PW-18-2303 (2)Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address
issue Date.10/25/2018
Parcel Number
Permit No.: PW-8-18-2303
Permit Type: Public Works
Work Classification: Public Works
Permit Status: Approved
Expiration: 04/23/2019
Project
1201 NE 96 ST, Miami Shores, FL 33138-2553 1132060143830 <NONE>
Contacts
POL ZAZADZE Owner POL ZAZADZE Applicant
1201 NE 96 ST, MIAMI SHORES, FL 33138 1201 NE 96 ST, MIAMI SHORES, FL 33138
Other:3057902785 Other:3057902785
HOME INTERIOR SERVICES AND Contractor
INVESTMENT INC
JUAN PABLO BETANCOURT
1690 W 38 PL 131, HIALEAH, FL 33012
Business: 3053288590
Other:7865978093
Description: DRIVEWAY APPROACH Valuation: $ 1,500.00 Inspection Requests:
305-762-4949
Total Sq Feet: 245.00
Fees
Education Surcharge
Notary Fee
Permit Fee
]Am
Scanning Fee
Technology Fee
Total:
Building Department Copy
Payments Date Paid
Amt Paid
Total Fees
$109.00
Credit Card 08/28/2018
$50.00
Credit Card 10/25/2018
$59.00
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 AVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws
regu ng co truction and zoning. Futhermore, I authorize the above named contractor to do the work stated.
n
Authorized Signature: Owner / Applicant / Contractor / Agent Date
October 25, 2018 Page 2 of 2
,f+ Miami Shores Village
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
Permit#: PC
��,J ►0 - 7 3b�
Name of Applicant (if utility see below): Z? a a d �p P,
Owner off the following described property:
Legal Description: Lot 16 Block Subdivision
Folio #;
Address: 1,)-01
UTILITY NAME:
Qualifier/Authorized Agent:
Address:
Citv:
Telephone: Email:
State Certification or Registration #:
State:
ZIP:
Certificate of Competency #
CONTRACTOR NAME:-, JdVdr- JQwJcM
Qualifier/Authorized Agent:' Solves-- .
Address: 'Lm cl o k
City: M . S t,� o.r- c State: fu ZIP: 3317 d
Telephone: -'?h7 6 5yf 1, 6 o ,�t'3 Email:
State Certification or Registration #: G%Q�C_%2-S°\30 8 . Certificate of Competency #:
Requests permission to install (describe work, attach separate page if necessary) i.nntthe adjoining right of
way: _�ruur.wa.a _ ca.oti i )i rsi- J- 4- �Sa • P_-A2� 0 CdAl ok��-
Type of Work: ❑ Paving ❑ Utility ❑ Sidewalk ❑ Electric ❑ Irrigation
❑ Landscape ❑ Antenna O'Other: �iiO-QwcujCp e-dy,..
DESIGNER: Arch itect/Enginee r:SE
Address: , 13 o ra SLA-) i 33L4 �—
City: Y0 f rll" L� State: -r't_ ZIP:
Telephone: 3W a �; 3 -�•��b Email: -5-z f-t� cola -
Registration
Value of Work for this Permit:,. $ 1 i �� rj Square/Lineal Footage of Work: a- —
*****Fees*****
Permit Fee $ 100.00
Notary $ 5 • ob Training/Education $ 0.20
Bond $ (if required)
Technology Fee $ 0.80 Scanning $
Total Fee Now Due $
Sol . ev
'pt
i
I
.., ..,. L •..: S
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 fo egoing instrument was acknowledged before
me this (Q day of %9 i 20 LT! , by
. P-1. i who
is personally known to me or who has produced
2/L as
identification.
Sign: cd� y -----y
Print: 0. wwS7 Q
SEAL:
APPROVED BY:
,r,r - T . .
ov( P(&Notary Public State of Florida
a° '� Dennis Leiton
r < MY Commission GG 073635
•9 O F woe Expires 02115/20`1AA j—o
Signature
C miA)4g-,\<T
y/Utility Agent
The foregoing in r mwas acknowledged before
Lne this day of 20(( � by
onally known to me or who has produced
I ers
DO`IEw- UZEW C_�- as
identification.
Sign:
Print: SIN
SEAL:uv��..
:poyP& Notary Public State of Florida Q
} • LQ SindiaAlvarez {
�p My Commission FF 156750
OF vl Expires 09/03/2018
************************************
Public Works Director, or Designee
2017-04-15