PW-19-2204Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address
226 NW 92ND ST, Miami Shores, FL 33150
Contacts
Issue Date: 03/09/2020
Parcel Number
1131010331240
Permit NO.: PW-9-19-2204
Permit Type: Public Works
Work Classification: Public Works
Permit Status: Approved
Expiration: 09/08/2020
Laurence Cox Owner
CHAMPION CONCRETE Contractor
226 NW 92ND ST, Miami Shores, FL 33150
JAIME BASILIO
10280 NW 63 TER 105, DORAL, FL 33178
Business: 3052528055 jaimechampion@yahoo.com
Mobile: 3052193091
Home: 3059784333
Other:7864024802
Ins ection Requests:
Description: PAVER DRIVEWAY Valuation: $ 6,500.00 Insp Lion R9
Total Sq Feet: 800.00
Fees
Amount
Education Surcharge
$1.40
Public Works Permit Fee
$100.00
Scanning Fee
$3.00
Technology Fee
$2.50
Total:
$106.90
Building Department Copy
Payments
Date Paid Amt Paid
Total Fees
$106.90
Credit Card
03/09/2020 $106.90
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 tv above named contractor to do the work stated.
Authorized Signature: Owner / Applicant % Contractor / Agent
Date
March 09, 2020 Page 2 of 2
RECEIVED
NW Miami Shores Village SEP 0 2��9
Public Works Department '
(305)795-2210
Public works forms are available from the building department, 10050 NE 2nd Ave., Miami Shores, ,FFL 3•
PUBLIC WORKS PERMIT APPLICATION
Permit Type: Work in the Right -of -Way on Miami Shores Village or Miami -Dade Property
Permit#: S" 0 1 ' 212,03
Name of Applicant (if utility see below): ��(/�� cu-x
Owner off the following described property: /
Legal Description: Lot Block Subdivision HUisM mil'" .Srt (�
Folio #; 11-5 /Dl ����?
Address:
UTILITY NAME:
Qualifier/Authorized Agent:
Address:
City:
Telephone:
State Certification or Registration #:
CONTRACTOR NAME:
Qualifier/Authorized Agent:
AAA— /07 Y0 j(w
City: „012Ll>_/I'il -
Telephone:
State Certification or Registration #:
Email:
State:
State:
ZIP:
Certificate of Competency #
ZIP:
Email: V
G�r
Certificate of Competency #.
Requests permission to install (describe work, attach se arat
way: �CII hP.yl ZZU /�-w 2
Type of Work: ❑ Paving ❑ Utility ❑ Sidewalk
❑ Landscape ❑ Antenna ❑ Other:
DESIGNER: Architect/Engineer:
Address:
City:
Telephone:
Registration #:
Value of Work for this Permit: $
Permit Fee $ 100.00
Notary $
Bond $
if necessary) in the adjoining right of
❑ Electric ❑ Irrigation
State: ZIP:
Email: _
Squ Ire/Lineal Foota,'gei6f1No,�k
i�VV.KI/y�. _� ..i f.q..I.+•hiY•T lyt'iPw �, lw.•.p,�..µew.*.
*****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:
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 the
attachment. Also, a certified copy of the recorded notice of commencement must be post a the job
site for the first inspection which occurs seven (7) days after the `public works permit is iss a In the
absence of such posted notice, the inspection will not be approved and a'reinspection wi b charged.
Signature Y - \ �"—,
`Applicant or Authorized Agent
The foregoing instrument was acknowledged before
me this ILYW day of -r l Y , 20 19 , by
L ata nenee CvX who
is personally known to me or who has produced
as
identification.
NOTARY PUBLIC:
Sign:
Print: � —
SEAL: THE000RE R. GAY
it GG 111555
ai r`= Expires Juiy 11, 2021 i P SINDIA ALVAREZ
Wed tmTmyF&Ile+vrmawws-a" - ti+,yCOMMISSION 8GG2382?3 I.
EXPIRES: September 3, 2022
Bonded Thru Notary Public Underwriters : C%
APPROVED BY: Public Works Director, or Designee
Signature
The foregoing instrtamEnt was acknowledged, before
me this 2-0 day ofsL:p'7E2, 20_Lj_J by
YN NA !C:- N V-MAWbo F>PZ-I L a who
is personally known to me or who has produced
TL'Z 112A 4�4`I./ f tI cis 1V 9L) as
identification.
2017-04-15
NOTARY U LIC:
Sign:
Print:
SEAL:
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 796.2204
Fax: (305) 756.8972
CFN 21 19RO593478
OR EY, 31616 F'q 1864 (iPss)
RECORDED 09/20/201.9 15e21:;,,.-i
HARVEY RUVIN► CLERK OF COURT
NIANI-DARE COUNTY, FLORIDA
STATE 0 lDA, COUNTY 0 !19lAh4!•DADE
I HE ,E Y CERT;F t, z4 thisMiS.co .� f the
origi. a filed in tr Q , ,y of
WIT SS m sr. ;if S-�I.
HAR _Y R t, 'i}0it*g +4W-iy Courts
COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY —
Whereas,
(owner) '10�G� 607c-'-
hereinafter referred to as the owner of the following described
property (address): 1J7-.�- A40 R"2-�;7—
Legal Description: Lot Block! _ Subdivision
Requests permission to install (describe work):_ -Mj
Within the public right of way of (add
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
R
State of Florida
County of Miami Dade
The foregoing instrument was acknowledged before me this 2 5 A day of u f , 20 !9 , by
a CA h c e C o )e who is person 1 known to mg or who has produced
as identification.
NOTARY PUBLIC: (arv
THEODORER.GAY
Sign: � 4 CommissionAGG11150
Print: SEAL:Expires July 11, 2021
",*d Thu Trot F& W~ NM-"