PW-07-24-1854ONTERED
v Miami Shores Village
JUL 18 2024 Public Works Department
� ,t� (305)795-2210
Public works foBY2L"Ua'the-building department, 10050 NE 2n' 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#: ' W —0-l- 2_LJ' (e�SLI
Name of Applicant (if utility see below): 2 o O jA'7
Owner off the following described property:
Legal Description: Lot Block Subdivision
Folio#; r 3/3�
Address' I-7� ia2 3`1 /1�i�rni 3
UTILITY NAME:
Qualifier/Authorized Agent:
Address:
City:
Telephone:
State Certification or Registration #:
Email:
State:
ZIP:
Certificate of Competency #
CONTRACTOR NAME: l�/%ZIiL Al LD a�12A&n l O>16,12 A
Qualifier/Authorized Agent:
Address: 1 0 U 0 N W to3 -4=xv-4-c�
City: :Z>ru-1 State: V:� ZIP: 33 1-?16
Telephone: 0 - Email:
State Certification or Registration #: Certificate of Competency #: 14-6 QS[3 Sir 8 t 5
Requests permission to install (describe work, attach separate page if necessary) in the adjoining right of
way: R 2Q1 uc 1 >9. P1r1/- 02 —20 3Z T
Type of Work: ❑ Paving ❑ utility ❑ Sidewalk ❑ Electric ❑ Irrigation
❑ Landscape ❑ Antenna ❑ Other:
DESIGNER: Architect/Engineer:
Address:
Citv:
Telephone:
Registration #:
_ State:
Email:
ZIP:
Value of Work for this Permit: $ 4 00 Square/Lineal Footage of Work:
Permit Fee $100.00
Notary $
Bond $
***** Fees *****
Training/Education $ 0.20 Technology Fee $ 0.80 Scanning $
(if required) Total Fee Now Due $
M
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. the
absence of such posted notice, the inspection will not be approved and a reinspection will be harged.
SignaturAApcantor
/
Authorized Agent
The foregoing instrument was acknowledged before
me this i-1 day of 1U1�A 20_?q_, by
z c� who
is person -ay known to me or who has produced
Jti L� c, as
identification
Signature
Co any/Utility Agent
The foregoi�g rnstru ent was acknowledged before
methis 1'1 daavxof JU(4 20-!�:L by
�CLuw\t. GQW11(o who
is personally known to me or who his produced
T —LVLVs 1, c as
identification
NOTARY PUBLIC:
NOTARYPUBLIC:
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SEAL:
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SEAL:
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Expires: Jan. 31,2026
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Expires: Jan. 31,2026
Public - State of Florida
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%,,, o Notary Public - State of Florida
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tary
APPROVED BY:
Public Works Director, or Designee
2017-04-15
LOT 7
LOT 6
BLOM IS
IV 13
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LOT 22
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BLOCK 13
PAYERS] LOT 23?,b
j BLOCK 13
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0' 15' 30'
1 inch = 30' ft.
LOT 21
BLOCK 1J O
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ONE STORY
RESCENCE
9 171
2250' PA"AY
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;V9ian1; Shores Village
ppROVED BY DATE
`TDNING, DEPT
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,ral Fi�GI II A f If�N
OF INTEREST:
Y FENCE CROSSES ONTO ADJACENT LOT.
MAP OF BOUNDARY SURVEY
Property Address:
171 NE102ST
MIAMI SHORES, FL 33138
nlineland
SURVEYORS,INC.
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LOT 4
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BLOCK 13
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LOT 5
BLOCK 13
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SURVEYOR-SCERTIFICATION:
I HEREBY CERTIFY THAT 7HIS'BOUNDARY SURVEY' IS A TRUE
AND CORRECT REPRESENTATION OFA SURVEY PREPARED UNDER MY DIRECTION. THIS
COMPLIES WITH THE MINI
STANDARDS, AS SET FORTH BY THE STATE OF
FLORIDA BOARD OF P
SIONAL SU RS AND MAPPER IN CHAPTER 5J-17.051, FLORI
ADMINISTRATIVECO U SLANT TO SEC 472.027, FLOIRDA STATUTES
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SIGNED
FOR THE FIRM
MIGUEL ESPIN0
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P.S.M. No. 5101
STA TE OF FLORIDA
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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 relocat
within 60 days notice by the Village to do so. Failure to
Village causing the item(s) to be removed and a lien
assessed against the Owner for all costs incurred in the
4. The undersigned further agrees that these conditions
with the land and shall remain in full force and effect a
an
e
their facilities at their own expense,
comply with this notice will result in the
being placed on the property and/or
removal and disposal of the item(s).
shall be deemed a covenant running
be binding on the undersigned, their
heirs and assigns, until such time as this obligations has been in
the Public Recor of Dade County, Florida by the Village Manac,�eneofi9G4�lfllage
or his ill autho iSed representative . Oda oonadsaa before ma this;
( y rn I ) ,.day of jtv� 20�TJ bY..
has
aaw
er ntau6`� State of Florida =,.; Comm.#GG924911 ',F rexOCbW22,20Z
County of MiamiDadEt�rexOCbpb��22'2023 °`°����T ne foregoing instrumewasBacdknowledge ore me this �_ day of �S� 20 ' ,
who is personally known tome or who has prod�ced
L1 - as identific lie =1 z5 -�(�
NOTARY PUBLIC:
ac-
SEAL:
by