PW-19-1515Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Isst Hate: 07/22/2019
Location Address Parcel Number
441 NE 101ST ST, Miami Shores, FL 33138 1132060170660
Contacts
Permit NO.: PW -07-19-151 5
Permit Type, Public Works
Work Classification: Public Works
Permit Status: Approved
Expiration: 12/30/2019
MICHAEL OBREGON Owner DRIVEWAYS BY DESIGN INC Contractor
441 NE 101 ST, MIAMI SHORES, FL 331382448 RENE VERLAAT
Business: 3057767916
Description: INSTALL A DECORATIVE PAVER DRIVEWAY AND Valuation: $ 7,300.00 Inspection Requests:
WALKWAY 305-762.4949
Total Sq Feet: 1,000.00
Fees
Amount
Education Surcharge
$1.60
Public Works Permit Fee
$100.00
Scanning Fee
$3.00
Technology Fee
$2.50
Total:
$107.10
Payments
Date Paid Amt Paid
Total Fees
$107.10
Check # 3908
07/22/2019 $107.10
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, PLUU8IN It, PotEjCHAN]CAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNERS AFFI IT:Imo(( oregoing information is accurate and that all work will be done in compliance with all applicable laws
reg ulating,c9r�tru op_a ning; Fut ermore, I authorize the above named contractor to do the work stated.
ignature: Owner / Applicant / Contractor 1 Agent Date
July 22, 2019 Page 2 of 2
Miami Shores Village
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#-DSr d) r 19 _
Name of Applicant (if utility see below):�-l� G!�(A F_L Q, e9l32 EO- oAl
Owner off the following described property:
Legal Description: Lotc.� r Block Subdivision Alf0 PLP : rr� 5�v2F5 $¢cq
Folio #; // - 3��- O(7 - o a
Address: _01// NE /yr -5f �1%+/7a / ,geES,C(- -33 /,V
UTILITY NAME:
Qualifier/Authorized Agent:
Address:
City:
Telephone:
State Certification or Registration #:
Email:
State:
ZIP:
Certificate of Ccmpetency #
CONTRACTOR NAME: Driveways by Design, Inc
Qualifier/Authorized Agent: Rene Verlaat
Address: 222 NE -65th ree
City: Miami State: FL
ZIP: 331
Telephone: 305-779-096b Email: rene@drivewaysbydesign.com
State Certification or Registration #: Certificate of Competency M E 17 0 0 3 3 6
Requests permission to install (describe work, attach separate page if necessary) in thn adjoining right of
way: h,4 (/F2 lOa'crei.,A f
Type of Work: ER Paving ❑ Utility
❑ Landscape ❑ Antenna
DESIGNER: Architect/Engineer:
Address:
City:
Telephone: _
Registration #:
State:
Email:
❑ Sidewalk ❑ Electric ❑ Irrigation
❑ Other:
ZIP:
Value of Work for this Permit: $ 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 $ . i Q; ( b
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 it a 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 specific311y 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 $2,500, the applicant must promise in good faith that a copy of thf.1 notice of commencement
and construction lien law brochure will be delivered to the person whose property is subject to the
attachment. Also, a certified copy of the recorded notice of commencement trust be posted at the job
site for the first inspection which occurs seven (7) days after the public works permit is issued. In t
absence of such posted notice, the inspection will not be approved and a reinspection wilLb
Signature / Signatur.
Applica or Authori2ec int ompany/Utility Agent
The foregoing instrument was ac dged before Th oin instrument was acknowledged before
me this day of 20, by m t 7b dayo ect_, 20 by
/C(r UYkF� 2 •1„Q/3 _�, who 12 v — R-% who
is persona to me or w o has produced is personall own to me or who has produced
as as
Identification. identification.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: Sign:
,, M A dC O M O R N I K
�? �oStat of I rda-Notary Public '_° %';State f orida-Notary Public
Print: _ _ Print: comrnission#GG128031
SEAL
''•,;�orv��`'` Y o mission Expires11
SEAL: %� P'� ommission
"""`" ulv 26. 2021 ° `P July 25, 2021
APPROVED BY: `//�✓y 7 ( Public Works Dtrec:tor, or Designee
eL P ---Y5
2017-04-15
=Fhb +19R.1-17 77 OR ❑❑ , .3{{ �ii5 �,_
C'K ~1__ r�J�JV'Jf 1:JCI'J
e
Miami Shoresilla9
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY
Whereas, (owner) 12 hereinafter referred to as the owner of
the following described property (address): 61 �1 NFlo( S/ AM. ' .S /Joel S FL3-91-28
S�h�QS s� ( (y
Legal DescriptionMikn; Lot [$¢_ c., 4 Block_ Subdivision
Folio # // - 3'z 0� 61 Z - 0660
Requests permission to install (describe work): A p'eo a t2 nA z/Pl) 00 " Ll F- (,/4 f
Within the public right of way of (address) (461 NZ_:; /o/ � /i-> %A� r % SNo�ES F� 33 i 3 �
IN CONSIDERATION of the approval of this permit by the Village, 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.
OR 8K 3151--15- PG 386SE
'—PkST PAGE
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 the undersigned, their heirs and assigns, until
such time as this obligations has been canceled by an affidavit filed in the Public Records of Dade County,
Florida by the Village Manager of Miami Shores Village (or his fully authorized representative).
SIGNED, SEALED, EXECUTED AND ACKNOWLEDGE on this b day of 2017
Owner's Signature)
SIGNED, SEALED, AND DELIVERED in the presence of:
M I OMORNIK
t e of F a -Notary Publi
o i on # GG 128031
y mission Expires
July 25, 2021
STATE OF FLORIDA, COUNTY OF MIAMI•DADE
I HEREBY CERTIFY that this is a true copy- of the
original filed in this office on da> of
%L " 2nto AD 20
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