PL-18-1582Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Project Address
Permit NO. PL-6-18-1582
Pennit Type: Plumbing - Residential
Work Classification: Gas
Pennit Status: APPROVED
tssue Date: 6/25/2018 Expiration: 12/22/2018
Parcel Number
Applicant
1151 NE 99 Street
Miami Shores, FL 33138-
1132050180070
Block: Lot:
ADAM CARRICO TRS
Owner Information
Address
Phone
Cell
ADAM CARRICO TRS
1151 NE 99 Street
miami shores FL 33138-
(415)533-8653
Contractor(s) Phone
ENERGY MULTISERVICES CORP (305)796-2270
CeII Phone
Valuation:
Total Sq Feet:
$ 4,770.00
0
Type of Work: INSTALL STANDBY GENERATOR AND LP TA
Type of Piping:
Additional Info:
Bond Return :
Classification: Residential
Scanning: 1
Fees Due
CCF
DBPR Fee
DCA Fee
Education Surcharge
Permit Fee
Scanning Fee
Technology Fee
Total:
Amount
$3.00
$2.25
$2.00
$1.00
$150.00
$3.00
$4.00
$165.25
Pay Date Pay Type
Invoice # PL-6-18-67869
06/25/2018 Credit Card
Amt Paid Amt Due
$ 165.25 $ 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 zoning. Futhermore, I authorize the above -named contractor to do the work stated.
Authorized Signature: Owner / Applicant / Contractor / Agent
June 25, 2018
Date
Building Department Copy
June 25, 2018 1
,
BUILDING
PERMIT APPLICATION
El BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION
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
RECEIVED
JUN 0 8 2018.
�>L
FBC 201IO
Master Permit No. F- Li O 1St51
Sub Permit No. Ttat U 145152
[PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF
CONTRACTOR
JOB ADDRESS: / / 5I MC 9 9 6-frCGt
City: Miami Shores County: Miami Dade
folio/Parcel#:II-3aa5-017- O70 d
Occupancy Type: Load: Construction Type: Flood Zone: fie
OWNER: Name (Fee Simple Titleholder): Adorn Carrico
Address: / 15I NE 99 o't.
City: I'1'1 iami 5hor'C3
Tenant/Lessee Name: fV 114
Email:
State: Ft -
EXTENSION RENEWAL
❑ CANCELLATION ❑ SHOP
DRAWINGS
Zip:33 I3'a
Is the Building Historically Designated: Yes NO
BFE: FFE:
Phone#: 105 - 533- a53
Phone#:
Zip: 33138
CONTRACTOR: Company Name: 6✓I cr9 y Multi 5 Gil%/ GC.S Co f9 Phone#: 3 0 S - - 7 to-o? g, '70
Address: 3 A '? -1 NIA, l 00 3't
City: IY1 1 G Wl 1 State: F/.
Qualifier Name: cJ t t'VI IY1 CG I d Gr"o o
State Certification or Registration #: LPG' A$(p O
DESIGNER: Architect/Engineer: I p
zip: 3314'7
Phone#:305 '79to" AA70
Certificate of Competency #:
Phone#:
Address: City:
//
Value of Work for this Permit: $ 7 -7 1 0 . 0 U
Square/Linear Footage of Work:
Type of Work: ❑ Addition I I Alteration New
State: Zip:
❑ Repair/Replace
n Demolition
Description of Work: LYI,S+Q 3tcnc1 b/ G-eneratot - 1 ns l-a 11 Tool* I cl q
L -I-ai2 - /ALL o i o i/iG-to/tn0G*i d t o new o?CKCKJS-i'andb,/ (1.J
Specify color of color thru tile:
Submittal Fee $ Permit Fee $ OQ,42— CCF $
Scanning Fee $ Radon Fee $ DBPR $ C:3." oZs
Technology Fee $ Training/Education Fee $
Structural Reviews $
CO/CC $
Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $ I o '
(Revised02/24/2014)
Bonding Company's Name (if applicable) /1/41 / I
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City State Zip
IU J14
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
ad —
OWNER or AGENT
The foregoing instrument was acknowledged before me this
I
ay of j t.......h..r..� 20 I by
%►' .Y,>✓t GI - i 4124 , who is personally known to
me or who has produced �` >s,Y/V�i`�-C�t✓i�as
(o a-6. 0
identification and who did take antodth ' V
NOTARY PUBLIC: <v.w,imilE,>e
.,0\AN TS/,q, ir',
Sign: 15, f� N-1
9 Sign' .s^r 44,1 `Uio.f�
CONTRACTOR
The foregoing instrument was acknowledged before me this
5 day of Junc , 20 I'g' , by
J i Imm'f Ca I d C.roi'1 ,/ , who is personally known to
me or who has produced P ICTrv1
identification and who did take an oath.
NOTARY PUBLIC:
Print: ) 7 ( !Print: Vi baf4h �J N Qd(�G
L I I o #F; 1443� = Al v ..4-.rasvvvinrv�no
Seal: 7 10.�� �1GY�1 tl� y ' "a r�,Tc Seal: <<F" SDEr o 0
COe)MY COMMISSION # FF176428
��tj
�i`\\ �,�»?III1i1111 �\` `c;*.s EXPIRES:Novembe r162018
as
************************************************************************************************************
APPROVED BY
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: 28607
Business Mailing Address Licensed Location Address
ENERGY MULTISERVICES CORP
3277 NW 100TH ST
MIAMI, FL 33147-1944
ENERGY MULTISERVICES CORP
3277 NW 100TH ST
MIAMI, FL 33147-1944
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 expiro 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 .. urrent license year upon written request to
the department by the original license holder. License transfers must be approved by the departmentAll licensing
requirements
rasa of LP mus Inspections at transferee 92and
Oa transfer fee of $50 will apply. To apply for a -transfer, contact the
Pursuant to Chapter 527, Florida Statutes, LP Gas licensees must present proof of licensue 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:
ENERGY MULTISERVICES CORP
3277 NW 100TH ST
MIAM1, FL 33147-1944
28607
August 31, 2018
September 1, 2017
$200.00
0803
�AMH.P��,
COMMISSIONER OF AGRICULTURE
By(14 C� cc.Yr 1 CC
floc Dewey') Li cs.h
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.
BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS
CONTENTS.
Signature:
Owner
State of Florida
County of Miami -Dade
The foregoing was acknowledge before me this day of v Cw0. , 20'a .
who is personally known to me or has produced
Notary:
SEAL:
as identification. `�tttu+uull,1
.^tip TSI.q �''°',/s
. ��co� 15 F,A,q .
�J<�t ' 1✓r :_
a #rrF144306
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•
%',.. 'Y°p • : °00.1st S','E : • .:' •$*
Energy Multiservice Corp.
3277 NW 100th Street
Miami, FL 33147
Master Qualifier License # 14852
State License # 28607
06/06/18
State of Florida
County of Miami Dade
Before me this day appeared Jimmy Calderon who being duly
sworn deposes and says, that he will be the only person
working on the project located at 1151 NE 99 St., Miami Shores,
FL 33138 to install a 500gal LP tank belowground and all piping
and connections to new 22KW standby generator.
Contractor Signature
Sworn to and subscribed before this 6th day of June, 2018 by
Jimmy Calderon who is personally known to me.
Notary Public
DEBORAH S. HODGE
MY COMMISSION # FF176428
\" 4� EXPIRES: November 16, 2018
5 0'F
Energy Multiservices Corp.
Drop Test Certification
Florida Building Code Fuel Gas
Section 406(IFGS) Inspection, Testing and Purging
406.1 General. Prior to acceptance and initial operation, all piping installations shall be
inspected and pressure tested to determine that the materials, design, fabrication, and
installation practices comply with the requirements of this code,
Owners Information: Permit Number: pi.- 6-/2-l.82.
Name: p C4 c c •
Address:
Contractor:
fJ (A
Type of Installation:
City: k- SlAacs - State: '
License Number:
Upgrade to Existing:
Description work: (Must include test details and include piping and appliances)
V-440 L&) (J, qI f c4 J 6i,1c j& 7 •
System Pressure from Meter: fo S If Hybrid system, branch pressure:
W . ter Column: 8 -D u.JC
st Duration: (owt
ontr tor (Qualifier) Signature Date
rint ►' ame
State of Florida
County of�
�
Swornto and subscribed before me this O'1 day of @ 20 ) 8 , by:
( Personally Known ( ) Produced Identification- Type of Identification
FY PJA
DEBOItAH S. HODGE
!y ) )my COMMISSION # FF116428
EXP!i: November 16,2018
Office: (305) 796-2270
Email: energymultiservices@yahoo.com State Lic. # 28607
3277 NW 100 Street. Miami, FL 33147