PW-18-592Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Project Address
Permit
Issue Date: 6/5/2018
Permit No. PW-3-18-592
Permit Type: Public Works
Work Classification: Public Works
Permit Status: APPROVED
Expiration: 09/03/2018
Parcel Number
Applicant
5 NE 107 Street
Miami Shores, FL 33161-7029
1121360070330
Block: Lot:
TIMOTHY A WILLIAMS
Owner Information
Address
Phone
Cell
TIMOTHY A WILLIAMS
5 NE 107 Street
MIAMI SHORES FL 33161-
(786)877-1808
5 NE 107 Street
MIAMI SHORES FL 33161-
Valuation:
$ 5,000.00
Total Sq Feet: 160
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-3-18-66709
06/05/2018 Credit Card
03/08/2018 Credit Card
Amt Paid Amt Due
$ 54.00 $ 50.00
$ 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 AFFIDAVIT: I certify that
construction and zoninc. uther
Author! .' ignatu
e foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
horize the above -named contractor to do the work stated.
/ Applicant /
ontracto
/ Agent
June 05, 2018
Date
Building Department Copy
June 05, 2018 1
Miami Shores Village
Public Works Department
(305)795-2210
Public works forms are available from the building department, 10050 NE 2"d Ave., Miami Shores, FL 33138
RECEIVED
MAR 0 8 2018
PUBLIC WORKS PERMIT APPLICATION
Permit Type: Work in the Right -of -Way on Miami Shores Village or Miami -Dade Property
Permit#: Jq 0
Name of Applicant (if utility see below): TI KC) mot A . W t c L,i A
!Owner off the following described property:
Legal Description: Lot 'j Block 2`t0 Subdivision
Folio #;
Address: 5 N e 40 Ti4 Slime-T, M in fill S Ito (LE < F L ('4
UTILITY NAME:
Qualifier/Authorized Agent:
Address:
City: State: ZIP:
Telephone: Email:
State Certification or Registration #: Certificate of Competency #
CONTRACTOR NAME: � N ea)
Qualifier/Authorized Agent: PAD E Qi 0 66 6 Aa4242 Ga C
Address: 't'$00 bA f 0-0A [ . 4 tee
City: M lA1't l (3EAC'rlt State: F ZIP: 33/59
Telephone: ig6 4q `- Email: (IA goo c 2 e GAN1 D LLG. c:U.n
State Certification or Registration #: Certificate of Competency #:
Requests permission to install (describe work, attach separate page if necessary) in the adjoining right of
way: (2Et-toi E A,(4c) ►n)S-rA tl, NE0 i (c_ES
Type of Work: ❑ Paving ❑ Utility ❑ Sidewalk ❑ Electric ❑ 'Irrigation
❑ Landscape ❑ Antenna ❑ Other:
DESIGNER: Architect/Engineer:
Address:
City: State: ZIP:
Telephone: Email:
Registration #:
DO0 i� 9-. �t
Value of Workforahis Pe"rmit $ Square/Lireal Footage ofWork: '(,60`SC�.
•
"?"* Fees *****
Permit Fee $ 100.00`
Notary $ Training/Education $ 0.20 Technology Fee $ 0.80 Scanning $ ��
Bond $ (if required) Total Fee Now Due $ ,S
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 $2,500, the applicant must promise in good faith that a copy of the notice of commencement
and construction lien law brochure will be delivered to the person whose property is subject to the
attachment.Also, a certified copy of the recorded notice of commencement must be posted at the job
site for the first inspection which occurs seven (7) days after the public works permit is issued. In the
absence of such posted notice, the inspection will not be approved and a reinspection will be charged.
Signature
Applicant or Authorized Agent
The foregoing instrument was acknowledged before
me this 0H day of rt pa -to , 20±L, by
TI HoTI4y W rlLlAh S who
is personally known to me or who has produced
identification.
Sign:
Prin
SE -r:
Signatur
Company/Utility Agent
The foregoing instrument was acknowledged before
me this n-r day of MA(LL!{ ,20'lci ,by
tillri Kto CA 43.,6e(4),C,0 S who
is personally known to me or who has produced
as as
AGOSTINO PEZZATINI
MY COMMISSION #FF113522
of.,'; EXPIRES April 16, 2018
(40i) 3se-01 Floridallotaryser.ise oom
..r
APPROVED BY:
-3V0
identification.
, Public Works Director, or Designee
2017-04-15
111111111111111111111111111111111111111111111
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 331.TEOFFL
Tel: (305) 795.2204 HEREBY CERTIFY
balonfile
Fax: (305) 756.8972 ARVEYRin
COVENANT OF CONS-J:a.UCT ON WITHIN R GHT OF WAY
Whereas,;(owner) 1 i .\�,, kJ, '//� ,15
hereinafter referred to as the owner of the following described
property (address): C N s LOI S4ve$
Legal Description: Lot Block 210 Subdivision
Folio #
Requests permission to install (describe work): EEt-ro VE rai'0 I N,','(QL
eeo TcuS
( FN 2018RO128988
OR BK. 30883 Fs 4306 (1F'gs)
HARVEY RUVI r I. "LER:;' Yf- COURT
N I A !.1--[ .DE COUNTY? FLORIDA
Within the public right of way of (address)
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 Da ounty, Florida by the Village Manager of Miami SSS� Village
(or his fully author" -d rear-ese" tative).
Signature
State of Florida
County of Miami Dade
The foregoing instrument was acknowledged before me this o i day of Inc A,Z 1
T n OT i y 1AI1 a f 4r1 who is personally known to me or who has produced
as identification.
NOTARY PU
TIMo TH y vW i LL I Pr S,
Sign:
Print:
SEAL:
, 20 l e , by
' AGOSTIN
p pgzzATINI
MYCOMMISSIQN#FF113522
",,.0c,; EXPIRES April 16, 2018
(4o7) 39e-0rs3"_ ridallotarySen,;iie corn