PW-18-2318 (2)sO1s y,�
Miami Shores Village
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10050 N.E. 2nd Avenue NE
it ��'''
Miami Shores, FL 33138-0000
Phone: (305)795-2204
FCORtDA
Permit NO. PW-8-18 2318
PePermit Type: Public Worksrillmit work Classification: Public Works
Permit Status: APPROVED
Issue Date: 8/3012018 1 Expiration: 1112812018
Project Address Parcel Numoer r+PPncam
128 NE 94 Street 1132060132980
SALVATORE INVESTMENTS INC
Miami Shores, FL 33138- Block: Lot:
Owner Information Address Phone Cell
SALVATORE INVESTMENTS INC 128 NE 94 Street (305)758-1169 (305)778-5961
MIAMI SHORES FL 33138-
6130 NE 4TH Court
MIAMI FL 33137-
Contractor(s) Phone Cell Phone
ARQUIGREEN CORP (305)778-5961 Q=
ing: 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: $ 2,000.00
Total Sq Feet: 419
Pay Date Pay Type Amt Paid Amt Due
Invoice # PW-8-18-68728
08/3012018 Credit Card $ 104.00 $ 0.00
Available Inspections:
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 dertifygitl(at all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zoning. �utpGrr4e, I authorize the above -named contractor to do the work stated.
August 30, 2018
Authorized ignature:/Oviner / Applicant / Contractor / Agent
Building�D�part(ment Copy
August 30, 2018
ED
_ UG 3 2 18
Miami Shores Village /',,� -
Public Works Department
(305)795-2210
Public works forms are available from the building department, 10050 NE 211 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#:
VIA) 1 - 8
Name of Applicant (if utility see below):i N�
Owner off the following described property:
Legal Description: Lot ii Block ?_ -4. Subdivision �I •�VC'i+06 - /49
Folio #; ! 1 -a
Address: 'i4 ST
UTILITY NAME:
Qualifier/Authorized Agent:
Address:
City:
Telephone:
State Certification or Registration #:
Email:
State:
CONTRACTOR NAME: G�Ip
Qualifier/Authorized Agent:
Address: NZ 4-tO C/N
ZIP:
Certificate of Competency #
City: j"I I �'khi State: P t_ ZIP: iT
Telephone: `iit-=�{f�1 Email: L4(— L5 ..e &e11,To0 s,.lieT
State Certification or Registration #: C67C_ bpi, I _5 I Certificate of Competency #:
Requests permission to install (describe work, attach separate page if necessary) in the adjoining right of
way: �i i i 0f_-iA3;?-Y A-�PYIOAA,�,
Type of Work: &I Paving ❑ Utility �g Sidewalk ❑ Electric ❑ Irrigation
❑ Landscape ❑ Antenna ❑ Other:
DESIGNER: Architect/Engineer:
Address:
City: State:
Telephone: Email:
ZIP:
Registration :#:-
Value of Work for this Permit: $ 21�oc1 Square%Lineal Footage of Work: d i 6
Permit Fee $ 100.00
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
Applicant or A t rized Agent
The foregoing instrument wa acknowledged before
me this Sa day of '� 1) 20 1' , by
`76�T A who
is personally known to me or who has produced
identification.
Sign:
Print:
SEAL:
as
KARINA ALE JANDRA LUNA
Commission A FF 950062
My Commission Expires
January 12, 2020
Signature
Company/ tility Agent
The foregoing instrument wa acknowledged before
me this day of JNV � JY 20 1 ?? , by
mot F� Ste' � who
is personally known to me n or who has produced
as
identification.
Sign:
Print: 1�- �,t�4-\, ' -j --1'�, .
SEAL:
KARINA ALEJANDRA LUNA
Commission M FF 950062
,t
My Commission Expires
January 12, 2020
APPROVED BY: o `� Public Works Director, or Designee
2017-04-15
IIIIIIIIIIIIIIIIIIIII IIIII IIIII!IIIIIIIIill
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
cra�r:�vf fi�tf rr,
COVENANT OF CONSTRUCTION WITHIN RIG
OR BK -1116 P3 2912 (Pgs)
RECORDED F12/27/2i'"
HARVEY RUVIN7 CLERK OF GOi_;R:i
NIi'ji7I-Gr DF.' C;OUhiF`' i_OF'IC j
�S FD. 20
j ard.e ,,a! .mat. �
, of
Whereas, (owner) � ��-iJ I � �a� i i � U � �; n� ":� � i v �— r D.C.
hereinafter referred to as the owner of the following descrmed
property (address): 4 si—
Legal description: Lot k) ,,r 13 Block Subdivision sic P-H,> F'- is 77
------—---
Requests permission to install (describe work):
Within the public right of way of (address) = s�r
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 County, Florida by the Village Manager of Miami Shores Village
(or his fully authorized representative).
Signature,
Owner �Agent
State of Florida
County of Miami Dade
The foregoing instrument was
as id
NOTARY PUBLIC:
Sign:
Print:
rvledged before me this 2- day of `'!J =T , 20 by
persons known to me or who has produced
......•
KARINA AL6JANDRA LUNA
Commission N fF 950062
SEAL: ®; My Commission Expires
:fir a c
January 12, 2020