PW-18-3508Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address
�2ir�`n10�
Issue Date: 01/22/2019
Parcel Number
810 NE 100TH ST, Miami Shores, FL 33138 1132060340060
Contacts
Permit NO.: PW-1 1 -18-3508
Permit Type: Public Works
Work Classification: Public Works
Permit Status: Approved
Expiration: 05/20/2019
Daniel & W Joseph Robin
810 NE 100 ST, Miami Shores, FL 33138
Owner R2 BUILDERS INC Contractor
RODOLFO RODRIGUEZ
Business: 3052313113
Description: TWO SIDEWALK FLAG REPLACEMENT Valuation: $ 800.00 Ins ection Requests:
Total Scl Feet: 50.00
Fees
Amount
Education Surcharge
$0.20
Public Works Permit Fee
$100.00
Scanning Fee
$9.00
Technology Fee
$2.50
Total:
$111.70
Building Department Copy
Payments
Date Paid Amt Paid
Total Fees
$111.70
Credit Card
01/22/2019 $111.70
Amount Due:
$0.00
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 foregoi for ation is accurate and that all work will be done in compliance with all applicable laws
regulating construction and zoning. Futhermore, I thoiq &A above named contractor to do the work stated.
Authorized Signature: Owner
ctor ! Agent
Date
January 22, 2019 �` Page 2 of 2
_ RF�Es V
-�. '%J Miami Shores Village
Public Works Department
(305)795-2210
Public works forms are available from the building department, 10050 NE 2"a 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#:(P('�' I o — —3SOY
Name of Applicant (if utility see below): 1 JAw 24,'"
Owner off the following described roperty:
Legal Description: Lot Olq!¢13'?'o1�lock Subdivision
Folio #;
Address: �'(0 NC I¢J0 s _MLLt A'A1 SVoiLeS
UTILITY NAME:
Qualifier/Authorized Agent:
Address:
City:
Telephone:
State Certification or Registration #:
CONTRACTOR NAME:
Email:
State:
Qualifier/Authorized Agent:
Address: fd':�'5 0 IJUJ ! 3 ST -
City: tAi klwa%,A roc, di.,., State:
Telephone: 365' 231 _31 13 Email:
State Certification or Registration #: C6NL. 15 1',.> ko'
ZIP:
Certificate of Competency #
JL r
l, ZIP: 33'
(LZ 1;L)11ckas I uL . coA4
Certificate of Competency #:_
Requests permission to install (describe work, attach separate paFe if necess ry) in the adjoining right of
way: —Two k1_' UW i/ ,Q IA12
Type of Work: ❑ Paving ❑ Utility 0 Sidewalk ❑ Electric ❑ Irrigation
❑ Landscape ❑ Antenna ❑ Other:
DESIGNER: Architect/Engineer:
Address:
City:
Telephone:
Registration #:
State:
Email:
ZIP:
Value of Work for this Permit: $ oQ " Square/Lineal Footage of Work: �y S
*****Fees*****
Permit Fee $ 100.00
Notary $ Training/Education $ 0.20 Technology Fee $ 0.80 Scanniff $
Bond $ (if required) Total Fee Now Due $ ' `t • 6
Bonding Company's Name (if applicable): P A -
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 $2,500, the applicant must promise in good faith that a copy of the notice of commencement
and construction lien law brochure will be delivered to the person whose property is subject to the
attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job
site for the first inspection which occurs seven (7) days after the public works permit is issued. In the
absence of such posted notice, the inspection will not be approved and a reinspection will be charged.
Signature
ApplicantyDrAuthorized Agent
The foregoing instrument was acknowledged before
me this day of 20 by
who
Signature
Company/Utility Agent
The foregoing instrument was acknowledged before
me this day of .20 by
is personally known to me or who has produced is personally known to me or who has produced
identification.
NOTARY PUBLIC:
Sign:
Print:
SEAL:
as
identification.
NOTARY PUBLIC:
Sign:
Print:
SEAL:
as
APPROVED BY:
Public Works Director, or Designee
2017-04-15
RICK SCOTT, GOVERNOR.
JONATHAN ZACHEM, SECRETARY
Fodda
d0pr
STATE OF FLORIDA
DEPARTMENT OF BUSINESSYAND--PROFESSIONAL REGULATION
CONSTRUC, Cf1t1S1,tkVX1C N'SING BOARD
k THE GENER C R* off"H4 WWC-�-El F. �UNDER THE
PROVISI RAPT R -,ES4-b9:.�FCCI�tlQ�IXS
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f3g.TH,�$TREff1%
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E S 33 sad
EXPIRATIONAMM'=AU YGUST 31, 2020
Always verify licenses online at MyFloridaLicense.com
Do not alter this document in any form.
This is your license. It is unlawful for anyone other than the licensee to use this document.
91 ROL..'
Im
CITY OF HIALEAH GA"ENS
10001 NW 87Ave - Hialeah Gardens, Florida 33016
BUSINESS TAX RECEIPT
Business Name: Date: 11/15/2018
R2 BUILDERS INC Issued to:
10750 NW 138 ST #05 RODRIGUEZ, RODOLFO
HIALEAH GARDENS, FL 33018 10750 NW 138TH ST UNIT 5
Business Type: GENERAL CONTRACTOR HIALEAH GARDENS, FL 33018
LICENSE NO.: BL19535 TOTAL F ' ES`PAID: $267.50
Delinquency Fee: A 10 percent delinquent fee will be'imposed if not renewed by October 1 and an additional 5
percent fee Is charged for each month thereafter with total fee not to exceed 25•percent.
Notes: OFFICE/STORAGE (General Contractor): No storage, junk yard or display outside -premises. No showroom or display. No
mechanical work. No retail or wholesale. All business shall be conducted inside of building
-Lq.-t—1 4,o t--
LICEN5E YEAR
City License 9fficial 201- 20 - 13
LICENSE MUST BE EXHIBITED CONSPICUOUSLY AT YOUR PLACE OF BUSINESS
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