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EL-16-1497 (2) Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-259974 Permit Number: EL-5-16-1497 Scheduled Inspection Date: July 15,2016 Permit Type: Electrical - Residential Inspector: Devaney, Michael Inspection Type: Final Owner: STEFAN, HELEN Work Classification: Solar Job Address:54 NW 92 Street Miami Shores, FL Phone Number 3051756-0222 Parcel Number 1131010170190 Project: <NONE> Contractor: CUTLER BAY SOLAR SOLUTIONS Phone: (786)457-5958 Building Department Comments INSTALLING SOLAR PANELS TO THE ROOF TO POWER infractio Passed Comments THE HOUSE INSPECTOR COMMENTS False Inspector Com Passed 121 Failed Correction Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. July 14,2016 For Inspections please call: (305)762-4949 Page 8 of 26 R 40, Miami Shores Village �. � � a�l _ 10050 N.E.2nd Avenue NW it W Miami Shores,FL 33138-0000 Phone: (305)795-2204 ` issul� 5 9 Expiration: 12119/2016 ���., . Project Address Parcel Number Applicant 54 NW 92 Street 1131010170190 Miami Shores, FL Block: Lot: HELEN STEFAN Owner Information Address Phone Cell HELEN STEFAN 54 NW 92 ST. 305/756-0222 MIAMI SHORES FL 33150 Contractor(s) Phone Cell Phone Valuation: =9,800.00CUTLER BAY SOLAR SOLUTIONS (786)457-5958Total Sq Fe Type of Work:INSTALLING SOLAR PANELS TO THE ROOF Available Inspections: Additional Info: Inspection Type: Classification:Residential Final Scanning:4 Review Electrical Review Electrical Review Planning Review Building Review Structural Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $6.00 DBPR Fee Invoice# EL-5-16-59984 $5.15 06/22/2016 Credit Card $491.30 $50.00 DCA Fee $5.15 Education Surcharge $2.00 05/31/2016 Credit Card $50.00 $0.00 Miscellaneous Fee $160.00 Permit Fee-Additions/Alterations $343.00 Scanning Fee $12.00 Technology Fee $8.00 Total: $541.30 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 00 S,ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing informal is c at nd that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore,I authorize the above-n d ont dolhe work stated. June 22, 2016 Authorized Signature:Owner / Applicant J ontract r / Agent Date Building Department Copy June 22,2016 1 Miami Shores a Villa ass g 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 2W-4 BUILDING (waster Permit No. f-:- L,9 PERMIT APPLICATION Sub Permit No. ❑BUILDING 0 ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING MECHANICAL PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP 571, 4 CONTRACTOR DRAWINGS JOB ADDRESS: 8-2-nw 92 st City: Miami Shores County: Miami Dade Zip: 33150 Folio/Parcel#:11-3101-017-0190 Is the Building Historically Designated:Yes NO X Occupancy Type: home Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder):Helen Stefan Phone#:305-807-7337 Address:82 NW 92 st City: Miami Shores State: Florida Zip: 33150 Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: Cutler Bay Solar Solutions Phone#: 786-457-5958 Address: 8301 SW 184 LANE City: Cutler Bay State: FL Zip: 33157 Qualifier Name: Raul Vergara Phone#: 786-457-5958 State Certification or Registration#: CVC 56957 Certificate of Competency#: DESIGNER:Architect/Engineer: Juan Rodriguez-Jomolca Phone#: 786-486-9099 Address:625 SW 82 ave city. Miami State: FI Zip: 33144 Value of Work for this Permit:$9,800.00 Square/Linear Footage of Work: Type of Work: ❑ Addition 0 Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: installing solar panels to the roof .4-0 ewer ��nQ n0171� Specify color of color thru tile: /� Submittal Fee$5C)' Permit Fee$ ��• 00 CCF$ CO/CC$ Scanning Fee$ 12— °C-10 Radon Fee$ - DBPR$ Notary$ 10 Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ l TOTAL FEE NOW DUE$ `t' 1 I • 3® (Revised02/24/2014) Bonding Company's Name(if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name(if applicable) Mortgage Lender's Address City 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$2500,the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Signature OWNER or AGENT CONTRACTOR The foregoing instrument /was acknowledged before me this The foregoing instrument was acknowledged before me this 6 day of �`/ 20 by day Jof L'I���i I 20 by G'I {{TC. (CA /I who is personally known o �( � Url) who is ers n II known t J N ay • t ��� 'fir/ � • ay • me or who has produced '` 0 , (, as me or who has pr•6duced l L„ 0, as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign: Print: " f� E�� � Print: t.; ' -jellJeff Diego Seal- `.rP.• l!eSeal: .•�1��@�P��'�% COMMISSION # FF181160 ,,$a. • ��, „i`. oQ EXPIRES:December 4,2018 _ COMMISSION # FF181160 www.AARONNOTA Y.COM EXPIRES:December 4,2018 APPROVED BY Plans Examiner lJv Zoning Structural Review Clerk (ReAsed02/24/2014) CERTIFICATE OF LIABILITY INSURANCE F DATE(MM/DDmyY) 05/20/2016 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 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 CONTACT NAME- Choice One Network PHONE 305 252-1873 F4X 305 677-7112 18400 Franjo Road E-MAIL ludy@Choiceone.us Miami FL 33157 INSURERS AFFORDING COVERAGE NAIC q INSURER A: Maxum Indemnity Company 26743 INSURED INSURER B: Raluna Solar Energy Solutions Inc. INSURER : dba Cutler Bay Solar Solutions INSURER D 8301 SW 184 Lane INSURER E: Cutler Bay,FL FL 33157 INSURER F: COVERAGES CERTIFICATE NUMBER: 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 CONTRACTOR 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 TYPE OF INSURANCE ADD L SUBR POLICY EFF POLICY EXP LTA POLICY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000 A CLAIMS-MADE �OCCUR DAMAGE TO RENTED $100,000 BDG0081823-03 05/14/2016 05/14/2017 MED EXP IAny one person $5,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 X POLICY�JECT F LOC PRODUCTS-COMP/OP AGG 2000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Fa annidA ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS UMBRELLA LIAR OCCUR EACH OCCURRENCE R DED I I EXCESS LIAB CLAIMS-MADE AGGREGATE RETENTION WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $AIf es,descr be under D PTI I E.L.DISEASE-POLICY LIMIT DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) BI/PD$500 DEDUCTIBLE PER OCCURRENCE. 15404-01 Metal Dealers or Distributors-nonstructural.12362-01 Distributors-no food or drink-Not Otherwise Classified. 91581-01 Contractors-subcontracted work-in connection with construction,reconstruction,erection or repair-not buildings-Not Otherwise Classified. A.Should any of the policies be cancelled,the insurer will provide 30 days written notice to the Certificate Holder. B.HSS Holdings Corp.,and any subsidiaries are named as additional insured with respect to the General Liability policy. CERTIFICATE HOLDER CANCELLATION Village of Miami Shores SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 10050 Northeast 2nd Avenue THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores,Florida 33138 AUTHORIZED REPRESENTATIVE� � 4LI> ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD (MD +� CERTIFICATE OF LIABILITY INSURANCE DATE 06/21/2016 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(les)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 CONTACT NAME: PHONE A/C,No,Ext): 1-800-277-1620 x4800 FAX AIC,No): 727 797-0704 FrankCrum Insurance Agency,Inc. E-MAIL ADDRESS: 100 South Missouri Avenue INSURE S AFFORDING COVERAGE NAIL# Clearwater,FL 33756 INSURERA: Frank Winston Crum Insurance Co. 11600 INSURED INSURER B: FrankCrum L/C/F Raluna Solar Energy Solutions Inc.dba Cutler INSURER C: Bay Solar Solutions INSURER D: 100 South Missouri Avenue INSURER E: Clearwater FL 33756 INSURER F: COVERAGES CERTIFICATE NUMBER: 364446 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 TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSRD WVD (MMMDIYYYY) (MMIDDIYYYY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ ENTED CLAIMS-MADE OCCUR DAMAGE TO R PREMISES Ea occunenoe $ MED EXP(Any one Person) $ PERSONAL 8 ADV INJURY $ q L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY =PROJECT =LOC PRODUCTS-COMPIOP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO OWNED AUTOS SCHEDULED BODILY INJURY(Per Person) $ ONLY AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PPROPEERTY DAMAGE $ ONLY AUTOS ONLY UMBRELLA LUIB OCCUR EACH OCURRENCE $ EXCESS LIAR H CLAWS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION AND WC201600000 01/01/2016 01/01/2017 X PER STATUTE oTH- A EMPLOYERS'LIABILITY Y/N ER ANY PROPRIETORIPARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? Q N/A E.L.EACH ACCIDENT $1,000,000 (Mandatory In NH) If yea,describe under E.L.DISEASE-EA EMPLOYEE $1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Effective 04/23/2016,coverage is for 100%of the employees of FrankCrum leased to Raluna Solar Energy Solutions Inc.dba Cutler Bay Solar Solutions (Client)for whom the client is reporting hours to FrankCrum.Coverage is not extended to statutory employees. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXP RATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores Village AUTHORIZED REP-RESENTATIVE 10050 NE 2nd Ave. Miami Shores,FL 33138 ©1888-2016 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD