PW-18-3521Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Issue Date: 04/19/2019
Location Address Parcel Number
550 NE 95TH ST, Miami Shores, FL 33138 1132060140810
Contacts
Permit No.: PW-11-18-3521
Permit Type: Public Works
Work Classification. Public Works
Permit Status: Approved
Expiration: 05/28/2019
DANIEL H. & ELIZABETH KENT Owner CHAMPION CONCRETE Contractor
550 NE 95 ST, MIAMI SHORES, FL 331382732 JAIME BASILIO
10280 NW 63 TER 105, DORAL, FL 33178
Business: 3052528055
Other:7864024802
Description: CONCRETE DRIVEWAY APPROACH AND SIDWALK Valuation: $ 1,950.00 on Requests:
Inspection titi4949
Total Sq Feet: 391.00
Fees
Amount
Education Surcharge
$0.40
Notary Fee
$5.00
Public Works Permit Fee
$100.00
Scanning Fee
$3.00
Technology Fee
$2.50
Total:
$110.90
Payments
Date Paid Amt Paid
Total Fees
$110.90
Check # 3100
04/18/2019 $110.90
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 permi sume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate
permits are required for ELEC IC L, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNERS AFFID IT: I rti that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws
regulating constr gtion and ing. Futhermore, I authorize the above named contractor to do the work stated.
Authorized
_ \ J '7&
/ Applicant / Contractor
/ Agent
Date
April 18, 2019 Page 2 of 2
_ RECEIVED
Miami Shores Village V 2 6. 1018
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#: J>S ts—gszo
Name of Applicant (if utility see below): //'1V�
Owner off the following described property:
Legal Description: Lot Block Subdivision
Folio #; v- 7-0�-
Address: .SJ ,OWE 331
UTILITY NAME:
Qualifier/Authorized Agent:
Address:
Citv:
Telephone:
State Certification or Registration #:
CONTRACTOR NAME:
Email:
State:
ZIP:
Certificate of Competency #
Qualifier/Authorized Agent: , � -f -� Izi A 5144 0
Address:
City: / State: ZIP: 7l
Telephone: Email:/INN® fw✓ n,4 r • `�
��-% y
State Certi ication or Registration #: Certificate of Competency #: Cy-
Requests permission to instal��scribwork, atta h separate p ge if ecessary) in t e adjoining right of
way:
Type of Work: ❑ Paving ❑ Utility • , Sidewalk ❑ Electric ❑ Irrigation
A ❑ Landscape ❑ Antenna ❑ Other:
DESIGNER: Architect/Engineer:
4 Address:
City: State: ZIP:
Telephone: Email:.
Registration #:
Value of Work for this Permit: $ -s� Square/Li neal Footage of Work:
*****Fees*****
Permit Fee $ 100.00
Notary $ o� Training/Education $ 0.20 Technology Fee $ 0.80 Scanning $
Bond $ (if required) Total Fee Now Due $ 110 90
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 issupd. In the
absence of such posted noti , the ins ection will not be approved and a reins ction wi be charged.
Signature V Signature
Applicant or Authorized Agent Co pany/Utility Agent
The fore 'ng instrument wa li owledged fore The foregoing instr ment was acknowledged fore
mg this day of 20 , by me this �lQday of N [)y 20� by
�j who who
is personally known rn m or who has produced is nally know to Ye or who has produced
as
identification. identification.
Sign: Sig
Print:
�_ Print:
SEAL: F U C� SEAL:
- MAHARAI K. GONZALEZ
MY COMMISSION # GG 044602
EXPIRES: November 2, 2020
OV1---�Cl
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) 766.8972
CFN 201LR071334,3
OR BK 31230 Ps 404'0 (1F3s)
RECORDED 11:126"1201? 1 :11':12
h,AR,VE`t rtUVIN. �::LERK OF COURT
7T N -DIC:OUha.. FL��,;1eh
COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY
Whereas, (owner),- I <a Gt -f4O T
hereinafter referred to as the owner of the following described
property (address): 5 S71 A& gs�571-
Legal Description: Lot Block Subdivision
Folio #
Requests permission to install (describe work):6�'VG%i'i'�
Within the public right of way of (address)
IN CONSIDERATION of the approval of this permit by the Village, the owner agreeg 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 authono r fa ive).
Signature
)AZ— 40`8v r�ier or Agent
State of Florida
County of Miami Dade f''
The foregoing instrument was acknowledged before me this day of _ t'�' , 20 lt� by
who is personally known to me or who has produced��„111�r,,,�
a identification. ,�``� GE M.
NOTARY PUBLIC: �`\�'�0TA?�
Sign: t��6d//CAPPorn.
3rd, 2019 -
Print: STATE OF ELMIDA C01 KM OF DAC SEAL: N No. FF 182397
1 HEREBYCERTifYOWft habweWofM» Rai,
'0UBECG:>Rgrhsf filedin this otl� ondey of '•,,OF F V0�\�`•