PW-19-1755Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address
Issue Date:
Parcel Number
285 NE 103RD ST, Miami Shores, FL 33138 1121360130440
Contacts
Permit NO.: PW-07-19-1755
Permit Type: Public Works
Work Classification: Public Works
Permit Status: Approved
Expiration: 02/03/2020
KENNETH & DEENY LORBER Owner
285 NE 103 ST, MIAMI SHORES, FL 33138
CB1 CONSTRUCTION INC Contractor
JOHN WIGGINS
7 NW 3 AVE, DANIA BEACH, FL 33004
Business: 9545204405 ASLEN@BMPDINC.COM
Description: INSTALL BRICK PAVERS OVER LEVELING SAND BED Valuation: $ 1,000.00 Inspection Resuuests:305-762-4�49
Total Sq Feet: 2,800.00
Fees
Amount
Education Surcharge
$0.20
Public Works Permit Fee
$100.00
Scanning Fee
$9.00
Technology Fee
$2.50
Total:
$111.70
Building Department Copy
Payments
Date Paid Amt Paid
Total Fees
$111.70
Credit Card
08/06/2019 $111.70
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 fd-ECNTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
g RSgI� ify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws
re a s r onin Futherm authorize the above named contractor to do the work stated.
Signature: Owner / Applicant / Contractor / Agent
Date
August 06, 2019 Page 2 of 2
..+ Miami Shores Village JULPublic Works Department U3 0 2019
(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
11
Permit#:,p V4 `y, -
Name of Applicant (if utility see below): J/-m//X /x A-*'4/7 GP j/.W T
Owner off the following described property: , / I% Legal Description• L t BI Subdivisionihp&C
Folio #; / W
Address:
UTILITY NAME:
Qualifier/Authorized Agent:
Address:
City:
Telephone:
State Certification or Registration #:
CONTRACTOR NAME:
�
Qualifier/Authorizgd ,
Address, _ �(&
City: /
Telephone:
State Certificati6n o
Requests peldds o i1 S77
way: ,� W� (7
State:
Email:
ZIP:
Certificate of Competency #
Certiticate of Competency #:
w.Qrk, atta se arat pa if ec sary in t e d'oi n right o
Type of Work: ❑ Paving ❑ Utility ❑ Sidewalk ❑ Electric ❑ Irrigation
❑ Landscape ❑ Antenna ❑ Other: %-t ff P ef.
DESIGNER: Architect/Engineer:
Address:
City:
Telephone:
Registration #:
Value of Work for this Permit: S
State:
Email:
***** Fees
ZIP:
Square/Lineal Footage of Work:
Permit Fee $ 100.00 `j
Notary $ Training/Education $ 0.20 Tech nology-Fee•$ 0.80 Scanning
Bond $ (if required) Total FeeyNow Due $_ l 1 j�
5
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, bg_inspection will not be approved and a reinspection will be charged.
Signature A f///1/Vi( r Wl—� �/" `-' Signature
(-'pplicant`p #uthorized Agent
The foregoLlinF, instrument ackn wledged b fore
met ' da by
who
is der ally known me of w h prodas
uced
i entification.
Sign:
Print: AV t7
SEAL:
o aRy P�,';s,
ASLEN RODRIGUEZ
_ ' " =
Notary Public - State of Florida
�=
Commission # GG 002423
'o;;oa:�
My Cdr".444cpM*JbNJ" f.*1b2e
The foregoi i trum
me this I d v of
is personally known to me
Print:
SEAL:
lity
produced
as
e- "'% ER[N McGOVERN
MY COMMISSION 4 GG254808
EXPIRES: September 25, 2022
APPROVED BY: Public Works Director, or Designee
& �1117 C %
2017-04-15
by
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
!llll{{iiillflllllllllllllllllllllllllllllfll
CFN 2019R0474729
OR Bk 31546 Pq .3713 1 P9s
RECORDED 07'/70/2019 i19:i19:5i1
HARVEY RUVINY CLERK. OF COURT
MIAMI—DADE COUNTY? FLORIDA
COVENANT OF TI CONSTRU NfflTHll�RIGHTOF WAY
Whereas, (owner) Nenr�e�� eOQer
hereinafter referred to as the owner of the following described
property (address): 05 1V,:t- /03
Legal Description: Lot Blo k Subdivision 1%%/�//7/ .J D/Y.C.1 .� e- J
Folio #���
Requests perm ssi n t install (describe work): i7 es �'/ 1 � W f O 1,W /Pyek&
Within the public right of way of (address)
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 tf a
dedicated right of way. If it becomes necessary for Miami Shores Village or Dade County it8
make repairs or maintain said items within public right of way including restoration of street t
j
reason of the Owner's failure to do so, such expense shall be paid by the Owner or sh 2 N
constitute a lien against the above described property until paid. o
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 oP w Qo
these items within the public right of way.
a -- Q
3. The Owner does hereby agree to remove or relocate their facilities at their own expense,n LL N
within 60 days notice by the Village to do so. Failure to comply with this notice will result in then =
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). 'o
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, them -
heirs and assigns, until such time as this obligations has been canceled by an affidavit filed in
the Public R�or f de County, Florida by the Village Manager of Miami Shores Village
(or his fully a horized r sentative).
Signature ✓'w j
Owner or Agent 4i rny-1 i I�"/
I
ate of Florida
;ounty of Miami Dade
��eg 'ng jnst_r�am�nt was acknowledged before me this day of /i�i�c- , 20 , by
VV(( c who is personally known to me or who has produced
)v'7"1 LEA?.,51 as identification.
JOTARY PU
;ign:
Irint: �J
i�""�a�'; ASLEN RODRIGUEZ
L
�• Notary Public - State of Florida
S Commission # GG 002423
r r.
OF; o?A' My Comm. Expires Jun 14, 2020
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