PW-18-3530Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Issue Date:12/13/2018
Location Address Parcel Number
1569 NE 104TH ST, Miami Shores, FL 33138 1122320320160
Contacts
Permit NO.. PW-11-18-3530
Permit Type: Public Works
Work Classification: Public Works
Permit Status: Approved
Expiration: 06/ 11/2019
ALAIN & CARLY GONZALEZ Owner
1569 NE 104 ST, MIAMI SHORES, FL 33138
Mobile: 7862779756
M.A.M BUILDERS Contractor
MARIEDY M MENDOZA
10667 NE 11 AVE, MIAMI SHORES, FL 33138
Business: 3055271089
Description: DRIVEWAY Valuation: $ 1,300.00 Inspection Requests:
f05-762-4949
Total Scl Feet: 170.00
Fees
Amount
Education Surcharge
$0.40
Public Works Permit Fee
$100.00
Scanning Fee
$9.00
Technology Fee
$2.50
Total:
$111.90
Building Department Copy
Payments
Date Paid Amt Paid
Total Fees
$111.90
Credit Card
12/13/2018 $111.90
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 foregoing information is accurate and that all work will be done in compliance with all applicable laws
regulating construction fuFuthermore, I authorize the above named contractor to do the work stated.
Authorized Signature: Owner / Applicant / Contractor / Agent Date
December 13, 2018 Page 2 of 2
r "s Miami Shores Village RECEIVED
Public Works Department
I" (305)795-2210 Nov ,�o,0
Public works forms are available from the building department, 10050 NE 2nd 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#: tDS 8 -
Name of Applicant (if utility see below): A I Cl i 11 Coil <1(e
Owner off the following described property:
Legal Description: Lot �— Block _ Subdivision Y_ kxl P
Folio #; )l t -a a-.* 04 03Q -01(-0
Address: 15C=q Uc /04 ,10,
UTILITY NAME:
Qualifier/Authorized Agent:
Address:
Citv:
Telephone:
State Certificatio r Registration #:
Email:
State:
CONTRACTOR NAME: � 114 • I`, S
Qualifier/Authorized Agent: al [ L1b
Addi`ess: - I (IL _ _ & . �lCf1S�
City: k- cam, ca�res� State:
Telephone: 1f:03 � ( Email: N a6PcW
State Certification or Registration #:rC1(!(`SQ S(.�
ZIP:
Certificate of Competency #
ZIP:
Certificate of Competency #:
Requests permission to install (describe work, attach separate page if necessary) in the adjoining right of
way:
i 7VekO o_�-A
Type of Work: ❑ Paving ❑ Utility
1 ❑ Landscape ❑ Antenna
DESIGNER: Architect/Engineer:
Address:
Citv: St
Telephone:
Registration #:
Value of Work for this Permit
ail:
❑ Sidewalk ❑ Electric ❑ Irrigation
❑ Other:
ZIP:
i.0)GO
$ Square/Lineal Footage of Work: 3 0 5
*****Fees*****
Permit Fee $ 100.00
Notary $ Training/Education $ 0.20 Technology Fee $ 0.80 Scanning
Bond $ (if required) Total Fee Now Due $ —11
SA
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 $2,500, the applicant must promise in good faith that a copy of the notice of commencement
and construction lien law brochure will be delivered to the person whose property is subject to the
attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job
site for the first inspection which occurs seven (7) days after the public works permit is issued. In the
absence of such posted pgtice, the inspection will not be approved and a reinspection will be charged.
Signature
Applicant or Autho&dd Agent
Th6'4 egoing strument was acknowledged before
me this Aay of k ( 20 i$ , by
who
is personally known to me or who has produced
T==� as
identification. ` I.
NOT �-811BL V�
LA
Sign =':
E PIRES February 26, 2021
Prin •
SEAL:
Signature
ompany/Util ty Agent
The foregoing instrument wa4 acknowledged before
me thi ycalfl�d"
day of 20 l P , by
who
is personally known tJ me or who ha!; -produced
�— as
identification.
NOTARY PUBLIC:
Sign: I; orwroe,,
MY COMMISSION # GG071524
Print: '?o:F EXPIRF.S` Foha..,.,, �c
SEAL:
*****TT*********** *** ** * ** * **** * ** **** *
R
A
APPROVED BY: �� "1 Public 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
STATE OF FL0RIDA
+ HERE Y 6 RTIFY M4
)ngi. �+ riic e%f+pa o�
COVENANT OF CONS RUCTION WITHIN RIGHT OF W
Whereas, (owner) A�t h Eoraa 6 --t
hereinafter referred to as the owner of the following described
property (address): I S G 9 0 ru Oc�- S-t T
Legal Description: Lot Block Subdivision Qt j�
Requests permission to install (des be work):
Within the public right of way of (address)
my
C F N 2C1133R11371 39 2
OR BK. 31.231 Pg 152A (i.P3s)
RECORDrD
HAR.VE't RUVINY (L'ER : OF C.OI_IR1
MIAMI-DADf.' COUNTTr FLORIDA
JAYF�49
e
o
ITIuit an€1 ounry Clk-/rLs
D C.
NGER #172204
i 4 fu
IN CONSIDERATION of the approval of this permit by the Village, the owner agrees as follows:
Coy�,_
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 representative).
Signature.
Owner or Agent
State of Florida
;ounty of Miami Dade ,(
Fhe f egoing . strume t was acknowledged before me this 2 (9 day of �)01 , 20J , by
who is personally known tome or who has produced
as Identification.
JOTARY PUB KELLY J VILLA
,I n ^\// FAY COMMISSION # GG071524
` g � - ` 'q?` ` EXPIRES February 26, 2021
Tint: g ICA SE'