PW-19-502Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address
10634 NE 11TH AVE, Miami Shores, FL 33138
Contacts
Issue :Hate: 03/08/2019
Parcel Number
1122320280650
Permit so.: PW-03-19-502
Permit Type: Public Works
Work Classification., Public Works
Permit Status: Approved
Expiration: 09/04/2019
ANTONIO REGOJO Owner STAR ISLAND CONCRETE DESIGN CORP Contractor
10634 NE 11 AVE, MIAMI SHORES, FL 33138 MIGUEL CORPAS
1018 nw 47 street, Miami, FL 33127
Business: 3057767916 miguelcorpas22@gmail.com
Description: INTERLOCKING BRICK PAVER APPROACHES Valuation: $ 2,000.00 Inspection Requests:
305-7 40
Total Scl Feet: 200.00
Fees
Amount
Education Surcharge
$0.40
Public Works Permit Fee
$100.00
Scanning Fee
$9.00
Technology Fee
$2.50
Total:
$111.90
Building Department Copy
Payments
Date Paid Amt Paid
Total Fees
$111.90
Check # 1121
03/08/2019 $111.90
Amount Due:
$0.00
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores
Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate
permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNERS AF IDAVIT: I ce i tall the foregoing information is accurate and that all work will be done in compliance with all applicable laws
regulating con truction and zoo uthermore, I authorize the above named contractor to do the work stated.
Authorized Signa ure: Owno "'�Applicant / Contractor / Agent
Date
March 08, 2019 Page 2 of 2
RECEIVED
Miami Shores Village MARK 0 7�%1019
Public Works Department
✓'
(305)795-2210 In
Public works forms are available from the building department, 10050 NE 211 Ave., Miami Shores, FL 33138
PUBLIC WORKS PERMIT APPLICATION
Permit Type: Work in the Right -of -Way on Miami Shores Village or Miami -Dade Property
Permit#:
Name of Applicant (if utility see below): 4�3-100 la 'iZv
Owner off the following described property:
Legal Description: Lot Block Subdivision M rat
Folio #;
Address:JO(,> >,Q- IJAVZ: AN -.AA � S�hv.lt-- �3 13$
UTILITY NAME:
Qualifier/Authorized Agent:
Address:
Citv:
Telephone:
State Certification or Registration #:
State:
ZIP:
Email:
Certificate of Competency #
CONTRACTOR NAME: C ki-Ag-j- Pe-,tel o
Dualifiex/Authorized Agent: Uu�- �tZ P/ •
Address: A0 %S N W
City:
Telephone: `7'(o 15G 7 -f-712Email
State Certification or Registration #:
State: ZIP: "253 \'s
Certificate of Competency #: EF--Lol 903
Requests permissiok to install (describe work, attach separate page if necessary) in the adjoining right Qf
way: � � t 1 V6 Z — 1 w k en - AL gaff �L
Type of Work: LYPaving ❑ Utility ❑ Sidewalk ❑ Electric ❑ Irrigation
❑ Landscape ❑ Antenna ❑ Other:
DESIGNER: Architect/Engineer:
Address: i
City:
% w State:
ZIP:
Telephone:
Email:
Registration#:.._
Value of Work for this Permit:
� a�
a$ 'Z d
uar
ineal Footage of Work_:
ZC :• .
4- ***** Fees
Permit Fee $ 100.00
Notary $ Training/Education $ 0.20 Technology Fee $ 0.80 Scanning,$
Bond $ (if required) Total Fee Now Due $ ` ► T
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 approveqFN a reinspection will be charged.
Signature
Applicant or Authorized Agent
The foregoing instrument was acknowledged before
me this-TaC day of 'L�Pin v% , 20 k! , by
A, IJ'C00 to 9-45: 6q 0 ;TO who
is personally known to me or who has produced
as
identification.
Sign ---,
Signatu
The foregoingg, inI
rument s ackn wledged before
me this "dof . 20 t5 by
"IC-S��LC-o2-Pft-a who
is personally known to me or who has produced
identification.
as
Print: SOS lJ J �+t-�vt�kic� Print:
SE SEAL:
'r""►'ey",JOSE N. ALFONSO +�r"�'+►"y JOSE N. ALFONSO
MY COMMISSION S GG 000984 r :~. MY COMMISSION A GG 000984
59
;o EXPIRES: July 12.2020 ° EXPIRES: July 12, 2020
t; Bonded Thru Notary Public UndenNrbm • M o«, os r Bonded Thru Notary Pubic Uncle. ten
***** ***********************************
APPROVED BY: h 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
OR BK 31055 P9 2415 (IF'ss)
fl [.-_:i.tra. E[ '_i�'� •.II: Ili,; f`_=:�-' .�.
Mf M -f' DE i'alf_Iha'I` "F_ORUD,
COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY E6"S�-RI�R 1722a4
Whereas, (owner) UTo ti
hereinafter referred to as the owner of the following described
property (address): 0; ' ( t 1� g -
Legat Description: Lot V; Block _ Subdivision kA(d t►A\
-Folio # -- — -- - -- ---
Requests permission to install (describe
w u utrT
Within the public hght of way of (address
.A� -
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 V
Owner or Agent
State of Florida
County of Miami Dade
T e foregoing in trument was acknowledged before me this L;1 day of C—eVcwh;-`r 20 by
iD o -10 who is personally known to me or who has produced
as id tification.
NOTAR BLIC:
Sign: ciLt ! JOSE N. ALFONSO
MY COMMISSION t GG OM84
Print: "j} Q • e� SEA ` EXPIRES: July 12 2020
`'•; nF f�� Bonded Thru Notary Public Underwriters