PW-19-700Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Issue Date:
Location Address Parcel Number
114 NE 106TH ST, Miami Shores, FL 33138 1121360050070
Contacts
Permit No.: PW-04-19-700
Permit Type: Public Works
Work Classification: Public Works
Permit status: Approved
Expiration: 10/01/2019
Jacqueline Irwin Owner EPIC CONSTRUCTION GROUP INC Contractor
114 NE 106 ST, MIAMI SHORES, FL 33138 JOSE SUAZO
Mobile: 914-588-8261 jirwin7464@aol.com 19390 NW 87 PL
Business: 7868973090
Mobile: 3057201998
Description: NEW CIRCULAR DRIVEWAY AND REAR SLAB PATIO Valuation: $ 1,000.00 Inspection Requests:
3�5-762-4t9
Total Sq Feet: 240.00
Fees
Amount
Education Surcharge
$0.20
Public Works Permit Fee
$100.00
Scanning Fee
$9.00
Technology Fee
$2.50
Total: •
$111.70
Payments
Date Paid Amt Paid
Total Fees
$111.70
Check # 4533
04/04/2019 $111.70
Amount Due:
$0.00
Building Department Copy
In consideration of the issuance to me of this permit, I ag ee-to perfor the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the p1Ps, drawings, atements o cifications submitted to the proper authorities of Miami Shores
Village. In accepting this permit I assume responsibility for all work one by ei r self, m ervants, or employes. I understand that separate
permits are required for ELECTRICAL, PLUMBINP�MECHANICAL/GVINgO� D RS, d SWIMMING POOL work.
OWNERS AFFIDAVIT: I certify that all th foregoing inf
regulating construction and zoning. Futhe ore, I authorize
Authorized Signature: Owner /
Ywill be done in compliance with all applicable laws
work stated.
1--(-g-( 5
Date
April 04, 2019 Page 2 of 2
�,► Miami Shores Village E C E1 W Eli
y Public Works Department
(305)795-2210
Public works forms are available from the building department, 10050 NE 2"d 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 Ty-\
Permit#:
Name of Applicant (if utility see below):
Owner off the following described property:
Legal Description: Lot 7 Block 2 d ( Subdivision
Folio #; _I ( 213(, w () 0'Z b
Address: I ( (� w CG 10 T2 L 7—
UTILITY NAME:
Qualifier/Authorized Agent:
Address:
City:
Telephone:
State Certification or Registration #:
Email:
State:
ZIP:
Certificate of Competency #
CONTRACTOR NAME: �—✓ e (f 00"Tnc.e� Gib �r�L
Qualifier/Authorized Agent: '_JUSC F— 5 Unb
Address: I � I (O Y1) W '?, 7 ✓g /2 (.ikGC
City: I -A L t-Ajl- State: !_— zip: 3 3 0 ► �3
Telephone: 7r9h OY7 3°/D Email: JfSvAZ,) 0- P-�l c-GytiSTat'02om G O_Zc' e, CA -A
State Certification or Registration #: G7 ' / 5765 2-1 Certificate of Competency #:
Requests permission to install (describe work, attach separate page if necessary) in the adjoining right of
way: flla""A—i T-D 3 L 13 u, 7ae�7 %�/1C ZIk IYyCLwJG£�
S Lr_- 1) 0 A-2, &J (z �
Type of Work: ❑ Paving ❑ Utility P Sidewalk ❑ Electric ❑ Irrigation
❑ Landscape ❑ Antenna ® Other: )7ja�Z
DESIGNE : Architec /Engineer: MA24f— Ak- C"egZlL A y_16+776-�
Address: A -,-tie SOU{� $
city: wl /A-"t r S 1 M State: I L' ZIP: 3 ! 36
Telephone: �J, 0 J 17;23. (v Email: ►�1/k2+�.h CGkwlr��� t✓L � ��� 3313� C=I�MA/c , G
Registration #: T (offs
to 00
Value of ork for this`Rermit: W,,$a 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 $ � I 1 •7r,-")
c ♦.
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.
Signatur4'inTstrumentwa
L/
t or Authors Agent
The fore cknowledged before
me thisay of 20' by
U el l who
s personallyt known C to me or who has produced
as
identification.
NOTAR U LIC:
Signature / —
C, tility Agent
The foregoing instr ment was acknowledged before
me this 2,U day of `l/J ,4VIC4�-- 2019 by
S L-- LAID who
is personally known to me or who has produced
F,,L- P-C_-_ as
identification.
NOTARY PUBLIC:
Sign:
Print: Print:
SEAL: r; MY COMMISSION # GG 044602 SEAL: yet Iota Pubbe SUft of FWW*
b' EXPIRES: November 2, 2020 i Chas CaffOW
Bonded Thru Notary Public Underwriters y MAY Commission G;G 303542
`j Erpira 02/25rdM
p
* ***** 7,Asa
APPROVED BY:Public Works Director, or Designee
N!
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
CFN 2019RO2011361
OR BK. 31385 F'9 2680 [1F3si
ltlRTED (fl1;j_il[iK` ijt;l �cr(;
OF
11. ire -PHDE �lJh'T`�' P FLt1F°I�'H
COVENANT OF CQNSTRUCTION WJTkIIN RIGHT OF WAY
Whereas, (owner) , j Af v1 2L !U f_
hereinafter referred to a the owner of the folldescribed
property (address): I I y�_J 0 �� S owin
Legal Description: Lot r_ Block 201 Subdivision n viv wI m.---
Folio# I(-2ilte-6o5-o07d
Requests permission to install (describe work): M( K-Tw1►-a
Within the public right of way of (address) I ►JOt - 10 4 15'�
'M "L S r - l 31
IN CONSIDERATION of the approval of this permit by the Village, the owner agrees as follows:
2.
3
112
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.
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.
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).
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 re esentative�v-.Tjj 0Y FLOkojA, rY t t t�s �,f)t
1�h1jp
Signaturea81'CAR)7qP^pl�t';a�stf1MeMalrc�aa,+jOf#* @ tt
` Eff K mtZUl`J dY°( .
Agent v1�TNES6*
Owner or A Na g RWMI%
and Courdy Coupe
State of Fldrfda + "'.---11—' o•e•
County of Miami Dade NICOL DAVIS #79943
The foregoing instrument was acknowledged before e this 2 I day of V'Anc%-4 , 20
3_'A-r-6AUvt,i1V iRu) i,v who is personally known to me or who has produced
PLI 10 KZ_ as identification.
NOTARY PU i_ - Nofery Public Slift of Flmids
ChaseCampbell
Sign: My Commission GG 305542
Print: C l.>/- - i'L— Expires02/250023
1 g , by