PL-06-21-1627, 10682 NE 11th CtMiami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address
Parcel Number
10682 NE 11TH CT, Miami Shores, FL 33138 1122320280500
Contacts
SAMI SPRINGER Owner INFINITY CONSTRUCTION SERVICES INC Contractor
10682 NE 11TH CT, Miami Shores, FL 33138 ANTONIO LUVARA
4156 96 AVE, MIAMI, FL 33165
Business: 7864439590
Inspection Requests:
Description: REMOVAL OF INTERIOR FINISH (KNOCK DOWN)ON M Valuation: $ 400.00
CEILINGS & WALLS TO SMOOTH FINISH. REPLACING DAMAGED EW'
EXISTING CABINETS (NO ELECTRICAL AND/OR PLUMBING) Total Sq Feet: 0.00
Fees
Amount
Application Fee - Other
$50.00
CCF
$0.60
DBPR Fee
$2.00
DCA Fee
$2.00
Education Surcharge
$0.20
Permit Fee
$50.00
Scanning Fee
$9.00
Technology Fee
$2.50
Work Without Permit Fee
$100.00
Work Without Permit Fee - Plus $100
$100.00
Total:
$316.30
Building Department Copy
Payments
Date Paid Amt Paid
Total Fees
$316.30
Credit Card
06/24/2021 $316.30
Amount Due:
$0.00
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 foregoin fbrmation is accurate and that all work will be done in compliance with all applicable laws
regulating construction and zoning. Futhermore, I authoti4t the above named contractor to do the work stated.
Authorized Signature: Owner / Applicant /
/ Agent
Date
June 24, 2021 1 Page 2 of 2
,RECEIVED Miami Shores Village
r 3 Building Department y
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 03A I.3j.38
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
FBC 20
BUILDING Master Permit No. RC-10-20-2226
PERMIT APPLICATION Sub Permit No.
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
QPLUMBING [:]MECHANICAL PUBLIC WORKS ❑ CHANGE OF CANCELLATION (] SHOP
CONTRACTOR DRAWINGS
JOBADDRESS: 10682 NE 11TH COURT
City: Miami Shores County:
Miami Dade Zip:
Folio/Parcel#: 11-2232-028-0500 Is the Building Historically Designated: Yes NO XX
Occupancy Type: Load: Construction Type:
Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): SAMI SPRINGER
Phone#:7865971053
Address: 10682 NE 11TH COURT
City: MIAMI SHORES State: FLORIDA
Zip: 33138
Tenant/Lessee Name: N/A
Phone#: n/a
Email: springersam88@gmial.com
CONTRACTOR: Company Name: —nF w i Con cU c-bou
L2(V iCe Phone#: % J "3j&(0
Address: gQ (C)D SV2 atm _
City: --?SY1 R, Ay" State: V__
Zip: 2��I 04
Qualifier Name:
Phone#:
State Certification or Registration M
Certificate of Competency #:
DESIGNER:;Architect/Engineer:
Phone#:
Address:
City: State: Zip:
Value of Work for this Permit: Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New
Q Repair/Replace ❑ Demolition
Description of Work: Repair/replace instant water heater.
Specify color v f color thru tile:
Submittal Fee $ Permit -Fee.,$.,, I CCF $ CO/CC $
Scanning Fee $
Technology Fee
Radon Fee $
Training/Education Fee $
DBPR $
Notary $
Double Fee $
Structural Reviews $
(Revised02/24/2014)
Bond $
TOTAL FEE NOW DUE $ 3 JV
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. Iry the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged. u
Signature
OWNER r AGENT
The foregoing instrumentwasknowledged before me this
17 day ofy VhE' 20 21 by
CS6(1 1 8bc11 QcJer who is personally nown to
me or who has produced N/. as
identification and who did take an oath.
NOT
Print
Seal: * P * CommNeWfn I GG 170000
EXPIM 111" 15, 200
APPROVED BY
Signature
NTRACTOR
The foregoing instrument was acknowledged before me this
17 day of JUV1e 20 2-1_, by
AW-M010 LUVA" , who is personally known to
me or who has produced DL4 L160-OW -U,-44 0 as
identification and who did take an oath.
NOTARY PUBLIC:
Print: - �Z ..
Sea l: i►*r "u"�' MARIA EMILIA WINGER
,rotary kitlic • Statt, of Florida
Commission Hd 003015
a
or n My Comm. Expires At.
10, 2024
0ondec through Nationai Notary Assn.
Plans Examiner
Zoning
(Revised02/24/2014)
Structural Review
Clerk
Infinity Construction Services, Inc.
12260 SW 8th St., Suite 224
Miami, FL 33184
06/23/2021
State of Florida
County of Miami -Dade
Before me, this day personally appeared Antonio Luvara who, being duly
sworn, deposes and says:
That he will be the only person working on the project located at:
-1na01) A1r -i-1th r%—..4 RA;-- CL%—roc+ CI 1!441�0
Cofitffidor Signature
Sworn to (or affirmed) and subscribed before me this 3�day of
� U�x,� , 20 �-/ , by �} n-4-0n � �� Lal v A R q
Personally Known,
Or Produced Identification f'
Type of Identification Produced b►- L Qa - 3 --
/���jr'i MARIA EMILIA SPRINGER
/F Notary Public State of Florida
! " Commission p HH 003015
'''� My Comm. Expires Aug 20, 2024
,i � Bonded through National Notary Assn.
Print, 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
tion 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:
l . 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:
O 1
ner
State of Florida
County of Miami -Dade
The foregoing was acknowledge before me this 23- day of Ton -e_ 20 A .
the or has produced