PW-19-1041Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address
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Issue Date: 05/10/2019
Parcel Number
501 NE 106TH ST, Miami Shores, FL 33138 1122310140090
Contacts
Permit NO.: PW-05-19-1041
Permit Type. Public Works
Work Classification: Public Works
Permit Status: Approved
Expiration: 11/06/2019
JAMES FIELDS Owner CHAMPION CONCRETE Contractor
501 NE 106 ST, MIAMI SHORES, FL 331382045 JAIME BASILIO
10280 NW 63 TER 105, DORAL, FL 33178
Business: 3052528055 jaimechampion@yahoo.com
Other:7864024802
Inspection Requests:
Description: TRAVERTINE PAVER DRIVEWAY, WALKWAY AND Valuation: $ 1,200.00 Inspec ion Re
PORCH
49
TotalSq Feet: 200.00
Fees
Amount
Education Surcharge
$0.40
Notary Fee
$5.00
Public Works Permit Fee
$100.00
Scanning Fee
$3.00
Technology Fee
$2.50
Total:
$110.90
Building Department Copy
Payments
Date Paid Amt Paid
Total Fees
$110.90
Credit Card
05/10/2019 $110.90
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 AFFIDA)AT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws
regulating construgfion and zoning. Futhermore, I authorize the above named contractor to do the work stated.
Authorized
Owner / Applicant / Contractor / Agent
Date
May 10, 2019 Page 2 of 2
I
Miami Shores Village
Public Works Department
(305)795-2210 $
Public works forms are available from the building department, 10050 NE 2n1 Ave., Miami Shores, FL 3'
PUBLIC WORKS PERMIT APPLICATION
Permit Type: Work in the Right -of -Way on Miami Shores Village or Miami -Dade Property oI
Permit#: S� 1 — I� 1 -
Name of Applicant (if utility see below): /
Owner off the following described property:
Legal Descri ion: Lot Block Subdivision
Folio #; 1 Pwuid
Address: � ti'% //1 � 7�i �T'
UTILITY NAME:
Qualifier/Authorized Agent:
Address:
City:
Telephone:
State Certification or Registration #:
Email:
CONTRACTOR NAME: 15! .41 4&,&
State:
Qualifier/Authorized Agent:
Address: l02.d-0 AV 7M& .
City: State:
Telephone: Emai
State Certification or Registration #:
ZIP:
Certificate of Competency #
ZIP:
of Competency #:
Requests permission to install (describe work, attach separate page if necessary) in the adjoining right of
way:
� Ott+'�+t+/;+1•
Type o Work.',D Paving ❑ Utility ❑ Sidewalk. ..El.... Electric.. ._,E1,Jrrjgption
Landscape ❑ Antenna ❑ Othef: y� '
DESOTER: Archie t/Engineer:
=Address:
City: ." f .� State: ZIP:
''•,,,Telephone` ` Email:
Registration M
Value of Work for this Permit: $ 20U . 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.1c) • 9 O
0
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 sted at the job
site for the first inspection which occurs seven (7) days after the public works permit ' issued. In the
absence of such posted notice, the inspection will not be approved and a reinspecti will be charged.
Signature Q�LU� Signature
pplicant or Authorized Agent
The fore instrume was acknowledged -before The foreg
methise day of 20C by a this _
' who
Cbmpany/Utility Agent
instrument�vy s acknowledge efore
day of V 20 by
is personally known to me or who has produced
rsonally known to me or who has p
identific
i .
DOGASILIO
JAIMEARMPJ.
ion.
—751
MCOMMICN # GG 227924
..:
NOTAR
re
LI0Tc
ARY
Sign:
Sign:
10,
Print:
Print: (1144 V
O
SEAL:
SEAL:
t� Y P!Z g'4
*** **************************************
APPROVED BY: o Public Works Director, or Designee
2017-04-15
�7
l7
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) �.li�/71L.� 74YL_�1_5 hereinafter referred to as the
owner of the following described property (address):
Legal Description Lot Block Subdivision
Folio # d - Z31 D Off?
Requests permission to install (describe work): JA!/en sr
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 authorized representative).
Signature.
Owner or Agent
The foregoing instrume}I t te
as acknowledged before me this a- day of �/l�� 0 by
,Plo is personally known to me or who has produced
as identification and who did take an oath. STATE OF FLORIDA, COUNTY OF
I N�CSWy 1WtW • .. a ep
algho4w;flle a dw ow". «�
NOTARY PUBLIC:. HARVEY o�Cirou� d
Sign:
Print: U Too
My Commissio Exp' es: JESSIE MERRIT('#310,22g
My COMM15SION FF2213776
EXPIRES March 25, 2019
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