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PL-17-2093
Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Project Address Permit Permit NO. PL-8-17-2093 Permit Type: Plumbing - Residential Work Classification: Gas Permit Status: APPROVED Issue Date: 10111/2017 Expiration: 04/09/2018 Parcel Number Applicant 9901 NE 13 Avenue Miami Shores, FL 1132050090480 Block: Lot: CAROL INVEST USA INC Owner Information Address Phone Cell CAROL INVEST USA INC 990 BISCAYNE Boulevard MIAMI FL 33132- 990 BISCAYNE Boulevard MIAMI FL 33132- Contractor(s) SUBURBAN PROPANE LP Phone (305)635-4427 Cell Phone Valuation: Total Sq Feet: $ 1,400.00 70 Type of Work: INSTALL 1/2 GAS LINE FROM EXISTING Type of Piping: Additional Info: INSTALL 1/2 GAS LINE FROM EXISTING Bond Return : Classification: Residential CAcivegruto Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Total: Amount $1.20 $2.25 $2.25 $0.40 $150.00 $3.00 $1.60 $160.70 Pay Date Pay Type Invoice # PL-8-17-64922 08/18/2017 Credit Card 10/11/2017 Credit Card Amt Paid Amt Due $ 50.00 $ 110.70 $ 110.70 $ 0.00 Available Inspections: Inspection Type: Final Press Test Review Plumbing 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 zoningrmore, I authorize the above -named contractor to do the work stated. ized Signature: Owner / Applicant / Contractor / Agent ing Department Copy October 11, 2017 Date October 11, 2017 1 BUILDING PERMIT APPLICATION fl BUILDING 11 PLUMBING L. 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 0 ELECTRIC 0 ROOFING n REVISION MECHANICAL pi PUBLIC WORKS C CHANGE OF CONTRACTOR JOB ADDRESS: 9901 NE 13 Ave. AUG ],8 2017 FBC 20 i �No.P,C, 17-2-092_ EI CANCELLATION El SHOP DRAWINGS City: Miami Shores County: Miami Dade Folio/Parcel#: 11-3205-009-0480 Occupancy Type: Load: Construction Type: Flood Zone: OWNER: Name (Fee Simple Titleholder): Carol Invest, USA Address: 990 Biscayne Blvd. Suite 801 City: Miami Tenant/Lessee Name: N/A Email: CONTRACTOR: Company Name: urban Gas totEkst. Address: City: Miami Qualifier Name: Alex Brito State:' Florida Zip: 33138 is the Building Historically Designated: Yes NO BFE: FFE: Phone#: Phone#: (305) 635-4427 State Certification or Registration #: 01196 DESIGNER: Architect/Engineer: Victor Bruce Address: PO Box 530019 Zip: 33142 Phone#: (305) 635-4427 Certificate of Competency #: Phone#: (305) 310-5030. City: Miami Shores State:Fl. zip:33138 Value of Work for this Permit: $ 1400.00 4 Square/Li ar Footage of Work: 70 OF , Alteration �JJ ,Repair/Replace n Demolition Type of Work: El Addition Description of Work: r. X Install 1/2" gas line from existing propane tankto new ventlessfiteiplace Specify color of color thru tile: Submittal Fee $ i Permit Fee $ 6 SD CCF $ - CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Notary S Technology Fee S Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ TOTAL FEE NOW DUE $ ( t ( . �O (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 IttOti 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 tfite tsslyaixeeof a permit and that all work will be performed to meet the standards of all laws regulating ,t construction in this jdict on. I understand that a separate permit must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, AIR CONDITIONERS, ETC tate. Zit✓ OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that ail 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 thy; t suance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy,gfthelnq ce of commencement and construction lien law brochure will be delivered to the person whose property to attachment Also, a certified copy the recorded notice ofcommencement must beposted at the job site P 'Y issubjecti� f of J for the first inspection:,') ich��occu s seven. (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not b'e approved and a reinspection fee will be charged. . - Marco Bru Signature AAA= OWNER dr AGENT Signature • CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this O3 day of rit.XQ 4 , 20 fl , by /45...' day of I?C6 Marco Bruzzi , who is ersonally know to Moe,. 6it i me or who has produced as me or who has produced as identification and who did take an oath. NOTARY PUBLIC: ,20 17 ,by , who i ersonall know to identification and who did take an oath. CANCELLED -y Sign: ��A�/ Sign: Print: C G►QI 1g[vrsi Piint. LUCIA G ISASI Seal: Seal: MY COMMISSION #FF182628 . . , `•''�o►�.d!:r EXPIRES December 10, 2018 (407) 398-0153 FloridallotarySenrice.com *****.' *' *':«****************.*************,,*ieR k********a APPROVED BY Plans Examiner . i�rl,'• QUEVEDO Structural Review Commission A GG 108333 My Comm, Expires Jul4, 2021 Bonded through National Notary Assn. Zoning Clerk (Revised02/24!2014) Florida Department of Agriculture and Consumed Services P.O. Box 6700 Tallahassee, Florida 32399-6700 License Number: 01196 Business Mailing Address SUBURBAN PROPANE, LP 3800 NW 59TH ST MIAMI, FL 33142-2032 Licensed Location Address SUBURBAN PROPANE, LP 3800 NW 59TH ST MIAMI, FL 33142-2032 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 annually. Any license allowed to expire shall become inoperative because of failure to renew. The fee for restoration of a license is equal to the original license fee and must'be paid before the licensee may resume operations. IN THE EVENT OF AN OWNERSHIP CHANGE AT THIS BUSINESS LOCATION: This license may be transferred 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 installing LP Gas systems and/or equipment. For future correspondence, please make any needed corrections or changes to your business mailing address and/or your licensed location address and return the UPPER PORTION with corrections to: POST LICENSE CONSPICUOUSLY Florida Department of Agriculture and Consumer Services P.O. Box 6700 Tallahassee, Florida 32399-6700 Cut Here State of Florida Department of Agriculture`and Consumer Services Division of Consumer Services Bureau of Liquefied Petroleum Gas Inspection (850) 921-1600 Tallahassee, Florida License Number: Expiration Date: Date of Issue: License Fee: Type and Class: Liquefied Petroleum Gas Ligcense 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: SUBURBAN PROPANE, LP 3800 NW 59TH ST MIAMI, FL 33142-2032 01196 August 31, 2017 September 1, 2016 $425.00 0601 ADAM H. PUTNAM COMMISSIONER OF AGRICULTURE 001450 Local Business Tax Receipt Miami —Dade County, State of Florida —THIS IS NOT A BILL — DO NOT PAY 4190310 BUSINESS NAME/LOCATION SUBURBAN PROPANE LP 3800 NW 59 ST HIALEAH FL 33142 RECEIPT NO. RENEWAL 1915918 LBTI EXPIRES SEPTEMBER 30, 2017 Must be displayed at place of business Pursuant to County Code Chapter 8A — Art. 9 & 10 OWNER SEC. TYPE OF BUSINESS .SUBURBAN PROPANE LP 205 DEALER/DISTR/INSTALLATION C/O SUBURBAN ENERGY SERVICES GROUPQIIIO 196 PAYMENT RECEIVED BY TAX COLLECTOR $270.00 07/26/2016 FPPU06-16-020322 This Local Business Tax Receipt only confirms payment of the Local Business Tax. The Receipt is not a license, permit, or a certification of the holder's qualifications, to do business. Holder must comply with any governmental or nongovernmental regulatory laws and requirements which apply to the business. The RECEIPT NO. above must be displayed on all commercial vehicles — Miami —Dade Code Sec 8a-276. For more information, visit www.miamidade.aov/taxcollector / T ® ACORD CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 09/29/2016 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 MARSH USA; INC. 445 SOUTH STREET MORRISTOWN, NJ 07960-6454 Attn: Morristown.CertRequest@marsh.com Fax: 212.948.0979 CLIE CONTACT PPHONE FAX 4A1G. No. Ent): (A/C, No)' EMAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : ACE American Insurance Company 22667 INSURED SUBURBAN PROPANE PARTNERS, L.P. 240 ROUTE 10 WEST WHIPPANY, NJ 07981 INSURER B : Indemnity Insurance Company of North America - 43575 INSURER C : ACE Fire Underwriters Insurance Company 20702 INSURER 0 : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: NYC-007656662-14 REVISION NUMBER:2 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 INSD UB WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DO/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY HDO G27856329 10/01/2016 10/01/2017 EACH OCCURRENCE $ 2,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) $ 250.000 CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 2,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L X AGGREGATE POLICY OTHER. LIMIT APPLIES PRO JECT PER: LOC PRODUCTS • COMP/OP AGG $ 2,000.000 I $ A AUTOMOBILE X X X LIABILITY ANY AUTO ALL OWNED AUTOSAUTOS X X SCHEDULED NON OWNED AUTOS ISA H09045065 10/01/2016 10/01/2017 COMBINED SINGLE LIMIT (Ea accident) $ 2,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ $ DED RETENTION S B A C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below YNN N / A WLR C48611175 (AOS) WLR C448611163 (CA, MA) SCF C48611187 (WI)10/01/2016 10/0112016 10/0112016 10/0112017 1010112017 10/01/2017 x I PER I STATUTE OTH- ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 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) RE: LICENSE #: 01196, LP GAS DEALER CERTIFICATE HOLDER CANCELLATION MIAMI SHORES VILLAGE ATTN: BUILDING DEPARTMENT 10050 NE 2ND AVENUE NORTH MIAMI BEACH, 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 of Marsh USA Inc. Manashi Mukherjee �tmuao►,+ ACORD 25 (2014/01) © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD