PW-02-22-490Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address
Issue Date: 04/20/2022
Parcel Number
69 NE 99TH ST, Miami Shores, FL 33138 1132060131300
Contacts
Permit NO.: PW-02-22-490
Permit Type: Public Works
Work Classification: Public Works
Permit Status: Approved
Expiration: 10/20/2022
Robert & Mallory Erickson Owner
69 NE 99 ST, Miami Shores, FL 33138
Mobile: 3055048901 r.erickson1188@gmail.com
MIAMI DADE WATER & SEWER DEPT Contractor
ISABEL RODRIGUEZ
3071 SW 38 ST, MIAMI, FL 33146
Business: 7862565200 adrian.triana@miamidade.gov
Mobile: 7862685414
Description: NEW I'SINGLE SERVICE WATER INSTALL AND Valuation: $ 1,200.00 Ins ection Requests:
RETIREMENT OF EXISTING SERVICE SIRP-410 305-762-4949
Total Sq Feet: 0.00
Fees
Amount
Education Surcharge
$0.40
Public Works Permit Fee
$100.00
Sunning Fee
$9.00
Technology Fee
$2.50
Total:
$111.90
Payments Date Paid Amt Paid
Total Fees $111.90
Credit Card 03/01/2022 $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 information is accurate and that all work will be done in compliance with all applicable laws
regulating construction and zoning. Futhermore, I authorize the above named contractor to do the work stated.
Signature:
/ Applicant / Contractor / Agent
April 20, 2022 Page 2 of 2
PT T11 T
/ Miami Shores Village I" FEBPublic Works Department I rZ�ZZ
(3-2210
Public works forms are available from the building department, 30050 NE 2n0 Ave., Miami Shores, FL >p
PUBLIC WORKS PERMIT APPLICATION
Permit Type: Work in the Right -of -Way on Miami Shores Village or Miami -Dade
Permit#: TW 67_ —a— I l0
Name of Applicant (if utility see below): MIAMI DADE WATER AND SEWER
Owner off the following described property:
Legal Description: Lot Block Subdivision MIAMI SHORES
Folio #;11-3206-013-1300
Address: 69 NE 99 ST
UTILITYNAME: MIAMI DADE WATER AND SEWER
Qualifier/Authorized Agent: _
Address: 3071 SW 36 AVE
City: MIAMI State: FL Zip: 33146
Telephone:_ 7( 861268-5134 Email: isabel.roddquez@miamidade.gov
State Certification or Registration #: NIA Certificate of Competency # NIA
CONTRACTOR NAME: MIAMI DADE WATER AND SEWER
Qualifier/Authorized Agent: Isabel Rodriquez
Address: 3071 SW 39 AVE
City: MIAMI State: FL ZIP: 33146
Telephone:.(786)268-5134 Email: WASD-NBSIRREVIEW@MIAMIDADE.GOV
State Certification or Registration #: NIA Certificate of Competency #: WA
Requests permission to install (describe work, attach separate page if necessary) in the adjoining right of
way: NEW 1" SINGLE SERVICE WATER INSTALL AND RETIREMENT OF EXISTING SERVICE
( SIRP-410 )
TypeofWork: ❑ Paving ff Utility ❑ Sidewalk ❑ Electric ❑ Irrigation
❑ Landscape ❑ Antenna M Other:
DESIGNER: Architect/Engineer:
Address:
City: State:
Telephone: Email:
Registration #:
ZIP:
Value of Work for this Permit: $$1.200 Square/Lineal Footage of Work
rxxxx Fees **•"*
Permit Fee $100.00
Notary $ Training/Education $ 0.20 Technology Fee $ 0.80 Scanru $
Bond $ (if required) Total Fee Now Due $
Bonding Company's Name (f 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.
Signature w4a'6d � 3 Signature
Applicant or Authari ed A nt Company/Utility Agent C/
The foregggQQQI instrume acknowledged before The foregoing instrumerttwa acknowledged before
me this day z j w me [his;(,�_, gu z ^ ZZby
Isabel Rodriquez s who Isabe R rR lguez wh
who hNs produced is persollihII 7Jwp#4 tprmor who has
as
7 (SI,12VIIN1MENEEZIM
Sign08onded
Sign: 4 '
Prin Print: 8al6AaA—
SEA YOANET ROaALCA6A SEAL:::, Notary Public of Florida
Notary Public - state of FloridaCommission i HH 2O4279
Commission 4 4H 2O4279 i '.'? d�` , ,� My Comm. FxDires Feb t4, 2026
my Comm. Dove, =eo 24. 2026 """" ded through National Notary Assn.
through National Votary Assn.
iiiiii 'ti iiiii•iiiiiiiiiifiiiiiiititiiiiti
r
APPROVED BY: Public Works Director, or Designee
2017-04-15
M IAM 1•DADE
miamidade.gov
February 23, 2022
Miami Shores Village
Building Department
C/O Mr. Ismael Naranjo
Building Official Director
10050 NE 2 Ave
Miami Shores, FL 33138
Re: Water Service Installation and Retirement for:
69 NE 99 ST
SIRP-410
Dear Mr. Naranjo:
Water and Sewer
PO Box 330316.3575 S. Lejeune Road
Miami. Florida 33233-0316
T 786-268-5360 F 305-6694059
Transmitted herewith for your approval and permit are two (2) copies of the water service
installation and retirement for the above referenced project. Upon approval and issuance of the
permit, it is requested that you return to us one copy of the approved sketch and the original
permit.
If your approval and issuance of the permit has special restoration requirements, we will need to
notify the customer of the additional charges involved with the installation. Please inform us if there
will be special restoration requirements for this permit request.
Should you have any questions regarding this matter, please advise.
Sincerely
Isabel Rodriguez
New Business Representative
(786)268-5134
isabel.rodriauez@miamidade.aov
VILLAGE OF MIAMI SHORES
MIAMI-nADF_ COUNTY r
SEC. 01 - 53 - 41
15' TOTAL
III FfB 2 4 2022
iami Shores Village Building f
'oning Dept. Date
Date
3uilding Dept.
Subject to compliance with all
State and County rules and rec
x - /i 7 - 22 `i'
NO MIAMOADE COUNTY
RIGHT-OPWAY CONSTRUCTION
NEW 1" SINGLE SERVIC
SET BOX AND SPACER
LOCATE AS MARKED OR
N
RETIRE EXISTING SERVICE k
AT REAR ALLEY WEST SCALE: N.T.S.
STAKED AT REAR ALLEY OF CENTER
WEST OF CENTER J
�e R3A pP,.��p'�i-�! �Zh�
ems..
HORES V.iL
WORKS OREVIE A -
- '_DATE
•%
1
N
CITY N
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o'aNpwnyrt �,
22'GRASS PARKWAY
NE 99 STREET
GENERAL NOTES
1. LANE CLOSURES PER F.D.O.T. STD PLAN. INDEX # 102-602
2. PAVEMENT RESTORATION PER M.D.C.P.W.M. R-21.1.
3. SIDEWALK RESTORATION PER M.D.C.P.W.M. R-13.1.
4. MAINTAIN MIN. 30" COVER ON ALL SERVICE LINES.
5. DO NOT SET METER(S) AT THIS TIME.
6.48 HOURS BEFORE DIGGING CALL SUNSHINE STATE ONE
CALL AT 1.800.432.4770TICKET #. 045201529
❑ FL. CITY GAS Z MDC PIN & TRAFFFIC ❑ COMCAST
IPf WINDSTREAM COM if A.T. & T. ❑ ATLANTIC COMM.
0 F.P.L. 12f A.T. & T. DISTRIBUION ❑ CLEAR
PARKING
z
M
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c
M
NEW WATER SERVICE AND
EXISTING SERVICE
RETIREMENT AT
69 NE 99 STREET
90007-SIRP-410
MIAMI-DADE WATER AND SEWER DEPARTMENT
NOTES:
J. This Does pplles ro Two -Una, Two-way
we Multllax RoedWays, fecludlp Medians
of divided rashness, with work on the
moulder.
2. L = T•por keph
X a Wort Zan Sign SWIM
B - duffer kwph
See IMex 103fi00 to, 'L'.'r.'B, aM
InewIrleg derlre spwlp values.
OM-Z
IS. Nate 6)
EXO
ROAD WORKI
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a IV Nlw
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MOT-1346 wZ0-1F
IS. no. 6)
S®•W9 ROAD
sM•p WUN(
Na •Dews yW�n
R®If
xao
1 For hxhdarel work (ep. moning or I'ller
..'I only in Ron Work A1Med son
RNLI •®Y RB pMl
Is rxulnd.
\1'AeOk m•B WSIY®1 EXD
NERD R •� ROAD WOR
a. WAx fwr w more wwk vehicles awful the
through traffic laws In a an . purled
li Hff MOI-1do II oOZ
f5x soh 61 WZl-A f6x Nate 61
(exfludlp eshalishlp ow termiwUp Ise
wwk areal, use o flpper or law clown
TWO-LANE ROADWAY
to aeawnmoeeto wwk vehicle Iprxs sN
SHOULDER WORK LESS THAN 2' FROM THE TRAVELED WAY
pwss.
WITH WORK ZONE SPEED OF 45 MPH OR LESS
5. for work Ins inn wo feet from the
Irene way on wort iwle Send Is
praccer th n 45 MPH, use a law closure.
'Wl'N 3O'JB
6. Tw'Swadip DoubledWhen
h-Ewon
90007—smr-410
N
Preseo'spwfFnk
MOT-Ow61ed
Rules
Road
NXFIf
Warr Slpns (6X-2) slop with IM
P 1
asseclaled Work Zaw alyn spwlp
dig.. s may be chilled when the
(Sae fte 61 MIM,
0001t
END'
V
wrWilry wwltix Is In aaea for 2x
ROAD WORx
AMFJA
A'
hearrs or less.
1 V
T. Temporary xvalwhe Iwrtlps mw ao
200
omxted whx the wort rw a Is In place
NE DO SLREET
for 3 days or less.
_ _ _ —
rh ����jj ��j
_ _ _ _
N. H In work elwresches w a mocked mryele
lew or nestle shoulder, close the hw or
b
2
shoulder In K[wd. wxh the pens.
Z�7Z�/-- ��/
m L!L— UL—i• __ ________L!L
/Z ___
X
9. WNt -Shoulder Closed' slow M31-Sa/ glop
2W I 200 500
Wth esw[INw wwk iaw sign whip
did. for work x the medlso
SYMBOLS:
® Nat Aran
•>® ROAD WORX
• • • • • • • • (A/0-g• • •
• • • • .Ise.
.�~..
�-
102
• Cllpwllilp f5tt iw DevicIn.{W)
WX 11` W7I-5d • •
• . • •
• • • • • • • �
• ♦ •
J
p Work Zone Sign
• • • •
TWO-LANE MADIOX?
b Use Iddlamxti0e aed Direetiw of T,effie
SHOULDER WORK BETWEEN 2' AND 15' FROM THE TRAVELED WAY
••• ••• • ••• ••• •
• • •••
Is Is• • •
• • • • Is 0 0 Is
•
DESCRTPfION:
FY 2021-22
• • • •
INDEX
SHEET
REVISION
TWO -LAMB AND XULTILAMB, WORT ON SXOL'LDER
111011'Sr
iy
m— STANDARD PLANS
102-602
1 Of 2
Miami -Dade County - Application Title
Type of Installation VNew Installation Q Repair/Maintenande Q Both
Method of Installation: Q Bore (b Excavation Q Both
Location of Installation: Q Within Right Of Way 16ublic Utility Easement Q Both
Will work commence
within 15 days of permit Q Yes No ,,,,
issuance ? : ,', •••••�
•••
Estimated Start Date:
30 DAYS
Canals maintained by Miami Dade County will require DERM approval.
Ca Is NOT maintained by Miami Dade County will require a permit from South Florida Water Ivtaanajernent Dis;v
Acknowledged „•„•
,,;•
Pedestrian Information • • • •..
������
1. Does excavation fall within the swale and/or QYes No '.
• • ..:.
sidewalk area? ..
2. Give dimensions from edge of pavement to NIA FT • •
•:
Work Zone in swale area. '..'
3. Will work damage existing sidewalk, curbs eNo
QYes
and/or gutters ?
4. Will work obstruct pedestrian access to Oyes VNo
sidewalk ?
5. Will work obstruct pedestrian crosswalk or Q Yes Q(No
ramp ?
6. Will work obstruct bike path ? Q Yes (No
Pedestrians, including persons with disabilities will be provided with a reasonably safe, convenient, and accessible path
Vreplicates as much as practical the desirable characteristics of the existing pedestrian facilities.
cknowiedged
Roadway Information (Are removing asphalt on a paved roadway)
7. Does the excavation fall on the asphalt of a
Q Yes ?(No
paved roadway?
8. Does excavation fall within a Signalized
Q Yes VNo
Intersection?
9. Does excavation fall within a Mid -Block
Q Yes Q(No
Signal?
10. Does excavation damage any traffic loops?
Q Yes (ir"No
11. Have the roads, which are impacted by the
proposed work recently been paved or
Q Yes Q(No
resurfaced?
Traffic Control Plan
12. Will work require a lane(s) closure for
Vehicular Traffic?
13. Give dimensions from edge of pavement to
trench of pole:
14. Provide number of lanes and direction that
will be affected.
15. Please provide an estimate of construction
time for which traffic flow will be affected
16. Functional classification of Roadway
affected by work.
17. Does workzone fall within Section Line or
Half Section line roadway?
18. Posted Speed Limit within work zone.
QYes VNo
NIA FT
North: = South: F-7 East:= West:
NIA DAYS
❑ Arterial ❑ Collector EdLocal
p Yes IVNo
30 MPH
At -grade Appurtenance (If you are placing a cabinet, or some other type of equipment on the ground. Do not use
3/4/2014
Miami -Dade County - Application Title
Drainage Information
23. Do the proposed construction plans alter or modify not applicable
d
existing drainage system? ..............................................
24. Does the proposed installation interfere with existing drainage not applicable
d
facilities ?
Miami Dade County Water and Sewer Department's customer division proposes to
perfomT the fagIGyiii1g
work within your right-of-way
..�
....
. .. ......
Total length of underground installation or
� � •
.
repair
,
Quantity
••••
•• .....
Water service connection: OLF
.,....
.�•.
.'
... .....
Sewer service connection:
••�� ��••••
LF
• • • •..
Construction or Replacement of Resurfacing
• • • • •.:.
Quantity Quantity
Sidewalk — LF In
�SQF
��
•• ••••��
'..'
Of Way
Of Way
Curb & Gutter LF On private SQF
Valley Gutter LF Property
Save Proceed