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PW-19-731Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Location Address el - Issue Date: 04/05/2019 Parcel Number 46 NE 93 ST, Miami Shores, FL 33138 1132060130190 Contacts Permit NO.: PW-04-19-731 Permit Type: Public Works Work Classification: Public Works Permit Status; Approved Expiration: 10/01/2019 MARCOS LEDESMA Owner SILVINA E FAR Owner 46 NE 93 ST, MIAMI SHORES, FL 33138 46 NE 93 ST, MIAMI SHORES, FL 33138 Other:3054958880 Other:3054958880 CONSTRUCTION DEVELOPER GROUP Contractor CORP GUSTAVO ASMAN 20381 NE 30 AVE 414, AVENTURA, FL 33180 Business: 3052151988 Inspection Description: NEW DRIVEWAY SAME SIZE LIKE EXISTING Valuation: $ 1,000.00 Inspection Requests: 4949 1 BEDROOM & 1 BATHROOM TotaISq Feet: 130.00 Fees Amount Education Surcharge $0.20 Public Works Permit Fee $100.00 Scanning Fee $9.00 Technology Fee $2.50 Total: $111.70 Building Department Copy Payments Date Paid Amt Paid Total Fees $111.70 Credit Card 04/05/2019 $111.70 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 cons t �uthermore, I authorize the above named contractor to do the work stated. Il f c^ � 6e Authorized Signature: Owner / Applicant / Contractor / Agent Date April 05, 2019 Page 2 of 2 REcE� V EG 4Ppp420 -� 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 Permit#: PV v-04-4 I --7J' Name of Applicant (if utility see below): IAA r s lec6s ' c Owner off the following described property: Legal Description: Lot Block Subdivision Folio #; A4- -52q; -013 V19a Address: 41A ft 1;;J3rJ S e UTILITY NAME: Qualifier/Authorized Agent: Address: Citv: Telephone: State Certification or Registration #: CONTRACTOR NAME: Email: Qualifier/Authorized Agent: Address: 2-0 33-4 'M E 30 'We City: M k 4 0";PbpLad Telephone: 30S- 15Email: _ State Certification or Registration #: CG4C State: pevel State: ZIP: Certificate of Competency # ZIP: 3' 4N9iI . as Certificate of Competency #: Requests permission to install (describe work, attach separa a page if necpss ry) in the adjoining right of way:---tjew Drive wf s"r 4, i41 exK n Type of Work: ❑ Paving ❑ Utility ❑ Sidewalk ❑ Electric ❑ Irrigation ❑ Landscape ❑ Antenna ro Other: DESIGNER: Architect/Engineer: Address: City: State: ZIP: Telephone:,- �",,, ^,Email: r. Registration #:' 10 Value�of Work for this Permit: $' DC�Q Square/Lineal Footage of Work: , : a•'�w `•r �a"a7e'l- M`N"-'. V, . , �x v • ...... C . - _ . "- . *****Fees***** Permit Fee $ 100.00 Notary $ Training/Education $ 0.20 Technology Fee $ 0.80 Scanni(' $ Bond $ (if required) Total Fee Now Due $ t I. 'lc) 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 �11e i t inspection which occurs seven (7) days after the,public works permit is issued. In the abse a of such osted notice, the inspection -will not be approd anJ a reinspectibn will be charged. Sign v signat re Z plican1_or_AatI`orized Agent Company/Utility Agent The fotrume twas acknowledged efore The foregoing instrument wasacknowledged befmeetthiof aCCL— 20�, by me this `� ( day ol A/1Cke_Ct--,_ , 20� by -pw CCXS who ���� V -��^ who is personally known to me or who has produced is personally known to me or who has produced as as identification. identification. NOTARY PUBLIC: Sign: Print: SEAL: . �.✓v •G. Notary Pub*4 a of Florida Josefina C3erez o My Commissiat GO 2W740 A>, n Expires 09/3W2022 NOTARY PUBLIC: Sign: Print: SEAL: ��►" Notary Public SUM d FbrWm loaeflns Bens + My Commission G© 2UT40 �! or do Expires OW3W2022 APPROVED BY: L1- 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 Notice to Owner — Workers' Compensation Insurance Exemption Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05 allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to obtaining a building permit. Pursuant to the Florida Division of Workers' Compensation Employer Facts Brochure: An employer in the construction industry who employs one or more part-time or full-time employees, including the owner, must obtain workers' compensation coverage. Corporate officers or members of a limited liability company (LLC) in the construction industry may elect to be exempt if: l . The officer owns at least 10 percent of the stock of the corporation, or in the case of an LLC, a statement attesting to the minimum 10 percent ownership; 2. The officer is listed as an officer of the corporation in the records of the Florida Department of State, Division of Corporations; and 3. The corporation is registered and listed as active with the Florida Department of State, Division of Corporations. No more than three corporate officers per corporation or limited liability company members are allowed to be exempt. Construction exemptions are valid for a period of two years or until a voluntary revocation is filed or the exemption is revoked by the Division. Your contr for i requesting a permit under this workers' compensation exemption and has acknowledge that he or she will not use day labor, art-ti a employees or subcontractors for your project. The contractor has provided an affidavit stating that he or she will be the only person llowed to work on your project. In these circumstances, Miami Shores Village does not require verification of workers'/compens ion insurance coverage from the contractor's company for day labor, part-time employees or subcontractors. BY SIVIANG B LOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS Owner State of County of Miami -Dade t CThe foregoing was acknowledge before me this day of- ft , 20 By PO4GOS }- Qd.Q}5 tY-U-- who is personally known to me or has produced as identification. Notary: Joieflna Gerez SEAL: My Commission GG 23E710 of Expires 09/3 =n C161 CONSTRUCTION DEVELOPER GROUP. 20381 NE 30`h Ave. #414, Aventura, FL 33180 PH: 305-878-4688 FAX: 786-265-6263 April 2, 2019 State of Florida County of Miami Dade Before me this day personally appeared Gustavo Asman who, being duly sworn, Deposes and says: That he or she will be the only person working on the project located at: 46 NE 93rd street, Miami Shores, FL 33138 Gustavo Asman Construction Developer Group - Owner License Number: CGC1504895 Sworn to (or affirmed) a d subscribed before me this u day ofL .2019 By _�OS t iyO 2t--& \C��A Personally Know _ y Or produced Identification Type of Identification NotAly a G bS of Fld� Ofi Joscfina Gentz My Commisbion C,. 236740 p w Expires f " 13012022 Print, Type or stamp Name of Notaryz-c* � p IlIIII illll IIIII IIIII IIIII IIIII IIIII IIII.III Miami Shores Village Building Department 10050 N.E.2nd Avenue STATE Y Fro Miami Shores, Florida 33138 ' HEREE Y ,ERT Tel: (305) 795.2204 )fiW r t` Fax: (305) 756.8972 rrri • Ry nan, COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY CF N 2i_1 19F4t_121-- 16617 OR BK. P9 'W4 (1P9s) I":Try"".-r..f;".r_' :":pLi GolJNTY OF DADE AD NAS DC. GER #172204 Whereas, (owner) M V Cc�S QeSM A - hereinafter referred to as the owner of the ollowi g descdb property (address): l� `33l SdKePE' Legal Description: Lot a—s ock 2— Subdivision W4-m; `;61f( sec 4 AM) Folio# 14 - —Oa3-0490 Requests permission to install (describe work): TI=W 1D0�1retA"f4t Within the public right of way of (address) RE IN CONSIDERATION of the approval of this permit by the Village, the owner agrees as follows: 2. 3 9 Sign 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. 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. 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). The under ' ned further agrees that these conditions shall be deemed a covenant running with the land nd shall remain in full force and effect and be binding on the undersigned, their heir and as igns, until such time as this obligations has been canceled by an affidavit filed in th Public ecords of Dade County, Florida by the Village Manager of Miami Shores Village r his fully uthorize4zop.Lsentative). or Agent State of Florida County of Miami Dade The foregoing instrument was acknowledged before me this 31 day of /�'L�.''�_�, 20 M , by who is personally known to me or who has produced as identification. NOT Sign: Print ter+ Notary Pubk SWof Florida ;P 4; .losefins Geroz My Conaniaa GCi 23e710 S*aw ExpirosOW10fZ022