PW-18-3363Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Issue Date:11/29/2018
Location Address Parcel Number
138 NE 109TH ST, Miami Shores, FL 33161 1121360090130
Contacts
Permit NO.: PW-1 1 -18-3363
Permit Type: Public Works
Work Classification: Public Works
Permit Status: Approved
Expiration: 05/28/2019
EAL INVESTMENT INC Owner ONE STOP PAVING Contractor
138 NE 109 ST, MIAMI SHORES, FL 33161 CARLOS M ACOSTA
Other: 7863160828 1463 NE 173 ST, N MIAMI BEACH, FL 33162
Business: 7862991354 carlosmarcia@yahoo.com
Description: STAMPED CONCRETE DRIVEWAY Valuation: $ 1,000.00 Inspection Requests:
305-762-4949
Total Scl Feet: 160.00
Fees
Amount
Education Surcharge
$0.20
Public Works Permit Fee
$100.00
Scanning Fee
$9.00
Technology Fee
$2.50
Total:
$111.70
Payments
Date Paid Amt Paid
Total Fees
$111.70
Check # 2263
11/29/2018 $111.70
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 cons ion and zoning. Futhermore, I authorize the above named contractor to do the work stated.
1
I
Authorized Signature: Owner / Applicant / Contractor / Agent
November 29, 2018 Page 2 of 2
Miami Shores village *Ov 0
Public Works Department f1'4441P
(305)795-2210
Public works forms are available from the building deparrtment, 0050 NE 2" d Ave., Miami Shores, FL 33138
PUBLIC WORKS PERMIT APPLICATION R
Permit Type: Work in the Right -of -Way on Miami Shores Village or Miami -Dade Property
Permit#: PAJ I h_^ 33 G3
Name of Applicant (if utility see A) A below): 2� , � /
Owner off the following described prop �Q 1� ke s '�'L rGccl�,
Legal Description: Lot _ 5 _ Block a___ ( —Subdivision ,
Folio #; l(a (b O O S 10 �rn i rrLs Ti f S
Address: ( JJ E I 0 � t
UTILITY NAME:
Qualifier/Authorized Agent.
Address:
Cam• State: ZIP:
Telephone: Email:
State CerUfication or Registration #:
fnJ Certificate of Competency #
CONTRACTOR NAME:�enr
c r0.0 t h
Qualifier/Authorized Address: 1410 E (43 ST
Crty: A) a r fat
Telephone: 2tiq ( �S 4 Email:. rt c� Ste, -�—'T—ZIP. 3 3 (l02
State Certification or Registration #: E a 3 0. o d. Co m
---Lod Certificate of ompetency #:
Requests permissl n to install (describe Wo attac s parate page if necessary) in the adjoining right of
way: v� r PAC( r► e r4on 41
------------- !1
Type of Work. ❑ Paving ❑ Utility ❑ Sidewalk
❑ Electric ❑ -Irrigation
❑ Landscape ❑ Antenna ❑ Other.
DESIGNER: Architect/Engineer:
Address:
city' State: ZIP.
Telephone: Email:
Registration#:
Value of Work for this Permit: $ 60d _ b 0
Square/Lineal Footage of Work:
Permit Fee $100.00 aes** Fees **s**
Notary $ Training/Education $ 0.20 Technology Fee $ 0.80 Scanning $
Bond $ (if required) Total Fee Now Due $ (1 1
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 constru
this jurisdiction. I understand that separate permits must be secured for ction in
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 constructio
right-of-way. n and specifically construction in the
"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 r 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
absence of such posted notice, the inspection will not be appsite for the first inspection which occurs seven (7) days after the public works permit is issued, In the
roved and a reinspection willbe charged.
a
Signature
Signature
or Authorized Agent
The foreg instrument was acknowledged before The foregoing instrument was acknowledged before
me,1<his day �tI V 20�, by me tj�is ( rt l dJ 20�, by
�n-, who (__ p s _ a
is personally known to me or who has produced Is personally to me or who has produced who
Went fication. as
as
identification.
Sign:
Sign:
Print: (cAy 9Wrl) 30-11/I Print: �CC�'D UOtn ✓!a SEAT: SEAL:
BAI ARQ SOBRINO
:s MY COMMISSION N FF 195634 r" " b BARBARO SOBRINQ
EXPIRES: February 3, 2019 W COMMISSION t FF 19M
' • Bonded Tutu No" Pubic Underwleere � EXPIRES: February 3, 2019
Bonded rMu Notafy Pubie Underwflen
* **** * *+*** :*• •+***+*s*ssssss*ssx****
APPROVED BY: �
Public Works Director, or Designee
2017-04-15
u
STATE OrTIF
'0 COUNTY OF OADE
r HEREBYY thafttis r. copy of the ew cc
A Miami Shores Village
NE ""yrevow
c° y3 tl Building Department
NARYEY RUVIM, CLEWRend ^y Ot�t.rts �.s,,, z, RUST P
`,� pG3 10050 N.E.2nd Avenue
�ioxcuP► Miami Shores, Florida 33138
IC STRINGER #172204 Tel: (305) 795.2204
Fax: (305) 756.8972
r�Q H
C t CO ANT OF CONSTRUCTION WITHIN RIGHT OF WAY
mac; Whereas, (owner)_ GnJre4 IJ � dt�J�
� hereinafter referred to as the
,
owner of the following described property (address): K; Ir log S i f,SoreS 33 I(Q I
` Legal Description Lot 5 Block -.)I (o Subdivision Don n 1015
tea' Folio#(I 0(5( noS OI.�o t!(tc�nn� 5r�ares.
Requests perr-gission to install (descri e wor ):
a -�
T Within the public righk of way of (address) Aj F I O ci ST
�L.Lj�
' L IN CONSIDERATION of the approval of this permit by the Village, the owner agrees as follows:
r 1- 1. To maintain and repair, when necessary the above -mentioned items) installed within th
K
3.
9
X- Signature
e
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.
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.
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).
The undersigned further agrees that these conditions shall be deemed a covenant
runnina 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 cif Miami Shores Village (or his fully authorized representative).
Agent
e f oregoing inst ui J�t was acknowledged before me this _�_ day of 0 , 20
!�.) �✓11rrc+--ZNho is personally known to me or -'who has produced
as identification and,who.did take an oath. - - v ,.,, ti>•:
NOTARY PUBLIC:
4
Sign:
Print: 5aruav or
My Commission Expires: o
(.Y, by
BARBARO SOBRINO
:z MY COMMISSION A FF I MM
EXPIRES: February 3, 2019
qg„k`�f Bonded Thru M'rY Public Undervdtenr