EL-20-204Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Issue Date: 02/13/2020
Location Address Parcel Number
112 NE 98TH ST, Miami Shores, FL 33138 1132060132410
Contacts
Permit NO.: EL-01-20-204
Permit Type: Electrical - Residential
Work Classification: Alteration
Permit Status: Approved
Expiration: 08/11/2020
PEGGIE CHEN Owner METPLANET ELECTRICAL Contractor
214 PINELLI DR, PISCATAWAY, NJ 08854 JEAN LESLIE TELEFORT
6231 GRANT CT, HOLLYWOOD, FL 33024
Business: 7542141695 JEANLTELFORT@AOL.COM
ns ecti
Description: 150 AMP ELECTRICAL SERVICE REPAIR INCLUDING Valuation: $ 3,500.00 Ion Requests:
762 4949
CHARGING OF ELECTRICAL CAR PANEL
Total Sq Feet: 0.00
Fees
Amount
Application Fee - Other
$50.00
CCF
$2.40
DBPR Fee
$2.00
DCA Fee
$2.00
Education Surcharge
$0.80
Permit Fee
$72.50
Scanning Fee
$9.00
Technology Fee
$3.06
Total:
$141.76
Payments
Date Paid Amt Paid
Total Fees
$141.76
Credit Card
02/13/2020 $91.76
Cash
01/29/2020 $50.00
Amount Due:
$0.00
Building Department Copy
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 ID certi that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws
regula g ruction and zoo ing. Futhermore, I authorize the above named contractor to do the work stated.
Authorized Signature: Owner / Applicant / Contractor / Agent Date
February 13, 2020 Page 2 of 2
11
BUILDING
Miami Shores Village
P"'.ECEIVED
Building Department JA 29 2020
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949 BY•
FBC k � `-
Master Permit No. Q —W Zo 1
PERMIT APPLICATION
❑BUILDING �CTRIC ❑ ROOFING
Sub Permit No.
❑ REVISION ❑ EXTENSION ❑ RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: I o ' V ' �` 'S Te&r
City: Miami Shores County: Miami Dade Zip: / 3�
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FIFE:
OWNER: Name (Fee Simple Titleholder): G ' � t �6aF, Phone —S
Address: d ' ")` &` '
City: i 6 m t' S 9 State: Zip:
Tenant/Lessee Name: ��%� ). Phone#:
Email:
CONTRACTOR: Company Name:_ p p Phone#:
Address: �% L= ex rI'
City: i State: Zip: �J�� z ce '
Qualifier Name �4'G� Phone#:
State Certification or Registration #: ertificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ i Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ,Repair/Replace ❑ Demolition
Description of Worker
Specify color
of color thru tile:
Submittal Fee $ J� J ' 0� Permit Fee $ CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Nota'ry $
Technology Fee $ Training/Education Fee $
Structural Reviews $ _
Double Fee $
Bond $ /
TOTAL FEE NOW DUE $
(Revised02/24/2014)
/I
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 com nceme must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. I the abs ce o such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature Signature
WNER or AGENT C NT ACTOR
The foregoing instrume ,gw,ass acknowledged before me this The foregoing stru acknowledged before me this
day of i Z 20 r�i% by day of J' 204 by
CA.) who is personally known to who is personally known to
me or who has produced as me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal: am
f1%WAM WW AWN AWL PWM
ZZOZ'Zt euar:$3HkM
9S6LZZ 90 # NOISSMV400 AIM
APPROVED BY
identification and who did take an oath.
NOTARY PUBLIC:
Sign: "-d —
Print: 6-
Seal: sisylM�eg1(Iom N41PQ •o
Z=Inwar:0141dX3 '
9MLZZ 00 # NOISSIWWt'D AW
. a
Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
EIECTRICAL LETTER FORM
Metplanet Electrical contractor Inc.
6231 Grant court,
Hollywood, FL 33024
Telephone: 754-214-1695
Email ieanitelfort@aol.com
CC EC 1300 7397
To whom it may concern
Date February 3, 2020
State of Florida
County Broward
Before me this day personally appeared Jean Telfort who been duly sworn disposes and say:
That he is the only one working in the project located at 112 NE 98 Street Miami Shore Florida
For Mrs. Peeaie Chen
Contractor Signature
Sworn to ( or affirmed) and subscribed before me this -31 day of February 2020
Personally Known — -------
Or produced identification
Type of Identification produced--
�;;L; ANDREAL.ALEXANDER
'� ' ,? MY COMMISSION 9 GG 227936
:•;; :o= EXPIRES: June 12. 2D22
Lbw ° Bdded Thru NOWY PubAG Uide�w�Rers y-
Print Type or Stamp Na a of Notary
,A -
Miami shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
CONTRACTORS' REGISTRATION
IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR:
A. COPY OF QUALIFIER'S STATE LICENCES
B. COPY OF LOCAL BUSINESS TAX RECEIPT
C. COPY OF LIABILITY INSURANCE*
D. COPY OF WORKERS COMPENSATION INSURANCE*
(Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit)
IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY:
A. COPY OF CERTIFICATE OF COMPETENCY OF QUALIFIER
B. COPY OF LOCAL BUSINESS TAX RECEIPT
C. COPY OF STATE REGISTERED CONTRACTOR LICENSE OR MIAMI DADE COUNTY MUNICIPAL
CONTRACTOR'S TAX RECEIPT.
D. COPY OF LIABILITY INSURACE*
E. COPY OF WORKERS COMPENSATION INSURANCE*
(Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit)
*YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE AS FOLLOW:
Certificate Holder:
MIAMI SHORES VILLAGE BLDG DEPT
10050 NE 2ND AVE
MIAMI SHORES, FL 33138
Certificate must specify the description of operations or contractor license number.
...........................................................................................
BUSINESS NAME:
BUSINESS ADDRESS:
BUSINESS PHONE: ( )
CELL PHONE ()
QUALIFIER'S LIC NUMBER:
CITY
FAX NUMBER ()
QUALIFIER'S NAME:
STATE ZIP
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:
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:
UU Owner
State of Florida
County of Miami -Dade
yK-
The �foegoing was acknowledge before me this day of le�� (/�L 120 42e-).
By (/ C(�rj who is personally known to me or has produced
as identification.
Notary:
SEAL: a&, — _
tNn IAL.ALEXANDER
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