PW-19-1739Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address
F�D
Issue Date: 03/27/2020
Parcel Number
1421 NE 104TH ST, Miami Shores, FL 33138 1122320320060
Contacts
Permit No.: PW-07-19-1739
Permit Type: Public Works
Work Classification: Public Works
Permit Status: Approved
Expiration: 10/12/2020
1421 MIAMI SHORES LLC Owner
1421 NE 104 ST, MIAMI SHORES, FL 33138
Home: 9544IS2648
THE WATER RESTORATION GROUP Contractor
HENRY DOW
Business:3056612505 hdow@thewaterrestorationgroup.co
m
Description: REPLACE EXSITING DRIVEWAY WITH CINCRETE Valuation: $ 7,500.00 Inspection Requests:
1305-762-4949
BLOCK PAVERS
TotalSq Feet: 1,800.00
Fees
Amount
Education Surcharge
$1.60
Public Works Permit Fee
$100.00
Scanning Fee
$3.00
Technology Fee
$2.50
Total:
$107.10
COVID 19
Applicant Copy
Payments
Date Paid Amt Paid
Total Fees
$107.10
Credit Card
04/13/2020 $107.10
Amount Due:
$0.00
For Inspections, Call (305) 762-4949 or Log on at https://bidg.miamishoresvillage.com/cap/.
Requests must be received by 3pm for following day inspections.
NOTICE: In addition to the requirements of this permit, there may be AND THERE MAY BE ADDITIONAL PERMITS REQUIRED FROM OTHER
additional restrictions applicable to this property that may be found in the GOVERNMENTAL ENTITIES SUCH AS WATER MANAGEMENT DISTRICTS,
public records of this county. STATE AGENCIES, OR FEDERAL AGENCIES.
April 13, 2020 Page 1 of 2
I�ECCA IVEI:)
UL 2 9 2019
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 33138
PUBLIC WORKS PERMIT APPLICATION
Permit Type: Work in the Right -of -Way on Miami Shores Village or Miami -Dade Property
Name of Applicant (if utility see below): -bU V.1
Owner off the following described property:
Legal Description: Lot Block Subdivision
Folio #;
Address: � ��1 Z\ w ) C q S
UTILITY NAME:
Qualifier/Authorized Agent:
Address:
City:
Telephone:
State Certification or Registration #:
Email:
State:
Permit#: TJV
ZIP:
Certificate of Competency #
CONTRACTOR NAME: 7 (S,-c;—►
Qualifier/Authorized Agent: A!wt , D6J
Address: Sr S N qS tl- S,,
City: ,,," State: I'�— ZIP: 3 3 } S 0
Telephone: 3 dSW�i 15 3 3 Email: w w cow
State Certification or Registration #: Cy C Certificate of Competency #:
Requests permission to install (describe work, attach separate page if necessary) in the adjoining right of
way: f�pia� �f'.��wc�, (,.1 � �,0erS
Type of Work: ❑ Paving ❑ Utility ❑ Sidewalk ❑ Electric ❑ Irrigation
❑ Landscape ❑ Antenna ❑ Other:
DESIGNER: Architect/Engineer:
Address:
City:
Telephone:
Registration #:
State:
Email:
va
Value of Work for this Permit: $ -7.5001
ZIP:
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 $ 10_-') . IZ)
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: 1 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 $2,500, the applicant must promise in good faith that a copy of the notice of commencement
and construction lien law brochure will be delivered to the person whose property is subject to the
attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job
site for the first inspection which occurs seven (7) days after the public works permit is issued. In the
absence of such posted notice, the inspection will not be approved and a reinspection will be charged.
Signature L: I
Applicant or Authorized Agent
The foregoing instrum nt was acknowledged efore
e this day of 20� by
who
_is persona14 known to me or who has produced
-(l..`Zi0)mv— (1 ri-MM, as
identification.
Sign:
Signature
Company/Utility Agent
The foregoing instrument was acknowledged before
me this day of 20 by
is personally known to me or who has produced
as
identification.
Sign:
Print: �(`� .�u�� Print:
SEAL: SEAL:
SINDIA ALVAREZ
MY COMMISSION # GG 233273
EXPIRES: September 3, 2022
goaded Thm N01M Putrlit UndeMtilc rs
1,
*******************************************
APPROVED BY: r �� Public Works Director, or Designee
who
2017-04-15
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 796.2204
Fax: (305) 756.8972
CFN 2019R04L3216
OR i?K 11551 Ps 3291 (1F•9s)
REDOIRGED 11$/01l20,19
HARVEY RUVIN: CLERK OF (: ;URT
MTeIMT--OADE COUNTI'y F!-�iRli)A
COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY
Whereas, (owner) IA -A ^L� �d,,-j
hereinafter referred to as th owner of the following described
property (address): ) `12 i N r 10
Legal Description: Lot 6 Block 3 Subdivision t,10f2.2 ��� ✓� v= Dti
Folio # (/ 3 2 f) 3 2 0000
Requests permission to install (describe work): tG,<<gAg 2-a-UtrS
Within the public right of way of (address) 1 KZ i N
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 IAIiwq � j
State of Florida
County of Miami Dade
The foregoing instrument was acknowledged before me this :Z57 day of JU , 20'1 by
N 1zy --bo\-�) Iwho is personally known to me or who has produced
r�oa jr,-2 UPEtA has identification.
Sign:
Print: F li.4 �° ` "TF S cy°"'" ••'
, DIA AwA�
I HEREBY CERTIFY that this is a rue u�. "' MY CO OMISSION#GG238273
filed in this office on .day of x x� EXPIRES:
oriAU i
U � ';Fe. �.;, wed ThSeptember 3, 2022
HH AD 20_._______— Q n' Pubtic Undenvritm
WITNESS hand a vial Seal.
HREEY t!V V. CI! of Ciit in�i Cgunty Courts �ogoF rn� iy