EL-15-1288Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INS P-236105 Permit Number: EL -5-15-1288
Scheduled Inspection Date: June 05, 2015 Permit Type: Electrical - Residential
Inspector: Devaney, Michael
Inspection Type: Final
Owner: CRUZ, HERIBERTO Work Classification: Alteration
Job Address: 1000 NE 96 Street
Miami Shores, FL
Project: <NONE>
Phone Number
Parcel Number 1132060143560
Contractor: JCL ELECTRICAL CORP Phone: (305)498-7268
Building Department Comments
REPLACE ALL CLOTH WIRE IN A PORTION OF THE
HOUSE AND PROVIDE AND INSTALL NEW TEMPER
RESISTANT RECEPTACLE.
06/01/2015
SMOKE AND CARBON MONOXIDE DETECTORS WILL
BE REQUIRED
INSPECTOR COMMENTS False
Inspector Comments
Passed EE], e
`-
Failed ely
Correction ❑
Needed
Re -Inspection ❑
Fee
No Additional Inspections can be scheduled until
re -inspection fee is paid.
June 05, 2015 For Inspections please call: (305)762-4949 Page 18 of 27
Project Address
Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Parcel Number Applicant
1000 N E 96 Street 1132060143560
HERIBERTO CRUZ
Miami Shores, FL Block: Lot:
Owner Information Address Phone Cell
HERIBERTO CRUZ 1000 NE 96 Street
MIAMI SHORES FL 33138-
1000 NE 96 Street
MIAMI SHORES FL 33138 -
Contractors) Phone Cell Phone
JCL ELECTRICAL CORP (305)498-7268
of Work: REPLACE ALL CLOTH WIRE IN A PORTION
onal Info:
kation: Residential
ling: 3
Fees Due
Amount
CCF
$1.20
DBPR Fee
$2.25
DCA Fee
$2,25
Education Surcharge
$0.40
Permit Fee - Additions/Alterations
$150.00
Scanning Fee
$9.00
Technology Fee
$1.60
Total:
$166.70
Valuation: $ 2,000.00
Total Sq Feet: 0
Pav Date Pav Type Amt Paid Amt Due I
Invoice # EL -5-15-55751
05/28/2015 Credit Card
06/01/2015 Credit Card
$ 50.00 $ 116.70
$ 116.70 $ 0.00
Available Inspections:
Inspection Type:
Review Electrical
Review Electrical
In consideration of the issuance to me of this permit, I agree to perform the w vered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, statements sped ions submitted to the proper authorities of Miami Shores Village. In
accepting this permit I assume responsibility for all work done by either self, my age t, servants, or employes. I understand that separate permits are
required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DO S, ROOFING nd SWIMMING POOL work.
OWNERS AFFIDAVIT: I certify that all the foregoing informatjo6 is accurate and th
AKall work will be done in compliance with all applicable laws regulating
construction and zoning. Futhermore, I authorize the above -n metractgr he work stated.
Authorized Signature: Owner / Applicant
/ Agent
June 01, 2015
Building Department Copy
June 01, 2015 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) 7624949
BUILDING
PERMIT APPLICATION
❑BUILDING `4 ELECTRIC ❑ ROOFING
MAY ,998 2015
F BC(`20/�
C"�
Master Permit No•_ L 1.-' I z
Sub Permit No.
❑ REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING ❑ MECHANICAL []PUBLICWORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: /000 1V L 9& S 1
City: Miami Shores County Miami Dade zip: �5 -i?)) 3 O
Folio/Parcel#: Is the Building Historically Designated: Yes NOP_
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder):P�_ tTI b" Phone#: -7f& 5-
Address: 10 0 0 iV e1� 6 11
City: State: Zip: 3�) 29
Tenant/Lessee Name: �74 Phone#:
Email:
CONTRACTOR: Company Name: --N, kt— � ,`..` l�.t.a.�� . Phnnpgt .� )4 T4 R -
Address: Wc Ltkk k x'
City: State:
Zip: 3 `�
Qualifier Name: 4N C L -;,r M2n Phone#:
State Certification or RegistratI5#: l 6-59S Certificate of Competency #: _
DESIGNER: Architect/Engineer: Phone#:
Address: City: State:
Value of Work for this Permit: $ 2-000.0-0 Square/linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New & Repair/Replace
Zip:
❑ Demolition
Specify color of color thru tile:
Submittal Fee $ , M .�A Permit Fee $ /��� ®® CCF $ CO/CC $
Scanning Fee $
Technology Fee $
Structural Reviews $
(Revised02/24/2014)
Radon Fee $
Training/Education Fee $
DBPR $ Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $ I G
1
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 del' ed to person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement mus a posted at th job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absenc of such posted n tice, the
inspection will n e approved and a reinspection fee will be charged.
t
OWNER or AGENT
The foregoing instrument was acknowledged before me th—Is
�X�22 day ofa� 20 S , by
Tk�OO au , who is personally known to
me or who has producedy --ppi we- wmo`as`
identification and whoAd take an oath.
NOTARY PUBLIC:
Sign:,
Signatu
The foregoing instrument was acknowledged before me this
day of r/t,- y , 20 I by
70t2 -GC 1a OA1 W , who is personally known to
me or who has produced 'R m � � WN�ras
identification and who did take an oath.
NOTARY PUBLIC:
Sign: '—Oh�k
Print: Print:
Seal: �'%` ° o Notary Public State of Florida
Sindia Alvarez Seal: Notary Puglia gt®to efi Fi®ii@
My Commission FF 156750` Sindia Alvarez
00 Expires 09/03/2018 4 My Commisola" FF 16®960
o,µd Expires 09l03l20q 8
* a* *
APPROVED BY !V49 Y Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
JCL ELECTRICAL CORP
"IF IT'S ELECTRICAL WE CAN DO IT"
16460 SW 144 AVE, MIAMI FL 33177 EC1 3006575
EMAIL:jclelectric@hotmail.com ---- PHONE: (305)498-7268
DATE: 0512420 k(;
STATE OF �L-6�J)DA
COUNTY OF
Before me this day personally-3®2GE �\ C'EwO
deposes and says:
That he will be the only person working on the project located at:
f� QG
who, being duly sworn
Sworn to ((or affirmed) and subscribe before me this day of . 2015 by
Personally know
OR Produce
Type of identification Produced
Print & Signature of Notary NIAL-v-A���
STAMP:
=J.,t
=GfFlOrlda
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 -rime 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
Signature:
Owner
State of Florida
County of Miami -Dade
The foregoing was acknowledge before me this day of f\AP,_C , 20-G—.
By A ` ,'OK U 0 P_U:t who is personally known to me or has produced
-1:5�e-- U(_10,JS1F_ as identification.
Notary:
SEAL:
° Notary Public State of Florida
Sindia Alvarez
A Z My Commission FF 156750