PW-19-2290Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
P'j�lmkc
Issue
Location Address Parcel Number
30 NE 93RD ST, Miami Shores, FL 33138 1132060130200
Contacts
Permit No.: PW -09-1,9-2290
Permit Type: Public Works
Work Classification: Public Works
Permit Status: Approved
Expiration: 04/06/2020
Jude Faccidomo Owner STAR ISLAND CONCRETE DESIGN CORP Contractor
30 NE 93 ST, Miami Shores, FL 33138 MIGUEL CORPAS
Business: 3057257598 1018 nw 47 street, Miami, FL 33127
Business: 3057767916 miguelcorpas22@gmail.com
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 1 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.
OWNEqj AFFIDAV T: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws
regulat - g onstruc n �d zoning. Futhermore, I authorize the above named contractor to do the work stated.
re: Owner / Applicant / Contractor / Agent
October 07,
Date
Page 2 of 2
Inspection Requests:
Description: PLAIN CONCRETE DRIVEWAY to replace
Valuation:
$ 1,000.00
permit#pw-19-129
305-762-4949
REPLACED PW -01-19-129
Total Sq Feet:
1,500.00
Amt Paid
Fees Amount
Payments
Date Paid
1009 Permit Renewal Fee $100.00
Total Fees
$100.00
Total: $100.00
Check # 1608
10/07/2019
$100.00
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 1 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.
OWNEqj AFFIDAV T: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws
regulat - g onstruc n �d zoning. Futhermore, I authorize the above named contractor to do the work stated.
re: Owner / Applicant / Contractor / Agent
October 07,
Date
Page 2 of 2
Miami Shores Village tEIVED
" Public Works Department C
(305)795-2210 SEP 3 0
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 <L✓IG I ,I� i�'/ ` 2"1
�w�t7�-i�� aaga
Name of Applicant (if utility see below): &_00 IAn�
Owner off the following described property:
Legal Description: Lot Block Subdivision
Folio #; 1/- 3X06- 02f))
Address: '3C) c � '
UTILITY NAME:
Qualifier/Authorized Agent:
Address:
Citv:
Telephone: Email:
State Certification or Registration #:
State:
ZIP:
Certificate of Competency #
CONTRACTOR NAME: I, CA_ i IG V 1 1-1 A 1 �
Qualifier/Authorized AeIn.t``
Address: 10 ( W
City: & I IM State: ZIP:
Telephone: ,t 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:
Type of Work: ❑ Paving ❑ Utility
❑ Landscape ❑ Antenna
DESIGNER: Architect/E
Address: 3o K)
City:
Telephone:
Registration #:
neer:
-? •fct�"
❑ Sidewalk ❑ Electric
❑ Irrigation
J Pc. rui l C✓
State' ZIP,
Email:
Value of Work for this Permit: $ V Square/Lineal Footage of Work: % 56 6
***** Fees*****
Permit Fee $ 100.00 {
Notary $ Training/Education $ 0.20 Technology Fee $ 0.80 Scanning $
Bond $ (if required) Total Fee Now Due $ 1.0:D-oz:b
Value of Work for this Permit: $ V Square/Lineal Footage of Work: % 56 6
***** Fees*****
Permit Fee $ 100.00 {
Notary $ Training/Education $ 0.20 Technology Fee $ 0.80 Scanning $
Bond $ (if required) Total Fee Now Due $ 1.0:D-oz:b
Bonding. Com pany'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 constructiori 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 inspectiodrill not be approved and a reinspection will be charged.
Signature
The foregoiol instrument as acknowledged before
e t is day of * 20 I , by
ei mro yv\Q who
NIPersor
I y known to me or who has produced
,rti L I as
. ,. `������.�����ppY PREF„A
PU LIC: ��\ • d���;•,••
d
Signature
Company/Utility Agent
The foregoing instrument was acknowledged before
me this day of 20 by
who
is personally known to me or who has produced
as
identification.
v i •y OW 217268 S
�V, •.`� e e�: r
Print: v� 1nrw:ye �n teN `• rint:
is Un
SEAL: .• �, SEAL:
//��,//;��eUO, SuMT "\���\`
RY PUBLIC:
APPROVED BY: 3o Public Works Director, or Designee
2017-04-15