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PL-17-203 Permit Ato. '�- -ee Miami Shores Village M GA 7y 7 Alit Tl x: Residential 10050 N.E.2nd Avenue NE ' Wb*-Pla_"fflCShbn,AdditionAltoratiorl Miami Shores,FL 33138-0000 Pent Ststus AP, RPVEir}; Phone: (305)795-2204 !•• �12�1°° Expiration: 08/07/2017 Is��> Ikre �' � Project Address Parcel Number Applicant 561 NE 95 Street 1132060140750 Miami Shores, FL 33138- Block: Lot: MICHAEL HETTICH Owner Information Address Phone Cell MICHAEL HETTICH 561 NE 95 Street MIAMI SHORES FL 33138-2731 Contractor(s) Phone Cell Phone Valuation: $ 2,000.00 I11 NFINITY CONSTRUCTION SERVICES (786)443-9590 _ _ - �..�� Total Sq Feet: 0 Type of Work:MOVE SINK TOILET AND SHOWER Available Inspections: Type of Piping: Inspection Type: Additional Info:MOVE SINK TOILET AND SHOWER Top Out Bond Return: Final Classification:Residential Scanning:3 Review Plumbing Underground �JE Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $1.20 Invoice# PL-1-17-62729 DBPR Fee $2'25 01/26/2017 Check#:1057 $50.00 $116.70 DCA Fee $2.25 Education Surcharge $0.40 02/08/2017 Check#:4447 $ 116.70 $0.00 Permit Fee $150.00 Scanning Fee $9.00 Technology Fee $1.60 Total: $166.70 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 assumq responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL,PL SING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS AFFIDAI certify hat all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zo g Futhe re,I authorize the above-named contractor to do the work stated. February 08, 2017 Authorized Si tur .Owner / Applicant / Contractor / Agent Date Building De artment Copy February 08,2017 1 A Miami Shores Village Building Department ;P1 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 Y.9 ____ __ INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20 BUILDING Master Permit No. QG— -(� �3 3�!• PERMIT APPLICATION Sub Permit No. P I I q — Z®-2) BUILDING ELECTRIC F-1 ROOFING F-1 REVISION [-] EXTENSION RENEWAL PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF [:]CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: GJ�I �� �6�_6 City Miami Shores County: Miami Dade Zia: -b 25 Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): fv!`,0,A*e_L �, �� •Cs� Phone#: Address: -1-(01 N �• �� City: ;rn ®Y State: Zip: Tenant/Lessee Name: Phone#: Email: ( ��� CONTRACTOR:Company Name L � C14► � "� r� `V C4 cj ' V(- Phone#: Address: 1 Cc,- 'I —Q_ ff s City: Py11 State:t Zip: It. r��C f Qualifier Name: Jkn vu� (��' Phone#: 7-96 Y13 2190 J State Certification or Registration M C e C J_ 2 certificate of Competency#: DESIGNER:Architect/Engineer: 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: \-"\0\C¢-, %\N L eA Specify colorofcolor thru tile: �J Submittal Fee$ CS Permit Fee$ ' CCF$ �. �'� CO/CC$ Scanning Fee$ Radon Fee$ Z s DBPR$ Z S Notary$ Technology Fee$ I• = Training/Education Fee$ Double Fee$ Structural Reviews$ - Bond$ h 1 (gyp TOTAL FEE NOW DUE$ (RevisedO2/24/2014) Bonding Company's Name(if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name(if applicable) Mortgage Lender's Address City State Zip 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 absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. AJJ Signature Signature OWNER or AGENT CONTRACTOR The foregoing instrumen as acknowledged before me this The foregoing instrument was acknowledged before me this 1 ( dayU�Q 7 ,20 ! ,by day of Z:Sia n ,20 In ,by who is personal nown o CsC 0(-\ I �'JG P`—who is personally known to MIC 14 , C96 who has produced as me or who has produced as Identification and who did take an oath. identification and who did take an©ath:-- RAUL NAVARRO NOTARY PUBLIC: NOTARY PUBLIC: . MY COMMISSION#FF972714 9s, EXPIRES:MAR 20,2020 Bonded'through 1st State Insurance Sign: Sign: Print: Print: IN, Notary Public State of Florida Seal: ?c\f Loly Martinez Seal: MY Commission FF 019208 OF w Expires 06/19/2017 ************************************************************************************************************ APPROVED BY Rd IV— Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) INFINITY CONSTRUCTION SERVICES INC. LICENSE NUMBER: 1428288 PHONE#786 443 9590 Date: 01/13/2017 County of: Miami Shores Village Building Department Before me this day personally appeared Antonio Luvara who, been duly sworn, deposes and says: That he will be the only person working on the property located at 561 NE 95 St. Miami Shores, FI 33138 C dially: A Rio Luvara Sw rn to and subscribed before me this I day of 20 By OcLsA k0QQ(-C .,. Personally know Or produced Identification._ RAUL NAV RO Type of identification P ° [Ily COMMISSION#FF972714 y,: 9 EXPIRE&MAR 20,2020 Fav°, Bonded through 1st State Insurance 13— j o-� _ � •� Print, Type or stamp of Notary 1�' 932 Y�C MMoog �,� iaml h®res rllalge � - W Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305)795.2204 Fax: (305)756.8972 ®tire to Owner — Workers' Compensation Insurance Exemption Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05 allows corporate officers in the construction industry to exert themselves from this requirement for any construction project prior to obtaining a building permit. Pursuant to the Florida Division of Workers' Compensation Employer Facts Brochure: An employer in the construction industry who employs one or more part-time or full-time employees,including the owner,trust obtain workers'compensation coverage. Corporate officers or members of a limited liability company (LLC) in the construction industry may elect to be exempt if I. The officer owns at least 10 percent of the stock of the corporation, or in the case of an LLC,a statement attesting to the minimum 10 percent ownership; 2. The officer is listed as an officer of the corporation in the records of the Florida Department of State_Division of Corporations;and 3. The corporation is registered and listed as active with the Florida Department of State,Division of Corporations. No more than three corporate officers per corporation or limited liability company members are allowed to be exempt. Construction exemptions are valid for a period of two years or until a voluntary revocation is filed or the exemption is revoked by the Division, Your contractor is requesting a permit under this workers'compensation exemption and has acknowledge that he or she will not use day labor,part-time employees or subcontractors for your project.The contractor has provided an affidavit stating that he or she will I be the only person allowed to work on your project,In these circumstances,Miami Shores Village does not require verification of workers' compensation insurance coverage from the contractor's company for day labor,part-tune employees or subcontractors. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. A ✓ �vfyl � Signature. _ Owner State of Florida County of Miami-Dade The foregoing was acknoZZ e before me this �7 day of 20 *7 B / /+op^ y_�r'��t,� _��,L��� who is personally known to me or has produced as identification, Notary: Pq SEAL: Lay Martinez e My Commission FF 018208 1 WoIExpires 08/18/2017 L u