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PW-19-1387 (2)Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Location Address Issue Date: 07/30/2019 Parcel Number 175 NW 100 ST, Miami Shores, FL 33138 1131010230320 Contacts Permit NO.: PW-06-19-1387 Permit Type: Public Works Work Classification: Public Works Permit status: Approved Expiration: 12/16/2019 CHRISTIAN LANSER Owner CHRISTIAN LANSER Applicant 175 NW 100 ST, MIAMI SHORES, FL 33150 175 NW 100 ST, MIAMI SHORES, FL 33150 Other:3057724313 Other:3057724313 ONE STOP PAVING Contractor CARLOS M ACOSTA 1463 NE 173 ST, N MIAMI BEACH, FL 33162 Business: 7862991354 carlosmarcia@yahoo.com Description: DRIVEWAY APPROACH. Valuation: $ 3,500.00 Inspection Requests: TotatSq Feet: 760.00 Fees Amount Education Surcharge $0.20 Public Works Permit Fee $100.00 Scanning Fee $3.00 Technology Fee $0.80 Total: $104.00 Payments Date Paid Amt Paid Total Fees $104.00 Credit Card 07/30/2019 $104.00 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 777 e nd zonin Futhermore, I authorize the above named contractor to do the work stated. uth gnature: Owner / Applicant / Contractor / Agent Date July 30, 2019 Page 2 of 2 ., `C JUN Miami Shores Village 8r; 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 Permit vv I — FVU ,b Name of Applicant (if utility see below): L%r i stpa vi 5e r Owner off the following described property: ��f Legal Description: Lot .�— Block or Subdivision Subdivision bCA-3 Mpqt- O- u/c. ftDti1 Folio #; \ :u 1 Z 3 — d-3a0 Address: '�J J CDn f-T UTILITY NAME: Qualifier/Authorized Agent: Address: City: Telephone: State Certification or Registration #: Email: State: ZIP: Certificate of Competency # CONTRACTOR NAME: ©V-) °P V.- C. Qualifier/Authorized Agent: LG os Address: 14(a �J 'j s City: )J _ Q ° State: -FL ZIP: 73 <(p2 Telephone: 18& 7,0I, 41 Email: C.oL—IL P s oL -- q o . cu State Certification or Registration #: 1 `\ Certificate of Competency #: E- 23 L 5 Db Requests permission to install (describe work, a�tach separate page if necessary in the adjoining right of way: Tr y a ? �ar C -c o'.. G r-e� -e a 0 H ro ark w J . S i J S Type of Work: ❑ Paving ❑ Utility ❑ Sidewalk ❑ Electric ❑ Irrigation ❑ Landscape ❑ Antenna ❑ Other: �ri v Q r UG DESIGNER: Architect/Engineer: Address: City: State: ZIP: Telephone: Email: �.� - - .,- •.� �,.-� Registration # �I �•.�.` y. �. Va[ue ofW rkf8r'tthis"Permit: 35p�.i Square,),L rieal Footage•of!Work: '760 • Ii n. .... .' a...... .�:..-._�.� Hf v a. .. 4ywA ", s...l". �. n-h. � .... .. �.... .Y ,'. P�..r�..4,� :.I �' Permit Fee $ 100.00 Notary $ Bond $ *****Fees***** -Train ing/Education $ 0.20 Technology Fee $ 0.80 Scanning $ (if required) Total Fee Now Due $ 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 and a reinspection will be charged. Sig ture or Authorized Agent The foregoing instrument was ac owledged before me this 1 7 day of 20 , by who is personally known to me or who has produced L ,52&- 10/- 64- 0/0 -O as identification. Sign: Print: SEAL: MY COMMISSION 6 GG 296168 EXPIRES: February 3, 2023 Bonded flYu No4w Pudic lkidawr m Signatur Company/Utility Agent The foregoing instrument as acknpwledged before me this tl day of r i I 20 by who is personally known to me or who has produced as identification. Sign: Print: SEAL:' ,.; ", BARBAROSOdRINO ,..?KMY COMMISSION 6 GG 296168 ; +:tEXPIRES: febriary 3, 2023 ,,,f:. r BMW NabrYAurllcllndenwNlnl APPROVED BY: 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) hereinafter referred to as the owner of the followin described property (address): 1 S N7 C=FN 2019R-1212433 OR EK 31792 Ps 2371 (iPss) r;', � t ) r,'I Ik+sCi ° 'Ai FF:K =1F C:i"'i_ihJRT , l i'' T-C.tADE GOINTYr FLO'�'M IY FLMY th eQIUNT(OFl`i11DN ive6R�'F�y that N��aa k g�b'oQ gq��plccdlhe t�,� STRINGER #172204 Legal Description: Lot Block�f Subdivision FAILl- PAS C.EjU(3 r-orrc> — --- — Regqnests permission to install (describe work): C-I�C_y �Z �S LA-t> Dowl�-'WA-V Within the public t right ofwvay of (address) 1 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 fW44-authQdzad representative). _ Signature or Agent State of Florida ;ounty of Miami Dade Fhe foregoing instrument was acknowledged before me this 2 day of , 20 , by Owlswin nn&(!,Y who is personally known to me or who has pr6duced _ ( as identification. 40TA Y BL1C. 1,pYP MAHARAI K. GONZALEZ ` ° _ MY COMMISSION # GG 044602 Sig '� EXPIRES: November2, 2020 SEAL: '-FP Bonded Thru Notary Public Underwriters