PW-19-1622Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Issue
Location Address Parcel Number
270 NE 92ND ST, Miami Shores, FL 33138 1132060133380
Contacts
Permit No.: PW -07-19-1
Permit Type: Public Works
Work classification; Public Works
Permit status: Approved
Expiration: 01/21/2020
Adam and Sandy Hollander Owner SANTA MARIA TRUCKING INC Contractor
270 NE 92 ST WILLIAM SANTA MARIA
18370 SW 212 ST, MIAMI, FL 33187
Business: 3053230400 jsmequipmentinc@hotmail.com
Inspection Requests:
Description: RESURFACE ASPHALT / CONCRETE RESTORATION Valuation: $ 1,000.00 5 xon Re
44
Total Sq Feet: 954.00
Fees
Amount
Education Surcharge
$0.20
Public Works Permit Fee
$100.00
Scanning Fee
$9.00
Technology Fee
$0.80
Total:
$110.00
Payments
Date Paid Amt Paid
Total Fees
$110.00
Check # 10075
07/25/2019 $110.00
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 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 authorize the above nod contr*tor V dQ the worlc stated. ,
Authorized Signature: Owner
/ Applicant / Contractor /
Date
July 25, 2019 Page 2 of 2
Miami Shores Village
Public Works Department
(305)795-2210
C
AL1fi''.,
,,U."
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#: W l �--
Name of Applicant (if utility see below): AJ, t -5 ly "/ kr `'j S 4 —C180 --S6-70
Owner off the following described property: 16N Cy
Legal Description: Lot ' Block 2S Subdivision t1io*vtj55 Sec 1 ARD
Folio #; II - 22 Gn (Z -m ego
Address: 27o NF 3 ,S+^ee-- Mrc,tAyu SkoreS q 53133:
UTILITY NAME:
Qualifier/Authorized Agent:
Address:
City: State: ZIP:
Telephone: Email:
State Certification or Registration #: Certificate of Competency #
CONTRACTOR NAME: .lin
Qualifier/Authorized Agent: )
Address: 18 3 70} -
city: io4,,,,1 State: ZIP: 33197
Telephoner 3oS_-3Z.3--ogoo Email: )sme9,1112MPrs lnr>—�iatrvio-J.COE=
State Certification or Registration #: Certificate of Competency #: E 1,o i c102-
Requests
IOZ
Requests permission to install (describe work, attach separate page if necessary) in the adjoining right of
way: _ ri° ".)r4ge - aSpk'it / corm. -g . 0oS,4c-xa-+low
Type of Work: ❑ Paving ❑ Utility ❑ Sidewalk ❑ Electric ❑ Irrigation
❑ Landscape ❑ Antenna Other: _ � Cbrr-►-Q-44z_
DESIGNER: Architect/Engineer:
Address:
City: State:
Telephone: Email:
Registration #•
ZIP:
Value'of Work for this Permit: $ 1sj p0.00 , Square/Lineal Footage of Work: _
*.:** Fees
Pernriit.Fee $100:00 t .
Notary $ Training/Education $ 0.20
Bond $ (if required)
Technology Fee $ 0.80 Scanning $
Total Fee Now Due $
110. 00
�L
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 $2,500, the applicant must promise in good faith that a copy of the notice of commencement
and construction lien law brochure will be delivered to the person whose property is subject to the
attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job
site for the first inspection which occurs seven (7) days after the public works permit is issued. In the
absence of such posted notice, the inspection will not be approved and a rein, pection will be charged.
Signature—Signature
Applicant or Authorized Agent o ny/ ity Agent
The foregoin instrume was acknowledged before The foregoing instrument was acknowledged before
e this 'I ay of T 20� by t+t1i$. y day of _ 20� by
C��cm'I O e ✓ who ! `(� CI - who
is personally known tome or who hroduced is personally knq to me or Ao has produced
CObL �` 1,6-3,Y3-052—as d . c ^ _ oi� l0_ ( � as
identification. identification.
NOTARY PUB IC:
i
Sign:
Print, ` �
/ �. ?,Ll,
NOTAR PU IC:
Sign:
Print:
SEAL: �
Jj
FAWZIA A SHAH
NOTARY PUBUC " ,- DAYIIN OME- FERNAN'i
STATE OF COLORADO ''� ;Notary Pu: ;c-c?ate of Florid,
NOTARY ID 20134034113 _'• Commissic.n i GG 3481G MYCOMMISSION RES SEPTEMBER 30,2p21 •ra„.My Commission Exr'JA
* June 24, 207
n
APPROVED BY:
2017-04-15
-111 i, 0\ Public Works Director, or Designee
1355 NW 97 A V SUITE 200 SURVEY No. 15-0000430-1
TELEPHONE:
MIAMI,FLORIDA 33'172 'j��' ; - '
LEPHONE: (305) 264-2660
FAX: (305} 264-0229
LAND SURVEYORS SHEET No. 2 OF 2
DRAWN 6Y: LG. B1.
OUNDARY SURVEY
SCALE = 1"= 20' .
N.F. 92n. ST. T(!) _PWIi
ASPHALT
o $ to t o�
Le)
-7k
0
• • •••• ••••••
y, 75.00' i ••••°Q5�1,. - ♦•: •
! F I-P 314 ! �9 5 G!C•
NO ..AP ' ; . I 40'4'0"' Ft 1' • • B.0 • • •
i—
i i ( � � � ; • • a� fiAF• •
•
f t) � , � �'� { of � •••• • •••••
•
'v0.80' c! 4AL_ Ii I I
f ! j i 10.20' 0 O EAC • •
i4 5C' :00000
tt •
•
LOT-4 27.3C L07-3
;� } tSLOCK - 25 { BLOCK-25
LOP-5 REMAINDER'
t! i ` i LOT-2
BLOCK - 25 1O ONE STORY r
BLOCK-25 2s
I ; BLOCK 25
I RES. # 270 3
4 5 5'
cn
N�
f o ; ' < �4
i 0.65' cl I� { 4 LL L
{ c7
�> 2
! !I ! j ro
- t I. ! ; w U
-c
Z
7
7
I it I I 1..« W❑ LJ Z
89'5749, - _ i . -> ((7 CDJ Q
O_ C� i ,u )t'
t i.P 3'4" ; 5.00' Fi.P 14" ` 6 L� C) m
O
NO CAP ij 71 Nv CAP i - i% U)
15-ALLEY (N.A.P.j t
of
SLR 1 £ i OR'S NOTF_:
2 j {{ aI! F rrcruutfting otrtre 1 ei� if hue's Prupartc IL ut-1. K(nek - ?5) on the Fasr side.
B/ Concrete Slab Eucroac-bitr, unto I- AIje)' nn tl+e Suuth side.
ALL
as' 'I Same sty
SC'R[ EFOR'S.VJTF
T6crr ma,: or Easeu,i•�zc., r� or�ed ir: the "ubiic Reo.,n+.:: n �,-,.,........ Sw-
-
S1'AZP3p`FL +HIDA, COUtdTYU AMP DARE���
cou t
HEREBY �RTIFY .hat this is a �',;e copy of the¢'ar �
L.EPK' ' 1
ori .aif' dint officePi= N 21_119R 14`?1_IC'39
j' 816 (IP9s)
n y�—�-- � w 1 BK 315137 F'9
I7 ESS myha-,:andC? c'sASe-,. \ aa� RECr'FIR["DED 117 0 7ri19 f�4.rr?;i�;'
(� ` \:H ^�G�1'%?RUST .'� HARVEY �� F\�IY J. 1'li CLERK I.�P• COURT
,; Cle ,Circ,+-'. inti county Ccur°ts �-. o -
By_ N\F` MIACfT—L'�r�DE C:DIJhaiY, FLORIDA
2LN -- - ,
OVEN NT OF CONSTRUCTION WITHIN RIGHT OF WAY
Whereas, (:owner) I- hereinafter referred to as the
owner of the following described pr perty (address): „17n I\r 9 S tg► IJ c�aT,, � s31��
Legal Description Lot P4-, Block zS Subdivision 1 1�,I s iprtj
Folio # I I - 22oc ol3 -.Z3Ro
Requests permission to install (describe work):re_s0,rjR-,_cp_ c—nor?)i'�rr42,4p _
in the public right of way of (address) 2-7n NE g,L ,; w0
IN CONSIDERATIO
FA
K
9
Signature
of the approval of this permit by the Village, the owner agrees as follows:
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.
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.
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).
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).
Owner or Agent
The forego.Ing in trument was acknowledged before me this 1 ��- day of K C6 � , 20 lei , by
�d ,A/1 Qo l vfH014,n ho is personally known to me or who has.produced 6bbL4,
as identification and who did take an oath. '
NOTARY PUBLIC:
Sign: FAWZA A SHAH
Print: NOTARY PUBUC
STATE OF COLORADO
My Commission Expires: 3LzO Z j NOTARY ID 2D134034113
MY COMMISSION EXPIRES SEPTEMBER 30.2021