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RC-14-225 (2)r �L BUILDING PERMIT APPLICATION Miami Shores Village Building Department SAY 1 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 20 Master Permit No. C- ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑PLUMBING ❑ MECHANICAL [:]PUBLICWORKS JOB ADDRESS: 112 NE 110 STREET Sub Permit Nr ❑ REVISION ❑ EXTENSION ❑ RENEWAL CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS City: Miami Shores County: Miami Dade Zip: Z 5161 Folio/Parcel#:1121360040410 Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): KELLY JANET Phone#: 305-759-5655 Address: 112 NE 110 ST City: MIAMI SHORES State: FL Zip: 33161 Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: CENTRAL FLORIDA SOLAR INC Phone#: 407-767-6527 Address: 980 SUNSHINE LANE STE R City: ALTAMONTE SPRINGS State: FL Zip: 32714 Qualifier Name: WILLIAM F PARK Phone#: 407-767-6527 State Certification or Registration #: CVC056645 Certificate of Competency #: DESIGNER: Architect/Engineer: RC ENGINEERING INC Phone#: 407.444.9181 Address: 2381 CREST RIDGE CT City: SANFORD State: FL Zip: 32771 Value of Work for this Permit: $1.00 Square/Linear Footage of Work: 144 Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: CHANGE OF CONTRACTOR TO OBTAIN FINAL BUILDING INSPECTION FOR PERMIT# RC -2-14-225 SOLAR PANELS ROOF MOUNTED Specify color of color thru tile: Submittal Fee $ �EllPermit Fee $ 4S `� CCF $ CO/CC $ Scanning Fee $ Technology Fee Structural Reviews $ (RevisedO2/24/2014) Radon Fee $ Training/Education Fee $ DBPR $ Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ , Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City Zip State 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 ----------- - 2-° _ - OWNER or AGENT i The foregoing instrument was acknowledgedbeforeme this day of O'� - 20 k5 , by _P T' ""--7 k5 , who is personally known to me or who has produced /7��°— as identification and who did take an oath. NOTARY PUBLIC: ,°�pvt�I�Ekll�a rig Sign: % Signature Cf, r CONTRACTOR The foregoing instrument was acknowledged before me this day of MA -1 , 20 1' , by WILLIAM r-. PARK ,who' personally known o me or who has produced identification and who did take an oath. NOTARY PUBLIC: Sign: AM r.- I)Q• W k ti/O� as Print: c����T_ Print:LNIM DAMNS Seal: , %Ng1 ' ��?� ��' Seal: NOTARY PUBLIC Ax a�nl� ° STATE OFFLORIDA ���rUrrr V I I I � . Comm# FF004980 ti�\� E*m 41M17 .� APPROVED BY Flans Examiner Zoning Structural Review Clerk (Revised02/24/2014) Miami shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. COPY OF QUALIFIER'S STATE LICENCES B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF LIABILITY INSURANCE* D. COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER Affidavit) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICATE OF COMPETENCY OF QUALIFIER B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF STATE REGISTERED CONTRACTOR LICENSE OR MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT. D. COPY OF LIABILITY INSURACE* E. COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER Affidavit) *YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE AS FOLLOW: Certificate Holder: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 Certificate must specify the description of operations or contractor license number. ............................................................................................ BUSINESS NAME: 6 E N flZk L FtioPI DA 5 O t kt'L j 1 I-AC,. BUSINESS ADDRESS: Olf0 SU K5M NE ONE, CITY NAIkHO"C)f STATE ZIP 3271 y - BUSINESS PHONE:q( 6 ) -110'1 • X21 FAX NUMBER (401 )7(oZ - (y"J?-A CELL PHONE( D1 ) q41-01640 QUALIFIER'S NAME: QUALIFIER'S LIC NUMBER: GJG 0 c -;(p tP44 CERTIFICATE OF LIABILITY INSURANCE DATE MI°DIYYYY) 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 pollcy(les) must be endorsed. If SUBROGATION IS WANED, 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(al. PRODUCER Blackadar Insurance Agency, Ina 1436 N Ronald Reagan Blvd Longwood FL 32750 INSURED CENTFLO-23 INsuRER a Floridausin Ind Central Florida Solar, Inc INSURER C: 980 Sunshine Lane INSURER D: Ste R Altamonte Springs FL 32714 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 1863033471 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 NTH 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. I`TRR TYPE OF INSURANCE AWL B POLICY NUMBER POLICY EFF POLICY EXP LIMITS Miami Shores FL 33138 GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE a OCCUR X XCU Induded 60391457 512015 315=116 EACH OCCURRENCE $1,000,000 DAMAGE TO ROM PREMISES (Ea oc erre ce $100,000 MED EXP one person $5,000 PERSONAL & ADV INJURY $1 000,000 X Contractual Liab GENERAL AGGREGATE $2,000,000 GERI. AGGREGATE LIMIT APPLIES PER POLICY KimLOC PRODUCTS - COMP/OP AGG $2,000,000 $ AUTOMOBILE X LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS 60391457 /5/2015 31512016 COMBINED SINGLE LIMIT accident$1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Per $ UMBRELLA Ld40OCCUR EXCESS LIAR HCLAIMS-MADE EACH OCCURRENCE $ AGGREGATE $ DED 1. 1 RETENTION $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETORIPARTNER/EXECUTIVE OFFICERIMEMSER EXCLUDED? El (Mandatory In NH) It yy8� describe order DESG�RIPTION OF OPERATIONS below N / A 10641525 1/2015 V112016 X Z" OTH- EL EACH ACCIDENT $500,000 EL DISEASE -EA EMPLOYEE $500,000 EL DISEASE - POLICY LIMB $500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remaft Schedsls, H mons space is required) State License Number CVC056645 & EC13006341 CERTIFICATE HOLDER CANCELLATION ©198&2010 ACORD CORPORATION. All rights reserved. ACORD 26 (2010105) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Shores Village ACCORDANCE WITH THE POLICY PROVISIONS. Building Department 10050 N.E. 2nd Ave. AUTHORIZED RJeMSENTATIVE Miami Shores FL 33138 ©198&2010 ACORD CORPORATION. All rights reserved. ACORD 26 (2010105) The ACORD name and logo are registered marks of ACORD v u-•• � yr • r.ro�• DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD LICENSE` NUMBER The SOLAR CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2016 PARK, WILLIAM FRANCIS CENTRAL FLORIDA SOLAR INC 980 SUNSHINE LANE STER&S ALTAMONTE SPRINGS FL 32714 ISSUED: 07/16/2014 DISPLAY AS REQUIRED BY LAW SEQ# L1407160000572 BUSINESS TAX RECEIPT Provision: Ordinance No. 1570-07 Business Control 0027881 No., Business Name: CENTRAL FLORIDA SOLAR INC WILLIAM F PARK PRESIDENT Expires: September 30, 2 015 Business 980'SUNSHINE LN R Address: AL'IAMONTE SPRINGS FL 32714 RECEIPT NO. CLASS DESCRIPTION FEE PENALTY 15-00109519 SERVICE/REPAIR-ALL OTHERS NOT SPECIFIED : $ 90.30 $ 0.00 15-00109521 SEMINOLE COUNTY REGULATED `` $ 45,00 $ 0.00 . 15-00109557 CONTRACTORS -ALL OTHERS- STATE LICENSE $120.75 $ 0.00 Restriction t " t21Vt. LICENSE CLAW D; �iTON 3$2� AN BEACH BLVD APT COCOA BEACH, FL 32931-3403 noo 44-20-1956 aEx M 11, 5-09 ISSUED 02-25-2009 Fxs 04-20-2f REST,A ENDORSE mv /f, aqol-5� Az so A, �,r4ejy �n5& (,1e trjl'/ PC, fl� Doe-, 3277/ 7o s�a�r e f7�rzr�a d/� z-/�-225 dh� /dl�Qmi s�?orc�s Ad'e �Jui�c�Iq� �PPC�/f1; our Se�vrces Grave 1�em �errar%sr�-�f /l z n/E Bio .sf-Y 33i�/ MAY 2 2 015 1250 Central Park Dr. sanford,FL 32771 Phone: 877 -503 -HEAT May 19,2015 Central Florida Solar, Inc. Attn: Michele Frazier 980 Sunshine Lane, Suite R Almonte Springs, FL 32714 RE: Parcel Number:1121360040410,Permit number Rc-2-14-225 Janet Kelly 112 NE 110th Street,Miami Shores, FL 33161-4046 Dear Ms.Frazier: This letter is to confirm that we have closed the business that handled the referenced permit for Janet Kelly. We will be unable to update the contractor license and insurance information but have no objections to having William F. Park, Central Florida Solar,lnc. assist Ms. Kelly with the change of contractor to obtain the remaining building inspection "final'. Thank You, Shane Ackerman Acknowledged Sworn to and subscribed before me on thiDay of015 Who is personally known to me/who produced L As identification and who did not take oath. State of a County ofD� SAFOAH ABUGAZALEH Notary Public - State of Florida My Comm. Expires Apr 22, 2018 Commission # FF 115262 UNITED STATES POSTAL SERVICE First-class MqjI Postage & Fees Paid USPS Permit No. G-10 • Sender. Please print your name, address, and ZIP+4® in this box' J, -4"f, 7- A'-O't4�y ■ Complete Items 1, 2, and 3. Also complete Item 4 if Restricted Delivery Is desired. ■ .Priint your name and address on the reverse so that we can return the card to -you. ■ Attach this card to the back of the mallpiece, or on the front if space permits. 1. Article Addressed to: s7�77,a /Z,&z OtFwrew ,]RUN A SI e 13 Agent X J06 ❑ Addressee ®dnte e) Darejoir �De rCeSr� D. Is delivery address different from item 1? E3 Yes !I If YES, enter delivery address below: C3 No 3. Service Type AT i�� 005 i certified Made 13 Priority Mail Expre"° registered 0 Retum Receipt for Merchandise C3 insured Mail C3 Collect on Delivery 4. Restricted Delivery? (Extra Fee) C3 Yes 2. Mote Number 70114 3490 0002 0810 7794 (11ansfer from service labeq { PS Form $811, July 2013 _ Domestic Return Receipt 1,