PW-06-19-1454, 9518 N Miami AveMiami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address Parcel Number
9518 N MIAMI AVE, Miami Shores, FL 33150 1131010330460
Contacts
MIGUELTEMBLADERA Owner SELENIS TECHNOLOGIES LLC Contractor
9518 N MIAMI AVE, MIAMI SHORES, FL 331501717 VALERIO CERRON
30310 SW 152 AVE, HOMESTEAD, FL 33033
Business: 7864439590
Inspection Requests:
Description: DRIVEWAY PAVERS Valuation: $ 750.00 305 762 4949
Total Sq Feet: 150.00
Fees
Amount
Education Surcharge
$0.20
Public Works Permit Fee
$100.00
Scanning Fee
$9.00
Technology Fee
$2.50
Tota I :
$111.70
Payments
Date Paid Amt Paid
Total Fees
$111.70
Credit Card
09/25/2019 $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 construction ang zonigg: Futhermore, I authorize the above named contractor to do the work stated.
/ Applicant / Contractor ! Agent Date
September 25, 2019 Page 2 of 2
g • 30 �: 2 a.CVA
Miami Shores Village
Public Works Department ° i� '?
(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
Permit#: DS ' CC- - (9 - % 2C4�
n ',iS l
Name of Applicant (if utility see below): M U LZ L 1 1 13LA i) . Q��
Owner off the following described property:
Legal Description: Lot 5 Block _I ?� ( Subdivision t)k4 rn k C> rIor-e jSCC_ (C
Folio #; 1 I- 3 i o1- D 33 0Q(-.,_
Address: IG 1 � N M ilhv-4 f _A01-::? 3/10
UTILITY NAME:
Qualifier/Authorized Agent:
Address:
City: State: ZIP:
Telephone: Email:
State Certification or Registration #: Certificate of Competency #
CONTRACTOR NAME:
Qualifier/Authorized Agent: 4 vD
Address: • o ® I S Z d FL �' �7
City: f '(.cam 5Gx d State: ZIP: 3 J 3
Telephone: '_W&- ttq.3-G Email: f1ra'tpe,Mrts �c r�>rs •C YI
State Certification or Registration #: C.yG t-5 2_q,';(2_ Certificate of Competency #:
Requests permission to install (describe work, attach separate page if necessary) in the adjoining right of
way: iUv i+h V4(* x M..` IA&4-e
Type of Work: ❑ Paving ❑ Utility ❑ Sidewalk ❑ Electric ❑ Irrigation
❑ Landscape ❑ Antenna ❑ Other: PCIAgroa ck
DESIGNER: Architect/Engineer:
Address:
City:
Telephone: Email:
Registration #:
ZIP:
Value of Work for this Permit: $ Square/Lineal Footage of Work:
i5e
***** Fees *****
Permit Fee $ 100.00
Notary $ Training/Education $ 0.20 Technology Fee $ 0.80 Scannin $�
Bond $ (if required) Total Fee Now Due $ ( a
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 approved and a reinspection will be charged.
Signature
A, or Authorized Agent
The foregoing instrument was acknowledged before
me this -ZO day of , .r1L 20 ! !1 , by
a 111 � % d.r, h L'Jo who
is p sonally k wn to me or who has produced
1�'4- 7r;ve r L, rra as
identification.
Signa
Company/Utility Agent
The foregoing instrument was acknowledged before
me this ao day of -,93rle— , 20 l9 . by
N,Ia i�o C Q1 oun, who
is personally known to me or who has produced
�-_ C.SO - no—5u-21-gs
identification.
Sign: Sign: ` I
Print: Print:
SEAL: �µ�rnua CARLOSARAGON SEAL:
Commission # GG 178191 E=NJy
N t ExpkesApril22,2022 4oPr
J 1ilLLAFOFF1-Po8°ndedTlwuBud9KN YSaivkN ON # GG071524ruary 26, 2021
**********************************************
� n
APPROVED BY: g . ''1 14 Public Works Director, or Designee
2017-04-15
1 IIIi1 111 'r
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) M 1 Fp t_f �2 _T M i; L A D E ( A
hereinafter referred to as the owner of the following described
property (address): 115 { $ K) M t n tA I IN\J (: j"g1A I
Legal Description: Lot Block Subdivision
Folio # _ nA U � 2
Requests permission to install (describe work): _ /�
tJ �� V1� J!.'P?•ti ( j "FV 2 (1Fra J)
i 1
!i it '
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 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 andfor
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
caner or Agent
State of Florida C9 L �� QZ�flt�pp,
County of Miami Dade I O t
The foregoing instrument Was acknowledged before me this day of 20 1 q_, by
✓ TGG1 14 -_1Cr77N0,j0Q who is personally known tome or who has produced
==ru- , as i
NOTARY PUBLIC:
Sign:
Print: � t o i 0_ -
1 HERESYCNMN#Wf1N!6a-btwtaWaFftlw
onjWd filed In 0* Am " day of
WIT Najd Sed.
ARV RU I f and Comfy Couds
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NICO E DAVISINMI
- CASTtLLON
, - State of Florida
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