PL-18-2986Location Address
Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Permit NO.: PL -10-18-2986 Permit IVR Number. 100229
Permit Type: Plumbing - Residential
�Ufl—1 $� Work Classification: Pool - Private
Issue Date:
Parcel Number
Permit Status: Approved
Expiration: 04/01/2019
Project
9400 N BAYSHORE DR, Miami Shores, FL 33138 1132050100110 <NONE>
Contacts
AMINE DOUKKALI MARIELA B ROVITO Owner AMINE DOUKKALI MARIELA B ROVITO Applicant
JTRS JTRS
801 N VENETIAN DR 907, MIAMI BEACH, FL 33139 801 N VENETIAN DR 907, MIAMI BEACH, FL 33139
Other: 3059926776 Other: 3059926776
INFINITY CONSTRUCTION SERVICES INC Contractor
ANTONIO LUVARA
4156 96 AVE, MIAMI, FL 33165
Business: 7864439590
Description: PLUMBING AS PER PLANS Valuation: $ 3,000.00 Inspection Re vests:
305-762-4949
Total Scl Feet: 231.00
Fees
Amount
Application Fee - Other
$50.00
CCF
$1.80
DBPR Fee
$2.00
DCA Fee
$2.00
Education Surcharge
$0.60
Permit Fee (Manual)
$50.00
Scanning Fee
$3.00
Technology Fee (Manual)
$2.50
Total:
$111.90
Building Department Copy
Payments Date Paid
Amt Paid
Total Fees
$111.90
Credit Card 10/12/2018
$111.90
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
reguI t' constr nd zonin Futhermore, I author' e t e above n ed contractor to do the work stated.
uthoriz n e: Own / Applica / Contractor / Agent Date
October 12, 2018 Page 2 of 4
k
BUILDING
PERMIT APPLICATION
rU
ING
BING
JOB ADDRESS:
Miami Shores Village
Building Department OCT o;
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 2a l'4
Master Permit No.3¢�3�
Sub Permit No. 1C/
❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
q'/00 N ` AY -04o(: Piz
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: t'�� 3�
Occupancy Type: 5 95- d/0 "' t7 i/D Is the Building Historically Designated: Yes NO lr
�oad: Construction Type: OSS Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): tVIV -Co o KAC-' t Phone#: 30't 6z,?^ 501-0
I
Address: / V V Q i .4-n r
City: i� t State: C _ Zip: 93011
Tenant/Lessee Name: _Phone#:
Email:
CONTF
Address:
City: State:- Zip: �GKJy
Qualifier Name: r` Phone#: �O-9
State Certification or Registration #: l F C Q ag3certificateof Competency #: _
DESIGNER: Architect/Engineer: Phone#:
Address: City: Stat
Value of Work for this Permit: $ 3( 00 0 Square/Linear Footage of Work: _
Type of Work: ❑ Addition ❑ Alteration El New Q epair/Replace
Description of Work: f 1 V �f d •� Aaj- e l xe-v
Specify color of color thru tile:
Zip:
❑ Demolition
Submittal Fee $ Permit Fee $ � 00 - 01-) CCF $ CO/CC $
Scanning Fee $ ' Radon Fee $ Z ° C� DBPR $ Notary $
Technology Fee $ 2- ° �� Training/Education Fee $ O Double Fee $
Structural Reviews $ Bond $
TOTAL FEE NOW DUE $ 1
(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 propert is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first ins action which urs seven (7 days after the building permit is issued. In the absence of such posted notice, the
inspection wIntbe approved%naispec n fee ill be charged.
S
Signature Signature
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this
day of 20 ' by
LA who is personally known to
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign
Seal:A01;
FMY COMMISSION # GG 041376
ecem
EXPIRES: Dber 30,2020
%Bonded Tbru Notary Public Underwriters
as
The foregoing instrument was acknowledged before me this
day of 20 1'& by
�A who is personally known to
me or who has produced -�>11L����s
identification and who did take an oath.
NOTARY PUB IC:
Sign:
Print: v
Seal: ARi0810E 6011EZ
• MY COWMSiBION tM13115
c EXPIRES: AUG 25, 2019
Bonded through 1st State Insurance
************************************************************************************************************
APPROVED BY
(Revised02/24/2014)
Plans Examiner
Structural Review
Zoning
Clerk
Notice to Owner — Workers' Com
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: al,
Owner
State of Florida
County of Miami -Dade
The foregoing was acknowledge before me this day of re— , 201 y
By;tl t,<ry �, M i tX :�%AU who is personally known to me or has produced
V_J vnn- kANSA, as identification.
Notary:
SEAL: _PF , W COMMISSION # GG 238273
EXPIRES: September 3, 2022
�� pr W B011 W Thu Wary PubIg UndewWrs
INFINITY CONSTRUCTION SERVICES INC.
4156 SW 96 Avenue
Miami, Florida 33165
Telephone 786 443 9590
LICENSE # CFC 1816795
LICENSE# CFC 1428288
Date:
State Of Florida
County:
Before me this day personally appeared_ IAJ. % `,, 9 i Who being duly
sworn, deposes and says:
That he or she will be the only person working in the project located at
Contractor Signature
Sworn to (or affirm) and subscribed before me this . ? day of ¢ .: 20-4
By
u�ro�o�caaFz
wrco�ars�w
E�AU0�,2�11
eoaad rroa�l tq ECMr.irurnxe
Personally Know
Or produced identification -
Type identification Produced
Print, type or stamp name of Notary
,'�`�,-fit'--- iib -Cal
_____ -,\,ten i ' RY
B..O,U= , DSA S U_ R1
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'- = -M ANU-SHORES-SE610 THREE
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LEGAL DESCRIPTION:
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LEGAL DESCRIPTION:
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DarvE, •
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THEREOF, AS RECORDED IN PLAT BOOK 40, AT PAGE 16, OF RIE •
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VILLAGE OF M"SHORES:120852
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