PW-20-106�N•��gZ,EY�
� JAN 16 2020
Miami Shores Village $Y.
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#: p S_ I ( I " { 2j10
�W-01-2A- 101p
Name of Applicant (if utility see below): J�rAAUS lit (WOVO 2-
Owner off the following escribed property:
Legal Description: Lot \q Block _fQ�5' Subdivision A �(AM\ Sinai G,
Folio#; %1-390('- 1 - 1,,
Address: S jU R .5 1" 1`Q I,�•' S (0_11 r
UTILITY NAME:
Qualifier/Authorized Agent:
Address:
City:
Telephone: Email:
State Certification or Registration #:
State:
ZIP:
Certificate of Competency #
CONTRACTOR NAME: C A I 1217ib--1 CC-., N _1"
Qualifier/Authorized Agent: Lo 5 A
Address: O -7b SLJ
City: (A--( i State: f_L_ ZIP: 33 1(,,y
Telephone: v Email:
State Certification or Re istration #: O 6 Certificate of Competency #:
Requests permission to install (describe work, attach separate page if necessary) in the adjoining right of
way: C&Y 0-kl !F4 t _4rf 5 `3NnA�:.ay .
Type of Work: V Paving ❑ Utility
❑ Landscape ❑ Antenna
DESIGNER: Architect/Engineer:
Address:
City:
Telephone:
Registration #:
State:
Email:
❑ Sidewalk ❑ Electric ❑ Irrigation
❑ Other:
ZIP:
Value of Work for this Permit: $ 1' 00 Square/Lineal Footage of Work: & 00524F
***** Fees *****
Permit Fee $ 100.00
Notary $ Training/Education $ 0.20 Technology Fee $ 0.80 Scanning $
Bond $ (if required) Total Fee Now Due $
M ,
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 $2,500, the applicant must promise in good faith that a copy of the notice of commencement
and construction lien law brochure will be delivered to the person whose property is subject to the
attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job
site for the first inspection which occurs seven (7) days after the public works permit is issued. In the
absence of such posted notice, the inspection will not be approved aAd a reinspectiopwill be charged.
Signature ���� Sign
Ap�lica thorized Agent
The foregoing instrument was acknowledged before
me this j—l— day of OrJ 20_Ll_, by
r'
car10S her ctn eZ who
is personally known to me or who has produced
as
identification.
U
Corh�an Utility Agent
The foreg ing strument as acknowledged before
me this 1day of J 20—LeL, by
:::�CXe 10S4cx who
is personally known to me or who has produced
identification.
Sign:( (&^
as
Print: Print:
-,*',�,,.�l 4,,o1✓;�,,+oP.a,T_ ' ..
ply COMMI$ON #.(0 912155
MCOMMSION S OO 912155
EXPIRES: Sepilember 11, 2WEXPIRES. Spember 11,2023
BpWedTku BMMTtn Nalmy Pubi6U&mllnBRENDASEWARTREASTEWART SEAL:
##############################################
APPROVED BY: , Public Works Director, or Designee
2017-04-15
111M I€I11111111111€11 `€ 1111 fill Hill fill, 111
I1l11#
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33136
Tel: (305) 795.2204
Fax: (305) 756.8972
WE Of ELURiUA, i,vui; i r U'r IYIIAri ` ;
:REBY CERTIFY that the tar ing is a true and correct cop oQf the s'
final filed in this office. / AO 20J
AVEY RUVIN, Cl of Circuit and County Courts
Duty Clerk
COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY ONA BRUNO #79806
Whereas, (owner) [ ur 1vS W-,(, ,,nde 7__
hereinafter referred to as the owner of the following described
property (address): 05 u_j7 q3 5-
Legal Description: Lot Block Subdivision
-F� li o #- ---- -- — — -- - — — — ----- -- -
Requests permission to install (describe work): (,r.nr,Ae 5ng <.ire S
Within the public right of way of (address) ig IS: H a 93 St—
_,li�4rGC Gw 4U�-e F7L a3/ 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 canceled by an affidavit filed in
the Public Records of Dade County, Florida by the Village Manager of Miami Shores Village
(or his fully,�uthorized representative).
Signature
er or Agent
State of Florida
County of Miami Dade
The foregoing instrument was acknowledged before me this day of �� , 20/4 , by
who is personally known to me or who has produced
as identification.
NOTARY PUB (_ ,Q
Sign:+►�� gRENpASTEWART
Print: S MY COMMISSION# GG 912155
��e;•• EXPIRES: September 11, 2023
'' P., ,4, 9ondod Thru Notary PO* UndeMnfiets
Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address
675 NE 93RD ST, Miami Shores, FL 33138
r'nntartc
Issue Date: 02/13/2020
Parcel Number
1132060141740
Permit NO.: PW-01-20-106
Permit Type: Public Works
Work classification: Public Works
Permit Status: Approved
Expiration: 08/11/2020
Masebs LLC Owner
67593
CAIBAI CONSTRUCTION LLC Contractor
JOSE LOSA
Business: 7862292770 caibaiconstruction@gmail.com
Description: CONCRETE SQUARES DRIVEWAY Valuation: $ 4,500.00 Inspection Requests:
i49
Total Scl Feet: 0.00
Fees
Amount
Education Surcharge
$1.00
Public Works Permit Fee
$100.00
Scanning Fee
$3.00
Technology Fee
$2.50
Total:
$106.50
Building Department Copy
Payments
Date Paid Amt Paid
Total Fees
$106.50
Credit Card
02/13/2020 $106.50
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
regulating constructs m
�he foregoing information is accurate and that all work will be done in compliance with all applicable laws
rmore, I authorize the above named contractor to do the work stated. / r
O� / / 012—t:>
Authorized
/ Applicant /
Agent
February 13, 2020 Page 2 of 2