PL-18-1446Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Project Address
mit
Permit NO. PL-5-18-1446
Permit Type: Plumbing Residential
Work Classification: Gas
Permit Status: APPROVED
issue Date: 7110/2018
Expiration: 01/06/2019
Parcel Number
Applicant
9505 NE 5 Avenue
Miami Shores, FL
1132060140710
Block: Lot:
DONALD STOBS
Owner Information
Address
Phone
Cell
DONALD STOBS
9505 NE 5 Avenue
MIAMI SHORES FL 33138-3161
(305)757-0950
9505 NE 5 Avenue
MIAMI SHORES FL 33138-3161
Contractor(s)
FOREVER GAS CORP
Phone
(305)298-0193
CeII Phone
Valuation:
Total Sq Feet:
$ 1,000.00
15
Type of Work: INSTALLATION OF GAS LINE SERVING NA
Type of Piping:
Additional Info: INSTALLATION OF GAS LINE SERVING NA
Bond Return :
Classification: Residential Scanning: 1
Fees Due
CCF
DBPR Fee
DCA Fee
Education Surcharge
Permit Fee
Scanning Fee
Technology Fee
Total:
Amount
$0.60
$2.25
$2.00
$0.20
$150.00
$3.00
$0.80
$158.85
Pay Date Pay Type
Invoice # PL-5-18-67709
05/25/2018 Check #: 1734 $ 50.00 $ 108.85
07/10/2018 Credit Card $ 108.85 $ 0.00
Amt Paid Amt Due
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, ROOand SWIMMING POOL work.
OWNERS AFFIDAVIT: I certify that all the fo
construction and zoning. Futhermore, I author'
g information is ac urate qd that all work will be done in compliance with all applicable laws regulating
above-na d contr ct to o the work stated.
Authorized Signature: Owner / Applicant / Contractor / Agent
July 10, 2018
Date
Building Department Copy
July 10, 2018 1
JOB ADDRESS: 95'b ,
City: Miami Shores
Folio/Parcel#: 3 ,- 0
Occupancy Type: 5-r Load:
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
BUILDING
PERMIT APPLICATION
❑BUILDING ❑ ELECTRIC ❑ ROOFING
L tJ
Mk( 2 5 2018
FBC 20 I-1 I
Master Permit No. pi 18 - i u U
Sub Permit No. P 1 " t qcf
❑ REVISION ❑ EXTENSION El RENEWAL
PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF
CONTRACTOR
❑ CANCELLATION ❑ SHOP
DRAWINGS
Zip:
Construction Type: o J Flood Zone: A/ BFE:
OWNER: Name (Fee Simple Titleholder): /1 S� phone#:303— 7r/ 79ii
Address: ,/
rj
City: / Cf,121 �S State: L —
County: Miami Dade
Is the Building Historically Designated: Yes NO
FFE:
Tenant/Lessee Name:
Email:
CONTRACTOR: Company Name:
Address:
City:
Qualifier Name:
State Certification or Registration #:
DESIGNER: Architect/Engineer:
Address:
Value of Work for thiPermit: $
Type of Work: Addition
Desc • 'on of Work:
/i/A-
x./(t) 6, ,a 1«
C•
State:
C�
5,4e,r-
�-d z r
r0) / c/« Certificate of Competency #: ,. �t!'�
/L/-4 Phone#:
City: State: Zip:
//e 0 oSquare/Linear Footage of Work: fr 4 ALcut. "-A
❑ Alteration ❑ New
Zip:
Phone#:
�r
Phone#: a/93 OJ
zip: 3361/
Z Phone#: ?(Vc)-71 d/93
ted
VIG
❑ Repair/Rep lace /❑ Demolition
/C/Ci4/) 4Jr
of -i
Specify color of color thru tile:
Submittal Fee $
Scanning Fee $
Technology Fee $
Structural Reviews $
Permit Fee $ ‘
Radon Fee $ 2
(Revised02/24/2014)
Training/Education Fee $
CCF $ CO/CC $
DBPR $ a �� Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $ toe • Se.
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 o copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, o 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.
OWNER or AGENT
The foregoing instrument was acknowledged before me this
day of /)) ► L , 20 / (i , by
"I61' S S , who is personally known to
/50161,f! .t'j& -A as
me or who has produced
taennnca ton an w o t a e an oa
NOTARY PUBLIC:
Sign:
Print:
Seal:
nrA•'S ,cLo
J,„+'errc r��'� Banded Thru But et Notary Servkes 'h Oc no, Bonded Thru beget Notary Services
Signature
CTOR
The foregoing instrument was acknowledged beforemethis
;7 ll o day of /' (-1 , 20 (U , by
Kt13?�v�ti l rlm7.�i,P� , whb is personally known to
me or who has produced (SOn�`1•I rn'.
identification and who did take an oath.
NOTARY PUBLIC:
Seal:
APPROVED BY
,po.a ► '. ALEJANDRA GRIGORESCU
* MY COMMISSION 1 FF 143529
EXPIRES: July 21, 2018
o,-;e-of
riOr\Qsu 1
'rw ►u'4 AIEJANORA BRICIORE✓BOU
MY COMMISSION i FF 143529
EXPIRES: July 21. 2018
Plans Examiner Zoning
(Revised02/24/2014)
Structural Review Clerk
Forever Gas Corp
18111 NW 68th Ave.
Miami, Fl. 33015
April 20, 2018
State of Florida
Miami Dade County
Before me this day personally appeared Robert Gonzalez who, being duly sworn, deposes
and says:
That he will be the only person working on this project located at:
9sr ,&j �'' 4z ' fAeir
Contractor Si
Sworn to (or of med and subscribed before me this day of, IA \ &
20 I
Personally know
OR Produced Identification
Type of Identification Produced:
A �nditi eiljortN
Print, Type or Stamp Name of Notary
ALEJANDRA GRIGORESCU
* MY COMMISSION 1 FF 143529
EXPIRES: July 21, 2018
cot Bonded Thru Budget Notary Services
fo re ve./
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. Fia..Stat § 940.05
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 ofa'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 BELO YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS
CONTENTLY_.
Signature'
Owner
State of Florida
County of Miami -Dade �
The foregoing was acknowledge before me this day of ► ^` ` Ck'A ,20
By ��Gv� cc, I GC. WCA
Notary:
SEAL:
who is personally known to me or has produced
as identification.
ALEJANDM GRIGORE9CU
* MY COMMISSION # FF 143529
EXPIRES: July 21, 2018
Bonded Thru 8i pt Notary Services
I'b -094
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-311163 Permit Number: PL-5-18-1446
Scheduled Inspection Date: August 28, 2018
Inspector: Massanet, Maykel
Owner: , STOBS, DONALD
Job Address: 9505 NE 5 Avenue
Miami Shores, FL
Project: <NONE>
Contractor: FOREVER GAS CORP
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Gas
Phone Number (305)757-0950
Parcel Number 1132060140710
Phone: (305)298-0193
Building Department Comments
INSTALLATION OF GAS LINE SERVING NATURAL GAS
FIRED 22 KW GENERATOR BURIED POLY PIPE WITH
METALLIC RISERS EACH PANEL
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
CREATED AS REINSPECTION FOR INSP-310046. CREATED AS
REINSPECTION FOR INSP-305229. FBC R P2503.2 work shall not be
cover
- missing pressure test insp.
- need drop test cert for final insp.
press test okay previously approved
Bob bickers
305-790-5899
8/13/18 neeed drop test cert.
Auaust 27. 2018
For Inspections please call: (305)762-4949
Panes %d of 41
18111 NW 68 AVE UNIT I-105
Hialeah FI, 33015
305- 298 -0193 CeII
305- 331- 2572 Office
Forevergas@live.com
NAME: eDDNAI S\d
DROP TEST CERTIFICATION
PERMIT NUMBER: Pl - S -)g' trVOS
DATE: 722' )Q
ADDRESS "ISOS N� 5f )E cry M)AM) S�DILI� ZIP '33) 3 4`
THIS LETTER IS TO CERTIFY THAT FOREVER GAS CORP. COMPANY PERFORM A DROP TEST TO
CHECK THE WHOLE GAS LINE.THIS DROP TEST HAS A THIRTY DAY WARRANTY FROM THE TESTED
DATE
TYPE OF INSTALLATION: NEW 0 EXISTING
THIS IS FOR A:
,NATURAL GAS:
O WATER HEATER
❑ STOVE/RANGE
❑ BARBECUE
❑ DRYER
;GAS GENERATOR.
0 OVEN
❑ POOL HEATER
❑ OTHER
�� 0 PROPANE GAS:
SYSTEM PRESSURE FROM METER: l/ SYSTEM PRESSURE FROM TANK
WATER COLUMN: 1/ 1 WATER COLUMN
TEST DURATION: IS %4 )10 a FLOW
DATE OF TEST: 4 22
PSI LOCKUP
TEST DURATION
DATE OF TEST:
IF YO Y FURT R QUESTIONS, PLEASE CALL 305-298-0193 ZD � 3
DATE: / ZZ / 17 rz ii -7 i �L
ROBO GO�:� ZXn,-31 ^1q
CONTRACT. ' (Q
SIGNATU
ALIFIER)
NOTARY PPBLIC
DATE: 0
JOUMARIE PINEIRO
Notary Public - State of Florida
Commission ft GG 75212
My Comm. Expires Feb 20, 2021
STATE #: 28379
CC # LPG 28379