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PLC-18-1123Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Project Address Permit Permit NO. PLC-4-18-1123 Permit Type: Plumbing - Commercial Work Classification: Addition/Alteration Permit Status: APPROVED Issue Date: 'S123/2018 Expiration: 11/19/2018 Parcel Number Applicant 689 NE 92 Street Number: 9-G Miami Shores, FL 1132060430210 Block: Lot: JOYCE D LANGE Owner Information Address Phone Cell JOYCE D LANGE 689 NE 92 Street MIAMI SHORES FL 33138- (305)632-0200 689 NE 92 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone INFINITY CONSTRUCTION SERVICES (786)443-9590 Valuation: Total Sq Feet: $ 1,000.00 0 • Type of Work: CHANGE OUT TOILET BOWL , SINK AND S Type of Piping: Additional Info: CHANGE OUT TOILET BOWL , SINK AND S Classification: Commercial Scanning: 1 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Notary Fee Permit Fee Scanning Fee Technology Fee Total: Amount $0.60 $2.25 $2.00 $0.20 $5.00 $150.00 $3.00 $0.80 $163.85 Pay Date Invoice # 05/23/2018 04/27/2018 Pay Type PLC-4-18-67333 Check #: 1129 $ 113.85 $ 50.00 Cash $ 50.00 $ 0.00 Amt Paid Amt Due Available Inspections: Inspection Type: Final Top Out Re Pipe Main Drain Heater Water Service Water Main Lavatory 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 that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore, I authorize the above -named contractor to do the work stated. May 23, 2018 Authorized Signature: Owner / Applicant / Contractor / Agent Date Building Department Copy May 23, 2018 1 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 BUILDING PERMIT APPLICATION 1 Ei BUILDING ❑ ELECTRIC ❑ ROOFING © REVISION PLUMBING ❑ MECHANICAL El PUBLIC WORKS ❑ CHANGE OF i CONTRACTOR 57 .0Far Miami Shores County: 1: Miami Dade Zip: 33/-3 % //'-- 3avl. "O y3-l73/47 Is the Building Historically Designated: Yes NO t Flood Zone: BFE: ' FFE: 6ss9.irE' �a,.d Address: Gil' `, dt%& 9 .tze.1 r5!?oI'GS City: , 7Ie2 ., , ' JOB ADDRESS: City: Folio/Parcel#: Occupancy Type: Load: csm t--' .DVED 18 Construction Type: j FBC 20 1? Master Permit No. C 1 Sub Permit No. ❑ EXTENSION ❑RENEWAL CANCELLATION El SHOP DRAWINGS OWNER: Name (Fee Simple Titleholder): 4C �. 64N fP State: C 6+t�/� �cl Tenant/Lessee Name: Email: Phone#:3;n54 rn c Givs" ; Ottp ip: 33 /3 • Phone#: CONTRACTOR: Company Name:_1-411ni CAnr6A6uG lYlrl Address:(' h O c h, A City: Mcal 1 State: Qualifier Name: t,VUT�b(.0 c; zip1 (o-') Phone#: `7,8 (D ccf 3' ._(-Qv State Certification or Registration #: c'i 'C. )'-4 `$,, Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ '' btofl Type of Work: ❑ Addition/t LiAlteration. Descri%pion of Work: j r,,, C J .,. d L.,71' S inotA.)e-( Square/Linear Footage of Work: n New i Repair/Replace ❑ Demolition 744 5.175. ,� 4 ..,_,a,_,,. --o ` a rw:=w'win .Zz_, i... 4-...-7.. '4`r•«e:.n t Specify color of color thru tile: Submittal Fee $ So pa 4 Permit Fee $ i, CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ n 5 . TOTAL FEE NOW DUE$ ,1 (Revised02/24/2014) identification and who did take an oath. MY COMMISSION # GG 044602 Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City _ g, ! ) 1 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. k ` r "WARNI'NG'-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 ingood faith that a copy of the notice of commencement and.construction lien law b ochure will be delivered to the person whose property is subject to attachment: Also, a certified copy of the'recorded notice of comcement must be posted at•tfie job site for the first _inspection which occurs seven (7) days after the building permit is issued. he absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. OWNER or AGENT The foregoing instrument was acknowledged before me this CONTRACTOR J' The foregoing instrument was acknowledged before me this �-{ day of l� , 20 1 by / Co day of 01 n 1 , 20 � � , by r / iri o is pers all nown to H.n1-crii personallyknown to Y l?t.1C,r� ,who is me or who has produced 1 (C " as me who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: RAUL NAVARRO MY COMMISSION #FF972714 EX. .RES: MAR 20, 2020 Bonded through 1st State Insurance APPROVED BY /41i 7' 3i ( Plans Examiner Zoning � 5r (Revised02/24/2014) Structural Review Clerk License: CFC#1428288 4156 SW 96 Ave. Miami F1 33165 Phone #786 443 9590 PROPOSAL & CONTRACT April 27, 2018/19/2018 City Of Miami Shores Building Department 10050 NE 2"d Avenue Miami Shores, FLO 33138 Ref: 689 NE 92 nd Street #96 SCOPE OF WORK: CONTRACT: Between ANTONIO LUVARA, plumbing qualifier and Joyce Dianne Lange Owner of property above mentioned, for the following jobidescription: Change out Toilet Bowl, Sink and Shower Labor $1000.00 (One Thous •� Dollars) Signature alifier Signature Of 0 er Print Name Print Name 679 N. Miami Ave, Loft #3, Miami, FL 33136 I Office:305.200.3131 I Fax:305.200.3422 INFINITY CONSTRUCTION SERVICES INC. 4156 SW 96 Avenue Miami, Florida 33165 Telephone 786 443 9590 LICENSE # CFC 1816795 Date: May 16 2018 State Of Florida County: Miami Dade Before me this day personally appeared A 117 Q hi/ #a Who being duly sworn, deposes and says: That he or she will be the only person working in the project located at // P? 4"6^. 97 96 7fOrr2I , 5//oie_-_,S Contractor'Signature Sworn to (or affirm) and subscribed before me this IL day of Pia 20 13 By Q4D'1D Lvtja Personally Know Or produced identification Type identification Produced Print, type or stamp name of Notary IL GOMEZ EXPIRES: AUG 25, 2011 :oF 1, Bonded through 1st State Insurance Notice to Owner — Workers' Com p Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204. Fax: (305) 756.8972 ensation 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. State of Florida County of Miami -Dade The foregoing was acknowledge before gym, me this z Ctday of , 20 18 . By 0 i, r �� Let who is personally kno n to me or has produced 11►!,1S as identification. Notary:-,i���;�- �y �► SEAL: 'Py'-. YANADY PRIEMO MY COMMISSION it FF 214031 - ., P EXPIRES: March 25, 2019 qF k44r' Bonded Thru Notary Pubic Underwriters