PW-03-22-739Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address Parcel Number
.._......_..__._........_..__..,._...._._........._...._-........._._....................................................................................................................................._.._..........................._..._..........._.... .. .-...........__._._....... .._........ _ _ __
9526 NE 2ND AVE, Miami Shores, FL 33138 1132060132660
Contacts
Miami Dade County Owner BLUE STREAK CABLE & Contractor
Fire Department TELECOMMUNICATIONS, LLC
9300 NE 2 AVE MICHAEL SEAN BURCHELL
8200 NW 41 ST 318, DORAL, FL 33166
Business: 7868680681 ycasanas@bluestreakllc.com
_.._._...._........._..... _...-..-...--.__.............. ..-.......... _._.................. __._._......._...._................v.-----........................_....._ ._._..._-. __.-__._-.......-....-....._-
€ Inspection Requests:
Description: PROPOSED DBORE 50 - REMOVE & RESTORE 25 SQ Valuation: $ 0.00 305 752 449 ;
FT OF GRASS AREA
Total Sq Feet: 0.00
,_.._..� 9 ,.
Fees Amount Payments Date Paid Amt Paid
Total Fees
Total:
Amount Due:
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 information is accurate and that all work will be done in compliance with all applicable laws
regulating cogstruction and zoning. Futhermore, I authorize the above named contractor to do the work stated.
Authorized Signature: Owner / Applicant / Contractor / Agent Date
June 07, 2022 Page 2 of 2
` C P,IVF,1 wJ
MAR n
'�-''�"�' / Miami Shores Village DV
Public Works Department
(305)795-2210
Public works forms are available from the building department, 10050 NE 2"`' Ave., Miami Shores, FL 33138
PUBLIC WORKS PERMIT APPLICATION
Permit Type: Work in the Right -of -Way on Miami Shores Village or Miami-GOV-03
erty
Z't— 73 c,
Permit#. A02B2CV
Name of Applicant (if utility see below): AT&T
Owner off the following described property:
Legal Description: Lot Block Subdivision MIAMI SHORES
Folio #; 11-3206-013-2630
=� Address: 9526NE2NDAVE
UTILITY NAME: BELL SOUTH TELECOMUNICATIONS LLC, DBAAT&T FLORIDA
Qualifier/Authorized Agent: CLAUDIA ISAC
Address: 600 NW 79TH AVE, ROOM 360
City: MIAMI State: FL ZIP:
Telephone: 305-746-6866 Email: ci611a@att.com
State Certification or Registration #: Certificate of Compete
CONTRACTOR NAME: Blue Streak Cable & Telecomunications, LLC
Qualifier/Authorized Agent: Michael Sean Burchell
Address: 12595 SW 137TH AVE, SUITE 208
126
ft
City: MIAMI — - State: FL ZIP: 33186
Telephone: 305-345-7618 Email: permits@bluestreakllc.com
State Certification or Registration #: EC 13004448 Certificate of Competency #
Requests permission to install (describe work, attach separate page if necessary) in thO adjoining right of
--� way: - PROPOSED DBORE 50' -REMOVE & RESTORE 25 SQ Ft OF GRASS AREA.
Type of Work: ❑ Paving W Utility ❑ Sidewalk ❑ Electric ❑ Irrigation
[] Landscape n Antenna [] Other:
DESIGNER: Architect/Engineer: CLAUDIA ISAC
Address: 600 NW 79TH AVE, ROOM 360
City: MIAMI State: FL Zip: 33126
Telephone: 786-333-9074 Email: al876h@att.com
Registration #:
Value of Work for this Permit: $ Square/Lineal Footage of Work:. 50'
**** Fees ***
Permit Fee $ 100.00
Notary $ ____ Training/Education $ 0.20 Technology Fee $ 0.80 Scar
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 issued. In the
absence of such posted notice, the inspection will not be approved and a rein spection'wilI be charged.
Signature _Gir,4W51A )SAC,
Applicant or Authorized Agent
The foregoing instrument was acknowledged before
me this 21 day of MARCH , 20 22 , by
CLAUDIA ISAC who
is personal) known to me or who has produced
as
identification. ^
NOTARY P BLIC:
Sign: _
Print: _
SEAL:
Q�ar n% Notary Public State of r=londa
e) YerH:nia Casanas
A� My tonmtssio;t GC 374027
* EYpire..0312W202A
ue c�
Signature I I
ny/Utility Agent
The foregoing it ent was acknowledged before
me this 22 Iday of More-ki 20 2_, by
i cvi -e ( $ •• i�J1.trC,l!le (( who
is person Ily known to me or who has produced
FL ` OL ' as
identification
NOTARY PL BLIC:
Sign _
Print:
SEAL:µFS ea r s�?*fawa�ov a
v y, try Cc.mnrnislmon fIG 974027
r ° <<1F sptr0s 0312�s12G2y4
t�F-k�>kfi:k*-Y•i«:x:#�k�%ia i'#•%kx%k#%k#:;c*#*�k >k �K�ffi:k +k �k**�k >'s �k**i **
APPROVED BY: _I �22 Public Works Director, or Designee
2017-04-15
VICINITY AIAP I NOT TO SCALE
k 97th St
IF 90h St NE 9601 St
IF 960 St
DWG 02
Q
9
NE 97th St
Elev8fi.1 Fitness
19
NE 96th St
Munit Modern Dentistry
el
NE 95th St NE 951h St
113
Starbucks
NE 94th St
SCOPE WORK:
- PROPOSED DBORE 50'
-REMOVE & RESTORE 25 SQ FT OF
GRASS AREA.
CONSTRUCTION_ NOTES AND SPECIFICATIONS:
1. RESTORATION TO COMPLY WITH CITY, COUNTY, AND STATE SPECIFICATIONS AND BSP
622-300-200.
2. RESTORE OR RELOCATE SHRUBBERY, TREES, SOD, SPRINKLER SYSTEM PUMPS AND
ASSOCIATED PIPES TO ORIGINAL CONDITION.
3. RESTORE PAVEMENT, CURBS AND SIDEWALKS TO ORIGINAL CONDITION OR BETTER, IN
ACCORDANCE WITH STATE & MUNICIPAL REQUIREMENTS. ALL SIDEWALKS MUST BE
REPLACED WITH CONCRETE (NOT ASPHALT) AND 6" FOR CONNECTORS AND DRIVEWAYS.
NOTE:
EQUAL OR BETTER MEANS IN COMPLIANCE.
CONNECTORS MUST HAVE DETECTABLE WARNING SURFACES (DWS).
RESTORATION FOR SIDEWALKS SHALL BE IN COMPLIANCE WITH ADA TITLE II MANDATES.
4. TYPES AND INSIDE DIMENSIONS OF HANDHOLES ARE SHOWN AT HANDHOLE LOCATIONS.
5. EXISTING UTILITY LOCATIONS HAVE BEEN TAKEN PRIMARILY FROM UTILITY OWNER OR
GOVERNMENT RECORDS. NO GUARANTEE IS MADE OF THE CERTAINTY OF THESE LOCATIONS
AND THE CONTRACTOR MUST VERIFY ALL LOCATIONS IN THE FIELD.
6. MINIMUM SEPARATION FROM FOREIGN UTILITIES SHALL BE 12" PARALLEL AND 6"
PERPENDICULAR.
7. FOLLOW MIAMI-DADE COUNTY MOT STANDARD R19.5 DURING THE ROAD CLOSURES.
8. ANY FLAG NEXT TO THE TRENCHING SITES, MUST BE REPLACED IF DAMAGED BEFORE OR DURING
CONSTRUCTION
CACCTV OI 11 MC-
1 . ALL EXISTING BURIED CABLES, UNDERGROUND AND LATERAL CONDUIT MUST BE MAINTAINED
UNLESS OTHERWISE SPECIFIED BY ENGINEER OR PLANT CONTRACT SUPERVISOR.
2. OBSERVE PRECAUTIONS PER BSP 622-100-010 DURING MANHOLE AND CONDUIT
CONSTRUCTION.
3. NOTIFY LOCAL TEST CENTER AND LOCATE SUBSCRIBER CABLES BEFORE DIGGING OR
BORING.
(CHECK FIRST DIG LATER).
4. NOTIFY OTHER UTILITIES AND LOCATE UNDERGROUND OBSTRUCTIONS BEFORE DIGGING OR
BORING.
CONTRACTOR RESPONSIBLE FOR:
1. PROPER BARRICADING AND LIGHTING DURING CONSTRUCTION.
2. VEHICULAR TRAFFIC COORDINATION WITH MIAMI-DADE POLICE DEPARTMENT. DADE COUNTY
TRAFFIC CONTROL AND STATE OF FLORIDA, DEPARTMENT OF TRANSPORTATION, TRAFFIC
CONTROL.
3. SPECIAL NOTE: SUPPORT AND MAINTAIN ALL TRAFFIC CONTROL DEVICES.
4. ANY INTERRUPTED BUS SERVICE MUST BE REPORTED TO MIAMI-DADE TRANSIT AT
786-469-5046 PRIOR TO CONSTRUCTION SPECIAL.
NOTE: SUPPORT AND MAINTAIN ALL TRAFFIC CONTROL DEVICES.
NOTE:
RESTORATION PER VILLAGE OF
MIAMI SHORES SPECIFICATIONS
Miami Shores Village Building Department
Zoning Dept. - Date
Building Dept. _ Date
Subject to compliance with all Federal,
State and ounty rules and regulations.
Permit#_y`I(1�— 03-22_-1
MIAMI SHORES
PUBLIC IRKS REVIEWAPPROVED\
"H�jVIE
MAR r
Know what's below
Call before you dig
LEGEND
- 55 - - --- 55--
-SD----SD-
- W - - - - W -
- - E _. _ E
R/W
P/L
UE
CA
DIW
SWK
0
0
O
e
0
SANITARY
STORM
WATER
COMMUNICATIONS
ELECTRIC
GAS
RIGHT OF WAY
PROPERTY LINE
UTILITY EASEMENT
EDGE OF PAVEMENT
CENTER LINE
DRIVEWAY
SIDE WALK
SANITARY MANHOLE
SANITARY VALVE
STORM SEWER MANHOLE
STORM INLET
WATER MANHOLE
WATER VALVE
WATER METER
FIRE HYDRANT
COMMUNICATION PEDESTAL
AT&T MANHOLE
COMMUNICATION HANDHOLE
' ELECTRIC CONCRETE POLE
ELECTRIC WOOD POLE
7 STREET LIGHT
FPL HANDHOLE
ELECTRIC MANHOLE
TRAFFIC LIGHT
TRAFFIC SIGNAL
GAS VALVE
PERMITS REQUIRED:
CHECK ALL THAT APPLY
11F.D.O.T.
MIAMI-DADE COUNTY.
CITY OF MIAMI
12(VILLAGE OF MIAMI SHORES
NOTE:
-PROPOSED HANDHOLE ON THE PUBLIC RIGHT
OF WAY SHALL BE ABLE TO RESIST HS-20
LOADING (LIAM ED. 2009, SECTION 375.08 (A)
NOTE:
-SWALE RESTORATION TO BE IN
ACCORDANCE WITH MIAMI-DADE SPEC.
R21.1, R13.1 & G2.1.
-SIDEWALK TO BE REPAIRED OR RESTORED
IN COMPLIANCE WITH ADA STANDARS.
ji
BORE PI F. 00+18
15 REMOVE AND RESTORE 25 SQ
FT OF GRASS AREA TO EQUAL
PLAT BOOK 10 PG 70
MOT 102-602
201
SCALE
HORIZONTAL: I"=16'
-VERTICAL: 1"=16'
AMM-1 STA 1: 00+50
Aw END DBORETO m
- awk 2
STA 1: 00+00
BE CONNECT IN T.
COSTUMER
LOCATION
9534
9526