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PW-18-3069Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Location Address issue Date:10/22/2018 Parcel Number Permit NO.:.PW-10-18-3069 Permit Type: Public Works Work Classification: Public Works Permit Status: Approved Expiration: 04/02/2019 1076 NE 98TH ST, Miami Shores, FL 33138 1132050180340 Contacts ROBERT ARMSTRONG 49 NW 98 ST, MIAMI SHORES, FL 331501736 Owner STAR ISLAND CONCRETE DESIGN CORP MIGUEL CORPAS 901 NW 55 ST, MIAMI, FL 33127 Business: 3057767916 Contractor miguelcorpas22@gmail.com Description: SQUARES PLAIN CONCRETE Fees Amount Education Surcharge Public Works Permit Fee Scanning Fee Technology Fee Total: $0.20 $100.00 $3.00 $0.80 $104.00 Valuation: $ 3,000.00 Total Sq Feet: ti 486.00 Inspection Requests: -762-4949 Payments Total Fees Credit Card Amount Due: Date Paid 10/22/2018 Amt Paid $104.00 $104.00 $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, drawings, statements o? 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. Authorized Signature: Owner / Applicant / - Contractor / Agent Date October 22, 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 2nd Ave., Miami S PUBLIC WORKS PERMIT APPLICATION Permit Type: Work in the Right -of -Way on Miami Shores Village or Miami -Dade Property Permit#: D5 V socoe Name of Applicant (if utility see below): ;a,c Q-,- iL-M<j-inC�)�G Owner off the following described property: Legal Description: Lot Block ( g0 Subdivision ; r i (Am\ S H-Iw 5 C-c..`z� Folio#; (1-3 5-01S — Address: i 0-i6' r' clZ 3 r UTILITY NAME: Qualifier/Authorized Agent: Address: City: State: Telephone:. Email: State Certification or Registration #: Certificate of Competency # ZIP: CONTRACTOR NAME: aC— f ue ce CO oL Address: I, b t S P Ct) 4-? S-t Qualifier/Authorized Agent: City: �-�✓--vl��C_. Telephone: �/Z Email: State Certification or Registration #: ' Certi icate of Competency #: Requests permission to install (describe work, attach separate page if necessary) in the adjoining right of way: �. u itAIM S PI /i I V -G 019 C 2n,xe Type of Work: ❑" Paving ❑ Utility 0 Sidewalk 0 ❑ Landscape El Antenna ❑ Other: DESIGNER: Architect/Engineer: Address: Electric 0 Irrigation City: State: ZIP: Telephone: Email: Registration #: Value of Work for this Permit: $ Square/Lineal Footage of Work: �6, ***** Fees***** Permit Fee $ 100.00 Notary $ Training/Education $ 0.20 Technology Fee $ 0.80 Scanning $ Bond $ (if required) Total Fee Now Due $ "ate 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 -p&rmit 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 theissuance 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 approvecla reinspection will be charged. Signature Signature App ' ant or Authorized Age The foregoing instrume - • • - •ged before - The foregoi me this • day of " i: •y me this ;W�_� i4y o is personally known to iden NOT Sign: fs4,;y cOMMISSIO ''E l� EXPIRES: August t •, kil f i bru Notary Public Underwriters Bonded' identificati NOTARY PU Sign: re , CARLOS R' s - ?vs 00 177 •.:tag !AY GPMMISSI.. is 2 IRES t' ` :t ` 020 Bandied?hMN Rollo Underwriters Print: Print: SEAL: SEAL: APPROVED BY: 1,41 , Public Works Director, or Designee 2017-04-15 111111111111111111111111111111111111111111111 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) 1- -T nereinatter referred w as ure owner o ure rorlowing described CFN 201.L;R7.15c•;-21- 3 OR BK. 31136 Ps 4OO (1F9 s i RECORDED 0r9: 1'=:2 i1S 11:33 1. HARVEY RUVIh1, :LERf OF -COURT IAMI-DAC'E C:OUAT'ir FLORIDA property (address): 1b-1U NC G 8-4, s t Legal Description: Lot /L- Block I frd Subdivision /2evi 5eP/i©f Nana/ S/1 re ---Folio-# Requests permission to install (describe work): / /cc .'t (a/rcreje Within the public right of way of (address) /0 36 Pk— 9 571 Hi ' i r' 9wres. 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 re Signature er or Agent State of Florida County of Miami Dade he foregoing i strum�ent was acknowledged before me this 31s+ day of ab-cyk- . . Dvms*•vonca who is personally known to me or who has produced �rIVNt k°(A{' S-{ identification. NOTARY i LIC: IA t VF I-LORIOA, COVN i Y OF DADE ' HEREBY CERTIFY that MI -sic a true copy of the anginal filed in this office &FP 1 2 2f18ayof AD20 WITNESS my hand and Official seal 41ARVEY RUVIN, CLERK, County Courts D.0 Sign: Print: 0 SEAL: " �oLa�'c ;'= COMMISSION a< Fr- 214 EXPIRES: March 25, 2019 Bonded TONG Kotary Pub',;‘;Underrder; MYC YANADY PRlErO 1 D31