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DS-06-23-1510Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Location Address Permit NO.: DS-06-23-1510 Permit Type: Driveways/Walkways/Slabs Work Classification: Addition/Alteration Permit Status: Approved Issue Date:11/14/2023 Expiration: 12/11/2023 Parcel Number 10515 NE 3111) AVE, Miami Shores, FL 33138 1122310130380 Contacts PEDRO EMILIO GARCIA QUINTERO Owner 10515 NE 3RD AVE, Miami Shores, FL 33138 CHAMPION CONCRETE JAIME BASILIO 10280 NW 63 TER 105, DORAL, FL 33178 Business: 3052528055 Mobile: 7864024802 Home: 3059784333 Other:7864024802 Contractor jaimechampion@yahoo.com Description: PAVERS DRIVEWAY Valuation: $ 13,420.00 Inspection Requests: 30562-949 x Total Sq Feet: 2,100.00 ; Fees Amount Application Fee - Other $50.00 CCF $8.40 Concrete/asphalt/pavers, slabs, dways, $150.00 swalks DBPR Fee $3.00 DCA Fee $2.00 Education Surcharge $4.20 Planning and Zoning Review Fee $70.00 Technology Fee $20.00 Total $307.60 Payments Date Paid Amt Paid Total Fees $307.60 Credit Card 06/13/2023 $50.00 Credit Card 11/14/2023 $257.60 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 regulating construction and zoning. F%uthermore, I authorize the ab e r rate and that all work will be done in compliance with all applicable laws I contractor to do the work stated. // 1y-4 Authorized Signature: Owner / Applicant / Contractor / Agent Date November 14, 2023 Page 2 of 2 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 I' s' JUN 13 AV3 FBC 202� BUILDING Master Permit No. PER T APPLICATION Sub Permit No. 7UILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP ``',S,� A� I//CONTRACTOR DRAWINGS ./OW /�� JOB ADDRESS: FA City: Miami Shores ,/ County: Miami Dade Zip: Folio/Parcel#:Tf -/�-- �r� '(,�/ °/ Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FIFE: OWNER: Name Fee Simple Titleholder Address: �� L%� ►% City: State: / Zip: 1 Tenant/Lessee Name: Phone#: Email CONTRACTOR: Company Name:�/-/ w 64qj� Phone#: -i ` f _ Address:l Email: Qualifier Name: State Certification or Registration #: DESIGNER: Architect/Engineer: Certificate of Competency #:ge.�d�/� Phone#: Address: City: State: Zip: Value of Work for this Permit: $ Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: ®-A✓eat Specify color of color thru tile: Submittal Fee $ 'Permit Fee $ Scanning Fee $ Technology Fee $ Structural Reviews $ DCA Fee $ Training/Education Fee $ CCF $ CO/CC $ DBPR $ Notary $ Double Fee $ P&Z Review $ Bond $ TOTAL FEE NOW DUE $ (Revised 04/05/2022) Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip IS Application is hereby made to obtain a permit to do the work 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 regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, AIR CONDITIONERS, ETC..... OWNER'S 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. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. 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 building permit with an estimated value exceeding $2500, 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 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 building permit is issued. In the obsenc of such posted notice, the inspection will not be approved and a reinspection fee will be charged. i Signature .. Signature 0 NER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this 06 day of IJA/f 20 � , by ,*bwho is personally known to me or who has produced 6 —tw go sl 3 Zl d as identification and who did take an oath. NOTARY PUBLIC: Sign: The foregoing instrument was acknowledged before me this day of 20 20 �� > by A-t1`(� who is personally known to me or who has produced as identification and who did take an oath. NOTARY P Sign: Print: ,%et-irMISSIONHH2692gg �E Print: Seal: Seal: *0APPROVED BY 0 Z Plans Examiner HEBERT MARTINEZ MY COMMISSION k HH 323216 EXPIRES: October 18, 2026 ********************** ************** .f! &—OareZoning C4 /V� � Structural Review (Revised04/05/2022) Clerk m ern +N 00,911 I• ' i5q'j z � I N .3 H m 0 > r I I w� aA n rn� K i NO U r V ' 100 0Z � o .,l all 41 a g R07 V I Nnr ..- F...- �,(Ozul � y i�Y ti r Mission: To protect, pronnte & improve the health of all people in Florida through integrated I �/��r state, oourrty & o�rrminity efforts. HEALTH Vision: T o be the Healthiest State in the Nation October 30, 2023 A SUPER SEPTIC AND DRAIN FIELD INC. 7701 W 18 Lane Hialeah, FL 33014 RE: Modification to a Single Family Residence - No Bedroom Addition Application Document Number: AP1981625 Centrax Permit Number: 13-SC-2762231 10515 NE 3 Avenue Miami, FL 33138 Lot: 15/16/17 Block: 12 Subdivision: Dear Applicant, Ron DeSantis Governor Joeopk A. Lad"% K% PhD State Surgeon General OCT 3 0 Z023 This will acknowledge receipt of a floor plan and site plan on 08/03/2023 for the use of the existing onsite sewage treatment and disposal system located on the above referenced property. No objection for driveway installation only as per information shown in signed site plan. No flow increase. No bedroom additions. This office has reviewed and verified the floor plan and site plan ,you submitted, for the proposed remodeling addition or modification to your single-family home. Based on the information you provided, the Health Department concludes that the proposed remodeling addition or modification is not adding a bedroom and that it does not appear to cover any part of the existing system or encroach on the required setback or unobstructed area. No existing system inspection or evaluation and assessment, or modification, replacement, or upgrade authorization is required. Because an inspection or evaluation of the existing septic system was not conducted, the Department cannot attest to the existing system's current condition, size, or adequacy to serve the proposed use. You may request a voluntary inspection and assessment of your system from a licensed septic tank contractor or plumber, or a person certified under section 381.0101, Florida Statutes. If you have any questions, please call our office at (305) 623-3500. Sincerely, Mariela Celi Engineering Specialist II Department of Health in Dade County MrWs Daparbwet of 11aNlh V WW.fleAdalnaluymr in Dade County - • , Florida TWITTER:HealthyFLA PHONE: (305) 623-3500 FACEBOOK:FLDepartmentofHealth YOUTUBE:fldoh 2" MIN. PAVERS (TUMBLE PAVERS- TREMRON HERRINGBONE PATTERN ® 45 DEG) 2" MAX LEVELING SAND I,I \\�i\X MIN LIMEROCK MIN. CO PA�jTE� '*--I=5 MIN. CONTINUOUS TUMBLE PAVES - TPEMPQN DETAIL NTS (OLD CHICAGO COLOR) SCOPE OF WO�,'K Il 3. 4. 5. 6. 7. 8. w SCALE 1 inch = 20 feet. 0 10 20 40 GRAPHIC SCALE (IN FEET) P�'0POSED D�'IVE'"/-Y PL N F -3- - EXIST. 40' TOTAL RIGHT-OF-WAY EXIST. 16' ASPHALT PVMT. p 22.0' p— EOP - - - - -- EXIST. SWALE a�0 120,L--RLVV- 153 LJ.V LOT SIZE 10'XIO' VISIBILITY _ — — � TRIANGLE AT BOTH; / 1 ,,375 SQ.FT. SIDES (TYP) SIB= \q6 NOTES 50`bTOTAL LA M _ SCAPEr ML 14,375 X 50% - 7,188 I I MINIMUM REQUIRED o 4 ]55 S(� �I - EXIST. WALL 1 PROP. (A AREAj (TOTAL) 1 �} �90 \qo q° REMANDER SOUTH -'�--�-- LOT 17 1 BLOCK - 12 1 25.0' I PS 6-82 (NOT A PART) FRONT YARD LANDSCAPE MINIMUM 7,188 X 20% -1,438 MINIMLM REQUIRED 1,717 SO. FT. PROP. GREEN AREA (FRONT YARD) RI6.5' -EXIST. TREE TO REMAIN (TYP.)_ _ _ - _ EOP _C PROP. TREE ROOT PROTECTION FENCING 579' EXIST. SWALE 125.1107'� �17 ■ • • •■ r r a '/l EXIST. ONE STORY SFR. 10515 NE 3 AVE MIAMI SHORES, FL 33138 FOLIO II-2231-013-0380 1 i i pl � -�� OI F6-'� rh�r III I I I I I I'I I I EXIST. CONC. LOT -17 111 I I I I I BLOCK - 12 1 11 1 2 11 III BLOCK LOT - - 12 CANVAS EXIST. WALL 1 PB 6-82 1 11 11 ' I I I I ' I I I I I� I I I I I PB 6-82 IIIIIIIIIIIIII u u u uuu 1 EXIST SEPTIC EXIST. TANK AND POOL 1 DRAINFIELD AREA EXIST. POOL DECK 1 (SYSTEM u I PER IDEP4015) 1 N� �. LOT 2 LOT - 3 125.00' `�, t'BLOCI -'12 m F i BLOCK - 12 EXIST. WALL P8 6-82 7 Ste. 5 Flo!'ida K_'PBAPART) ;il-'iB,_ic u�:�itilly NOT A ART) �. S. INUL�I ' 7 ; �a�, A}.licpilar Late: 1 �2 PROPOSED PAVERS APPROACH TO !PA EXIST. ASPHALTvFJlr -24.T---- ' ------- EOP - - —pp' CN R525.0' EXIST. SWALE -14. - —-7 —RAW - — R5.0' GARAGE LT.ERQACE \� / n � EXIST. IRON FENCE 1 'EXIST. WALL EXIST. ASPHALT DRIVEWAY TO BE BLOCK 1512 i REPLACED WITH PB 6-82 14' WIDE TUMBLE I PAVERS - 1 TREMRON (COLOR ! SAND DUNE) (TYP) I 1`n 1 EXIST SEPTIC TANK AND rDPAINFIE /- nD n PRERA SYSTEM DEP4015) III II i II� II I I I LOT -14 Itl �1 BLOCK - 12 PB 6-82 EXISTJ PLASTIC i (NOT A PART) SHE] f' i -EXIST. WALL EXIST. CONC. I ' LOT 4 LOT - 5 BLOCK - 12 BLOCK - 12 PB 6-82 B(NOT A PART) (NOTA PART) 2" MIN. PAVERS (TUMBLE PAVERS- TREMRON HEIRRINGBONE PATTERN o 45 DEG) 2" MAX LEVELING SAND " MIN LIMEROCK MIN. j'Co )MPA TEP SUB I�AD �� In5 MIN. �j �� �\�j�j��` CONTINUOUS N, TUMBLE PAVES - T�IEM�DON DETAIL NTS (OLD CHICAGO COLOR) SCOPE OF WO�,'K I. 2. 3. 4. 5. 6. 7. 8. COMPACT SUBG12ADE AND INSTALL 6' WELL COMPACTED LIM 32OCK BASE. INSTALL 2' LEVELING SAND, GRADE SURFACE AND TUMBLE PAVERS - TREMRON (COLOR SAND DUNE) AT DRIVEWAY AND APPROACHES AS INDICATED ON SITE PLAN USING HERRINGBONE PATTERN AT 45 DEGREES. INSTALL FOOTER 8'X8' AT PERIMETER WITH REBA12 4 5 FOR EXTRA SUPPORT. POUR CONCRETE AT PERIMETER EDGE. TRIANGLE OF VISIBILITY SHALL BE KEPT CLEAR OF VISUAL OBSTRUCTION BETWEEN A HEIGHT OF TWO AND HALF (Z5) FEET AND EIGHT (8.0) FEET ABOVE THE ESTABLISHED GRADE 50% OR GREATER OF GREEN AREA WILL BE MAINTAINED ON THIS PROPERTY. ALL WATER WILL BE RETAINED WITHIN PRIVATE PROPERTY. NO TREES BEING REMOVED FOR PROPOSED DRIVEWAY. ALL IMPROVEMENTS ON THE RIGHT OF WAY AREA DAMAGED DURING CONSTRUCTION TO BE RESTORED TO ORIGINAL. OR BETTER CONDITIONS. ANY DEBRIS WILL BE REMOVED AND RE -SODDING OF DISTURBED SWALE AREAS IF REQUIRED. S SCALE 1 inch = 20 feet. 10 20 40 GRAPHIC SCALE (IN FEET) 1 LOT SIZE j 14,375 SQ.FT. e 50%TOTAL LAMINIMUM SCAPE O �-I 14,375 X 50% = 7,755 MINIMUM REQUIRED o 7 883 S0. FT. I = PROP. Gk�l AREA (TOTAL) O•. q 125.0' FRONT YARD LANDSCAPE MINIMUM 7,755 X 20Z =1,551 MINIMUM REQUIRED 1,845 SO. FT. PROP. GREEN AREA FRONT YARD) ---- NE --- fi`_gAi�-------- EXIST. 40 TOTAL RIGHT 0 VPAY EXIST. 16' ASPHALT PVMT. 220' — — — -EXIST. TREE TO o REMAIN (TYP.) p— EOP— -----—————— — -EOP - EXIST. SWALE � , MN„� PS '_ PROP. TREE ROOT R- 0 12.0' o PROTECTION FENCING a5 5.3' - 57.9' 10'XIO' VISIBILITY — TRIANGLE AT BOTH SIDES (TYP.) SEE NOTES EXIST. WALLS i i REMANDER SOUTH LOT - 17 i BLOCK - 12 i PB 6-82 (NOT A PART) b 0 i EXIST. WAIL- j RI6.5' LOT - 17 BLOCK - 12 PB 6-82 t � --�- ---- ------ -- -- LOT - 2 LOT - 3 125.00' BLOCK - 12 BLOCK - 12 EXIST. WALL PB 6-82 , PB 6-82 (NOT A PART) (NOT A PART) PUBLIC NOOKS REVIEW T DATA RL EXIST. SWALE 125.00' \\\ PROPOSED TUMBLEPAVER - o T12EM12ON (COLOR SAND DUNE) DRIVEWAY AS PER PLAN 47.5' v L`.'J 'i1i �.£i PROPOSED PAVERS APPROACH TO FBE FLUSH WITH EXIST. ASPHALT PAVEMENT (TYP.) 24.0' -------EOP---o 14.0' R5.0' EXIST. SWALE 25.7' -1 R/W IRON FENCE COVERED PORCH EXIST. ONE STORY SFR. 10515 NE 3 AVE MIAMI SHORES, FL 33138 c 14.0' FOLIO: 11-2231-013-0380 1 11 TERRACE EXIST. CONIC. LOT 16 \ \ EXIST. CbNC BLOCK - 12 CANVAS PB 6-82 i GARAGE LOT - 14 BLOCK - 12 EXIST. PB 6-82 EXIST. POOL POOL EJ (NOT A PART) DECK EXIST. PLASTIC i TERRACE SHED i EXIST. CONIC. ------ LOT-4 -- -- -I� BLOCK - 12 LOT 5 PB 6-82 i BLOCK - 12 PB 6-82 (NOT A PART) (NOT A PART) Miami Shores Village Building D*de t Zoning Dept. - R Date Building Dept. Date Subject to compliance with all , State and County rules and regulations. Permit# `EXIST. WALL EXIST. ASPHALT DRIVEWAY TO BE REPLACED WITH 14' WIDE TUMBLE PAVERS - TREMRON(COLOR ! SAND DUNE) (TYP.) LOT -15 BLOCK - 12 PB 6-82 EXIST SEPTIC TANK AND DRAINFIELD AREA. t i EXIST. WALL Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Permit NO.: PW-06-23-1511 Permit Type: Public Works''"` Work Classification: Public Works r, Permit Status: Approved issue ©ate: 11/14/2023 Expiration: 12/11/2023 Location Address Parcel Number 10515 NE 3RD AVE, Miami Shores, FL 33138 1122310130380 Contacts PEDRO EMILIO GARCIA QUINTERO Owner 10515 NE 3RD AVE, Miami Shores, FL 33138 CHAMPION CONCRETE JAIME BASILIO 10280 NW 63 TER 105, DORAL, FL 33178 Business: 3052528055 Mobile: 7864024802 Home: 3059784333 Other:7864024802 Contractor jaimechampion@yahoo.com Description: PAVERS DRIVEWAY Valuation: $ 13,420.00 Inspection Requests: sus ' Total Sq feet: 0.00�` �. a Fees Amount Education Surcharge $4.20 Public Works Permit Fee $100.00 Scanning Fee $3.00 Technology Fee $10.00 Total: $117.20 Payments Date Paid Amt Paid Total Fees $117.20 Credit Card 11/14/2023 $117.20 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 inform#tic)n is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore, I authoriz' the b ve named contractor to do the work stated. Authorized Signature: Owner / Applicant / Co tw or / Agent Date November 14, 2023 Page 2 of 2 r� z.r,, Miami Shores Village OP1� Public Works Department (305)795-2210 Public works forms are available from the building department, 10050 NE 2"a 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#:4 Name of Applicant (if utility see below): ��'�/>'/i/G� 47d&.b/A Owner off the following described property: Legal Description: Lot Block Subdivision,tsY�¢- Folio #; /%' 2 Z-3/_ 0/�Z_ 0_ : Address: �%S its .!l i✓ UTILITY NAME: Qualifier/Authorized Agent: Address: City: Telephone: State Certification or Registration #: CONTRACTOR NAME: G7' Qualifier/Authorized Agent: Address: 02?o A4(') -bt; City: , A84 Telephone: State Certification or Registration #: State: Email: State: Email: n%.AdfAP ZIP: Certificate of Competency # Certificate of Competency #: A Requests permission to install (describe work, attach separate page if necessary) in the adjoining right of way: _ Y-AYY' Type of Work: ❑ Paving ❑ Utility ❑ Sidewalk ❑ Electric ❑ Irrigation ❑ Landscape ❑ Antenna ❑ Other: DESIGNER: Architect/Engineer: Address: City: State: Telephone: Email: Registration #: ZIP: Value of Work for this Permit: Square%Lirieal Footage of Work: Permit Fee $ 100.00 Notary $ Bond $ ***** Fees***** _ Training/Education $ 0.20 Technology Fee $ 0.80 Scanning $ (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 reinspectiggwill be charged. Signature G Applicant or Authorized Agent The foregoing instrument was acknowledged before me this Ob day of J 20213 by qO�,44Z who is personally known to me or who has produced as identification. Signature ¢6mpany/Utility Agent The foregoing instrument was acknowledged before me this day of Its 20S;�)_ by _,fie �� who is personally known to me or who has produced t i' as identification. 6 NOTARY PUBLIC: NOTARY PUBLIC: ! 1 J h) Sign: Print: y SEAL: JAIMEARMANDO BASILIO W COMMISSION S HH 2WA EXPIRES: am 12, 2026 APPROVED BY: Sign: Print: SEAL: 11 HEBERT MARTINEZ W COMMISSION # HH 323216 EXPIRES: October 18, 2026 ************************* Public Works Director, or Designee 2017-04-1S Miami Shores Village Public Works Department (305)795-2210 Public works forms are available from the building department, 10050 NE 2nd Ave., Miami Shores, Fli`�3t3� I R[EiY C original filed WITNESS COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY C- E= N 21_ 1 ? 3 % a i 4111 4- 9 air 9 OR BI_. Py ti•o ,1 1 F'a= RID':ORDEF) 06/133/71_I'_% JUAN FERWINDET -BARD!?TN :I_ERK. OF THE COURT r; :_:OiIPTROL. ER HTAhIT-DAD.F. C-OUNTYx FL LORIDA, COUNTY OF ANAIVII-DADE -" :Y,TIFY that this is a tru A�� col�Nrr Zr �f the �� CLERK n this o,Tf�e-on _ Zr day of hand and Ofr; m Cler suit and In �Uli9 �i, 'H oon tit r�,uar Whereas, (hereby referred to as the owner) 1K%!:'W Of the following described prppperty: 00 4,f.9 A lad o f Legal Description: Lot !�� twl Block l Subdivision _ A� 4 Folio #; t1- ��' �U Address: 1054S *0— R A11 r#W MAJ 5h%% H,, 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 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). 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). Signature7 Y' �, ✓ 04ner or Authorized Agent State of County of -i '6* e The foregoing instrument was acknowledged before me this T day of , 20 , by who is personally known to me or who has produced iMO tPhO VQs identification. NOTARY PUBLIC: ,�y Sign: %/�, L,� Print: 'V #Im !0_5,�Oi> SEAL: fly' JAIMEAAMANDOSASILIO '* MY COMMISSION # HH 269243 ' o EXPIRES: Juno 12, 2026 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