PL-10-425Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 138095 Permit Number: PL- 3- 10-425
Scheduled Inspection Date: March 31, 2010
Inspector: Hernandez, Rafael
Owner: HERNANDEZ, FRANCISCO
Job Address: 126 NE 93 Street
Miami Shores, FL 33138-
Project: <NONE>
Contractor: AMERIGAS PROPANE AND SUBSIDIARIES
Building Department Comments
Passed
fx'/
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
March 30, 2010
For Inspections please call: (305)762 -4949
GV
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Gas
Phone Number (786)282 -9014
Parcel Number 1132060133130
Phone: 305 -883 -8600
Page 9 of 23
Project Address
126 93 Street
Miami Shores, FL 33138-
Owner Information
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138 -0000
Phone: (305)795 -2204
Address
Parcel Number
1132060133130
Block: Lot:
Contractor(s) Phone
AMERIGAS PROPANE AND SUBSIDIA 305 - 883 -8600
Cell Phone
Fees Due
CCF
Education Surcharge
Permit Fee - Additions/Alterations
Scanning Fee
Submittal Fee
Submittal Reversal Fee
Technology Fee
Total:
Amount
$1.20
$0.40
$150.00
$3.00
$50.00
($50.00)
$1.60
$156.20
Authorized Signature: Owner / Applicant / Contractor / Agent
Building Department Copy
Phone
Type of Work: 2 TANK SET ONLY
Type of Piping: GAS
Additional Info: PLUMBING
Bond Retum :
Classification: Residential
Pay Date Pay Type Amt Paid Amt Due
Invoice # PL -3-10 -37301
03/23/2010 Check #: 4671 $ 106.20 $ 50.00
03/16/2010 Check #: 4478 $ 50.00 $ 0.00
Expiration: 09/19/2010
Applicant
FRANCISCO HERNANDEZ
Date
CeII
FRANCISCO HERNANDEZ
126 93 Street
MIAMI SHORES FL 33138 -2818
(786)282 -9014
(561)212 -5079
Valuation:
Total Sq Feet:
Available Inspections:
Inspection Type:
Final
Press Test
ROW
1
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.
March 23, 2010
March 23, 2010 1
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BUILDING
PERMIT APPLICATION
FBC 20
Permit Type: PLUMBING
Owner's Name (Fee Simple Titleholder) r ¢44- e e
Owner's Address / i 1/ e. 9,5sta
Cityge-Le 0 State
Tenant/Lessee Name
Job Address (where the work is being done)
City Miami Shores Village
FOLIO / PARCEL #
Is Building Historically Designated YES _ NO
Contact Phone
Type , ofWork:
Desckbe Work:
3 eF 6,&0
Value of Work For this Permit $
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
/Poo
6Ya 9 S'
County Miami -Dade
Contractor's Company Name 9 � �--
Contract .r'sAddress /®0 -1 'a- LJ t9
City _ � ' State
Qualifier Name 46
State Certificate or Registration No. vC Pa ®®
E -mail
g3aMIWZR
lAR 1 F 2011)
L 19-5
/�l:
Permit No � —
Master Permit No. d'C 3- 09 - 4,25
Zip SO/56
Phone #
Phone # ize - 6
Zip
Phone # eto k 60
Certificate of Competency No.
.2 ia. -moo 9
Zip SS 3S
Flood Zone
Architect/Engineer's Name (if applicable) Phone #
Square / Linear Footage Of Work:
❑Addition RAlteration fNew 0 Repair/Replace ❑ Demolition
- / fra
** * ** * * * ** * * * * * * * * * * * ** * * * * *, * * * * * * ** F *** * * * * * * * * * * * * * * * * ** * * * * * * * **
Submittal Fee $ + v Permit Fee $ / 5 — s r -e d CCF $ 1 ' CO /CC $
Notary $ Training/Education Fee $ 0 ' Technology Fee $1`0
Scanning $ � 00 Radon $ DPBR $ Bond $
Violation date:
Double Fee $ /,,
Structural Review. $ Total Fee Now Due $ 1062'20
See Reverse side -+
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
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 ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and 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 reinsp'ctio. ' e ill be charged.
Signature / °
APPROVED BY
Owner or Agent
The foregoing instrument was acknowledged before me this arsi
day of ,20 %),by
who is personally known to me or who has produced D/
`r 220 6 Rt�`l- As i dent ifi cat i on and who did take an oath.
(Revised 07 /10 /07)(Revised 06/10/2009)
• �6� Ja e 114 :
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Sign _
Print: i4 Y �p �•.0 : *_
• 1"16 896587 : .Q`
My'ConunissionExpires: ( %.:41,�eaed+ 0: ct 41:
* * * * * * * * * * * * * * * * * * * * * * * ** * * * * * * * * * * * * * * * * **
Plans Examiner
Engineer
QQ`
Contractor
The foregoing instrument was acknowledged before me this 12
day of ,l1A 1.Vii , 20 l) , by
who s personally known to r3 or who has produced
as identification and who did take an oath.
NOTAR iLLIC:
* • •. =
My Commission Expires: 61 gam cos � Q s
9 I' S o : t o
Zoning
Clerk checked
.10 CCf IT} ALL FEDERAL
, _ • Y ES AND REGULATIONS
6
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DETERMINE NORTH
JOB:
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REVISED:
DATE:
SCALE:
APPROVED BY
AFFIDAVIT:
This nation sh
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AfileinGaS
Amesiciet PropaneCompani
DRAWN BY:
Signature d Qual
PRINT NAME:L. tigia A titSc•
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Type of kientrocadon Produced: - v
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OluniuktO
Pj with NFPA 54, NFPA 58,
codes and regulations.
PLAN Page_ of
GENERAA. SI
Seem to and spbScid before me this I. 7 t-it
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POST UCENSE
CONSPICUOUSLY
OIL
State of Florida
Department of Agriculture and®CorlsUmer Services
Division cif Standards License Number: 00899
Bureau of Liquefied Petroleum Gas Inspection Expiration Date: August 31, 2010
Date of Issue: September 1, 2009
(850) 921 -8001 Type License � iFee: 42 00
Tallahassee, Florida
Liquefied Petroleum Gas License
CATEGORY 1 LP GAS DEALER
GOOD FOR ONE LOCATION ONLY
ANY CHANGEBOF OWNERSHIP OR SALE OF THIS BUSINESS RENDERS THIS UCENSE INVALID
This' license is issued under authority of Section 527.02, Florida Statutes, to:
if
AMERIGAS EAGLE PROPANE
10052 NW 89TH AVE
MEDLEY, FL 33178 -1444
A
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5 N HS.:' OF 'r
EXEMPT t ;.
OTHER ;
SEE OTHER SIDE
DO NOT FORWARD
AMERIGAS PROPANE LP
10052 NW 89 AVE
MEDLEY FL 33178
H LES H. BRONS.,.
COMMISSIONER OF AGRICULTURE
402
TEm Pprams OF INSURANCE I15TPD BLOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR 11th MILLI; Y rtxtUU snUU.n.tnu rvu ...a.... r.,.. ,...—
ANY PIQUfREM5Kr, TERM DR coNbl7ioN of ANY CONTRACTOR OTHER DOCUMENT MTH k&9 ?SCfTO'M *MI CH THIS CERTIFICATE MAY BE ISSUED OR MAY
PERTAIN, THE INSURANCE AFFORDED BY TEE POLICES DESCRIBED HEREIN IS SUBJECT TO ALL TEE TURNS, EXCLUSIONS AND OONDITIQNS OF SUCH POLICIES.
AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED EY PAID CLAIMS.. UMITS SHOWN ARE AS REQUESTED
Certificate No : 570035341032
BIM
I'M
DI
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TYPE OF INSURANCE
POLICY NUMBER
POLICY'TEEMS%
DATSRvIKTIDPYYYY)
POLICYB%PIRAT[ON
DAT MM/DW.YVYYI
I rr't
A
HDOG2493259A
07/01/2000
07/01/2010
BAcl[occUltRENCE
51,000,000
IrALLIA)§ILi7Y
COMMERCIAL GENERAL LIABILITY
CLAIMS MADE 171 OCCUR
BARD=TO RENTED
PkEMIEES (Fa oecarttnet)
51, 000, 000
MBD BXI' (Any ant Person)
510,000
PFRSONALEzADVAUURY
$2,000,000
' CIWEALAWKWATE
$2,000000
GEM_
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AGGREGATE WIT APPLIts PM
POLtcY ❑ PRO- ❑ LOc
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P&ODUCTS. COMP /OP AGG
52, 000, 000
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AUTOMOan..E
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ALL OWNED AUTOS
SCHEDULED AUTOS
AIRED Auras
NON OWNED AUTOS _ _ _
IsAH08579908
07/01/2009
07/01/2010
comBnizo SINOLC LIMPf
(Ramada*
51,000,000
BODILYINNRY
( Per perm)
BODILYIADURY
(ParaaeidamE
PR.OPBRTYDAMAGE
(Pmaocidant)
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GARAGE LIABILITY ...
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07/01/2000
07012009
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07/01/2010
07/01/2010
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EMPLOYERS' LIABILITY
ANY PROPRIETOR t PARTNER reXECUAYE
REXC ""7
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- $1,000,000
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DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED DY ENDORSEMENT/SPECIAL PRDVISIONS
CERIFICATT HOLDER CANCELLATION
M
Miami S 1 4 tore . V 7 1 l a ge
Building Department
1.005.0 . HE 2nd Avenue
Miani SHores, FL 331,33_,..
SHOULD ANY UWE ABOvE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, TFIE ISSUIN0 INSUREA ENDEAVOR TO MAIL
sIIr p e o slIAT O. ) NO OAi GATIONOOA L IABI L TO TEE T .
OP ANY KM UPON THH INSURER, ITS ACHIMORREPRESENTATIVBS.
AUTHORIZED REPRESENTATIVE � „�
nno vnnn A /'+elan 'r moan ATIDN. All rights reserved
r-
JUL /U2 /2009 /THU 10:13 AM amerigas
CERTIFICATE OF LIABILITY INSURANCE
PRODUCER
Aon Risk Services Central, Inc.
Philadelphia PA Office
One Liberty P1 ace
1650 Market Street
Suite 1000
Phil adelp hia PA 19103 USA
MOM . (866) 283 -7122 FAX- (847) 953 -5390
INSUi E6
Atari Gas Eagle Propane, LP
PO BOX 96$
valley Forge PA 19482 USA
PATE (M �YYYY)
07 2009
TIMES CERTIFICATE YS ISSUED AS A IVIATTEPI.OP' INFORMATION ONLY
AND CONFERS NO RIGHTS UPON 5 CERTIFICATE HOLDER fi, TICS
CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE
COVERAGE AP FORDED 8'Y T13E POLICYES $FLOW.
IN$[URSRS AFFORDINO COVERAGE
arsua R ACE American Insurance Company
INSURER B: Indemnity Insurance co of North Amer• ca
INSURER C:
INSUkEkD:
INSURER E:
NAIC �l
22667
43575
COVERAGES
ACORD 2, thuu ,ur)
FAX No. 610 992 3238
The 4 CORD name and logo are registered marls of ACO
Holder Identifier :