PW-19-2508Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
U no
Issue Date12/02/2019
Location Address Parcel Number
1201 NE 94TH ST, Miami Shores, FL 33138 1132050100010
Contacts
Permit NO.. PW-10-19-2508
Permit Type: Public Works
Work Classification: Public Works
Permit Status: Approved
Expiration: 06/01/2020
BERNARD & DEMETRIO LORIS LEE Owner CORE BIM, LLC Contractor
1201 NE 94 ST, MIAMI SHORES, FL 33138 MICHAEL COURTNEY
Other: 9546736513 110 MERRICK WAY 3-A, CORAL GABLES, 33134
Business: 7864873895
inspection Requests:
Description: REMOVAL OF EXISTING ASPHALT DRIVEWAY AND Valuation: $ 12,000.00 inspec ion Re
CONSTRUCTION OF NEW CONCRETE DRIVEWAY
TotalSq Feet: 900.00
Fees
Amount
Education Surcharge
$2.40
Public Works Permit Fee
$100.00
Scanning Fee
$3.00
Technology Fee
$2.50
Total:
$107.90
Building Department Copy
Payments
Date Paid Amt Paid
Total Fees
$107.90
Credit Card
12/02/2019 $107.90
Amount Due:
$0.00
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores
Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate
permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and �at all work will be done in compliance with all applicable laws
regulating construction and zoning. Futhermore, I authorize the above named contract to do the work stated.
2 / 2-
Authorized Signature: Owner / Applicant / Contractor / Ageni V I Date
December 02, 2019 Page 2 of 2
r
,+ Miami Shores Village
Public Works Department
(305)795-2210
Public works forms are available from the building department, 10050 NE 2"d Ave., Miami Shores, FL 33138
PUBLIC WORKS PERMIT APPLICATION
Permit Type: Work in the Right -of -Way on Miami Shores Village or Miami -Dade Property
Permit#:
Name of Applicant (if utility see below): fey-N
Owner off the following described property:
Legal Description: Lot I Block Subdivision Wt / j►M I �, %iti5 f3q N
Folio #; 11 - 3 20 'j -OI0 " G a % a
Address: l Z01 Nt ' `i 54Y--t&
UTILITY NAME:
Qualifier/Authorized Agent:
Address:
City: State: ZIP:
Telephone: Email:
State Certification or Registration #: Certificate of Competency #
CONTRACTORNAME: Lb\7lrJMAM VICVVLiPvhJ'1
Qualifier/Authorized Agent: VVYIt.Ha L'L 6y13rly-kC1
Address: b 14V VIE 52 I-ewA [-
City: mhilml State: _V),
Telephone: 166 "'1 37 S Email: IML jP CoVr-}�
State Certification or Registration #: L C4 C 15 22$IZ.Certifi
ZIP: 33)i
of Competency
Requests permission to install (describe work, attach separate page if necessary) in the adjoining right of
way: 06YtGW--k- JYtvf IMn F—AA✓S 05 607-k rtslm of ✓ EW d
Type of Work: 3ZPaving ❑ Utility
❑ Landscape ❑ Antenna
❑ Sidewalk ❑ Electric ❑ Irrigation
❑ Other:
DESIGNER: Architect/Engineer: WA
Address:
City: State: ZIP:
Telephone: Email:
Registration #:
Value of Work for this Permit: $ 12,0o D Square/Lineal Footage of Work: 15�00 �-2 I✓
***** Fees*****
Permit Fee $ 100.00
Notary $ Training/Education $ 0.20 Technology Fee $ 0.80 Scannin $
Bond $ (if required) Total Fee Now Due $ JU • n
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 ZI day of 644%> 15 e —, 20 1 N, by
who
is personally known to me or who has produced
identification.
Sign:
Print:
SEAL:
APPROVED BY:
Signature
Company/Utility Agent
The foregoing instrument was acknowledged before
me this day of .20 by
is personally known to me or who has produced
as
identification.
NOTARY PUBL
Sign:
Print:
wwww. SEAL:
�*xv Notary Public State of FWids
Arnie Edmiston
My Commission GG 292496
Expires 01/17/2023
as
Public Works Director, or Designee
who
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
OR RX 31156 P3 i'JC (1F3s)
,,.-.
i-L l RI?_ir?
COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY
Whereas, (owner) .9 Lt-- E
hereinafter referred to as the owner of the following described
property (address): IZo I t rC Q µ+- e4 MlAyw Plo"s Alre
Legal Description: Lot I Block Subdivision mAAvAt 4Nnt4; 15Ay vied
Requests permission to install (describe work): Apo cat-tc,T_tc, Gtnele".
Within the public right of way of (address)12, ► /v 9 q- �trtg_4 plun4i 5AMV_5 � f-L 3 313 g
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 Villa
(or his fully authorized representative). STATE OF FLORIDA, COUNTY OF MIAMI-DADE Pao couy�.y
I HEREBY CERTIFY that this is a true copy of the � .o0
da of
original fi'.ed in this cff. y 13
Signature FCrncrc><pCT 2 2 �.. �Q
WITNESS my hand an�d? vial S I. v� w000..e,cust
Owner or Agent FiARVEY RUM,�ler,C aounty Courts
State of Florida
County of Miami Dade
The foregoing instrument was acknowledged before me this 21 day of �G�''L 20
Demd,VA Lee_. who is personally known to me or who has produced
as identification.
NOTA�LIC;
Sign:
Print: i i" L-T>4 vl I S RW SEAL
19 , by
wvw,✓
s���
lori
Notary public of Fda
Amk Edmiston
a w
My Commission 00 292490
Expires 01/17/2023