PW-19-1095Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Issue Date: OS/17
Location Address Parcel Number
1530 NE 105TH ST, Miami Shores, FL 33138 1122300530080
Contacts
Permit NO.: PW45-19-1095
Permit Type: Public Works
Work Classification: Public Works
Permit Status: Approved
Expiration: 11/13/2019
HARBOUR CLUB VILLAS CONDOMINIUM Owner R2 BUILDERS INC Contractor
CORPORATION INC RODOLFO RODRIGUEZ
J ROBERT STOBS
1420 NE 105 ST #D12, MIAMI SHORES, FL 331382114 Business: 3052313113
Description: SIDEWALK FLAG REPLACEMENT TO SATISFY Valuation: $ 8,000.00 Inspection Requests:
305-762 4949
NUMBER LOT -003696-2019 ISSUED ON 4/24/2019 CASE
Total Sq Feet: 0.00
Fees
Amount
Education Surcharge
$1.60
Public Works Permit Fee
$100.00
Scanning Fee
$3.00
Technology Fee
$2.50
Total:
$107.10
Building Department Copy
Payments
Date Paid Amt Paid
Total Fees
$107.10
Credit Card
05/17/2019 $107.10
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 AFFID I. I rtify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws
regulating constru, i oning. Futhermore, I authorize the above named contractor to do the work stated.
Authorized Signa: Owner
/ Applicant / Contractor / Agent
Date
May 17, 2019 Page 2 of 2
AY
—�.•- Miami Shores Village
Public Works Department Big
(305)795-2210
Public works forms are available from the building department, 10050 NE 2nd 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 O�
Perm it#: W ^ 0-s- I s
Name of Applicant (if utility see below): Harbour Club Villas
Owner off the following described property:
Legal Description: Lot , Block Subdivision
Folio #; 11-2230-053-0001
Address: 1530 NE 105th Street, Miami Shores, FL 33138
UTILITY NAME:
Qualifier/Authorized Agent:
Address:
City: State:
Telephone: Email:
State Certification or Registration #:
CONTRACTOR NAME: R2 Builders, Inc.
Qualifier/Authorized Agent:
Address: 10750 NW 138th Street, Unit 5
ZIP:
Certificate of Competency #
City: Hialeah Gardens State: FL Zip: 33018
Telephone: (305) 231-3113 Email:
State Certification or Registration #: CGC 1513969 Certificate of Competency #: NA
Requests permission to install (describe work, attach separate page if necessary) in the adjoining right of
way: Sidewalk flag replacement to satisfy case number Lot -003696-2019 issued on 04/24/2019
Type of Work: ❑ Paving ❑ Utility ® Sidewalk ❑ Electric ❑ Irrigation
❑ Landscape ❑ Antenna ❑ Other:
DESIGNER: Architect/Engineer: NA
Address: NA
City: NA State: NA ZIP: NA
Telephone: NA Email: NA
Registration #: NA
Value of Work for this Permit: $ gGbo 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 $
Bonding Company's Name (if applicable): NA
Bonding Company's Address: NA
City: NA
State: NA Zip: NA
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 approve4re,
n will be charged.
Signature nature p Lica orized Agent
me this a of 20 � b met 1 owledged b fore
The foregoin i trument was acknowledgesrY The foregoing- J 20 j by
who who
is personally known to me or who has produced is personally known to me or who has produced
as T)L as
identification. identification.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign:
Print:
MEGAN BOGAERT "
Notary Public - State of Florida
Commission A GG 255273
My Comm. Expires Jul 18, 2020
Bonded through National Notary Assn,
Sign:
Print: `— GUEZ
SEAL: :.'.Y
' °' `.
%C{ ',3',
Notary Public - State o(F une 0
CornGG 18291 (1
mission N
2022
u.,rvled
My Comm. Expires
throug h National Not,"Y A"'
APPROVED BY: (Gb�_, Public Works Director, or Designee
2017-04-15
D
harbour. club •vI as
condominiums
1530 N.E. 1051h Street, Wamt Shores, Florida 33138 • Phone 883.8178
May 10th, 2019
Y Y/5
This let-ter.will authorize R2 Builders to take
out a permit to replace concrete sidewalks at
Harbour Club Villas located at 1530 NE 105th
Street.
President, Harbour Club Villas