PW-18-2279Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Issue Date:
Location Address Parcel Number
40 NE 105 ST, Miami Shores, FL 33138-2031 1121360120060
Contacts
Permit NO.: PW8-1 &2279
Permit Type: Public Works
Work Classification: Public Works
Permit status: Approved
Expiration: 03/04/2019
RAUL V GUERRA Owner RAUL V GUERRA Applicant
40 NE 105 ST, miami shores, FL 33138 40 NE 105 ST, miami shores, FL 33138
Other: 3057965337 Other: 3057965337
BLUEWATER CONSTRUCTION & Contractor
MANAGEMENT CORP
RAUL GUERRA
Description: INSTALLATION OF PAVER DRIVEWAY Valuation: $ 1,000.00
Inspection Requests:
305-762-4949
Total Scl Feet: 662.00=j .==
Fees Amount
Education Surcharge 0.20
Permit Fee 100.00
Scanning Fee 3.00
Technology Fee 0.80
Total: 104.00
Building Department Copy
Payments Date Paid Amt Paid
Total Fees 104.00
Check# 14563 11/01/2018 54.00
Check # 120 08/27/2018 50.00
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 A DA IT: I certi I"the foregoing information is accurate and that all work will be done in compliance with all applicable laws
regulating constru n zoning. Futhermore, I authorize the above named contractor to do the work stated.
Applicant / Contractor / Agent Date
November 01, 2018 Page 2 of 2
RECEIVED
Miami Shores Village
Public Works Department AUG 2 7 2018
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 /Prro pe(rttyy
Permit#:` -sr ' "
Name of Applicant (if utility see below): &L.21 V, 6U
Owner off the following described property:
Legal Description: Lot Block Subdivision
Folio #; 11 — — --
Address: J() AJC 105 5E
UTILITY NAME:
Qualifier/Authorized Agent:
Address:
City:
Telephone:
State Certification or Registration #:
CONTRACTOR NAME: I
Qualifier/Authorized Agent: C
Address: "25b AJE 6q 01
City:
Telephone: D
State Certification or Registration
Requests permission to install (d
way: 1n5 AI QAInn
Email:
State: ZIP:
Certificate of Competency #
It ,my, Mr • i
ificate of Competency #:
be work, attach separate page if necessary) in the adjoining right of
QG.,Upw, A Y t J 0_W A_!A
Type of Work: Paving Utility
Landscape Antenna
DESIGNER: Architect/Engineer:
Address:
City:
Telephone:
Registration #:
Sidewalk Electric Irrigation
IOther:
State:
Email:
ZIP:
Value of Work for this Permit: $ Square/Lineal Footage,of..Work:.
y~
Z
Fees *****• , .•,
Permit Fee $ 100.00 .
R....... .,. ,..... . ..,
r .r:,
Notary $ Training/Education $ 0.20 Technology Fee $ 0.80 Scanning $
Bond $ (if required) Total Fee Now Due $ SY - G"l
Bonding Company's Name (if applicable):
Bonding Company's Address:
City: State: ZIP:
G
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 reirispection will be charged.
Signature— Signature
App ican or Authorized Agent Company/Utility Agent
The foregoing instrum was acknowledged before The foregoing instrument was acknowledged before
me this fi1lday of
t
U 20fJ by me this day of 20 by
who who
is ersonally kno o me or who has produced is personally known to me or who has produced
as as
identification.
NOTARY PUBLIC:
Print:/ /1 I..n
APPROVED BY:
2017-04-15
HALEY HOLEM Apt 1
MY COMMISSION 0 GG I'll' 164
EXPIRES:Ausust t, iJ'1 t
sondes Thro Notary Puuic Uncle, , : •'+
identification.
NOTARY PUBLIC:
Sign:
Print:
SEAL:
It , Public Works Director, or Designee
Miami Shores Village
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) 'jl 2 2
hereinafter referred to as the owner of the following described
property (address): ! O F ( n i'
Legal Description: Lot Block Subdivision
Folio # 2.1 6 'b1-.-r Ob
Requests permission to install (describe work): Ina-0Slc - d n paves
Within the public right of way of (address)
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 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 authoriz re resentative).
Signature.
er or Agent
State of Florida
County of Miami Dade h
Th fore oin instrument was acknowledged
fi
e this day of AJQ05-K20LLby
J 1 e, who is rsonally know to me or who has produceJI
as identification.
NOTARY PUBLIC
Sign:
Print: CA P L, TF
W;.
MLEYHOLEMAN
SEAL: (:
MY
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