PW-19-2277Miami Shores Village
10050 NE 2 Ave
Miami Shores Fl- 33138
305-795-2204
Location Address Parcel Number
1290 NE 104TH ST, Miami Shores, FL 33138 1122320300090
Contacts
Issue
Permit NO.: PW -09-19-2277
Permit Type: Public Works
Work Clossiffcation: Public Works
Permtot€rs: Applied
Expiration: 03/25/2020
MICHAEL CONLEY Owner CHAMPION CONCRETE Contractor
1290 104 JAIME BASILIO
10280 NW 63 TER 105, DORAL, FL 33178
Business: 3052528055 jaimechampion@yahoo.com
Other: 7864024802
Description: CONCRETE APPROACH Valuation: $ 1,500.00 Inspection Requests:
Total Sq Feet: 0.00 11 1
Fees
Amount
Education Surcharge
$0.40
Education Surcharge (Manual)
$0.20
Notary Fee
$5.00
Public Works Permit Fee
$100.00
Scanning Fee
$3.00
Technology Fee
$2.50
Total:
$111.10
Building Department Copy
Payments
Date Paid Amt Paid
Total Fees
$111.10
Credit Card
10/28/2019 $111.10
Amount Due:
$0.00
-4
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 info ation is accurate and that all work will be done in compliance with all applicable laws
regulating construction and zoning. Futhermore, I authorize above named contractor to do the work stated.
\ lo -1130 -
Authorized Signature: Owner / Applicant / tractor / Agent Date
October 28, 2019 Page 2 of 2,
•
AUG, 2015 *,
Miami Shores Village SEP
Public Works Department
(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
Permit#: _� ` �'I ' (71 pi.-�
Name of Applicant (if utility see below): �/J 414k, (J'NJA.,J
Owner off the following described property:
Legal Description: Lot Block Subdivision L-) UY"t
Folio #; // 7-Z.52- n''3 r7 0 W O
Address: j 2 �/d ,ei� / (,9 y 3`7^� I Am &ON
UTILITY NAME:
Qualifier/Authorized Agent:
Address:
City: State: ZIP:
Telephone: Email:
State Certification or Registration #: Certificate of Competency #
CON
Qual
Addi
City:
Tele
Stat(
Requests permission to install (describe work, attac separate page if necessary) in the adjoining right of
way: G Vhf M"O � 4'
2 /U Y r
Type of Work: ❑ Paving ❑ Utility ❑ Sidewalk ❑ Electric ❑ Irrigation
❑ Landscape ❑ Antenna ❑ Other:
DESIGNER: Architect/Engineer:
Address:
City:
Telephone:
Registration #:
State:
Email:
ZIP:
Value of Work for this Permit: $ 4 �g7 o Square/Lineal Footage of Work: / lfU J
***** Fees*****
Permit Fee $ 100.00 o.40 Q.50
Notary $ • OV Training/Education $49, 9 Technology Fee $4.89 Scanning $ J • Do
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 postedt the job
site for the first inspection which occurs seven (7) days after the public works permit is issuq� In the
absence of such posted notice, the inspection will not be approved and a reinspection wile charged.
Signature V., k L e `j
.,—
/Applicant or Authorized Agent
The foregoing instrument was ackyiowledge fore
me this day ofsi�1%'1 /�( , 20, by
i"J I4eAel LnAv/Y"Y who
is personally kn n to r h, s prg�luced
C S4 U �0 - - cJJ as
identification.
Sign: /
Print:% 0%/H'y-- �SiV%J
SEAL:
APPROVED BY:
2017-04-15.
Signature
Compfiy/Utility Agent
The foregoing instrument was acknowledged before
me this?- 'S day ofS ip'la mil f 0—L9, by
74P I AZ 2P IA 7J?b <3ASILA -U who
is personally known to me or who has produced
-Tk.— -D P, QED Z_ LA -C" as
identification.
Sign:
Print: ((A I>(
SEAL:
SINDIA ALVAREZ
4WEARMAND013431L10 .; MY COMMISSION # GG 238273
EXPIRES: September 3, 2022
My COMMI� M # GG 22M , %F�F Bonded Thru Notary Pubtic Underwriters
EXPIRES: June 12,2M
Public Works Director, or Designee
10' A dtP
.1l.,avanent
y14'-PtTrkwo
I� \I Corner_ - S' Concrete SIdW l
Recordo ; a • j4
21.83'
•` ' ' IJ
� � effete ;
c Def"' . Poonter Concrete B
•' % 15.9f
0.15' . •,• Co�lliretp
trot 23.10' €c1
gob N
4.00 "T
16.00' •
One Story
Residence No. 1290
B'0 V N D A RY
0.30'
o
�_ a
„ i q 210 Face
1�m, Shores VVIPge
w', 3jECT TO COMPLIANCE W i H ALL FEDERAL
"7 C7'. ` 1Y RJt FS AN') RFGJLATIONS
SURVEY
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i
w,: ,W J; ^N.•.Ss- sG'CTs:�✓ d - .aEvr.S.:n d:•a. ..
:4'Z LOCATION SKETCH
X_ —am m} U SAY PARK, eecordng to the Rot thereof, N
41 at Wqe of the Pubic RaooMe of Rade County, Florida 1) FtDGS �IIE: AE SASE BS' PAHA; GpgS J
01— Y F I COIEY COWRNiTY N0. 120051 '
SAT: OF NAP 3-1-94
1290 NE 1W1H STREET IiERE MAY BE AOO1fONAL RESIRICOOIS THAT ARE NOT 9tONN ON
it r+u1IF 91OIFA FLORIDA aouNl r THAT NAY eE F1IlM W TIE PIIBUC RECORDS aF THS
�- 11tOW 011fY: Thot Tho SKETCH t>F SIIRV£Y of tAa show m toned 3) EtAMWATOW Of AEISTRACT Of DTE IPF
NAPE TO SE MADE TO
'� Was
under my rgxNobn ond/ar 'head , to Ne hoot of mr IoioMedOy� end heh.t 4) t GTMNE EH AHp 0FT1pF1CA , A PROPERTY
pp�e r • ^^7 boob a aieade tM Wk�' 7 *AW Sfmdarde def IaN !y tl�e flulda AODORpANCE NRH TUB 0 ANY ARE SNOMN IN
06 " o,Y __7ptu BIG -17-0 Fiorillo Admtilotrathe Co*.Punumt to 1GFOEDPtAT
i/ISdQ OMlmr B SUSECT TO'OPIItlCN OP TITLE
TME DF SUBLET: BOUNDARY SIdOEY
SUR ! RIRWLEM O WY ISCO VAUD FUR79 W IW MATURE ANO THE
TA 9IRN YORS OIG //�� ORIGINAL RAISED SEAL OF A FLORIDA UCJ;iM SURVM AND MAPPER
C 1T37fH A1fNIlE 0) THS PLAN OF SIAYEY NAS Bml fNIEPARtD FOq Ti E)fClUSiti IISE CF
I�-� FL090A A1B6 WAX F. PAEZ Tt[ ENnTIEs 1WiED I�ERfaN. 171E t"ikR7U1CATE DOES NOT EXIE)D TO
OF
v� W PROFESSIONAL SURVEYOR AND WA M v ANY UHIAYED PARTES
✓j NO. am iOj UNOERtR01A1O UN70 ARE NOT OERCTEO HEREON, OONT91' THE
r St'P100 CERTIFICATE OF A nHORIZATo APPROPRIATE A(MOOIY PPoCR TO ANY OESICN NOplt OR
L& NIL 33es CWSiRUCTgN S
ON THE PROPFATY FIEAEIt OFStlOt1E0 StR1flOR HALL
STAT OF ftORpA SE MOWED AS TO ANY DENATHIH FROM UTUTIES SHOW NMON,
1HE SIIRVEYDR OF RECORD DOES
'T r Of%11GE'OPLOFFOM UDMR NTS Ow IA
TON OF
••L 12) wai-DEIRIFlm FEAIUAES N 6 SUiWY AND MAP HAVE SEEHH
O O
9EAUM TO AN EMINATED IIORZORTAL NV09TI01 X ACOURACY OF
t:750o FT.
o- �J 13) IN souE OISTAT
GERAIm TO MjE GAAPHC REFREWATNYIS HAVE BEER
DAG ORE DEARLY ELUSIRATE REIA7101 M
MTAM U) WWENSION9��! SHALLALL CONTROL iFE LOCARAPROMENTS MD/OR TION TIOH
�or IW
K
m+RowolOtTs oYFA scum FYl5lTltali
rn < Flab Ak7Wy DATE 7-18-0 SCALE: I' . 2C DUNN BT: DA.
DRANWG DATE: 7-17-03 F& 219 PR 62 DRAN91G N6: 07-73OK
rn
rn SFS/�Fo
Miami Shores Village
Building Department
10050 NE.2nd Avenue
Miami Shores, Florida 33735
Tel: (305) 795.2204
Fax: (305) 756.8972
AII IN 1111,
C o= N 2 i_319 R f-161.61.12 8'
OR BK ir,.3l Ps 32011 !1F'3si
—n fil li l l F �F I'
-
STATE rJi Fi O ISA, COUNTY i iii € A DF o coin,,
I HEREE FRTIFY that this I i ^ cr .� 'ply
of the J`t� .ARK ry �'e
origi u!
AD 20
V. ESS r y Mand and Qf'ricia r ml,
HARVEY R :VIN, Clerk o xuit and C unaorta D�
N GOO l4E'RUST d
By
D. C. 4FCoieNt��
COVENANT OF CON,5-[RUCTIO WI IN IGHT OF WAY
Whereas, (owner) N! I G � KR TRINGER #172204
hereinafter referred to as the owner of thfollowing described
property (address): _� Z oto /U &
Legal Description: Lot lock Subdivision
Folio #
Requests permission to install (describe work) CbAyl n'
Within the public right of way of (
IN CONSIDERATION of the approval of this permit
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 tIie:undersigned,. their
heirs and assigns, until such time as this obligations has been canceled by>an affidavit.filed in
the Public Records of Dade i✓ounty, Florida by the Village Manager of Miami Shores ViIlage
(or his fully authorized representative). _
Signature
Owner or Agent
State of Florida
County of Miami Dade
The foregoing instrument was acknowledged before me this ` a% day of ?� 20 �, by
ffV lr�owle' a who is personally known to me or who has produced....,
r as identification.
NOTARY PUBLIC:
Sign:
Print: . IA-n,�
JAIME ARMANDO BASILIO
EXPIRES: June 12, 2022