PL-18-2184Project Address
Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Permit No. RL -8-18-2184
■ Permit Type: Plumbing - Residential
er it
Wink Classification: Addition/Alteration
Permit Status: APPROVED
Parcel Number
Isst a Date: 9fj/20j8 ] Expiration: 03/06/2019
Applicant
873 NE 98 Street 1132060142520
Miami Shores, FL 33138- Block: Lot: MAURICIO VELAZQUEZ
Owner Information Address Phone Cell
KARLA UTTING 873 NE 98 Street (786)444-0602
MAIMI SHORES FL 33138-
873 NE 98 Street
MAIMI SHORES FL 33138-
Contractor(s) Phone Cell Phone
INFINITY CONSTRUCTION SERVICES (786)443-9590
Type of Work: PLUMBING WORK FOR KITCHEN REMODELIN
Type of Piping:
Additional Info: PLUMBING WORK FOR KITCHEN REMODELIN
Bond Return :
Classification: Residential Scanning: 1
Fees Due
Amount
CCF
$1.20
DBPR Fee
$3.75
DCA Fee
$2.50
Education Surcharge
$0.40
Permit Fee
$250.00
Scanning Fee
$3.00
Technology Fee
$1.60
Total:
$262.45
Valuation: $ 1,200.00
Total Sq Feet: p
Pay Date Pay Type Amt Paid Amt Due
Invoice # PL -8-18-68574
09/07/2018 Credit Card $ 212.45 $ 50.00
08/16/2018 Credit Card $ 50.00 $ 0.00
Avaname i
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 assu a responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL,UMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: A e fy th t all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zoni I authorize the above-named cotract r to do ie work stated.
�l�c�C UL _e September 07, 2018
Authorized Signa re: Owner / Applicant / Contractor / Agent Date
Building Department Copy
September 07, 2018 1
tj H
Miami Shores Village- IED
Building Department f AUG 16 218
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 ''
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949 ."A
FBC 207 b
BUILDING Master Permit No. WC
PERMIT APPLICATION Sub Permit No. L (06
❑ BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑ RENEWAL
PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
G (+ n CONTRACTOR DRAWINGS
JOB ADDRESS:
City: Miami Shores County: Miami Dade Zip: ,/
Folio/Parcel#: Is the Building Historically Designated: Yes NO 1 �
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): M A Q'l �- C l 0 UtL Phone#: �S l0 3 S 3
Address: ( 1y
City: (�/��(a^� S�G^ State: l Zip:
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name4.
if PhoneM '1azq'Abg ! 5,1
Address: L CI S ' 4,-) '1'1
a, 3 (n
City: ro lcr'o 1
State:
Zip:�� SCS
Qualifier Name: _ _F\iiC-V O \l-7V0(c3-'
Phone#: •"V?-, `-
State Certification or Registration #: CFC-
1q) 7J c; 97
Certificate of Competency #:21
r
DESIGNER: Architect/Engineer:
Phone#:
I�00
Address:
City: State:
Zip:
Value of Work for this Permit: $
Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration
❑+ New
ti ❑f 1epair/R place
n n ❑ De olition
� `�
Description of Work: _ �0 M
�� w prj, V=
Aoa V` 1
l ` 'a
Specify color of color tru tile: '1
Submittal Fee $ So Permit Fee $ d S� CCF $ CO/CC $
Scanning Fee $ Radorrfee $ Z- S� DBPR $ Notary $
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $
(Revised02/24/2014)
Bond $
TOTAL FEE NOW DUE $ 2) Z
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 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 which4and
even (7) days after the building permit is iss d. In the absence of such posted notice, the
inspection will not be approveein pection fee will be charged.
Signature Signatur
OWNER or AGENT
The foregoing instrument was acknowledged before n me this
(o`t� day of S 20 11Z) by
t\kAtri 0 i �Y `1r who is petrsonally known to
me or who has produce 1)riVAMV 'e as
identificatiorland'%vho did
NOT
Sign:_
Print:
CONTRACTOR
The foregoing instrument was acknowledged before me this
1?) day of 20(1 by
f-!� n t3:�, .L o �J �1c,/C= who spersonally known to
'!s
me or who has produced _ as
NAVARROL
identification and who did take an"ciath. RAU'
4 MYCOMMISS10,J#FF972714
NOTARY PUBLIC: I F EXrAEF MAR 20, 2020
I ` Bonded thrc n 1st State Insurance
Sign: :, . ,: ✓ �. ';,�i,
GV
Print:
Seal: _ Seal:
YANADY PRIETO
MY COMMISSION # FF 214031
EXPIRES: March 25 2019
APPROVED BY O/d��� Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
t,
� � w
License: CFC#1428288 License CAC1816795
4156 SW 96 Ave. Miami FI 33165 Phone #786 443 9590
Date: July 25, 2018
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
P'ltt, "- S�aarus 331348
Cordial
i
Antonio Luvara
Sworn to and subscribed before me this ((�> day of 201 J by 0
Personally Know
Or produced Identification
Type of identification
�^� RANL NAVARR 972714
OM ISS10N #�
o � Pu�� ._ M� � Y RES•. MAR 20, 2020
�,,ch 1stSt�<e �nsutance
679 N. Miami Ave, Loft #3, Miami, FL 33136 1 Office:305.200.3131 I Fax:305.200.3422
J_ n
n0 2020
Print, Type or stamp seal of Notary
�Siatemsurance
�^� RANL NAVARR 972714
OM ISS10N #�
o � Pu�� ._ M� � Y RES•. MAR 20, 2020
�,,ch 1stSt�<e �nsutance
679 N. Miami Ave, Loft #3, Miami, FL 33136 1 Office:305.200.3131 I Fax:305.200.3422
Miami shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
IMUL ce uu owner — VVOrKers- 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 A NOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS
CONTENTS. i
Signature:
O ner
State of Florida
County of Miami -Dade
The foregoing was acknowledge before me this S day of 20 ( • j.
Byy 4el 1.-b is personally known tome or has produced
Notary:
C>C'— � U`C�l`J s)✓ as identification.
SINDIA ALVAREZ
MY COMMISSION # GG 238273
EXPIRES: September 3, 2022