PW-19-344Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
ft rAlt
Issue Date -
Location Address Parcel Number
815 NE 99TH ST, Miami Shores, FL 33138 1132060340100
Contacts
Permit NO.: i-0-1$-344
Permit Type: Public Works
Work Classification: Public Works
Permit status: Aourared
Expiration: 08/19/2019
CAROL STOBS Owner HARD J CONSTRUCTION CORP Contractor
815 NE 99 ST, MIAMI SHORES, FL 33138 MAC DONALD JUMBO
Other: 3057511692 20141 NW 2 AVE 217, MIAMI GARDENS, 33169
Business: 3059349971
Description: DRIVEWAY RE -PAVING ASPHALT Valuation: $ 1,499.00
Ins ection Requests:
305-762-4949
Total Sq Feet: 90.00
Fees Amount
Education Surcharge 0.40
Public Works Permit Fee 100.00
Scanning Fee 3.00
Technology Fee 2.50
Total: 105.90
Payments Date Paid Amt Paid
Total Fees 105.90
Money Order 02/19/2019 $105.90
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 areAquired f60 ELECy*ICfI ,, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
at all the foregoing information is accurate and that all work will be done in compliance with all applicable laws
Futhermore: I authorize the above named contractor to do the work stated.
Authorized Signature: Owner / Applicant /. Contractor / Agent Date
February 19, 2019 Page 2 of 2
RECE
B1491MiamiShoresVillage
BY:
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#: — 3-1/ 3
n
C,
Name of Applicant (if utility see below): Gf1G G' 7 S
Owner off the following described property:
Legal Description: Lot _ /3 Block 16 9 Subdivision '
Folio #; //- ;3;g 40 (}
I/.-- !.7% o
Address:
UTILITY NAME: %-U%lq ,
Qualifier/Authorized Agent: %
Address: zleye /71
City: /
Telephone: 6 l9_ . f
State Certification or Registration #:
CONTRACTOR NAME:
Qualifier/Authorized Agent: i.1V4
Address:
City: /!I
Telephone: ET 3TC___133 Z
State Certification or Registration #:
Certificate of Competency #
of Competency #:
Requests permission to install (describe work, attach separate page if necessary) in the adjoining right of
way: C/
Type of Work: Paving Utility Sidewalk Electric
Landscape Antenna Other:
DESIGNER: Architect/Engineer:
Address:
City:
Telephone:
e10.+inn vai;InY :;rtL+c3f'!'a t';M
VvValueo
State: ZIP:.
Irrigation
lJ Square/Lineal'Footage,of•Work: Q
Fees*****
Permit Fee $ 100.00
Notary $ Training/Education $ 0.20 Technology Fee $ 0.80 Scanning $
Bond $ (if required) Total Fee Now Due $
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 in 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
Applicant or Authorized Agent
The foregoi g instrum t as acknowledged before
me this d y of 20,E by
who
is personally known to me or who has produced
MIA as
identification.
Sign:
Print: MEGAN BOGAERT
SEAL: Notary u c • tate o]
Aon,
Florida
Commission M GG 255MyComm. Expires Jul ti
Bonded through National Nota
Signature
Company/Utility Agent
The foreggZng instrument a acknowledged before
me this day of F 20 %, by
1A1# "VU 1 177Uyy7' - t, who
i , onally kn to me or who has produced
as
identification.
t>
l
NnTORV PI IRI ir• r"*"IM, /;.iAL1
Sign:
Print:
SEAL:DERRIfCA GORDON
14ts of fFloritfe•Notery PublicCommission1FF22354
My Commission ExpiresE4)it 2? 201!
r 7sAPPROVEDBY: -4q 711 Public Works Director, or Designee
2017-04-15.
OWk COUNTY WOFSTATEOFFLM
tERltCS-TJFY that 9* ig 4469, Miami Shores Village
Building Department
ADX20
itWESni_yy7h w;4_a"W MW tj, 10050 N.E.2nd Avenue
HARVEY RUVIN, CLERK ou* ft'k N SOD Miami Shores, Florida 33138
F, —
D C.. Tel: (305) 795.2204
1 722 Fax: (305) 756.8972
rJ, C T OF CONSTRUCTION WITHIN RIGHT OF WAY
NUNN=
4Nhereas, (ow er)) ;bsX "*":; hereinafter referred to as the
bwner of the folio described property address): w
r- - -
MEMO= -:`.Legal Description of 1-5 Block 4 Subdivision
Folio # 0-3V 0/,600
40"NA"c' R.equests permission to install (describe work):
rr- LAeal4V
C1:1 7-
NVithin the public right of way of (address)
N CONSIDERATION of the approval of this permit by the Village, the owner agrees as follows:
is f
1. To maintain and repair, when necessary, the above-mentioned item(s) inctn1inri %AA+k;r, 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
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).
Signature,
Owner or Agent
The foregoing instrument was acknowledged before me this _day of 70—V-) 20 _n, byI95tb -S who is personally known to me or who has produced r\,)
as identification and who did take an oath.
NOTA
Sign
Print:
My Comm
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