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PL-18-1659Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Project Address Permit Permit NO. PL-6-1 &1659 Permit Type: Plumbing - Residential Work Classification: Gas Permit Status: APPROVED Issue Date. 6121/2018 Expiration: 12/18/2018 Parcel Number Applicant 362 NE 95 Street Miami Shores, FL 1132060136070 Block: Lot: NORA PALOU Owner Information Address Phone Cell NORA PALOU Contractor(s) Phone PRESTIGE GAS SERVICES CORP. (305)300-0608 Cell Phone Valuation: Total Sq Feet: $ 2,494.40 0 • Type of Work: NEW GAS LINE TO NEW GAS DRYER AND N Type of Piping: Additional Info: NEW GAS LINE TO NEW GAS DRYER AND N Bond Return : Classification: Residential Scanning: 3 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Total: Amount $1.80 $2.25 $2.00 $0.60 $150.00 $9.00 $2.40 $168.05 Pay Date Pay Type Invoice # PL-6-18-67957 06/18/2018 Credit Card 06/21/2018 Credit Card Amt Paid Amt Due $ 50.00 $ 118.05 $ 118.05 $ 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 AFFIDAVI . I ertify that all the foregoing information is accu to and that all work will be done in compliance with all applicable laws regulating construction yd ro' mg. ' uthermore, I author' ve-named cont p (or to the work stated. Sign to e: Owner / Applicant / Contractor / Agent June 21, 2018 Date Building De • - rtment Copy June 21, 2018 1 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-306619 Permit Number: PL-6-18-1659 Scheduled Inspection Date: August 02, 2018 Inspector: Cabrera, Miguel Owner: PALOU, NORA Job Address: 362 NE 95 Street Miami Shores, FL Project: <NONE> Contractor: PRESTIGE GAS SERVICES CORP. Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Gas Phone Number Parcel Number 1132060136070 Phone: (305)300-0608 Building Department Comments NEW GAS LINE TO NEW GAS DRYER AND NEW 40 GALLON WATER HEATER Infractio Passed Comments INSPECTOR COMMENTS False Passed Failed Correction Needed Re -Inspection Fee No Additional Inspections can be scheduled until re -inspection fee is paid. Inspector Comments ofor Goi6A-cd_ 5/)-2-\11 J August 01, 2018 For Inspections please call: (305)762-4949 Page 18 of 38 PRESTIGE GAS SERVICES CORP. 1511 SW 71 CT MIAMI FL 33144 PHONE: 305-300-0608 FAX: 305-356-4332 DATE: AUGUST 2, 2018 TO: WHOM IT MAY CONCERN: THIS LETTER IS TO CERTIFY THAT PRESTIGE GAS SERVICES CORP HAS PERFORMED A DROP TEST AT THE FOLLOWING SITE AND TESTED ALL THE APPLIANCE CONNECTIONS. THE GAS LINE HAS BEEN CHECKED TO THE STANDARDS OF THE 2017 FLORIDA BUILDING CODE AND PROPERLY TESTED TO MEET THE STANDARDS OF NFPA 54. THE WORK WAS PERFORMED FOR NORA PALOU AT 362 NE 95 ST Mum FL 33138 TEST PRESSURE: 8.0 LOCK UP PRESSURE: 112 OPERATING PRESSURE: 110 TEST TIME 30 MINUTES STATE LICENSE NO: LPG 32634 TYPE AND CLASS: 0803 IF YOU SHOULD HAVE ANY QUESTIONS REGARDING THE MATTER PLEASE DO NOT HESITATE TO CALL US. SINCERELY, LAZARo PAZ ; r CEO.- _ PRESTIGE , GAS , SERVICE CORP. ,.:1 _... YE�y I 911.AR li State of Flor!da • Com'n s,o, = GG 142883 My Comm. Exalres Sep 13, 2021 ''',.'oFFl. Bo,'dedthrcu:,- National Notary Assn. BUILDING PERMIT APPLICATION BUILDING ❑ ELECTRIC El PLUMBING ❑ MECHANICAL JOB ADDRESS: 362 NE 95 ST 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 ❑ ROOFING ▪ PUBLIC WORKS FBC20V-/('+h Master Permit No. Pl._ IS — 16 59 Sub Permit No. ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS City: Miami Shores County: Folio/Parcel#:11-3206-013-6070 Occupancy Type: Load: Construction Type: OWNER: Name (Fee Simple Titleholder): Nora Palou Address:362 NE 95 ST Miami Dade Zip: Is the Building Historically Designated: Yes NO no Flood Zone: BFE: FFE: Phone#: 3052996482 City: Miami Shores State: FL Tenant/Lessee Name: Phone#: Zip: 33138 Email: CONTRACTOR: Company Name: Prestige Gas Services Address: 1511 SW 71 CT Phone#: 3053000608 City: Miami State: FL Qualifier Name: Lazaro Paz Zip: 33144 Phone#: 3053000608 State Certification or Registration #: LPG32634 Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ 2494.40 Square/Linear Footage of Work: 30 Type of Work: ❑ Addition El Alteration ❑ New ❑ Repair/Replace Description of Work: New Gas line to new gas dryer and new 40 gallon water heater. ❑ Demolition Specify color of color thru tile: Submittal Fee $ Permit Fee $ / 7) CCF $ Scanning Fee $ Radon Fee $ a . Q DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ TOTAL FEE NOW DUE$ . / Ie• 05 CO/CC $ as (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 The foregoing instrument was acknowledged before me this Z day of C%h^� , 20 /t , by 'a day of (lU" "e / , 20 ' , by "4:2/79 aze,J , who is personally known to z_4-7/9V A-z_ , who is personally known to me or who has produced 7 U- as me or who has produced Oc._ identification and who did take an oath. identification and who did take an oath. �- CON�RACTOR The foregoing instrument was acknowledged before me this NOTARY PUBLIC: NOTARY PUBLIC: Sign: Print: ye�D14L _/1 ;• a n YESENIAAGUILAR Seal: :� Notary Public - State of Florida • Commission 4 GG 142883 My Comm. Expires Sep 13, 2021 Bonded through National Notary Assr. Sign: Print! Seal: as .••.�s+�p„_'•. fig YESENT,4GUILAR Notary Public - State of Florida • : ``�' • Commission a GG 142883 My Comm. Expires Sep 13, 2021 Bonded through National Notary Assn. **************ls rirrsw94,4s414+xssiminr*ss4rs*ssiis4 Rit************s**********************************s*************** APPROVED BY lf--%f Plans Examiner Zoning (Revised02/24/2014) Structural Review Clerk Florida Department of Agriculture and Consumer Services P.O. Box 6700 Tallahassee, Florida 32399-6700 License Number: 32634 Business Mailing Address Licensed Location Address PRESTIGE GAS SERVICES CORP. 1511 SW71STCT MIAMI, FL 33144-5440 PRESTIGE GAS SERVICES CORP. 1511 SW71STCT MIAMI, FL 33144-5440 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 shill become inoperative because of failure to rene-wTThe feefor . " -- 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 License LP GAS INSTALLER GOOD FOR ONE LOCATION ONLY ANY CHANGE OF OWNERSHIP OR SALE OF THIS BUSINESS RENDERS THIS LICENSE INVALID Thls license is issued under authority of Section 527.02, Florida Statutes, to: PRESTIGE GAS SERVICES CORP. 1511 SW 71ST CT MIAMI, FL 33144-5440 32634 August 31, 2018 September 1, 2017 $200.00 0803 ADAM H. PUTNAM COMMISSIONER OF AGRICULTURE 009181 Local Business Tax Receipt Miami —Dade County, State of Florida -THIS IS NOT A BILL - DO NOT PAY 7110307 BUSINESS NAME/LOCATION PRESTIGE GAS SERVICES CORP 1511SW71CT MIAMI FL 33144 RECEIPT NO. RENEWAL 7387897 EXPIRES SEPTEMBER 30,.2018 Must be displayed at place of business Pursuant to County Code Chapter 8A - Art. 9 & 10 �Y v r 1 OWNER E SEC. TYPE OF BUSINESS ... ECEIVED PRESTIGE GAS SERVICES CORP I 205 LPG INSTALLER: ' ( PAYMENT BY Tax cOuecLLECTOR LPG32634 000.00 `'07/06/2017 '• ' t. r 1 CREDITCARD-17-043810 I 1 I ! ,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. t, mT The RECEIPT NO. above.must be displayed on all commercial vehicles - Miami -Dade Code Sec 8a-276. ' For more information visit- v vw.mta aidade.gov/taxcollector7 JEFF ATWATER CHIEF FINANICAL 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: 2/22/2017 PERSON: PAZ FEIN: 800872716 BUSINESS NAME AND ADDRESS: PRESTIGE GAS SERVICES CORP 1511 SW 71 CT MIAMI FL 33144 SCOPE OF BUSINESS OR TRADE: Gas Main or Connection ❑ Construction and Drivers EXPIRATION DATE: 2/22/2019 LAZARO IMPORTANT: 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 arty 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 certificate at any time for failure of the person named on the certificate to meet the requirements of this section. DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS? (850)413-1609 MCCMa ,.. CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 06/18/2018 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 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 Claudia's Insurance 18901 SW 106th Ave 132 Miami, FL 33157 Phone . (786) 293-9141 Fax (786) 293-9142 CONTACT CLAUDIA M DE LA ROSA NAME: PHONE o, ), (786) 293-9141 FAX No): (786) 293-9142 ADDRESS: claudia@claudiasinsurance.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Scottsdale Insurance Co. 41297 INSURED Prestige Gas Services Corp 1511 SW 71Ct Miami FL 33144 INSURER B: INFINITY COMMERCIAL AUTO 22268 INSURER C : Scottsdale Insurance Co. 41297 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. INSR TYPE OF INSURANCE ADDLSUBR INSR WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITSLTR A M COMMERCIAL GENERAL LIABILITY N N CPS2838789 05/11/2018 05/11/2019 EACH OCCURRENCE $ 1,000,000.00 ❑ CLAIMS -MADE 0 ❑ o PREMISES ((S ERaa occurrence) $ 100,000.00 MED EXP (Any one person $ 5,000.00 ❑ PERSONAL & ADV INJURY $ 1,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: V POLICY ❑ PRO- JECT LOC ❑ OTHER GENERAL AGGREGATE $ 2,000,000.00 PRODUCTS - COMP/OP AGG $ 1,000,000.00 $ B AUTOMOBILE LIABILITY N .. N 509800013843001 11/12/2017 11/12/2018 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000.00 BODILY INJURY (Per person) $ ►n ANY AUTO OWNED • AUTOS SCHEDULED ❑ BODILY INJURY (Per accident) $ AUTOS ONLY HIRED n NON -OWNED n AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE (Per accident) $ ❑ i $ C ►n UMBRELLA UAB ❑ OCCUR ►n EXCESS LIAB ❑ CLAIMS -MADE N N XBS0093306 05/11/2018 05/11/2019 EACH OCCURRENCE $ 1,000,000.00 AGGREGATE $ 1,000,000.00 ❑ DED ❑ RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N N / A ' . STATUTE ❑ OTH- ER E.L. EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVFn OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) GAS LINE INSTALLATION SERVICE AND REPAIR AND GAS APPLIANCE INSTALLATION SERVICE AND REPAIR CERTIFICATE HOLDER CANCELLATION Miami Shores Village Building Department 10050 NE 2nd Ave Miami Shores, 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 ACORD 25 (2016/03) OF © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Longest Run: 30 Feet Total Load: 120,000 BTU's Type of Gas: Natural Gas Materials: Galvanized Pipe CSST New Outlet (S) 2 New Connection (S) 2 Existing Meter For Equipment Meter Gas Outlet 3/4" 0.5 PSI Gas System New Gas Dryer 22,000 BTU's 1/2" Outlet 1/2" Shut off Valve New 40 GI Water Heater 38,000 BTU's 1/2" Outlet 1/2" Shut off Valve Existing Gas Stove 60,000 BTU's 1/2" Outlet 1/2" Shut off Valve Install a new vent through the roof for the new water heater. The new bent will be tiype B double Wall Wall Penetration sleeve New 3/4" gas line Strapped to wall (Galvanized) New 3/4" gas line Thought Crawl space CSST EHD#25 Florida Building Code - FUEL GAS 2014 Chart # 402.4 (13) (CSST Pipe) Chart # 402.4 (2) (Metallic Pipe) New Gas Dryer 22,000 BTU's 1/2" Outlet 1/2" Shut off Valve New 40 GI Water Heater 38,000 BTU's 1/2" Outlet 1/2" Shut off Valve New 3/4" gas line Strapped to wall (Galvanized) Existing 1/2 metallic gas line feeding a existing stove longest run 30ft , line is tie in to existing gas meter • • • • • •• • • • • • • • • • • • •• •• • • • • • • • • • • ••• • • • • • • • '•••• . • •• • • S. •. • • • • • • •• • • • •• • • • •• • • • • ••• . • .• • • • • • ••..•• •• • • • . APPROVED #: pL l a Miami Shcrea Village BY DAIS ZONING DEPT BLDG DEPT SUBJECT t'O CCNIPI IFINCE WI 11-1 All FEDERAL STATE ANL) l.( INN r ALL=S k"!1•. ,.I„ . Existing Meter For Equipment Meter Gas Outlet 3/4" 0.5 PSI Gas System Prestige Gas Services LPG32634 1511 S.W. 71th CT Miami, Florida 33144 Phone:(305) 300-0608 / Fax:(305) 356-4332 Installation done in accordance with NFPA 54 & 58 regulatipns as well as 6/12/2018 11:11 Lazaro Paz Job Address: 362 NE95 ST ESENIA AGUILAR Pubi State of Florida sion GG 142883 mm. Expires Sep 13, 2021 ,uGI NatiU INmay R55r CFI Florida Building Code - FUEL GAS 2014 Chart # 402.4 (13) (CSST Pipe) Chart # 402.4 (2) (Metallic Pipe) North) New Gas Dryer 22,000 BTU's 1/2" Outlet 1/2" Shut off Valve New 40 GI Water Heater 38,000 BTU's 1/2" Outlet 1/2" Shut off Valve 1 • • • • • •• • • •••• • • ••.• • • • . • •• •• •• • Ekieting Meter For Equipment • • )niter GIs Outlet 3/jt" • -••••[ 0t•5 PS4 Gas SIM etal• •••• • • •.•. • • • •• • • • • •• • • • • • 10' New 3/4" gas line Strapped to wall (Galvanized) Front of House • •• • • •. • • • • Prestige Gas Services LPG32634 1511 S.W. 71th CT Miami, Florida 33144 Phone:(305) 300-0608 / Fax:(305) 356-4332 6/12/2018 11:11 Lazaro Paz Job Address: 362 Installation done in accordance with FBC 2014, NFPA 54 & 58 regulatipns as well as all 95 S YE IA AGUILAR ublic - State of Flofida Commission = GG 142883 y Comm. t• l4�l D. J.J .I . J t