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PL-11-20-2528Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Location Address Parcel Number 730 NE 94TH ST, Miami Shores, FL 33138 1132060141690 Contacts MARTA GIERCZYK Owner Marta Gierczyk Applicant 730 NE 94 ST 730 94th ST NE 730, Miami Shores, FL 33138 Mobile: 305-639-0194 MARTAGIERCZYK@GMAIL.COM martagierczyk@gmail.com INFINITY CONSTRUCTION SERVICES INC Contractor ANTONIO LUVARA 4156 96 AVE, MIAMI, FL 33165 Business: 7864439590 Description: SINK FOR KITCHEN REMODELING Valuation: s $ 1,000.00 Inspection Requests: / i Total Sq Feet: 116.00 ��%ji ' 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 $3.00 Technology Fee $2.50 Total: $110.30 Building Department Copy Payments Date Paid Amt Paid Total Fees $110.30 Credit Card 11/20/2020 $110.30 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 foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore, I authorize the above named contractor to do the work stated. r" t Authorized Signature: Owner / Applicant / Contractor / Agent Date November 20, 2020 Page 2 of 2 r Miami Shores Village RECE1 ED 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 FBC 20 BUILDING Master Permit No. -C I O PERMIT APPLICATION Sub Permit No.7 1 ( —20' 5;2)0 ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL 'RPLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: X� ��� �. A Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder):/ G `�-';( (:1:21 �-1 Phone#: Address: kg- G City:; C State'��Icllr_J CL.- Zip: 3V) �)-i Tenant/Lessee Name: Phone#: CONTRACTOR: Company Name: �4�1 C�7i(01C— 122 6 y UV) Phone#: Address:1,-22—bd 15 Z 1 City: VA.%C State: � t Zip:3! ) Qualifier Name: b 1L7.7Ca Phone#: �' fl-3 f Jp2l State Certification or Registration #: �'�. I "1 Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: r)e3(','Y'% 159 5 W Address: City: State: Zip: Value of Work for this Permit: $ Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New +� ❑ Repair/Replace ❑ Demolition Description of Work � t >1 �,� l� �X! 1 �© M If3 r Specify color of color thru tile: Submittal Fee $ Scanning Fee $ Technology Fee $_ Structural Reviews $ Permit Fee $ Radon Fee $ Training/Education Fee $ CCF S DBPR $ CO/CC $ Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ 1 O (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 WE Zi 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 notic of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is it d. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Si g Q natuY\�P� Si natu �t;, g OWNER' or AGENT The foregoing instrument was acknowledged before me this (Y` day of �x , 2" , by who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: S Print: t. Seal: r Gar., m G 4�?953 CONTRACTOR The foregoing instrument was acknowledged before me this 2' day of r\c1i 20 `23- by who is personally known to me or who has produced as identification and who;aa� hqq NOtaiy Put)il atnPE Of FIGraJe NOTARY PUBLIC: F Raul N� ru My C or..a, .inn GG 962853 :gyp Exp cs 0,/20/2021 Sign: r Print:�C'±) ` tom- ) Seal: APPROVED BY ��i /L� Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Notice to Uwner — worKers' Lompensation Insurance txem on 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 1 \\ Owner State of Florida County of Miami -Dade The foregoing was acknowledge before me this )_ day of ✓lam , 20 By q4Q�3 i QY Z__ �ho is personally known to me or has produced as identification. <" 4s Notary: SEAL: a "°' - Notary Public State of Florkga R,-1Ui NQ rro t My Con -pion GG 962853 E),pires 0s/20/2.024 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 0 Lj'.aQ,c— Who being duly sworn, deposes and says: That he/ oshe will be the only person working in the project located at T� ntractor Signature Sworn to (or affirm) and subscribed before me this -2--- By &nI�DO 0 1�3�Q�4—' FiDu P PU)1i ; St to of Fl orida L oinn GG 962853 uz '024 �� . day of r�--11'-J Personally Know, Or produced identification Type identification Produced 20 Print, type or stamp name of Notary