RC-19-1798Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address
62 NE 109TH ST, Miami Shores, FL 33161
rnntacts
Issue Date: 08/14/2019
Parcel Number
1121360110350
Permit NO.: RC-08-19-17 8
Permit Type: Building (Residential)
Work Ciassifrcation. Solar
Permit Status: Approved
Expiration: 02/10/2020
DAVID HARRISON Owner GOLDIN SOLAR, LLC Contractor
DAREN GOLDIN
Other:3059849481
Business: 3054699790
Inspection Requests:
Description: INSTALLATION OF PV SOLAR SYSTEM ROOF Valuation: $ 500.00 305-762 4949
MOUNTED AND 2 POWERWALLS
Total Sq Feet: 0.00
Fees
Amount
CCF
$0.60
DBPR Fee
$2.00
DCA Fee
$2.00
Tota I :
$4.60
Building Department Copy
Payments
Date Paid Amt Paid
Total Fees
$4.60
Credit Card
08/14/2019 $4.60
Amount Due:
$0.00
In consideration of the issuance to me of this permit, 1 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 authorize the above named contractor to do th"ork sta)dd�
/ Applicant / Contractor i Agent
Authorized Signature: Owner
Date
August 14, 2019 Page 2 of 2
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
pub �01�
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BY•
FBC 20 1-T
BUILDING Master Permit No.`DJ
PERMIT APPLICATION Sub Permit No.
QBUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING [-]MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF [:]CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 62 NE 109 ST
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#:11-2136-011-0350 Is the Building Historically Designated: Yes NO X
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): DAVID HARRISON Phone#: 305-984-9481
Address: 62 NE 109 ST
City: MIAMI SHORES, State: FL Zip: 33161
Tenant/Lessee Name: Phone#:
Email: david@harrisoncrane.com
CONTRACTOR: Company Name: Goldin Solar LLC Phone#: 480.208.4688
Address: 3447 Percival Ave
City: Miami State: FI Zip: 33133
Qualifier Name: Daren Goldin Phone#: 480.208.4688
State Certification or Registration #: CV656965 Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State:
Value of Work for this Permit: $� ' Square/Linear Footage of Work:
Zip:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: Installation of pv solar system roof mounted and 2 powerwalls
Specify color of /or thru-tile:
Submittal Feet Permit Fee $
Scanning Fee $
Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $
CCF $ CO/CC $
DBPR $ Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE 4 4
(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 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.
Signaturh 6k, Signature
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The (foregoing instrument was acknowledged before me this
day of 20 I`j" by Ot day of 20 t9 by
(ILSO who is personally known to pie 1 who is ersonall known to
P Y P Y
me or who has produced as me r who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: ` - Sign: Ja
Print: ��11Y P Print: a ,r*" Notary Public State of Florida
1
io �E.p,.,�0110612
G 288924
Seal: ' • ? Notary Public - State of Florida Seal• '�j� 3
Commission # GG 001951
•a w
%';;orr�Q;.•' My Comm. Expires Oct 14, 2020
am
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APPROVED BY Plans Examiner Zoning
Structural Review
(Revised02/24/2014)
Clerk