PLC-19-1313Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Issue Date: 06/27/2019
Location Address Parcel Number
770 NE 91ST ST 7, Miami Shores, FL 33138 1132060380070
Contacts
Permit NO.: PLC-06-19-1313
Permit Type: Plumbing - Commercial
Work Classification: Alteration
Permit Status: Approved
Expiration: 12/24/2019
ELISE CHAMBERS Owner INFINITY CONSTRUCTION SERVICES INC Contractor
ANTONIO LUVARA
Home: 2252057042 ELISEWCHAMBERS@GMAIL.COM 4156 96 AVE, MIAMI, FL 33165
Business: 7864439590
Inspection Requests:
Inspec ion Re
Description: INSTALL TOILET VALVE, VANITY KITCHEN SINK
Valuation:
$ 1,000.00
AND REFRIGERATOR TO REPLACE PERMIT#PL-4-15-790.
49
Total Sq Feet:
325.00
Amt Paid
Payments
Date Paid
Fees Amount
100% Permit Renewal Fee $150.00
Total Fees
$150.00
Credit Card
06/27/2019
$150.00
Total: $150.00
Amount Due:
$0.00
Building Department Copy
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. Futhermppe, I authorize the above named contractor to do the work stated.
Signature:
/ Applicant / Contractor / Agent
Date
June 27, 2019 Page 2 of 2
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
F B /C� 20 Q
BUILDING Master Permit No� i11
—U��
PERMIT APPLICATION Sub Permit No. L CSb' l 4?)l
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
LUMBING ❑ MECHANICAL PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 77y Iy W FI- r �1
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): ��l/-SE �� //////�%'!i�/�1^ S Phone#:
Address: (O// 5 /yT qo? —d g z—'
City: -rid% G��Lor�� State: �� Zip: I CJ
Tenant/Lessee Name: _Phone#:
Email: J'G bo C`'1 � �^✓'s'(1� /ACT pi1�1^ �/
CONTRACTOR: Company Name: ,�
Address: 65 S N W -7
l7
one#: ?,y (6 -1 t� 7 74Wv
City: (1Jo State: r7: L Zip: 33 r G C=
,9
Qualifier Name: v'�0_nj) � U u Q,1Q,I� Phone#: ?� O 5 2 J& 3a ZC�
State Certification or Registration #: Cl--C I Lf Z. 9 2F O Certificate of Competency #: _
DESIGNER: Architect/Engineer: I _ Phone#:
Address: City: State
Value of Work for this Permit: $ f�l�� Squaref Linear Fddtage.of-Work:
Type of Work: ❑ Addition ❑ Alteration -❑ New �� Replace
Type
Dperrintinn.nf Wnrk
* �w
i
Zip:
�s
❑ Demolition
y'k ' 2yp °0C
Specify color of color thru tile: v c+"
Submittal Fee $ Permit Fee $ CCF $ CO/CC $
Scanning Fee $ _ Radon Fee $ DBPR $ Notary $
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ Bond $
TOTAL FEE NOW DUE $
0
(Revised02/24/2014)
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
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 which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Sig nat ram(/- %Y/ ' Signature
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this
2A daKmbz
, 1 ,20 �by
D 1 e w
rs- , who is per, onally known to
me or who has
as
produced
identifica ion a
ho did take an oath.``Nglll��,
N TARY UBLIC:
PRIETop����i
``��►�_�pOY
Sign:
v� _ • fC
Print:
�`Jl •
Seal:
e
�i�� ?�bwiU�a" •• �C`.
The foregoing instrument was a knowledged before me this
2 day of , 20 L n by
�j w o is personally known
me or who has produced �C s
identification and who qid tak an oath. lcj
NOTARY PUBLIC:
Print:
APPROVED BY F> /!ir /g Plans Examiner
Structural Review
Zoning
Clerk
(Revi sed02/24/2014)
INFINITY CONSTRUCTION SERVICES INC.
4156 SW 96 Avenue
Miami, Florida 33165
Telephone 786 443 9590
LICENSE # CAC 1816795
LICENSE# CFC 1428288
Date: June 20, 2019
State Of Florida
County:
Before me this day personally appeared A v1o�� Vy mf),S)- Who being duly
sworn, deposes and says:
That he or she will be the only person 1
,7.7y ►`i w R ( s-L ne
' IL
Contractor Signature
ng in the project located at
kucL'tiI 1h &-a4. 13
Sworn to (or affirm) and subscribed before me this 2-0
By
day of 20 l It
Personally Know
Or produced identification -
"""••y AMNI01)6gizldentification Produced
?� •'? : MY COMMISSION NFF913115 A '
= EXPIRES: AUG 25, 2019 v `YIA
A m e Z
; Bonded through 1st Stave Insurance
Print, type or stamp name of Notary
r.A
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
The foregoing was acknowledge before me this V I day of LQ , 20
By C�� �lb-f- VV CYW �►� r S who is personally known to me or has produced
(j V as identification.
`1��►,p`! PR/ET� �//
Notary:�l�``�
SEAL:
x
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