PW-18-2153Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Project Address
Pe
mit
Permit NO. PW-8-18-2153
Permit Type: Public Works
Work Classification: Public Works
Permit Status: APPROVED
Issue Date: 811412018
Expiration: 11/12/2018
Parcel Number
Applicant
1263 NE 92 Street
Miami Shores, FL 33138-
1132050270270
Block: Lot:
MARTA J PACHECO BOBONIS
Owner Information
Address
Phone
CeII
CHRISTOS TZAVARAS
1263 NE 92 Street
MIAMI SHORES FL 33138-
(787)233-3606
1263 NE 92 Street
MIAMI SHORES FL 33138-
Contractor(s)
ORINOCO BUILDING LLC
Phone
(786)531-9479
CeII Phone
Valuation:
Total Sq Feet:
$ 1,400.00
60
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 Amt Paid Amt Due
Invoice # PW-8-18-68531
08/14/2018 Credit Card $ 104.00 $ 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 ELECTf?ICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNERS
constructio
T: I certi
ng. Futhe
that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
more, I authorize the above -named contractor to do the work stated.
I _
Authoriz4d signature: pwner / Applicant /
Contractor
/ Agent
August 14, 2018
Date
Building Department Copy
August 14, 2018
1
RECEIVED
Miami Shores Village AUG 14 zing
Public Works Department
(305)795-2210
Public works forms are available from the building department, 10050 NE 2' 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#: 1 FS "2151
Name of Applicant (if utility see below): M ( 1 ' \ 1'}EC 0
Owner off the following described property:
Legal Description: Lot 1(7 Block 2.
Folio #;
Address: )263 NE /2* 3t I tt;a„ t.,, Por44 fit, 3313P
Subdivision ''?.Qta book
UTILITY NAME:
Qualifier/Authorized Agent:
Address:
City: State: ZIP:
Telephone: Email:
State Certification or Registration #: Certificate of Competency #
CONTRACTOR NAME: aftk40cD
Qualifier/Authorized Agent: ?Cuts w 0
Address: Coo .YJE q8-i44. . U,
City: M,iouu i• 'ta_ State: T. L ZIP: 33 4 3$
Telephone: (70s) 333 316? -Email: st-otto P Co-c>A••Q • CAW.
State Certification or'Registration #: 7 Certificate of Competency #:
Requests permission to install (describ work attach separate page if ec sa ) in the adjoining r'ht of
wa : . �4 OnJ�.t► S PM �/i1 t i` W V+I, +lt WI '� .l.t^ ��,A,,' e12A.c. isU.- y ,\,i/tAk
Type of Work: '® Paving ❑ ;Utility ❑ Sidewalk ❑ Electric ❑ Irrigation
❑.. Landscape ❑ Antenna ❑ Other:
DESIGNER: Architect/Engineer:
Address:
City: State: ZIP:
Telephone Email
Registrati 'n #:•r....
r:;%r
Value of orksfor.this Permit: m $ 4.,409,, . Square/Lineal Footage of.Work:1,
• -''' "_ "-- 47' P... r* ** Fees
Permit Fee $ 100.00
Notary $ Training/Education $ 0.20 Technology Fee $ 0.80 Scanning $
Bond $ (if required) Total Fee Now Due $ tO� •�
**
**
„J-, '410..-.1 111.1Y..
F' .. x"`s!r^ '".ems'"" *:„.00.... ,;00..n, .+,.r'..,..,'0007, *; r`
Sign:
Print:
SEAL:
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 e'nspection.+will be charged.
Applicant or Authorized Agent
The forego ng ihstrumen't was acknowledged befo e
me this •day of /4()60s, , 20 (g , by
MiArira5 ackeco Bob aNi5 Titivr'vaS who
is personally known to me or who has produced
R-ILPIZI-550- q-543 -o
as
identification.
NOTARY P 1(3L•
C:
OAOS WO- yG.
�AM.a
i4►R "*i ,� CARLOS J ZELAYA
E.�1 c Notary Public - State of Florida
S Commission # GG 031309
'% of.4 My Comm. Expires Sep 18, 2020
•
es*** ************************
APPROVED BY: . : \ktk4 , Public Works Director, or Designee
Signature
. Comp /UtilityA:-nt
The foregoing instrume t as'ac nowledged before F
me this Pday of 2071•' by -
Es La( TA oe who
is pqrsosnally knoy,n to me or who has produced
‘IJC 1 Vf.r—S t i GGY► as
identification. 003Z-ZO 1-t-J9 —49Z-6
Sign:
Print: v I
SEAL: 441,4* ",
s
RAPHAELA ST."AUDE
t Notary Public - State ot Florida
;if Commission # GG 051820
,,,,,, �,` My Comm. Expires Nov 30, 2020
2017-04-15
111111111111 hill um mii iiiii ouii usi mi
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204 STATE OF F
MR
Fax: (305) 756.8972 IHEREBY
Jng�C°
l on file in
HARVEY RW
COVENANT OF CONSTRUCTION WITHIN RIGHT OF WA
Whereas, (owner) M ARTA .1. PACK2.O JESSI ► MERRITT #310229
hereinafter referred to as the owner of the following described
property (address): 1263 NI: 92&ot St ,Miawk Shores T1.33t38
Legal Description: Lot (6 Block Z Subdivision yL/T 8cox
—Folio-# --63
Requests permission to install (describe work): PA VEZS I-0 (kttde Wdi
2,0 -fit ilia ctivzt
Within the public right of way of (address) 1263 Ni; q2 ud. St t k � S.ko JP.d
33t38
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
is fully auti}erri ed represer tive).
C FN 201:L8:R04-S3251
OR RK. 31094 Ps 3051 t1P9s;
RECORDED 08/09,/201S 11:27:04.
HARVEY RUVINr CLERK. OF COURT
MIA11I--LADE COUNTYr FLORIDA
Owner or Agent
ORJDA, COUNTY OF
and
A
t 1
IN -
State of Florida
County of Miami Dade 4}-71)S
The foregoing instrument was acknowledged before me this 9 day of
���i-� Pakece, (? ,>,;,5 T vctivho is personally known to me or who has produed
ia)- ««Z I-550-51-5-q3.o as identification.
NOTARY PUI .IC:
Sign:
Print:
Ito
SEA
, 20 /q , by
; CARLOS J ZELAYA
Notary Public - State of Florida
z Commission # GG 031309
OFF�� ss My Comm. Expires Sep 18, 2020
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
Notice to Owner — Workers' Compensation Insurance Exemption
Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05
allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to
obtaining a building permit. Pursuant to the Florida Division of Workers' Compensation Employer Facts Brochure:
An employer in the construction industry who employs one or more part-time or full-time
employees, including the owner, must obtain workers' compensation coverage. Corporate officers
or members of a limited liability company (LLC) in the construction industry may elect to be
exempt if:
1. The officer owns at least 10 percent of the stock of the corporation, or in the case of
an LLC, a statement attesting to the minimum 10 percent ownership;
2. The officer is listed as an officer of the corporation in the records of the Florida
Department of State, Division of Corporations; and
3. The corporation is registered and listed as active with the Florida Department of
State, Division of Corporations.
No more than three corporate officers per corporation or limited liability company members are
allowed to be exempt. Construction exemptions are valid for a period of two years or until a
voluntary revocation is filed or the exemption is revoked by the Division.
Your contractor is requesting a permit under this workers' compensation exemption and has acknowledge that he or she will not use
day labor, part-time employees or subcontractors for your project. The contractor has provided an affidavit stating that he or she will
be the only person allowed to work on your project. In these circumstances, Miami Shores Village does not require verification of
workers' compensation insurance coverage from the contractor's company for day labor, part-time employees or subcontractors.
BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS
CONTENTS.
State of Florida
County of Miami -Dade
IA
The foregoing was acr.
owledge before me this / O day of
Bymalt. achao
Notary:
SEAL:
1,20/
who is personally known to me or has produced
Li as identification.
CASSANDRA HARRISON
Notary Public, State 01 Florida
Comm1asi0n8 FF 987414
My comm. expires May 20, 2020
Orinoco Building LLC
Date: g /13 6
State of Florida
Miami -Dade County
Before me this day personally appeared Eloy Paredes Paoli who, being
duly sworn, deposes and says:
That he will be the only person working in the Project located at:
r
1263 NE 92nd St.
Miami Shores, FL 33138
Eloy P
edes
Contractor signature)
Sworn (or affirmed) and subscribed before me this )31-hay of
i
t.t,-- . 2018, by ELV, L-% E5
Personally known
Or produced identification
Type of Identification Produced p65Z-Zoi_Ll9-oc -d
-aaa
„OW II,,,
i '•• RAPHAELA ST. AUDE
''��L Notary Public - State of Florida
I', �' e Commission # GG 051820
vii)
Print, Type & Name of Notary
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RECEIVED
COUNTY RULES AND PEG ULATiONS
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200.001(R) amsc
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LEGAL DESCRIPTION:
Lot 18, In Bock 2, "BAY LURE', accorclhp to the Plat thereof, as recorded
In Plot Book 44, at Page 83, of the Public Records of Miami Dade County,
Florida.
1110
FLOOD MO WITHIN ION!: Al
!LEVA-ION, 0.0'
CONMINI-T: 120652
'AN!. NO.: 0506
SJFPIX: L
5ATE: 09 RN2009
OR0IRNOJ MTD/M
P*W Wee'FILE.
DAM 5E•T1M0E61 0. 2016
UPOAT6
OPOATO
PROPIRTY FORM
1283 N.E. 92nd Street
MIerN Shores, FL, 33138
FORI CHPISTOS TZAVARAS AND
MARTA J. PACHEc0 BOHONIS
I NEPEO. CERTIFY+ -ray OM MARINA FNRESENTN THE Woo/ tF A sum: Or Tr4
W1'*IN 56000)0.0 7100PEF'Y AND Tr11 ORNYIN0 AND SAD PINEY SOS PFEPNRO 01
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