EL-19-1262Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address
10675 NE 11TH CT, Miami Shores, FL 33138
Contacts
Issue Date: 07/01/2019
Parcel Number
1122320280190
Permit NO.: EL-06-19-1262
Permit Type: Electrical - Residential
Work Classification: Solar
Permit Status: Approved
Expiration: 12/02/2019
MICHAEL GREEN Owner GOLDIN SOLAR LLC Contractor
RUBEN BLAYA
Business: 3128989679
Business: 4802084688
Description: INSTALLATION OF PV SOLAR SYSTEM ROOF Valuation: $ 500.00 Inspection Requests:
4949
MOUNTED
Total Sq Feet: 0.00 11
Fees
Amount
CCF
$0.60
DBPR Fee
$2.00
DCA Fee
$2.00
Total:
$4.60
Building Department Copy
Payments
Date Paid Amt Paid
Total Fees
$4.60
Credit Card
07/01/2019 $4.60
Amount Due:
$0.00
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 authorize the above named contractor to do the work stated.
Authorized Signature
/ Applicant / Contractor / Agent
Date
July 01, 2019 Page 2 of 2
BUILDING
PERMIT APPLICATION
f
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 2011 �
Master Permit No. RC- 06 �q ^I 2-b
Sub Permit No.�l J�" I /,P2
❑BUILDING ro-1 ELECTRIC ❑ ROOFING
PLUMBING ❑MECHANICAL ❑PUBLICWORKS
JOB ADDRESS: 10675 NE 11 CT
❑ REVISION ❑ EXTENSION RENEWAL
CHANGE OF CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#:11-2232-028-0190 Is the Building Historically Designated: Yes NO
Occupancy Type: Owner Load: Construction Type: PV SOLAR Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder):MICHAEL F GREEN Phone#:(312) 898-9679
Address:10675 NE 11 CT
city: MIAMI
Tenant/Lessee Name:
Email: michaelfaisaigreen@gmail.com
State: FL
e#:
Zip: 33138
CONTRACTOR: Company Name: GOLDIN SOLAR LLC Phone#: 480-208-4688
nrf,irP«. 1382 NW 78 AV
City: DORAL State: FL Zip: 33126
Qualifier Name: RUBEN BLAYA Phone#: 480-208-4688
State Certification or Registration #: EC 13008547 Certificate of competency #:
DESIGNER: Architect/Engineer:
e#:
Address: City: State:
Value of Work for this Permit: $500 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/FINAL INTERCONNECTION
Specify color of color thru tile:
Submittal Fee $ Permit Fee $
Scanning Fee $ _
Radon Fee $
CCF $ co/CC $
DBPR $
Notary
Technology Fee $,
Structural Reviews $
Training/Education Fee $
Double Fee $
a-
•
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
Zi
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. 1 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 $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Sign ature��� Signature
OWNER or AGENT CONTRACTOR
The foregoing instrument vyas acknowledged before pm,e this
r ` 2 day of Y 20 l ! by
C 644Li 1 ri-n, who is personally k�no^n to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
The foregoing instrument was acknowledged before me this
�f day of h 20 , by
1 ft'1 *k who is personally vw known to
me or who has produced as
identification and who did take an oath.
NOTARY
Sign:
Print:
a M #$A)
Sign:_
Print:
Seal:=Notate
of Florida
d GoldmanGG
Seal:
22635522
�I� I��
APPROVED BY
I
Plans Examiner
Oc&� Notary Public State of Florida
Steven Howard Goldman
My Commission GG 226355
Expires 06/07/2022
(JIw
Zoning
Structural Review Clerk