PW-19-2280Location Address
Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
1i
IIIIIIII UI
Issue Date: 10/28/2019
Parcel Number
9207 NE 1ST AVE, Miami Shores, FL 33138 1132060133150
Contacts
Permit NO.: PW -09-192280
Permit Type: Public Works
Work Classijicatton: Public Warks
Permitomus: Approved
Expiration: 03/25/2020
Miguel Mudafort Jr Owner CHAMPION CONCRETE Contractor
9207 NE 1 AVE JAIME BASILIO
10280 NW 63 TER 105, DORAL, FL 33178
Business: 3052528055 jaimechampion@yahoo.com
Other: 7864024802
Description: REPLACE BROKEN STREET SIDEWALK (7) Valuation: $ 1,000.00 Inspection Requests:
Total Sq Feet: 120.00
Fees
Amount
Education Surcharge
$0.20
Notary Fee
$5.00
Public Works Permit Fee
$100.00
Scanning Fee
$9.00
Technology Fee
$2.50
Total:
$116.70
Building Department Copy
Payments
Date Paid Amt Paid
Total Fees
$116.70
Credit Card
10/28/2019 $116.70
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 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 authoriz4he above named contractor to do the work stated.
Authorized Signature: Owner / Applica
r / Agent
Z�
October 28, 2019 Page 2 of 2
s
0\ REGEEV'0
Miami Shores Village SEP 2 17
` Public Works Departments
(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#:` \U " 09 — I �' p 180
Name of Applicant (if utility see below): H1 `WL S /�LVa90y? -��-•
Owner off the following described property:
Legal Description: Lot Block Subdivision 1'60i444 .ice 5j2i
Folio#, /1-32'16- 0/3- 3/SD
Address: 4207 NS- 14V • ft"" 4-V MAO 3'i1Ir
UTILITY NAME:
Qualifier/Authorized Agent:
Address:
City:
Telephone:
State Certification or Registration #:
CONTRACTOR NAME:
Email:
Qualifier/Authorized Agent:
Address: 102,rD NW 'o3 7rkA
City: .19404—
Telephone:
9404_Telephone: V s Email:
State Certification or Registration #:
State:
State:
FM
Certificate of Competency #
ZIP:
Certificate of Competency
Requests permission to install (describe work, attach separate page if necessary in t e adjoining right of
way: IZL' d w= �soY'A/ 3`?w�' S 0-1cwl- ,7
Type of Work: El Paving ❑ Utility ❑ Sidewalk ❑ Electric ❑ Irrigation
❑ Landscape ❑ Antenna
DESIGNER: Architect/Engineer:
Address:
City: State:
Telephone: Email:
Registration #:
❑ Other:
ZIP:
Value of Work for this Permit: $ Square/Lineal Footage of Work: 17,0JE
***** Fees *****
Permit Fee $ 100.00 9,50
Notary $ Training/Education $ 0.20 Technology Fee $4 -ft Scanning $ 00
Bond $ (if required) Total Fee Now Due $ 111p. �}
dFC
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 wiAe charged.
Signature
ApoLtantNr Authorized Aged
The foregoing instrument was acknowledged efore
me this 2�_ day of 5 M, 20 by
)Gvy� /tly,0 �4T I- who
is personally known to me or who has produced
M31 & SS -7 (,(n4S6 Q as
identification.
Sign:
Signature
Compfny/Utility Agent
The foregoing instrumeftt was acknowledged before
e this 2S day of 'EMB 0 (e7 , by
ML AQfi44abD fa51 u G who
is personally known to me or who has produced
TL `71 W (2- v-cctJS-E as
identification.
Sign:
Print: r-✓ gQ3J . Print: SL N9� P
SEAL:
JAIME ARMANOOMSIUO SEAL:
t t YYCO "#GG227824 {� SINDIA ALVAREZ
P Y,
SIRE&.NmB �� 2022 FAY COA4MlS3lO;V ✓EGG 238273
•'•:+ds i; °`� Forded 11ru Notary PuEMc lhrwdBers w:
EXPIRES: September 3, 2022
Bonded Thru Notary Public Underwriters
APPROVED BY: Public Works Director, or Designee
2017-04-15.
NW 94th S
NE 94th St
C C
••••••
•
C
NW 93rd S
? '
NE 93rd St
92nd S
� 2
�
E 92
THIS 9uR
�:.� 7
NW 91st
1
NE 91st St
4
�ocaT�mN S1G/LrLL.{
9C�1 Le•_
I 40
�i1 o.S �uGQ I WnLLiz,7
JJ na fl (n �l
1' IN I AL ML,a. L 0�
r ae i
- 25.1 s-rean cas
W
4 1 V ,a5 S4 3L 9 I Z
—. �� 427.3' ': •. ��-_! ssr
r E
m , c
19' nnvGM GAff A� !
0.
ronases
- 9207 N.L. 1 AVENUE
M1AM1 SHORES, rLORZDA 33139
LEGAL DESCRIPTION
Lot 15 and the West h of Lot 16, Block 23, AMENDED PLAT OF MIAMI SHORES SECTION No. 1
subdivision, according to the plat thereof, as recorded in plat book 10, at page 10,
Public Records of Dade County, Florida; subject to dedications, reservations, easements
or restrictions of record, if any..
SURVEYOR'CERTIFICATE
I hereby certify that this sketch of survey of the above described property is true and
correct to the best of my knowledge and belief as recently surveyed under my direction,
and it conforms to the Minimum Technical Standards adopted by the Florida Land Title
Association, pursuant to Section 472.027 of the Florida Statutes. There are no
encroachments except as shown.
CHRISTOPHER B. COOKE
Registered Land Surveyor #4229
State of Florida
15021 N. Saxon Circle
Ft. Lauderdale, Florida 33331
4954) 434-2695
Not valid unless sealed with an embossed surveyors's seal.
Date of field work: January 25, 1997
FLOOD ZONE INFORMATION: 120652 093 J 3/2/94 X
CERTIFIED TO: Miguel S. Mudafort, Attorneys' Title Insurance Fund, Inc., Joseph R.
Colletti, Temple Inland Mortgage Corp., its successors and/or assigns as their
interests may appear.
R rnlaze
c
.:�rc9:Iry .....
00 00 00
••••
••••••
•
••••
••••••
—A1�� �n�a7 ��ng1I9
RP eF�VF0
2? prlrg
W \
Q o C(
o W F -LL
lu
CXY
- J LLQ t
CO A/
Q Y�
U
(� U)Z
L
U
LL'
�� o w F--
f �
w
_� (3...-1
fir"'
Miami Shores Village
Building Department
10050 N.E.2nd6Avenpe
Miami Shores*Floridt5M38
Tjj:P (105) AS.6�W4
Fax: W05) 756.$972
„66 ..
SURVEY AFFIDAVIT
STATE OF (FLORIDA)
COUNTY OF (DADE)
The undersigned Affiant, Miguel S. Mudafort does hereby attest that
(Property owner)
The attached survey, performed by Christopher B. Cooke - Registered Land Surveyor 94229 -State of Florida
(Name of surveyor's company)
Foraddress: 9207 NE 1 Avenue Miami Shores, Florida 33138
0000.. ... .
0000 ..
0000..
0000..
Performed on January 25, 1997 (date of survey) is an accurate representation of the existing conditions and
locations of all structures on the property as of this date.
The purpose of this Affidavit is to induce Miami Shores Village to issue a building permit for the property
without first providing a survey less than seven (7) years old old. The Affiant, as property owner, further agrees to
remove or obtain permits for any structures which now may exist on the property which are not permitted or which
may violate zoning or building code regulations. The Affiant further understands that the existence of any such
structures may affect final inspections as applicable to this or other permits.
Fu her, Affiants t n ugi
L q'Q(j'qC16 Miguel S. Mudafort
Property Owner Signature Property Owner Print Name
SWORN TO AND SUBSCRIBED before me this .0 day of 5W&Mbec
Affiant is personally known to me, produced as identification.
ojir'iu URSULA RAMIREZ • /
=�/`�1 1 Notary Public - state of Florida
Commission Commission M GG 20x312 Notary
'tof F�dt. My Comm. Expires Apr 5, 2422
Revised on 5122120091 Revised on 6112109' Bonded through National Notary Assn.
0000..
0060..
0000..
00000
0,0000
66.00.
6,666,
0