PL-19-2272ADVANTAGE GAS SERVICES
16891 SW 139 PL.
MIAMI FL. 33177
PHONE: 305-979-8281
LPGX LIC: 42062
Master Permit Number: Gmil' Z-ZL -1
Plumbing Permit Number:
Job Site Address: 104co 1JG. q E T� Sir
Date & Time of Test: 0 I - 2-3 Z0
Natural Gas: XLiquid Propane:
Starting Time: .�:oD
Ending Time: 2- 362
Manometer Test: Water Column Open Side, + 5 , and Lock Side, - 5.
Test Details: The drop test was measured with a manometer of water column, "U",
showing not variation and held the same differential for the time of test.
State License: L142062
Daniel Santana
V//Z
�9 Notary Public State ofFkW da
Signature: Carlo Covello
er w E tores� ii 323tJ05
Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
QlfTfJ!J�i�
Issue Date:
Location Address Parcel Number
1070 NE 95TH ST, Miami Shores, FL 33138 1132050120030
Contacts
Permit NO.: PL-09-19-2272
Permit Type: Plumbing - Residential
Work Classification: Gas
Permit Status: Approved
Expiration: 04/21/2020
JANENE CHURCH Owner
1070 NE 95 ST, MIAMI SHORES, FL 331382548
ADVANTAGE GAS SERVICES INC Contractor
DANIEL SANTANA
16891 SW 139 PL, MIAMI, FL 33177
Business: 3059798281 info@advantagegas.com
Description: NEW GAS LINE FOR GENERATOR Valuation: $ 1,500.00 Inspection Requests:
305-62-4949
TotalSq Feet: 0.00
Fees
Amount
Application Fee - Other
$50.00
CCF
$1.20
DBPR Fee
$2.00
DCA Fee
$2.00
Education Surcharge
$0.40
Permit Fee
$50.00
Scanning Fee
$3.00
Technology Fee
$2.50
Total:
$111.10
Building Department Copy
Payments
Date Paid Amt Paid
Total Fees
$111.10
Credit Card
10/24/2019 $61.10
Credit Card
09/27/2019 $50.00
Amount Due:
$0.00
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores
Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate
permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNERS ffFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws
regulating construction d zoning. Futhermore, I authorize the above named contractor to do the work stated.
0
Authorized Signature: Owner / Applicant / Contractor / Agent Date
October 24, 2019 Page 2 of 2
BUILDING
PERMIT APPLICATION
❑BUILDING
[PLUMBING
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
❑ ELECTRIC ❑ ROOFING
�
FBC 20
Master Permit No. ail - 09 -) 1 - 22 7 f
Sub Permit No. TL Oq-1 1-z27Z
❑ REVISION ❑ EXTENSION ❑RENEWAL
❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: ty `0 t_�
City: Miami Shores County: Miami Miami Dade Zip:
Folio/Parcel#: ��- J [�' �� Z� LJ� Jy Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type
OWNER: Name (Fee Simple Titleholder):
Address: to-ic Neh� QS
City: M��ii� <�bO`{
Tenant/Lessee Name:
Email:
CONTRACTOR: Company Name:
Address: ,� `
r
City:
Qualifier Name:
State Certification or Registration #:
DESIGNER: Architect/Engineer:
Flood Zone: BFE: FIFE:
y101-)
one#: 3Cf5- col^co-1 Q -3
State: -Y `- Zip:
Phone#:
ne#: -Of T4-$�1
Certificate of Competency #:
Phone#:
Address: City: '
Value of Work for this Permit: $ Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace
Description of Work:
Zip:
❑ Demolition
Specify color of color thru tile:
Submittal Fee $ 5 0 PO C Permit Fee $ 100 CCF $ 1. a 0 CO/CC $
Scanning Fee $ 3. 01� Radon Fee $ o2 • 00 DBPR $ 4.00 Notary $
Technology Fee $ off. SD Training/Education Fee $ 0. 4D Double Fee $
Structural Reviews $ Bond $ �
TOTAL FEE NOW DUE $ U1. 10
(Revised02/24/2014)
B;ndirig Company's Name (if applicable)
Bonding Company's Address
City
State
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 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
OWNER or AGENT
The foregoing instrument as acknowledged before m this
da of
20 t , by
Jwho
is personally known to
me or who has produced
as
identification and who
did take a oath.
NOTARY PUBLIC:
Sign:
Print:
r •�
�Seal:
Notary' Pu lic State of Flonda
Carlo Ca alto
.
My Commi Sion GG 323605
N .
4'?orwo
Expires0613012023
Signature
CONTRACTOR
The foregoing instrument was acknowledged before me this
_(day of (/� , 20, by
I(Qx mho ir���as
o
me or who has produced _
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
`F
Notary Public Stat of Flonda
Carlo Cavallo
My Commission GG 323605
Expires 06/30/2023
APPROVED BY t1�1 Plans Examiner
Zoning
Structural Review
(Revised02/24/2014)
Clerk
Advantage Gas Services
16891 SW 139t1i PL
Miami, FL 33177
Phone 305-979-8281
L142062
Date: 10/11/2019
State of Florida
County of Dade
Before me this day personally appeared Daniel Santana who, being duly sworn, deposes and says:
That he will be the only person working on the project located at: 1070 NE 95 St, Miami Shores FL
33138.
Contractor Signature
Sworn and subscribed before me this 11 day of October 2019. By Daniel Santana
Ily
�Or Notary Public State of Floritla
Carlo Cavallo
Y-P
My Commission GG 323605
Expires 06/30/2023
Notice to Owner - Workers' Corn
Miami shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
nsation 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:
l . 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: 'k�cv, &�=
Owner
State of Florida
County of Miami -Dade
The foregoing was acknowledge before me t 's?-(P day of� , 20�
who is personally known to me or has produced
as identification.
Notary:
�,�++p4d Notary Public State of Florida
SEAL: Carlo Cavallo
it gyp'` Expires 06/30/2023 323605