PW-18-255�srO1s L,�
Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
CORIOp'
rmit
Issue Date: 2/812018
Permit No. IOW-2-18-255
Permit Type: Public Works
Work Classification: Public Works
Permit Status: APPROVED
Expiration: 05/09/2018
Project Address Parcel Number Applicant
94 NE 93 Street 1132060130150
Miami Shores, FL 33138- Block: Lot: CHARLES WALTER MARIA PAU
Owner Information Address Phone Cell
CHARLES WALTER MARIA PAULA 838 SALZEDO Street
- - - CORAL GABLES FL 33134-
838 SALZEDO Street
CORAL GABLES FL 33134-
Contractor(s) Phone Cell Phone
SFL (786)356-8806
ning: 1
Fees Due
Amount
CCF
$0.00
DBPR Fee
$0.00
DCA Fee
$0.00
Education Surcharge
$0.20
Permit Fee
$100.00
Scanning Fee
$3.00
Technology Fee
$0.80
Total:
$104.00
Valuation: $ 3,500.00
Total Sq Feet: p
Pay Date Pay Type Amt Paid Amt Due
Invoice # PW-2-18-66299
02/08/2018 Credit Card $ 54.00 $ 50.00
02/01/2018 Credit Card $ 50.00 $ 0.00
Available Inspections:
Inspection Type:
Excavation
Review Public Works
Final Public Works
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 informatiolis a ur and that all work will be done in compliance with all applicable laws regulating
construction and zoning. Futhermore, I authorize the above-nam ctor to do the work stated.
February 08, 2018
Authorized Signature: Owner / Applic /
Building Department Copy
/ Agent
February 08, 2018 1
0 2018
,r Miami Shores Village
R Public Works Department
(305)795-2210 BY
Public works forms are available from the building department, 10050 NE 2nd Ave., Miami Shores, FL 33 8
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): Aari-A t. 6c✓a4
Owner off the following described property:
Legal Description: Lot Block Subdivision
Folio #;
Address: 9q,vI 13 5
UTILITY NAME:
Qualifier/Authorized Agent:
Address:
City:
State:
Permit#: b ��
ZIP:
Telephone: Email:
State Certification or Registration #: Certificate of Competency #
CONTRACTOR NAME: Sd FL�I— L �!� TlVc- 0 B- SFL
Qualifier/Authorized Agent: _� 1.{,c.ry- g
Address: /gTS6 Zla _c*7—
City: tate: PlL- ZIP:
Telephone: 3fL 910G Email: _ Ot 4n A Sash Ad'c, ee
State Certification or Registration #:_CMG �Sr�91Ss" Certificate of Competency #:
Requests permission to install (describe work, attach separate page if necessary) in the adjoining right of
way: p1 Q,w Cates k, 4 d/.-aI ch
Type of Work: ® Paving ❑ Utility - ❑ Sidewalk ❑ Electric ❑ Irrigation
❑ Landscape ❑ Antenna ❑ Other:
DESIGNER: Architect/Engineer:
Address:
City: State: a--- _._ZIP.-:.
Telephone: Email: i`�,ti�t `fik a fil9r� ►
Registration #:-:,z ,4n _ j �co C;,;�., a �,,,`4 r.,v,
�'x ra; r �; , a i',..?dr,,•� ., . :� I � � S� .'+S f.aa�;�u'.::�> 9X .� �: . i
Value:of,Work.for,this Permit:$: +� 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 $
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 indicatdd..l certify that no work or installation has commenced prior to the issuance of a
mi pert an cl 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; certified copy of the recorded notice of commencement must be posted at the job
site for the first..Anspection 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.
• r in
c
t/
~Signature
pplicant or A thorized Agent
The foregoing instrument s acknowledged before
meth"_ day of A tvr4, 20, by
4 who
is per onally known to me or who h s produced
Zee- t � as
identification.
NOTARY PU
Signature
Company,/Utility Agent
The foregoing instrument as'acknowledged efore
me this day of v 20 by
who
is pers99�ally known to me or who as produced
`rCt�'3R� as
identification.
NOTARY PUBLIC:
Print: +"'' GEOFFREY CHAN print:
SEAL: � , _ #'36185JL
+= MY COMMISSION 2021 SEAL: ;t�"`�" GEOFFREY CHAN
EXPIRES AuWM 20. ? MY EXPIRES Alugust 20. 2021
** * *************************************
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
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!-iraF'V F2t.fttli�i a_EF,''r; CE
it ALIT -DADS
COVENANT OF CONXTRUCTI P N WITHIN RIGHT OF WAY
Whereas, (owner) / ��r4 .P,rarS
hereinafter referred to as tl;e owner of the following described
property (address): 141 N6: 93 sT
Legal Description: Lot Block Subdivision
Folio # /I- 3ZO G- O f 3- O /5-O
Requests peermission to install (describe work):60 mt�V;odr- 4eAe_1,e,4,
A ODlon
Witf{ifi the public right of way of (address) 9y/ 371-7,8
=fir,
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
State of Florida
County of Miami Dade
The oregoi instrument was acknowledged before me this 31 day of :LAual— 20 A , by
4irl,'X Sl i I A f who is personally known to me or who has produced
NOTARY P
Sp r
•Eq r CERTIFY that this is a true o', of the GEOFFREY CHAN
original filed ,n this off eon day COMMISSION °� v u�': MY COMMISSN # GG136185
AD 20 ?a• EXPIRES
3 August 20,2021
WITNESS my hand and Official Seal.
HARVEY RU!gm:
ircuit and county Courts
��l7 -- D.C. COU