PW-18-304Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Issue Date: 2/6/2018
Permit NO. "PW-2-18-304
Permit Type: Public Works
Worm Classification: Public Works
Permit Status: APPROVED
Expiration: 05/07/2018
Project Address Parcel Number Applicant
17 NE 105 Street 1121360060100
OLIVER &ANDREE STEPHANIE
Miami Shores, FL 33138- Block: Lot:
OLIVER & ANDREE STEPHANIE 17 NE 105 Street
MIAMI SHORES FL 33138-
17 NE 105 Street
MIAMI SHORES FL 33138-
Contractor(s) Phone Cell Phone
HIDALGO CONSTRUCTION GROUP LI (786)262-3596
ning: 1
Fees Due
Amount
CCF
$0.00
DBPR Fee
$0.00
DCA Fee
$0.00
Education Surcharge
$0.20
Permit Fee
$100.00
Scanning Fee
$3.00
Technology Fee
$0.80
Total:
$104.00
Cell
Valuation:=768.00Total Sq Fee
Pay Date Pay Type Amt Paid Amt Due
Invoice # PW-2-18-66361
02/06/2018 Credit Card $ 54.00 $ 50.00
02/06/2018 Credit Card $ 50.00 $ 0.00
Available Inspections:
Inspection Type:
Excavation
Final Public Works
Review 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 ang6zoning, Futhermore, I authorize the above -named contractor to do the work stated.
February 06, 2018
rr ed Signature: Owner / Applicant / Contractor / Agent
Building Department Copy
February 06, 2018 1
5ose 0 re flm,"
Miami Shores Village RECEIVED
Building Department FEB 06 2018
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949 cob
FBC 20
BUILDING Master Permit No. 30
PERMIT APPLICATION Sub Permit No.
BUILDING ❑ ELECTRIC ❑ ROOFING REVISION ❑ EXTENSION RENEWAL
PLUMBING ❑ MECHANICAL PUBLIC WORKS ❑ CHANGE OF CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: V3 IVE /Os S�rtt, t
City: Miami Shores County: Miami Dade Zip: 9aJ1 3
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): 54& oAyrie Se(yat Phone#: oC0�2� y�aS-Gd
Address: 1'4- /V F )175 Skree. � A of i 51.0rry. 1=C.1 36(3 3?
City: c rf 5 State: Zip: 3613 fS
Tenant/Lessee Name: PhonneMM#:
Email: 3D&C . gcc
CONTRACTOR: Company Name: 44FA(�Q COa51rLG•1,on J.(O(,p Phone#: �86'aZ(Oa; 3Sy6
Address: "410 IVCV 9 � d & �+,r
City: /P CG ---i State: 1 " zip:
1 �JI�
Qualifier Name: ,i r^ tti LlA (h n Phone#:
State Certification or Registration #: Ut C. 15 1 S)1 a Certificate of Competency #:
DESIGNER: Architect/Engineer:
Address: City: State: Zip:
Value of Work for this Permit: $ 44 46_ $ �Square/Linear Footage of Work: tf#f3` at o
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: E -k d E- ?(Avtr 5 Dr i rY
Specify color of color thru tile:
Submittal Fee$ r �. Permit Fee $
Scanning Fee $ Radon Fee $
Technology Fee $,
Structural Reviews $
Training/Education Fee $
t
LS
CCF $
DBPR $
,-tit.ls.i uric �..
CO/CC $
Notary $�
Double Fee $
Bond $
(Revised02/24/2014)
TOTAL FEE NOW DUE $
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
State
Zip
Zip
Application is hereby made to obtain a permit to do the work 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 regulating
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS,
FURNACES, BOILERS, HEATERS, TANKS, AIR CONDITIONERS, ETC.....
OWNER'S 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.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. 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 building permit with an estimated value exceeding $2500, 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 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 building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signatur ,2 Signature
OWNER or AGENT CONTRACT
The foregoing instrument was acknowledged before me this
a dayof Janvcr% ,20 11 by
44rc40, S4-e 9 kar> f 51r- who is personally known to
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign:_
Print:
Seal: BR.uiTTE VENDRELL
Notary Public - State of Florida
3• ' Commission # FF 947409 .
APPROVED BY
My Comm. Expires Jan 3, 2020
The foregoing instrument was acknowledged before me this
a� dayof SGVlyov 120 1 8 by
Al aiN ll091P who is personally known to
as me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
ssssssssssssss
I I Plans Examiner
as
8hiu,TTE VENURELL
Notary Public - State of Florida
•t=
Commission # FF 947409
a:F
CIF
My Comm. Expires Jan 3, 2020
OF f ;��.•��
Bonded through Nation a] Notary Assn.
�j
- Zoning
(Revised02/24/2014)
Structural Review
Clerk
Property Search Application - Miami -Dade County Page 1 of 2
w OFFICE PROPERTY
Summary Report
Property Information
Folio:
11-2136-006-0100
Property Address:
17NE105ST
Miami Shores, FL 33138-2030
Owner
Mailing Address
OLIVIER SERVAT
ANDREE STEPHANIE SERVAT
LAGATTU
... ....... _
17 NE 105 ST
MIAMI SHORES, FL 33138 USA
PA Primary Zone
1000 SGL FAMILY - 2101-2300 SQ
Primary Land Use
0101 RESIDENTIAL -SINGLE
FAMILY: 1 UNIT
Beds / Baths / Half
2/1/1
Floors
1
Living Units
1
Actual Area
1,562 Sq.Ft
Living Area
1,312 Sq.Ft
Adjusted Area
1,437 Sq.Ft
Lot Size
9,225 Sq.Ft
Year Built
1940
Assessment Information
Year
2017
2016
2015
Land Value
$230,638
$198,007
$163,894
Building Value
$111,684
$112,517
$100,015
XF Value
$915
$930
$756
Market Value
$343,237
$311,454
$264,665
Assessed Value
$342,599
$311,454
$116,582
Benefits Information
Benefit
Type
2017
2016
2015
Save Our Homes Cap
Assessment Reduction
$148,083
Non -Homestead Cap
.... ... ___.._--
Assessment Reduction
$638
...................... ...... _.........
Homestead
Exemption
$25,000
Second Homestead
Exemption
$25,000
Note: Not all benefits are applicable to all Taxable Values (i.e. County,
School Board, City, Regional).
Short Legal Description
DUNNINGS MIAMI SHORES EXT NO 2
PB 41-78
LOT 10 BLK 202
LOT SIZE 75.000 X 123
OR 17699-3084 0697 1
Generated On : 2/5/2018
Taxable Value Information
2017
2016, 2015
County
Exemption Value
$0
$0
$50,000
Taxable Value
$342,599
$311,454
$66,582
School Board
Exemption Value
$0
$01 $25,000
Taxable Value
$343,237
$311,4541 $91,582
City
Exemption Value
$0
$0
$50,000
Taxable Value
$342,599
$311,454
$66,582
Regional
Exemption Value $0 $0' $50,000
................
Taxable Value S342 599$311,454i $66,582
Sales Information
Previous
OR Book
Price';
Qualification Description
Sale
Page
29783
09/09/2015
$420,000
Qual by exam of deed
0421
23585-
Sales which are disqualified as a result
06/01/2005
$0
2677
of examination of the deed
17699
._....... __ _.-..........
06/01/1997
$108,000
Sales which are qualified
3084
17356-
09/01/1996
$62,500
Other disqualified
4824
The Office of the Property Appraiser is continually editing and updating the tax roll. This website may not reflect the most current information on record. The Property Appraiser
http://www.miamidade.gov/propertysearch/ 2/5/2018
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 Exemation
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 i£
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.
Signature: , &
O er
State of Florida
County of Miami -Dade
The foregoing was acknowledge before me this � day of , 20�.
By h �rt C S[e qka, % e SQ t-Gk I who is personally known to me or has produced
identification.
BRIGITTE VENDRELL
X Nota AP('.-
Commission PU'= Notary Public - State of Florida
ry:
` ` Commission N FF 947409
'.;�,, `4 My Comm. Expires Jan 3, 2020
SEAL: .,6p
Bonded through National Notary Assn.
I
Date: 2-- S ol'1
State of F to n da
County of /it a-i DA
Before me this day appeared kk atn 14 G 6 who, being duly sworn, deposes and
says:
That he or she will be the only person working on the project located at:
1`74 N15 S1\4 fre, FE, 3313 IS
Contractor
Sworn to( or affirmed) and subscribed before me this f� day of FeI ry wr l 20 t 8
by A- V ow, I�
Personally known_
Or Produced Identification
Type Of Identification Produced
i s
bN,u.TT E VENORELL
Notary Public - State of Florida
Commission / FF 9, 7409
oP;•'
FL
My Comm. Explrm Jan 3, 2020
Bonded through National Notary Assn,
Print, Type or Stamp Name Of Notary
OD\J -.erbrd ( ,
HIDALGO CONSTRUCTION GROUP LLC
Certified General Contractor: Alian Hidalgo
License No. CGC151578
Page 1 of 1
Invoice
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138-0000
Phone: (305)795-2204 Fax: (305)756-8972
For Inspections please call: (305)762-4949
eturn to:
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138-0000
Bill To
OLIVER & ANDREE STEPHANIE SERVAT LA,
17 NE 105 Street
MIAMI SHORES, FL 33138-
MIAMI SHORES, FL 33138-
Permit Number: PW-2-18-304
Invoice Date: February 06, 2018
Invoice Number: PW-2-18-66361
Bond Number:
Comments:
Permit Type: Public Works / Work Classification: Public Works
Date
Fee Name
Fee Type
Fee Amount
02/06/2018
Technology Fee
Calculated
$0.80
02/06/2018
Education Surcharge
Calculated
$0.20
02/06/2018
CCF
Calculated
$0.60
02/06/2018
DBPR Fee
Calculated
$2.88
02/06/2018
Permit Fee
Calculated
$192.00
02/06/2018 Scanning Fee Calculated $3.00
02/06/2018 DCA Fee Calculated $2.00
Total Fees Due: $201.48
Payments
Date Pay Type Check Number Amount Paid Change
02/06/2018 Credit Card $50.00 $0.00
Total Paid: $50.00
ITotal Due: $151.48
Tuesday, February 6, 2018
NORTH MIAMI AVENUE
— -----------------
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APP iO'VED BY
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DATE
St IJ—Ei✓T 10 CCNIPL)�11C9W1 FH ALL FE�iI rE�W
STATE ANv LLI-JN`rY riLLS AND REGtII1Ti(aNS
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Signature _ -,
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Bearing, if any, shown based on
N/A (reference) N/A
REVISIONS:LEVATION
FLOOD ZONE
COMM.0No.
PANEL No.
SUFFIX:
NOTE: IF APPLICABLE
( )
Not valid unless
itbearsthe
120652
0302
L
L.F.Elev.= 12.29, (lowest habitable floor elevation).
Elevation shown hereon refer to N.�.V.D. 1929.
ibears
signature and the
Lowest adjacent grade elevation= DWG.
1 9
original, raised seal
of Florida licensed
F.I.R.M.DATE
F.I.R.M.INDEX
BASE ELEV.
09 / 11 / 09
09 / 11 / 09
+ N/A N.G.V.D.
BM. # N-567 . Elev.= 10.54'
Garage Elev.= 10.37' Erp = _ �Lli_.
Surveyor and
Mapper.
a @m "
"
LEGEND
—�'v $
�
a
=arc
A.
v I a m m
8
ASPH
= Asphalt
= Bench Mark
I`
BM
S
BRG
CATv
= Bearing
= Cable TV
c
a
m
v
CB
= Catch basin
CBS
= Concrete Block structure
r e
m
CH
= Chord
Chattap Chattahoochee
E o,
c
= Center Line
m a a r
c
$
CLF
= Chain Link Fence
g _S e m m
8 ,-
'g
CL. ,
= Clear
m � 8
CONC: Conaeoa
a� 2 � a
D
= Delta
v
O N
°
0
- Diameter
m
a �° $ '6 -
'd
DH
DIME
=Drill Hole
= Drainage & Maintenance
c m' w S m e
w
Easement
z a $
v d
E.B.
= Elecbic Box
m � 8
5 8
Enc.
= Encroachment
c
a E E m Q
q
F.F.
= Finish Flow
8 m
F.H.
- Fire Hydrant
e
o m m g L
?
F.I.R.
= Found Iron Reber
a ii c, c E
FPL
= Florida Power & Light
'a E m s io
E v c '
o
$ c
F.I.P.
F N
= Found Iron Pipe
= Found Nall
This property described as: 5 - i v I m S LP. =Light Pee
Lot 10, Block 202, a a z M = Measured
DuNNINas MIAMI SHORES EXTENSION No 2, 8 � m 8 a M.F. =Metal Fence
m E e n p M.H. saNanhole
according to the Plat thereof g o i` : ` M ' .Jment unO .....
m$� nm Ei m•S
as recorded in Plat Book 41, Page 78, g01.= Mgrumnt e•
v w m @ WA• yNot Applicable •
of the Public Records of Miami -Dade County, Florida. o 1 • • • • • •
m' NID = r1a1 & Disc
RIo><�
NTS = Not to scale • •
• m ^• 0/3 0:08faet �••••:
Certified to: s
� •�• • Utllljjr�ps,
Oliver Servant and Andiee Stephanie Servant Lagattu o.u.Lr�GYBriread
49ME , • , off ,�QVhang • • � • • •
Guaranteed Rate, Inc Mail -
I • •9 PB • • = Plat'book **so:*
•
its successors and/or assigns, ATEV A :•,� • PC = Point of Curvature ,
•
First American Title Insurance Company w 8 'g P = PaVd of CoMWWV, • ,
g -0 ...curvature
Concorde Land Title Services, Inc, • a PCP =Permanent COoI Point
Address:
17 N.E. 105 Street, Miami Shores, FL 33138
CL Notes:
No platted easements in this lot
No visible encroachments in this lot
»A
b s �
• ••.•
PG • r, Page • •
'
P.I! P nt of Intersection
•'=
g
g Property Line
cm
PL = Planter
2 €
P.O.B. = Point of Beginning
a
`o
ti a
P.O.C.= Paint of Commencement
m
m
m Q
P.P. = Power Pole
E a o a
P.R M.= Permanent Reference
c
a
Monument
PAC. = Point of Reverse
a
$
m
H
Curvature
c
v o c
PT = Point of Tangency
m
S W E a, -a 11R
= Radius
I c g m o� E
RIR = Railroad
PSM = Professional Surveyor
r
g m 0.
Mapper
m{,
c. c 2,12 a�o m
RIW = Right-f--Way
E
°
m g a v g E
SWK = Sidewalk
cry
m
�•
°
m 2 c m 0
P 3 co 2 a
Sec. = Section
= Typical
mE
g 8
(TYP)
T = Tangent
`o
Im c m I B
m 0 B t �
U.E. = Utility Easement
W.F. = Wood Fence
$5
op$ c`c�
W.M. = Water Meter
"TEAS SURVEY DECLARATION IS MADE ON THE FIELD
DATE INDICATED, OWNER(S) LISTED. IT IS NOT
§ € oil `o E m a
1 "_� '. m
W.V. = Watervalve
TO THE
8 m
- Denotes Spot
T'UNSCERABLE TO ADDITIONAL INSTITUTIONS OR
m m m io
Elevations Taken
SUBSEQUENT OWNERS "
2 m a o v m C
BOUNDARY AND TOPOGRAPHIC SURVEY.
I HEREBY CERTIFY: that this survey meets the
Alvarez, Aiguesvives and Assoctes, Inc.
Standards of Practice as set forth by the
Surveyors, Mappers and Land Planners
FLORIDA BOARD OF P ION SURVEYORS
5701 S.W. 107th Avenue #204, Miami, FL 33173
AND MAPPERS i ap J-17 F da Administrative
Code, pursuant to S 'on 47 . Florida Statutes.
Phone 305.385.0385 Fax 305.385.0623
------�
L.B. No. 6867 / E-mail: fastsurvey@aol.com
REN AI S 10/22/15
Field Date
Scale:
Drawn by:
Drwg. No.
PROF SIONAL SURVEYOR AND
10/20/15
1"=20'
J.A.
15-21762
MAPPER No. 4327. State of Florida.
RECEIVED
Miami Shores Village
Public Works Department FEB 0 6 71119
(305)795-2210 �q n
Public works forms are available from the building department, 10050 NE 2"a Ave., Miami Shores, FL 33138 Tom- `/
PUBLIC WORKS PERMIT APPLICATION
Permit Type: Work in the Right -of -Way on Miami Shores Village or Miami -Dade Property
Permit#: ► & 1 V 1303
Name of Applicant (if utility see below): Ar-� A t o ke-At Spurn t
Owner off the following described property:
Legal Description: Lot Block a0,�- Subdivision . oir,65 / e,—, 5kot5
Folio #;
Address: r/V& IDS s}M J 'Yxisk-"k Sl Gretj R, 3313b
UTILITY NAME:
Qualifier/Authorized Agent:
Address:
City:
Telephone:
State Certification or Registration #:
Email:
State:
ZIP:
Certificate of Competency #
CONTRACTOR NAME: P i A VIIh,n CiO1454(VCG4ioy% (royQ`L(i
Qualifier/Authorized Agent: /4Li o 41, dal9c,
Address: 11" NW Yard ?L
City: 'd4Av.i State: FL_ ZIP: 1631d b
Telephone: "4-Pb-eL6X-3 511�q(o Email: AV &A A ki"4(9 net CcE Aet 4vrok I . Co►ti
State Certification or Registration #: (;G L IS l51` Y Certificate of Competency #:
Requests permission to install (describe work, attach separate page if necessary) in the adjoining right of
way: -kiP(afe_ 5,`ic(fV*W !4IfroKk and ll.,°Mr 5(*wAIit foc a�.,v,r11 �i�t�.uIrG
Type of Work: ❑ Paving ❑ Utility ❑ Sidewalk ❑ Electric ❑ Irrigation
❑ Landscape ❑ Antenna ❑ Other:
DESIGNER: Architect/Engineer:
Address:
Citv:
Telephone:
Registration #:
Vale of Work for this Permi
Permit Fee $ 100.00
State:
Email:
ZIP:
t: $ -4G9.00"q aitie/Lineal Footage of Work:
f b
Fees* . * N
,.•,`"-,,` 114z sq_ lei.
po,crtr5
Notary $ Training/Education $ 0.20 Technology Fee $ 0.80 Scanning $
Bond $ (if required) Total Fee Now Due $
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 Signature
App icant or t rized Agent Company/Utility A nt
The foregoin instrumen was acknowledged before The foregoing instrument was ackn ledged before
me this Adayof n 20tlk, by m t is ay f v 20�, by
lye- ^C rr0 who who
is personally known to me or who has produced is personally known t me or who das produced
as
as
identification.
identification.
NOTARY PUBLIC:
NOTARY PUBLIC:
Sign:
Sign:
CC
Print:
ervd
Print: r
SEAL:
SEAL:
a c "Luh«�
��w, Poe•, pr, , 'TE VENORt�I
Notary Public - State of Florida
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`:
Notary Public • State of Florida
• • :. Commission # FF 947409
w.
omm ssion # Fi ja; 409`0
My Comm. Expires Jan 3, 2020
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%170,
My Comm Expires Jan 3, 2020
<«�•
Bonded through National Notary Assn.
�a� %o!ary Assn.
APPROVED BY:
Public Works Director, or Designee
2017-04-15
COVENANT OF
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
NSTRUCTION WITHIN RIGHT
OR BK 30851 Pg 4449 tIPssi
RECORDED i i2/i i5/2Ct18 12: i i3:25'
HARVEY RUVINY CLERK OF COURT
MIANI—DADS COUNTY, FLORIDA
sTNMOF CMW of oADE *taD
hfe yOW fiis es Of the a��CUM
YrVi Of)
t y,
Nl7Al my h : Urn O ; r : � -d. /1
Whereas, (owner) ncl,✓'e_e. . I n �e "'`"
hereinafter referred to as the owner of the following described
property (address): 1"I tlC IDS5TvcGi , r luHi bl-tuv�s�l 5313
Legal Description: Lot tO Block 202 Subdivision'�rrrvrVjS "ICLM[ ShotzS
Folio# t1-213�-oozy-oi-oo
Requests permission to install (describe work): F X -4AI f uvi ll, 5 4 p f rocah abaci
New tl `Ljgrveak I ko-_plkc-ed i3rcirch 5j,4,„-UIt
r,= 2
Within the public right of way of (address) ►4 tic W6 IS-e,ei-r , mctgt Sh�,S M.33 tsb
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 Cou , Florida by the Village Manager of Miami Shores Village
(or his fully autporized represe a e)./7
Signature
r or Agent
State of Florida
County of Miami Dade
The foregoing instrument was acknowledged before me this 3 I day of Gtrxaotr , 20 I , by
Ar�� STe_0y1r►t e-S-eXv4TNho is personally known tome or who has produced
as identification.
NOTA Y PUBLIC: - — -- -- -
Sign: ,,a N aye, BRUTTE VENDRELL
�_ v,��� Notary Public -State of Florida
t rrtT� SEAL: =�.
Print: �r Commission aE FF 947409
My Comm. Expires Jan 3, 2020
' FO"` Bonde9 through National Notary Assn.