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PL-17-739 Psrrar N P'L 4 7 Miami Shores Village � PC 17Jlit?yam Plum lin �,ftsi e1tial 10050 N.E.2nd Avenue NE ' *Cla .srficr�t;on:Cas Miami Shores,FL 33138-0000 ' O trr7tt' faU 1�1i�`iI�C1/Ei P8 .; yrPN Ng°c Phone: (305)795-2204 �LORiDII` Issue Dat$.51 /2017 Expiration: 10/30/2017 Project Address Parcel Number Applicant 1532 NE 104 Street 1122320320370 Miami Shores, FL 33138- Block: Lot: GERARDO PINEIRO B)=ATRIZ Bi Owner Information Address Phone Celt GERARDO PINEIRO BEATRIZ 1532 NE 104 Street ------ - - -- MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone Valuation: $ 1,108.52 TRUST PLUMBING CORP (786)287-3412 Total Sq Feet: 0 Type of Work:100#GAS TANK PROPANE Available Inspections: Type of Piping: Inspection Type: Additional Info: 100#GAS TANK PROPANE Final Bond Return: Press Test Classification:Residential Scanning:1 Review Plumbing Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $1.20 Invoice# PL-3-17-63364 DBPR Fee $2.25 05/03/2017 Credit Card $ 115.70 $50.00 DCA Fee $2.25 Education Surcharge $0.40 03/17/2017 Credit Card $50.00 $0.00 Notary Fee $5.00 Permit Fee $150.00 Scanning Fee $3.00 Technology Fee $1.60 Total: $165.70 In consideration of the issuance to a of this ermit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto in stri o ormity with a plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this ermit as m responsi ili for all Work done by either myself, my agent, servants, or employes. I understand that separate permits are required for LECTRI PL BING, CHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. i OWNLc7ionand AVI : Ice t4afF a foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating constroning. Fut l I a thorize the above-named contractor to do the work stated. May 03, 2017 ed Signature Owner / Applicant / Contractor / Agent Date Building Departme t Copy May 03,2017 1 COMPANY LETTER HEAD Date: State of Florida. County of Miami Dade. Before me thus day personally appeared ALCIDES HERNANDEZ who, being sworn, deposes and says: That he or she will be the only person working on the project located at 1532 NE 104 ST Miami Shores, Florida 33138. Sworn to (or affirmed) before me this 20 day march. of 2017 by H655-000-66- 430-0 Personally know Alcides Hernandez OR Produced Identification H655-000-66-430-0 Type of identification produced Driver license VAA*VA"'o comes- v. Vollei low"wow a Print,Type or Stamp Na a of Notary Miami Shores Village ?9 e Building Department M 172017 g p -_-- 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 Z® 14 v, BUILDING Master Permit No.y [— 17 -" 'm PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL 4PLUMBING ❑ MECHANICAL F-1 PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP `! CONTRACTOR DRAWINGS JOB ADDRESS: 1.53-k VE 10V �T City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated:Yes—_NO Occupancy Type: Load: /C'onstruction Type:. Flood Zone: BFE: G� FFE: C/ OWNER: Name(Fee Simple Titleholder): '-Ap 1�ArWA Phone#:_-q®S- %W` '?, Sg-3 Address: 13 4J®I -15�0 ;57 City: 1WAod State:! Zip:3��5� Tenant/Lessee Name: Phone#: Email: yam/ /,, 2 CONTRACTOR:Company Name: r(lA / !��'7 d/`�(� �( �'TPhone#: 7•J G' �t7 -J V12 Address: ve /o City:-MI'el/`'1/ Cr�"�%(`lv,� State: �"'�®!'a�Ct'Cl Zip:_3JL15*eP ---- Qualifier Name: d&e s f�CJ'�✓1✓�> It�Z Phone#: 71-Y6 State Certification or Registration#: -4 . I C12, j __Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ 1L. `S 2. Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: 004� S IGnK P►'D i ._� �D T��1GC C �xa►Y"Qd�'� 1�- TL IZ-- (669 Specify color of color thru tile: Submittal Fee$ Permit Fee$ If ' CCF$ L' CO/CC$ __ Scanning Fee$ y Radon Fee$ `2 ' 2 S DBPR$ 2° Notary I $ _ Technology Fee$ 'U Training/Education Fee$ ` Q ® Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ (Revised02/24/2014) )VY 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_ 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. fn the absence of such posted notice, the inspection will not be approve a reinspect' ifl charged. I /) Signature _ Signature- 0 ignature OWNER or AGE T CONTRACTOR The foregoing instrument was ackno ledged beforemethis The foregoing instrument was acknowledged before me this SLI day of �0-� 120 f- , by _ �pp day of l.&Ck ,20 �� _, by .� e r r k ll"e poo,..ro who is personally known to (4(0;1411� &A440 t who is personally known to ✓�J �e� S-e as me or who has produced X655� '�� ��Vas me or who has produced L�/Lt P ----- identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign: Print: GABRIEL COLON Print: MY COMMISSION#FF911687 ry Pubk State of Fbrtda Seal: EXPIRES:AUG 23,2019 Seal: Cabanas Bonded through 1 st state insurance My t 13111M FF 9M28 APPROVED BY �'Z�'' '07Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) Prope Search Application-Miami-Dade County Page 1 of 2 OFF�CE OF THE PROPERTY APPRAISER Summary Report Generated On:3/17/2017 Property Information Folio: 11-2232-032-0370 1532 NE 104 ST ", 3 Property Address: �- Miami Shores,FL 33138-2666 E f GERARDO M PINEIRO Owner BEATRIZ C BORREGALES MALAVES Mailing Address 1532 NE 104 ST � MIAMI SHORES,FL 33138 USA Primary Zone 1100 SGL FAMILY-2301-2500 SQ 0101 RESIDENTIAL-SINGLE r Primary Land Use FAMILY: 1 UNIT i k Beds!Baths/Half 3/3/0 a Floors 1 .,.. i r Living Units 1 Actual Area 3,197 Sq.Ft Living Area 2,210 Sq.Ft Taxable Value Information Adjusted Area 2,643 Sq.Ft 2016 2015 2014 Lot Size 8,850 Sq.Ft County Year Built 1970 Exemption Value $0 $0 $50,000 Taxable Value $394,542 $358,675 $250,872 Assessment Information School Board Year 2016 2015 2014 Exemption Value $0 $0 $25,000 Land Value $309,729 $270,112 $177,194 Taxable Value $489,164 $449,129 $275,872 Building Value $171,795 $173,169 $169,509 City XF Value $7,640 $5,848 $5,930 Exemption Value $0 $0 $50,000 Market Value $489,164 $449,129 $352,633 Taxable Value $394,5421 $358,6751 $250,872 Assessed Value $394,542 $358,675 $300,872 Regional Exemption Value $0 $0 $50,000 Benefits Information Taxable Value 1 $394,542 $358,675 $250,872 Benefit Type 2016 2015 2014 Save Our Homes Assessment $51,761 Sales Information Cap Reduction Previous Sale Price OR Book-Page Qualification Description Non-Homestead Assessment Cap Reduction $94,622 $90,454 12/29/2011 $415,000 27949-3710 Qual by exam of deed Homestead Exemption $25,000 07/01/2005 $720,000 23704-2788 Sales which are qualified Second Homestead Exemption $25,000 08/01/1999 $246,000 18739-4293 Sales which are qualified Note:Not all benefits are applicable to all Taxable Values(i.e.County, 04/01/1987 $131,500 13258-3654 1 Sales which are qualified School Board,City,Regional). Short Legal Description 32 52 42 RIVER BAY PARK ADD PB 40-72 LOT 16 BLK 4 LOT SIZE 75.000 X 118 OR 18739-4293 08 1999 1 http://www.miamidade.gov/property search/ 3/17/2017 M!ami Shores V rrrr nmr� Building Department �Cppl 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305)795.2204 Fax: (305)756.8972 Notice to Owner— Workers' Compensation 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 contractor's company for day labor,part-time employees or subcontractors. BY SIGNING BELOW YOU A OWLED THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature: Owner State of Florida County of Miami-Dade �1 The foregoing was acknowledge beef,ore me this 1� day of 1'1,A r C�_,20 1- . By �"z►'C4r ® MIA Cn 1"i n C I V-0 who is personally known to me or has produced ' b identification Notary: ;,.`y;:::Pian Y.aNADY PRILTO MY COIMMISSIONI FF 214031 SEAL: EXF:RES:March 25,2019 Bended hru Moir'?ub';c a deiwmers '.e 1 .tYA'Y .5 _—�,.X_-vim—r•- - STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD CFC 1429183 The PLUMBING CONTRACTOR a Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2018 HERNANDEZ, ALCIDES _ TRUST PLUMBING CORPF 19320 NW 19TH AVENU - - MIAMI GARDENS —FL-t-30'60 `< { ISSUED: -08/2t12046 `DISPLAY-AS REdUIR'E€-B -LAW . ' SEO# L1608210002936 Local Business TexReceipt Miai-Dade County, State of Florida12 —THIS IS NOTA 611.1—DO NOT PAY L3 7178947 $USI USS NAMIJLOCATION RECEIPT NO. EXPIRES TRUST PLUMBING CORP RENEWAL SEPTEMBER 30, 2017 19320 NW 19 AVE 7459164 Must be displayed at place of business MIAMI GARDENS, FL 33066 Pursuant to County code Chapter SA-Art. 9& 10 C SEC. TYPE OF BUSINESS OWNER PAYMENT R#CrAVED TRUST PLUMBING CORP 196 PLUMBING; BY TAX COLLECTOIR CIO ALCIDES HERNANDEZ PRES CONTRACTOR 45.00 09/2'612016 Worww 1 CFC1429183 0200-16-0039461 This Local Business Taut Re only coirnm payment of 60 Local Bauji s Tauc.1'h*R Ipt is aot a<tnce permit,or a certiBention of the boldees quafillin ions,to do busies.Holder mat,comply with any wermental or Wnpoveaarmsntal repulatoly laws and mpirgmeab Which apply to the bud. The REC�PT N0.abm displayed on all cummemiarl vehicieic—M da - IMIAM Forum*infonnatian,visit 703/13/2017 (MMMD/YYY'0 c ® CERTIFICATE OF LIABILITY INSURANCE 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 polloy(les)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 endomement(s). PRODUCER NANTTE C NANCY MOORE NYM SOLUTIONS INC DBA NYM INSURANCEPHONE FAX ,Extis 305 644 9177 1 A/C No):305 644 9178 1250 NW 7TH ST,SUITE 201 EMAIL MIAMI,FL 33125 ADDRESS: INSURER(S) AFFORDING COVERAGE MAIC# INSURER A:ARCH SPECIALTY INSURANCE COMPANY INSURED TRUST PLUMBING CORP INSURER 9: COMMERCE AND INDUSTRY INSURANCE COMPANY 19320 NW 19AVE INSURER C: MIAMI GARDENS,FL 33056 INSURER D: INSURER E: 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 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. I�jR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER PMD EXP MfDDDY EFF PLIMITS GENERAL LIABILITY EACH OCCURRENCE $1,000,000 E O RENTS X COMMERCIAL GENERAL LIABILITY [T r PREMISES Ea occurrence $100,000 CLAIMS-MADE 1-1OCCURI MED EXP(Any one person) $5,000 A AGL0043528 12/05/2016 12/05/2017 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $1,000,000 POLICYF7 PRO LOC $ AUTOMOBILE LIABILITY r_ F_ COMBINED SINGLE LIMIT Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident UMBRELLA LIAB X OCCUR FX EACH OCCURRENCE $ 2,000,000 B X EXCESS LIAB CLAIMS-MADE EBU027083483 02/03/2017 12/05/2017 AGGREGATE $ 2,000,000 ri—DED 500 RETENTION$ PRODUCTS-COMP/OP AGG $ 2,000,000 WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY T LIMITS ANY PROPRIETORIPARTNER/EXECUTIVE YIN N/A E.L.EACH ACCIDENT $ OFFICE/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under F_ E.L.DISEASE-POLICY LIMB $ I DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) COMMERCIAL AND RESIDENTIAL PLUMBING CERTIFICATE HOLDER CANCELLATION Miami Shores Village SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Building Department THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 10050 N.E.2nd Avenue, ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores,Florida 33138 AUTHORIZED REPRESENTATIVE ,�I'1�;cJiJ ©1888-2010 ACORD CORPORATION. All rights reserved. ACORD 26(2010/05) The ACORD name and logo are registered marks of ACORD Wla'.,ox. JEFF ATWATER CHIEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS'COMPENSATION **CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS'COMPENSATION LAW CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers'Compensation law. EFFECTIVE DATE: 12/7/2016 EXPIRATION DATE: 12/7/2018 PERSON: HERNANDEZ ALCIDES FEIN: 471247000 BUSINESS NAME AND ADDRESS: TRUST PLUMBING CORP 19320 NW 19 AVE MIAMI GARDENS FL 33056 SCOPES OF BUSINESS OR TRADE: LICENSED PLUMBING CONTRACTOR Pursuant to Chapter 440.05(14),F.S.,an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section may not recover benefits or compensation under this chapter.Pursuant to Chapter 440.05(12),F.S.,Certificates of election to be exempt...apply only within the scope of the business or trade listed on the notice of election to be exempt.Pursuant to Chapter 440.05(13),F.S.,Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if,at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate.The department shall revoke a DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS?(850)413-1609 Miami Shores Village Building Department 10050 N.E. 2nd Avenue Miami Shores, FL 33138 Tel: 305-795-2204 Fax: 305-756-8972 11/16/2015 1532 NE 104 Street Miami Shores, FL 33138- RE: Process No-PL-4-12-689 Address: 1532 NE 104 Street Dear Owner, Our records indicate that the above referenced permit has expired without obtaining the proper permit approval. In order to serve you better, we need to keep our files up to date. As per section 105.3.2 of the Florida Building Code, "An application for a permit for any proposed work shall be deemed to have been abandoned 180 days after the date of filling, unless such application has been pursued in good faith or a permit has been issued." Please be advised that open permits will hinder your ability to refinance or sell this property. Please contact the Building Department,within 15 days of receipt of this letter in order to take care of this matter. Sincerely, C—� ,l ) f r /, Ismael Naranjo, CBO Building Department Official 305-795-2204 Miami Shores Village Building Department 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 APRT 17 2 1 Tel:(305)795.2204 Fax:(305)756.8972 BUILDING Permit No. PERMIT APPLICATION Master Permit No. FBC 2004 Permit Type(circle): Building Electrical Plumbing Mechanical Roofing Owner's Name(Fee Simple Titleholder) Phone# � � 5' —� 79 Owner's Address City .J State , Zip Tenant/Lessee Name Phone# Job Address(where the work is being done) / /0�"/- city Miami Shores Villaee County Miami-Dade Zip FOLIO/PARCEL# Is Building Historically Designated YES NO Contractor's Company Name Phone# Contractor's Address ;2 —� City 7 State__r1- . Zip f ' Qualifier Name "nZZ, Phone# State Certificate or Registration No. Z Certificate of Competency No. Architect/Engineer's Name(if applicable) Phone# Valu r this P /� �'�1�� � S are/L��1~'pe Of Wgr �,.•",y W1214 to OWS-ait*A yes ` €bi4 +r©stoz-N400 VTVGH I a 2 rdi.It flu 4510Klw �.tntizo3 � .�� vas.r r 1a0 0�1e*3 ertr►oo lid QAlteration �T arr/R:ae„p Q Demolition es rte or Submittal Fee$ Permit Fee$ CCF$ CO/CC Notary$ Training/Education Fee$ Technology Fee$ Scanning$ Radon$ DPBR$ Zoning$ Bona$ Code Enforcement$ Double Fee$ Structural Review.$ Total Fee Now Due$ See Reverse side-� 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 ELECTRICAL WORK, PLUMBING, SIGNS, WELLS,POOLS,FURNACES,BOILERS,HEATERS,TANKS.and 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, TH CONSULT WIYOUR 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$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien.law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notide of commencement must be posted at the job site for.the first inspection which occurs seven (7) days after the building permit is issued In the absence o such posted notice, the inspection will not be approvM and a reinspection fee will be charged Signature ` Signature Owner or Agent Contractor The foregoing instrument was acknowledged before me this 1-7 The foregoing instrument was acknowledged before me this day of 20 12 by f�,U y" �q2�, day of 20 /a�'i` , b Y who is personally known to me or who has produced ,�•Z who is personally known to me or who has produced 10 40 76 As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: ••. REfNA E OMON `$ •. RENA E SMON . Notery Public-State of FWWa no"Public-Sto of Honda Sign: "% -� . My Conus.Egdm Oct 11,2015 Sign: s My Comm.EVUN Oct 11.2015 a,, �� �� > 7317 Print: `or' P rint: ✓d My Commission Expires: My Commission Expires: APPLICATION APPROVED BY: Plans Examiner Engineer Zoning (Revised 02/08/00 Florida Department of Agriculture and Consumer Services Bureau of Liquefied Petroleum Gas Inspection P.O. Box 6720 Tallahassee, Florida 32399.6720 License Number: 15520 Business Mailing Address Licensed Location Address 4 1 U`= G.AS 1)ISTRIBUT10N.LLC BLUE GAS DISTRIBUTION,LLC Dg.a BLUE GAS PROPANE-BLUE GAS PLUMBING DBA BLUE GAS PROPANE-BLUE GAS PLUMBING 1234 NW 79TH ST 1234 NW 79TH ST FL 33147-8212 MIAMI,FL 33147-8212 The iiquefied petroleum gas license at the bottom of this form is valid ONLY for the company located at the address on the license. Each business location of a company must be licensed. All LP Gas licenses must be e,leweo annually. Any license aiiowed to expire shall become inoperative because of failure to renew. The ,'ee for restoration of a license is equal to the original license fee and must be paid before the licensee may -esume operations tJ THE fE EVENT OF AN OWNERSHIP CHANGE AT THIS BUSINESS LOCATION: This license may be �arlsfen ed to any person, firm or corporation for the remainder of the current license year upon written request to the department by the original license holder. License transfers must be approved by the department. All licensing requirements must be met by the transferee and a transfer fee of$50 will apply. To apply for a Transfer,contact the Bureau of LP Gas Inspections at(850)921-1600. Pursuant to Chapter 527. Florida Statutes. LP Gas licensees must present proof of licensure to any consumer, owner, or end user upon request when engaged in the business of servicing,testing, repairing, maintaining or In:tallinn LP Gas systems and/or equipment. �cr futjre correspondence, please make any needed corrections or changes to your business mailing address and/or your licensed locution address and return the UPPER PORTION with corrections to: Florida Department of Agriculture and Consumer Services Bureau of Liquefied Petroleum Gas Inspection P.O. Box 6720 Tallahassee, Florida 32399-6720 __ - --- - - - Cut Here State of Florida :77, . De attmlent of Agriculture and Con S>?::4!er Se3'`1lvL'� A! `F` Division of Standards License Number: 15520 Bureau of Liquefied Petroleum Gas Inspection Expiration Date: August 31,2012 (850) 921-1600 Date of Issue: September 1,2011 POST LICENSE License Fee: $425.00 CONSPICUOUSLY Tallahassee, Florida Type and Class: 0601 Liquefied Petroleum Gas License CATEGORY I LP GAS DEALER GOOD FOR ONE LOCATION ONLY ANY CHANGE OF OWNERSHIP OR SALE OF THIS BUSINESS RENDERS THIS LICENSE INVALID This license is issued under authority of Section 527.02,Florida Statutes,to: BLUE GAS DISTRIBUTION, LLC DBA BLUE GAS PROPANE - BLUE GAS PLUMBINII 1234 NW 79TH ST ADAM H.PUTNAM MIAMI, FL 33147-8212 COMMISSIONER OF AGRICULTURE a Florida Department of Agriculture and Consumer Services Bureau of Liquefied Petroleum Gas Inspection 3125 Conner Boulevard, Suite N Tallahassee, Florida 32399-1650 Master Qualifier Mailing Address Licensed Location Address CECILIA MARTINEZ BLUE GAS DISTRIBUTION, LLC BLUE GAS DISTRIBUTION. LLC 1234 NW 79TH ST 1234 NW 79TH ST MIAMI, rL 33147-8212 MIAMI, FL 33147-8212 Certificate Number License Number 27863 15520 This Master Qualifier Certificate is issued pursuant to Chapter 527, Florida Statutes. This certificate is valid only for the person and licensed holder listed. Any changes to the Master Qualifier status (such as transfer or termination of employment) must be reported to the Bureau of LP Gas Inspection at (850) 921-1600 immediately. The Master Qualifier Certificate is valid only through the date noted on the Certificate. A notice of renewal will be sent to you in advance of your expiration date. A Master Qualifier Certificate may be renewed if certification of a minimum of 12 (twelve) hours continuing education is provided along with the renewal form. If training cannot be documented, an examination must be taken. If there are any errors on the certificate, please submit all changes in writing to: Bureau of Liquefied Petroleum Gas Inspection 3125 Conner Boulevard, Suite N Tallahassee, Florida 32399-1650 ------------------------ Cut Here -------------------------- �'� State of Florida Department of Agriculture and Consumer Services Division of Standards Certificate No: 27863 - __���= Bureau of Liquefied Petroleum Gas Inspection Exam Date: June 8,2011 (850) 921-1600 Issue Date: July 15,2011 Tallahassee Floridaxpiration Date: July 14,2014 Duda Exam: 0601 MASTER QUALIFIER CERTIFICATE This Certificate is issued under authority of Section 527.02, Florida Statutes,to: CECILIA MARTINEZ Valid For License Number: 15520 BLUE GAS DISTRIBUTION,LLC 1234 NW 7STH ST MIAMI,FL 33147-8212 ADAM H.PUTNAM COMMISSIONER OF AGRICULTURE 2011 LOCAt FIRST-CLASS TA MIA MMADE US.POSTAGE FLAC ST, E.x PAID MUST E u WAM9,fl-33.14" MIAMI.FL U� ." PERU -r10.xis 63&j82- l `4 ';;�s RENEWAL .,, F%--Xi'MiAffNG STATE S 501976-5 1234 NW 79 ST 3-3147 LININ MADE COUNTY BLUE GAS DISTRIBUTION LLC 2t aE"Lk'� MER 1 MFG DO NOT FORWARD CIS BLUE GAS PLUMBING Pte:ca STEVEN SSTERNECK PRES 1234 NW 79 cT MIAMI FL 333.47 60030000181 . �OEsl:;i�f2011 H0450.00 th46�tti #i8@&$1; 01? Sild$t9 19l i E>t1�43U1 t:Sti tit 8$'�'df"{� ,_Ef ;DTHER SIDE 9 a ^ CERTIFICATE OF LIABILITY INSURANCE112/0812011 DATE(MAA/DDIYYYY) kft R 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 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 it lieu of such endorsement(s). PRODUCER CONTACT Billie Tucker Jamerson McLean Corporation PHONE 407-366-3482 F IC .407-366-8508 P.O.Box 621149 E-MAIL . billle@jmcleaninsurance.com 825 Executive Drive PRODUCER Oviedo FL 32762 INSURERS AFFORDING COVERAGE MAIC INSURED INSURER A: AIX Specialty Insurance Company 12833 Propane USA Distribution,LLC,Blue Gas Distribution,LLC INSURER B: NOVA Casualty Company 42552 _ dba Blue Gas Plumbing dba Blue Gas Propane INSURER C: dba Consumer Gas Plumbing INSURER D: 1234 NW 79th Street Miami,Florida 33147 INSURER E: [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 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. INSRR TYPE OF INSURANCE DL BR POLICY MBER POLICY EFF POLICY EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $1,000,000 A X COMMERCIAL GENERAL LIABILITY LGZ-CL-0020010-1 1211112011 12111/2012 DAMAGE TO RENTED $300,000 CLAIMS-MADE Fx�OCCUR MED EXP(Any oneperson) 5,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 X I POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $1,000,000 B X ANY AUTO LGP-CL-0010009-1 12111/2011 1211112012 BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE X HIRED AUTOS (Per accident) $ X NON-OWNED AUTOS $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LLAB HCLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY Y I N rp ANY PROPRIETOR/PARTNER/EXECUTIVr--I NIA E.L.EACH ACCIDENT OFFICER/MEMBER EXCLUDED? u (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ H describeunder E RIPTION F OPE TIObe!2wL--t E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101,AddlUonal Remarks Schedule,If more space Is required) CERTIFICATE HOLDtR CANCELLATION Miami Shores Village SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 10050 NE 2 Avenue ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores,FL 33138 AUTHORIZED REPRESENTATIVE <BKG> Phone: Fax: ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD CERTIFICATE OF LIABILITY INSURANCE 11/29/2011 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). CONTACT PRODUCER WAGE: ONE 1-800-277-1620 X4800 Fax 727-797-0704 MIN FRANKCRUM INSURANCE AGENCY,INC. CRESS: 100 S.MISSOURI AVE. INSURERS AFFORDING COVERAGE NAIC# CLEARWATER FL 3375" INSURER A: FRANK WINSTON CRUM INSURANCE,INC. 11600 INSURED INSURER B! INSURER C: FrankCrum 1-800-277-1620 INSURER D: 100 S MISSOURI AVENUE INSURER e CLEARWATER FL 33756 INSURER F: COVERAGES CERTIFICATE NUMBER: 193624 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. INSRTYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EPF POLICY EXP LIMITS INSR VIVO (MMIDDA-" (MWOONYYY) GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES(Ea occune $ CIAIMS.MADE =OCCUR MED EXP(ARY one peason $ PERSONAL&ADV INJURY $ GENERAL.AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ POLICY PROJECT LOC- $ COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY (Ea aecideno $ ANY AUTO BODILY INJURY(Per person) $ ALLOWNED SCHEDULED BODILY INJURY(Per accidenl) AUTOS AUTOS $ NON-OWNED PROPERTY DAMAGE HIREDAUTOS AUTOS (Peracelderd) $ $ UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS LIlB CLAIMS-MADE AGGREGATE $ _ OED I RETENTIONS $ WORKERS COMPENSATION AND WC2O12�000 1/1/2012 1/1/2013 WC A X TORYY LIMITS ER ER EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE E.L.EACH ACCIDENT $1 OOO OOO OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) Ifyes,describeunder E.L.DISEASE•EA EMPLOYEE $1,000,000 DESCRIPTION OF OPERATIONS below EI DISEASE.POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,M more space is required) EFFECTIVE 1111712008,COVERAGE IS FOR 100%a OF THE EMPLOYEES OF FRANKCRUM LEASED TO BLUE GAS DISTRIBUTION,LLC DBA CONSUMER GAS PLUMBING(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 i Miami Shores Village THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN 10050 NE 2 Avenue ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Miami Shores,FL 33138 01988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD