PL-18-2222` �µORfs yir
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F�ORIOp`
Project Address
Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Permit
Parcel Number
Permit NO. PL-8-18-2222
Permit Type: Plumbing - Residential
Work Ciassiflcadon: Addition/Alteration
Permit Status: APPROVED
issue oata: 8129/2018 Expiration: 07/2512019
Applicant
1223 NE 102 Street 1132050250140
LEMAY &ALEJANDRA SANCHE
Miami Shores, FL 33138- Block: Lot:
Owner Information Address Phone Cell
LEMAY & ALEJANDRA SANCHEZ 1223 NE 102 Street (786)514-0776
MIAMI SHORES FL 33138-
1223 NE 102 Street
MIAMI SHORES FL 33138-
Contractor(s) Phone Cell Phone
INFINITY CONSTRUCTION SERVICES (786)443-9590
Type of Work: REPLACE TOILET + VANITY AND REMOVE
Type of Piping:
Additional Info: REPLACE TOILET + VANITY AND REMOVE
Bond Return :
Classification: Residential Scanning: 1
Fees Due
Amount
CCF
$0.60
DBPR Fee
$3.75
DCA Fee
$2.50
Education Surcharge
$0.20
Penalty Fee
$100.00
Permit Fee
$250.00
Scanning Fee
$3.00
Technology Fee
$0.80
Work without Permit Fee
$250.00
Total:
$610.85
Valuation: $ 500.00
Total Sq Feet: 0
Available Inspections:
Inspection Type:
Top Out
Final
Review Plumbing
Underground
Pay Date Pay Type Amt Paid Amt Due
Invoice # PL-8-18-68616
08/29/2018 Credit Card $ 560.85 $ 60.00
08/21/2018 Credit Card $ 50.00 $ 0.00
In consideration of the issuance to ermit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict co ormity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this permit I assume r sponsibility fo all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL, PLUM ING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: I certify
construction and zoning. Futher
Authorized Signatu Ow r Applica
Building Depa ent Copy
August 29, 2018
n is accurate and that all work will be done in compliance with all applicable laws regulating
-d contractor to do the work stated.
Contractor / Agent
August 29, 2018
V i� w ,
Miami Shores Village AUG 120
Building Departmentt92
s
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
FBC 201� b�^
BUILDING Master Permit No. 9-k/1 � - 2,Z2-1
PERMIT APPLICATION Sub Permit No. '?L' D - 222-2-
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
LUMBING ❑ MECHANICAL ❑ PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: � 2Z � N,--- r o Z 9 r/
City: Miami Shores County: Miami Dade Zip:
1-3d
Folio/Parcel#: I � - 3u 5 - W S `-() k`k U _ Is the Building Historically Designated: Yes NO +/
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): L`e—
Phone#: -?& • � / l� • d �� �„
Address:Z 3 Ot_— to S
p„
l/
City: 1" I t J(��,In��l s ��� State: 1y
Zip: G 3 k
Tenant/Lessee Name:
Phone#:
Email:
CONTRACTOR: Company Name:-+ n �fv� WltSl�.•-�.Y� �
j,
Phone#: % �(^�' 3 , `f (y1 /�
Address: (P
City: State: �
Zip: 1
Qualifier Name: nr)ll ,.1,�Q.t-.
Phone#:
State Certification or Registration #: C- (` 1 F2 8 Y Certificate
of Competency #:
DESIGNER: Architect/Engineer:
Phone#:
Address: City:
State: Zip:
l
V Value of Work for this Permit: $ J� 0 1 0 Square/Linearr Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New
N�rRepai(r�/Replace ❑ Demolition
Description of Work: (- AA L4 z�:, 4.��g'am1L
✓yW _ f?
Q i n G �^C �.� LL1� n
Specify color of color thru tile:
Submittal Fee $ SO::� 1 Permit Fee $� • r.. CCF $_
Scanning Fee $ Radon Fee $ DBPR $
Technology Fee $ Training/Education Fee $
Structural Reviews $
CO/CC $
Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $
(Revised02/24/2014)
rq
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
State
Zip
Zip
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that wa 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, HEATERS, TANKS, AIR CONDITIONERS, ETC.....
,LLff the1,,,-�- CS ; 1St o✓► o we 2(C,
`i v, t S W rv.v y �JYy b Y' - 4SS i.�u t O - � to (7- '{tti W'sJ Gvr re'''u%
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 w;ov
iccurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be appe and a re c fee will be charged.
Signature
OWNER or'*AKNT
The foregoing instrument was ackn wledged beforemethis
sJday of , 20 Y , by
CtOA-CLiA ' itt " who is personally known to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
:� Sien4,e-- V
Pri
Seal jR MY COMMISSION # GG 207279
c o; � EXPIRES: April 1S.2022
Barlad Tlru W43ty P1d�tlo
Signature
CONTRACTOR
The foregoing instrum t was ack owledged before me this
20 day of 20 1 /� by
^\
who is personally known to
me or who has produced as
identification and whQmdid take an oath.
NOTARY PUBLIC:
Sign:_
Print:
Seal:
APPROVED BY Plans Examiner
Structural Review
HILDA E. GARCIA
MY COMMISSION # GG 2DI279
EXPIRES: Apra 16. 2022
Bonded T1ru Notary Pubk Under mbM
Zoning
Clerk
(Revised02/24/2014)
Q1uwl, "15
INFINITY CONSTRUCTION SERVICES INC
4156 SW 96 AVE
MIAMI, FL 33165
CFC1428288
8/27/2018
STAT FLORIDA
DADECOUNTY
BEFORE ME THIS DAY PERSONALLY APPEARDED ANTONIO
LUVARA WHO, BEING DULY SWORN, DEPOSES AND SAYS:
I ANTONIO LUVARA WILL BE THE ONLY PERSON WORKING
ON THIS PROJECT LOCATED AT:
1223 NE 02 ST MIAMI SHORES. FL 33138
ANTONIO LUVARA
SWORN TO (OR AFFIRMED) AND SUBSCRIBED BEFORE ME
THIS AUGUST 29, 2018 BY: ANTONIO LUVARA.
AE GP����1�19
00 vi CAMM, S P�Pt`7 ��Z�'12
PRI
IMI
TY
PER-SONALY KNOWN:
QED DNTIFI TION:
OF DENTIF ATION:
, TYPE OR STAMP NAME OF NOTARY
Notice to Owner — Workers' Corn
Miami shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
nsation 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:
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 subcontrac rs for your project. The contractor has provided an affidavit stating that he or she will
be the only person all d to work on ur proj t. In these circumstances, Miami Shores Village does not require verification of
workers' compensati n i surance co erage from he contractor's company for day labor, part-time employees or subcontractors.
BY SIGNING BE O YOU A KNOWL GE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS
CONTENTS. 1-1
Signature:
Owner
State of Florida
County of Miami -Dade
The foregoing was acknowledge before me this day of 20&
By L-QL' , � who is personally known to me or has produced
as identification.
Notary:
SEAL. "a HILDAE.GARCIA
MY COMMISSION # GG 207273
'•.^.. P�: EXPIRES: Apri 15, 2022