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RC-18-855Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Project Address Parcel Number Permit NO. RC-4-18-855 Permit Type: Residential Construction Work Cia i:ation: Solar Permit Status: APPROVED Expiration: 11/11/2018 Applicant 304 NE 99 Street Miami Shores, FL 33138-2437 1132060135600 Block: Lot: JOHN FORBES Owner Information Address Phone Cell LILLIAN CLAVERIA 304 NE 99 ST MIAMI SHORES FL 33138-2437 Contractor(s) Phone Cell Phone PROSOLAR GROUP LLC (888)462-5005 (850)222-3554 Valuation: _Total Sq Feet: $ 5,250.00 0 Approved: In Review Comments: Date Approved: : In Review Date Denied: Type of Construction: PV ARRAY Stories: Front Setback: Left Setback: Bedrooms: Plans Submitted: Yes Certificate Date: ,Bond Return : SYSTEM 7.8 KW 26 300 Occupancy: Single Family Exterior: Rear Setback: Right Setback: Bathrooms: Certificate Status: Additional Info: Classification: Residential Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Plan Review Fee (Engineer) Scanning Fee Technology Fee Total: Amount $3.60 $2.36 $2.00 $0.00 $0.00 $45.00 $0.00 $0.00 $52.96 Pay Date Pay Type Amt Paid Amt Due Invoice # RC-4-18-67017 05/15/2018 Credit Card $ 52.96 $ 0.00 Available Inspections: Inspection Type: Final Solar Review Structural Review Electrical Review Electrical Review Building Review Building 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 AFF construction an that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating e, I authorize the above _named contractor to do the work stated. Authorized Signature: Owner / Applicant / Contractor / Agent Buildiri'g Department Copy May 15, 2018 Date May 15, 2018 1 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204:Fax: (305) 756-8972 --�f INSPECTION UNE PHONE NUMBER: (305) 762-4949 FBC 20 jz BUILDING �—� e " 8ss Master Permit No. PE IT APPLICATION Sub Permit No. BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION EXTENSION ❑ RENEWAL ❑PLUMBING ❑ MECHANICAL ['PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: City: Miami Shores ��County: I Miami Dade Folio/Parcel#: 1,+ 3206, -013 - 6b00 Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): Jo kW foe-10es Phone#: Address: 30H NE qc ST Zip: 33 13 S City: M)AM i 5 h OQ&.S State: 02.r DA Tenant/Lessee Name: Phone#: Zip: 33 / 38 Email: CONTRACTOR: Company Name: IZO5d { SZOOp i G6G Address: f r�400 UTODOCl/ & wMI City: / v( 1 SE State:� Qualifier Name: lj Eiac ► ) Phone#: FtOk Zip: 32 3 Phone#: 2213564 State Certification or Registration #: G QC, 640 28 Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ 0r CY r2 .DSquare/Unear Footage of Work: __/ Type of Work: ❑ Addition in Alteration �� ,.� (/�� �N7ew ❑/ Repair/Replace � ❑ Demolition Description of Work: l " � <s3d5F P ` v `t, 0 �) 2.b U Q`a 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 $ (Revised02/24/2014) TOTAL FEE NOW DUE $ �.6 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 wilt be clone 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 promisee 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 must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issu In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged: Signature Signature The foregoing instrument was acknowledged before me this The foreg •ng instrument was acknowledged before me this Li -O\ � Iday of i 1 lb 20 �, by �n �,n • V QYll\ ror S , who is personally known to me or who has'produced F(QI 2- L1'} 2 ^ 7- 2ecp a? meorwho has produced identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBUC: OWNER or AGENT Sign: Print Seal: sssssssssssssssss JULIO A: VIJIL Notary Public - State of Florida N • .: Commission # FF 198998 My Comm. Expires Feb 12, 2019 Sign: Print: Segl: day of P/ CONTRACTOR irl 20 / , by Mara /44,//s-ieih) ssssssssssssssss : 'u MARA MILLSTEIN ik6MY COMMISSION # FF185731 rA EXPIRES- December 28, 2018 s,P�i°ass♦ sssssssssss APPROVED BY t Plans Examiner Zoning (Revlsed02/24/2014) Structural Review Clerk Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Solar Installation Requirements Check type of Solar System to be installed: I ❑ Solar Thermal Required Inspections: PLumbing Solar Final Electrical Solar Final Structural Solar Final Solar Electrical Required Inspections: Electrical Solar Rough Electrical Solar Final Structural Solar Final ❑ Solar Hybrid Required Inspections: Electrical Solar Rough Electrical Solar Final PLumbing Solar Final Structural Solar Final Owner Notification: Installation of roof mounted photovoltaic or solar support systems typically require roof system Penetrations to allow attachment to the structure which may create additional long-term roof system maintenance requirements and/or jeopardize roof system manufacturer's warranties. Roof mounted solar systems generally required removal and reinstallation of solar panels/arrays in order. to perform routine roof system maintenance, repair or replacement. fti I hereby ack owledge that I have read and understand the above notification on this Y da of I, I , 20 I S . Print owner name J AA\ -o?S Owner signature .4 Property address t`c '3 ST Permit # Notary stamp Print Notary Na , Miami Shores, FL 44rivArr JULIO A. VIJIL 1. Notary Public • State of Florida I Commission # FF 198998 My Comm. Expires Feb 12, 2019 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD 2601 BLAIR STONE ROAD TALLAHASSEE FL 32399-0783 ROSEN, PETER SAMUEL PROSOLAR GROUP LLC 510 NE 24TH STREET • WILTON MANORS FL 33305 Congratulations! With this license you become one of the nearly one million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range from architects to yacht brokers, from boxers to barbeque restaurants, and they keep Florida's economy strong. Every day we work to improve the way we do business in order to serve you better. For information about our services, please log onto www.myfloridalicense.com. There you can find more information about our divisions and the regulations that impact you, subscribe to department newsletters and learn more about the Department's initiatives. Our mission at the Department is: License Efficiently, Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. Thank you for doing.txssiness in Honda, and congratulations on your newlicensel. (850) 487-1395 4_". a -.... _ice ...._...�.y, v;5> 9 ._. ,._ . � .. w.,..,. - _ x'��-� .s.-. �.�.�..:.. _ .."tom'•; DETACH HERE ---701VATwN 7AcHEN SE t TK tY - ___. _ STATE OF FLORIDA ' DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION. CONSTRUCT! O( INDUSTRY LICENSING BOARD LICENSE NUMBER 'r ,. ,CVC57028 .: The SOLAR CONTRACTOR Named :below.IS CERTIFIED Under the provisions of Cnipter 489 FS: Expiration date;' AUG 31, 2018 ROSEN;=PETER SAMUEL,-. • PROSOLAR.GROUP LLCM :1600,WOODGATE WAY. TALLAHASSEE; FL 32308;_ ,/, ISSUED:. 11/16/2017 DISPLAY AS REQUIRED BY LAW SEQ # L1711160001826 BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895 — 954-831-4000 VALID OCTOBER 1, 2017 THROUGH SEPTEMBER 30, 2018 DBA: PROSOLAR GROUP LLC Business Name:, 'Owner Name: PETER ROSEN Business Location: 725 WEST OLAS BLVD FT LAUDERDALE Business Phone: 850-222-3554 Rooms Seats Employees 1 Receipt 8:ALL OTHERTYPESCONTRACTOR1 BU !eSSTlYPe: iCERTIFIED SOLAR CONTRACT+ Business Opened:ol/18/2o3.8 State/County/Cert/Reg:CVC57 02 8 Exemption Code: Machines Professionals For Vending Business Only Vending Type: Tax Amount . Transfer Fee NSF Fee Penalty Prior Years Collection Cost Total Paid 27.00 0.00 0.00 0.00 0.00 0.00 27.00 THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT This tax is levied for the privilege of doing business within Broward County and is non -regulatory in nature. You must meet ail County and/or Municipality planning WHEN VALIDATED and zoning requirements. This Business Tax Receipt must be transferred when the business is sold, business name has changed or you have moved the business location. This receipt does not indicate that the business is legal or that It it.'Ni ramplrernaa vats %torte or tonal Woos acidvasulagions.. Mailing Address: PROSOLAR GROUP LLC 1'1 725 WEST OLAS BLVD l FORT LAUDERDALE, FL 33312 rt;Vt i 2017 - 2018 Receipt #02C-17-00001852 Paid 01/18/2018 27.00 AC U` CERTIFICATE OF LIABILITY INSURANCE °"'E"°"°°"'"n 4/2/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(Ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to -the certificate holder in lieu of such endorsement(s). PRODUCER Asset One Insurance 575 Anton Blvd., 3rd FL Costa Mesa CA 92626 NAME: (ac No, Ext): 714 625 8204 T. No): 714-625-8290 AIL ADDDRESS: ADRE ara@solarinsure.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Preferred Contractors Insurance Co. 12497 INSURED ProSolar Group LLC 1600 Woodgate Way Tallahassee FL 32308 INSURER B : ' INSURER C : INSURER D : INSURER E : . INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. • INSR TYPE OF INSURANCE ADM INSD SUBR WVD POLICY NUMBER POLICY EFF (MM/DDMIYY) POLICY EXP (MM/DD/YYYIf) LIMITS A X COMMERCIAL GENERAL LIABILITY PC83567 9/18/2017 ' 9/18/2018 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE ;; OCCUR UPREMIS AO rctnir0 'PREMISES (Eaocaufrenoe) $ 50,1300 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L X AGGREGATE POLICY OTHER: LIMIT APPLIES PRO- PER: LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 1,000,000 $ AUTOMOBILE —° _ LIABILITY ANY AUTO ,,, ALL OWNED `AUTOS ,.,... HIRED AUTOS — _`AUTOS — SCHEDULED ...;... NON -OWNED AUTOS .. .. COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ '. BODILY INJURY (Per accident) .$ - PROPERTY DAMAGE (Per accident) $ $ UMBRELLA UAB EXCESS UAB — OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? - (Mandatory in NH)- - . .— If yes, describe under DESCRIPTION OF OPERATIONS below Y / N —� NIA, -. i PER STATUTE O 1H- ER E.L. EACH ACCIDENT $ Et. DISEASE -EA EMPLOYEE S E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Certificate Holder is named Additional Insured. CBCI261e71 AND CVC 57028 CERTIFICATE HOLDER CANCELLATION Miami Shores Village Building Department 10050 NE 2nd Ave Miami Shores FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 71.4.0 ACORD 26 (2014/01) © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD JIMMY PATRONIS 'CHIEF FINANICAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW * * CONSTRUCTION INDUSTRY EXEMPTION This. certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: 12/12/2017 EXPIRATION DATE: 12/12/2019 PERSON: ROSEN PETER S FEIN: 822575318 BUSINESS NAME AND ADDRESS: PROSOLAR GROUP LLC 1600 WOODGATE WAY TALLAHASSEE FL 32308 '" SCOPE OF BUSINESS OR TRADE: Licensed Building Contractor IMPORTANT: Pursuant to Chapter 440.05(14), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section may not recover benefits or compensation under this chapter. Pursuant to Chapter 440.05(12), F.S., Certificates of election to be exempt... apply only within the scope of the business or trade listed on the notice of election to be exempt Pursuant to Chapter 440.05(13), F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation It. at any time after the firing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. DFS-F2-OWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS? (850)413-1609 DATE: v State of: County of: 1\'(IA-N i Before me this day personally appeared deposes and says: LICENSE CVC57028 '` M who, being duly swom, That he or she will be the only person working on the project located at: Contractor Signature Swom to (or affirmed) and subscribed before me this bysen Type of identification Produced Print, Type Stamp Name of Notary MARA MILLSTEIN MY COMMISSION # FF185731 EXPIRES' December28, 2018 '� or noQ 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: 11 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: State of Florida County of Miami -Dade The foregoing was acknowledge before me this (l4hday of ?\ pr; 1 .20 16. By J 6'r. f0 itx 5 who is personally known to me or has produced FctoL..10Z• 623 •2g-0 Notary: SEAL: as identification. JULIO A. VIJIL Notary Public - State of Florida I Commission # FF 198998 0-.••' My Comm. Expires Feb 12, 2019 Page 1 of 2 Property Search Application - Miami -Dade County Summary Report Property Information Folio: 11-3206-013-5600 Property Address: 304 NE 99 ST Miami Shores, FL 33138-2437 Owner LILLIAN CLAVERIA & JOHN L FORBES Mailing Address 304 NE 99 ST MIAMI SHORES, FL 33138-2437 PA Primary Zone 1000 SGL FAMILY - 2101-2300 SQ Primary Land Use 0101 RESIDENTIAL - SINGLE FAMILY : 1 UNIT Beds / Baths / Half 3 / 1 / 0 Floors 1 Living Units 1 Actual Area Sq.Ft Living Area Sq.Ft Adjusted Area 1,452 Sq.Ft Lot Size 11,500 Sq.Ft Year Built 1930 Assessment Information Year 2017 2016 2015 Land Value $345,138 $287,615 $276,299 Building Value $101,059 $101,059 $101,059 XF Value $41,483 $41,952 $26,846 Market Value $487,680 $430,626 $404,204 Assessed Value $171,696 $168,165 $166,997 Benefits Information Benefit Type 2017 2016 2015 Save Our Homes Cap Assessment Reduction $315,984 $262,461 $237,207 Homestead Exemption $25,000 $25,000 $25,000 Second Homestead Exemption $25,000 $25,000 $25,000 Note: Not all benefits are applicable to all Taxable Values (i.e. County, School Board, City, Regional). Short Legal Description MIAMI SHORES SEC 1 AMD PB 10-70 LOT 11 &12BLK41 LOT SIZE 100.000 X 115 OR 16939-0010 0995 1 Generated On : 4/3/ Taxable Value Information 2017 2016 2 County Exemption Value $50,000 $50,000 $50. Taxable Value $121,696 $118,165 $116. School Board Exemption Value $25,000 $25,000 $25. Taxable Value $146,696 $143,165 $141. City Exemption Value $50,000 $50,000 $50. Taxable Value $121,696 $118,165 $116 Regional Exemption Value $50,000 $50,000 $50. Taxable Value $121,696 $118,165 $116. Sales Information Previous Sale Price OR Book -Page Qualification Descriptic 09/01/1995 $132,500 16939-0010 Sales which are qualified 08/01/1989 $93,000 14219-0569 Sales which are qualified 08/01/1985 $78,000 12603-1943 Sales which are qualified 09/01/1976 $51,000 00000-00000 Sales which are qualified The Office of the Property Appraiser is continually editing and updating the tax roll. This website may not reflect the most current information on record. The Property Appra https://www.miamidade.gov/propertysearch/ 4/3/2018