The URL can be used to link to this page

REV-19-707Miami 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 Permit#: v- ol(- ('9 Name of Applicant (if utility see below): �tc' a 4 0.5 Owner off the following described property: Legal Description: Lot Block Subdivision Folio #; Address: 4/ u) G,.LII : 6kt E Y1'N&A6 i � iY�� 31So UTILITY NAME: Qualifier/Authorized Agent: Address: City: Telephone: State Certification or Registration #: Email: State: ZIP: Certificate of Competency # CONTRACTOR NAME: PSG 6"Ovc-7ITI&IU "40 Qualifier/Authorized Agent: 5 Address: 0 9 4-AA P WC City: State: L ZIP: 3 Q Telephone: Email: "� A�` GP• GGOl�s�7cr GD/l.gr+0c10, r� State Certification or Registration #: CQ C 1516629 Certificate of Competency #: Requests permission to install (describe w_orknh �attach sepa ate page if necessary) in the adjoining right of way: '� c. �PJ,� S Type of Work: ❑ Paving ❑ Utility Sidewalk ❑ Electric ❑ Irrigation ❑ Landscape ❑ Antenna ❑ Other: DESIGNER: Architect/Engineer: Address: Citv: Telephone: Registration M State: Email: ZIP: Value of Work for this Permit: $ �;-l/V 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 $ 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 Applicant or Authorized Agent The foregoing instrument was acknowledged before me this L dayof 20 !`:�J , by 7y9--- k who is personally known to me or who has produced as identification. NOTA UBLIC: Sign - Print: Print: �lNYIALl, Al.�L-QED, SEAL: APPROVED BY: 2017-04-15 Signature Z�a tility Agent The foregU instru ent was acknowledged before me this day of �' 20 t by -7i95i I- - SoA a?D who is personally known to me or who has produced as identification. NOTARY PUBLIC: Sign: (Ai Print: SEAL: DELFINA E LOPEZ SINDIA ALVAREZ MY COMMISSION # GG011630 :;v ...;• MY COMMISSION 4 GG 238273 o; E EXPIRES July 22, 2020 P ; XPIRES...eptember 3, 2022 (a 7) 3 Bonded Thru Notary Public Undenvritor3 9P-0 53 FloriAallotcrySeti co com Public Works Director, or Designee r Q I 148 NW 96TH STREET, MIAMI SHORES, FL 33150 IN POINT OF _ ( INTERSECTION uj Q i p •' I l` ` F I FOUND 112" IRON PIPE Q = 25. 16' ASPHALT ROADWAY SHORELAND BOULEVARD 0 0 v NW 96TH STREET (F) T ASPHALT ROADWAY 80' RIGHT-OF-WAY 0 0 v ND ON WALL INE± zi V EST 1121c I OF )0' M o 1 M LOT 9 Jz LOT 10 LOCK 5- i p BLOCK5 CLUDED) COVER o w 30.8' 0 CBS WALL 25.3' i CBS WALL o _, a= COVERED >- w - o' o z col --�' m - F_ Q `�' N o �I 9.9' '0 55, � a 50 9.0'4, Z) ¢� 3F �[jc—i 20.3 Lu af 2319' o cR O rr o 21.0' uj "'9.7' U � = .6 COVERED 9'g� Z a, UTILITY N Q o a 3 Z w m N I in � � - POOL oZ I o _ Z En bLu LL_ co 25.0' 0.0' 15.0' 75 00' D Poo lEnui nunrnnn^nu . . .... .... . 5SIDEWAN ; • • • • "BLOCK "" ' `-FOUND 1l2"! •:iLLO' ( ) CORNER .... IRON PIPE �••••� .'AYI.OT8 .... .... .... FENCE I ":"� 0.•BI.00K5 �� • 0.2 W �-BASISOF I • ••••: BEARING i : • I Erg �.i..' O I oo Y Lc) I 1— U N I N I OJ m I -FENCE j 0.1' W I REMAINDER; OF LOT 9 1 BLOCK 5 JOT INCLUDED ) FENCE I --r- ( ) LFOUND 1/2" FOUND 1/2 ? y • IRON PIPE LOT 11 PUMP IRON PIPE BLOCK 5 w Z t " e Z 2" ALL ANGLES AND DISTANCES SHOWN HEREON ARE BOTH RECORD AND MEASURED UNLESS OT RERWISE NOTED CURVE TABLE 17 LENGTH RADIUS DELTA C1 39.39' 25.00' 90°17'00" _:cnt�wu PHONE: 561.508.6272 THE APPEARING ON THIS D ENT WAS AUTHORIZED BY NSURVEYING, 1 FAX:561.508.6309 LB 8111C ;I 'MfiN ' L PSM 288 LLC. `fsQN 11/291201@ae 5601 CORPORATE WAY, SUITE 103 WEST PALM BEACH, FL 33407 °"� UAVEUV NexgenSurveying.com JE 'I :NV r 148 NW 96TH STREET, MIAMI SHORES, FL, 33150 LEGAL DESCRIPTION: THE WEST 1/2 OF LOT 9 AND ALL OF LOT 10, BLOCK 5, BONMAR PARK, ACCORDING TO THE PLAT THEREOF, RECORDED IN PLAT BOOK 17, PAGE(S) 11, OF THE PUBLIC RECORDS OF MIAMI-DADE COUNTY, FLORIDA. CERTIFIED TO: JOSE E. CABANILLAS FIRST INTERNATIONAL TITLE, INC. CITIZENS BANK, N.A., ITS SUCCESSORS AND/OR ASSIGNS FIDELITY NATIONAL TITLE INSURANCE COMPANY • • •••• • • • •••• FLOOD ZONE: • • • • • • • • • 12086CO302L • • •••••• •••• •••• ZONE:X • •••••• • EFF:9/11/2009 •••� •••• •••• SURVEY NOTES: •••• •••• • ••• - This survey is for conveyance purposes only and not intended for construction purposes without permission of t�tls6urveyor. • • NO NOTABLE CONDITIONS FOUND • •• •• • •• • ••w• • LEGEND AIC AIR CONDITIONER P& -PLATBOOK .-FENCE AL -ARCLENGTH P.G. -PAGE ., A -NUMBER CG -E 4 -CENTERLINE (O -CALCULATED P.U.E. - PUBLIC UTILITY EASEMENT n -ASPHALT D.E. -DRAINAGE EASEMENT R -RADIUS {ONCRETE C3 -CATCH BASIN (M) -MEASURED (R) -RECORD N-PAVEWBRICK -PDRAM P.Q.B. -POINTOFBEGINNING U.E. -UTILITY EASEMENT © --WOOD`0 1) -POLEOLEla 'MANHOLE P.O.C.-POINTOF COMMENCING WM -WATERMETER *-LIGHTPOLE -TOPOGRAPHIC ELEVATION ® -WELL SCAN MEI r �! r