PW-18-3695Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address Parcel Number
371 NE 103 ST, Miami Shores, FL 33138 1121360130270
Contacts
Permit NO.: PW-12-1 &3695
Permit Type: Public Works
Work Classification: Public Works
Permit Status: Applied
Issue Date: Expiration: 06/12/2019
GONZALO & JOHANNA NOALES Owner GONZALO & JOHANNA NOALES Applicant
371 NE 103, MIAMI SHORES, FL 33138 371 NE 103, MIAMI SHORES, FL 33138
Mobile:3056329753 GNOALES@GMAIL.COM Mobile:3056329753 GNOALES@GMAIL.COM
STATE ELECTRICAL CONTRACTOR LLC Contractor
ARMANDO CATO
1100 SW 97 AVE, MIAMI, FL 33174
Business: 7862567068
Description: SERVICE OVERHEAD & UNDEGROUND Valuation: $ 2,000.00 Inspection Requests:
REVIEWER./INSPECTOR NOTE: All asphalt restoration will 305-762-4949
be done•with 1"'of HOT -asphalt nd 8" CLR bbase ff wider Total Sq Feet: 0.00
than trench and full width of alle '
Fees
Education Surcharge
Public Works Permit Fee
Scanning Fee
AAm
Technology Fee
Total:
Building Department Copy
Payments
Date Paid Amt Paid
Total Fees
$105.90
Credit Card
12/17/2018 $105.90
Amount Due:
$0.00
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores
Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate
permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws
regulating construction and zoni>eFut��rmqm'l authodze the above named contractor to do the work stated.
/ Applicant // onTff=r / Agent Date
December 17, 2018 Page 2 of 2
0
\�`\\ 4BY:_CL
4 201$Miami Shores Village
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
Name of Applicant (if utility see below):
Owner off the following described property:
Legal Description: Lot Block Subdivision
Folio #;
Address:
UTILITY NAME:
Qualifier/Authorized Agent:
Address:
City:
Telephone: Email:
State Certification or Registration #:
State:
Permit#:
tiv —,.a
ZIP:
Certificate of Competency # ,
CONTRACTOR NAME: `!SAS 17"Tr 47 G� er— • /)1,5t -C, , C—!—
Qualifier/Authorized Agent: o0t2t /fAA'5-7� p47-/- 2-00
Address: Od • ttJ . /'�7/.0
City: State: L ZIP:
Telephone: Email:
State Certification or Registration #:tl & Certificate of Competency #:
Requests permission to install (describe work, attach separate page if necessary) in the adjoining right of
way: 2yc�'V_D SI—xyi Cc= _
Type of Work: ❑ Paving ❑ Utility ❑ Sidewalk E✓J Electric ❑ Irrigation
❑ Landscape ❑ Antenna ❑ Other:
DESIGNER: Architect/Engineer:
Address:
City:
Telephone:"
Registration #:
Value of Work for this Permit:
i a ,.
Permit Fee $ 100.00
Notary $
Bond $
State:
Email:
ZIP:
$ �� Square/Lineal Footage of Work:
+r .3
*****Fees*****
Training/Education $ 0.20 Technology Fee $ 0.80 Scanning $
(if required) Total Fee Now Due $ b
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 •o the issuance of a public works permit with an estimated value
exceeding $2,500, the applicant ust promise in good faith that a copy of the notice of commencement
and construction lien law brochu a 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 wNth occurs seven (7) days after the public works permit is issued. In the
absence of such posted notic , the inspection will not be approved and a reinspection will be charged.
Signature
Applican r'Aut orized Agent
The foregoing instrument was acknowledged before
me this 7-1 ` day of :�DX c 20 (Y , by
6"ZZA(z-�2 A)04LCS who
J er pnally known tome or who has roduc d
-f� «S� kV0-N3- 61-W-IT
identification.
NOTARY PUBLIC:
Sign:
Print:
SEAL:
APPROVED BY:
2017-04-15
Signature
Company/Utility Agent
The foregoing instrume t was acknowledged before
me this -,?A day of C 20 by
�,412-ltpt1t C> i-)7( 70 who
is personally known to me or who has produced
as
identification.
NOTARY PUBLIC:
Sign:
Print:
Notary Public - State
ofFlorida SEAL:
`s
;;"•; NotaryPuWic- StateoPFlj
Commission t GG 112857
• Commission # GG 1128
My Comm. Expires Dec 15, 2019
My Comm. Expires Dec 15,8ordedthrou9hNationalNotaryAssn.8crdedthtoughNationalNotar
Public Works Director, or Designee