PW-20-476Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address
1311 NE 105TH ST, Miami Shores, FL 33138
r'nntartc
Issue Date: 03/10/2020
Parcel Number
1122320270050
Permit NO.: PW-03-20-476
Permit Type: Public Works
Work Classification: Public Works
Permit Status: Approved
Expiration: 09/08/2020
DAVID CARLISLE Owner VICO CONTRACTORS INC Contractor
700 NE 90 ST, Miami Shores, FL 331382138 ANTONIO LYON
Business: 3052182999 david@davidinmiami.com 1825 PONCE DE LEON BLVD 561, CORAL GABLES, FL 33134
Business:3056998582 antonio.lyon@vicocontractors.com
Description: REMOVAL OF EXITING ASPHALT IN 9 PARKING Valuation: $ 7,432.15 Requests:
Inspection 305-4949
SPACESINFRONT OF BUILDING. REPLACEMENT WITH 3000 PSI
CONCRETE AT 4" DEEP. REMOVAL AND REPLACEMENT OF 6 Total Sq Feet: 1,900.00
SIDEWALKS
Fees
Amount
Education Surcharge
$1.60
Public Works Permit Fee
$100.00
Scanning Fee
$3.00
Technology Fee
$2.50
Total:
$107.10
Building Department Copy
Payments
Date Paid Amt Paid
Total Fees
$107.10
Check # 1306
03/10/2020 $107.10
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 jinfd im4on is accurate and that all work will be done in compliance with all applicable laws
regulating construction and zoning. Futhermore, I autho ize t a ove named contractor to do the work stated.
Authorized Signature: Owner / Applicant /
Agent
Date
March 10, 2020 Page 2 of 2
RECEIVED
AR U 4 2020
Miami Shores Village
` Public Works Department BY.
(305)795-2210
Public works forms are available from the building department, 10050 NE 2nd Ave., Miami Shores, FL Z3138
PUBLIC WORKS PERMIT APPLICATION
Permit Type: Work in the Right -of -Way on Miami Shores Village or Miami -Dade Property
Permit#: Z.1.'10'�"1��3v
W-63- 2b- 46
Name of Applicant (if utility see below): MAD ( Dcl A_xi Uri
Owner off the following described property:
Legal Description: Lot Block Subdivision ��� �(Y4
Folio #; dc)SO
Address: C, 1 /\ t t)kaI \ g6irP.�
UTILITY NAME:
Qualifier/Authorized Agent:
Address:
City:
Telephone:
State Certificate or Registration #:
CONTRACTOR NAME:
Qualifier/Authorized Agent:
Address:
City:
Telephone:
State Certificat on or AeRisti
Requests permission to installl(
way: Ri D\f1(It, a5A,
State:
Email:
-- I r
Type of Work: ❑ Paving ❑ Utility
❑ Landscape ❑ Antenna
DESIGNER: Architect/Engineer:
Address:
Citv:
Telephone:
Registration #:
State:
Email:
ZIP:
Certificate of Competency #
53 13�j
page if necessary) in; he adjoining,right of
❑ Sidewalk ❑ Electric ❑ Irrigation
❑ Other: r1mu'Alt
Value of Work for this Permit: $ 15 1 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 $ l U4 • 10
Bonding Company's Name (if applicable):
Bonding Company's Address:
City: Statue
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.
Appficantbr Authorized Agent
The for going instrument was acknowledged before
me this ! day of 20 � , by
A J , n CA- R- 4-1 s who
is personally known to me or who has produced
as
identification.
Sign:
Print:
SEAL:
et .C/L A ::Z7-L,2R-lA &A
APPROVED BY:
Company/Utility Agent
The foregoing instrume t was acknowledged before
me this-?Z_ day of 20ZO , by
R,.-\'Q..: L e� Ly r�.� who
is_personally known to me or who has produced
as
identification.
Sign:
Print: , �V-1�0v—
[HL: IAN�,MU
CECILIA ITURRIAGA *, y: fJY COM�18SI0N it G0 WINS
.:'
No -ay pug c - State o' onCa EXPIRES' deflWry 18, 2024
A, My Conn. Exons 974
Mar 13. 2021 0
f3gid�d TMi Nowt' Pumun6mi1111
J 9j,F oc F��`;• horded;hmugh Na!#ial Notary A.sn.
Public Works Director, or Designee
2017-04-15
/ . *
C= IF H 2 4-12 _-1 R a 1 r-e A �
itr' °,f•. 1 ' : P9 1. _ 2,I I
UVithln the public right of way of {address} Stk
IN. CONSIDERATION of the approval ofthis 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 Ovrner'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 liabil:ity, which. may rise by virtue of permitting the installation of
these itemswithin 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 1}y the Village to do so. Failure to comply with this notice will'result in the
Village causing: the item(s) to be removed and alien Tieing 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 su as this obligations has been canceled by an affidavit fled in
the Public Records of ade C , Florida b e Village Manager of Miami Shores Village
(or his hilly auth�ri c., re ..._,
RTI
State of dor' a
County of Miami Dade
The foregoing instrument was acknowledged before me this day of k0i0vk , 20 ?� , by
i _A y ) Gt /L L rs c6 who is personally known to me or who has produced
Sign:
Print: e C c ; I-
G
STATE tit" I LJ'" l . Ct, J.>TY C
I HEREBY CERTIFY boat t•ii3 is a tr,
original filed in this on ce on�-
AD 2L,
WITNESS my hand and Cff ciai Seal. 9 f c
HARVEY RUVIN, Clerk of Circuit and Courty Coirts "� TRUST
d5?Vi5kL)-D C,
F
CECILIA ITURRIAGA
Notary public - State of Florida
Commission # GG 081974
13, 2021
SEAL: ; s: oP=
My Comm. Fxoires Mar
Bonded through National Notary Ass11.
ftw-r' UJ-t.