PW-11-23-2920Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address
901 NE 97TH ST, Miami Shores, FL 33138
Contacts
Issue Date: 11/27/2023
Parcel Number
1132060143310
Permit NO.: PW-11-23-2920
Permit Type: Public Works
Work 0assif9cation: Public Works
Permit Status: Approved
Expiration: 05/27/ 2024
JESSICA CARY EAGAN ELENA SANTANA Owner CHAMPION CONCRETE Contractor
901 NE 97 ST, Miami Shores, FL 33138 JAIME BASILIO
10280 NW 63 TER 105, DORAL, FL 33178
Business: 3052528055 jaimechampion@yahoo.com
Mobile: 7864024802
Home: 3059784333
Other: 7864024802
Ins eion Requests:
Description: CONCRETE APPROACH Valuation: $ 1,500.00 ct
305-762-4949
Total Sq Feet: 200.00
Fees
Amount
Education Surcharge
$0.60
Public Works Permit Fee
$100.00
Scanning Fee (Manual)
$9.00
Technology Fee
$10.00
Total:
$119.60
Building Department Copy
Payments
Date Paid Amt Paid
Total Fees
$119.60
Credit Card
11/27/2023 $119.60
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 AFFIDAV : I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws
regulating constru on a zoning. Futhermore, I authorize the above named contractor to do the work stated.
,/✓�ih�c gASlo) 11-z7- z�
Authorized Signature: Owner / Applicant / Contractor / Agent Date
November 27, 2023 Page 2 of 2
I2EC �YVEi�
_ NOV 2 0 2023
Miami Shores Village —
Public Works Department BY:
(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#: r W- 11 -�3 --2qZ4D
Name of Applicant (if utility see below): �L'SSY2 C�G�iU
Owner off the following described property:
Legal Descripption: Lot Block Subdivision �ea1%ii 5J1fl/tirS 5�C
Folio #; /l 32dd n 5z 47
Address: D/ A10? qT 5 - /7 bd40 .L&��
UTILITY NAME:
Qualifier/Authorized Agent:
Address:
City:
Telephone:
State Certification or Registration #:
CONTRACTOR NAME: e G �
Address:
City:
State Certification or
Requests permission to install
way: L
ZIP:
Email: {
Certificate of Competency #
L1njuJ LIJND7,17P
State:
i'AI:A
_ Email:9JM1R1 -CP? f /�J/it✓�vk'ri7-
#: Certificate of Competency
work, attar
h separate page if necessary) in the adjoining right of
Type of Work: ❑ Paving ❑ Utility ❑ Sidewalk ❑ Electric ❑ Irrigation
❑ Landscape ❑ Antenna ❑ Other:
DESIGNER: Architect/Engineer:
Address:
Citv:
Telephone:
Registration #:
_ State:
Email:
ZIP:
Value of Work for this Permit: $ Square/Lineal Footage of Work: GG Si
***** Fees *****
Permit Fee $ 100.00
Notary $ Training/Education $ 0.20 Technology Fee $ 0.80 Scanning $
Bond $ (if required) Total Fee Now Due $ 1 � I V
&'.r
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 post5O at the job
site for the first inspection which occurs seven (7) days after the public works permit is is ed. In the
absence of such posted notice, the inspection will not be approved and a reijtspection yfill be charged.
Signature
�Appjrcant or AumoOyacAgent
The foreg ng instrume�� as a�ck wledged before
me this day of bib 0 20 by
Cs/_}e;4)'V1 who
is personallyinQvLtwr who has produced
as
identification.
NOTARY PUBLIC:
Sign:
Print:
SEAL:
APPROVED BY:
Signature
Company/Utility Agent
The foregoing instrument was acknowledged before
me this ?_-D day of Al o ve„ fa - 20� by
f3Q� ; Iro who
is personally known to me or who has produced
as
identification
NOTARY PUBLIC:
Sign:�J��
Print: " t t-e'✓tei1 '�Qd
SEAL:
Vivienne Yao
JAIME ARMANDO BASILIO
MY COMMISSION# HH 269243
;n.,
� ��P.. �e
=i°.' ' i=
Comm.:HH222410
EXPIRES: June 12,2026
y�`�=
Expires: Jan. 31,2026
Notary Public -State of Florida
Public Works Director, or Designee
2017-04-15
EIVED
N¢V 2 0 204-3
u°�R.r✓
F.I.P. 1/2"
z
D
Z wC-
Y m��
II
LOT 10 1 inch = 20' ft.
•I •' •• • BLOCK 78
mI .`...` 112.5V (R&M)
u: 3750'......
s
8.0' LOT 9 0.70' C.O.
II
o
WOOD BLOCK 78 WALL 'a
•
I
10.02' & DECK m
°
. 4.80' 4.0-n
0.0
H 15.30' AC ,.i 17.0'
14.73'
�
I
21.86
m 53.70'
3
OII
12.15'
WOOD
.�
mII
oF.cK 2fi ONE STORY $
grWl
...-.....
z�
a
^� RESIDENCE n
a
W W'
II
# 901
> m
E�
• �• `O
m
29.7V
6.30• 1210'
24.80'
m
Q
3
Y 4
a.U]
a
— —
0.2'�;ram
J
—
O
1 :v0'i
MAP OF BOUNDARY SURVEY
Property Address:
901 NE 97TH STREET
MIAMI SHORES, FL 33138
/I )nlineLand
j SURVEYORS,INC.
15271 NW 60 AVE, Suite 206
Miami Lakes, FL 33014
waw.OniinetandSurveyom Com
as a
SIGNED 'b FOR THE FIRM
MIGUEL ESPINO . 5 P.S.M. No. 5101
STATE OF FLORIDA
NOT VNID"n UT AN AD WnC DEMONIC SM THE MD AIRHENnI MD
EIFCTRp1IC 5FALN4'G MS 5NOTV.LLID WTHW E5If•NPT Nlp MG.
aAaEo sEu oe A ik:ENSE suN.�EraN AND aAwEa
Survey Date:7I6I2020 Survey Code:0-61712 Page 1 of 2 Not valid without all pages.
Miami Shores Village
Public Works Department
(305)795-2210
Public works forms are available
from the building department,
10050 NE Zed Ave., Miami Shores, FL 33138
COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY
CFN 202; ROS19'646
OR OK. 33969 Ps 1875 QPss)
RECORDED 11/15/2023 14:26:03
JUAN FERHANDEZ-EAROUIN
CLERK. OF THE COURT L COMPTROLLER
MIAMI-DADE COUNTYP FL
Whereas, (hereby referred to as the owner) �z✓SSlG� �~ 7'
Of the following described property:
Legal Description: l
Lot ,rat Bock Subdivision Folio #; (/b ✓
Address: fo/AV Sr
Requests permission to Install (describeWrkr attach separate page if necessary) in the adjoining right of way:
INCONSIDERATION 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 indemnify 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 author entative).
STATE OF FLORIDA, COUNTY OFMIAMI-DADE
IHEREBY CERTIFYthat this Isatrue copy Ofthe
State of
County of .J9/J`(' a
The foregoing instrument was acknowledged before me this ��ay
J7,-55eA ��60ft/who is person
E , 9 L as identification.
NOTARY PUBLIC:
Sign: ,�
Print: ' v% ) " "/%�
e -545�6? SEAL:
�p� �•: JAIMEARMANDO BASILIO
• " MY COMMISSION# HH 269243
'4r • ..• EXPIRES: June 12, 2026
"adve�$•`
an day of
MtM AD 20
'hand and Official Seal.
jerk of Circult and County Courts
_D.C.
by
known to me or who has produced
Documents are recorded at the Clerk
of the Courts,
MIAMI-DADE COUNTY RECORDER,
COURTHOURSE EAST,
22 N.W. First Street, 1st Floor, Miami,
FL 33128.
2017-04-11