PW-20-420Miami Shores Village
Building Department NOZ L I M
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
BUILDING
PERMIT APPLICATION
❑BUILDING ❑ ELECTRIC ❑ ROOFING
FBC 201--
Master Permit No. PI/11 " 02 20" 42C�
Sub Permit No.
❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING [—]MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF j C��ANCELLATION ❑ SHOP
rr CONTRACTOR ` DRAWINGS
JOB ADDRESS: b 1 Ny � � s4-
City: Miami Shores County: Miami Dade zip:
Folio/Parcel#: ) I Z13 b --o Is the Building Historically Designated: Yes NO
Occupancy Type: l� Load: Construction Type: �L �� Flood Zone: Po BFE: FFE:
OWNER: Name (Fee Simple Titleholder): 3V s �� I�u-L—� a Phone#: 3c95- 205- ? / yl
Address: �' I P rs /0 "6p- S-�
City: M (►a n 1 5 �weState: Zip:
Tenant/Lessee Name: Phone#:_
Email:
CONTRACTOR: Company Name:
Address:
City:
Qualifier Name:
State Certification or Registration #:
DESIGNER: Architect/Engineer:
ne#:
Zip:
Phone#:
Certificate of Competency M
Address: City: State: Zip:
Value of Work for this Permit: $ 2-I 100 Square/Linear Footage of Work:
Type of Work: ❑ Addition El Alteration El New 2 Repair/Replace ❑ Demolition
Description of Work: Y yy--Qy4 �} S ®'"�1. 1 �l 1y GL.� �) (�. k.. �.� r) c -c
Specify color of color thru tile:
v
Submittal Fee $ Permit Fee $ CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Notary $'
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $.
Bond $
(Revised02/24/2014)
TOTAL FEE NOW DUE $
'r
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
State
Zip
Zip
Application is hereby made to obtain a permit to do the work 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 regulating
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS,
FURNACES, BOILERS, HEATERS, TANKS, AIR CONDITIONERS, ETC.....
OWNER'S 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.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. 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 building permit with an estimated value exceeding $2500, 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 attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspects' which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not; a�proved and o reinspection fee will be charged
OWNER or AGENT Wiz- " CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
T l� day of �-�C--C-4 l 20 2� by day of 20 , by
U-�� 5✓!U { b ,"�� is personally known to
me or who has produced fl , �1 V�� ' was me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign:_
l
Print:
Seal:
,,pY o •. SINDIA ALVAREZ
•;+: MY co # GG 22022
EXPIRES: September's,
' s'• 'O' puglic Underwfiters
APPROVED BY
(Revised02/24/2014)
who is personally known to
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
as
******************************************************************
Plans Examiner
Structural Review _
W 0"U4S
3 �3o(�aa
Zoning
Clerk
"po-p ILo✓ ENTERED
�. �,\✓� �\ ic)�� Miami Shores Village FEB 2 b 202
�� �ePublic Works Department
.(305)795-2210 ��yy'
Public works forms are available from the building department, 10050 NE 2nd Ave., Miami Shores"
PUBLIC WORKS PERMIT APPLICATION
Permit Type: Work in the Right -of -Way on Miami Shores Village or Miami -Dade Property
Permit#: ?" -t)-2 —�'`' Lf
Name of Applicant (if utility see below): �JVS-cQ� b V'j
Owner off the following described property:
Legal Description: Lot Block Zi 5 Subdivision Tk v-aW we,_5 M 10Yn i
Folio #; I I— Z 13 L a ok-)ba
Address: kn NE IoP Y-1 iA Y'1 I cS'h IPL 33 )(,1
UTILITY NAME:
Qualifier/Authorized Agent:
Address:
City:
Telephone:
State Certification or Registration #:
Email:
CONTRACTOR NAME:
Qualifier/Authorized Agent:
Address: V9 S W Z1. O
City: 6 -i 1 WL t
Telephone: —1 Ito — 3S16 �SJO r Email:
State Certification or Registration #: GC- I
Requests permission to install (describe work,
way: jVIS�a Lk_ YL&XAJ S---oiu C)at
State:
pSGb4P
ZIP:
Certificate of Competency #
F_C_� ZIP:
Certificate of Competency
rate page if necessary) in the adjoining right of
Type of Work: & Paving ❑ Utility ❑ Sidewalk ❑ Electric ❑ Irrigation
❑ Landscape ❑ Antenna ❑ Other:
DESIGNER: Architect/Engineer:
Address:
City:
Telephone:
Registration #:
Value of Work-:fo'r.this Kermit:
Permit Fee $ 100.00
State:
Email:
ZIP:
Square/Lineal Footage of Work:
Fees *****
Notary $ Training/Education $ 0.20 Technology Fee $ 0.80 Scanning $ /
Bond $ (if required) Total Fee Now Due $ 1 ID . 00
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 ood faith that a copy of the notice of commencement
and construction lien law brochure will be del to the person whose property is subject to the
attachment. Also, a certified copy of the recor tice of commencement must be posted at the job
site for the first inspection which occurs seven ys after the public works permit is issued. In the
absence of such posted notice, the inspection w lbe approved and a reinspection will be charged.
Signature G?nature
or Authorized Agent w Co p ny/Utility Agent
The foregoi g instrument was acknowledged before The foregoing instrument was acknowledged before
me this Zi day of 201-0 by me this ZS day of �IRCWA_Q_ YL- 20 20 , by
who A[L\4lr-", R� who
is personally known to me or who has produced 1—js per onally known to-+�e-o�i who has produced
*:::Z— Jp?1yr0_ as as
identification. identification.
NOTARY PUBLIC: NOTARY PUBLIC:
a\\\` IRil1//,1�LLQ,
Sign: N ti Sign:
arch 9
Print: '� s _ v ; Print:AM
SEAL: "c� . ® = SEAL: /y��,� �y��
#c, �Sa ® °j� • �/111I�1U1jR{J ��adnol 1
Ide
OMM
E 0` (&8nWftA=N*y���\\♦♦♦
ii:;J l l t?l4�EV\
********************************************
APPROVED BY: `; �dLO Public Works Director, or Designee
2017-04-15
CFN 2021DRID119639
OR Br, 31825 Ps 1350 (IP9s)
Miami Shores Village RECORDED 112/24/2ii2A 10:25:11-
HARVE'i RLJV114Y t LERK OF COURT
Building Department 111AMI--DADE COUNTY, FLORIDA
10050 N.E.2nd Avenue
Miami Shores, Florida 33138 STATE OF FLORIDA, COUNTY OF MIAMI-DADE as couyl
Tel: (305) 795.2204 1 HEREBY CERTIFY that this is a true copy of the ���° CLEAK
Fax: (305) 756.8972 orig���leiin Zhis office on___________—uay of p
Q _, HD ZG
WITNESS my ha d an fficial Seal. \9 Q�w_TRW
COVENANT OF CONSTRUCTION WITHIN RIGHThlzvr
le ° ircuita dCountypCourtI J
ac.
Whereas, (owner) sK-
k 1U ES E MERRITT #31'02
hereinafter referred to as the owner of the following describe
property (address): 1
Legal Description: Lot 144 Block 21. Subdivision s, N,r ! N q S Miami %l irt-5
i IF
Folio # I I -Z 13C, —oil _o% 0
Requests permission to install (describe work): JZ.-t�ot/c. Vas y�--r P<< w4,i 01 +
�E Y S 144) I S �aUtsZS
GXT 7
Within the public right of way of (address) L,_ 1 S}-yo ie olk Sl.0Xs
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':'b`y 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 igns, until such time as this obligations has been canceled by an affidavit filed in
the Pub�corade County, Florida by the Village Manager of Miami Shores Village
(or his 11presentative).
Signature.
Owner or Agent
State of Florida
County of Miami Dade
The foregoing instrument was , acknowledged before me this Z4 day of f , 20 , by
k` p,
S�-A}-I Fv��oti who is personall�,)rd�rvr;e or who has produced
1:�,(2kvr/L —aside tification. `` •"°• °•``c'�
NOTARY PURLt�
Sign:
Print: -ADS_ ,� 5 ��r�2n F ;= rtv "' a�°r w SEAL: