PW-19-1893Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
L-V I I h e
�1�1' U J u 1,1,
Issue Date:10/15/2019
Location Address Parcel Number
1205 NE 95TH ST, Miami Shores, FL 33138 1132060143970
Contacts
Permit No.: PW-08-19-1893
Permit Type: Public Works
Work Classification: Public Works
Permit Status: Approved
Expiration: 04/13/2020
ROBERT BAILEY Owner
HOME INTERIOR SERVICES AND Contractor
1015 NE 97 ST, MIAMI SHORES, FL 331382555
INVESTMENT INC
Business: 3057880235 nflrecord@aol.com
IUAN PABLO BETANCOURT
1690 W 38 PL B1, HIALEAH, FL 33012
Business: 3053288590
Other:7865978093
Description: INSTALL NEW DRIVEWAY APPROACH Valuation: $ 9,000.00 Inspection Requests:
49
Total Sq Feet: 1,400.00
Fees
Amount
Education Surcharge
$1.80
Public Works Permit Fee
$100.00
Scanning Fee
$9.00
Technology Fee
$2.50
Total:
$113.30
Payments
Date Paid Amt Paid
Total Fees
$113.30
Check # 2496
08/16/2019 $50.00
Credit Card
10/15/2019 $63.30
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 construc nir�g. Futher authorize the above named contractor to do the work stated.
Authorized Signature: Owner / Applicant / Contractor / Agent Date
October 15, 2019 Page 2 of 2
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Public Works Department
(305)795-2210 BY: �"—
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
Permit#.15 —cg -11- Ice 2
W-oe,-0-1 013
Name of Applicant (if utility see below):
Owner off the following described property:
Legal Description: Lot Block Subdivision
Folio#; //- 32&6 -0/y
Address: ! 2-O r YvC^; 9,.5 fh R l- M l arrt 4 '3 3
UTILITY NAME:
Qualifier/Authorized Agent:
Address:
Citv:
Telephone: Email:
State Certification or Registration #:
A CONTRACTOR NAME: �2— r, I n-6x
State:
Qualifier/Authorized Agent:
Address: '1 0 6 1 S w C � I
City: k1AC' ` State:
Telephone,76 6 1 b 0 1 Email: I�')
State Certification or Registration #:GK G 1 &Y9 3 r
ZIP:
Certificate of Competency #_
iL— ZIP: _
C—e/Mie- (.,- Torvk*C
Certificate of Competency #:
ti .
Requests permission to instalL(describe work, attach separate page if necessary) in the adjoining right of
way: %�n� l�rrwew�(vI
Type of Work: ❑ Paving ❑ Utility ❑ Sidewalk ❑ Electric ❑ Irrigation
❑ Landscape ❑ Antenna ❑ Other:
DESIGNER: Architect/Engineer:
Address:
City:
Telephone:
Registration #:
Value of Work for this Permit: $
Permit Fee $ 100.00
Notary $
Bond $
State:
Email:
ZIP:
Square/Lineal Footage of Work:
***** Fees *****
Training/Education $ 0.20 Technology Fee $ 0.80 Scan ,ping $
(if required) Total Fee Now Due $(03 .3�_
011
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. 1 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.
Signature
Applicant or Authorized Agent
The foregoing instrument Awas acknowledged before
M thisday of 20 (GI , by
A10D---t t- who
is per
onally known to me or who has produced
Signature
on any/Utility Agent
The foregoini instrum nt was acknowledged before
rrie this '20t day of 20 1 l , by
unn
ideificati`n / �`\'':•';�sioP�r,►Rc�..'T�'''����i� \ident
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Sig . • .. Sign:
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Print: IV ' r ti 'y B �� *' PrintGy
SEAL: �i✓✓j Ok U� . Q'`��� SEAL:
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0•CFctoC()V r-I- who
known to me or who has produced
r l i c��SM as\`\���N�NIY
** ** ****** ******************************
APPROVED BY: Public Works Director, or Designee
5 EGG 287265
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 CONST UCTION WITHIN RIGHT OF WAY
Whereas, (owner) o 14e,7_ /C-
hereinafter referred to as the owner of the foh6wing described
property (address): l a 0 s /UE �S'r" S
Legal Description: Lot Block Subdivision
-Folio
Requests permission to install (describe work):
Within the public right of way of (address)
C-FN 21-319RID518738
OR. 6K. ?1572 F3 4796 (11"3s)
REi:ORDEO
HARVE`r` RLIVINt CLERK. OF COURT
MIAMI-LADE COMM FLORIDA
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
State of Florida
County of Miami Dade
he forego' ins umE
s was
NOT RY BLIC: ;i'"����`�N•;
Sign: L-a =*� i*
Print: SEAL: �ccurise
ice"•, o N•
if Ae�'�O�\�
FCERTIFY that this true
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a CNTy
,\�PNa UoK
I HEREBthis is�o
original Ffileln9ft,aos day ofAo zoWITN S0 ial Seal. 3Owner or Ge„•-Eand County CourtsD.C. E CCU40,
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t was acknowledged before me thisay of MU tit , by
�who is personally known to me or who has produced-`\\\�� ppY P�lgll
&--ratification. ,.• ow .