PW-19-2526Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address
Issue Date: 01/03/2020
Parcel Number
18 NE 106TH ST, Miami Shores, FL 33138 1121360060070
Contacts
Permit NO.: PW-10-19-2526
Permit Type. Public Works
Work Classification: Public Works
Permit Status: Approved
Expiration: 07/01/2020
MARILENE SCHOFIELD Owner
18 NE 106 ST, MIAMI SHORES, 33138
ROSS SERVICES Contractor
BARRY S GRIEPER
5325 NW 109 LN, CORAL SPRINGS, FL 33076
Business: 9542278944 rossservices713@gmail.com
Ins Requests:
Inspection R
Description: INSTALL APPROX .800 SQ FT PAVERS Valuation: $ 10,700.00 Inspec 499
DRIVEWAY/WALKWAY /SWALE
Total Sq Feet: 800.00
Fees
Amount
Education Surcharge
$2.20
Public Works Permit Fee
$100.00
Scanning Fee
$3.00
Technology Fee
$2.50
Total:
$107.70
Building Department Copy
Payments Date Paid Amt Paid
Total Fees $107.70
Cash 01/03/2020 $107.70
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
regulating construction and zoning. Futhermore, I authorize the above r
work will be done in compliance with all applicable laws
the work stated.
Authorized Signature: Owner
/ Applicant / Contractor / Agent
Date
January 03, 2020 Page 2 of 2
ENTERED
OCT 24 2019
,v Miami Shores Village
Public Works Department
(305)795-2210
Public works forms are available from the building department, 10050 NE 2nd 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#: fW —1p- iq" ;15a'ty
Name of Applicant (if utility see below): MAR lLEh E SCHOP LD
Owner off the following described property:
Legal Description: Lot % Block 202 Subdivision bUt71111765 tifl�l/•f1 �St/OK'f..S
Folio#; _!/2/,3(000(, 00%0 F_X% A/OZ
Address: /_S NE /06 c57- 14/,4A41 sN0,'eE S PL
UTILITY NAME:
Qualifier/Authorized Agent:
Address:
City:
Telephone: Email:
State Certification or Registration #:
State:
ZIP:
Certificate of Competency #
CONTRACTORNAME: -KOSS 5gtyl'CeS
Qualifier/Authorized Agent: S. ,4/e12/� ,&1E,4Ek
Address: 620 W COS ilneg6l, -L 4,3/Vr/ _#-,_
City: State: FL ZIP:
Telephone: 9 ?_27,Wqq Email: 0
State Certification or Registration #:CGC/.SD7S2Z Certificate of Comp ency #:
Requests permission to install describe work, attach separate page if necessa ) in the adjoining right of
way: A P E&O X 90O W pallars dr! Ue ag avid ;cc�a,
Type of Work: 0
El
Paving ❑ Utility ❑ Sidewalk ❑ Electric ❑ Irrigation
Landscape ❑ Antenna ❑ Other:
DESIGNER: Architect/Engineer:
Address:
City: State: _
Telephone: Email:
Registration #:
Value of'Wor`k for',this Permit:
I — f
ZIP:
5 . ..t€r._...r...*HwA^r:r ti",al..rYs-n w.. Y1•. .�•.
Square/Lineal Footage of Work: 00
F
*****Fees*****
Permit Fee`$'200:00�
Notary $ Training/Education $ 0.20 Technology Fee $ 0.80 Scanning $
Bond $ (if required) Total Fee Now Due $ �� • �O
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.
Signatur
Ap cart rAutho zed Agent
The foregoing Instrument was acknowledged before
me this 19 day of AvG sr . 20 69 , by
MAIL! E 5G who
is personally known to me or who h roduce
FL- D L as
identification.
Print:
SEAL:
Signature
Company/Ofility Agent /
The foregoing instrument was acknowledged before
me this 2,41 day of O(-T 20� by
who
is ersonally kn to me or who has produced
as
identification.
Sign:
Print: 5AI)b0 �-• j�fVt2A
SEAL:
,,,, SANDRA L RIVERA
SANDRA L RIVERAo; Notary Public - State of Florida
Notary Public - State of Florida ': - Commission i GG 71319
:. .:
Commission N GG 71319 My Comm. Expires 04.03 2021
My Comm. Expires 04-03-2021 Kr`; Bonded Through
National NotaryAsaooiation
APPROVED BY: L on , Uk-'Min , Public Works Director, or Designee
2017-04-15
IIIIII III II IIIII IIIII IIIII IIIII IIIII IIII IIlI
C-F*'N /'21_119'R1ic34294
OR BK. 31581 Pq 3670 (iF`ss)
F'E[IIi'�,
It�fZVEY fiUt IN Y (i_E.RK OF :i71_ R
h1±,alIT-Ci;:C{ :ilJKY9 FLOR11-11A
COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY
Whereas, (owner) i- Ayz i t i`h r= Sr-N o v i EL I) hereinafter referred to as the
owner of the following described property (address): i 8 N E Io(o zT m i &m 1 skolzF.So'F L331M
Legal Description Lot r_ Block 2 0 2- Subdivision Do n n i S
Folio # 11, 2 i3lo - 006 - 0690 M I A M I .SIRES
Requests permission to install (describe work): InS+ai�Trox SOO onyerS
Within th6tubiic right of way of (address) Is N E into ST M iA t-11 5 n RE.SFL, .331,38
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 f Mi hores Village (or his fully authorized representative).
4
,Uwner or Ag0nt
.The foregoing instrument was acknowledged before me this 1_ day of Jut_ , 20 IC{ , by
HARILEne nct-Ap IEU-) who is personally known to me or who has produced F D L
as identification and who did take an oath.
NOTA P LIC:
Sign:
Print: 44 C, ki i
My Commission Expires:
, SANDRA L RIVERA
Notary Public - State of Florida
s Commission • GG 71319
My Comm. Expires 04-03-2021
iy `r� Bonded Through
.br N.. National Notary Association
STATE OF FLORIDA, COWITY OF MIAM'-DARE
I HEREBY CERTIFY that this i of the
onjina]IW, in this office G of tiJ Z
., AD 20
HARVl:Y a Clerk ,uit Yn f unty Courts
I3Y — - D.G. �° co✓'
STRINGER M72204