2 3 day of SUi , 20 / , by
Mgir.i co vJ HJ who
is personally known to me or who has produced
4i ,sO as
identification.
NOTARY
Sign:
Print:
SEAL:
R�2
� wt Netary Pubic: St4:e cioeda
'F Ana Maria Ncrc:
• d MyCommissior.GG¶9IC84
ano' Expires 021260,202
*******,**4******************************
, Public Works Director, or Designee
2017-04-15
Notice to Owner — Workers' Com
p
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
ensation Insurance Exemption
Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. §,440.05
allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to
obtaining a building permit. Pursuant to the Florida Division of Workers' Compensation Employer Facts Brochure:
An employer in the construction industry who employs one or more part-time or full-time
employees, including the owner, must obtain workers' compensation coverage. Corporate officers
or members of a limited liability company (LLC) in the construction industry may elect to be
exempt if:
1. The officer owns at least 10 percent of the stock of the corporation, or in the case of
an LLC, a statement attesting to the minimum 10 percent ownership;
2. The officer is listed as an officer of the corporation in the records of the Florida
Department of State, Division of Corporations; and
3. The corporation is registered and listed as active with the Florida Department of
State, Division of Corporations.
No more than three corporate officers per corporation or limited liability company members are
allowed to be exempt. Construction exemptions are valid for a period of two years or until a
voluntary revocation is filed or the exemption is revoked by the Division.
Your contractor is requesting a permit under this workers' compensation exemption and has acknowledge that he or she will not use
day labor, part-time employees or subcontractors for your project. The contractor has provided an affidavit stating that he or she will
be the only person allowed to work on your project. In these circumstances, Miami Shores Village does not require verification of
workers' compensation insurance coverage from the contractor's company for day labor, part-time employees or subcontractors.
BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS
CONTENTS.
Signature:
Owner
State of Florida
County of Miami -Dade The foregoing was acknowledge before me this 2 S day of (1�y/v/ , 20 % D .
who is personally known to me or has produced
as identification.
By f`f/v/Z,o aolfrf7
L O/'i" vQr• --r?owl A)
Notary:
SEAL:
.c� Notary P:,ohc State o '
Ana Maria
My.Commissior. Gr 191084
Expires 02/28/2022
toitA),,-4-41
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
111111111111111111111111111111111111111111111
C Fh{ 2O13RO4-4r9416
OR BK 31074 Ps 4547 (1P9s)
RECORDED 07/25/2013 15:59:43
HARVEY RUVIN, CLERK. OF COURT
I1IAl1I-DADE COUNTY/ FLORIDA
COVENANT OF CONST UCTION WITHIN RIGHT OF WAY
Whereas, (owner) c4 7
hereinafter referred to as the owner of the following described
property (address):/4i / j4Z ,// 7
Legal Description: Lot /4 Block, 3 Subdivision
Folio # / 2-2-3 � '7 3 —,2
Requests permission to install (describe work):' 4'2 l///Uete- - y,-)L-
(5jct-lam .ez—/
Within the public right of way of (address) /e9/ /� // 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.
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 authorized representative).
Signature
State of Florida
County of Miami Dade
The foregoin• instrument was acknowledged before me this 10 day of du (_ j , 20 19 , by
. 2J1JRC GUE who is personally known to me or who has produced
-pl7,l S1as identification.
NOTARY P = _I C:
Sign:
Print:
' o'e Notary Public State of Florida
Bindle Alvarez
< My Commission FF 156750
:STATE OF F OR1r , ntJNTV nc Wont oraoPA Expires09/0312016
I HEREBY C
Owner or Agent
t D a 0 i--tita
original Ned
Seat
K, of Circuit and County Courts
D.C.