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`
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"'vim ry
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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