PW-03-20-682, 544 NE 93rd StMiami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address
Parcel Number.
544 NE 93RD ST, Miami Shores, FL 33138 1132060141070
Contacts
GREGORY RUDNICK Owner
544 NE 93 ST, MIAMI SHORES, FL 331382844
Other:3057587791
JAIME BASILIO
10280 NW NW 63 terr 105, DORAL, FL 33178
Business: 3052528055 jaimechampion@yahoo.com
Mobile: 7864024802
Home: 3059784333
Other:7864024802
Description: REPLACEMENT OF 5 BROKEN SIDEWALK Valuation: $ 1,000.00Ins ection Re uests:;•
Total Sci Feet: 250.00
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
11/02/2020 $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 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 and zoning. Futhermo/e, I authorize the above named contractor to do the work stated.
Authorized Signature: Owner
icant / Contractor / Agent
Date
November 02, 2020 Page 2 of 2
Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address
Parcel Number
544 NE 93RD ST, Miami Shores, FL 33138 1132060141070
Contacts
GREGORY RUDNICK Owner
544 NE 93 ST, MIAMI SHORES, FL 331382844
Other:3057587791
CHAMPION CONCRETE Contractor
1AIME BASILIO
10280 NW NW 63 terr 105, DORAL, FL 33178
Business: 3052528055 jaimechampion@yahoo.com
Mobile: 7864024802
Home: 3059784333
Other:7864024802
Ins Description: REPLACEMENT OF 5 BROKEN SIDEWALK Valuation: $ 1,000.00 ectton Requests:
TotalSq Feet: 250.00
Fees
Amount
Education Surcharge
$0.20
Public Works Permit Fee
$100.00
Scanning Fee
$9.00
Technology Fee
$2.50
Total:
$111.70
Payments
Date Paid Amt Paid
Total Fees
$111.70
Credit Card
11/02/2020 $111.70
Amount Due:
$0.00
Applicant Copy
For Inspections, Call (305) 762-4949 or Log on at https://bidg.miamishoresvillage.com/cap/.
Requests must be received by 3pm for following day inspections.
NOTICE: In addition to the requirements of this permit, there may be AND THERE MAY BE ADDITIONAL PERMITS REQUIRED FROM OTHER
additional restrictions applicable to this property that may be found in the GOVERNMENTAL ENTITIES SUCH AS WATER MANAGEMENT DISTRICTS,
public records of this county. STATE AGENCIES, OR FEDERAL AGENCIES.
November 02, 2020 Page 1 of 2
Miami Shores Village P.-FICEIVED
Public Works Department
(305)795-2210 ��d Z�Z�
Public works forms are available from the building department, 10050 NE 2"d Ave., Miami Shores, FL Ajj8)
PUBLIC WORKS PERMIT APPLICATION BY: —
Permit Type: Work in the Right -of -Way on Miami Shores Village or Miami -Dade Property
Permit#:?V4, Q 2j— 2JQ C08_2
Name of Applicant (if utility see below): k'_ "7 �wy 1-6
Owner off the following described property:
Legal Description: Lot�- , Block Subdivision /1dWV $/' p" 5'�
Folio #; //, 5 2-04- 07 10
Address: '� i%-f �a a Z 150� aw
UTILITY NAME:
Qualifier/Authorized Agent:
Address:
City:
Telephone:
State Certification or Registration #:
CONTRACTOR NAME:
Qualifier/Authorizgd Agent:
Address:
City: __4
Telephone:
State Certi ication or Registi
State:
ZIP:
Email:
Certificate of Competency #
U
Requests permissio2 to install (describe work, attach separate page if necessary) in the adjoining right of
way: ` C
Type of Work: ❑ Paving ❑ Utility Sidewalk ❑ Electric ❑ Irrigation
❑ Landscape ❑ Antenna ❑ Other:
DESIGNER: Architect/Engineer:
Address:
City: State: ZIP:
Telephone: Email:
Registration #:
Value of Work for this Permit:. $ 1, 000 Scl4are' A neal Footage,of W41k is S
7
Fees
Permit Fee $ 100.00
Notary $ Training/Education $ 0.20 Technology Fee $ 0.80 Scanning $
Bond $ (if required) Total Fee Now Due $ • —ri.)
F
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 sev0 7) days after the public works permit is issu9b. In the
absence of such posted notice, th m, pectjbn will not be approved and a reinspection will a charged.
Signature
gt(plicant or Authorized Agent
The foreg ng instrume t was acknowledged efore
me this?Q day of IY.'nM 20 i V , by
41ei1ty1"A04 who
is personally known to me9r who has produced
as
identification. r
NOTARY PUBLIC:
Sign:
Print: .J44%,K, 6A SyVS
Signature
CompaAy/Utility Agent
The foregoing instrumenj was acknowledged before
me this 3 0 day of a VC Vl 20 20 , by
�AM12 f\(�.�r(lQ I�lS�L % 0 who
is personally known to me or who has produced
��- D�\Nef-S L tCey1Se as
identification.
NOTARY PUBLIC:
Sign:
Q—EC--2—
Print: Selena Ilya do
SEAL: SEAL:
_ •- 'K WC ON#GG2VM;.;.; SELENA ARANDA
.; COMMISSION # GG 97t705
EXPPS"� 1$ 2022 ';,r `.: EXPIRES 22, 2024
�;N• 7MU••_... Pu61cUNA MO04 '••�oPiti�.'• gp Tin NofmyPUbIICUIIdef1NllfBrS
1
APPROVED BY: 3,�02 Public Works Director, or Designee
2017-04-15
9era1 , �L � 331't8
Miami Shores Village
Building Deparbnent
10060 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (306) 795.2204
Fax: (305) 766.8972
COVENANT OF CONSTRUCTIONWITHIN' 01 y
Whereas, (owner) a JefD i'A>C
hereinafter referred to s t e owner o the fol wing described
property (address): — L1 y `
Legal Descri do : L t Block Subdivision /'11*W S/ AAd S& Z
—Felio-# a „4-4
—I — — - — -- -
Requests permission to install (descrl4e yvorl )-
CFN: 20200586348 BOOK 32144 PAGE 2836
DATE:10/15/2020 08-.44:49 AM
HARVEY RUVIN, CLERK OF COURT, MIA-DADE CTY
Within the public right of way of dress <Cl,�J AA? g
IN CONSIDERATION of the approval of Us 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 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 obl' tions has been canceled by an affidavit filed in
the Public Records of Dade County, i by the Village Manager of Miami Shores Village
(or his fully authorized representativ
Signature
0 nerorAgent ��•a�er-r 8rv�� n�d�:�
State of Florida
County of Miami Dade
The foregoing instrument was acknowledged before me this 3 day of M4444t , 20 'I' , by
4"fo fiE
ho is personally known to me or who has produced
as !dent i to .
NOTARY PU,uuW a� W
Sign: •. mycomms"0
Print: G Ija►5� s: w"��,sm SEAL:
�t P
.tl
=a s�
K PC FENS
�i
0
NE. S- 4"A (/6-/vUC
4F, R/w /-/N 9,
E
Z S, 00'OAS
Z
)EWALK ,�
611 THICK
>RIVEWAy
0
o
0
Z
7s,
a
3'75 f
MIAMI SHOD'' . �� S VI LAIG
-,4E A/�vpE,e 6077 3 PUBLIC RKS REW.'?� t
��ocK .s7 �voT z��cGuo� APPROVED ' QATE_3�w
Ln
m m
m
• r- ;o
m
>ym
Zr�
M (n
;u 0
�X�
�0m
000
z=
VQm
om
0 1::�� i-