PL-18-2283Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
CORIDA
Permit NO. P'L-8-18-2 83
Permit Type: Plumbing - Residential
Pen' Work Classification: Gas
Permit Status: APPROVED
Issue Date: 8/30/2018 1 Expiration: 02/26/2019
Project Address Parcel Number Applicant
868 N E 100 Street 1132060340020
MOHAMMED ALJEHANI
Miami Shores, FL Block: Lot:
Owner Information
Phone Cell
MOHAMMED ALJEHANI 868 NE 100 Street (412)613-3587
MIAMI SHORES FL 33138-
868 NE 100 Street
MIAMI SHORES FL 33138-
Contractor(s) Phone Cell Phone
HOME GAS CORP/ MEDLEY GAS COB
Type of Work: 10 feet to 1-200 tank for range por
Type of Piping:
Additional Info:
Bond Return :
Classification: Residential Scanning: 3
Fees Due
Amount
CCF
$0.60
DBPR Fee
$2.25
DCA Fee
$2.00
Education Surcharge
$0.20
Permit Fee
$175.00
Scanning Fee
$9.00
Technology Fee
$0.80
Total:
$189.85
Valuation: $ 567.74
Total Sq Feet: 10
Pay Date Pay Type Amt Paid Amt Due
Invoice # PL-8-18-68687
08/30/2018 Credit Card $ 139.85 $ 50.00
08/27/2018 Credit Card $ 50.00 $ 0.00
Available
Inspection Type:
Final
Press Test
Review Plumbing
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 a re t riz a above-nam contractor tq do the work stated.
cZ(ta /`/jv1 e� August 30, 2018
Authorized Signature: Owner / Applicant / Contractor / Agent Date
Building Department Copy
August 30, 2018
1
BUILDING
Miami Shores Village
Building Department LU272018110050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949 f
FBC 20 \2�
Master Permit NoTUy - 7,�..(J
PERMIT APPLICATION Sub Permit No.
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
p CONTRACTOR DRAWINGS
JOB ADDRESS: r) / oo '4
City: Miami Shores County: Miami Dade Zia: ,1/ 3 U
Folio/Parcel#: %l 3-20Z- — 63 CjUokG Is the Building Historically Designated: Yes • NO
Occupancy Type: 7.S Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titlehold,-.,%Ajhk in o v d AIJP k a n -4 Phone#"4 I,9,'&/ 3 -,3 5?7
Address:
City: State: State: 1• Zip: -3S/3$
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: rx� ��S Phone#:53
Addresy!Q�gG S?'d "a-)
City: ►G,
Qualifier Name:
0u<�--
r>
p:
o
State Certification or Registration #:0 t e-) t,, Certificate of Competency #: , l
DESIGNER: Architect/Engineer: Phone#:
Address: Cit''"• 4,tateR Z p
Value of Work for this Permit: $ •6&?• `7 r Square/Linear Footage of Wgf
Type of Work: ❑ Addition Alterations ❑ New ❑ Repair/iie ,lace El Demolition
•
Description of Work: �� 1" 1 ` �c)o Tti h k �b^'"nS'a� Vi1tl�, P(
Specify color of color thru tile:
Submittal Fee $ '��J Permit Fee $ jq 5 CV
Scanning Fee $
Technology Fee
Radon Fee $
Training/Education Fee $
CCF $
DBPR $
CO/CC $
Notary $
Double Fee $
Structural Reviews $.
(Revised02/24/2014)
Bond $ TOTAL FEE NOW DUE $ 3 p ` •75
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
Zip
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 insp ich occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection w' of be app oved and a reinspection fee will be charged.
OWNER or AGENT
Signature
CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
8 day of ��- 20 . by , day of'r �Ir 20� o by
l%%%d�i4imm�pl �l ! ohcan , , who is personally known to / ��-`201 CtY- ? who is personally known to
me or who h as
V
YAM_ �Y A. VALDES
identificationa" Pits; . State of Florida
NOTARY PU LtolamiSWon N GG 038648
My Comm. Expires Oet 25, 2020
Bonded through, National Notary Assn.
Print: %�i�/r7 m !il /S•
Seal:
me or who has produced as
identificat
n asp ,�o d
ICI ta ce( . VALDES
'Notary
NOTARY
�=
Public -State of Florida
Commission # GG 038648
�•''"°�
M Comm. Expires Oct 25. 2020
1r��P`
Bonded Through National Notary Assn.
Sign:
Prin
Seal: /<! f
APPROVED BY J � Plans Examiner Zoning
Structural Review Clerk
(Revised02/2412014)
Property Information
Folio:
11-3206-034-0020
Property Address:
868 NE 100 ST
Miami Shores, FL 33138-2512
Owner
JOSEPH PIPERATO
MOHAMMED ALJEHANI
Mailing Address
868 NE 100 ST
MIAMI SHORES, FL 33138 USA
PA Primary Zone
1100 SGL FAMILY - 2301-2500 SQ
Primary Land Use
0101 RESIDENTIAL - SINGLE
FAMILY: 1 UNIT
Beds / Baths / Half
2/2/0
Floors
1
Living Units
1
Actual Area
2,012 Sq.Ft
Living Area
1,655 Sq.Ft
Adjusted Area
1,833 Sq.Ft
Lot Size
8,850 Sq.Ft
Year Built
1953
Assessment Information
Year
2018
2017
2016
Land Value
....................
$265,791
$265,791
$229,776
Building Value
$159,471
$127,577
$127,577
XF Value
$1,658
$1,665
$1,672
Market Value
$395,033
$359,025
�$426,920
Assessed Value
$426,920
$136,905
$134,090
Benefits Information
Benefit
Type
2018
2017
2016
Save Our Homes
Assessment
Cap
Reduction
$258,128
$224,935
Homestead
Exemption
$25,000
$25,000
Second Homestead
Exemption
_
$25,000
$25,000
Note: Not all benefits are applicable to all Taxable Values (i.e. County,
School Board, City, Regional).
'Short Legal Description
5-6 53 42
MIAMI SHORES SEC 8 PB 14-33
LOT 3 & E1/2 LOT 4 BLK 169
LOT SIZE 75.000 X 118
OR 16572-2743 1194 1
Generated On : 8/27/2018
Taxable Value Information
2018. 2017 2016
County
Exemption Value $0
$50,000
$50,000
Taxable Value $426,920
$86,905
$84,090
School Board
Exemption Value $0
$25,000
$25,000
Taxable Value $426,920
$111,905
$109,090
City
Exemption Value
$0
$50,000
$50,000
Taxable Value
$426,920
$86,905
$84,090
Regional
Exemption Value $0
$50,000
$50,000
Taxable Value $426,920
$86,9051
$84,090
Sales Information
Previous
OR Book -
Price
Qualification Description
Sale
Page
30681-
09/02/2017
$525,000
Qual by exam of deed
4573
26704-
Sales which are disqualified as a result
11/05/2008
$10
0032
of examination of the deed
16572-
11/01/1994
$40,000
Sales which are qualified
2743
The Office of the Property Appraiser is continually editing and updating the tax roll. This website may not reflect the most current information on record. The Property Appraiser
and Miami -Dade County assumes no liability, see full disclaimer and User Agreement at hfp://www.miamidade.gov/info/disclaimer.asp
Version:
https://www.miamidade.gov/propertysearch/
8/27/2018
Category I LP Cz .s Dealer
HOWARD GOUZ
Cert Number: 13125
Expires: 7/3/2021
Scope of Work
Sales of LP gas; cylinder excharpe; sale or tease of LP gas appliances or
ecg,mment; installation, service and repair of LP gas appliances acid
equipment; earburriion. equipment sales and installation; regualification
of cylinders.
ClradqAesua
tj nq 13rd
ICfM
CER'CIFICATE OF COMPETENCY
)00001616
GM CQRPORATION
GOUZ HOWARt3
Is c�r#w undo the provisions Of CtIapter , 0 of Mi�rti Dade C �`!
State of Florida '
pTipartmlent of Agriculture and rorIsx,jer Serwit
Bureau of Compliance
Adam H. Putnam
kµ Commiscioner
www.freshfromflorida.wtn
(850)921-1600
cscomplia nce@fresh(romflorida.c,)m
QUALIFIER IDENTIFICATION CARE)
Category I LP Gae Dealer
This qualifier idanlihcahon card -, evidence that this person has passed a
4on're'en4y e)womt,,ion adm€ cterc d by the state of Florida, and may act a-
QUALIFIER for an LP q.•rq:coml—ai+v licensed i€. th ,-tenory above pursuar,: to
Chapter 527 Flooda Mutes
anstrueskitan quafffyrtlg Board
,INSS CERTIFICATE OF COMPETENCY
V tIOD
Local Business Tax J$eceipt
Miami -Dade County, State of Florida
-THIS IS NOT A BILL - 00 NOT PAY
5252192
BUSINESS NAME/LOCATION
HOME GAS CORP
1060 SW 27rH AVE
MIAMI FL 33135
rNER
OME GAS CORP
009438
RECEIPT NO.
EXPIRES
RENEWAL
SEPTEMBER 30, 2019
3578888
Must be displayed at place of business
Pursuant to County Code
Chapter BA - Art. 9 & 10
SEC. T1_E OF BUSINESS
205 DEALER/DISTR/INSTALLATION PAYMENT RECEIVED
UO0001816-.
8Y TAX COLLECTOR
$270.00 07/05/2018
CREDITCARD-1B-049889
This boat Business Tas Racsipt otLLLF firms payment of the Local Business Tax. The Receipt is not a license,
permit,at 661111uficaftri of the hoidWspaiifications, to do business. Holder must comply with any governments[
or nangevernme rapulafory le"and requirements which apply to the business.
The RECEIPT NO. above must be displayed on all commercial vehicles - Miami -Dade Code Sec 6a-276.
For more information, visit
Local Business Tax Receipt
Miami -Dade County, State of Florida
-THIS IS NOT A BILL -DO NOT PAY i
2673698
BUSINESS NAME/LOCATION RECEIPT NO.
MEDLEY GAS CO RENEWAL
8240 NW 90TH ST 2802560
MEDLEY FL 33166
111
EXPIRES
SEPTEMBER 30, 2019
Must be displayed at place of business
Pursuant to County Coda
Chapter 8A - Art. 9 & 10
OWNER SEC.TYPE OF BUSINESS
MEDLEY GAS CO 205 LPG DEALER / MFG PAYMENT RECEIVED
BY TAX COLLECTOR
$270.00 07/05/2018
CREDITCARD-18-049902
This Local Business Tax Receipt only confirms payment of the fecal Business Tax. The Receipt is not a license,
permit or a certification of the hoidar sqquaiifrctrtlons, to do busioass. Holder must Comply with any governmental
of nangovemmentafiepuiatorytai�vs and tegtdremetns which apply to the business.
The RECEIPT NIVahnvrmnethodimlooedw..me ... .... u:__: n_..w_..... .. ..
- -''ea"I'll HOMEGAS-03
ONTIEL
DATE 1Y)
144cORO' CERTIFICATE OF LIABILITY INSURANCE
�---�'�
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 poiicy(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 rl hts to the certificate holder in lieu of such endorsements .
PRODUCER
C TACT
Morris & Reynolds Inc.
14821 South Dixie Highway
Miami, FL 33176
HON Ems; 305 238-1000 Nd:{305} 255-9643
INSURER AFFQPV.INQ 99VERAGE
NAIC#
IN URERA:Crum & Foster Indemnity Co.
31348
INSURED
Home Gas Corporation
Mrs. Laura Gouz
INSURER : Brid efield Employers Ins. Co.
10701
INSURER C :
1060 SW 27th Avenue
INSURERD:
INSURER E :
Miami, FL 33135
INSURER F :
COVERAGES CERTIFICATE NUMBER! REVISION NUMaI RE
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
ADDL
SUBR
POLICY NUMBER
POLICY EFF .
POLI Y EXP
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE 1 V r OCCUR
506-894275-8
07/01/2018
07/01/2019
EACH CCURR NC°
1,000,066
:TV RENTED S
I 100,000
MEA EXP (My one rsan)
5,000
PERSONAL & A V INJWRY
1,000,000
WLAGGRE TG LIMIT APPLIES PER:
PR�4
POLICY Jc T LOC
OTHER:
P.ALA EGATE
S 2,000,000
PR 'T - MPtOPA G
2,000 000
e r
g
A
AUTOMOBILE LIABILITY
ANY AUTO
OWNED SCHEDULED
AUTOS ONLY AUTOSoT �yN p
XI
X AUTOS ONLY X 2VO� ON Y
506-894275-8
07/01/2018
07/01/2019
COMBINED SINGLE LIMIT
u_
a 1,000,000
130DILY INJURY Mer Orson
$
DILY IN�1RY (Per accident,
5
t78E Y AMAGE
5
UMBRELLA UAB
EXCESS LIAB
CLAIMS -MADE
EACH OCCURRENCE
e
HOCCUR
-,TIE
$
DED I I RETENTION$
a
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANYPROPRIETOR/PARTNER!EXECUTIVE Yr�N.
FFICERIMEM6ER EXCLUDED?
�tandetory in NHI
If yes, describo under
DESCRIPTION F OPERATIONS belowE.L.
NIA
83046965
01/07/2018
01/07/2019
�( PER OTH-
E..EA tRE T
---
. 100,000
RI E S -EA PL Y E
_
100,000
�,,,,,_._,_sss___
DIS ASE - PQLICY LI 17
500 0
' 00
DESCRIPTION OF OPERATIONS/ LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached it more space Is required)
LPG DEALER - State of Florida
Ref. Howard Gouz License #000001616
Miami Shores Village
Building Department
10050 N. E. 2nd Avenue
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 (2016103) 01988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
-11
0
1060 SW 27 AVE
MIAMI FL 33135
(305) 643-1611)
Fax (306) 643-1616
PGR+r
i
ti103
Y /
PIPING DIAGRAM
CONTRACTOR LICENSE # 1616
CONTRACTOR SIGNATURE
Sworn to and subscribed before me
this dX2 day d'
��INIYP /•//
TAMMY 6. VALDES `
'
Notary Public • State of Florid;•
- _
Commission a GG 038648
MY�l,➢q' E�PireS Oct 25, 2(,20
C
Bo iA� National Notary Assn
Rt_DG DFPT 1
'I l/V\l(;F WITH ALL FE DFRAl.
I I S AN) RF GI II All(lNS
At
l
••••
• •
Qhr-r— �y n �. PIPE SIZE:
�LL?'C PIPE SIZE: PIPE: SIZE;
2EG, TYPE ftEG. TYPE
REG. TYPE RE:G. TYPE
'HIGH PRESS) rILOWPFIESS) LOW PRESS)
�I.OW PRE58)