PW-19-1075Location Address
Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Issue Date: 06/03/2019
Parcel Number
1060 NE 104TH ST, Miami Shores, FL 33138 1122320290220
Contacts
Permit No.: l-05-18-1075
Permit Type. Public Works
Work Classification: Public Works
Permit Status: Approved
Expiration: 12/02/2019
Description: APROACH PAVERS REPLACE EXISTING Valuation: $ 13,100.00 Inspection Requests:
Total Sq Feet: 2,200.00
Fees
ERIC WOODLING Owner
1060 NE 104 ST, MIAMI SHORES, FL 33138
Other: 7275600539
CHAMPION CONCRETE Contractor
JAIME BASILIO
10280 NW 63 TER 105, DORALL33178
Business: 3052528055echampion@yahoo.com
Other: 7864024802
$2.80
Public Works Permit Fee
$100.00
Description: APROACH PAVERS REPLACE EXISTING Valuation: $ 13,100.00 Inspection Requests:
Total Sq Feet: 2,200.00
Fees
Amount
Education Surcharge
$2.80
Public Works Permit Fee
$100.00
Scanning Fee
$3.00
Technology Fee
$2.50
Total:
$108.30
Payments
Date Paid Amt Paid
Total Fees
$108.30
Check # 613
06/03/2019 $108.30
Amount Due:
$0.00
Building Department Copy
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores
Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate
permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws
regulating construction and zoning. Futhermore, I authori$e the above named contractor to do the work stated.
Authorized Signature: Owner / Applicant /
/ Agent
Date
June 03, 2019 Page 2 of 2
E V.1
Miami Shores Village MA 1 4 2019
Public Works Department
(305)795-2210
Public works forms are available from the building department, 10050 NE 2"d Ave., Miami Shores, FL33i
PUBLIC WORKS PERMIT APPLICATION
Permit Type: Work in the Right -of -Way on Miami Shores Village or Miami -Dade Property
Perm it#: S`b�–I�
S
Name of Applicant (if utility see below): _ — UC &? DUy L1 NG.
Owner off the following described property:
Legal Descri tion: Lot Block Subdivision
Folio #; - Cq
Address: MS 1,04 191- HX4IrM 7KA-M
UTILITY NAME:
Qualifier/Authorized Agent:
Address:
City:
Telephone: Email:
State Certification or Registration #:
State:
ZIP:
Certificate of Competency #
CONTRACTOR NAME: CJJA A&A 1
Qualifier/Authorized Agent: M'1f A5"y
Address: VJ CO A4(–
City: J -opyf4, State: V2 ZIP:
Telephone: Email:
State Certification or.Registration #: Certificate of Competency #:
Requests permission to install (describe work, attach separate page if necessary) in the adjoining right of
way: —P w)'�h 1
Type of Work: ❑ Pavinl
o�k014rc�i:, ❑ Landscape E]Antenna ❑ Other:
}"DESIG'NER: Architect/Engi
ddress:{ `
• City � y
iTelep one. ,`'.w
��- • �' �,;hRegist�-atan`:#-� -
�f��r�Yalue,ofl�Vork for this Permit: $
❑ Utility , ❑ Sidewalk ❑ Electric ❑ Irrigation
neer:
State: ZIP:
Email:
Square/Lineal Footage of Work:
***** Fees*****
Permit Fee $ 100.00 x
Notary $ Training/Education $ 0.20 Technology Fee $ 0.80 Scanning $
Bond $ (if required) Total Fee Now Due $ 10p, --nl
' I
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 the job
site for the first inspection which occurs seven (7) days after the public works permit is issLfd. In the
absence of such posted notice, the inspection will not be approved and a r#spection wi!ybe charged.
SignatLIdapyroci
/ _ Signature
t or Authorized Agent C mpany/Utility Agent
The fot was acknowledge fore The fore oing instrument acknowledged before
me th20 , by e this 4� day 20� by
who who
is personally known to me or who as produced 14 Q(rsonally knoQwn to me or who has produced
as l l� u }1S as
identification. i entifica Ion. \``�N�NNNNa���////
-A
NOTARY P LIC: NO RY BLIC •. O
24
Sign: Sign:
Print: v�'* /� if`) Yr ,��(I�'Y�a^-- Print: rwwc ..�tdI11N
SEAL: SEAL: 4 e�� �Oe
CATHERINE A.DUFFIN /11111111
Notary Public - State of Florida
Comr(,Iglon a GG 104296
r My CGrtrm, Expires May 14, 2021
APPROVED BY: 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
OR BV: :,144.0 F'9 1335 (Pss)
RECORDED 05/1-3/2019 15: 41)
rir�,c;l+EY RIJV!Nr { L.ERK OF COURT
`1IAMI—DADE (OIJNTY- FLORIDA
STATE OF V LORIDA, COUNTY OF DADE
I HEREBY C1 RTIFY that this is a PV?Ppy of (ho
o
0,F,onal filed it this Office / //
G , A.D. _ 20
55
COVENANT OF CONSTRUCTIO WITHIN RIGHT O panda UfficiatSeal.
R V K tar ur�ty Courts,
Whereas, (owner) kN 00.6 LWZ D.C.
hereinafter referred to as t e owner of the following describ
property (address): 10 S .-
Legal Description: Lot Block Subdivision J!�Ue1/VO&.&sJ.�
-Folio-#----
Requests permission to iins�t�alll (describe work):
.A 1/n )
Within the public right of way of (address)
.Im GOD WE Ism
IN CONSIDERATION of the approval of this permit by the Village, the owner'ag ees 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
State of Florida
Owner or'Agent
County of Miami Dade
The foregoing instrpent was acknowledged before me this J:5" day o , 201, by
�QyC' ZU 000t // hQ who is personally know_ n to me or who has produced
as identification. - - - - - - - -
NOTARY L G: ;.t�a:iy WHERINEA.DUFFIN
NotaryPuWic-State ofFbrida
Sign: - . ; , comrMsfon sf GG tU4296
E,cpires May 14,2021
Print: G. -lac.- e- X f ` J FAiA✓