PW-18-3151Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address
r' U11
Issue Date:11/19/2018
Parcel Number
1055 NE 105TH ST, Miami Shores, FL 33138 1122320280810
Contacts
Permit NO.: PW-10--18-3151
Permit Type: Public Works
Work Classification: Public Works
Permit Status: Approved
Expiration: 05/20/2019
HOME OWNER Owner
HOME OWNER
CONCRETE SERVICES PUMP & FINISH INC Contractor
HECTOR LUIS ROMAN
10061 SW 44 ST, MIAMI, FL 33165
Inspection Requests:
Description: INSTALL NEW PLAIN CONCRETE DRIVEWAY IN Valuation: $ 30,000.00 30"72 494
SECTIONS OF 12'X6' 4" DEEP + 3000 PSI. APPROACHES 6" DEEP
+3000 PSI PLAIN CONCRETE. Total Sq Feet: 2,100.00
Fees
Amount
Education Surcharge
$2.00
Public Works Permit Fee
$100.00
Scanning Fee
$3.00
Technology Fee
$2.50
Total:
$107.50
Payments Date Paid
Amt Paid
Total Fees
$107.50
Check # 1888 10/12/2018
$50.00
Credit Card 11/19/2018
$57.50
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 construction and zoning. Futhermore, I authorize the above named contractor to do the work stated.
Authorized Signature: Owner / Applicant / Contractor / Agent
Date
November 19, 2018 Page 2 of 2
„. Miami Shores Village
Public Works Department.
(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#: ( A —31so
—31s1
Name of Applicant (if utility see below): W k(ily' (Till T�Q r
Owner off the following described property: �A (� '�
Legal Desc i do Lot 10 Bloc 5 Subdivision M `0.�il �1bgI L STL
S.
Folio #; Address: JU65 KBE 105 i(,XM1 G homy
UTILITY NAME:
Qualifier/Authorized Agent:
Address:
City: State: ZIP:
Telephone: Email:
State Certification or Registration #: Certificate of Competency #
CONTRACTOR NAME: l
Qua lifier/Authoriz )d Age
Address:
City: 411 P1 M
Telephone: 1
State Certification or Ree
Reques s per is on to install ( escribe work, attach h eparate page if necessary) in the ad'oin'n fight f (�
way: + �U
Type of Work: ❑ Paving ❑ Utility ❑ Sidewalk ❑ Electric ❑ Irrigation
❑ Landscape ❑ Antenna ❑ Other:
DESIGNER: Architect/Engineer:
Address:
City: State: ZIP:
Telephone: Email:
Registration#: - -� - - T”
e g t
.� a •. 1^':,c .A ..L
Value of Work for this Per $ l �/ V Square/Lineal Footage of Work:. '{ .
m ***** 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 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.
Signature_ '
Applicant or Authorized Agent
The foregoing instrument vlas acknowledge efore
me h' oZ da 20 by
who
is personally known to me or who has produced
as
identification.
/ 04
Signature
Co pang/Utility Agent
The foregpiRg instrument w s acknowledged efore
me i of day o 261L by
who
is personally known to me or who has produced
as
identification.
Sign:
Sign:
(I lwkaf
i
-J4—,t
Print: �.il��.
Print:
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SEAL'
LISVET PEREZ
SEAL:
;,; ; LIISVET PEREZ
�. : MY COMMISSION p FF927989
= !ii MY COMMISSION # FF927989
a
EXPIRES October 15. 20t9
EXPIRES October 15, 2019
(107139Bdt33
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APPROVED BY:
D
Public Works Director, or Designee
2017-04-15
IlIIIiEIIIlllli!IIII IlilltllEl iIIIIIIPlII
DOCUMENT COVER PAGE
For those documents not providing the required 3 x 3 inch
space on the first page, this cover page must be attached.
An additional recording fee for this page must be remitted.
Document Title:
(Mortgage, Deed, Etc.)
Return Document To / Prepared By:
i,R. rK. 31176 r'3s 4i t?F's_i
(Space above this line reserved for recording office use)
�w CLEpER wry\
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IN GOD WE TRUST Q
\moo OF cou F'
Rule 2.520 (d) On all ... documents prepared ...which are to be recorded in the public records of any county... a 3 - inch by
3 - inch space at the top right-hand comer on the first page and a 1- inch by 3 - inch space at the top right-hand corner
oneach sub se quentpage shallbe leftblank andreservedfor use by the clerk of court.
CLK/CT 155 Rev. 08/16 Clerk's web address: www.miami-dadecierk.com
1-1
COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY
5�
�
(Individual)
WHEREAS, I V ukL111 J_aar
^' � (�
' V ✓✓ IVE 'yJ�
CL
hereinafter referred to as the OWNER(S) of the following described property:
Dl a, Y9 �mj'r 3ho(0 PL 331
,,.,
N
A n l� ,, n /�
requests permission to install 1 lxM/ r)cl� :1� ✓J oc A Q,:�—
LLI
ons �rrn 1�'x G
rl <
-L6 ST.
within the public right of way of
IN CONSIDERATION of the approval of this permit by the Miami -Dade County Public Works Department, 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 the County to make repairs or maintain said item(s) 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 -Dade County harmless from any and all liability
which may arise by virtue of Miami -Dade County permitting the installation of these item(s) 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 Public Works Department to do so. Failure to comply with this notice will result in the County causing
the items(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 obligation has been cancelled by an affidavit filed in the Public Records of Miami -Dade County, Florida
by the Director of the Public Works Department (or his fully authorized representative).
Signed, sealed, executed and acknowledged on �� day of YJC./ 202at Miami, Florida
Signed, sealed and delivered in the presence of:
4 IA1 E ut- PLORIUA, GOUN, Y OF DA0E
'HEREBY CEfY���
2018
onainal filed in this off, day of
(SEAL)
,VJTNESS my hand and Offic' MY COMMISSION # FF927989
4ARVEY RUVIN, CL nd County Cour#s r3`� EDL
EXPIRES October 15. 2019
STAFE
V' 153 fiord NocalySe-ic;e cm
} SS.
MIAMI DA E COUNTY }
I HEREBY CERTIFY, that on this('� v day of / �' A.D. 201, before me personally
ay_ I 1 _T AA f
appeared
to me known to be the person describes in and who executed the foregoing Covenant to Miami -Dade County, a
body Corporate, and a politii subdivision of the State of Florida, and acknowledged to me the execution
thereof to be free act and deed for the uses and pu or, d�therein
ymentioned.
WITNESS my signature and official seal at .'/`u in the County and State aforesaid,
the day and year last aforesaid.
LISVET PEREZ
MY COMMISSION # FF927989 NotaryPu lic, State of Air
EXPIRES October 15, 2019
t40►r 3984+53 Floridallota•yservice.con, My Commission Expires:
1of1