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BOARD OF RULES AND APPEALS (Broward County)

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One North University Drive, Suite 3500-B Plantation, Florida 33324 TL 954.765.4500 FX 954.765.4504
c:\users\mguerasio\desktop\certification forms\epe.docx
March 10, 2017
BROWARD COUNTY
BOARD OF RULES AND APPEALS
Certification Form for Position of Electrical Plans Examiner
For Building Department of: ___________________________________________________________________________
Name: _____________________________________________________________________________________________
Home Address: _____________________________________________________________________________________
City: __________________________________________ State: _____ Zip: __________ Phone: _____________________
Effective date of hire/promotion/contracted staff: ____________________________________________________________
All applicants shall sign the attached affidavit to ensure compliance with Chapter 71-575, Paragraph 4(b), Laws of Florida.
(BORA policy #14-02, effective May 9, 2014.)
Please mark in each corresponding box to Indicate compliance with appropriate Code Sections:
104.10.2. Certification of the Electrical Plans Examiner. To be eligible for appointment as an Electrical Plans
Examiner, such person shall be certified as required by the State of Florida, BCAIB as an Electrical Plans Examiner and as
an Electrical Inspector. Such person shall be certified by BORA and shall meet at least one of the following qualifications:
Exception: Engineers are exempt from BCAIB certification only.
104.10.2.1 An Engineer in the discipline requested and having practiced for a minimum of three (3) years and a minimum
of two (2) years as an Electrical Inspector employed by a municipality or private company contracted with a municipality
or School Board within the State of Florida.
104.10.2.2 An Engineer in the discipline requested and having practiced for a minimum of five (5) years, within the State
of Florida.
104.10.2.3 Seven (7) years of combined experience as a Master Electrician Contractor or Electrical Contractor or
Journeyman Electrician, five (5) years of which shall have been construction experience in the Electrical discipline and a
minimum of two (2) years as an Electrical Inspector employed by a municipality or private company contracted with a
municipality or School Board within the State of Florida. An applicant for Certification as an Electrical Plans Examiner
under the provisions of this section who is a graduate from an accredited school holding a Bachelor or Associate of
Science Degree in Electrical Engineering may be credited for three (3) years for a Bachelor Degree or one (1) year for
an Associate Degree of the required seven (7) years of experience.
IN ADDITION TO THE AFOREMENTIONED REQUIREMENTS:
104.10.2.4 Each of the applicants shall possess a current Certificate of Competency as a Master Electrician Contractor
or Electrical Contractor issued by of the following entities:
A. Florida Electrical Contractors Licensing Board.
B. Broward County Central Examining Board of Electricians.
C. Miami-Dade County Construction Trades Qualifying Board, Block proctored, issued on or after
January 1, 1968.
D. Florida Department of Business and Professional Regulation as an Engineer.
BROWARD COUNTY
BOARD OF RULES AND APPEALS
One North University Drive, Suite 3500-B Plantation, Florida 33324 TL 954.765.4500 FX 954.765.4504
c:\users\mguerasio\desktop\certification forms\word version\revised applications\si.docx
March 10, 2017
Note: Al
l applications shall include the required information in the following order. Failure to include these items shall be cause for rejection.
1. This application is to be signed by the Building Official, Chief Executive Officer, Human Resources Director, or other duly authorized
representative. For Building Official, the CEO (City Manager, Acting City Manager or Mayor) shall sign.
2. A clear copy of a current photo ID.
3. A copy of State Certification, State Provisional License or letter from employing official verifying applicant’s submittal to State for each
BCAIB certification and copies of appropriate Certificate of Competency or license.
4. Résumé of education and experience.
5. Verifiable evidence of employment such as, IRS forms, tax returns, W-2 forms or notarized written statements (affidavit) including contact
information attesting to employment from former employers, partners or design professionals knowledgeable of the applicant professional
or trade experience.
6. BORA staff is authorized to request additional information to verify employment and/or experience.
Note: For first time applicants only, upon staff approval, a 120 DAY TEMPORARY STAFF APPROVAL OF BORA CERTIFICATION APPLICATION FORM will
be issued; upon obtaining BCAIB Provisional and BORA approval, a certification card will be issued and mailed to the Building Official.
The undersigned makes application for certification and indicates compliance with aforementioned Code Sections and vouches for the truth
and accuracy of all statements and answers herein contained by affixing his/her signature below.
Printed name and Signature of Applicant.
State of Florida |
| SS
County of Broward |
On the _______________ day of _______________, 20___, personally appeared before me the above named individual who signed the
foregoing instrument declaring same to be true to his/her knowledge and belief.
Notary-Public: __________________________________________________________________________________________
My Commission Expires: ____________________________________ Seal:
I certify that I have verified that the above named applicant meets all the requirements for this position in accordance with the Broward
County Amendments to the Florida Building Code.
Printed name and Signature of Building Official, Chief Executive Officer, Human Resources Director, or other duly authorized
representative.
State of Florida |
| SS
County of Broward |
On the _______________ day of _______________, 20___, personally appeared before me the above named individual who signed the
foregoing instrument declaring same to be true to his/her knowledge and belief.
Notary-Public: ___________________________________________________________________________________________
My Commission Expires: _____________________________________ Seal:
Approved: __________________________________________________ Date: _____________________________________________
Chief Code Compliance Officer
Disapproved: ________________________________________________ Date: _____________________________________________
Chief Code Compliance Officer
Approved by BORA on the_________________________________________________ day of ________________________, 20_______
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5.159
G:\SHARED\Policies & Procedures\2014\policy 14-02 cert of comp.docx
Broward County Board of Rules and Appeals Policy #14-02 Effective: 05/09/2014
Subject: Policy/Affidavit to ensure compliance with Chapter 71-575, paragraph 4(b), Laws of Florida
P
OLICY/AFFIDAVIT
The requirements below have been adopted by vote of the Broward County Board of Rules and Appeals on April 10,
2014, to help ensure compliance with Chapter 71-575, paragraph 4(b), Laws of Florida.
________________________________________________________________________________________
NOTICE
All applicants for certification or re-certification are required to execute the following statement and to have same
notarized by a duly authorized Notary. Failure to execute and have this statement notarized will prevent the
certification / re-certification process from proceeding to completion.
THE UNDERSIGNED HEREBY VOLUNTARILY AND KNOWINGLY STATES AS FOLLOWS:
The undersigned has read Chapter 71-575, paragraph 4(b), Laws of Florida and has had the opportunity to have same
reviewed and explained by legal counsel. Undersigned understands the terms of same and that any Inspector (such
as and including but not limited to structural, engineering, plumbing, mechanical, or electrical) or other building
official charged with enforcing or otherwise supervising or inspecting any work covered under any section of the
Florida Building Code as applicable to Broward County pursuant to Chapter 71-575, Laws of Florida, and who is
required to hold or who otherwise holds a Certificate of Competency in any area of construction shall not use
his/her Certificate of Competency to engage in free enterprise thereby, competing against persons or firms that may
do business within Broward County whose work he/she may also inspect, nor may he/she allow his/her Certificate
of Competency to be used by another person or firm. This includes any activity, such as, but not limited to bidding,
contracting, code consulting, design, employment, plan review, special building inspections, etc., regardless of
compensation. The undersigned makes application for certification or re-certification, affirms compliance with
aforementioned Code Section, and vouches for the truth and accuracy of all statements and answers herein
contained by affixing his/her signature below. The undersigned agrees that failure to comply with the requirements
of chapter 71-575 shall be considered a material breach of the terms of certification and may result in decertification/
denial of certification.
A copy of a legal opinion with respect to Chapter 71-575 is available upon request.
___________________________________________________________________________________
Printed Name and Signature of Applicant.
State of Florida
SS |
County of Broward
On the _______________ day of _______________, 20___, personally appeared before me the above named
individual who signed the foregoing instrument declaring same to be true to his knowledge and belief.
Notary-Public: _______________________________________________________________________
(Printed name and Signature of Notary Public, State of Florida)
(NOTARY SEAL)
Personally Known ______ OR Produced Identification _______
Type of Identification Produced __________________________________________________________________
Editor’s Note: Affidavit Authorized by BORA vote on May 8, 2014, and issued by Chair on May 9, 2014.
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BOARD OF RULES AND APPEALS (Broward County)

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Completed 27 August 2020

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