PW-07-22-1733Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Permit NO.: PW-07-22-1733
Permit Type: Public Works
Work Classification: Public Works
Permit Status: Approved
Issue Date:07/18/2022 Expiration:01/18/2023
Location Address Parcel Number
9819 NE4TH AVENUE RD, Miami Shores, FL 33138 1132060170210
Contacts _..
MEIDA Matos Owner r2 builders inc Contractor
98194 Rodolfo Rodriguez
10750 NW 138TH STREET # 5 NA, HIALEAH GARDENS, FL 33018
Business: 3052313113 r2_builders@yahoo.com
Mobile: 3059756331
r j Description: 4 X SIDEWALK SECTIONS Valuation: $ 1,600.00 Insection Requests:
305-762-4949
j I Total Sq Feet: 0.00
I � `sa: . ....ram....
Fees
Amount
Education Surcharge
$0.40
Public Works Permit Fee
$100.00
Scanning Fee (Manual)
$9.00
Technology Fee
$2.50
Total:
$111.90
Payments
Date Paid Amt Paid
Total Fees
$111.90
Credit Card
07/18/2022 $111.90
Amount Due:
$0.00
Building Department Copy
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores
Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate
permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: I certify that all the foregoing infor i is accurate and that all work will be done in compliance with all applicable laws
regulating construction and zoning. Futhernore, I author i hz9i�i�gy� named contractor to do the work stated. r
q
2'-
Authorized Signature: Owner / Applicant / C4woor I Agent
Date
July 18, 2022 Page 2 of 2
SR6
L. RCF ZIV ��
Miami Shores Village
Public Works Department JUL 11 W22
(305)795-2230
Public works forms are available from the building department, 10050 NE 2nd Ave., Miami Shores,1,-�3138
PUBLIC WORKS PERMIT APPLICATION
Permit Type: Work in the Right -of -Way on Miami Shores Village or Miami -Dade Property
Permit#: ? IV oTzz_ 1-733
Name of Applicant (if utility see below): -,
Owner off the following described property:
Legal Description: Lot 5 (e Block Subdivision 17.e-,$
Folio #;
Address:20A'
UTILITY NAME:
Qualifier/Authorized Agent:
Address:
Citv:
Telephone:
State Certification or Registration #:
Email:
State:
CONTRACTOR NAME: 1Z2 I�chly " IWL
Qualifier/Authorized Agent: Po@•16 Do ti
Address: WW I S9 S i
City: Atc.',WA 9p eK 5 State: F
Telephone: 305 7,M $1 1 3 Email: (w�v z
State Certification or Registration #: �G 16139' (o q C
ZIP:
Certificate of Competency #
Requests permission to install (describe work, attach separate
way: q K Su$e wa f k S&
ZIP:
of Competency
r&
if necessary) in the adjoining right of
Type of Work: ❑ Paving ❑ Utility s Sidewalk ❑ Electric ❑ Irrigation
❑ Landscape ❑ Antenna ❑ Other:
DESIGNER: Architect/Engineer:
Address:
Citv:
Telephone:
Registration #:
_ State:
Email:
ZIP:
Value of Work for this Permit: $ 1 r (000 � Square/Lineal Footage of Work:
***** Fees *****
Permit Fee $ 100.00 410
Notary $ Training/Education $ 0.,W Technology Fee $ 0.80 Scanning $
Bond $ f required) Total Fee Now Due $ 1 I ).Ct
Bonding Company's Name (if applicable): P AT
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 _L 1 day of UI V 20� by
Mend?/ MAIDS who
is personally known to me or who has produced
DL as
identification
NOTARY PUBLIC:
Sign:
Signature
Compan'"tility Agent
The foregoing instrument was acknowledged before
me this I) day of 5 UL20 22 by
�odlol frr� µ12_ who
is personally known to me or who has produced
D L— as
identification
NOTARY PUBLIC:
Sign:
Print: ` 41 Notary Puoiic - State of F:onaa Print: t'i Notary 7umic - State or =:anaa
omm,, ti• ommission:7RMUT—
SEAL: c
SEAL: .'.?a n:•" My Comm,. Espires Mdr S. 2026 '','„Exn my Comm. Expires mar S. 2021
sanded thrat.gh vationa: votary Assr. 3accec thraLh vzrara, vctary assr.
APPROVED BY: Public Works Director, or Designee
2017-04-15
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Miami Shores Village
Building Department
10050 N.E.2nd Avenue
tcit
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY
Whereas, (owner) P"N el(jw MA IPS
owner of the following described
hereinafter referred to as th
props (address):
j IV V-C 124*7
Legal Description Lot -4 /P Block
Subdivision M J AA4 i S A a ee3
Folio #
Requests permission to install (describe work): X
,
S re w6,L k 5CCX;ok1S
Within the public right of way of (address) T 1 I
N R' k7o
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 Manag r of Miami Shores Village (or is fully authorized representative).
Signature Rj & N\
Owner or Agent
The oregoin�in9trument was acknowledged before me this I I I h day of �n , 20 ZZ, by
8 t&t who is personally known tome or who has produced D L.
as identification and who did take an oath.
NOTARY PUB L C• ' ' JULISSA ROCRIGAZ
' rica
n: Si `� « . Notary ?uoric • State of -.o
9 "' Commission 3 AH 228503
Print: lav �116?— My Comm. rx0res mar S. 2026
My Commission Expires: J------B-oRed through . ctarl Assr.
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LANNES & GARCIA, INC.
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MIAMI SHORES VILLAGE
PUBLIC MKS REVIEW Zz
APPROVED -mil