PL-18-2280Miami Shores Village RECEIVED
Building Department AUG 27 1010
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
QPLUMBING MECHANICAL [:]PUBLICWORKS
40 NE 105th St
FBC 20 V?
Master Permit No. OS 1 - 2 Z
Sub Permit No. I9t — ?n<) -C?
REVISION EXTENSION RENEWAL
CHANGE OF CANCELLATION SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS:
City: Miami Shores County: Miami Dade Zip:33138
11-2136-012-0060 X
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder):
Raul V. Guerra
Phone#: (
305) 796 - 5337
40 NE 105th St
Address:
City:
Miami Shores
State:
FL
Zip:
33138
Tenant/Lessee Name: Phone#:
Email:
Raul@arrasair.us
CONTRACTOR: Company Name:
Excel Plumbing Services Inc.
6810 SW 81 st St
Address:
e#:
305) 273 - 1138
Miami FI 33143
City: State: Zip:
Carlos Perez
Qualifier Name: Phone#:
State Certification or Registration #:
CFC035688
Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $
3,000.00
Square/Linear Footage of Work:
Type of Work: Addition Alteration New El--Repair/Replace Demolition
Description of Work:
Installation of new underground propane tank. Installation of gas line for future
use.
Specify color of color thru tile:
Submittal Fee $
Scanning Fee $
Permit Fee $ J LO • W CCF $ CO/CC $
Radon Fee $
Technology Fee $ Training/Education Fee $
w
Structural Reviews $
r
Revised02/24/2014)
DBPR $ Notary $.
Double Fee $
Bond $
TOTAL FEE NOW DUE
Bonding Company's Name (if applicable)
Bonding Company's Address
City State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City State
Zip
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 inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be aper nd a reinspection fee will be charged.
Signature Signature
O or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this
day of 12015 by
who i ersonally known
me or who has produced
identification and who did take an oath.
NOTARY
as
The foregoing instrument was acknowledged before me this
day of V L%5A— 20 by
eQ,'i who i ersonally know to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
1
vU Sign:_
1cPrint: a umVyyi' t Print:
Seal:
I
HALEY HOLEMAN
MY COMMISSION F GG 139194
EXPIRES: August 1, x2l
Bonded Thru Notary rubk uni i vers
Seal:... ..... HALEY HOLEMAN
M`! COMMISSION X GG 130194
EXPIRES: August_ 1.22 0 2 1
y
i.OF.F n'•. Bonded Tf nr Notary NuNic Underw**
APPROVED BYr Plans Examiner
Structural Review
Revised02/24/2014)
Zoning
Clerk
TO: WHOM IT MAY CONCERN:
I)S
PRESTIGE GAS SERVICES CORP.
1511 SW 71 CT MIAMI FL 33144
PHONE: 305-300-0608
FAX: 305-356-4332
DATE: APRIL 12, 7.019
THIS unmm IS TO CERT<fii THAT PRESTIGE GAS SERVICES CORP HAS PERFORMED A DROP TEST AT
THE FOLLOWING SITE AND TESTED ALL THE APPLIANCE CONNECTIONS. THE GAS LINE HAS BEEN
CHECKED TO THE STANDARDS OF THE 2017 FLORIDA BUILDING CODE AND PROPERLY TESTED TO MEET
THE STANDARDS OF NFPA 54. THE WORK WAS PERFORMED FDR RAUL GUERRA AT 40 NE 105 ST,
Mum FL 33138
TEST PRESSURE: 80
LOCK UP PRESSURE: 2.2 PSI
OPERATING PRESSURE: 2.0 PSI
TEST IPM 30 MINUTES
STATE LICENSE Na LPG 32634
TYPE AND CLASS: 0803
IF YOU SHOULD HAVE ANY QUESTIONS REGARDING THE MATTER PLEASE DO NOT HESITATE TO CALL US.
SINCERELY,
LAZARQ P X
CEO r .
PRESTIGE GAS SERVICE CORP:
SY'p" MESEA IIAR
otary c tate of Florida
ssion s GG 142883
My om . Aires Sep 13, 2021
Barded through Naticral Nctary Asir.