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PL-17-1436 PL-6-1 7-1436 Miami Shores Village el;7Nt-Type, f"Onbin -Res dential 10050 N.E.2nd Avenue NE Miami Shores,FL 33138-0000 ',�M .; Phone: (305)795-2204 Ap Issue nates 712812017Expiration: 1924/2018 Project Address Parcel Number Applicant 1301 NE 104 Street 1122320300040 Miami Shores, FL 33138- Block: Lot: DION SENA Owner Information Address Phone Cell DION SENA 1301 NE 104 ST MIAMI SHORES FL 33138-2661 Contractor(s) Phone Cell Phone Valuation: $ 3,550.00 ADVANCE EXCAVATING LLC (561)602-5354 Total Sq Feet: 0 Type of Work:INSTALL ABOVE GROUND 2 120 GAL LP T Available Inspections: Type of Piping: Inspection Type: Additional Info: Final Bond Return: Press Test Classification:Residential Scanning:3 Review Plumbing Fees Due Amo]$2.25 Pay Date Pay Type Amt Paid Amt Due CCF Invoice# PL-6-17-64144 DBPR Fee 07/28/2017 Check#:2500 $ 169.90 $0.00 DCA Fee Education Surcharge Permit Fee $Scanning Fee Technology Fee Total: $16 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. July 28, 2017 Authorized Signature:Owner / Applicant / Contractor / Agent Date Building Department Copy July 28,2017 1 Inspection Worksheet Miami Shores Village EL 11- 1433 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-283385 Permit Number: PL-5-17-1436 Scheduled Inspection Date:August 14, 2017 Permit Type: Plumbing - Residential Inspector: Hernandez,Rafael Inspection Type: Final Owner: SENA, DION Work Classification: Gas Job Address:1301 N104 treet Miami Shores,FL 33138- Phone Number Parcel Number 1122320300040 Project: <NONE> Contractor: ADVANCE EXCAVATING LLC Phone: (561)602-5354 Building Department Comments INSTALL ABOVE GROUND 2 120 GAL LP TANKS AND Infractio Passed Comments GAS PIPPING/t CONNECTIONS TO 22 KW STANDBY INSPECTOR COMMENTS False GENERATORS Inspector Comments Passed 10' Failed Correction Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. August 11,2017 For Inspections please call: (305)762-4949 Page 7 of 39 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-283384 Permit Number: PL-5-17-1436 Scheduled Inspection Date: August 14,2017 Permit Type: Plumbing - Residential Inspector: Hernandez,Rafael Inspection Type: Press Test Owner: SENA, DION Work Classification: Gas Job Address:1301 NE 104 Street Miami Shores,FL 33138- Phone Number Parcel Number 1122320300040 Project <NONE> Contractor: ADVANCE EXCAVATING LLC Phone: (561)602-5354 Building Department Comments INSTALL ABOVE GROUND 2 120 GAL LP TANKS AND Infractio Passed Comments GAS PIPPING//CONNECTIONS TO 22 KW STANDBY INSPECTOR COMMENTS False GENERATORS Inspector Comments Passed Failed Correction Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid August 11,2017 For Inspections please call: (305)762-4949 Page 6 of 39 .O � Miami Shores Village Building Department RECEIVE® 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 MAY 3 0 20V Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 206'6 BUILDING Master Permit No ,:F-(— Ldp 3 PERMIT APPLICATION Sub Permit No.P_`_ 1 F-IBUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION EJRENEWAL FM-]PLUMBING ❑ MECHANICAL DPUBLICWORKS CHANGE OF ❑CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 1301 NE 104 St. City: Miami Shores County: Miami Dade Zip: Folio/Parcel#:11 2232 030 0040 Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: AE BFE: 8 FFE: OWNER:Name(Fee Simple Titleholder): Dion Sena Phone#:305-986-8772 Address:1301 NE 104 St. City. Miami Shores State: FL Zip: 33138 Tenant/Lessee Name: N/A Phone#: Email: ItcoWner@aol.com CONTRACTOR:Company Name: Advance Excavating LLC Phone#: 561-602-5354 Address: 890 SE 5 Ct. City, Pompano Beach State: FL Zip: 33060 Qualifier Name: Keith Bikes Phone#: 561-602-5354 State Certification or Registration#: LPG 23069 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$3550.00 Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑■ New ❑ Repair/Replace ❑ Demolition Description of Work: Install aboveground 2-120gal. LP tanks and gas piping/connections to 22KW Standby Generator Specify color of color thru tile: Submittal Fee$ Permit Fee$ ��� CCF$ CO/CC$ Scanning Fee$ Radon Fee$ 2` Z S DBPR$2— Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ � TOTAL FEE NOW DUE$ I`G'7O . l Q (Revised02/24/2014) Bonding Company's Name(if applicable) N/A Bonding Company's Address City State Zip Mortgage Lender's Name(if applicable) N/A 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. 0 Signature 111.en Signature OWNER or AGENT G� CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this 30 day of M 4� 120 11 by 23rd day of May ,20 17 by =It' Jr to A who is personally known to Keith Bikes ,who is personally known to me or who has produced as me or who has produced Pktm as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign:b„L ma� `?`W T- Sign: 1 !V 7lL Print: borah S N 0 qc Print: Deborah S Hodge Seal: S a 41�Y PUB DEB °4�c DEBORAH S.HODGE DEBORAH S.HODGE MY COMMISSION#FF176428 MY COMMISSION#FF176428 P EXPIRES:November 16,2018 ° +F °e EXPIRES:Novenber 16,20]8 SOF-° APPROVED BY C� ✓` Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) Florida Department of Agriculture and Consumer Services P.O. Box 6700 Tallahassee, Florida 32399-6700 License Number: 23069 Business Mailing Address Licensed Location Address ADVANCE EXCAVATING,LLC 4DVANCE EXCAVATING,LLC 890 SE 5TH CT 990 SE 5TH CT POMPANO BEACH,FL 33060-8118 POMPANO BEACH,Fl 33060-8118 The liquefied 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 renewed annualt . Any license allowed to expire shall become inoperative because of failure to renew. The fee for restoration of a license is equal to the odgftl Iibense be and must be paid bewe the licensee may resume operations. IN THE EVENT OF AN OWNERSHIP CHAN!RE AT THIS 9USINES3 LOCATION: This license may be tralta erred to any person,firm or corporation for the remainder of the current license year upon writtenuam to the department by the original tense boder. License mast be approved by the dttpartmen�-AtiWlicensing requiremerits must be met by the transferee and a transfer fee of 356 will apply. To apply for a transfer,conted the Bureau of LP Gas Inspecsions at(850)921-1600. Pursuant to Chapter 527,Florida Statutes,LP Gas lid must present proof of fic encsure to any Consumer, owner,or end user upon request when engaged in the business of servicing,testing,repairing,maintaining or installing LP Gas systems and/or equipment For future correspondence,please make any needed corrections or changes to your business mailing address andfor your licensed location address and return the UPPER PORTION with corrections to* Florida Department of Agriculture and Consumer Services P.O. Box 6700 Tallahassee, Florida 32399-6700 cut Hera �' State of Florida Department of Agricufture and Consumer Services Division of Consumer Services License Number: 33069 Bureau of Liquefied Petroleum Gas Inspection Expiration Date: August 31,2017 (850)921-1600 late of hsaua: September 1,2016 Tallahassee,Florida License Few $200.00 POST Type and Class: 0803 CONSPICUOUSLY ue "ed PetroleumLicense LP GAS INSTALLER GOOD FOR ONE LOCATION ONLY ANY CHANW OF OWNERSHIP OR BALE OF THIS BUSINESS RENDERS THIS LICENSE INVALID That license Is Issued under authartty of Sedlon 527.02,Florida Statutes,to: ADVANCE EXCAVATING, LLC 890 SE 5TH CT ADAM H.PUTNAM POMPANO BEACH, FL 33060-8119 COMMISSIONER OF AGRICULTURE 27 velf ADDRESS PERMIT NUMBER THIS SYSTEM HAS BEEN MANOMETER TESTED FOR 15 MINUTES, START e2 W.C. F1NfSH e."L INCHES W,C. INSTALLER DATE JANET BETANCOURT Z Commission#FF IMM W Exphm May 1,2018 Adva '1f BoufdihrvTmYFnnfn�amce�p3&47019 ng - (-g III LP Gas Kafir. Sikes PhOne: 661,402.53S4 1140 N E 23r4l Place FAX 954-781-5746 Pumparto Beach, Fl— 3306 af. „d•�iei�r..�.�i`,'2. i,k..e ,I'aa- '�.:� ?;-rt�t°%��s?df5r.�.�.s�'.S�b �"�.'�.,�53{ °�`�'.'"S ,i� ' BROWARD COUNTY LOCAL BUSINESS TAX.RECEIPT 115 S.Andrews Ave., Rm.A-100, Ft. Lauderdale, FL 33301-1895—954-831-4000 �< VALID OCTOBER 1,2016 THROUGH SEPTEMBER 3Q,2017 DBA: Receipt#:262-37 ti BUSPnBSS Name:ADVANCE EXCAVATING LLC Business Type:INSTALLATION LP GASS APDL/] UP yp (LP GAS INSTALLER) Owner Name:KEITH BIKER, - Busing Op@ned:11/os/2 007 Business Location:890 SE 5 C'r ! State/County/cert/Reg:23069 POMPANO BEACH Exemption C001®: Business Phone:561-602-53 54 Rooms seats Employes Machines Professionals For Vending Business Only Number of Machines: Vending Type: Tax Amount Transfer Fee NSF Fee Penalty Prior Years Collection Cost �75 v 75.00 0.00 0.00 0.00 0.00 0.00 sdi 'a r; THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS o THIS BECOMES A TAX RECEIPT This tax is levied for the privilege of doing business within Broward County and Is y non-regulatory in nature.You must meet all County and/or Municipality planning WHEN VALIDATED and zoning requirements. This Business Tax Receipt must be transferred when °> the business is sold, business name has ganged or you have moved the G? business Dation.This receipt does not indicate that the business is legal or that it is in compliance with State or local laws and regulations. Mailing Address: ADVANCE EXCAVATING LLC Receipt d1CP-15-00017091 890 SE 5 CT Paid 08/02/2016 75.00 POMPANO BEACH, FL 33060 2016 - 2017 J JEFF ATWATER CHEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OFFINANCIAL SERVICES rel *I OF ORICE@eI.�tCOMIPSA� CERTIFICATE OF ELECTION To BE EXERT FROM FLORIDA WORM"COMPENSATION LAW.. CONSTRUCTION INDUSTRY EXEMPTtpN This certifies that the individual lid below has elected to be exempt from Florida WOrkWs'Compensedo n law. EFFECTIVE DATE: 4/16/2016 EXPIRATION DATE: 4/18/2018 PERSON: BIKES KEITH FEIN: 020771433 BUSINESS NAME AND ADDRESS: ADVANCE EXCAVATING LLC 890 SE 5TH COURT POMPANO BEACH FL 33080 SCOPES OF BUSINESS OR TRADE. GAS MAIN OR CONNECTION?CONST Pursuant to Chapter'440.x(14),F.S.,an Wow of a oapcpMb %fw elects eamrrow*on OMt dulpW by fft a oertrfcda or election kmft thIs seatlon may not recover baa of cmrpart MM under Mdt dvap.r.Posod to Chaplar 440.05(12).F.S.,CerpllcaQsa Of abdlofl b be exonpf...apply o* wrhln the eoope d Mie bustroea or Credo ai M»rrotlee d dOCW to be sxWML PW"W to Chapter 440. 1$),F.S.,NWM of.larder to be waerrrpt and d a#eoM�to Oe aterrrpt etmr he aubjaG to rwowMar r,of any t*rre atlertta�d Mee hofker or rre kelmrave drur tsrM}Imte, the peraon run ed an the rhe or owWk*m no lapel r►reela ltra ra**n wit d 9*tadton tar Issumme of a owtft &The deparbnent alar nvoka a DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED W13 QUESTIONS?(850)413.1808 � OATTc(M�rDOrYYYv} CERTIFICATE OF LIABILITY INSURANCE 13/232017 THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATWMY 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. j IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the poilcy(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 right's to the certificate holder In fiau of SuchettdorSeme s. Cetficale DW. PRODUCER Gateway-Acentria Insurance,LLC PLANE FAX 1 2430 W.Oakland Park Blvd. "° Fort Lauderdale FL 33311 INSURER(S)AFFORDING COVERAGE ._—._ NAIC S INSURER A: odrConfinent Casuab Co. -23418 INSURED ADVAEXC-CD INSURER B Advance Excavating,LLC INSURERC: Attn:Mr.Keith Bikes 890 S.E.5 Court INSURER D: Pompano Beach FL 33060 INSURER E: INSURERF: COVERAGES CERTIFICATE NUMBER:176631936 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. ILIVN I TYPE OF INSURANCE im wVD POUCYNU1111SER POLICY EFF PO EXP LImwffms A GENERAL LIABILITY 04GL000971697 3/21/2017 3/21/2018 EACH OCCURRENCE $1,000,000 DON-A-GE RENTED X COMMERCIAL GENERAL LIABILITY PRM FSFA o n® $1()0,000 CLAIMS-MADE AI OCCUR MED EXP Any oneperson) $Induded PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPJCP AGG 1$Z000,()00 .X7 POLICY L PRO- Ll LOC $ AUTOMOBILE LIABILITY COWSWED sadden! ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS SCHEBODILY INJURY(Per academ) $ HIRED AUTOS AUTOSNON-OPROPERTY idm) AGE $ $ A X UMBRELLA LIAR X OCCUR 04XS199377 3/21/2017 312112018 EACH OCCURRENCE $000,000 EXCESS LUIS CLAIMS-MADE AGGREGATE $4,000,000 DED X I RETENTIDN$10,000 $ WORKERS COMPENSATION WC S ATU AND EMPLOYERS LIABILITY YIN TORY L ANY PROPRIETOR/PARTNER EXECUTIVE❑ N/A EL.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.OiSEASE-EA EMPLO $ Ii yes describe under DESCRIPTION OF OPERATIONS bdowr E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Audi ACORD 101,Additional Remeft SchedWe,N mora space Is re*dmd) CERTIFICATE HOLDER IS INCLUDED AS ADDITIONAL INSURED WITH REGARDS TO THE GENERAL LIABILITY COVERAGE SHOWN ABOVE IF REQUIRED BY WRITTEN CONTRACT SUBJECT TO THE TERMS,CONDITIONS AND EXCLUSIONS OF THE POLICY. Gas Contractor 1 I I CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE MIAMI SHORES VILLAGE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 10050 N.E.2 AVENUE ACCORDANCE WITH THE POLICY PROVISIONS. MIAMI FL 33138 USA AUTIJORUM REPRESENTATIVE i ©198&2010 ACORD CORPORATION. All rights reserved. j f ACORD 25(29010105) The ACORD name and logo are registered marks of ACORD PO WER one � �sE�RT®RSDEALER -stopshop for Poser r j The best choice for peace of mind' PROVIDER 5/23/17 State of Florida County of Broward Before me this day appeared Keith Bikes who being duly sworn, deposes and says: he is the qualifier of Advance Excavating LLC, state license # LPG 23069 and he will be the only person working on the property located at 1301 NE 104 St., Miami Shores, FL 33138 for the installation of 2 —aboveground LP tanks and gas piping to new generator. Sworn to (or affirmed) and subscribed before me this 23rd day of May, 2017 by Keith ikes whom is personally known to me. Keith Bik s—Advance Excavating LLC DEBORAH S.HODGE � a MY COMMISSION N FF176428 e�oP EXPIRES:Novenbm 16,2018 Notary: O.c-lWOA'- . Deborah S Hodge 364 S.W. 4th cr Dania Beach, FL 33004 • TO: 954-922-3800 • Fax: 786-228-8449 • www.empowergenerators.com OR Miami hares Village Building ent rCp� 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305)795.2204 Fax: (305)756.8972 Notice to Owner -- Workers' Compensation Insurancexe tion 1^ f MR, ..X. 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 Broehure: 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 from the contractor's company for day labor,part-time employees or subcontractors. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNIDERSTAND [TS CONTENTS. Signature _,4� L=__ Owner State of Florida County of Miami-Dade III I The foregoing was acknowledge before me this 3o day of ,20—Q-1 By L) ; .n 6 e n Q who is personally known to me or has produced FL DL as identification. Notary: 4YM4,Ll t SE ° DEBORAH S.HODGE, MY COMMISSION#FF176428 "�OF0.0 EXPIRES:November 16,2018