PW-05-22-1301Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address
489 NE 101ST ST, Miami Shores, FL 33138
Contacts
Pamela Jarvis Owner
489 NE 101 ST, Miami Shores Village, FL 33138
Issue Date:05/26/2022
Parcel Number
fik 611111*111*D1
Permit NO.: PW-05-22-1301
Permit Type: Public Works
Work Classification: Public Works
Permit Status: Approved
Expiration: 11/28/2022
JAIME BASILIO
10280 NW NW 63 terr 105, DORAL, FL 33178
Business: 3052528055 jaimechampion@yahoo.com
Mobile: 7864024802
Home: 3059784333
Other: 7864024802
Description: replace brokem sidewalk Valuation: $ 3,000.00 Ins ection Requests..
Total Sq Feet: 250.00
Fees
Amount
Education Surcharge
$0.60
Public Works Permit Fee
$100.00
Technology Fee
$2.50
Total:
$103.10
Payments
Date Paid Amt Paid
Total Fees
$103.10
Credit Card
05/26/2022 $103.10
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
regulating
1 certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws
and zoning. Futhermore, I authorize the above named contractor to do the work stated.
Owner / Applicant / Contractor / Agent
Date
May 26, 2022 Page 2 of 2
/�0
,_. _ .
Miami Shores Village AAY 2 3 2022
" Public Works Department
(305)795-2210 Y
Public works forms are available from the building department, 10050 NE 2nd Ave., Miami Shores, fL
PUBLIC WORKS PERMIT APPLICATION
Permit Type: Work in the Right -of -Way on Miami Shores Village or Miami -Dade Property
Permit#:Rj-�J� -
Name of Applicant (if utility see below): 7 J - "rw�5
Owner off the following described property: ��h1���
Legal Description: Lot Block Subdivision � 044 S/ wlvJ �t f1'o
Folio #; #-J2-06-- ol7 - 061fQ
Address:_ 1-trlL NE /Ul YT- "A" 5/A110
UTILITY NAME:
Qualifier/Authorized Agent:
Address:
Citv:
Telephone:
State Certification or Registration If:
CONTRACTOR NAME: _
Qualifier/Authorized Agent:
Address: 4OaD A)&
City: /l �OdIAC -
State Certification or Registration
Email:
Email:
Requests permission to install (describe work,
way: SLY//A(t� (O �Itoz'%
Type of Work: ❑ Paving ❑ Utility
State:
State:
ZIP:
Certificate of Competency #
ZIP: ��:?Kn _
separate page if necessary) in the adjoining right of
❑ iS dewalk ❑ Electric ❑ Irrigation
❑ Landscape ❑ Antenna ❑ Other:
DESIGNER: Architect/Engineer
Address:
City:
Telephone:
Registration #:
_ State:
Email:
ZIP:
Value of Work for this Permit: $ p° V Square/Lineal Footage of Work: W—If '
***** Fees *****
Permit Fee $ 100.00
Notary $ Training/Education $ 0.20 Technology Fee $ 0.80 Scanning $
Bond $ (if required) Total Fee Now Due $
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 i ued. In the
absence of such posted notice, the inspection will not be approved and a reinspectionl be charged.
Sign atur-&-f
' (✓l/ !/�✓/
/—Applicaj
or Auth rized Agent
The foregoing instrume
wa cknowledged before
meth d y of
20% by
)A
S who
is person I known to me or who has produced
2(�Z%_ as
identification.
NOTARY PUBLIC:
Sign: q,/,� ,�,r Sign:
Print: "�M/�YKi 'CK MY U0VWSzf0
L Notary
SEAL
JAIME ARMANDO BASILIO
MY COMMISSION # GO 227924
EXPIRES: June12,2022
APPROVED BY:
2017-04-15
Signature
Company/Utility Agent
The foregoing instrument was acknowledged before
me this 2� day of 110_3 . by
SA,mf.. T3r�Sl who
is personally known to me or who has produced
as
identification.
NOTARY PUBLIC:
ti
Print: : �"•"•"`�-••• ARLENIS SILVERA
SEAL: •� �;'
EXPIRES: March 6, 2024
h°•' BorAed TlwPublleUMery
Public Works Director, or Designee
w
Miami Shores Village
Public Works Department
(305)795-2210
Public works forms are available
from the building department,
100S0 NE 2n1 Ave., Miami Shores, FL 33138
COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY
CFN 2022RO394110
OR BK 33187 Ps 773 (1P9s)
RECORDED 05/16/2022 14:10:07
HARVEY RUVIN, CLERK OF COURT
MIAMI-DADE COUNTYr FLORIDA
Whereas, (hereby referred to as the owner) /7/lO(A- I%, yo
Of the following described property:
Legal Description: Lot Block Subdivision Folio #;
Address: 4e? NE /D/ 57— T1" S%S & 3317Y
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 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 indemnity 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 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
,Owner orAuth izta edAg. nt �IM��� A/J) S
State of V 111
County of J9" The foregoing instrument was acknowledged before me this _h> day of N'��'I'(' 20 2L by
AiW4 n,AAWf / who is personally known to me or who has produced
-l1�L
as identification.
NOTARY PUBLIC: :c'"�"Fi:• w.'L,iE ARMANDO 6ASI1.I0
r. MYt.OrtM
n:
gISS10NgGG227724
` Si •a:r EXPI �':jvin;;r,: RE3: June 12, 2012
..1 ._ acnOed TMutgxvyp„pgp�_
Print: 'iiSG SEAL:
Documents are recorded at the Clerk of the Courts,
MIAVW@p ),Y tJklCpy SOUR
22 NIV16f MURtoft dat Flows WEl:;6 df N
2017-04-11 original filed in this office on day of
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MIAMI SHORES VILLAGE
PUBLIC WORKS REVIEW
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