PW-18-1054Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Project Address
Permit
Permit NO.pw P--'i-�l r34
Permit Type: Public Works
Work Classification: Public Works
PermitStatus: APPROVED
Issue Date: 5/25/2018
Expiration: 08/23/2018
Parcel Number
Applicant
83 NE 100 Street
Miami Shores, FL 33138-
1132060131440
Block: Lot:
MATTHEW AULTON
Owner Information
Address
83 NE 100 Street
MIAMI SHORES FL 33138-
83 NE 100 Street
MIAMI SHORES FL 33138-
Contractor(s)
DECORATIVE MASONRY INC
Phone
(305)757-7765
Cell Phone
Phone
Cell
Valuation:
$ 2,400.00
Total Sq Feet: 600
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
Invoice # PW-4-18-67243
04/23/2018 Credit Card
05/25/2018 Credit Card
Amt Paid Amt Due
$ 50.00 $ 54.00
$ 54.00 $ 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 AFFIDAVIT: I certify that all the foregoing informationate . •� work will be done in compliance with all applicable laws regulating
construction and zoning. Futhermore, I authorize the above-n-mod - ed.
Authorized Signature: Owner /
/ C
/ Agent
May 25, 2018
Date
Building Department Copy
May 25, 2018 1
RECEIVED
Miami Shores Village APR 23 7018
Qe
Public Works Department
(305)795-2210
Public works forms are available from the building department, 10050 NE 2"d 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#: tIC t053
Name of Applicant (if utility see below): /719WE?i2' /tl�� Y
Owner off the following described property:
Legal Description: Lot,'/Block
Folio #;
Address: ,jy,-/..„,"!
Subdivision "447 l6,I yPS
UTILITY NAME:
Qualifier/Authorized Agent:
Address:
City: State: ZIP:
Telephone: Email:
State Certification or Registration #: Certificate of Competency #
CONTRACTOR NAME: �eCpr�3�f1/e'/JJ�iYi J�fl _
Qualifier/Authorized Agent: ./, yy/E-1/1,z.,
Address:
City: „ / _0122. —/ State: /1-le
ZIP:%r2Y-
Telephone: % a?.29►-.3V,5, Email: /-Q/X7
State Certification or Registration #: /Y. Certificate oftbmpetency #:1F,53-
Requests permission to install (describe work, attach separate page if necessary) in the adjoining right of
way: �'r-....�..1/14 ji/fi >'/1l �7/e;X
Type of Work: R Paving ❑ Utility ; ❑ Sidewalk ❑ . Electric, ❑ Irrigation
❑ Landscape ❑ Antenna ❑ Other:
DESIGNER: Architect/Engineer:
Address:
City: State:
r:`"Telephone: '" "' .``.�.-.. Email:
Registration ,#: •
Value' of Work Permit } S uare Lineal
l�/ ,
* $oGjY� q / Footage of Work'f�L�
r
***** Fees*****
Permit Fee $ 100.00
Notary $ Training/Education $ 0.20 Technology Fee $ 0.80 Scanning $
Bond $ (if required) Total Fee Now Due $
rrf',`
d/l i._r
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.
• i
Signature ,,..----------(:WO
Applicant or Authorized Agent
The forego' instrument was acknowledged fore
_ Arne this day of � �� 20 { , by
(N
ei t
is personally known toje_or who has pro uced
lor�c1 Ian as
identification.
NOTARY PUB
Si T� tit
who
Print:
SEAL:
APPROVED BY:
,,s: ,,,,,,•. MAHARAI K. GONZALEZ
• „MISSION # GG 044602
EXPIRES: November 2, 202'
Bonded Thru Notary Public Underwriters
OF,«:
wfR10P.•
The fore
me this
Company/Utility Agent
g instrument was acknowledgeckefcire
day of 20 ( , by
e) f)� who
ispersonally �know�or who has produced
as
identification.
NOTARY PUBLIC.
Sign:
Print:
SEAL:
MAHARAI K. GONZALEZ
s MY COMMISSION # GG 044602
.1 EXPIRES: November 2, 2020
.� of p��".• Bonded Thru Notary Public Underwriters
ism
f(''-` , Public Works Director, or Designee
2017-04-15
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
111111111111 ltlll 11111 11111 111111111111111111
C FN 2O1 R023 7 9i"r e
OR BK. 3094? P3 2244 (1F'3s)
RFCnR Fli 04/19' i 1-`. .1.1G_I'`v.52
MI MI-D DE .OHNT I_'1i,.°1.i_i=;
�i117 cx PLOMA, COUNTY OF DADS
CERTIFY/hetIsheeftke
thmiath
=iA
COVENANT OF CONSTRUCTION WITHIN RIGHT OF W4Y
Whereas, (owner)
hereinafter referred to as the owner of the following described
property (address): _ tc
Legal Description: Lotd4 Vz' lock Subdivision /r r-7/i,-5-A,,,y'-e.
—Folio-#
A
my hand and • al Seel.
RUVIN, CLERK, of Cite v t County Courts
Requests permission to install (describe work): C2ML,Ai o P - u - °Pr1vES
oN7. Pao - \N -ts kj) 'cZ� �Z z v.. ?
Within the public right of way of (address) u�� �Pr�vL
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
Owner or Agent
State of Florida
County of Miami Dade
The fAir4942 n instrument was acknowledged before me this day of pr , 20 \7
.OIa O t i
NOTARY PUBLIC:
Sign:
Print:
o is personally known to me or who has produced
identification.
SEAL:
by
MAHARAI K. GONZALEZ
MY COMMISSION # GG 044602
EXPIRES: November 2, 2020
Bonded 7hru Notary Public Underwriters