PW-18-2207Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Project Address
Pei
mit
Permit NO. PW-8-1 822O
Permit Type: Public Works
Work Classification: Public Works
Pennit Status: APPROVED
Issue Date: 8122/2018
Expiration: 11/20/2018
Parcel Number
Applicant
1053 NE 95 Street
Miami Shores, FL
1132060143600
Block: Lot:
SEAN SHEA
Owner Information
Address
Phone
Cell
ROSALIE SHEA
1053 NE 95 ST
MIAMI FL 33138-2547
Contractor(s)
TECO PEOPLES GAS SYSTEM
Phone Cell Phone
(305)957-3857 (305)970-1783
Valuation:
Total Sq Feet:
$ 1,000.00
0
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
$0.00
$50.00
$0.00
$0.00
$50.00
Pay Date Pay Type Amt Paid Amt Due
Invoice # PW-8-18-68600
08/20/2018 Check #: 3009 $ 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 AF
construction a
oregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
orize the above -named contractor to do the work stated.
uthoriz ;;II► nature: Own r / Applicant / Contractor / Agent
August 22, 2018
Date
Building Department Copy
August 22, 2018 1
Miami Shores Village
Public Works Department
(305)795-2210
Public works forms are available from the building department, 10050 NE 2nd 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#:PN 1 -Z201
\TED
018
GU
Name of Applicant (if utility see below):
Owner off the following described property:
Legal Description: Lot Block Subdivision
Folio #;
Address:
UTILITY NAME:
Qualifier/Authorized Agent:
Address:
City: State: ZIP:
Telephone: Email:
State Certification or Registration #: Certificate of Competency #
CONTRACTOR NAME: •= G pG cs 41s S� i z l.•�
Qualifier/Authorized Agent: ry/ 5 liER
Address: /s77 9 w w/
City: iU . Yi(• , State: f2 - ZIP: Z
Telephone: Email:
State Certification or Registration #: Certificate of Competency #: k
Requests permission to install (describe work, attach separate page if necessary) in the adjoining right of
way:
IFC .JEi) Pre__
PLO --238e
Type of Work: ❑ Paving ❑ Utility ❑ Sidewalk ❑ Electric 0 Irrigation
❑ Landscape ❑ Antenna ❑ Other:
DESIGNER: Architect/Engineer:
Address:
City: State: ZIP:
Telephone:
Registration'#:
2.2
Value of Work for this Permit:
Email:
Square/Lineal Footage of Work:
***** Fees*****
Permit Fee $ 100.00
Notary $ Training/Education $ 0.20 Technology Fee $ 0.80 Scanning $
Bond $ (if required) Total Fee Now Due $
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 Signature
Applicant or Authorized Agent
C.JcZ�.sa v
Company/Utility `A ent
The foregoing instrument was acknowledged before The foregoing instrument was acknowledged b ore
me this day of , 20 , by me this 49l day , 20 by
who �i,s�s V c-9 / who
is personally known to me or who has produced is personally known to me or who has produced
as
as
identification.
NOTARY PUBLIC:
Sign:
Print:
SEAL:
APPROVED BY:
identificatio
NOTARY
Print:
SEAL:
1.
•tt7"�"Y4°. HUBERTNUNEZ
,•• MY COMMISSION # GG 104234
'e1�.4, • EXPIRES: September 11. 2021
"ram:':: °::
Bonded Thru Notary Public Underwriters.
********** *************************
`6'10-1 (g , Public Works Director, or Designee
2017-04-15