PW-19-2744Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address
P(1)1I i�iUI9
Issue Date:11/26/2019
Parcel Number
1230 NE 95TH ST, Miami Shores, FL 33138 1132060144080
Contacts
Permit No.: PW-1 1 -19-2744
Permit Type: Public Works
Work Classification: Public Works
Permit Status: Approved
Expiration: 05/13/2020
ROSARIO DUMAS Owner
1230 NE 95 ST, MIAMI SHORES, FL 331382550
CHAMPION CONCRETE Contractor
JAIME BASILIO
10280 NW 63 TER 105, DORAL, FL 33178
Business: 3052528055 jaimechampion@yahoo.com
Other:7864024802
Ins ecti
Description: CONCRETE APROACH Valuation: $ 1,950.00 on Requests:
305-762 4949
Total Sq Feet: 400.00
Fees
Amount
Education Surcharge
$0.40
Public Works Permit Fee
$100.00
Scanning Fee
$3.00
Technology Fee
$2.50
Total:
$105.90
Payments
Date Paid Amt Paid
Total Fees
$105.90
Check # 3244
11/26/2019 $105.90
Amount Due:
$0.00
Building Department Copy
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. Futhermiore, I authorize the above named contractor to do the work stated.
Authorized Signature: Owner /---Applicant / Contractor / Agent
Date
November 26, 2019 Page 2 of 2
ID
s
Miami Shores Village �N�v
Public Works Department
(305)795-2210 BY:
Public works forms are available from the building department, 10050 NE 2"d Ave., Miami Shores, FL 33138
?I `9
PUBLIC WORKS PERMIT APPLICATION
Permit Type: Work in the Right -of -Way on Miami Shores Village or Miami -Dade Property r�
Permit#: —I 1-1 I—Z 1+3y/
Name of Applicant (if utility see below): dOW0 �VIS
Owner off the following described property:
Legal Description: Lot Block Subdivision
Folio #; " 3 0 — — yo% yJ
Address: / 7_3 n AR 9 /�.46 'f IWM / l � 33XY
UTILITY NAME:
Qualifier/Authorized Agent:
Address:
City: State: ZIP:
Telephone: Email:
State Certification or Registration #: Certificate of Competency #
CONTRACTOR NAME: F1
Qualifier/Authorized Agent: 64
Address: 6er
City: State: ZIP:
Telephone: _4 Z D Email• fn00� syt
State Certification or Registration #: (ferti icate of Competency
Requests permission to install
way: / 0AX 7
Pe work, attach separate page if necessary) in the adjoining right of
Type of Work: ❑ Paving ❑ Utility Sidewalk ❑ Electric
❑ Landscape ❑ Antenna ❑ Other:
DESIGNER: Architect/Engineer:
Address:
City:
Telephone:
Registration #:
State:
Email:
ZIP:
❑ Irrigation
Value of Work for this Permit: $ id _ Square/Lineal Footage of Work: L1049
***** Fees*****
Permit Fee $ 100.00
Notary $ Training/Education $ 0.20 Technology Fee $ 0.80 Scanning $
Bond $ (if required) Total Fee Now Due $ J as 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 sted at the job
site for the first inspection which occurs seven (7) days after the public works permit i issued. In the
absence of such posted notice, the inspection will not be approved and a reinspectio ill be charged.
Signature f —&,,-,��ignature
Applicant or Authorized Agent
The forego'foregp'hg instrumepj��was acknowledged before The fore
me this fl day of tJC 7010efi— . 20141� by e this
4 Loco %o -0q"&i who I1imv.
is personally known tome or who has produced i ersona
Jj �
as
identification. idenffic&t
Corrimny/Utility Agent
ing instrument w s acknowledge before
m day Rf lid/ 20by
Ai . kl a who
Ily known to me or who has produced
as
c;
,^n►dS3101y
Sign: Sig = . �..W
A #GG 287268 '
Print: _./A1R- .�(� a �.��' 0. B �,:
Print: �t A onyea lh� '�0 ' O:
SEAL: •<►i:,:." SEAL: STATE0' �\011 \\
;R.• "' ;; JAIyM�EnARRMANDO BASIUpfn
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My ��eY �fY11Ii018fp PIJ�C 20
2
I r.A......e—_
APPROVED BY: _� Y-� \ 1� � Public Works Director, or Designee
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
COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY
Whereas, (owner) ,0-5400 -A)ly#3
hereinafter referred to as the owner of the following described
property (address): 100 U8 R.S � *>
Legal Description: Lot Block Subdivision
l Folio # — 3206 " Cal 14-'-I O,YO
C= F N ? 1-319 R o-I 7 17 I C17
OR BK ,169A P. 29'3" (1F:js)
. F.Y FThy, t 1-Rf`:. +:1E C;iyl! �;(.`UVF
C:fIIJN;'i :+ FL_fj.;t!1�-
TATE ice' FLORIDA, C00TY OF NIAr.11•DAD2 �,r COUNrr
IIERLW' (: .TIFY th-ttr. the
r 3; i 4� In t^'S�--N— -1
� N I
.,Tt.ESS my t_n ' -, .1
C', �•. C ity Ccus
i.v
Requests permission to install (describe work): ZO/NA/' ,e7nf
Within the public right of way of (address)
J
Sp ANGER 0722
04
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
State of Florida
County of Miami Dade
The f egoing instrument was acknowledged before me this 27 day of OC704 l-
-V-O5 / 1LOD � 0t1,4 who is personally known to me or who has produced
as iden °tfication.
NOTARY PUBLIC: .►�:?;%. % MMEARMMOOBASIUO
Sign: =.; .= W COMMISSION # GG 227924
/� 6 5/� v JeVF1 oe
22
Print: �,! / -f �- "''
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