EL-19-1613Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Permit NO.: L -E7-19-1613
Permit Type: Electrical - Residential
Work Classifrcatfon: Addition/Alteration
Permit status: Approved
Issue Daw. 07/16/2019 F Expiration: 01/13/2020
Location Address Parcel Number
269 NW 111TH TER, Miami Shores, FL 33168 1121360010360
Contacts
Blessed Management Group Owner METPLANET ELECTRICAL Contractor
269 111 JEAN LESLIE TELEFORT
6231 GRANT CT, HOLLYWOOD, FL 33024
Business: 7542141695 JEANLTELFORT@AOL.COM
Description: INSTALLATION OF LIGHTS, GFI FOR BATHROOM Valuation: $ 1,500.00Ins ection Requests:
305-7`62-49
Total Sq Feet: 646.00 —j
Fees
Amount
Application Fee - Other
$50.00
CCF
$1.20
DBPR Fee
$2.00
DCA Fee
$2.00
Education Surcharge
$0.40
Permit Fee
$50.00
Scanning Fee
$3.00
Technology Fee
$2.50
Total:
$111.10
Building Department Copy
Payments
Date Paid Amt Paid
Total Fees
$111.10
Check # 630
07/16/2019 $61.10
Check # 629
07/12/2019 $50.00
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 AFVIT: I certifypq all the foregoing information is accurate and that all work will be done in compliance with all applicable laws
regulating,Gon ruction and ;onj4. Futhermore, I authorize the above named contractor to do the work stated.
Signature'wn,pr5W'- / Applicant / Contractor / Agent
Date
July 16, 2019 Page 2 of 2
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 A=ON
BUILDING ECTRIC ❑ ROOFING
P1F1cEzvE
JL 1 2019
BY
f_ Pi
FBC 20 (-�
Master Permit No. R C..' 03 -1-7-
Sub
1 -7 -Sub Permit NoR - ()I--� X613
❑ REVISION ❑ EXTENSION RENEWAL
❑PLUMBING ❑ MECHANICAL []PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: Wl-e- r—
City: IMiami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FIFE:
OWNER: Name (Fee Simple Titleholder): 6LeQ5rrd l v `QK jC,-fhP .2�— tree. Phone#:
Address: KoV5-2-, "F 7,-e? Aoe-
City: I,-) rAY-; State: Zip: 33) (D 2
Tenant/Lessee Name:
Email: )orar4„ Do I Lcf-iC (2 -
CONTRACTOR: Company Name:
hone#:
Address:
644A,41 -
City: State: Zip::Z3d2—_ r -
Qualifier Name: am L (Q2 9=1-- Phone#:
State Certification or Registration #: ! 1. f 3bC7 3 Certificate of Competency #:
DESIGNER: Architect/Engineer:
Add
— -- Phone#:
City: State: Zip:
Value of Work for this Permit: $ 4) o, Square/Linear Footage of Work:
Type of Work: ❑ Addition 1❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: j 0-fi
1 L 1 � -S
e' /rte
;(..1±". �. ea •..+..K... YyM4.iyM[. rF.,._. �.la. F..yy.. ... _._z ..�.. �.JbMr ..T .. .. �. ""
Specifi. coloj"of
Submittal Fee$v' v Pefrriit'Fee�$ CCF
�: _ �:� �� ,� � �.,+ .. ,� � ;•' Vit.' � ".
Scanning Fee $ Radon Fee $ DBPR $ - Notary $
Technology Fee $
Training/Education Fee $
Double Fee $
Structural Reviews $ Bond $
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
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 $1500, 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. Inuch posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature L N
OWNER or AGENT
The foregoing instrument was acknowledged before me this
4 day of ZKU 20 \C by
Qc,� d v..r " , who is personally known to
-------------
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign: r ii
Print: b L
Seal:
APPROVED BY
(Revised02/24/2014)
Sign
The foregoing instru'rrreent was acknowledged before me this
1. L�day of �1, l 20 t cl by
, et v► —1e t l who is personally known to
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print: o c co
1
Seal:
BRITTANY SOCOL �"t;••• BRITTANY SOCOL
Mfr coMtr+tSslor! # GG 232035 *_ ,I w COMMIS M 800 232035
Bonded 71xu NotmY ,?:W WRF;ijumne 2s. 2022
;M 6ona.a Ti w Notary
Plans Examiner Zoning
as
Structural Review
Clerk
Miami shores Village
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. 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:
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;
The officer is listed as an officer of the corporation in the records of the Florida
Department of State, Division of Corporations; and
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: P�
Owner
State of Florida
County of Miami -Dade
The foregoing was acknowledge before me this [ 5 day of 20_ft_.
B 13 rc, `w� Pp who is personally known to me or has produced
as identification.
Notary:
SEAL: BRITTANY S=
MY C0MM1$SION B GG 232035
.:OMS: Jima = 20M
,''•.;a�!:s:;?�8ondedllruNolmyPubiclhMawrtkers
Metplanet Electrical Contractor Inc.
Certified Electrical Contractor EC #13007397
6231 Grant Court, Hollywood, FL 33024
Jean Telfort - 754.214.1695
jeantelfort@aol.com
Date 7/15/19
State of Florida
County of Miami -Dade
Before me this day personally appeared 7 -el To T`f- who, being duly sworn,
deposes and says:
That he or she will be the only person working on the project located at:
269 NW 1111h Terrace, Miami Shores, FL 33168
Sworn to (or affirmed) and subscribed before me this
by -,eco,. 1, IFS---f-
BRITTANY EEI
'A WCOI&AMION�I GPEXPIRES:25Bor" Va PWII
I S day of ZYW-Q . 2019
Personally Known V
OR Produced Identification
Type of Identification Prodiced
Print, Type or Stamp Name of Notary