PL-18-599Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Project Address
Permit
Issue Date
Permit NO. PL-3-18-599
Permit Type: Plumbing - Residential
Work Classification: Addition/Alteration
Permit Status: APPROVED
3/20/2018
Expiration: 09/16/2018
Parcel Number
Applicant
10618 NE 11 Court
Miami Shores, FL
1122320280420
Block: Lot:
ARTURO RODRIGUEZ
Owner Information
Address
Phone
Cell
ARTURO RODRIGUEZ
10618 NE 11 Court
MIAMI SHORES FL 33138-
(305)877-0897
10618 NE 11 Court
MIAMI SHORES FL 33138-
Contractor(s) Phone
INFINITY CONSTRUCTION SERVICES (786)443-9590
Cell Phone
Valuation:
Total Sq Feet:
$ 500.00
0
Type of Work: PLUMBING FOR SHOWER , INSTALL PLUMB
Type of Piping:
Additional Info: PLUMBING FOR SHOWER , INSTALL PLUMB
Bond Return :
Classification: Residential
Scanning: 1
Fees Due
CCF
DBPR Fee
DCA Fee
Education Surcharge
Permit Fee
Scanning Fee
Technology Fee
Total:
Amount
$0.60
$2.25
$2.00
$0.20
$150.00
$3.00
$0.80
$158.85
Pay Date
Invoice #
03/20/2018
03/08/2018
Pay Type
PL-3-18-66716
Credit Card
Credit Card
Amt Paid Amt Due
$ 108.85 $ 50.00
$ 50.00 $ 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 AFFID: : I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction -, d zoni g. Futhermore, I authorize the above -named contractor to do the work stated.
Autho
na ure: Owner / Applicant / Contractor / Agent
March 20, 2018
Date
Buildin Department Copy
March 20, 2018 - 1
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
BUILDING ,
PERIAIT APPLICATION
❑ BUILDING ❑ ELECTRIC ROOFING
VPLUMBING
JOB ADDRESS:
z
City:
tO(Q(' N)E
Miami Shores
(� MECHANICAL ❑PUBLIC WORKS
Cc£ lit
❑ REVISION
MAR 0,$ 2018
FBC 2011
Master Permit No. ?G I$— 513
Sub Permit No. PL 3 - 1 S _..Sc 1
EXTENSION ❑ RENEWAL
CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
County: Miami Dade
Zip: -3D i 38"
Folio/Parcel#: Is the Building Historically Designated: Yes
Occupancy Type: Load:
Construction Type:
Flood Zone:
BFE:
OWNER: Name (Fee Simple Titleholder): 147r7'i- ' , Phone#: .
Address: IO(Q 1�N38 l' (1-wet
L=1
City: (a r) 1 \SI C State: Fl(]y1 d Zip: 3 3 13g
NO.
FFE:
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name:
,r,n c.0e/
Address: '1 )5So Sc R v--�
City: rf1 \ CV-(\ , I
Qualifier Name: PI l\��r\i
State Certification or Registration #:
DESIGNER: Architect/Engineer:
'State: C 1
O3Qrr�
Phone#: =305 - 41So - Y / / 3
Zip: 753
Phone#: tl —3
C.FC_ I ya1S 1 �Jc Certificate of Competency #:
Phone#:
State: Zip:
Address: City:
Value of Work for this Permit: $ ,SO D .
Square/Linear Footage of Work:
Type of Work: ❑ Addition L Alteration ❑ New
Description of Work: r(> tnt: y(
(/
el Repair/Replace
0-Demolition
'Specify color of color thru tile:
Submittal Fee $ S 0 J d Permit Fee $ 67
Scanning Fee $ Radon'Fee $ a
Technology Fee $
Training/Education Fee $
CCF $ CO/CC $
DBPR $ Notary $
Double Fee $
Structural Reviews $
(Revised02/24/2014)
4
Bond $ U
TOTAL FEE NOW DUE $ 1 O t`1 • G 5
-- •
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 workand 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
coristructiori 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 issue. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature
OWNER or AGENT
Signature%
CONTRACTOR
The foregoing instrume t was acknowledged before me this -The foregoing instrument was acknowledged before me this
day of QII1
, 20 UP) ,b�by day of [`� tel , 20 7 , by
1iVYA �-Dd•Cl.o , who is ersonally knowntb An 0 kWQ (- 111 ��I , who is personally known to
me or who has produced as me or who has produced • as
identification and who didtake an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
C Q,a- \Ct L cL
********
KELLY J VILLA
: MY COMMISSION # GS011524
,, EXPIRES February 26, 2021
APPROVED BY
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
3--e---11 Plans Examiner
ANTONIO E. GOMEZ
•
EXPIRES: AUG 25, 2019
Bonded through 1st State Insurance
Zoning
(Revised02/24/2014)
Structural Review Clerk
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:
Owner
State of Florida
County of Miami -Dade , t-
The foregoing was acknowledge before me this 13 day of �d,l'ihn , 20 IS .
By f U i'0 PC611f:tUt& who is personally, knowna`o the or has produced
=,'.r z
Nota c>c-i
t& ft(
SEAL:
as identification.
Notary Public State of Monde
Ana Maria Perez
j) My Commission GG 191084
e. . pF Expires 02/28I2022
IMFINITY CONSTRUCTION SERVICES INC
LICENSE # CAC 1816795
PHONE NUMBER 786 443 9590
Date; 3/5/18
COUNTY OF MIAMI SHORES VILLAGE
Building Department
Before me this day personally appeared Antonio Luvara who, been duty sworn deposes and says:
That he will the only person working on the property located at I 0 (v 18 N 1 cc k) r-4'
yam? s('rores Fc.33t3�
741\a:
Antoni Luvara
Sworn"to and subscribed
Personally Know
Or "produced Identification
Type of identification
fore me this S day of WQ'J7 20 \/ 9 by 140 CD 00( �•--
Print, Type or stamp seal of Notary
AN(ONIOE OMEZ
M9 3ii5
s� ruBvc MY IABESSI Ui9
pCP\ ES.A
G 25 20
Bonded thcoa9h 1st State Insurance