PW-05-21-1355, 177 NW 96 StMiami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address
177 NW 96 ST 11-3101-02S-0140, Miami Shores, FL
33138
Contacts
E.. =
Permit NO.: PW-05-21'1w
IN
Permit Type: Public Wdj"',
Work Classification: Public WAS
Permit Status: Approved
Issue date f)5/27(2021
Expiration: 11/29/2021
DIANA ROMAN Owner CORE BIM, LLC Contractor
177 NW 96 ST, MIAMI SHORES, FL 33150 MICHAEL COURTNEY
Business: 786 ARTPOSITED@GMAIL.COM 110 MERRICK WAY 3-A, CORAL GABLES, 33134
Mobile: 7865144974 Business: 7864873895
Home: 514
Other: 514
� Inspection Re uests
ovecallpwth 20'pmax. re tlace 4Xwalkwariven auao m aee Valuation: $ 3,000.00 305-762-4949'
p Y g p TotalSq Feet: 756.00
landings. Wire &fiber mesh construction @ 6"
Fees
Amount
Education Surcharge
$0.60
Public Works Permit Fee
$100.00
Scanning Fee
$3.00
Technology Fee
$2.50
Tota I :
$106.10
Building Department Copy
Payments
Date Paid Amt Paid
Total Fees
$106.10
Credit Card
05/27/2021 $106.10
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 AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws
r stru,ction and zoning. Futhermore, I authorize the above named contractor to do the work stated. —7 %
Authorized Signature: Owner / Applicant / Contractor / Agent
May 27, 2021 Page 2 of 2
k
S
MAY 2 - 202�
Miami Shores Village
Public Works Department )y
(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#:4r7u_ OS -2,i _i3ss
Name of Applicant (if utilitv see below): &4eJ A cus + .' r 61 anG, K 0th a
Owner off the following described property:
Legal Description: Lot I H Block Subdivision Re S Utj 01 i S I oN d V aC1( 3
Folio#; II-3to1-oZ5—o1L-Ip NU'A 0,\ Poocv
Address: Ili- Nw gb`rW STEP MIf�Mi Shores FL 331so
UTILITY NAME:
Qualifier/Authorized Agent:
Address:
City:
Telephone:
State Certification or Registration #:
CONTRACTOR NAME:
Email:
L'_L
State:
ZIP:
Certificate of Competency #
Qualifier/Authorized Agent: Im ckW N A-he1Y
Address: IL C
City: p State:
Telephone: �7 `� � ' �1- � K �� Email: �f, 3 I o ..-+ � z�_
State Certification or Registration #:C6L i511k11 Certificate
ZIP: 'I
Competency
Requests permission to install (describe work, attach separate page if necessary) in the adjoining right of
way: I%vvvcwciy g9Pr%a_r_6 Gwci re�a:t' Cra�,Ic�d Po�itow
OF S►dewc%.\1C
Type of Work: ❑ Paving ❑ Utility
❑ Landscape ❑ Antenna
[T Sidewalk ❑ Electric ❑ Irrigation
❑ Other:
DESIGNER: Architect/Engineer: tAe. Arch rl ee-1 , 1-L-C_
Address: 138c1ci i3, Sca_4y\c Gk\) a Su%Ve 308
City: N U rTH R j a fA i Gt-og'\ State: PL ZIP: 3 3 16 Z
Telephone: 305 - 52-7- Sk 15 Email: IM% T e I rM�r _ o rc, •%, A ec l - c owk
Registration #: 114 2 400 z 3 a 9
Ov
Value of Work forthis Permit: $ 000 Square/Lineal Footage of Work: 00 5 u4'e
***** Fees*****
Permit Fee $100.00
Notary $ Training/Education $ 0.20 Technology Fee $ 0.80 Scanning $,7
Bond $ (if required) Total Fee Now Due $ 06 . 1
P a°
J
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
Applicant or Authorized Agent
The foregoing instrument was acknowledged before
me this 1'7 day of M 14 , 20 Z ! by
esfi ry -r Geo5-� who
is personally known to me or who has produced
�Ti g>� T!-)33v as
identification.
NOTARY PUBLIC:
Sign:
Print: ' - 1---\0 C/1.4"tV2S1
SEAL:
,g CINTHYA E. MORALES
Notary Public - State of Fierira
`.?lCommission M GG 956712
My Comm. Expires Feb 10, 2024
APPROVED BY:
2017-04-15
Signature ( 1I
Company/Utilky Agent
The foregoing instrument was acknowledged before
me this —3 day of M a 1& 120� by
1'�►tt`cl Col_ l who
is personally known to o mewho has produced
as
identification.
NOTARY PUBL C:
L--
Sign:
y�
Print:
9TAlj
SEAL-
Notary Pubk $tale of Florida
•
Amis Edmiston
�1
W COW411on GG 202406
Expires 01/17/2023
**********************************************
Public Works Director, or Designee
ENTERED
� `" 2 5 021
Mia�riVwes Vill
Public Works DepartiMiff -`
(305)795-2210
Public works forms are available
from the building department,
10050 NE 211a Ave., Miami Shores, FL 33138
COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY
Whereas, (hereby referred to as the owner)
Of the following described property:
Legal Description: Lot 14 Block
3 Subdivision Folio #;
CFN: 20210368668 BOOK 32525 PAGE 3735
DATE:05/24/2021 02:59:38 PM
HARVEY RUVIN, CLERK OF COURT, MIA-DADE CTY
11-31o1-025-01y0
Address: NW ckVl1. Ayl, �• iNA\ Anni Sl10re5 f-L 33150
Requests permission to install (describe work, attach separate page if necessary) in the adjoining right of way:
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 watt. Jf it
becomes necessary for Miami Shores Village or Miami -Dade County to make repairs or maintain said items within the public
right of way including restoration of the 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 herby agree to indemnify and hold Miami Shores Village or Miami -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 14 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 the se condi:ians shalt be deemed a covenant running with the land and shall remain in
full force and effect and be binding on the ttru;ersigned, their heirs and assigns until such time as this obligation has been
cancelled by an affidavit filed in the Public kecvrds of Miami -Dade County, Florida by the Village Manager of Miami Shores
Village (or his fully authorized representative).
4�L-
Signature �
Owner or Authorized Agent
State of 'RO YOOL
County of MlGihtt 1{ VI
The foregoing instrument was acknowienged before me this `i day of "CL 201,J by
�, ACO.Q Gt who Is personally known to me or who has produced
TLOVICla-bKVCrrS `lam as identification.
NOTARY PUB IC:
Sign'
Print: LltA41WCA SEAL:
2017-04-11
CINTHYA E. MORALES
Notary PUbJk . state of Florida
'®
Commission N GG 956782
My Comm. Expires Feb 10, 2024
LOT - 15
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BLOCK
CORNER
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W. U.P. OUL ROMAN
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PAVERS :=
— Cos
177 N.W. 96th STREET,
F.LP. %J' MIAMI SHORES, FLORIDA .
NO ID. FLOOD ZONE: X
MAP & PANEL= 12086CO30
COMMUNITY No.: 120652
SUFFIX. L
DATE OF FIRM: 09-11-200�
BASE ELEV. = N/A
L.F. ELEV. = 12.22 NOTE
ELEVATIONS SHOWN REF
LOWEST ADJACENT GRAZ
B.M. # N-568 ELEV. = 9.6;
o GARAGE ELEV. = N/A
° E.R.P. = 9.60
o NTERED
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5' CONC.WWEST 75.00'R&M T-':`:..
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IP PARKWAY
17' ASPHAL T Pd VEMF_ IV r
9� 15' MEDIAN
N. W. 96th STREET
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NOT VALID WITHOUT THE SIGNAR
ORIGINAL RAISED SEAL OF A FLORI
SURVEYOR AND MAPPE