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PW-19-2599Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Issue Date:11/07/2019 Location Address Parcel Number 424 NE 103RD ST, Miami Shores, FL 33138 1132060170750 Contacts Permit NO.. PW-10-19-2599 Permit Type: Public Works Work Classification: Public Works Permit Status: Approved Expiration: 05/05/2020 OMAR HERRERA Owner TRUE STAMP CONCRETE LLC Contractor 424 NE 103RD ST, Miami Shores, FL 33138 WILLIAM TRUEBA Mobile: 3057107071 Business: 3054944465 wtrueba@yahoo.com ect Description: PLAIN CONCRETE APPROCHABLE IN SLAB PATTERN Valuation: $ 1,000.00 Ins ion Requests: AND REPLACE SIDEWALK Total Sq Feet: 400.00 Fees Education Surcharge Public Works Permit Fee Scanning Fee jAmnl Technology Fee Total: Building Department Copy Payments Date Paid Amt Paid Total Fees $105.70 Cash 11/07/2019 $105.70 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 accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore, I authorize the above named contractor to do the work stated. Authorized Signature: Owner / Applicant / Contractor / Agent Date November 07, 2019 Page 2 of 2 r ENTnRED OCT SO, 2 19 Miami Shores Village Public works Department By. (305)795-2210 Public works Corms are available from the building department 10050 NE 2"d Ave., Miami Shores, FL 33138 PUBLIC WORKS PERMITAPPLICATiON Permit Type: Work In the Right -of -Way on Miami Shores Village or Miami -Dade Property Permit#: �a /O -- /o/ - z 3 /Z ►FW -10-19 - A5` cv Name of Applicant (if utility see below): 0& A mil. Pe,& k P k q Owner off the following described property: _ Legal Description: Lot 4.,,J„ (dock Subdivision f9 OIL O Folio #; 4:7 Q2•!�: e Address: tiF _��Z_ �7it`e e7`' M /; rt . S 4� A- s . ,_-)L 3 ( 3 UTILITY NAME: Quallfier/Authorized Agent: Address: City: State: ZIP:. Telephone: Email: State Certification or Registration #: Certificate of Competency # CONTRACTOR NAME: �� � ��/ t'rt� ea " . Qualifier/Authorized Agent: Address: v Q 2 City: JM / 1211C2 4 State: /—"c ZIP:7> 3 / Z 7 Telephone: %o 4 C/9L(cAt( Email: ' State Certification or Registration #: 50 _Certifica of Competency #: Requests permission to install (describe work, attach separate page if necessary) in the adjoining right of way: et4'4ZC � Type of Work: ❑ paving ❑ Utility Sidewalk ❑ Electric ❑ Irrigation (] Landscape 0 Antenna [Other: �/¢T1w"opR6,4 DESIGNER: Archttect/Engineer: Address: Citv: Telephone: Registration #: State: Email: ZIP: Value of Work for this Permit: $ //Q a Q Square/Lineal Footage of Work: ( W ***** Fees ***** Permit Fee $100-00 Notary $ Training/Education $ 0.20 Technology Fee $ 0.80 Scanning $ Bond $ (if required) Total Fee Now Due $ JQs •O Bonding Company's Name of 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 Installatlon has,commenced prior to the issuance of a permit and that all workk will be performed to meet the standards of all laws, regulation construction in this jurisdiction. I understand that separate permits must be secured for APPUCAA n AFFIDAVIT: I certifythat ail 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 severe (7) days after the public works permit is issued. In the absence of such posted n i._..^+ion will not be approved and a reinspection will be charged. Signature ` kmskant or Authorized The foregoing instrument was�wledged before me this � day of © C I` 21tij� , by 11.....l-A .-PA A ✓R,4 who isally known to me or who has produced M identification. Sign: Q Print his La�eZ SEAL Commt Wm of GG 306334 Expires September 18, 2023 �Oif1.� B�ndWTMuBWpMNNMTSrrykp Signature 6�z Company/UtI ty Agent The foregoing Instrument was acknowiedpd fore me this day of CX-7% ZO (M by 4/14Z CA-g �q who ip-knoa me or whoo has produced as Identification. Sign: Print; G.r�2 l.S toL'ei ARANELISGONZALEZ SEAL: r • Commission N GG 366334 Expires �OF f!Irj Bonded Tfeu BBpudget Notety Smrkee # # #######t • ##*#############irk########at#* APPROVED By. Public Works Director, or Designee 2017-04-15 CFN 2019RO577517 OR BK 31607 P9 236E (Pss) RECORDED 09/16/2019 10:00:3E Miami Shores Village HARVEY RUVINt CLERK. OF COURT Building Department MIAMI--DADE GOUNTYr FLORIDA 10050 N.E.2nd Avenue Miami Shores, Florida 33138 STATE OF FLORIDA, COUNTY OF MIAMI•DADE as COUNTY Tel: (305) 796.2204 1 HEREBY CERTIFY th this is a true copy of the �P C:EPK on inal filed in thi . i on day of �` Op -A Fax: (305) 756.8972 [� AD 20 i" H 4"ATNESS y hand and ffici Seat. �v wWs COVENANT OF CONSTRUCTION WITHIN RIG OF R 1nN a County C D C 4y Whereas, (owner)aM,, /L �& /LIL p I w JESME MERMTT #31 hereinafter referred to as the owner of the following described property (address): 42q ti% /p '77 S7A-,ee7,",,0,4 i S�O�Ps Legal Description: Lot pBlock 92- Subdivision jqr,D & oG 5Wox es -Fefle-# '-o--- - — -- ---- Requests permission to install (describe work): Qti� l� _61f-P�`-P W_&p in the public right of way of (address) IfIC (o 3 5- 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-ef-Dad-e-Go4 ty, Florida by the Village Manager of Miami Shores Village (or his fully, orized representati-Ve). Signature Owner or Agent State of Florida County of Miami Dade h e_*1, The foregoing instrument was acknowledged before me this �`� day of — lw,\4vrr-Qrq who is personally known to me or who has produced l' (V'h N__as identification. NO rR P BLIC: Sig Print: �o SEAL: