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EL-11-20-2621, 735 NE 94th StMiami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Location Address Parcel Number 735 NE 94TH ST, Miami Shores, FL 33138 1132060141990 Contacts STEPHEN ICHNIOWSKI Owner Mobile: 4436324934 TITAN SOLAR POWER FL INC Contractor SCOTT PORTIER Business:3053896017 DIEUNE@TITANSOLARPOWER.COM Description: ROOF TOP SOLAR Valuation: 839.00 Inspection Requests: P $ 25, s{� /i a a Total Sq Feet: 0.00 v Fees Amount CCF $15.60 DBPR Fee $13.57 DCA Fee $9.04 Total: $38.21 Applicant Copy Payments Date Paid Amt Paid Total Fees $38.21 Credit Card 12/31/2020 $38.21 Amount Due: $0.00 For Inspections, Call (305) 762-4949 or Log on at https://bidg.miamishoresvillage.com/cap/. Requests must be received by 3pm for following day inspections. NOTICE: In addition to the requirements of this permit, there may be AND THERE MAY BE ADDITIONAL PERMITS REQUIRED FROM OTHER additional restrictions applicable to this property that may be found in the GOVERNMENTAL ENTITIES SUCH AS WATER MANAGEMENT DISTRICTS, public records of this county. STATE AGENCIES, OR FEDERAL AGENCIES. December 31, 2020 Page 1 of 2 Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Location Address Parcel Number 735 NE 94TH ST, Miami Shores, FL 33138 1132060141990 Contacts STEPHEN ICHNIOWSKI Owner TITAN SOLAR POWER FL INC Contractor SCOTT PORTIER Mobile: 4436324934 Business:3053896017 DJEUNE@TITANSOLARPOWER.COM Description: ROOF TOP SOLAR Valuation: $ 25,839.00 Inspection Requests Total Sq Feet: 0.00 E y Fees Amount CCF $15.60 DBPR Fee $13.57 DCA Fee $9.04 Total: $38.21 Building Department Copy Payments Date Paid Amt Paid Total Fees $38.21 Credit Card 12/31/2020 $38.21 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 accurat and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore, I authorize the above named on roor to do the work stated. Authorized Signature: Owner / Applicant / Contractor / Date December 31, 2020 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 FBC 2pp0t') BUILDING Master Permit No. F-L` 11-710'—aLl PERMIT APPLICATION Sub Permit No. ❑BUILDING IV( ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOBADDRESS: 735 NE 94 ST MIAMI SHORES, FL 33138 City: Miami Shores County: Miami Dade Zip: Folio/Parcel#:11-3206-014-1990 Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder):STEPHEN ICHNIOWSKI Phone#: Address.. 735 NE 94 ST City: MIAMI SHORES State: FL Zip: 33138 Tenant/Lessee Name: Email: steve.ichniowski@gmail.com Phone#: (443) 632-4934 N ii (�L Ti -tom 5 OL41-e— Po -or L , t oe� CONTRACTOR: Company Name: TITAN SOLAR POWER FL Phone#: 305-389-6017 Address: 12221 N US HIGHWAY 301 TAMPA FL 33592 City: MIAMI SHORES State: FL Zip: 33592 Qualifier Name: SCOTT PORTIER Phone#: 305-389-6017 State Certification or Registration #: EC13009924 Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: Value of Work for this Permit: $ 25839 Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace Description of Work: ROOF TOP SOLAR Specify color of color thru tile: Submittal Fee $ Permit Fee $ Scanning Fee $ Radon Fee $ Technology Fee $ Training/Education Fee $ Structural Reviews $ CCF $_ DBPR $ M ❑ Demolition CO/CC $ Notary $ Double Fee $ Bond $ (Revised02/24/2014) TOTAL FEE NOW DUE $ :3 48 - 2-1 Ci R,onding 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 Signature ole� Z_d__ NER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrumet as acknowledged before me this �q day of ��� 20 0 by Z gWiday of �� I 20 7X by e e 6e hti is personally known to C d2j & �, who is personally known to me or who has produced �li �� as me or who has produced :) L as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: ************** PHILLIP SORIANO State of Florida -Notary Publ E Commission # GG 931627 My Commission Expires Ncve>mhar 13 M71 identification and who did take an oath. NOTARY PUBLIC: **************** APPROVED BY49kz Plans Examiner Aln IV Structural Review OAP"Ey CIVIL- ,EUh Notary Public - state or FiGri �y omm. Expires Oct 1, 1024 . Bonded through NatiOnal NOt?ry Assr. _ Zoning Clerk (Revised02/24/2014) 0 Ron DeSantis, Governor STATE OF FLORIDA Halsey Beshears, Secretary d F�ondpr DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD THE ELECTRICAL CONTRACTOR HEREIN IS CERTIFIED UNDER THE PROVISIONS OF CHAPTER 489, FLORIDA STATUTES PORTIER, SCOTT ALAN TITAN SOLAR POWER FL INC 12221 N US HWY 301 THONOTOSASSA FL 33592 LICENSE NUMBER: EC13009924 EXPIRATION DATE: AUGUST 31, 2022 Always verify licenses online at MyFloridaLice nse.com Do not alter this document in any form. This is your license. It is unlawful for anyone other than the licensee to use this document. ACCOUNT NO. 2020 - 2021 HILLSBOROUGH COUNTY BUSINESS TAX RECEIPT EXPIRES SEPTEMBER 30, 2021 43400 OCC.CODE RENEWAL 090.008002 ELECTRICAL CONTRACTOR 1 Employees Receipt Fee 18.00 Hazardous Waste Surcharge 0.00 Law Library Fee 0.00 EC13008093 BUSINESS TITAN SOLAR POWER FL INC 12221 N US HWY 301 THONOTOSASSA, FL 33592 Uffa Z 0 AZ U Z 1 NAME TITAN SOLAR POWER FL INC MAILING 12221 N US HWY 301 ADDRESS THONOTOSASSA, FL 33592 Paid 19-0-399181 07/17/2020 18.00 BUSINESS TAX RECEIPT DOUG BELDEN, TAX COLLECTOR HAS HEREBY PAID A PRIVILEGE TAX TO ENGAGE 813-63"200 IN BUSINESS, PROFESSION, OR OCCUPATION SPECIFIED HEREON THIS BECOMES A TAX RECEIPT WHEN VALIDATED. _A C E® �`i CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 11/11/2020 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Lovitt & Touche A Marsh and McLennan Agency, LLC 1050 W Washington Street, Suite 233 Tempe AZ 85281 CONTACT NAME: Deb Streeter Alc°NN Ext : 602-778-7005 a/c No : 480-708-0973 E-MAIL ADDRESS: dstreeter@loviff-touche.com INSURERS AFFORDING COVERAGE NAIC # INSURER A: Gotham Insurance Company 25569 INSURED PM&MELE-Cl INSURER B : New York Marine and General Insurance Co 16608 Titan Solar Power FL, Inc 525 West Baseline Road INsuRERc: Berkley Assurance Co 39462 INSURER D: Amerisure Mutual Insurance 23396 Mesa AZ 85210 INSURERE: UNITED SPECIALTY INS CO 12537 INSURER F : NORTH AMERICAN CAPACITY INS CO 25038 COVERAGES CERTIFICATE NUMBER:203737417 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE DL IN SUBR POLICY NUMBER EFF MM/DDfYYYY POLICY EXP MM/ DrPOLICY LIMITS A X COMMERCIAL GENERAL LIABILITY Y Y PK202000016453 3/10/2020 3/10/2021 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY I I PRO- LOG PRODUCTS -COMP/OPAGG $2,000,000 $ OTHER: B AUTOMOBILE LIABILITY Y Y AU202000016721 3/10/2020 3/10/2021 COMBINED SINGLE LIMIT Ea accident $ 1,000,000 BODILY INJURY (Per person) $ X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ X HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY E F UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE BTN2016243 BUN2010327 DO-X-0002444-00 3/10/2020 3/10/2020 3/10/2020 3/10/2021 3/10/2021 3/10/2021 EACH OCCURRENCE $ 5,000,000 X AGGREGATE $ 5,000,000 DED RETENTION $ $ D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANYPROPRIETOR/PARTNER/EXECUTIVE N Y WC2111454 4/1/2020 4/1/2021 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBEREXCLUDED7 N /A E.L. DISEASE - EA EMPLOYEE $ 1,000,000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 C Professional/Pollution PCAB-5011142-0320 3/10/2020 3/10/2021 Each $1,000,000 Aggregate $2, 000, 000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Certificate Holder is included as Additional Insured as respects General Liability and Automobile Liability if required in a written contract. Waiver of Subrogation applies to the General Liability, Automobile Liability and Workers' Compensation coverage if required in a written contract. The General Liability insurance is primary and certificate holder's insurance is non-contributory if required by written contract. Coverage is subject to all policy terms, conditions, definitions, exclusions, forms & endorsements. *Excess Auto Liability Policy IXG932983 03/10/20-03/10/21 General Star Indemnity Company See Attached... laK I II-IUA I t MULUtFC I.AINI-rill IUIN Miami Shores Village Building Department 10050 NE 2ND Avenue Miami Shores FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: PM&MELE-C1 LOC #: ACCMDO ® ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY Lovitt & Touche A Marsh and McLennan Agency, LLC NAMED INSURED Titan Solar Power FL, Inc 525 West Baseline Road Mesa AZ 85210 POLICY NUMBER CARRIER NAIC CODE EFFECTIVE DATE: 3 Will zi it-7 THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE Workers Compensation is covered under Florida Law License Number: Kenneth Williams, EC13008093 ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD