PW-10-19-2325Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address
Issue Date: 10/04/2019
Parcel Number
102 NW 101ST ST, Miami Shores, FL 33150 1131010220210
Contacts
Permit NO.: PW-10-19-2325
Permit Type: Public Works
Work Classification: Public Works
Permit Status: Approved
Expiration: 04/01/2020
Alvina Guevara Owner ANGEL FLORIDA BRICK INC Contractor
102 NW 101 Sr JOSE RAUDA
17 NW 169 ST, NORTH MIAMI BEACH, FL 33169
Business: 7867159687
Description: INSTALLING 12X12 CONCRETE PAVERS ON
DRIVEWAY AND REPLACING ASPHALT APPROACH WITH 12X12
CONCRETE PAVERS. WALKWAY ENTRANCE TO BE REPLACED
Fees
Amount
Education Surcharge
$0.80
Public Works Permit Fee
$100.00
Scanning Fee
$3.00
Technology Fee
$2.50
Total:
$106.30
Valuation: $ 3,750.00 Ins ection Requests:
S-762-4949
Total Sq Feet: 700.00 _
Payments
Date Paid Amt Paid
Total Fees
$106.30
Check# 1265
10/04/2019 $106.30
Amount Due:
$0.00
Building Department Copy
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores
Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate
permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws
regulating gpk4truction and zoning. Futhermore, I authorize the above named contractor to do the work stated. I y
Signature: Owner / Applicant / Contractor I Agent
October 04, 2019 Page 2 of 2
eEMK
Miami Shores Village
Public Works Department
(305)795-2210
Public works forms are available from the building department, 10050 NE 2nd Ave., Miami Shores, FL 33138
PUBLIC WORKS PERMIT APPLICATION �y�j•"\'/7�—
Permit Type: Work in the Right -of -Way on Miami Shores Village or Miami -Dade Property
Permit#: 19_ �3
��- lo--►g-a�as
Name of Applicant (if utility see below): !4 LU I N d G1Je✓4r'1'4
Owner off the following described property:
Legal Description: Lot_( Block 3 Subdivision Cnou�) Cfz$ST 5(t5
Folio#; 1f — z 101—017-0210 _
Address: io 2 n/W lot S`r. M 14r" I SA"155 Z . [ .T 3 13-0
UTILITY NAME:
Qualifier/Authorized Agent:
Address:
City:
Telephone:
State Certification or Registration #:
CONTRACTOR NAME: 144
Qualifier/Authorized Agent:
Email:
State:
ZIP:
Certificate of Competency #
101919re it les.
Address: f4 A/W 169 5T
city: No2tN Alldw1 19941CH State: let- ZIP: 33 lb 9
Telephone:Jk6 i45-96S-* Email:
State Certification or Registration #: n 3BS OM3 3 Certificate of Competency #: 0 3 B 5 001f33
Requests permission to install (describe work, attai:h separatq page if necessary) in the adjoining right of
r
way: / l X 12it x 2rr [^orr crifP ea�✓P✓S ra Vr;r llot{-ren on brr'zC wtJ Over
1,mervchc s~cl.
Type of Work: 0 Paving ❑ Utility ❑ Sidewalk ❑ Electric ❑ Irrigation
❑ Landscape ❑ Antenna ❑ Other:
DESIGNER: Architect/Engineer:
Address:
City:
Telephone: _
Registration #:
_ State:
Email:
ZIP:
Value of Work for this Permit: $ 301 -7S0 Square/Lineal Footage of Work: ior%
***** Fees*****
Permit Fee $ 100.00 0, 80 a. 50
Notary $ Training/Education $-GIRO Technology Fee $4-86 Scanning $ 3• n
Bond $ (if required) Total Fee Now Due $ 1010.30
Bonding Company's Name (if applicable):
Bonding Company's Address:
City:
State:
M3
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 L4i",A aft r'`wt*�
Applicant or Authorized Agent
Thefore in instrumen((w acknowledged efore
me this dayof JU 20by
AIUi v 6 r.e Ja''— who
is personally known to me or who has produced
FL -P (— as
identification
NOTARY PUBLIC:
Sign:
Print: it)
SEAL: -- John Roques
NOTARY PUBLIC
-'STATE OF FLORIDA
Comm# FF946106
"�Ncs ian� grX0r0A .411.71P020
Signature
Company/Utility Agent
The forego!nF instrumt was acknowledged before
me this Ze day of U ( 20J9� by
) ��-3c f who
is personally known to me or who has produced
r= as
identification.
NOTARY PUBLIC:
Sign:
Print:
VV061siv,
1oques
SEAL: QNOTARY PUBLIC
oSTATE OF FLORIDA
Comm# FF946106
Expires 4/17/2020
APPROVED BY: 1 Public Works Director, or Designee
2017-04-15
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RECORDED 0"fCii,'20i 12=47:49
,HARVEY RUVIN, CLERK. Of COURT
MIMI-DADE COUNTY, FLORIDA
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LAST PAGE
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY
Whereas, (owner) 4-/ vtnll46 4 Ay#a.* hereinafter referred to as the
owner of the following described property (address): to z rvw IOI sT /V)tarHr sJfa2�, 33r S
Legal Description Lot Block Subdivision G,ot D crtssr
Folio# II- NO
— ot2 - 0Z(0
Requests permission to install (d9scribe work): I zsr r z r.+c/L-VTr f&-C! s
Within the public right of way of (address) 16 2 Alw 101 ST
rnr9fit; Jniweg__s 33 f,Sn
IN CONSIDERATION of the approval
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 items) 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 �'�``,��62 e4z'
Owner or Agent
The foregoing instrument was acknowledged before me this 2� day
ed F
of 3yK f 20 1 �, by
W yl v-4 r, S t;,jy r � who is personally known to me or who has produc:' vL
as identification and who did take an oath.
STATE Of FLORIDA, COUNTY 0r� MIAMI.OADE coy
I HEREBY CERTIFY that this is a true copy of the
NOTARY PUBI.I�
Sign:
Print: n z
My Commission Expires:
WITNESS
T�tPeY John *Wag
cr Y NOTARY PUBLIC
A
STATE OF FLORID
corn# FF946106
1VCF 19�� Expires 4/1712020
aay of
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