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PW-12-20-2920, 9505 NE 5th AveMiami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Issue Date: 01/05/2021 Location Address Parcel Number 9505 NE 5TH AVE, Miami Shores, FL 33138 1132060140710 Contacts DONALD STOBS Owner 9505 NE 5 AVE, MIAMI SHORES, FL 331383161 Other:3057570950 Permit NO.: PW-12-20-2920 Permit Type: Public Works Work Classification: Public Works Permit Status: Approved Expiration: 07/06/2021 CHAMPION CONCRETE Contractor JAIME BASILIO 10280 NW NW 63 terr 105, DORAL, FL 33178 Business: 3052528055 jaimechampion@yahoo.com Mobile: 7864024802 Home: 3059784333 Other:7864024802 _... _,,,__„___,_ ,__.__,................. Inspection Requests: Description: STREET SIDEWALK REPLACEMENT Valuation: $ 2,000.00 305-762 4949-71 Total Sq Feet: 200.00 Fees Amount Education Surcharge $0.40 Public Works Permit Fee $100.00 Scanning Fee $9.00 Technology Fee $2.50 Tota I : $111.90 Building Department Copy Payments Date Paid Amt Paid Total Fees $111.90 Check# 3437 01/05/2021 $111.90 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. Futhermore, I authorize t* abovefamed contractor to do the work stated. Authorized Signature: Owner / Applicant / \Cont)actor // Agent Date January 05, 2021 Page 2 of 2 Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Location Address 9505 NE 5TH AVE, Miami Shores, FL 33138 Contacts _..,... ...... _ ,"" —_ __- I DONALD STOBS Owner 9505 NE 5 AVE, MIAMI SHORES, FL 331383161 Other:3057570950 issue Date: 01/0512021 Parcel Number 1132060140710 Permit NO.: PW-12-20-2920 Permit Type: Public Works Work Classification: Public Works Permit Status: Approved Expiration: 07/06/2021 CHAMPION CONCRETE Contractor JAIME BASILIO 10280 NW NW 63 terr 105, DORAL, FL 33178 Business: 3052528055 jaimechampion@yahoo.com Mobile: 7864024802 Home: 3059784333 Other:7864024802 Inspection Requests: Description: STREET SIDEWALK REPLACEMENT i Valuation: $ 2,000.00 305 762 4949 Total Scl Feet: ------ Fees Amount Education Surcharge $0.40 Public Works Permit Fee $100.00 Scanning Fee $9.00 Technology Fee $2.50 Tota I : $111.90 Applicant Copy Payments Date Paid Amt Paid Total Fees $111.90 Check# 3437 01/05/2C21 $111.90 Amount Due: $0.00 For Inspections, Call (305) 762-4949 or Log on at https://bidg.miamishoresvillage.com/cap/. Requests must be received by 3pm for following day inspections. NOTICE: In addition to the requirements of this permit, there may be AND THERE MAY BE ADDITIONAL PERMITS REQUIRED FROM OTHER additional restrictions applicable to this property that may be found in the GOVERNMENTAL ENTITIES SUCH AS WATER MANAGEMENT DISTRICTS, public records of this county. STATE AGENCIES, OR FEDERAL AGENCIES. January 05, 2021 Page 1 of 2 0, s� Z_ � Miami Shores Village `°" 0 Public Works Department (305)795-2210 Public works forms are available from the building department, 10050 NE 2"d Ave., Miami Shores, FL 33138 �v Name of Aoolicant (if utilitv see below): i,/cJn0o PUBLIC WORKS PERMIT APPLICATION Permit Type: Work in the Right -of -Way on Miami Shores Village or Miami -Dade Property qProperty Permit#: �i — 1 2-01 Owner off the following described property: o is tn'cA g AbS s r _— M, ©F Legal Description: Lotl�(�I� Block 5+ F Subdivision tfln Folio#;((— `�i2-00-6 ),4 —o-7 ►0 Address: S, t__ 3 3k iJ T 1 L If T l NIAivf 'I: _ Qualifier/Authorized Agent: Address: City: State: ZIP: Telephone: Email: State Certification or Registration #: s-` Certificate of Competency # CONTRACTOR NAME: dil YWIAN) Qualifier/Authorized Agent: -e— 4 0 1 Address: 0o %`✓41 1? & irq City: ./fir-9,64'e-, State: ZIP: Telephoner ZS �'r�i� Email &e4ftt-i" ' t` State Certification or Registration Certificate of Competency #:4Ce0.1r!s.5 a.'A" Requests permission to install (describe work, attach separa a page if necessary) in the adjoining right of way: Joe) heev Type of Work: [I Paving ❑ Utility N/Sidewalk ❑ Electric ❑ Irrigation E] Landscape ❑ Antenna [j Other: DESIGNER: Architect/Engineer: Address: City: State: ZIP: Telephone:' ' - .., _ Email:. Registration #: Value of Work.for this -Permit:- r$ � ``Square/Lineal. Footage of Work:. 4 0 1' *****Fees***** Permit Fee $ 100.00 Notary $ Training/Education $ 0.20 Technology Fee $ 0.80 Scanning $ Bond $ (if required) Total Fee Now Due $ �(� 4 0 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..) 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 -PAPCE 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 subj to the attachment. Also, a certified copy of the recorded notice of commencement must be po ted at the job site for the first inspection which occurs seven (7) days after the public works permit is s ued. In the absence of such posted notice, the inspection will not be approved and a reins�ction ill be charged. Signaturd Applicant or Authorized Agent The foregoing instrument was acknowledged before me this -1� day of IIIYP 20 ZQ , by 1pofakk t ohs I-1 T� _ who is personally known to me or who has produced N/k as identification. NOTARY PUBL!C: Sign: OZ % 910 V (oC ViP �) /E Print: J-, itn�.ZrC��c SEAL: mamar A. NOTARY PUBLIC STATE OF FLORIDA SCMOT CorrxnlD GG927605 W E Expires 10/29/2023 Signature Company/Utility Agent The foregoes instrument was acknowledged before me this I� day of20 Z-3, by , rnL 45-14AO who i ersona y nown o me or who has produced as identification. ivvTARY PUBLIC' Sign: Print: -- SEAL: ;:""�"; MY COMMISSION # GG 950477 o EXPIRES: March 6, 2024 Bonder'ThruNoharYPubkUndr.tri•" ******************************************* APPROVED BY: Public Works Director, or Designee 2017-04-15 rYa fa lazza NW 6y, .. i (03 +" 0v�bDer4�q ( 1f' , I73t7ld 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 COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY CFN: 20200705995 BOOK 32229 PAGE 2043 DATE:12/09/2020 08:34:47 AM HARVEY RUVIN, CLERK OF COURT, MIA-DADE CTY Whereas, (hereby referred to as the owner) ho�a iV , -57� Of the following described pr y: W444&WOA ` / D �Id Legal Description: lot Block � Subdivision Z " olio #; !/� 3Z_QF�' Address: _ f-5 /w 40e, Requests permission to install (describe work, attach aarat�e paa a 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 way. If 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 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 obligation has been cancelled by an affidavit filed in the Public Records of Miami -Dade County, Florida by the Village Manager of Miami Shores Village (or his fully authorized representative). Signature Ow or Authorized Agent - -State of ot: - - - - County oftlitxw, ._ttiAt-.<,.... _ The foregoing instrument was acknowledged before me this � day of gee 1- 20 _ , by VICi CA S�06S who is,2ersonally known to me or who has produced KI A as Identificatlon. NOTARY PUBUQ uG tsanur A ypl>rf�r 8 Sign: /J�✓/ �J�/� NOTARY PUBLIC jy- C STATE OF FLORIDA Print: y�'1CcC I t(;+Yyl l 2 2 c S SEAL: Cww*GG977W Expires 1012912023 Documents are recorded at the Clerk of the Courts, MIAMI-DADE COUNTY RECORDER, COURTHOURSE EAST, 22 N.W. First Street,1st Floor, Miami, FL 33128. m a • • • or) p--------- - - - --------- _ • • O° ° • • � w+w nlf'�� 1 BY �. • • cPT ••• •w• .fie* C) P.Pc z. • AL-L-EY_ ' •., o 30.00_ F �P �' 1"00' ,00?, BCM }� FD. tV' • • • • 0-0'° • . • 16' ` AfiE .' 4' C FE CE ••• e•� • •9a• •` �� `1�111 JrO J • 4 C.L.8.5 S� `n ,, • • .,:.. •�'0.42j, J z DRIVE: w WAY., A �` ALJ U) aa rz (� ti - 27.76' ' 14.50' �' 15.1' G RASS Y 4 PARKWAY `v/ 5.0'Nt << Al _ 27.74' 6.0 /24. �� y 1-sn C.B.S. RESIDENCE Ir o 6NO. 9505 Ln .0' ev: La in N, co 'n o `v CORAL TILES �.' 5.0 "' 13.0 o U Ln �p oo m TILES: Tft 04 p N J 24.84 1 •0 6.0' SCREEN PORCH is P.LE FLOOR N Ui • i r • 24.83' 13.6' • • K •••• FD. D.H. 4 T=25.00' ., , J •., t.A =89'58'30' o, f C L=39.26 N rn .. •,'« .. T=24.99' o 0 ofLei 04 • • ' i 1 N N '� ,t •• •• 30.00_ _ SIP 50 f IP FD. P •.• I Tim 5' CONS. - t. Florida Health Miami -Dad O.S.T.D.S. & Well Prog*a,-:�ofaPPlication No. (N BLI :.- REi� gl , 6i Date. A 0�/E_ Signature I� 20' ASPHALT PAVFAIFNT N.E. 95th STREET i.