PW-10-20-2359Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address
Parcel Number
766 NE 95TH ST, Miami Shores, FL 33138 1132060141880
Contacts
TIA BOWMAN Owner
766 NE 95 ST, MIAMI SHORES, FL 33138
Home: 3053454247
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: DRIVEWAY PAVERS Valuation: $ 1,800.00�4949
TotalSq Feet: 150.00 `
Fees
Amount
Education Surcharge
$0.40
Public Works Permit Fee
$100.00
Scanning Fee
$3.00
Technology Fee
$2.50
Total:
$105.90
Building Department Copy
Payments
Date Paid Amt Paid
Total Fees
$105.90
Credit Card
11/02/2020 $105.90
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. Futhermre, I authorize the above named contractor to do the work stated.
Authorized Signature: Owner -/—�pplicant / 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
766 NE 95TH ST, Miami Shores, FL 33138 1132060141880
Contacts
TIA BOWMAN Owner
766 NE 95 ST, MIAMI SHORES, FL 33138
Home: 3053454247
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
_.._ ... W Inspection Requests:
Description: DRIVEWAY PAVERS Valuation: $ 1,800.00 74
TotalSq Feet: 150.00
Fees
Amount
Education Surcharge
$0.40
Public Works Permit Fee
$100.00
Scanning Fee
$3.00
Technology Fee
$2.50
Total:
$105.90
Applicant Copy
Payments
Date Paid Amt Paid
Total Fees
$105.90
Credit Card
11/02/2020 $105.90
Amount Due:
$0.00
For Inspections, Call (305) 762-4949 or Log on at hops://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 maybe 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
RECEIVED
p, Miami Shores Village
Public Works Department
(305)795-2210
Public works forms are available from the building department, 10050 NE 2"d 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-P - 20-23 G8
Name of Applicant (if utility see below): 1 f A- AOV L�AA)
Owner off the following de cribed property:
Legal Description: Lot Block'7 Subdivision .Ai QJS2M 3e-
Folio #, 1/ ~ 3`Z bL--
Address: W
UTILITY NAME:
Qualifier/Authorized Agent:
Address:
City:
Telephone:
State Certification or Registration #:
Email:
State:
ZIP:
Certificate of Competency #
CONTRACTOR NAME: G� � �" do
Qualifier/Authorized Agent: _/,�}iifi+G 64 4i
Address 0 -D AAt-� 63
City: 12 % State: ZIP: 5 / I
Telephone,1>5 CiW-4333 Email:
State Certification or Registration #: Certificate of Competency #:
Requests permisslop to
way:
6
(describe work, attach separate page if necessary) in the adjoining right of
Type of Work: ❑
Paving
❑
Utility
Sidewalk
❑
Landscape
❑
Antenna
❑ Other: _
DESIGNER: Architect/Engineer:
Address:
Citv:
Telephone:
Registration #:
State:
Email:
;5/Z'r_''L j'j .Fi I
❑ Electric ❑ Irrigation
ZIP:
Value of Work for this Permit: 'a d Square/Lineal Footage of Work:
***** Fees
1-5-4) sr<
Permit Fee $ 100.00
Notary $ Training/Education $ 0.20 Technology Fee $ 0.80 Scanning $
Bond $ (if required) Total Fee Now Due $ (66• tv
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. 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.
Si natur
Applicant or Authorized Agent
The fore �o,✓ing instrument as acknowledged before
me this l/0 day of 0-&, _, 20 zG , by
T/.2- 6oy"A d) who
is personally known to me or who has produced
as
identi icatlon.
Signature
Company/Utility Agent
The foregoing instrument was acknowledged before
me this day of 20 by
is personally known to me or who has produced
as
identification.
- - NOTARY-PUBL1C: - — ---NCYTARY-P-UBL1C.
Sign:
Print:f�
SEAL:
JAIME ARM?JUDO BASIUO
MY COMMISSION # GG 227924
EXPIRES: June 12, 2022
':� dFa+4• • Bonded Thru Net:i-v Public UndOrWIS'M
Sign:
Print:
SEAL:
wip�
APPROVED BY: Public Works Director, or Designee
2017-04-15
�HORF.e .
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
3T79
CFN: 20200545680 BOOK 32116 PAGE 1141
DATE:09/25/2020 12.20:32 PM
HARVEY RUVIN, CLERK OF COURT, MIA-DADE CTY
COVENANT OF CONSTRUf TION WITHIN RIGHT OF WAY
Whereas, (owner) TIA- .! rDWW d
hereinafter referred to as the owner of the following described
property (address): -7 4 6 N`5 5 T
Legal Description: Lot i Block G7 Subdivision H LA/tA !9"C5 5eG Z
Folio # I / - 32 06 " OAT— Q YV
Requests permission to install (describe work):
Within the public right of way of (address) '2 6 G NC
WA4 5I-6ono-S k - 33 t 3 Y
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 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 obligations has been canceled by an affidavit filed in
the Public Records of Dade County, Florida by the Village Manager of Miami Shores Village
his fully authorized representative).
Signature
Owner or Agent j ii s %6WAAA^
State of Florida
County of Miami Dade
The foregoing ins nt was acknowledged before me this _�day o� _, 20 AL by
who Is personally known to me or who has produced
NOTARY PU
Sign:
L�/�'J�r•��h1f