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PW-19-3019Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Location Address 1255 NE 95TH ST, Miami Shores, FL 33138 contacts Issue Date: 01/24/2020 Parcel Number 1132060144000 Permit NO.: PW-12-19-019 Permit Type: Public Works Work Classificatian: Public Works Permit Status: Approved Expiration: 07/22/2020 BLAINE AND LORI WILLENBORG Owner 1255 NE 95 ST, MIAMI SHORES, FL 331382549 Other: 3057542604 SFL Contractor ALEXIS JAVIER BADA 6331 SW 16 TER, Miami, FL 33155 Business: 7863568806 abada@soflalandscape.com Inspection Requests: Description: REMOVE EXISTING ASPHALT DRIVEWAY AND Valuation: $ 8,000.00 05-762-4949 CORAL STONE WALKWAYS & REPLACE WITH CHICAGO BRICK PAVERS Total Sq Feet: 890.00 Fees Education Surcharge Public Works Permit Fee Scanning Fee jAmnt Technology Fee Total: Building Department Copy Payments Date Paid Amt Paid Total Fees $107.10 Credit Card 01/24/2020 $107.10 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 FIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating J�q istruction and zoning. Futhermore, I authorize the above named contractor to do the work stated. Signature: Owner Applicant / Contractor / Agent Date January 24, 2020 Page 2 of 2 I�AiI�d � (2lzo Miami Shores Village ENTEIRED Public Works Department (305)795-2210 DEC 20�9 Public works forms are available from the building department, 10050 NE 2"d Ave., Miami Shores, FL 33 PUBLIC WORKS PERMIT APPLICATION BY: Permit Type: Work in the Right -of -Way on Miami Shores Village or Miami -Dade Property Name of Applicant (if utility see below): L-or,' (�t1( or, bar Owner off the following described property: Legal Description: Lot Block Subdivision Folio #; Address: It I'f' VE 19 ST UTILITY NAME: Qualifier/Authorized Agent: Address: Citv: Telephone: State Certification or Registration #: Email: State: Permit#:� �w-Izr\a—�t71 ZIP: Certificate of Competency # CONTRACTOR NAME: S # L Qualifier/Authorized Agent: '4W'T b•g Address: I y 9-S-0 sw Zla City: AA jr.,, ) State: rL, ZIP: Telephone: (-)I�1 �,ss6 _ % " ( Email: a 6A ��„g a rGsPt- r'00% State Certification or Registration #: 6641T1115T Certificate of Competency #: Requests permission to install (describe work, attach separate page if necessary) in the adjoining right of Type of Work: ❑ Paving ❑ Utility ❑ Sidewalk ❑ Electric ❑ Irrigation ❑ Landscape ❑ Antenna ❑ Other: DESIGNER: Architect/Engineer: Address: Citv: Telephone: Registration,#: State: Email:.. ZIP: :.A Value of Work for this Permit: $ ' $ioda Square/Lineal Footage of Work: $ 6 Sq ***** Fees ***** Permit Fee $ 100.00 Notary $ Training/Education $ 0.20 Technology Fee $ 0.80 Scanning $ Bond $ (if required) Total Fee Now Due r' 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 ppli nt or Authorized A e The foregoing instrument was acknowledged before me this IC% day of pcccA161V , 20 G1 , by 1oIr; 0--((,.5#f1 who is personally known to me or who has produced tit-, t as identification. NOTARY PUBLIC: Sign: Print: SEAL: ;;v:y'Se; eHAN c•: "' MY COMMISSION # GG136185 '405-71 EXPIRES August 20.2021 Signature Comoany/Utility Agent The foregoing instrument was acknowledged before me this day of Dice 20) 4 by WIN who is personally known to me or who has produced t1,W -- as identification. NOTARY PUBLIC: Sign: Print: SEAL: GEOFFREY CHAN MY COMMISSION # GG136185 EXPIRES August 20.2021 v n APPROVED BY: `�tY'� C`�-� , 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 CF N 2019RO77.3187 OR BK 31726 F9 4969 (1F'3s ) RECORDED 12/13/2019 15:25:06 HARVEY RUVIN, CLERK. OF' COURT IIIAMI-DARE COUNTYr FLORIDA STATE OF FLORID COUNTY OF MIAMI•DADE ao Covy I HEREBY CERTIFY t this is a true Copy of the �� CLEN( origin fllgd thjs o i i on AD 20 day of Z pk(; 3 WITNESS my hand and ficial Seal. s HARVEY RlJll�lt+� Clerk imuit and County Courts COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY IANASHIAARNWI Whereas, (owner) tart Ul-Ap-rx6ci hereinafter referred to as the owner of We following described property (address): OR 1r 51— s Legal Description: Lot 7Tf10 Block 9_ Subdivision A4ixl Aodlr �,_ C_ Folio # 11 - 3106 - 01q- goo v Requests permission to install (describe, work): r i Jt wc, F i- ir ,� Af- _ Within the public right of way of'(address) ►Z St NE /0.3T- 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). Signature � Owner or Agent State of Florida County of Miami Dade The foregoing instrument was acknov 1ri 1JIL4.3r" ,who is t lerne as NOTARY PUBLIC: Sign: Print: Gar; W IIIen Fjdr( . Bh d before me this 10 day of Pttcm6y , 20 17 , by nally known to me or who has produced SEAL: