EL-14-2266C IL4 -
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-221659
Scheduled Inspection Date: May 21, 2015
Inspector: Devaney, Michael
Owner: ATASH, KARIM 81 METIS CORINA
Job Address: 1195 NE 100 Street
Miami Shores, FL
Project: <NONE>
Contractor:
JJ ELECTRICAL OF DORAL LL
7YIILIIIKV UU[J 11LIIICIIL VV111111C11M
Permit Number: EL -10-14-2266
Permit Type: Electrical - Residential
Inspection Type: Final
Work Classification: Addition/Alteration
Phone Number (305)790-5551
Parcel Number 1132050190360
Phone: (305)305-1620
ADDING OF RECESS LIGHTING, NEW ELECTRICAL Infractio Passed Comments
INSPECTOR COMMENTS False
PANEL MOVING OF ELECTRICAL OUTLETS IN KITCHEN,
ADDITIONAL OUTLETS.
Inspector Comments
Passed ET
Failed
Correction ❑
Needed
Re -Inspection ❑
Fee
No Additional Inspections can be scheduled until
re -inspection fee is paid.
May 20, 2015 For Inspections please call: (305)762-4949 Page 6 of 42
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
OCT 9 4.
ABY:
FBC 201.C)
BUILDING Master Permit No.�
PERMIT APPLI TION Sub Permit No. -114-12r.(0
❑BUILDING ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR
tj JOB ADDRESS: 75 A/G 10c) 5t
City: Miami Shores County: Miami Dade Zip:
rr1 IV,IIz141
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): 4,4 -R_:j �s'9 16 S-)�- Phone#: 3o5_ / I o— 155 5 1
Address: 1 9�5 ,All-_ 1,90 S /Z L/-- e---r—
City: ���/✓iJ�,S d/ State: ��- Zip: '3313?
Tenant/Lessee Name: Phone#:
Email: �f �M t r fl r/MYi.TL Co "o
CONTRACTOR: Company Name: ZF� �J��-ice c�fi �i Phone#:
Address: �G� si-Q-) lomat �-
City: State:
L
Qualifier Name: Phone#:
State Certification or Registration #: E p /44 a 1 Certificate of Competency #: _
DESIGNER: Architect/Engineer: Phone#:
`aos --1-716) �3_ - /G2,
-3 aA __i8.
/3 r=- 0000 e4
Address: City: State: Zip:
Value of Workforthis Permit $ ® O Square/Linear Footage of Work: .2-Y-0 d
Type of Work: ❑ Addition Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work:
Specify color of color thru tile:
Submittal Fee $ Permit Fee $'
Scanning Fee $
Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $
(Revised02/24/2014)
CCF $ CO/CC $
DBPR $ Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $2,13, Y2-
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 brochur will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commenceme t must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the abse ceof suc -posted notice, the
inspection will not be approved and a reinspection fee will be charged. �1
Signature b/ ---, 74V
OWNER or AGENT
The foregoing instrument was acknowledged before me this
day of 0(l Oh e r , 20 I yy`-t , by
who is personally known to
me or who has produced �i')PLD as
identification and who did take an oath.
NOTARY PUBLIC:
The foregoing instr en I acknnmhledged before me this
Oq day of D0` 010 e-( , 20 , by
la',) (eL ( JU f aQ(T), who is personally
,,known to
me or who has produced � R`�"'t'las
identification and who did take an oath.
NOTARY PUBLIC:
--:Sign: Sign:rDjALC�
a
Print: �7Aa,� lc� ��(� P Print: IUG �fi. 1 ,Lrat?•-� _
Seal: ,
APPROVED BY
(Revised02/24/2014)
Seal: "TALbA LARA
NATALIA 4ARA x a '`= MY COMMISSION ;# EE124530
MY COMMISSIM-1 I EE124530 EXPIRES September 30, 2015
EXPIRES 5 e* 0 *5>° ' x �ts3 Floridallo- service. **************
NIW'i��tarv8ervira r.F,,,,
`� ®e fans Examiner
Structural Review
Zoning
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:
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. In these circumstances, Miami Shores Village
does not require verification of workers' compensation insurance coverage from the contractor's company. Therefore, you may be
personally liable for the worker compensation iniuries of anyperson allowed to work under this permit. Please check with your
insurance carrier since most property insurance policies DO NOT cover this type of liability.
BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTIOr AND UNDERSTAND ITS
CONTENTS. r
Owner
Print Name:
Signature:
State of Florida )
County of Miami -Dade )
Sworn to and bscribed before me this I .,
day of , 20_L4�.
By _til +� fn A. S)
1
(SEAL) , •�, ''" "
L1: friES September 30, 2015
I , r-, r4�c .
Print Name:
v
State of Florida )
County of Miami -Dade )
Sworn to ansubscribed before me this _
day of , 20
By
7�
/CL' AT \ .:aiiEVIRtr8 September 30, 2015