RC-19-1466Location Address
Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
� I I
Issue Da t 08/29/2019
Parcel Number
242 NW 92ND ST, Miami Shores, FL 33150 1131010331250
Contacts
Permit NO.: RC t16ki 9-1466
Permit Type: Building (Re idendifl)
Work Classiftc#on: Solar
Permit Status: Approved
Expiration: 02/17/2020
VILMA E ROMERO, ROBERTO BACA Owner DEPARTMENT OF GREEN ENERGY INC Contractor
242 NW 92 ST, MIAMI SHORES, FL 331502231 WILLIS SPERBERG
1915 FLORANADA RD 107, FORT LAUDERDALE, FL 33308
Business: 8444733651
Description: INSTALLATION OF SOLAR SYSTEM Valuation: $ 30,000.00 Inspection Requests:
^^ ^^
49
Total Sq Feet: 0.00
Fees
Amount
CCF
$18.00
DBPR Fee
$13.50
DCA Fee
$9.00
Total:
$40.50
Payments
Date Paid Amt Paid
Total Fees
$40.50
Check # 15318
08/29/2019 $40.50
Amount Due:
$0.00
Building Department Copy
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 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. Futhermore, I autflorize the above named contractor to do the work stated.
Authorized Signature: Owner / Applicant /
Date
August 29, 2019 Page 2 of 2
LIMITED POWER OF ATTORNEY
PERMITTING AUTHORIZATION FORM
m
OWNER OF THE PROPERTY LOCATED AT ADDRESS;.
S�r ,
DO HEARBY AUTHORIZE THE PERMITTING DEPARTMENT OF DEPARTMENT OF
GREEN ENERGY INC. (LISTED BELOW) TO SIGN AND APPLY FOR A BUILDING
PERMIT ON MY BEHALF. THIS AUTHORIZATION IS VALID ONLY FOR THE PURPOSE
OF OBTAINING A PERMIT TO PERFORM THE SOLAR INSTALLATION WORK
CONTRACTED FOR BY AND BETWEEN OWNER AND DEPARTMENT OF GREEN
ENERGY INC. THE ONLY PERMIT(S) WHICH MAY BE APPLIED FOR UNDER THE
TERMS OF THIS LETTER ARE THOSE WHICH THE AUTHORITY HAVING
JURISDICTION (CITY OR COUNTY) DEEMS) NECESSARY UNDER THE CURRENT
FLORIDA BUILDING CODE, GIVEN THE SCOPE OF WORK CONTRACTED FOR.
DEPARTMENT OF GREEN ENERGY INC. WILL BE RESPONSIBLE FOR ANY AND ALL
FEES ASSOCIATED WITH THIS PERMIT APPLICATION. THE AUTHORIZATION WILL
REMAIN VALID UNTIL SUCH PERMITS) IS/ARE ISSUED BY THE RESPECTIVE
BUILDING DEPARTMENT, OR UNTIL THIRTY (30) CALENDAR DAYS FROM THE DATE
LISTED BELOW HAVE TRANSPIRED, WHICHEVER IS LESS.
HOMEOWNER SIGNATURE
DANI LEEA:V'EP-f
MY COMMISSION #0 2920 `Qr I
EXPIRES May
PRINTED NAME DATE
1915 Floranada Rd, #107, Ft. Lauderdale, FL 33308 1 (844) 473-36511 Info@departmentofgreenenergy.org
Miami Shores Village 1
Building Department JUN 5 201
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 ❑ ;
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
BUILDING
PERMIT APPLICATION
FE—]BUILDING ❑ ELECTRIC ❑ ROOFING
U.
FBC 200
Master Permit No. —Ot G
Sub Permit No. ' Uv 7-1rr 11 I T b /
❑ REVISION ❑ EXTENSION ❑ RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 242 NW 92nd Street
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: 11 -3101 -033-1250 Is the Building Historically Designated: Yes NO X
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): Roberto Baca Phone#: 305-281-6943
Address:242 NW 92nd Street
City. Miami Shoresstate: FL Zip: 33150
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: Department of Green Energy, Inc
Address: 1915 Floranada Rd Suite 107
hone#: 844-473-3651
City: Ft. Lauderdalestate: FL Zip:
33308
Qualifier Name: Willis Sperberg
Phone#:
State Certification or Registration #: CGC1527228 Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $� , DG � Square/Linear Footage of Work:
Type of Work: 0 Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: Installation of a solar system
IV)
Specify color of color thru tile:
Submittal Fee $ Permit Fee $
Scanning Fee $ Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $
(Revised 02/24/2014)
CCF
DBPR $
CO/CC $
Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $ d
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 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
OWNER or AGENT
The foregoing instrument was acknowledged before me this
day of.. 120 Iq by
o ,A who is personally known to
me or who has produced 1 ir'yus as
identification and who did take an oath.
NOTARY PUBLIC:
Sign
B
Print:Y C
Seal:
EXPIRES May 10, 2020
Signature—u
CONTRACTOR
Thee foregoing instru.�miW. ent was acknowledged before me this
�J/ day of �.JA20 % by
(,(/+/�5 Q°,/jQf`oj who is person illy known to
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign: /
Print:
Seal: `t ?otNk
11407)39"153
.VERS
EXPIRES May 10, 2020
as
APPROVED BY Vf Plans Examiner Zoning
If
Structural Review
(Revised 02/24/2014)
Clerk
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
IVVLILAd TV VW"er — VVOFKers" Compensation Insurance txemption
Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05
allows corporate officers in the constriction 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:
I . 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 ail 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 pen -nit 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:
Owner
State of Florida
County of Miami -Dade
The foregoing was acknowledge before me this�� day of
By AY1/ S rt',V who is personally known to me or has produced
as identification DANIELLE BEAVERS
Notary '- MY COMMISSION # FF991146
EXPIRES May 1a, 2020
SEAL:
4b7} 34ROtii7 I rRtkANrot•ry9ery ccm
DEPARTMENT OF GREEN
UNLIMITED
1915 Floranada Rd, #107
Ft. Lauderdale, FL 33308
rENERGY
(844) GREEN -51
www.4cpartmtntofilreentnergy.org
SILAR
info@departmentofgreenenergy.org
License # CGC1525641, CVC57051, EC13008127
2�7 !�,E i" �zi .
v
Homeowner(s)
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Date
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Address L
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State Zip Code .A
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Home Phone
Cell Phone
Email
Estimated Date of Completion
# of Panels A
PROJECT DESCRIPTION
Total Project Cost
A InverterEOOi tam Down Payment
7� Warranty r:-
PV System Size Qe6 U kw ❑ Optimizer #_ Payment @ Permitting
t{Jw
Panel Type t'�+ ti
Ype M �� �� � Digital Monitoring Final Payment
Warranty 7 l _t
Electric Company ❑ FPL ❑ Duke ❑ Teco ❑
,0,Aeroseal A/C Units
IceCOLD �_ Oz's
Nest Thermostat �_ Qty
Line Conditioner I Qty
❑ Solar Pool Heater
❑ Solar Hot Water Heater
❑ 200 Amp Service Panel
❑ 400 Amp Service Panel
Includes: All Materials, Labor, Engineering Permitting Taxes and Fees
Additional Work to be Performed:
Finance Terms
1.
2.
3.
4.
Application #
❑ CC #
Visa MC AE Disc
Exp. Date CVC
Tax credits and rebates: Buyer understands that tax credits are credits against buyer's income tax liability. In the event the buyer does not have an income tax liability,
then the tax credits will not be applicable to the buyer. Department of Green Energy Inc. may assist buyer in obtaining financing of products with third party lenders.
Buyer understands that Department of Green Energy Inc. does not provide the actual financing. Approval of any financing of products is subject to a third party lender.
Lenders are unrelated to Department of Green Energy Inc. Department of Green Energy Inc. is not an agent of any lender but simply facilitates the approval of
financing for Buyer. Terms and payments are an "Estimate" and third party lenders will determine final values. First payment is due in accordance with the contract
from third party lenders. Buyer understands that Terms and Lease Terms are estimated payments and pre tax credit and rebates received.
In consideration of the rendering of the services andlor the furnishing of materials, as above designated, Itwe, the undersigned property owner(s) jointly and separately
agree to pay Department of Green Energy Inc. or any third party lender, the amount listed above and pay all cost of collection, including attorney's fees and interest at
the rate of 1.5 percent per month (which is an annual percentage rate of 18%) should this account be referred for collection The contract constitutes the entire
understanding of the parties, and no other understanding, collateral or otherwise, shall be binding unless in writing and signed by both parties. This agreement is not
final until signed by an officer of Department of Green Energy Inc.
Notice of Cancellation
You may cancel this transaction, without penalty or obligation within three business days from the above date. If you cancel, any property traded in, any payments
made by you under the contract or sale and any negotiable instrument executed by you will be returned within 10 business days following receipt by the seller of your
cancellation notice and any security interest arising out of the transaction will he rancalled If you cancel, you must make available to the sager at your residence in
substantially good condition as when you received any goods delivered to you under this contract or sale. If you wish, comply with the instruction of the seller regarding
the return shipment of goods at the buyer's expense and risk. If you do make the goods available to the seller and the seller does not pick them up within 80 days of
the date of your notice of cancellation you may retain or dispose of the goods without any further obligation. If you fail to make the goods available to the seller, or if
you agree to return the goods to the seller and fail to do so, then you remain liable for performance of all obligations under the contract. To cancel the transaction, mail
or deliver a signed and dated copy of this cancellation notir�a r any other written notice to: Department of Green Energy Inc. 1915 Floranada Rd #10T Ft. Lauderdale,
FL 33308, not postmarked or delivered later than: (Date)_t 2nT ?,pl j
I hereby cancel this transaction this date: Buyer's Signature:
Homeo erSipfSattre Date Ftr�eow'erSignature Date
j SC4�
Deia�',�eerilhf Green Energy Inc. Date
V 1.1.10500
NOTICE TO PURCHASER
1. Department of Green Energy Inc. assumes no responsibility for payments made to any of its sales representatives or employees
unless payment is made by check and check is made payable to Department of Green Energy Inc.
2. Charges for late payment: If any payment is not paid within 10 days after its due date, buyer agrees to pay a late charge of either
5% of the late payment or $10.00 whichever is greater.
3. Interest after maturity: Buyer further agrees to pay interest at the Annual Percentage Rate shown on this agreement on any
accounts which remain unpaid after the final due date on this agreement.
4. Purchaser (s) agree that he/she will sign a Contractor's Completion Certificate, Promissory Note, Deed of Trust and any other
documents deemed necessary for Department of Green Energy Inc. or any financial institution to which Department of Green
Energy Inc. may assign its rights and obligations under this contract.
5. This contract constitutes the entire understanding and agreement of the parties and they acknowledge that there is no other
understanding or agreement, oral or otherwise, and the only inducement to the purchaser to enter into this agreement with
Department of Green Energy Inc. is as herein contained.
6. If the Purchaser(s) refuse to complete the purchase as agreed, the Purchaser(s) shall be liable for the entire balance of the
contractual price, due and payable Immediately. If Department of Green Energy Inc. employs legal counsel for the purpose of
enforcing the terms thereof, Purchaser(s) agree to pay all costs of collection, including but not limited to, reasonable attorney fees
and costs.
7. Purchaser(s) understand(s) and agrees that if this contract is cancelled after the three (3) day rescission period, that the
Purchaser(s) will be liable for substantial penalties not less than twenty-five (25%) of the total sales in repayment of damages
incurred.
8. Tax credits and utility company R.E.C. (renewable energy credits) Rebates: Seller is not responsible in the event that the buyer
does not receive that utility company rebates or federal or state tax credits. Seller may assist buyer with processing the
paperwork to obtain the rebates and tax credits but seller is not responsible in the event that the utility company rebates or federal
or state credits are not paid to buyer for any reason. Buyer understands that tax credits are credits against buyer's income tax
liability. In the event that buyer does not have an Income tax liability, then tax credits will not be available to buyer. Upon the
expiration of the utility companies R.E.C. Purchaser term, the R.E.C.'s revert back to seller or its assignee.
9. Utility bill savings: Solar energy systems do capture the sun's energy and transfer that energy for use in the home, and this will
save the buyer money, however, many factors play Into how much it appears from reading subsequent utility bills that the buyer is
saving. Therefore, Seller does not make any claims nor guarantee any savings to buyer. Any examples given are just for
illustration purposes only. Aeroseal is a proven duct sealing method, however, no savings are guaranteed as some ducts are
already sealed; however, until they are fully tested, it is unknown. This is why seller recommends performing the Aeroseal so that
in the likely event that they leak, the Aeroseal can seal them. In the event that the ducts do not need sealing (a small percentage),
at least the buyer will then know that they are sealed and they are not wasting energy through leaking ducts.
10. It is understood that Department of Green Energy Inc. shall not be held liable for any loss, damage or delays occasioned by fire,
strikes, or material stolen after delivery upon premises, lock -outs, acts of God or the public enemy, accidents, boycotts, material
shortages, delayed delivery of seller's supplies, force majeure, inclement weather, floods, freight embargoes, causes beyond
control. Prices quoted are in this contract and subsequent submissions are based upon current prices and no guarantee of price
is implied or inferred beyond the date indicated on this contract.
The liability of Department of Green Energy Inc. for defective material or installation shall be limited to the replacement of correction of said
defective materials and/or installations that appear within a period of two (2) years from the date of substantial completion of the contract,
unless otherwise specified under the terms of this contract, and no other claims or demands whatsoever shall be made against Department
of Green Energy Inc. Any and all appliances, assemblies, units and so on purchased by Department of Green Energy Inc. for use under
this contract are sold and installed subject to the manufacturers guarantee and/or warranty and not subject to any by Department of Green
Energy Inc. Purchaser(s) agree (s) once the job is completed, inspected, and approved by purchaser (s), purchaser(s) accept (s) the work
as having been completed in a workmanlike manner. Such completion, inspection, and approval shall be deemed to have taken place no
later than five (5) days after Department of Green Energy Inc. and all subcontractor(s) have left the jobsite. If the work has been
completed, or, if later, on the day any required authority (s) having jurisdiction (s) final inspection (s) have been satisfactorily completed
purchaser (s) agree (s) other than Department of Green Energy Inc. liabilities set forth just above for defective material or installation that
purchaser (s) accepts the work as is, with no warranties express or implied, including but not limited to, the Implied warranties or
merchantability and fitness for a particular purpose, and good workmanship have been made or extended by Department of Green Energy
Inc. Notwithstanding anything to the contrary above, Department of Green Energy Inc. agrees to abide by any Registrar of Contractor
reasonable written requirements or orders directed specifically to Department of Green Energy Inc. relating specifically to the work to be
performed under this agreement. This provision and its limitations apply to everything sold by Department of Green Energy Inc. or is
representatives to the purchaser (s) Including but not limited to any and all systems, appliances and any other items or services sold.