PW-18-3731Location Address
Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
440 GRAND CONC, Miami Shores, FL 33138
Contacts
•
Issue Date: 01/15/2019
Parcel Number
1132060170030
Permit No.: PW -12-18-3731
Permit Type: Public Works
Work Classification: Public Works
Permit status: Approved
Expiration: 06/18/2019
Description: REPLACE 3 FLAGS OF SIDEWALK Valuation: $ 700.00 Inspection Requests:
-762-4949
Total Sq Feet: 60.00
Fees
EDUARDO & XIMENA CALLE Owner
440 GRAND CONC, MIAMI SHORES, FL 33138
Other: 3057512707
ROHI CONCRETE & FINISH CORP Contractor
HOMER VIRGILIO MURILLO
Business: 7863126131
$0.20
Public Works Permit Fee
$100.00
Description: REPLACE 3 FLAGS OF SIDEWALK Valuation: $ 700.00 Inspection Requests:
-762-4949
Total Sq Feet: 60.00
Fees
Amount
Education Surcharge
$0.20
Public Works Permit Fee
$100.00
Scanning Fee
$9.00
Technology Fee
$2.50
Total:
$111.70
Payments
Date Paid Amt Paid
Total Fees
$111.70
Credit Card
01/15/2019 $111.70
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
reguI t' truction and zoning. Futhermore, I authorize the above named contractor to do the work stated.
Aut orizE(d ature: Owner / Applicant / Contractor / Agent Date
January 15, 2019 Page 2 of 2
EC 2 A 2018
�.,. Miami Shores Village illy: v
Public Works Department
(305)795-2210
Public works forms are available from the building department, 10050 NE 2"d 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#:
VW
Name of Applicant (if utility see below): ' (ReLfti, -4— C'k ((e
Owner off the following described property: kt&AeAA I vlw"V ? clwuC
Legal Description: Lot Block Subdivision aA4,( 4. Ir3-�
Folio #; i I • 3`1-D�b O I �' • 00::� 0
Address: (—SQ—
UTILITY NAME:
Qualifier/Authorized Agent:
Address:
City:
Telephone:
State Certification or Registration #:
CONTRACTOR NAME: V -U K l
Qualifier/AuthorizedQAgent:Mc
Address: �l N
City: VI.(CvIXi
Telephone:%T` & q;712 (l'✓ �
State Certification or Registration #:
State: _
Email:
oonc"4c ci
14 ez • k u
State: _
Email:
ZIP:
Certificate of Competency #
zip: 331 25'—
Certificate of Competency #:
Requests permission to install (describe work, attach separate page if necessary) in the adjoining right of
way: 0-�QIiiGC 3 ?�locacs a RtOU�G�-lL
Type of Work: ❑ Paving ❑ Utility WSidewalk ❑ Electric ❑ Irrigation
❑ Landscape ❑ Antenna ❑ Other:
DESIGNER: Architect/Engineer:
Address:
City: State: ZIP:
Telephone: Email:
Registration #:
x o,,r .
Value of W' o'ck•for this Permit:. $+ %ice ':.` ` Square/Lineal Footage of Work:
Fees *****
Permit Fee $ 100.00
Notary $ Training/Education $ 0.20 Technology Fee $ 0.80 Scanning $ tAID
Bond $ (if required) Total Fee Now Due $
�j �'.�.•.i r"=:: a -["s? � �i %�f�{•,.�1 �l�t 1`����'t� t i��, i
.. W'.YI•'l +�.Y�.v .•�A �.0 SH .. ..i1 I
Bonding Company's Name (if applicable):
Bonding Company's Address:
City: ri" State:
C'al*
ZIP: wig & r
rAd
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 will be charged.
Signature
`A0QLjpAt or Authorized Agent
The foreoing instru was acknowledged before
me this day ofnt 20_[�L, by
who
is personally known to me or who has produced
b2l141;21U c� as
identification.
Signature gt,� JCZ 4
1 Company/Utili $ Agent
The foregoing instrument was' acknowledged before
me this day of Ral. 20_/� by
G/Oltht"t, &jai 0 who
is personally known to me or who has produced
�/,L1�!/�rlD-3�tC�i/~t170-O as
identi�.
Sign: Sign: 4rfiL5�
E ROURIGUEZ
Print: k Print:
SEAL:
yy-,,VyV'�I",EYv JSEAL: �erww!
=oow 11,&# Notary Public State of Florida f l :"►t�'�r E::AS ;
^ Sindia Alvarez f,t =�; MY % �t' . ."320
My Commission FF 156750 .. 2021
No, �.P Expires 0 910 312 01 8
***************************************
APPROVED BY: ► Public Works Director, or Designee
ERASMO ROORWIM
MYCOMMISBWN 10012M
* 1MRtB: Biopty" 23, 2021
2017-04-15 0 ihN „y I rc UNIOWN I