RC-18-2085b EN—"�'•�ye
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Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Permit No. RC-8-18-2085
Permit Type: Residential Construction
erlI I Work Classification: Solar
Permit Status: APPROVED
issue Date: 8/24/2018 1 Expiration: 02/20/2019
rrorecc Huuress Parcel Number Applicant
68 NE 91 Street 1131010200020
Miami Shores, FL 33138- Block: Lot: ROBERT IRWIN FLOYD GONZAL
Owner Information Address Phone Cell
ROBERT IRWIN FLOYD GONZALES 68 NE 91 Street (305)492-9763
MIAMI SHORES FL 33138-2808
68 NE 91 Street
MIAMI SHORES FL 33138-2808
Contractor(s) Phone Cell Phone
ELEMENT SOLAR LLC (305)542-2928
Valuation: $ 63,000.00
Total Sq Feet: 0
Approved: In Review
Comments:
Date Approved:: In Review
Date Denied:
Type of Construction: INSTALLATION OF PHOTOVOLTAI
Occupancy: Single Family
Stories:
Exterior:
Front Setback:
Rear Setback:
Left Setback:
Right Setback:
Bedrooms:
Bathrooms:
Plans Submitted: Yes
Certificate Status:
Certificate Date:
Additional Info:
Bond Return :
Classification: Residential
Fees Due
Amount
CCF
$37.80
DBPR Fee
$28.35
DCA Fee
$18.90
Education Surcharge
$0.00
P&Z Review Fee
$0.00
Permit Fee
$0.00
Scanning Fee
$0.00
Technology Fee
$0.00
Total:
$85.05
Pay Date Pay Type Amt Paid Amt Due
Invoice # RC-8-18-68453
08/24/2018 Credit Card $ 85.05 $ 0.00
Available? Inspections:
Inspection Type:
Final
Solar
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 qQ.0 z0ng7(IjuW6rmor$4 I authorize the above -named contractor to do the work stated.
August 24, 20118
Auth&4ze4-P7gnature:Owner / Applicant / Contractor / Agent
Building Department Copy
August 24, 2018
1
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Miami Shores Village 1141 9O �� e
Building Department �0�4.
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
OBUILDING ❑ ELECTRIC ❑ ROOFING
F—BC 2onb
Master Permit No. F� I � — G-c)' I
Sub Permit No. ILG k y ` IV&S
❑ REVISION ❑ EXTENSION ❑ RENEWAL
❑PLUMBING ❑ MECHANICAL [—]PUBLIC WORKS ❑ CHANGE OF CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 68 NE 91 St. Street
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#:11-3101-020-0020 Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): Floyd Gonzales Phone#: 305-4929326
Address:68 NE 91 St, Street
City: Miami Shores State: Florida Zip: 33138'
Tenant/Lessee Name: Phone#:
Email
CONTRACTOR: Company Name: ELEMENT SOLAR LLC Phone#: 305 5422928
Address: 1200 Brickell Bay Dr ## 3822
City: Miami State: FI Zip: 33131
Qualifier Name: Gabriel Da Veiga Phone#: 305 5422928
C �r�
State Certification or Registration #: cy(_ — ' % ±�. 5 Certificate of Competency #:
DESIGNER: Architect/Engineer: Mauricio Salazar Phone#: 305 772-7599
Address: 140 Buttonwood Dr City: Key Biscayne state: FL
Value of Work for this Permit: $ 63000 Square/Linear Footage of Work:
Zip: 33149
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of work: Installation of Photovoltaic System
Specify color of color thru tile:
Submittal Fee Permit Fee $ CCF $ 3� CO/CC $
Scanning Fee $ Radon Fee $ 10'1 9 ' O DBPR $ Z� 3s Notary $
Technology Fee $
Training/Education Fee $
Double Fee $
Structural Reviews $
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 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 AGE
The foregoing instrument was acknowledged before me this
/3 day of J) 20 l� by
Fe--UV/2 (5ryt)2.*cl53 who is personally known to
41
me or who has produced 67 pogw✓F2; (,Xno as
identification and who did take an oath.
NOTARY PUBLIC:
Sig
�u Pri
ON #FF151526
XPIRES August 14, 2018
Seal(407)015
FlrjrigaNatary��� iR� �a�
a���I---�
Signature
CON RACTOR
The foregoing inst 'ument was acknowledged before me this
sw
13 day of ( L, 20 /9 by
6+184yet .94 VFze.,!- who is personally known to
me or who has produced 4Q- 12Armg2j zze�, c as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:_
Print:
2 A JIM R RENE
Seal:
MY COMMISSION #FF151526
EXPIRES August 14, 2018
(407) 398 �0153 Floritlallot
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
ELEMENT SOLAR LLC
Date:
State of Florida
County of Miami Shores Village
Before me this day personally appeared 6-r who being duly sworn,
deposes and says:
That he or she will be the only person working on the project located at:
68 NE 91 St. Street, City Miami Shores, State Florida, Zip 33.138
d'=14 1��
Contracto gnatu
Sworn to (or Affirmed) and subscribed before me this 6e2l day.. of 6vau 20
BY hP-1e
NEE]
State of Florida austin GG 2371
/2022 ersonally Know
0`
Or Produced Identification
Type of identification Produced
Notary Public State of Florida
Wm'd;Antonio J Insausti
My Commission GG 237142
Expires 07/11/2022
1
Print, Type or Stamp Name of Natary r
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
ivVUlUW w vvvnvi — vvumvub %.vumpensauon 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:
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.
State of Florida
County of Miami -Dade
The foregoing was acknowledge before me this 03 day of ���eZ�� 20
By�who is personally known to me or has produced
as identification.
Notary:
Notary Public State of Florida
SEAL: Antonio J Insausti
My Commission GG 237142 to
or w Expires 07111/2022