PW-17-2835Miami Shores Village
10050 N.E. 2nd Avenue N
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Project Address
Parcel Number
Isst
■
Permit NO. PW-11-17-2835
Permit Type: Public Works
Work Ciassifrcation: Public Works
Permit Status: APPROVED
Date:11130/2017
Expiration: 02/28/2018
Applicant
9290 N BAYSHORE Drive
Miami Shores, FL 33138-
1132050270240
Block: Lot:
RICKI LONDON
Owner Information
Address
Phone
Cell
RICKI LONDON
9290 N BAYSHORE Drive
MIAMI SHORES FL 33138-2949
9290 N BAYSHORE Drive
MIAMI SHORES FL 33138-2949
Contractor(s) Phone
ARTISTIC CONCRETE GROUP INC (305)888-9095
Cell Phone
Valuation:
$ 14,500.00
Total Sq Feet: 450
Scanning: 1
Fees Due
CCF
DBPR Fee
DCA Fee
Education Surcharge
Permit Fee
Scanning Fee
Technology Fee
Total:
Amount
$o. oo
$o.00
$0.00
$0.20
$100.00
$3.00
$0.80
$104.00
Pay Date Pay Type
Invoice # PW-11-17-65782
11/30/2017 Credit Card
11/30/2017 Credit Card
Amt Paid Amt Due
$ 50.00 $ 54.00
$ 54.00 $ 0.00
Available Inspections:
Inspection Type:
Excavation
Review Public Works
Final Public Works
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 be done in compliance with all applicable laws regulating
construction and zoning. Futhermore, I authorize the above -named contractor to d
vember 30, 2017
Authorized Signature: Owner / Applicant / Contractor
gent
Date
Building Department Copy
November 30, 2017 1
Miami Shores Village
NOV 2017
Public Works Department
�--'
(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--77(1
Permit#: �S — 283f
r� W 11-2$3S
Name of Applicant (if utility see below): Y'`\ Gk\ " (b`'‘
Owner off the following described property:
Legal Description: Lot Block Subdivision
Folio #; I I -3/QS- 2271 - Q2ya
Address: et ZOO ►•.l O\\/Sc
UTILITY NAME:
Qualifier/Authorized Agent:
Address:
City: State: ZIP:
Telephone: Email:
State Certification or Registration #: Certificate of Competency #
CONTRACTOR NAME: ik{ \S! ( �av�C� eke GA--auc°
Qualifier/Authorized Agent: keC4oC
Address: to cfs N-AN q3 'rF ( C
City: \ IC\ v-v‘e State: C\ ziP:33i C
Telephone: O5 8• 101S Email: AR.-rl.51"-X.0 CV-676- GjZo f' A . at25vv‘
State Certification or Registration #: 479 bZX'6'-1 Certificate of Competency #:
Request jpermission to install (describe work, attach se arate page if necessary) in the adjoining right of
way: K-e+^'�o E (S 1�1V•(t kf efO ZT C,k T0a v4'‘. Cori C rP
+b heftwief Se.n0v1-C'S
Type of Work: ErPaving
❑ Utility ❑ Sidewalk ❑ Electric ❑ Irrigation
❑ Landscape ❑ Antenna ❑ Other:
DESIGNER: Architect/Engineer:
Address:
City: State: ZIP:
Telephone: Email:
Registration #:
Value of Work for this Permit: $ / tit S(%(7�
Square/Lineal Footage of Work: I 64to
***** Fees*****
Permit Fee $ 100.00
Notary $ Training/Education $ 0.20 Technology Fee $ 0.80 Scanning `$'
Bond $ (if required) Total Fee Now Due $ S '-(• G�
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 reinspection will be charged.
Signature (� f
Applicant or Authorized Agent
The fore ,o g instrurrent was ac
this % day of
1\�CKt Lo8A.0ri
is„pe� Hall
identification.
owledged before
,20 \--),by
who
known to me or who has produced
as
NOTARY PUBLIC:
Sign:
Print:
SEAL:
40ARY4s„ John Rogues
NOTARY PUBLIC
STATE_: OF FLORIDA
Comm# i• 1=9416106
Expires 4/17/2020
*****r **
APPROVED BY:
Signature
t2i
Company/Utility Agent
The foregoing instrument was ac�jnowledged before
mer this Z 1"w`" day of ViJ( , 20 I), by
- who
is sonally know) to me or who has produced
identification.
NOTARY PUBLIC:
Sign: VA
Print: Jam\ v o P-J
SEAL:
.p`RYgo rq, NOTARY PUBLIC
STATE. OF FLORIDA
2 Comm# FF946106
/NOE 1�1� Expires 4/17/2020
*************************************
as
, Public Works Director, or Designee
2017-04-15
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
CFN: 20170647360 BOOK 30759 PAGE 1191
DATE:11/16/2017 04:19:26 PM
HARVEY RUVIN, CLERK OF COURT, MIA-DADE CTY
COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY
Whereas, (owner) }Z;c.Ic; Lc,4Joni hereinafter referred to as the
owner of the following described property (address): 1240 N 3ays'cc �(I s -1 sh.(4s
Legal Description ^r8 `1q-63 Lot 12.. Block Z Subdivision." Loft
Folio # l 1-3'2-05- 027- D240
Requests permission to install (describe work): _Cvc1 Cov,C<e.4 uac es
vv` -`11C ewQ"9 .ex►, kffepotc,k
Within the public right of way of (address) q7gj ►.J L)L<k e f
eS if l e-4:21:�
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 Dade County
to make repairs or maintain said items within public right of way including restoration of
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 hereby agree to indemnify and hold Miami Shores Village or 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 60 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 obligations has been
canceled by an affidavit filed in the Public Records of Dade County, Florida by the
Village Manager of Miami Shores Village (or his fully authorized representative).
Signature
�
Owner or Agent (ck LantAwn-awY1 e '
Tt} for c
going instrument was acknowledged before me this b day of 14i 41*/-1` 2011, by
c,111 Lori 6- - who is personally known to me or who has produced F c- D L
as identification and who did take an oath.
NOTARY PUB IC.
Sign:
Print: , O
My Commission Expires:
NOTARY PUBLIC
STATE OF FLORIDA
Comm* FF946106
Expires 4/17/2020
John Rogues
NOTARY PUBUC
STATE OF FLORIDA
Commit FF948106
Expires 4/17/2020