EL-14-2801 Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-235850 Permit Number: EL-12-14-2801
Scheduled Inspection Date: June 10,2015 Permit Type: Electrical - Residential
Inspector: Devaney, Michael Inspection Type: Final
Owner: DAIDONE, GLENN Work Classification: Addition/Alteration
Job Address:54 NE 97 Street
Miami Shores, FL Phone Number (305)788-2711
Parcel Number 1132060130770
Project: <NONE>
Contractor: CUSI ELECTRICAL SOLUTIONS INC Phone: (786)390-4962
Building Department Comments
ROUGH ELECTRICAL FOR NEW BATHROOM WATER Infractio Passed Comments
HEATER AND A/C SPLIT SYSTEM INSPECTOR COMMENTS False
Inspector Comments
Passed CREATED AS REINSPECTION FOR INSP-225758. Add combo smokeEJ /
carbon monoxide detectors outside bedrooms.
Add a light fixture by the back door.
Failed
Correction f
Needed
Re-Inspection ❑
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid.
June 09,2015 For Inspections please call: (305)762-4949 Page 21 of 27
Miami Shores Village
Building Department 1 . DEC 2 3 2812014
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 — -_
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(30S)762-0949
FBC 206
BUILDING Master Pew moo_ 1`Z�' _(4- —cC�3
PERMIT APPLICATION Sub Permit No. �
❑BUILDING ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS:
City: Miami Shores County: Miami Dade Zia:
Folio/Parcel#: ( ( "0 1"3 --077 0 Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: .�FFFF3E:
OWNER:Name(Fee Simple Titleholder): ���, D Phone#: S
Address: !_AA 4 ��i 1 at—
City:
� y Q
City: "ta'"A( 19q0iR State: Ft_ Zip: I CS
Tenant/Lessee Name: Phone#:
Email: / �/�r
CONTRACTO
�R
q:Company Name:�,U,ii Le.�f�Cry �
( soft/� S 1�V e . Phone#:
Address: b s"IyS L 0i ii1 . Cl �9
City: M*k Q)M l Sat"
State: F L Zip:—3-3 1 '1
ZStatQualifier Name: 6�Q-S.S r�SAl�.�:-a-p Phone#: 1'314232/®— ` !q '7—
State
e Certification or Registration#: Certificate of Competency#: 1 rW_o 0 0 12 2
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$'6- Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
--es ripUon of Work: .toe Q ;&C r-3 e— L4-d
((
7 wee,
Specify color of color thru tile:
Submittal Fee$ Permit Fee CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$ 1, 2- 96
(Revised02/24/2014)
tta
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 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 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 Signature
7 2NER or AGENT CON RA OR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of ,20 by 14 day ofbfq'' ,20 14 by
aj-o& wno personally known JA34homo Is p sonally kno to
me or who has produced as me or who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: Sign:
Print: Print:
os•.. =�:o. .........c
....�', MABELIS E FERNANDEZ
Seal: Seal: '*s *�
MY COMMISSION#FF127992 f P} MY COMMISSION #FF121d;.,
. ...... EXPIRES June 1, 2r,1 t-s.,°
?',.e�A,d+'•'' EXPIRES June 1, 2018 ,av�„,,,•
(407)398 153 FloridallotaryService.com (407)398 0153 FloridallotaryService.,:a4s:
Coe —::-v/y
APPROVED BY PlansExaminer Zoning
Structural Review Clerk
(Revised02/24/2014)
♦5�oR9�G1!
some Miami shores Village
Building Department
��OR11� 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 injuries of my Rgrson 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 NOTICE AND UNDERSTAND ITS
CONTENTS.
Owner Contractor
Print Name: Print Name: C, ' 1' \ cp_ . n
i
Signature: Signature:
State of Florida) State of Fl 'da)
County of Miami-Dade) County of Miami-Dade)
Sworn d subscribed before me this Sworn t d subscribed before me this r7- 3/L9
day of ,20 1 t day of 1 ,20�.
`�,r•4" ;+�` YP�'L::MABELI$E FERN
MABEUS E FERNANDEZ i EZ
(SE ) (SEAL)
T of Iden' � ° T of Id "r-uceMIS2
June , o, ,one ,2018
(407)39"153 FlorldawtarySwce.com (407)39"153 FWdallotaryServlce.Com
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