PL-18-1519�sr'O1s y!
Miami Shores Village
10050 N.E. 2nd Avenue NW
Miami Shores, FL 33138-0000
Phone: (305)795-2204
F�ORtDp'
Project Address
148 NW 96 Street
Miami Shores, FL 33150-
OCA CORP TRS
Permit NO. PL-6-18-151
P rm t Permit Type: Plumbing -Residential
work Clessifrcation: Addition/Alteration
Permit Status: APPROVED
Parcel Number
1131010240290
Block: Lot:
Address
148 NW 96 Street
MIAMI SHORES FL 33150-
148 NW 96 Street
MIAMI SHORES FL 33150-
Contractor(s) Phone Cell Phone
INFINITY CONSTRUCTION SERVICES (786)443-9590
s of Work: KITCHEN REPLACE FIXTURES
of Piping:
itional Info: KITCHEN REPLACE FIXTURES
d Return :
;sification: Residential Scanning: 1
Fees Due
Amount
CCF
$1.20
DBPR Fee
$2.25
DCA Fee
$2.00
Education Surcharge
$0.40
Permit Fee
$150.00
Scanning Fee
$3.00
Technology Fee
$1.60
Total:
$160.45
issue Date: 715/2018 1 Expiration: OVOV2019
Applicant
OCA CORP TRS
Phone Cell
Valuation: $ 1,200.00
Total Sq Feet: 0 J_
Pay Date Pay Type Amt Paid Amt Due
Invoice # PL-6-18-67788
07/05/2018 Credit Card $ 110.45 $ 50.00
06/04/2018 Credit Card $ 50.00 $ 0.00
Avauaoie inspections:
Inspection Type:
Top Out
Final
Review Plumbing
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 AF jam�f certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
consp4ctio d i : Futhermore, I authorize the above -named contractor to do the work stated.
July 05, 2018
Authorized Signature: Owner / Applicant / Contractor / Agent
ilding Department Copy
July 05, 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
FR R -(- f7
UN 4 018
BY: A};
FBC 2ql "
BUILDING Master Permit No. IBC IS - 10,39
PERMIT APPLICATION Sub Permit No. PL(2)
[--]BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
'PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR
DRAWINGS
JOB ADDRESS:
' '-r-3 0 W
C &
St
City:
Miami Shores
County: Miami Dade
1- !�
Zip: 33 t9_
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder). V c ` COR ` 1 R's Phone#:
Address:( /q"o N 6 `S7-
City: "t UAI&'Ot• &bn?- 0-3 State: �( / �" Zip: X 9,? / r?L
Tenant/Lessee Name:
Email
CONTRACTOR: Company Name: n O-g64, Phone#:7 2 6 'Y ('372"�D
Address: i 7 % (� (v kl�-Q
City: State: State: Zip: %
Qualifier Name:
e#:
4
State Certification or Registration #: �' rr �� to / Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City:
Jq Qd
Value of Work for this Permit: $ ! dCif� O Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New epair/Replace
Description of Work:---'�c�uc,�.�
14
Specify color of color thru tile:
Submittal Fee $ v 1 L' Permit Fee $ 100
Scanning Fee $
Technology Fee $
Structural Reviews $,
Radon Fee $
Training/Education Fee $
Zip:
❑ Demolition
CCF $ CO/CC $
DBPR $
Notary $,
Double Fee $
Bond $ S
TOTAL FEE NOW DUE $
(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
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 th�absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature_ ������ Signature
_ zvk
OWNER or AGENT
The foregoing instrument was acknowledged before me this
J d day of 20 l by
who is pers n to
me or who has produced
identification and who did t roath.
., �, cARLOS PROW
NOTARY PUBLIC: #FF21IMS
OR Bonded Ytno , dp t Notary S6ftft
Sign:"
Print: �•
ORFt HOi,JGv 1t � �+k�itNbidrygMYioN
Seal:
W
CONTRACTOR
The foregoing instrument was acknowledged before me this
day of jj M nn , 20 I by
;-� ✓I It 11 0 LV r 4/9'�vho is personally known to
me or who has produced �P.( �( Cka Jas
identification and who did take an oath.
NOTARY P LIC:
Sign:
Print: �Y11�CL'J
Seal: AMMMEGO U
•. lIV CAYSSIOM 1FH13115
E)fPRES: AUG 2S, 2Ms
Bonded fh ghlstState Insurance
APPROVED BY I� Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
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 Yl "e2 l✓ 1/v Lai Who being duly
sworn, deposes and says:
That he or she will be the only person working in the project located at
/ L%'� P IV '76' s ;" • IE P.r Sluro.::5
4 "
Contractor Signature
Sworn to (or affirm) and subscribed before me this 3f
By "V�9417,
day of� 20 c F
Personally Know
Or produced identification
Type identification Produced
Print e o stamp name of Notary
ANTWO g GNU
*COMMWION SFF913115
EXPIRES: AUG 25, 2018
^� ` Bonded though tat State Insurance
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:
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:,,>g/�� ZA-1/,52-h
Owner
State of Florida
County of Miami -Dade
The foregoing was acknowledge before me this day of ` 4_91 , 20 ly
By SL `` r� - /9yA k, , who is personally known to me or has produced
r _ as identification.
Notary: MY MISSY #FF217809
11 IRE
t IFd 2019
'�"oF fta� 9a�dee Tlmr Buepe� Wolary SerNoe�
SEAL: