PW-18-3095Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address
Permit NO.: PW-10-18-3095 Permit IVR Number: 100338
Permit Type: Public Works
Work Classification: Public Works
Permit Status: Approved
Issue Date:10/09/2018 Expiration: 04/08/2019
Parcel Number
Project
9400 N BAYSHORE DR, Miami Shores, FL 33138 1132050100110 <NONE>
Contacts
AMINE DOUKKALI MARIELA B ROVITO Owner AMINE DOUKKALI MARIELA B ROVITO Applicant
1TRS JTRS
801 N VENETIAN DR 907, MIAMI BEACH, FL 33139 801 N VENETIAN DR 907, MIAMI BEACH, FL 33139
Other:3059926776 Other:3059926776
SLUYTER CONSTRUCTION Contractor
GREG ALLEN SLUYTER
237 NE 102 ST, MIAMI SHORES, FL 33138
Business: 9703799730
Description: CONCRETE DRIVEWAY, PAD AND SLABS FOR Valuation: $ 500.00 Inspection Requests:
305-62-4949
CONDENSERS, WALKWAY AND PROPANE TANK
TotalSq Feet: 100.00
Fees
Amount
Education Surcharge
$0.20
Public Works Permit Fee
$100.00
Scanning Fee
$3.00
Technology Fee
$0.80
Total:
$104.00
Building Department Copy
Payments
Amt Paid
Total Fees
$104.00
Credit Card
$104.00
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 AFFIDAVIT: I cethat all the foregoing information is accurate and that all work will be done in compliance with all applicable laws
regulat(nlconsj=tjwr'pnd z nin . Futhermore, I authorize the above named contractor to do the work stated.
re: Owr/lIt/ / Applicant / Contractor / Agent Date
October 09, 2018 Page 2 of 4
RECEIVED
Miami Shores Village OCT 0 9 201!80
Public Works Department
(305)795-2210
Public works forms are available from the building department, 10050 NE 2nd 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#: 1 "' 1 Y 2 1
Name of Applicant (if utility see below): 4124ZLQ b,6,.))CC,*J
�
Owner off the following described property:
Legal Description: Lot Block Subdivision N • 'J� L U� F
Folio #; // , 32 - OI & — Olt D
Address: q C'/
UTILITY NAME:
Qualifier/Authorized Agent:
Address:
City:
Telephone: Email:
State Certification or Registration #:
CONTRACTOR NAME: L LJ
Qualifier/Authorized Agent: --P
Address: r7 04J
City: I'Ki.,¢,ci� 5y✓Z
Telephone: Email:
State Certification or Registration #:C. 1&_
State:
ZIP:
Certificate of Competency #
LX_ T(
State: r L ZIP: I
1-
Certificate of Competency—#'
44,4,L , fcY2t
Requests permission to install (describe work, attach sep rate page if necessary) in the adjoining right of
way: D� F W ,�/. ► u,l%'� "�'�-/1�'r-e �— �S w4
Type of Work: ❑ Paving ❑ Utility
❑ Landscape ❑ Antenna
DESIGNER: Architect/Engineer:
Address:
❑ Sidewalk ❑ Electric ❑ Irrigation
[Other: C J A ( ('— 0 ('C �t-2�✓a-a-
City: State: ZIP:
Telephone: Email:.
Registration #: S
Value of Work for thkPerniit: , $ ' �� �' Square/Lineal'Footage of Work.
ti .•
***** Fees
Permit ree a Luu.uu
Notary $ Training/Education $ 0.20 Technology Fee $ 0.80 Scanning $
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 reinspection will be charged.
Signature
ak-
Applicant or Authorized Agent
The foregoing instrum nt_was acknowledged before
me this G day of UQU-15�C-c= , 20 gL J by
I kt VZ--2 PM 1 Kk 12101.)iG:cAU who
is personally known to me or who has produced
as
identification.
NOTARY P LIC:
Sign:
Print: (.::;,I "IN
SEAL:
SINDIA ALVAREZ
MY COMMISSION # GG 236273
EXPIRES: September 3, 2022
Balled Thru Natvy Publk Wftwrkem
APPROVED BY:
2017-04-15
Signature
Corr�i�fiy/Utility Agent U
The foregoing instrumvv t was acknowledged before
me this 15 day of��ti� , 20 16 by,
me or who has produced
P C
p,rr'y^ SINDIA ALVAREZ
MY COMMISSION # GG 238273
EXPIRES: September 3, 2022
Baided TAro Notary Public UndeneNae
Public Works Director, or Designee
111111H111111111111111 11111 Ail 111111H 1111
CIR BY. 31.170 F's ?641. (1F'ss)
Miami Shores Village
Fri; ' '-'" Building Department
��.� M�. =f"'
10050 N.E.2nd Avenue
F Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY
Whereas, (owner) A .-41 ovV L))f_I L F
� hereinafter referred to a the
owner of the following described property (address): Z/ Ott ��1, ,
Legal Description Lot Block Su division L)/X0L/ l
Folio# //32cs-Old-D//O
Requests permission to install (describe work): C p ✓I c /� Lo <0yV A y
Within the public right of way of (address) He o 0 _ AJ ✓5.4 sad ��� �i/Z,
i4v�1' �ND2N S �( l 3
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 M nager of Miami Shores Village (or his fully authorized representative).
Signature
Owner or Agent
The foregoing instrument was acknowledged before me this _� day of , 20 1 v , by
Pi i�w AM, �6� �� r r�l who is personally known to me or who has produced1,2
�L
as identification and who did take an oath.
- u-rA tt or K0Rfi3A, oOUNTY OF DA0E
NOTARY RUBLIC:
Sign:
Print: S t f ,".
My Commission Expires:
'HEREBY CERTIFY►s � kw IF fNe
onvinal filed in this olr I� d� of ¢
_ AD20
,VI TNESS my hand and Official Seal.
a County Courts M TM" °� '
_ r
yC� 'ogo�!tr
.V`yy SINDIA ALVAREZ
g„ MY COMMISSION # GG 238273
EXPIRES: September 3, 2022
' Eo•'.`° ' Bonded 71uu Notary Public Underwriters