EL-17-382Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-276652
Permit Number: EL -2-17-382
Scheduled Inspection Date: October 13, 2017
Inspector: Devaney, Michael
Owner: ATTILA, BIRO
Job Address: 241 NW 92 Street
Miami Shores, FL
Project: <NONE>
Contractor: CJ ELECTRICAL SERVICES INC
Permit Type: Electrical - Residential
Inspection Type: Final
Work Classification: Pool - Private
Phone Number (305)608-4672
Parcel Number 1131010331180
Phone: (954)292-5711
Building Department Comments
ELECTRICAL FOR NEW POOL
Infractio
Passed Comments
INSPECTOR COMMENTS
False
Passed
Failed
Correction
Needed
Re -Inspection
Fee
No Additional Inspections can be scheduled until
re -inspection fee is paid.
Inspector Comments
/3 e, -r � r
October 12, 2017
For Inspections please call: (305)762-4949
Page 7 of 27
Project Address
Miami Shores Village
10050 N.E. 2nd Avenue NW
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Permit
Permit" NO. EL -2-17-382
Permit Type: Electrical - Residential
Work Classification: Pool - Private
Permit Status: APPROVED
Issue Date: 31812017
Expiration: 09/04/2017
Parcel Number
Applicant
241 NW 92 Street
Miami Shores, FL
1131010331180
Block: Lot:
PERFECT HEAT LLC
Owner Information
Address
Phone
Cell
PERFECT HEAT LLC
241 NW 92 Street
MIAMI SHORES FL
(305)608-4672
241 NW 92 Street
MIAMI SHORES FL
Contractor(s)
CJ ELECTRICAL SERVICES INC
Phone
(954)292-5711
Cell Phone
Valuation:
Total Sq Feet:
$ 1,000.00
0
Type of Work: ELECTRICAL FOR NEW POOL
Additional Info: ELECTRICAL FOR NEW POOL
Classification: Residential
Scanning: 3
Fees Due
CCF
DBPR Fee
DCA Fee
Education Surcharge
Permit Fee - Additions/Alterations
Scanning Fee
Technology Fee
Total:
Amount
$0.60
$4.50
$4.50
$0.20
$300.00
$9.00
$0.80
$319.60
Pay Date Pay Type
Invoice # EL -2-17-62939
03/08/2017 Check #: 3502 $ 269.60 $ 50.00
02/14/2017 Check #: 3500 $ 50.00 $ 0.00
Amt Paid Amt Due
Available Inspections:
Inspection Type:
Final
Light Niche
Bonding
Review Electrical
Alarms
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.
March 08, 2017
Aut rzed Signature: Owner / Applicant / Contractor / Agent
Building Department Copy
Date
March 08, 2017
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
BUILDING
PERMIT APPLICATION
❑ BUILDING IZ ELECTRIC ❑ ROOFING
▪ PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS
JOB ADDRESS: a "1 k 3u.) q'3e.�
i
City: Miami Shores County: Miami Dade Zip: 531 SO
Folio/Parcel#: t k c> cT S 1\s Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder):W tecir F Ea LLL. ^ 4k-.ktl4 UL YO Phone#:
1150 S. Shores D r1 CR(
City: VkLQVV . 2 PQC. State: FC— Zip: 331(4 (
Tenant/Lessee Name: Phone#:
Email: /�
CONTRACTOR: Company Name: CTe�C-C I C S //GCS l4C•
Address: 4/0 0 /uw 6 5- r''r Q— 8-2--(3
RECEYNI77:
1 i
FEB 1, 4r 2017
BY:
STA
FBC 20 ((- f
Master Permit No. ri;;1P P 1; ^C)
Sub Permit No.„ ( 1 .'� $ 2..
❑ EXTENSION ❑ RENEWAL
❑ REVISION
❑ CHANGE OF
CONTRACTOR
❑ CANCELLATION ❑ SHOP
DRAWINGS.
Address:
Phone#: 9 - ? 2- ' S7//
City: / 94494e State: �L
Qualifier Name: 1774-7w- r/tt C 97(
zip: 3 3 0 6 3
Phone#: % — Zp Z - 5-7//
State Certification or Registration #: (EC 7;00 56/ 7 Certificate of Competency #:
DESIGNER: Architect/Engineer: ko1. cth C_ C .k('-tvtj (7g Lneet5 (ACS Phone#: SCA P45 7
Address: �� I1 1 I,1)clkt5 de.' brUX_ .� City: Roca Qd4e-li, State:F - Zip: `33 5
Value of Work for this Permit: $ 1 r 00o_ 0o.
Square/Linear footage of Work:
Type of Work: 0 Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work:-fec{-rtCa-( k /I P.w paal ccnstrtcc1f e)
Specify color of color thru tile:
Submittal Fee $ Permit Fee $ J7cPG f e' t;' CCF $ CO/CC $
Scanning Fee $ . Radon Fee $ DBPR $ Notary $
Technology Fee $ . Training/Education Fee $ Double Fee $
Structural Reviews $ Bond $ r�0
i
(Revised02/24/2014)
TOTAL FEE NOW DUE $ `V' t
i`'
Bonding Company's Name (if applicable)
Bonding Company's Address
City State- Zip
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 alt
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.
Signature
bt41--
OWNER or AGENT
The foregoing instrument was acknowledged before me this
_ day of .-Pcsari\¢pr , 20 WO , by
4 r t 2 r -o , who is personally known to
me or who has produced -11=c, O tusesS l;�CnnSR as
identification and who did take an oath.
NOTARY PUBLIC:
Seal:
**********
KYLE C HAMBRICK
As MY COMMISSION 6 G0066511
EXPIRES January 26, 2021
• IAPPROVED BY
(Revised02/24/2014)
r
Signature L/G--,
CONTRACTOR
The foregoing instrument was acknowledged before me this
day of bQ2Cp(Woe , 20 `6 by
Jca11 Of CAD S1191 , who is personally known to
me or who has produced l Di -10-11 t-s-Csirt.f. as
identification and who did take an oaths
NOTARY PUBLIC:
Sign:
Pri
Seal:
*********************
X /4( f— Plans Examiner
jib iks KYLE C HAMBRIICK
e MY COMMISSION S,GG0611511
***is1•.*
***********
Zoning
Structural Review Clerk
Miami Shores Viiiage
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. tStat. § 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:
State of Florida
County of Miami -Dade
(pe,4e,d- CLC)
The foregoing was acknowledge before me this Zs}h day of "Ft 1xvol 1.
By l/' 1r -D who is personally known to me or has produced
cur',dam✓11 "
l.) C'e V1 S � as identification.
,20I .
Notary:
SEAL:
}
��". •nNe - YANADY PRIETO
MY COMMISSION # FF 214031
her
;r a EXPIRES: March 25, 2019
........ Bonded Thru Notary PubSc Underwriters
Notice to Owner
Miami Shores1 Viiiage
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
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 parttime 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:
4 64_, - (Pe -2 CT f E,
Owner
State of Florida
County of Miami -Dade
The foregoing was acknowledge before me this day of Marc% ,2o 11
By 1444-4
who is personally known to me or has produced
as identification.
KYLE C HAMBRICK
1 MY COMMISSION 0 GG068511
EXPIRES January 28, 2021
G Electrical Services, Inc.
400 NW 65th Ave B-213 Office: 954-292-5711
Margate, FL 33063 Fax: 305-982-1621
Date: 03/ o t j g oti
State of ftcn?a
County of t?›Ta,6c:Lo
Before me this day personally appeared Zi«u` 5VA who being duly
sworn, deposes and says:
That he or she will be the only person working on the project located at
2q/ Nto 92nd . Sre. MtaM, 3hcte,7 Ft
Sworn to (or affirmed) and subscribed before me this day of March , 20163 by
—Minot ale, Srnjh
Personally Known
Or Produced Identification a Dri,efs Ltcenae
Type of Identification
�,Gii'
Print, Ty of p Name of Notary
.0! •"i ;; KYLE C HAMBRICK
MY COMMISSION # GG088S11
EXPIRES January 28, 2021
r4