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PL-18-1794Miami 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 BUILDING PERMIT APPLICATION ❑BUILDING ❑ ELECTRIC ❑ ROOFING M PLUMBING D MECHANICAL []PUBLIC WORKS ❑ REVISION CHANGE OF CONTRACTOR JOB ADDRESS: 9707 NE 5 Avenue Road, Miami Shores, FL 33138 City: Miami Shores Folio/Parcei#:11-3206-018-0030 Occupancy Type: residential Load: County: Miami Dade RECEIVED JUN292013 h FBC 20 I� Master Permit No._12.C.-1 - l 20S Sub Permit No.9 1 C' > ❑ EXTENSION RENEWAL ❑ CANCELLATION ❑ SHOP DRAWINGS Zip: Is the Building Historically Designated: Yes Construction Type: euned9"'a"k Flood Zone: nia BFE: OWNER: Name (Fee Simple Titleholder):DIIVer DiPietro Address:9705 NE 5 Avenue Road City: Miami Shores State: FL NO X FFE: Phone#: (786) 301-2770 zip: 33138 Tenant/Lessee Name: Email: Phone#: CONTRACTOR: Company Name: Dade Gas Contractors Address: 6259 SW 39 Terrace city: Miami Qualifier Name: Julio Orta State Certification or Registration #: 26163 DESIGNER: Architect/Engineer: Address: 11�11 Value of Work for this Permit: $ Y1 SJL.��-'• �� State: FL Phone#: (786) 805-9561 zip, 33155 Phone#: (786) 805-9561 Certificate of Competency #: 79049 Phone#: City: State: Zip: Square/Linear Footage of Work: Type of Work: ❑ Addition Ei Alteration ❑ New Description of Work: 1000 gal buried gas tank installation ❑ Repair/Replace ❑ Demolition Specify color of color thru tile: Q^� ��/�� Submittal Fee $ Permit Fee S 3 D J CCF $ Scanning Fee $ Radon Fee $ 3 • gi'. ' DBPR $ LJ Technology Fee $ Structural Reviews $ (Redsed02/24/2014) CO/CC $ •9 [! Notary $ Training/Education Fee $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ 3SS ' 2-3 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 ubje ttt to att hment. Also, a certified copy of the recorded notice of commence ent must be posted at the job site for the first inspe ion which oc tars seven (7) days after the building permit is issued. In thbsence of such posted notice, the inspection will not b approved and o reinspection fee will be charged. OWNER or AGENT The foregoing instrument was acknowledged before me this day of )cwv-4 20) , by li\W.-{ is-- a •'i kse w who is personally known to me or who has produced f/A+ (Jn 1)M1iJs1 (' CMS( as 1:"1,-1, 51-- 5S-t:,1 -o identification and who did take an oath. NOTARY PUBLIC: Sigh: Print: I vlln Seal: kL tu4 M. s, t v.,{ MARLENE M. SIEGEL Notary Public - $W u of Florida Commission • IT IMe360 My Comm. Expires Oet te. 2018 APPROVED BY 7/O/(,� (Revised02/24/2014) Signatur CONTRACTOR The fgoing instrument was acknowledged before me this lot day of t' who J me or who has produced OLI O C?l2T'4 as identification and who did take an oath. 20 by INA MEN: L Puslic - S o` Florida 018 Plans Examiner Structural Review Zoning Clerk AW RD CERTIFICATE OF LIABILITY INSURANCE Lows"' DATE(MM/DD/YYYY) 06/28/2018 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: 1f 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 All Nation 8520 S.W. 40th St. Miami, FL 33155 Phone (305) 220-0900 Fax (305) 220-3029 CONTACT MANUEL GONZALEZ NAME: PHONE ON o. Ext): (305) 220-0900 FAX No): (305) 220-3029 ADDRESS: manuel@allnationinsurance.com INSURER(S) AFFORDING COVERAGE NAIC # INSURERA: NATIONWIDE SCOTTSDALE INSURANCE CO. INSURED DADE GAS CONTRACTOR INC 12392 SW 213TH TER Miami FL 33177 INSURER B INSURER C : 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 LTR TYPE OF INSURANCE ADDLSUBR INSR WVD POCY NUMBER POUCY POUCY EFF (MM/DD/YYYY) POLICY EXP (MDD/YYYY) M/ LIMBS A lf COMMERCIAL GENERAL LIABILITY ❑ CLAIMS -MADE m OCCUR CPS 2639996-01 03/22/2018 03/22/2019 EACH OCCURRENCE $ 1,000,000.00 PRTORENTED PREMISES ((Ea oMurrence) $ 100,000.00 MED EXP (Any one person $ 5,000.00 ❑ PERSONAL & ADV INJURY $ 1,000,000.00 GEN'L AGGREGATE LIMIT APPLES PER: ❑ POLICY ❑ JECTT ❑ LOC ❑ OTHER GENERAL AGGREGATE $ 2,000,000.00 PRODUCTS - COMP/OP AGG $ 1,000,000.00 $ AUTOMOBILE IJABILI Y ❑ ANY AUTO ❑ALL OWNED SCHEDULED AUTOS ❑ AUTOS NON -OWNED ❑ HIRED AUTOS ❑ AUTOS ❑ ❑ COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ ❑ UMBRELLA LUU3 ❑ OCCUR ❑ EXCESS IJAB ❑ CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ ❑ DED ❑ RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / NER ANY PROPRIETOR/PARTNERIEXECU OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes. describe under DESCRIPTION OF OPERATIONS below N / A ❑ STATUTEPER ❑ OTH E.L. EACH ACCIDENT $ 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) Dade Gas Contractors Inc. License: 38239 CERTIFICATE HOLDER CANCELLATION Miami shores village 10050 NE 2nd ave Miami Shores, FL. 33148 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POUCY PROVISIONS. AUTHORIZED REPRESENTATIVE 7 � �o.sao ACORD 25 (2014/01) OF © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ti Florida Department of Agriculture and Consumer Services P.O. Box 6700 Tallahassee, Florida 32399-6700 License Number: 38239 Business Mailing Address Licensed Location Address DADE GAS CONTRACTORS, INC 12392 SW 213TH TER MIAMI, FL 33177-5942 DADE GAS CONTRACTORS, INC 12392 SW 213TH TER MIAMI, FL 33177-5942 The Iinuefied petrpleum gas license Pt the bottom of this fern ie valid ON! Y 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 License LP GAS INSTALLER 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: DADE GAS CONTRACTORS, INC 12392 SW 213TH TER MIAMI, FL 33177-5942 38239 August 31, 2018 January 4, 2018 $200.00 0803 ADAM H. PUTNAM COMMISSIONER OF AGRICULTURE Local Bus! ness Tax Recei pt Miami -Dade County, State of Florida THIS IS NOT A BILL - DO NOT PAY 6323711 BUSINESS NA M EILOCA TION DADE GAS CONTRACTORS INC 12392 SW 213 TER MIAMI, FL 33177 O `A'N ER DADE GAS CONTRACTORS INC CIO JEAN C GONZALEZ PRES MIAMI ODE RECEIPT NO RENEWAL 6590252 LBT1 EX PIRES SEPTEMBER 30, 2018 Must be displayed at place of business Pursuant to County Code Chapter 8A Art 9 8 10 SEC TYPE OF BUSINESS 205 DEALER/DISTR/INSTALL ATION LPG38239 PAYM ENT RECEIVED BY TAX COLLECTOR 562.50 01/10/2018 0233-18-001887 This Local Business Tax Receipt only con °rms payment of the Local Business Tax. The Receipt is not a license, permit, or a cacti "cation of the holder's quali "cations, to do business. Folder crust 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 - Miam -Dade Code Sec 8a-276. For more inforrrotion, visit www.thardslage,g0v/taxsagglef STATE OF FLOFSDA DEPARTliclINF T OF RNANCIAL SERVICES DMSIOII CONSTRUCTION INDUSTRY EBMIPTION CERTIFICATE OF ELECTION TO BE EXEMPT FROIS FLORIDA WORKERSCOMPENSATION LAW EFFECTIVE DATE: 212612018 PERSON: ORTA FEIN: 371801064 BUSINESS NAME AND ADDRESS: DADE GAS CONTRACTORS INC. 12392 SW 213TH TERRACE . JUIJO EXPIRATION DATE026/2020 SR IMPORTANT F Pursuant to Chapter 440.05(14). F.S.. an officer of a corporation 0 who eels exemption from this chapter by firing a certificate of election under this section may not recover benefits or L 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 H listed on eie notice of election to be exempt. E Pursuant to Chapter 440.05(13), F.S., Notices of election to be exempt and certificates of election to be exempt shad be R subject to revocation if, at any time after the filing of the notice E 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 Miami Shores Village Building Department 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 from the contractor's company for day labor, part-time employees or subcontractors. CONTENBY SIGNING BELOW OU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS TS. L Signature: Owner State of Florida County of Miami -Dade The foregoing was acknowledge before me this \ ' day of 3-0 11/4.f. , 20 (e . BY r't DI--; O1Z1-v Notary: SEAL: who i as identification. GINA MENENDEZ �'�lotary Public - State of Florida _• My Comm. Expires Aug 16, 2018 Commission # FF 114240 E' . Bonded Through National Notary Assn. to me or has produced Dade Gas Contractors (786) 805-9561 Ortajulio502@gmall.com July 18, 2018 State of Florida County of Miami -Dade Before me this day personally appeared Julio Orta who, being duly sworn, deposes and says: That he will be the only person working on the project located at: 707 NE 5th Avenue Road Miami Shores L 33138 a, Dade Gas Contractors Sworn to (or affirmed) and subscribed before me this l8th day of July, 2018. GINA MENENDEZ Notary Public - State of Florida • « . •? My Comm. Expires Aug 16, 2018 Commission # FF 114240 •'- OF F��,,` • ,,,,," Bonded through National Notary Assn. Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Project Address Permit Parcel Number Permit NO. PL-648-1794 Permit Type: Plumbing -Residential Work Classification: Gas Permit Status: APPROVED Date: 7125/20/8 Expiration: 01/21/2019 Applicant 9707 NE 5 Avenue Road Miami Shores, FL 33138-2444 1132060180030 Block: Lot: OLIVER DI PIETRO Owner Information Address Phone Cell OLIVER DI PIETRO 9707 5 Avenue Road MIAMI SHORES FL 33138- Contractor(s) DADE GAS CONTRACTORS INC Phone Cell Phone Valuation: Total Sq Feet: $ 1,000.00 0 Type of Work: 1000 GAL BURIED GAS TANK INSTALLATI Type of Piping: 1000 GAL BURIED GAS TANK INSTALLATI Additional Info: 1000 GAL BURIED GAS TANK INSTALLATI Bond Return : Classification: Residential Scanning: 3 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Amount $0.60 $5.78 $3.85 $0.20 $385.00 $9.00 $0.80 Total: $405.23 Pay Date Pay Type Amt Paid Amt Due Invoice # PL-6-18-68102 06/29/2018 Credit Card $ 50.00 $ 355.23 07/25/2018 Credit Card $ 355.23 $ 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 AFFI I certi that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and rmore, I auth ' rize the above -named contractor to do the work stated. Authorize ature: cant / Contractor / Agent July 25, 2018 Date Building Il a artment -opy July 25, 2018 1