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PW-18-596`5 01 Miami Shores Village 10050 N.E. 2nd Avenue NW Miami Shores, FL 33138-0000 Phone: (305)795-2204 F<ORID� (Permit Issue Date: 3/8/2018 Permit NO. PW-3-18-596 Permit Type: Public Works Work Classification: Public Works Pennit Status: APPROVED Expiration: 06/06/2018 Project Address Parcel Number Applicant 129 NW 96 Street 1131010250100 Miami Shores, FL 33138- Block: Lot: ERIK SACCOMANI owner mtormatlon Address Phone Cell ERIK SACCOMANI 129 NW 96 Street MIAMI SHORES FL 33150- 129 NW 96 Street MIAMI SHORES FL 33150- Contractor(s) Phone Cell Phone NORTHERN STAR CONSTRUCTION II• (786)201-5522 ning: 1 Fees Due Amount CCF $0.00 DBPR Fee $0.00 DCA Fee $0.00 Education Surcharge $0.20 Notary Fee $5.00 Permit Fee $100.00 Scanning Fee $3.00 Technology Fee $0.80 Total: $109.00 Valuation: $ 750.00 Total Sq Feet: 220 Pay Date Pay Type Amt Paid Amt Due Invoice # PW-3-18-66713 03/08/2018 Credit Card $ 50.00 $ 59.00 03/08/2018 Credit Card $ 59.00 $ 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 information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhgrmore, I authorize the above -named contractor to do the work stated. March 08, 2018 Authorized Signaffuse!Owner / Applicant / Contractor / Agent Building Department Copy March 08, 2018 1 _ R 0. 2018 .,v Miami Shores Village Public Works Department L: (305)795-2210 f Public works forms are available from the building department, 10050 NE 2nd Ave., Miami Shor/s, FL 33138 PUBLIC WORKS PERMIT APPLICATION Permit Type: Work in the Right -of -Way on Miami Shores Village or Miami -Dade Property Permit#: 7C/-��, �o Name of Applicant (if utility see below): C_64�'e-.^ (` Owner off the following described property - Legal _ p Legal Description: Lot D Block _ Subdivision /na ( l r Folio #; c) - O Z5 - OI a0 ` Address: .Z Q 41 k) 9 4, UTILITY NAME: Qualifier/Authorized Agent: Address: Citv: Telephone: State Certification or Registration #: Email: State: ZIP: Certificate of Competency # CONTRACTOR NAME: J,� //t✓ Qualifier/Authorized Agent: Address: 69 S j City: 4< <^'I State: ZIP: -7 C, Telephone: - -L , Email: )ee-1 0g/ST q/-. �. n State Certification or Registration #: C PV- IZ,23.63 Certificate of Competency #: Requests permission to install ( scribe work, attach separate page if necessary) in the adjoining right of way: 0 /Z i gel Type of Work: Paving ❑ Utility ❑ Sidewalk ❑ Electric ❑ Irrigation /❑ Landscape ❑ Antenna ❑ Other: DESIGNER: Architect/Engineer: Address: City: State: ZIP: Telephone: Email: Registration #: Value of Work for this Permit: $ Square/Lineal Footage of Work: 2Z� Z l O� ***** Fees***** Permit Fee $ 100.00 3 Notary $ .5 Training/Education $ 0.20 Technology Fee $ 0.80 Scanning $ Bond $ R C 117 required) Total Fee Now Due $ Sq . 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 ---"7'Applicant o uthorized Agent The foregoing instrument was acknowledged before ethis 7 dayof MQrC.b , 20 3_, by Yi % SOCCQ (ncrn who isppersonally known to me or who has produced Ti C i V Q Y � % as identification Sign: Print: o SEAL: 1 ,aY'Py�y, YANAD PRIEfO ° = Ml COMMISSION # FF 214031 _. a: EXPIRES: March 25, 2019 '•f,;�� 1`�`. Bonded Thiu No;;.ry PUDSC Underwriters **** * ********I** APPROVED BY: \ Signature Company/Utility Agent The foregoing instrument was a knowledgecj efore me this 1 day of r' MDrC 20 II9, by hri±b Anxo In who is penally known to me or who has produced o '6l V c( liC`ms),e as identification.. Sign: Print: SEAL: YANADYPRIETO MY COMMISSION # FF 214031 EXPIRES: March 25, 2019 Bonded Thor Norry Pub!ic Underw*rs ************************ qPublic 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 OR. BK 30388 F9 714 (1F 9s ) RECORDEF! If.],'03i'_111t j�IC44Eii!:� HARVE•i RU�AIh{, UIRK OF c IURi MIA111—DADF CGRU[`TYr FLORIDA. COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY Whereas, (owner) /�«,,,-, , hereinafter referred to as the owner of the following described property (address): 1 L `7 N -X 4- 5 � Legal Description: Lot � Block 2— Subdivision Folio # / %- 310 i - 0 2- Sl - 0100 Requests permission to install (describe work): i kjc woC,\ 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 Dade County, Florida by the Village Manager of Miami Shores Village (or his fully authorized represe tative). Signature '� ; ��/G C�v -► �� f O ner or Agent State of Florida County of Miami Dade The foregoing instrument was acknowledged before me this (9 day ofp�a-1 , 20by �-_ r c r� �,�a _ who is personally known to me or who has produced 4::t I t�2Id-entification. NOTARY�UBLIC: Sign. > ' : Print: '\ (1 � �� SEAL: .r,:�4 ;; .sty. ,�f Florida �. *'. T P�y1 ri'*� �4;1^iaAlvare�z {; FF'1 $b'750 d: FLORIDA, COUNTY OF DADE COU/yj` r�° . a "'vim ry �,.e My,..pmrt-IggiDn ,. F_XiJIlES 051L'^i2Q78 {i STATE OF I HFRFRY CFRTIFv tha+ the foreaom2 is trigand-C� ect copy of the.. F+� - original on file m this office. 1� AD - u r HARVEY RUVIN, Cii rk i;irCt'� \° Deputy Clerk m p GIRLYNE P�Etw- OC noll 3