PW-18-3106Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address
Issue Date :10/25/2018
Parcel Number
Permit NO.: PW-10-18-3106
Permit Type: Public Works
Work Classification: Public Works
Permit Status: Approved
Expiration: 04/08/2019
895 NE 98TH ST, Miami Shores, FL 33138
1132060142530
Contacts
JAYSON & KRISTINE YAO
895 NE 98 ST, MIAMI SHORES, FL 331382532
Owner
CHAMPION CONCRETE
JAIME BASILIO
10280 NW 63 TER 105, DORAL, FL 33178
Business: 3052528055
Other: 7864024802
Contractor
Description: REPLACE 12 BROKEN FLAGS SIDEWALKS.
Fees
Amount
Education Surcharge
Public Works Permit Fee
Scanning Fee
Technology Fee
Total:
$0.60
$100.00
$9.00
$2.50
$112.10
Valuation: $ 2,450.00
Total Sq Feet: 300.00
Inspection Requests:
305-762-4949
Payments
Total Fees
Check # 2990
Amount Due:
Date Paid
10/25/2018
Amt Paid
$112.10
$112.10
$0.00
Building Department Copy
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores
Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate
permits are required f% ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNERS ' FFIDAV : I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws
regulating onstruc n and zoning. Futhermore, I authorize the above named contractor to do the work stated.
Authorized Signature: Owner / Applicant / Contractor
Agent Date
October 25, 2018
Page 2 of 2
RECEIVE")
0T092018
Miami Shores Villagerj•--)`°`
Public Works Department BY
(305)795-2210
Public works forms are available from the building department, 10050 NE 2nd Ave., Miami Shores, FL 33138
PUBLIC WORKS PERMIT APPLICATION
Permit Type: Work in the Right -of -Way on Miami Shores Village or Miami -Dade Property
Permit#: �� (8-3 106
Name of Applicant (if utility see below): J4N 9 4-0
Owner off the following described property:
Legal Descri tion: Lo Block Subdivision
Folio #; / 2-0s7 25l0
Address: �' I J L�` �'' �fi 4A u ' t)).A,\
UTILITY NAME:
Qualifier/Authorized Agent:
Address:
City: State:
Telephone: Email:
State Certification or Registration #:
ZIP:
CONTRACTOR NAME: G16*(4:0Matu CJp1C
Qualifier/Authorized Agent: R rJ h)V, A61..Ito
Address: 1.0\2- 'O /U+c1' Cow 7'`eV 4
Certificate of Competency #
City: eD 01 \ \ State: 14 ZIP: S3 (77f
Telephoner 2-Z8O5$ Email:..j 4i. .P7- +/D a .•
State Certification or Registration #: Certificate of Competency #:C.c(�Sv.sockrf
Requests permission to install (describe work, attactyseparate p ge if necessary) in the adjoining right of
way: c
--Yf 1 12 s k J L 4 s 1 v *4(3
Type of Work: ❑ Paving ❑-Utility Sidewalk ❑ Electric 0 Irrigation
0 Landscape ❑ Antenna
❑ Other:
DESIGNER: Architect/Engineer:
Address:
City: State:
Telephone: . • ` ; Email:
Registration #:
:! a Value{ of,Wgrkforthisf Permit 1 $ 111450.
U, r
pa ^fit C1.ir11 r .s iliIV3 iy$t
++i - " 1bG^;11 ur ++:tad rrt;,:t aH .�+o> .Jr+
�rs.+✓e��23'•+~FJa+�v nTj•`'+�ia•'erYre>.n •:irui;Liz Sf.7.6rw ;:... ..,•;
Permit Fee $ 100.00
Notary $ Training/Education $ 0.20 Technology,Fee $ 0.80 Scanning $
Bond $ (if required)
J)
.,ure 1il. avi Iw•„tillt i n:ns.r
SquareeLnlotgfk"o°
***** Fees*****
Total Fee Now Due $ 2• • I
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
4. + i
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 post
site for the first inspection which occurs seven (7) days after the public works permit is i
absence of such posted notice, the inspection will not be approved and a reirlspection
zt�
plicatit or Author' ed Agent
The fore Sng instrum twa ac owledged before
m this day of v --P_(20 by
is personally known to me or ho has produced
identification.
NOTARY PUBLIC:
Sign:
as
Signature
Copany/Utility Agent
The foregoing instrunAnt.itas acknowledged before
me this day &QUO B cr,-20 I , by
b ►► c t\C U O who
is personally known o me or who has produced
as
at the job
ed. In the
I be charged.
APPROVED BY:
identification.
NOTARY PUBLIC:
Sign:
Print: �1 Nc:A
SEAL:
SINDIA ALVAREZ
MY COMMISSION N 0G 238273
EXPIRES: September 3, 2022
• ,.1t •°`'' Bonded T ru Notary Public underwriters
************************************
`O\A'ic , Public Works Director, or Designee
2017-04-15
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All clearances and/or encroachments shown hereon are of apparent nature. Fence owners
by visual means. Legal ownership of fences not determined.
• Encroachments Noted:
• Underground structures; if any, not located.
• Bearings, if shown, are based on assumed meridian or Plat of Record:
• Lands shown hereon were not abstracted for easements and/or right-of-ways,of record.
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