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PL-18-2283 (2)Miami 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)