PL-16-1983•
Project Address
Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Permit
Permit NO. PL -7-16-1983
Permit Type: Plumbing - Residential
Work Classification: Addition/Alteration
PermitStatus: APPROVED
tssue Date: 7/21/2016
Expiration: 01/17/2017
Parcel Number
Applicant
5 NE 105 Street
Miami Shores, FL 33138-2030
1121360060090
Block: Lot:
GROUP 10 CAPITAL MANAGEMI
Owner Information
Address
Phone
Cell
GROUP 10 CAPITAL MANAGEMENT,
1680 MICHIGAN AVE Avenue
MIAMI BEACH FL 33139-
Contractor(s) Phone Cell Phone
INFINITY CONSTRUCTION SERVICES (786)443-9590
Valuation:
Total Sq Feet:
$ 5,000.00
00
Type of Work: 2 NEW BATHROOMS AND KITCHEN FIXTURE
Type of Piping:
Additional Info:
Bond Return :
Classification: Residential
Scanning: 3
Fees Due
CCF
DBPR Fee
DCA Fee
Education Surcharge
Permit Fee
Scanning Fee
Technology Fee
Total:
Amount
$3.00
$4.50
$4.50
$1.00
$300.00
$3.00
$4.00
$320.00
Pay Date Pay Type , Amt Paid Amt Due
Invoice # PL -7-16-60613
07/21/2016 Credit Card $ 320.00 $ 0.00
Available Inspections:
Inspection Type:
Top Out
Final
Review Plumbing
Underground
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
construction and zoning. F
t all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
ore, I authorize the above-named contractor to do the work stated.
July 21, 2016
Authorized Si ure: Owner / Applicant / Contractor / Agent
Building Department Copy
Date
July 21, 2016
BUILDING
PERMIT APPLICATION
Miami Shores Village RECEr\TED
Building Department JUL 15 2016
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY:_ Grvie,„
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
FBC 20
Master Permit No. 2c
Sub Permit No %L / -l9Y3
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
UMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: q N C= 1 0 S <./*
City: Miami Shores County: Miami Dade f Zip: �3 ,1 '457 `
Folio/Parcel#: ,Is'the Building Historically Designated: Yes NO V
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder):
Address:
6 ro,..r (0 Lar, ( Phon i
('`l f is /✓l [(-,-- Acv Q
City: Owl 17Pvti,1? o L State:
Tenant/Lessee Name: Phone#:
Email:
Zip:
CONTRACTOR: Company Name: Irltell l •IZI VI cq_ Phone#: 0 8Co1/4-i`'13Ct y `tai
Address: 4 L S (c) SL
City: (TN Crim ` State€ 1 1—Zip: 1 331 {j
�,
Qualifier Name: tCl-Fsz. -1 o `.)rG-. Phone#:
State Certification or Registration #: Or --C— 1`i38$(2) Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address:City: State: Zip:
Value of Work for this Permit: $ '( OW Square/Linear Footage of Work: l00 S
Type of Work: ❑ Addition ❑ Alteration Ell New [Repair/Replace ❑ Demolition
Description of Work: 2 pg-,..., 6-,-,1hr0o44 s a n cg w }-c-4..e_.„.
Specify color of color thru tile:
Submittal Fee $ Permit Fee $ 3e' CCF $ �l t- CO/CC $ it)
Scanning Fee $ oz)\� Radon Fee $ DBPR $ Notary $
Technology Fee $ � W Training/Education Fee $ 1 - OD Double Fee $ 0
Structural Reviews $fi Bond $ 0
TOTAL FEE NOW DUE $
(Revised02/24/2014)
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 cmencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issu ; In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature
The foregoing instrument was acknowledged before me this
It -4 day of —34-1/4(1 ,20 1 b b day of 20 __ (0 by
Signature
CONTRACTOR
The foregoing instrument was acknowledged befor me this
fi61,159c7n'41-ro , who is personally known to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
2".°4Z%: ALIPELEGRIN
ION #FF1 n3894
/ pin November 23, 2018
(407) 39 ,:
8.0153 FloridallotarySeroice.com
Cr-F6A0 0 ,ei-wh. personally kno to
me or who has produced as
identification and who did take an oath.
NOTARY
i n:
C:
Print:
Seal:
—.AI
MY COMMISSION #FF972714
EXPIRES: MAR 20, 2020
„* Bonded through 1st State Insurance
************************************************************************************************************
APPROVED BY 49-1,' Plans Examiner Zoning
(Revised02/24/2014)
Structural Review
Clerk
INFINITY CON STRUCTION SERVICES INC.
License CFC 1428288
Ph#786 443-9590
Date: 07/8/2016
County Of N\
Before me this day personally appeared
dully sworn, deposes and say:
�n o v 1 L who, being
That he or she will be the only person working on the project located at: S NE i(.1.SkJ t`c\fWY.t
Sworn to (or affirmed) and subscribed before me this day of 2016 by
\ 00 _k) \(>\
If you have any question, please do not hesitated to contact me at 786 449 9590
Sincerely,
nio Luvara
RAUL NAVARRO
MY COMMISSION infitin4
RondedOtht MAR 20tat2020
ela utaACA
0.,
PtR(UULL NAVARRO
ro UOMMtSSION #FF972714
!FIRES: MAR 20, 2020
through 1st State Insurance
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
Notice 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 exempt 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, must obtain workers' compensation coverage. Corporate officers
or members of a limited liability company (LLC) in the construction industry may elect to be
exempt if:
1. 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
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-time employees or subcontractors.
BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS
CONTENTS.
Signature:
State of Florida
County of Miami -Dade
The foregoing was acknowledge before me this 1 5 day of �� lh , 20 1 ` .
By IA r; who is personally known to me or has produced
as identification.
No
?o`'"r'* •S; ,' M PELEGRIN
SE i,;'at .° M COMMISSION #FF178894
of f,d!;. EXPIRES November 23, 2018
(407) 398-0153 FloridallotaryService.com
JEFF ATWATER
CHIEF FINANCIAL OFFICER STATE OF FLORIDA
DEPARTMENT OF FINANCIAL SERVICES
DIVISION OF WORKERSCOMPENSATION
* * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW * *
CONSTRUCTION INDUSTRY EXEMPTION
This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law,
EFFECTIVE DATE: 9/21/2015
PERSON: LUVARA
FEIN: 364796470
BUSINESS NAME AND ADDRESS:
INFINITY CONSTRUCTION SERVICES INC
4156 SW 96TH AVE
MIAMI
EXPIRATION DATE: 9/20/2017
ANTONIO
FL 33165
SCOPES OF BUSINESS OR TRADE:
LICENSED PLUMBING
CONTRACTOR
SHEET METAL WORK - HEATING, VENTILATION,
INSTALLATIO AIR-COND
Pursuant to Chapter 440.05(14). F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section
may not recover benefits nr compenSation under this chapter. Pursuant to Chapter 440.05(12), F,S., Certificates of election to be exempt._ apply only
within the scope of the business or trade listed on the notice of election to be exempt. Pursuant to Chapter'440.05(13), F.S„ Notices of election to be
exempt and certificates of election to be exempt shall be skibiect lo revocation if, al eily_tirrie titter the tiling of the notice or the issuance of the cenificate,
the person named on the notice or certificSle 00 longer meets the rerarements of this section foxisstrance of a certificate. The department shall revoke a
DFS-F2-DWC .252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 06-13 QUESTIONS? (850)413-1609
ACORD CERTIFICATE OF LIABILITY INSURANCE
DATE(MMIDD/VY)
March292016
PRODUCER
Florida Insurance Agency of Miami
P.O. Box 441340
Miami, FI. 33144
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER, THS CERTIFICATE DOES NOT AMEND, EXTEND CR
ALTER THE COVERAGE AFFORDED BY THE POLICIES SELOW.
,
P; 305-445-9100
INSURER AFFORDING COVERAGE
NAICS 4
INSURED
INSURER A: United pec Co
Infinity Construction Sen/ices Inc
INSURER 87
4156 sw 96 ave
INSURER C:
Miami Fl 33165
N URER D:
INSURER E:
INSURER F:
c vera es
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN SSUED tO THE INSURED NAMED ABOVE FOR THE POLICY PERI JO INDICATED, NOT-
WITHSTANDING ANY REQUIRENIENT,TERM,OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
N - SR
LTR
ADDL
INSR
TYPE OF INSURANCE
POLICY NUMBER
EFFECTIVE
CMM/OD/Yr
EXPIRATION
(MMiDDIYY)
LIMITS
GENERAL LIABILITY
CH OCCURRENCE
1.000000
x
COMMERCIAL GENERAL LIABILITY
AMAGE i o kEN I EA)
FREMISES(Ea OCCUrrence)
5100,000
I
!CLAIMS MADE
OCCUR
MED EXP (any one peron
35000
A
.
PERSONAL & ADV INJURY
1.000.000
5111003b19227
10/9/2015
10/9/201
GENERAL AGGREGATE
2.000.000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS-COMP/OP AGO
2.000.000
x
POLICY
.1
PROJECi
LOC
AUTOMOBILE
LIABILITY
ANY AUTO
COMBINED SINGLE LIMIT
(Ea accident)
I=
ME
ALL OWNED AUTOS
SCHEDULED AUTOS
BODILY INJURY
(Per Person)
HIRED AUTOS
BOUILY INJUt-ZY
NON -OWNED AUTOS
(Per Accident)
T.,
PROPER I Y UANLAUE
(Per Accident)
(JA
' ,..,;7. LIABILiFY
AU i 0 ONLY -EA ACCIDENT
ANY AUTO
ALL OWNED AUTOS
AUTO ONLY AGG
,
EXCESS UMBRLLALTAbiLi i 7
I—I
EACH OCCURRENCE
OCURR I 'CLAIMS MADE,
AGGREGATE
DEDUCTIBLE
RETENSION 3
v./OR ERS COMPENSA TION ANU
EMPLOYERS LIABILITY
U-
TORY LIMITS[
0 „
ER
ANY PROPIERTORIPARTNER/EXECUTiVE
EL tiA -1 AUGli t.1N i
OFFICER/MEMBER EXCLUDED ?
EL•L SEJA-E.-E..A hMLUYEE
if yes describe under
EL U1SEASE-POLIL,V LiM ,
SPECIAL PROVISIONS below
UIHEK
DESCRIPTION OF OPERATIONS / LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT 1 SPECIAL PROVISIONS:
. ..,
C &i-4&2-88PIurnb3coto
CERTIFICATE HOLDER I JADEYL.INSURED
Miami Shores Village
Buuilding Deparftment
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO 00 50 SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURED. ITS 'AGENT OR
10050 NE 2nd Avenue
Miami Shores, F133138
AUTHORIZED REPRESENTATIVE
Tony Zogtibi
ACORD 25 (2001/08)
ACORD CORRORATION 1988
Local Business Tax Fbceipt
Miami- Dade County State of Florida
L.
6694773
BUSINESS NAM EfLCICA1I )N
INFINITY CONSTRUCTION
SERVICES INC
4156 SW 96 AVE
MIAMI, FL 33165
OWNER
INFINITY CONSTRUCTION
SERVICES INC
ANT(Nin I I !VARA
Worker(s)
SEC
196
RENEWAL
6967781
yPE OF FIUSiNe&S
PLUMBING
CONTRACTOR 75.04 09/2412015
CFC1428288 0235-15-0136466
"syCSS Aayrs ettt o the t Busi n s Tax Trte i cei pt Is rot "a i ice€1se,
I" t to hIch a i pass. tiddsr mist ccitti ty with any zolrernmer al'
re,' rtswh#ch applytglte x lrt t.
ial vetoes -=fit oxiesec 21
www.rlsnicaciz
EXPIRES
SEPTEMBER 30, 2016
Must he displayed al place of business
Pursuant to County Code
Chapter 8A Art. 9 & 10
(v1 EN' RECEIVED
� 'r A. x COLLECTOR
RC1,-;„ f7;; CO Tr, GOVF RN OR
UCENS1 NUIYMER
CFC1426286
KEN LAWSON, SECRETARY
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL RrntILATION
CONSTRUCTION INDUSTRY LICENSING BOARD
The PLUMBING CONTRACT o R
Named below IS CERTIH ED
Linder the provisions of Chapter 489 FS.
xpirat;on date: AUG 31 2016
LUVARA, ANIONIC)
INFINITY CONSTRUCTION.SEFVICES
4156 SVV 06 rH AvENuE
FL 33165
iSSUED: 08/17/2015
DISPLAY AS REQUIRED BY LAW