PW-18-1422�` gy►OREy y'!�
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Project Address
Miami Shores Village
10050 N.E. 2nd Avenue NW
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Permit NO. PW--18-1422
Permit Type: Public Works
Perlill't Work Classification: Public Works
Permit Status: APPROVED
Parcel Number
Issue Date: 6/28/2018 1 Expiration: 09/26/2018
Applicant
149 NW 108 Street 1121360100280
Miami Shores, FL 33168-4312 Block: Lot: CHARLENE LEWIS
Owner Information Address Phone Cell
CHARLENE LEWIS 1546 NE QUAYSIDE Terrace
MIAMI FL 33138-
1546 NE QUAYSIDE Terrace
MIAMI FL 33138-
Contractor(s) Phone Cell Phone
DECO CONCRETE INC (305)828-5158 (305)345-4740
Scanning: 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
Valuation:=7,000.00Total Sq Fee
Pay Date Pay Type Amt Paid Amt Due
Invoice # PW-5-18-67685
05/24/2018 Credit Card $ 50.00 $ 54.00
06/28/2018 Credit Card $ 54.00 $ 0.00
Available Inspections: I
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
construction and zoning. Futhermore, I authorize the above-nam
and that all work will be done in compliance with all applicable laws regulating
to do the work stated.
June 28. 2018
Authorized Signature: Owner / Applica
Building Department �*
une 28, 2018
/ Agent
RECEIVE[.
,. Miami Shores Village MAY 2 4 2018
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#: fD S 1P — M
�7 _ (1 1
C42
Name of Applicant (if utility see below):
Owner off the following described properXy�
Legal Description: Lot is -
Block '3 Subdivision
Folio #; — oZ
Address: 9 P-i W 10 A
UTILITY NAME:
Qualifier/Authorized Agent:
Address:
City:
Telephone:
State Certification or Registration #:
Email:
State:
CONTRACTOR NAME: tVw
Qualifier/Authorized Agent: cY\
Address: �0$� 7 G(p�
City: M l Sta
Telephone: 3.6 Email:
State Certification or Registration #:
Requests permission to in tall (describ work,
way: C1d\t)'g\ , -e- Yj0 �S U
Type of Work: ❑ Paving ❑ Utility
❑ Landscape ❑ Antenna
DESIGNER: Architect/Engineer:
Addre�-
City: State:
Telephone: Email:
Registration #:
ZIP:
Certificate of Competency #
ZIP: 3-CA
e_0CtiGYtc e1 t%P. cfrl
rtificate of Competency #:
separate page if necessary) in the adjoining right of
❑ Sidewalk
❑ Other: _
❑ Electric ❑ Irrigation
ZIP:
Value of Work for this Permit: $ " Square/Lineal Footage of Work:
***** Fees*****
Permit Fee $ 100.00
Notary $ Training/Education $ 0.20 Technology Fee $ 0.80 Scanning $
Bond $ (if required) Total Fee Now Due $ Oi
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 $2,500, the applicant must promise in good faith that a copy of the notice of commencement
and construction lien law brochure will be delivered to the person whose property is subject to the
attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job
site for the first inspection which occurs seven (7) days after the public works permit is issued. In the
absence of such posted notice, the inspection will not be approved and a reinspection will be charged.
Signature
Applicant or Authorized Agent
The foregoing instrument w s acknowledged before
me thi pay of 20Lb� by
4- V. who
is personally known to me or who has produced
as
identification.
Signature
Comp ny/Utility Agent
The foregoi instrume t w s acknowledged before
me this ay of 20� by
✓ who
is personally Q kknnoyv� to me or who has produced
X `1 b(4 jai4 0"Ilr) as
ide tification. _
Sign:
Sign:
Print: �%�/�i /�'! . , �,
Print: /�<��%
�• J���%/�/� —'
SEA _
• •,
— -= '�1 -
MARIA M. AGUILAR
SEAL:. .��,_.
,�
t ,a+�T—
MARIA M. AGUILAR
_• ;�� ; •.-
Notary Public State of Florida
My Comm. Expires Jul 15, 2018
•Y i' -.,, ._
* S
�n -
Notary Public -State of Florida
MY Comm. Expires Jul 15, 2018
Commission # FF 142170
=s•' "
Commission # FF 142170
s; F
Bonded Through National Notary Assn.
,,,t, •
Bonded Through National Notary Assn.
APPROVED BY:
Public Works Director, or Designee
2017-04-15
CFN: 20180300041 BOOK 30984 PAGE 1168
DATE:0512212018 08:42:48 AM
HARVEY RUVIN, CLERK OF COURT, MIA-DADE CTY
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY
Whereas, (owner) ,V\C(f 1S hereinafter referred to as the
owner of the followin described property (address): O
Legal Description l - Lot Block a 121 Subdivision ry
Folio # _ i 2l$!!c' 0 � �I,SNira
Requests permission to install (describe work):_tUA& OIrm(Y ¢ t IQ 1=1 � c Wah
Within the public right of way of (address) OL
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 ano.,:assigns, until such time as this obligations has been
canceled by an affidavit filid"In the Public Records of Dade County, Florida by the
Village Manager of Miami Shores Village (or his fully authorized representative).
SIgnatuSA"
Owner or Agent
.The foregoin Instrument was acknowledged before me this 47 day of �, 20 by
Owrkk„ _ who Is personally known to me or who has prod uosd PA~ 4
as Identification and who did take. an oath.
NOTARY PUBLI
Sign:
Print:
My Is io x sires:
MARIA M. AGUILAR
Notary Pub11c - state o1 Florwa
My Comm. Espiros Jul is. 2018
Commission # FF 142170
-- BOW Through National fbary Assn.