PW-19-641Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address
Issue Date: 03/27/2019
Parcel Number
148 NW 96TH ST, Miami Shores, FL 33150 1131010240290
Contacts
Permit NO.: PW-03-19-641
Permit Type: Public Works
Work Classification: Public Works
Permit Status: Approved
Expiration: 09/23/2019
JOSE CABANILLAS RODRIGUEZ Owner
600 NE 36 ST APT 1917, MIAMI, FL 33187
Home: 7867478191 CABASCASITA@GMAIL.COM
EPIC CONSTRUCTION GROUP INC Contractor
JOSE SUAZO
19390 NW 87 PL
Business: 7868973090
Mobile: 3057201998
Description: ADD DRIVEWAY Valuation: $ 1,800.00 Inspection Requests:
3t75.762-4949
TotalSq Feet: 150.00
Fees
Amount
Education Surcharge
$0.40
Public Works Permit Fee
$100.00
Scanning Fee
$3.00
Technology Fee
$2.50
Total:
$105.90
Building Department Copy
Payments
Date Paid Amt Paid
Total Fees
$105.90
Credit Card
03/27/2019 $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 zoning. Futhermore, I authorize the above named contractor to do the work stated.
Authorized Signature: Owner / Applicant / Contractor / Agent Date
March 27, 2019 Page 2 of 2
�Fc
�.•�+ Miami Shores Village
Public Works Department
(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 Property r
Permitit
Name of Applicant (if utility see below):
Owner off the following described property:
Legal Description: Lot Block Subdivision
Folio #;
Address: l k. ff u) m,17 w ) 5 n SO
UTILITY NAME:
Qualifier/Authorized Agent:
Address:
City: State: ZIP:
Telephone: Email:
State Certification or Registration #: Certificate of Competency #
CONTRACTOR NAME:
Qualifier/Authorized Agent: S ✓A *d,
Address: 14ra iO N LA.> 8 'T"� +�I& C-t
City: 44,,e /*.-In State: ZIP: 3 3 o f 9
Telephone: 49(( 84+ 34D90 Email: J F6vo2oQ tp:c canTiyToil fin'✓tl . Gunn
State Certification or Registration #: � C1 G is1 &-s3gCertificate of Competency #:
Requests permission to install (describe work, attach separate page if necessaf) in the adjoining right of
way: /�!�'V�A'/►i � I" tors � i ��. rEt� GID�rOQ ei. l ✓1 L. `J J'-J
Type of Work: ❑' Paving ❑ Utility ❑ Sidewalk ❑ Electric ❑ Irrigation
❑ Landscape ❑ Antenna ❑ Other:
DESIGNER: Architect/Engineer:
Address:
City:
Telephone: _
Registration #:
Value of Work for this Permit:
Permit Fee $ 100.00
Notary $
Bond $
State:
Email:
ZIP:
Square/Lineal Footage of Work:
***** Fees *****
Training/Education $ 0.20 Technology Fee $ 0.80 Scanning $
(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 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
thorized Agent
The foregoing ins umen•.t,A�was� acknowledged before
me this ZL d y of r`fA�✓W� . 20__Lq_, by
JOs� 1=�, S✓/-I;zO who
is pegrsonally known to me or who has produced
.Aizide/L�c_S'.ZDO5 24-9Z f(d/--bs
identification.
Sign:
Notary Public State of Florida
Marta Mack
f� My Commission GG 299389
Expires 02/07/2023
Signature
Company/Utility Agent '
The foregoing instrument was acknowledged before
me this241" day of h'to2C4-4 , 2019 • by
TO Z C—AI6"IU-AY `laprlr/uf Z who
is personally known to me or who has produced
r-L— as
identification.
NOTARY PUBLIC
��'a��'•��N2 ON '' • • N *�'�i
Sign:
LO'
Print: A2l.Frv� Sly
SEAL: o .• 0? s ��
***** **************************************
APPROVED BY: :�a� Public Works Director, or Designee
2017-04-15
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 W THIN RIGHT OF WAY
Whereas, (owner)�Yt4e C- r9�"IMS
hereinafter referred to qp the owner of th follo i g described
property (address): ��! �I� i' s1t�,i S(&�5
Legal Description: Lot JD Block 5: Subdivision
bI--I) Wf
Requests permission to install (describe work): I ' 0, h
Within the public right of way of (address) ISB N vJ At yFL
1231 co
OR BK. :723b! F'3 1226 (1F'3s i
l.filll `1'f;ifl !111_JP;ITn iLl}.]tA
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). 41ArE: cx FLORW ►, GOUN,nr of DAOE
' HEREBY CERTIFY that thus is a tare copy of &9 o
mmmal rw A this elrice o�L�� �-- 'i CUM
Signature
State of Florida
County of Miami Dade
The foregoing instrum
TL lit S�
NOTAq PUBLIC:
Sign:
Print: We
Owner or Agent
=1ARVEY RUVIN,
� a
I
.,_._
ent was acknowledged before me this 12 day of , 20 Lln_, by
who is personally known to me or who has pro uced
as identification.
cjeNwuapun mnq% Amm N41 moos
SEAL: ZZOZ £ jagwaldaS *S3211dX3
£LZ8£Z 90 # NOISSIWW03 AR
Z3VVAIV VICINIS