PW-19-2723Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address
Issue Date:12/09/2019
Parcel Number
311 NE 103RD ST, Miami Shores, FL 33138 1121360130240
:ontacts
Permit NO.: PW-11-19-2723
Permit Type: Public Works
Work Classification: Public Works
Permit Status: Approved
Expiration: 06/08/2020
SERGIO SIGALA Owner PAMSCO INC Contractor
311 NE 103 ST, MIAMI SHORES, FL 33138 ROSSI ROBERT
9350 NW S RIVER DR, MEDLEY, FL 33166
Business: 3058873090 PAMSC01@AOL.COM
Description: PAVERS ON SAND AND DRIVEWAY APPROACH Valuation: $ 14,500.00 Requests:
Inspection 305-4949
Total Sq Feet: 1,450.00
Fees
Amount
Education Surcharge
$3.00
Public Works Permit Fee
$100.00
Scanning Fee
$3.00
Technology Fee
$2.50
Total:
$108.50
Payments
Date Paid Amt Paid
Total Fees
$108.50
Check # 34009
12/09/2019 $108.50
Amount Due:
$0.00
Builjit , D� partment Copy
In nsi raton f t e issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
nin Aret an in strict conformity with .the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores
V lag In a cept g his permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate
rmit�s are re uire f ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws
(d(�zoning. Futhermore, I authorize the above named contractor to do the work stated. — 1 1) L, /- , ,
Authorized
i
/ Applicant / /Contractor,
/ Agent
Date
v —
December 09, 2019 Page 2 of 2
REC 'TED
Miami Shores Village AY:
V Y 4 _ J 1g
Public Works Department
(305)795-2210
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#: �� l - n� 2-Z
Name of Applicant (if utility see below): � 2 Ti ,, S { /4-1 A
Owner off the following described property:
Legal Description: Lot Block j 1 u Subdivision
Folio #; t I Z 11 _h - o z a
Address: 3 L t / o 3:5 1—
UTILITY NAME:
Qualifier/Authorized Agent:
Address: _
City:
Telephone:
State Certification or Registration #:
Email:
State:
ZIP:
Certificate of Competency #
CONTRACTOR NAME:
Qualifier/Authorized Agent: herr f Zn55 ;
Address: &q.0 A_'>u1 2 e- &ye
city: _ k i A-A4 r State: Fe, . zip:
Telephone: _ -SOS Rat -i - Email: PA14SW t. (P AOi_ P.,�H
State Certification or Registration M Certificate of Competency M ^ k -) zgo
Requests permission to install (describe work, attach separate page if necessary) in the adjoining right of
way: -7&4Le S D /) 5 #4
Type of Work: & Paving ❑ Utility ❑ Sidewalk ❑ Electric ❑ Irrigation
❑ Landscape ❑ Antenna ❑ Other:
DESIGNER: Architect/Engineer:
Address:
.:.- .:.._..:e. r...,.. _..n,yti �...�� :— -
City: State: 2' ZIP '-, '
Telephone':",'.".'... ' ' ;; Email: t'.. �, 2� .rr `a Y 41 ;y
Registration # -
Value of Work for this Permit:' $ Square/Lineal Footage of Work:
***** Fees *****
Permit Fee $ 100.00
Notary $ Training/Education $ 0.20 Technology Fee $ 0.80 Scanning $
Bond $ (if required) Total Fee Now Due $ I C)8 • �
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.JN_
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 reins ction will be charged.
i
Signature Signature
Ap I ant or Authorized Agent 11 dom Agent
The foregoing instrument was acknowledged before The foregoing instru a was acknowledged before
me is 11 day of V91Q 20J2__, by m this dj o V • 20 i! , by
who %o `CW who
is personally own to me or who has produced is personally known to me or who has produced
—� nVt'' �-%�� . as as
identification. identification. t
Sign:
Print:
SEAL: 11 -�,,;F �'
W10f,' Bp*dMn
Sign:
Print:
pubticUnden^rs 11 SEAL:
EXPIRE8:Apr818, 2022
BmW Thm Nowy Public Uf&n
*******************************************
APPROVED BY: °� Public Works Director, or Designee
2017-04-15
OR M 31687 Ps 1673 tlPssl
REC0RKD 11!13=2I-t1Q 120 3 23, .1 .
H,`.1-Ty 'r.UVINY C:L.ER;; OF' COURTMIANI-DARE C:OIJFii'y, F!_;.!r7 i DA
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY
k
Whereas, (owner) DL I �j' �� hereinafter referred to as the
owner of the following described property (address):
Legal Description Lot Block if 9, Subdivision u1LA.SEtrves
Folio # Se -LT 5
Requests permission to install (describe work): D�iIV��
Within the public right of way of (address) 3 t O Z� 3 �,
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
cancel by an affidavit filed in the Public Records of Dade County, Florida by the
Village aager of Miami Shores Village (or his fully authorized representative).
1'
Signature
I " Owner or Agent 08
The foregoing instrument was acknowledged before me this ''i' day of 0( �<rZ, 20 19 , by
Stt��O �� aLA who is personally known to me or who has produced-F, i! r1Z u_CZNa
as identification and who did take an oath.
NOTARY 13LIC: STATE OF FLO :tDA, COUNTY OF f,141.1-DARE
Sign: I PERE ' C . 'IFY ththa s:s a opy offt�ttic
Print: TZU -DO 20
My Commission Expires: _� _ _ __ •,F4 my I.
SINDIA ALVAREt - i
h=.
FAY COIAkilSSION ,'I GG 2382'3
EXPIRES: September 3, 2022
Bonded Thru Notary Public Underxritei
ern i, C rcultyfd Courty Courts
C STRI^°CER 4172204