PW-19-2873ENTERED
Miami Shores Village DEC 0 4 2019
Public Works Department
(305)795-2210 $x
Public works forms are available from the building department, 10050 NE 2"d Ave., Miami Shores, FL 33139
PUBLIC WORKS PERMIT APPLICATION
Permit Type: Work in the Right -of -Way on Miami Shores Village or Miami -Dade Property
Permit#: k1c D/
Z- 101 - �3
Name of Applicant (if utility see below):/-N'J
Owner off the following described property: `lgy /6/oZs I%-e,,' ^"J
Legal Description: Lot Block Subdivision
Folio #; r
Address: // .z►t �" Z
UTILITY NAME:
Qualifier/Authorized Agent:
Address:
City:
Telephone:
State Certification or Registration #:
Email:
CONTRACTOR NAME:
Qualifier/Authorized Agent: •��'
Address: -7
City: Vi
Telephone: I EEm�maa++il��:
State Certification or Registration #: Ls.K.-
Requests
way:
State:
6Of
i
State: �
ZIP:
Certificate of Competency #
ZIP:
Certificate of Competency #:
fission to install describe work, attach separate page if necessary) in the adjoining right of
i';V rV /l!i/'er I
Type of Work:
Paving
❑
Utility
❑
Landscape
❑
Antenna
DESIGNER: Architect/Engineer:
Address:
Citv:
Telephone:
Registration #:
❑ Sidewalk ❑ Electric ❑ Irrigation
State:
Email:
❑ Other:
ZIP:
Value of Work for this Permit: $ 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 $
toe')
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 reinspection will be charged.
Signature
<AppTicant or Authorized Agent
The foregoin instrument was acknowledged before
me this t da�y of /VdvetK %/ , 20 /9 by
Pfka yf W fSP%ed'Q who
is personally known to me or who has produced
as
identification.
NOTARY P BLIC:
Sign: ,,//
Print:
TRACY L. LOPEZ
MY COMMISSION # GG 340105
EXPIRES: June 20, 2023
Bonded Thru Notary Public llei
Signature
Company/Utility Agent
The foregoing instrument wps acknowledged before
this.?—?— ^
day `J6V 20_M by
MkA r d Yi CIL 7 who
is personally ktkwn to me or,ktho has produced
ARK PU
Si
Print:
SEAL:
as
DY PRl j1/
`� ,• �MISSIOry i�
1 G� EtGH 24 ••
#GG 287268 '
lie
//11111141111
*********************************************
APPROVED BY: I'd it Public Works Director, or Designee
2017-04-15
uuuiiiiumu omiuuumumuiiiiiii
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 766.8972
CFN 21-119Rj_ 74-2'566
OR BK. 31706 N t0E-7 (I N s )
HAIRVE'; RUIVI'H? CLERK OF Cn[jR,-
NIANI-DAE�E :_:OUNTY. FLORIDA
STATE OF FLORIDA, COUNTY OF MIAMI-DADE
I HEREBY CEP,TIFY that this is a trpe„Fo the
original flied in this office oh"4 0 y of
AD zo
WITNESS my h ind and .1 cial Seal.
HAft Cir t and County Courts
COVN�
A
D. C. �.:c
COVENANT OF CON TRUCTION WITH! JE SIE MERRIIT#310?,29
Whereas, (owner) r17j/r ej
�
hereinafter referred to as the owner ofthe following described
property (address):
Legal Descri ion: Lot Block Subdivision
—
Requests permission to install (describe work):al
Within the public right of way of (address)
1N 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 /4"
The foregotdc�_
nstrument was acknowledged before me this i day of I O✓YP, � `f , 20 1 �' , by
�Ii'611 r V
who is personally known to me or who has produced
as identification.
NOTARY P, BLIC: �p
Sign: c i�QL��j�F� ta�ti TRACYL.LOPEZ
Print: I rA' n ,r l L L cia eZ SEAL: ,: •MYCOMMISSION#GG340105
;Po: EXPIRES: June 20, 2023
-'%L;oF F�� •` Bonded Tbru Notary Public UndernrHers
Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address
Issue Date:12/09/2019
Parcel Number
1181 NE 92ND ST, Miami Shores, FL 33138 1132050270340
Contacts
Permit NO.: PW-12-19-2873
Permit Type: Public Works
Work Classification: Public Works
Permit Status: Approved
Expiration: 06/08/2020
ANDREW & DANIELLE BEYDA Owner CRR GENERAL CONTRACTORS INC Contractor
1181 NE 92 ST, MIAMI SHORES, FL 33138 ALEXANDER M RODRIGUEZ
18255 SW 68 CT, SOUTHWEST RANCHES, FL 33331
Business: 3057107861 arodriguez@crrgc.com
Description: DRIVEWAY APPROACH -CONCRETE Valuation: $ 0.00 Inspection Requests:
49
TotalSq Feet: 600.00
Fees
Amount
Notary Fee
$5.00
Public Works Permit Fee
$100.00
Scanning Fee
$3.00
Technology Fee
$2.50
Total:
$110.50
Building Department Copy
Payments
Date Paid Amt Paid
Total Fees
$110.50
Credit Card
12/09/2019 $110.50
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
regulating
the
information is accurate and that all work will be done in compliance with all applicable laws
ze the above named contractor to do the work stated.
Owner / Applicant /
/ Agent
Date
December 09, 2019 Page 2 of 2