EL-17-23212/N'
pti '
6 5
Permit NO. EL -9-17-2321
Permit Type: Electrical - Residential
Work Classification: Solar
Permit Status: APPROVED
Issue Date. 1011612017 Expiration: 04/14/2018
Contractor(s) Phone Cell Phone
ENERGY SMART SOLAR LLC (954)228-4902
of Work: SOLAR PV
onal Info:
ification: Residential
canning: 3
Fees Due
CCF
DBPR Fee
DCA Fee
Education Surcharge
Permit Fee - Additions/Alterations
Permit Fee - Additions/Alterations
Revision Fee
Scanning Fee
Technology Fee
Total:
Amount
9.60
8.40
5.60
3.20
0.00
560.00
120.00
9.00
12.80
728.60
Valuation:=16,000.
00TotalSqFee
Pay Date Pay Type Amt Paid Amt Due
Invoice # EL -9-17-65175
10/16/2017 Credit Card $ 628.60 $ 100.00
09/27/2017 Credit Card $ 100.00 $ 0.00
Available Inspections:
Inspection Type.-
Final
ype:
Final
Review Structural
Review Electrical
Review
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 an F=thle the above-named contractor to do the work stated.
October 16, 2017
Signature: Owner / Applicant / Contractor / Agent
Building Department Copy
October 16, 2017
Miami Shores Village
10050 N.E. 2nd Avenue NW
Miami Shores, FL 33138-0000
Phone: (305)795-2204
toRtvA
Permit NO. EL -9-17-2321
Permit Type: Electrical - Residential
Work Classification: Solar
Permit Status: APPROVED
Issue Date. 1011612017 Expiration: 04/14/2018
Contractor(s) Phone Cell Phone
ENERGY SMART SOLAR LLC (954)228-4902
of Work: SOLAR PV
onal Info:
ification: Residential
canning: 3
Fees Due
CCF
DBPR Fee
DCA Fee
Education Surcharge
Permit Fee - Additions/Alterations
Permit Fee - Additions/Alterations
Revision Fee
Scanning Fee
Technology Fee
Total:
Amount
9.60
8.40
5.60
3.20
0.00
560.00
120.00
9.00
12.80
728.60
Valuation:=16,000.
00TotalSqFee
Pay Date Pay Type Amt Paid Amt Due
Invoice # EL -9-17-65175
10/16/2017 Credit Card $ 628.60 $ 100.00
09/27/2017 Credit Card $ 100.00 $ 0.00
Available Inspections:
Inspection Type.-
Final
ype:
Final
Review Structural
Review Electrical
Review
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 an F=thle the above-named contractor to do the work stated.
October 16, 2017
Signature: Owner / Applicant / Contractor / Agent
Building Department Copy
October 16, 2017
BUILDING
PERMIT APPLICATION
BUILDING N ELECTRIC
Fc
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
FBC 2014
Master Permit No. fL'-—e kB04
Sub Permit No.
ROOFING F-1 REVISION [:] EXTENSION RENEWAL
PLUMBING MECHANICAL PUBLIC WORKS F-1 CHANGE OF CANCELLATION [-] SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: f q ( 'v \0 q,
City: Miami Shores County: Miami Dade Zip: S -e I J C--'
Folio/Parcel#: Is the Building Historically Designated: Yes NO V-
1,
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FIFE:
OWNER: Name (Fee Simple Titleholder):_ )_ E4 )z 1 J 41- Phone#: sOS Ll
Address: / !24 WJta j !3e Vii' S.r A4 ! /'4 M f
City: M / d M 1 S 140 Jq ES State: 1=L Zip: _'46/g~
Tenant/Lessee Name:
Email:
CONTRACTOR: Company Name: g4" C --y S M A'Ar SoLR A{ Phone#: 55!J -fig- `P
Address: J•i y'7/ -5. U-) 14y
City: o b&EQ "e 1 1^ y state: zip: J` 3 ciC-_1
Qualifier Name: 21+Iy / S AWnt.-lo Phone#: 9 3 zi- 0_0-9-49
State Certification or Registration M CVC- 5 "/c9i9 _'A Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ Square/Linear Footage of Work:
Type of Work: Addition Alteration New Repair/Replace Demolition
Description of Work: -5n Lin- Q P.%/
Specify color of color thru tile:
Submittal Fee $ Permit Fee $ r4-, 442 CCF $ GO CO/CC $
Scanning Fee $ _ Radon Fee $ 17 , « DBPR $ T Notary $ _
Technology Fee $ L J Training/Education Fee $ 3,2-0 Double Fee $
Structural Reviews $ U " Bond $
TOTAL FEE NOW DUE $
Revised02/24/2014)
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 o 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 issugd. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged. U
Signature e:3ySignature
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of .Sr 20 /7 by
who is personally known to
me o who has produce as
identification and who did take an oath.
NOTARY PUBLIC:
tr
day of /} UG LtST 20 /1 by
tj 0-1 I L, 4- ;:A-N " who i ersona y now to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
APPROVED BY
T;,V---
Revised02/24/2014)
Plans Examiner
Structural Review
Zoning
Clerk
Sign: i2Sign:ALk4tll`
Print: jxAi Q /VJ„1l iL Print: V t4 M l5—
Seal: Seal: r.,, Notary Public Stats of Florida
Alexander Pavlinek
My Commission GG 035271
J 'gar ExpirBs
Seal: p '" °e
sof
noll
Notary Public State of Florida
Alexander Pavlinek
My Commission GG 035271
Expires 12/19/2020nog •
12/19!2020
s***
APPROVED BY
T;,V---
Revised02/24/2014)
Plans 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
Solar Installation Requirements
Check type of Solar System to be installed:
Solar Thermal
Required Inspections:
PLumbing Solar Final
Electrical Solar Final
Structural Solar Final
Owner Notification:
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
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.
I hereby acknowledge that I have read and understand the above notification on this 1.6 -
day of g LLCs -5-r 20-1-7.
Print owner n
Owner signat
Property address 1!5!6 1a W T C S]'' Miami Shores, FL
Permit #
R Notary Public State of Fbrida tary stamp Print Notary Name 44EXA 0 )%'4_-Wg-kAlexanderPavlinek
My Commission GG 035271
Expires 12/19/2020
gaw
SMART SOLAR
Profit from your roof space • Reduce your energy bills • Let us show you how!
September 18, 2017
Stare of Florida
County of Broward
Before me this day personally appeared ?J.EAJl 1271, .5 Q N'r'O Ytp who, being duly sworn,
deposes and says:
That he will be the only person working on the project located at:
196 NW 95th Street, Miami Shores, FL 33150
Contraictor Signature
Sworn to (or affirmed) and subscribed before me this 1 7 day of fiLIG ,(5V , 20_L_7
4971 S.W. 94th Way
Cooper City, FL 33328
Personally know
Or produced Identification
Type of Identification Produced
WA A-V R, E_
a Notary Public State of Florida
Nexander PavilnekMycommissionGG035271
Expires 1211912020
954.228.4902
energysmartfl@gmail.com
www.energysmartsolar.com
44
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 txematlon
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 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 —1 :1 day of _14,(A(9(t 6J— , 20 /'J.
By Ls' } \1 i rA who is personally known to me or lfzaEEced
as identi
ff" LIII-Lul A
SEAL:
x'
01 rr,, Notary Public State of Florida
Alexander Pavlinek
c ; My Commission GG 035271