PW-18-3432Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address
Issue Date: 11/13/2018
Permit NO.: PW-11-18-3432
Permit Type: Public Works
Work Ctassificotion: Public Works
Permit Status: Approved
Expiration: 05/13/2019
Parcel Number
22 NW 105TH ST, Miami Shores, FL 33150
1121360131170
Contacts
WHALEN GROUP, LLC
22 NW 105 ST, MIAMI SHORES, FL 33150
Other: 3057106801
Owner
Description: DRIVEWAY REPLACEMENT WITH PAVERS TO
REPLACE PERMIT#PW18-1143
BRUNO CONSTRUCTION CORP
VICENZO ANTONIO BRUNO
Business: 3057668984
Contractor
Valuation: $ 2,400.00
Total Sq Feet: 800.00
Fees
Amount
Public Works Permit Fee
Total:
$50.00
$50.00
Inspection Requests:
30;
7
2-4949''
Payments
Total Fees
Credit Card
Amount Due:
Date Paid
11/13/2018
Amt Paid
$50.00
$50.00
$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 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
regul.tin. construe 'on and zoning. Futhermore, I authorize the above named contractor to do the work stated.
Authori d Signature: 0 Applicant / Contractor / Agent
l �3 jib'
Date
November 13, 2018
Page 2 of 2
Miami Shores Village
Public Works Department
(305)795-2210
8
OV 1 8 21118
Public works forms are available from the building department, 10050 NE 2nd Ave., Miami Shores, FL 33138
Y•
PUBLIC WORKS PERMIT APPLICATION -*- if
Permit Type: Work in the Right -of -Way on Miami Shores Village or Miami -Dade Property
Name of Applicant (if utility see below):
Owner off the following described property:
Legal Description: Lot Block • Subdivision
Folio #;--�—�—
Address Z2 Il J (eV /OS7' S
UTILITY NAME:
Qualifier/Authorized Agent:
Address:
Permit#:7S
-3q 32._.
1,3
City: State:
Telephone: Email:
State Certification or Regis
CONTRACTOR NAME:
Qualifier/Authorized Agent:
Addr- s':
City
ZIP:
tration #: Certificate of C!�petency #
4/J/,2 % .
�r
State:
Telephone: ,E1�all:
State Certification or Registration #:[ �L
Certificate of Competency #:
Requests permission to install (describe work, attach separate page if necessary) in the adj fining right of
way: V►J CF -�- ' C
Type of Work: ,1 Paving ❑ Utility 0 Sidewalk 0 Electric ❑ Irrigation
❑ Landscape ❑ Antenna ❑ Other:
DESIGNER: Architect/Engineer:
Address:
City: State:
Telephone: Email:
Registration
tj w .A. f..i .A.
Value of Work for- this,Permit $
Permit Fee $ 100.00
Notary $ Training/Education $ 0.20 Technology Fee $ 0.80 Scanning $
Bond $ (if required) Total Fee Now Due $ O. a
ZIP:
Square/Linea) Footage oftWork a,
**** Fees*****
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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.
1.
"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.
•
-a
Signetu
The fore
t(.1n
identification.
Applicant or Authorized Agent
g instrume s acknowledge
cv oar f20 >�
e
NOTARY PUBLIC:
I �Y`�_
Sign: 1.1 1 •l 1,L'1
Print: AlfJia)1d
SEAL:
produced is personally known
as
ANTHONY E. KILISSANLY,
MY COMMISSION # GG 100640
47i EXPIRES: May 2, 2021 v
Bonded Thru Notary Public Undenrilfei
1
APPROVED BY:
. iSignature `
Company/Utility Agent
efore < The foregoing instrume as acknowledgedpefore '
by m Idday of e i i' ��J 20 . / O , by
who "/'' C. 4 rtJive
o me or who has produced
as
identification.
----Sign:
Print:
SEAL:
•VYYtIN MY COMMISSION 1 GG 100640
:tis3 EXPIRES: May 2, 2021
Bonded Thu Notary Public Undenvritirs
—
************************`********
, k\, VAk) ,.Public Works Director, orDesignee'
who
2017-04-.15.