PW-19-1760- 1
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Location Address
Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
1322 NE 105TH ST, Miami Shores, FL 33138
Contacts
M*,- m fl J
Issue date: 07/30/2019
Permimo.: M-07-19-9760
Permit Type: Public Works
Work Classification: Public Works
Permit Status: Approved
Expiration: 01/27/2020
TED RICHERT Owner ARROW ASPHALT & ENGINEERING INC Contractor
1322 NE 105 ST APT 10, MIAMI SHORES, FL 331382130 SHAWN O'TOOLE
Other: 3058951229 3051 NW 129 ST, OPA LOCKA, FL 33054
Business: 3056888639 ar@arrow-asphalt.com
Mobile: 3056888686
Description: ASPHALT OVERLAY Valuation: $ 1,000.00 Inspection Requests:
305-762-4949
Total Sq Feet: 2,980.00
Fees
Amount
Education Surcharge
$0.20
Public Works Permit Fee
$100.00
Scanning Fee
$3.00
Technology Fee
$2.50
Total:
$105.70
Building Department Copy
Payments
Date Paid Amt Paid
Total Fees
$105.70
Check # 1238
07/30/2019 $105.70
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.
inFuthermore, I authorize the above named contractor to do the work stated.
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e
Authorized Signature: Owner / Applicant / Contractor / Agent Date
July 30, 2019 Page 2 of 2
- Miami Shores Village 'eCF ED
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
FBC 201
BUILDING Master Permit No. bS' 61 6 - IJy
PERMIT APPLICATION Sub Permit No. i W - 01 111- I - �0
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑ PLUMBING [:]MECHANICAL PUBLIC WORKS ❑ CHANGE OF [:]CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: j-9.221 NE -IDE U
City: Miami Shores County: Miami Dade Zip: 33138
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FIFE:
OWNER: Name (Fee Simple Titleholder): R1 C R F- R T Phone#:
Address: I3�z NE 1 �5 ST itP% l�
city: MtA M i 9*,eC.S State: /� L zip: 33 (38
Tenant/Lessee Name:(( Phone#:
Email: tedc�e_h0. (2h�JSrJA"Hej
CONTRACTOR: Company Name: dRuij A512NOL7 9= AIG)A GL U& , 11q Phone#: YB" 96&
Address: 3o, a 14 W 1.29'- ST,
City: 0p0. L oc- k'c_ State: % zip: 33v.6-411
Qualifier Name: Phone#:
State Certification or Registration #: Certificate of Competency #: v. " ,
-
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $
Type of Work: ❑ Addition ❑ Alteration
Description of Work: 2 2 4Qi?.�'11A C
Square/Linear Footage of Work:
❑ New ❑ Repdr/Replace
A AL ��, n ,. -V A Oft-' ,AlkQI. .
Specify color i2f color thru tile:
Submittal Fee $ Permit Fee $ CCF $ `CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ l''.. Notary $
Technology Fee $
Structural Reviews $
(Revised02/24/2014)
Training/Education Fee $ ,Double
Bond $
Demolition
i., '.
TOTAL FEE NOW DUE $ 105 '141-0
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
State
Zip
Zi
Application is hereby made to obtain a permit to do the work 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 regulating
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS,
FURNACES, BOILERS, HEATERS, TANKS, AIR CONDITIONERS, ETC.....
OWNER'S 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.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. 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 building permit with an estimated value exceeding $2500, 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 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 building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature NN2d / 1 /.;r-4�
OWNER or AGENT
The foregoing instrument was acknowledged before me this
� day of LJ 20 by
Tri 2(C,44 , who is per49n—! i)own to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC: /
Sign:
Print: 'f`. 9
°' o'
Seal:
APPROVED BY (
(Revised02/24/2014)
Signature .
CONTRACTOR
The foorregoing instrument was acknowledged before me this
��1 day of 20 12 by
.��
in
qn L w is personally known to
me o)who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Plans Examiner
Structural Review
Zoning
Clerk
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
li{►I I ��� ►� 1s#1 IRS
4 ss s s s s s s. ms
_IR RK . 1.'•11.2 Ps ,!r,2 . 1t 9 =
I ;-ts j:':Gy CURTIFY that t;Iis is a true copy of the
orig "�ULed�(gs 2611 n _day cl
z.c ?c
W114ESS rn t d and
w,&vr!) R�4 f . clerk,
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COVENANT OF CONSTRUCTION WITHIN RIGHT OF WATT
Whereas, (owner) T"- M, RI ct4c e -r S H RRA RAZE. #162588
hereinafter referred to as the owner of the following described
properly (address): 1322 A45 105 S,r
Legal Description: Lot 6-B Block Subdivision ANCE3
Folio# 11-,2,23a-0.?7-oi(oo
Requests permission to install (describe work): 1 a ror S -C z
!2c o ltd t&O .1.4cd S-
Within tli6 Oublic right of way of (address 1.322 NC /05 S'r, Mlh-Ml Sko2tSi F[ 33f3f3
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.
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 andfor
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).
Signature
Owner or Agent
State of Florida
County of Miami Dade
The foregoing instrument was acknowledged before me this '� day of 104, , 20 by
::12d Aj , who is personally known to me or who has produced
_ as identification.
NOTARY P BLIC:
Sign:
Tint: &IVod jd StiI IR SEAL:
;�Y ryes, LINDA M. SMITH
,�. Commission # FF 917472
er Expires September 21, 2019
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