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PL-10-543Inspection Number: INSP - 139444 Permit Number: PL -3 -10 -543 Scheduled Inspection Date: July 09, 2010 Inspector: Hernandez, Rafael Owner: BRAZIS, LILLIAN & ALBERT Job Address: 330 NE 97 Street Miami Shores, FL 33138- Project: <NONE> Contractor: MIAMI GAS CORP Building Department Comments July 08, 2010 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 For Inspections please call: (305)762 -4949 Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Gas Phone Number Parcel Number 1132060135850 Phone: (305)634 -6646 GAS PIPE INSTALLTION WITH ABOVE GROUND TANK Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments Page 2 of 11 04/07/2010 10:31 3056346442 DO NOT FORWARD MIAMI GAS,CORP SXLVIO FERNANDEZ' PRES 3235 NW 41 ST ' MIAMI FL 33142 SEE OTHER EIDE WhAuJJAdd i l .Ndhil.ndLuOnatt il l DO NOT FORWARD NIAMI'GAS CORP S/LVIO FERNANDEZ PRES 3235 NW 41 ST MIAMI FL 33142 SEEOTHERSIDE hdha ut a l h diddlLahallundliuM n and LP 00662.s 51 €Y 7— PAGE 01/02 04/07/2010 09:30 3056346442 COVERAGES GENERAL tjASILITT COMMERCIAL GENERAL LIABILITY CLAIMS MADE OCCUR AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRFD AUTOS NON-OWNED AUTOS GARAGE LIAINLITY ANY AUTO D ED UC TIBLE R S WORKERSCOmPENSATION ANC EMPLOYERS' ANT DD OPREErODNARTNERiE ECUTng OFFl E cERINEEN01 IELLIEEDT N yea. WswIM un4N sPECIAL NRVNDIONA MEWY THE POLICIES OF INSURANCE LISTED DELow HAVE BEEN ISSUILQ TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF AIV1' CONTRACT 1 )R OTHER DOCUMENT RESPECT TO WHICH THIg CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES Qr ?SCRIBED HERP_IN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH W ER POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCf•D BY PAID CLAIMS, . TYPE OF INSURANCE POLICY EMBER ,■� 6605738 L817 "' uMrrg BA5739L.039 WC0097581115 141, 08/22/09 Prey EID'k1AYIEN 08/22/10 PERSONAL & ADV INJURY 08 /22/09 08122/10 BODILY INJURY (Per parson) MegrMPATIM OTHER THAN AUTO ONLY; EACH OCCURRENCE, 10/30/09 10/30/10 E.L EACH ACCIDENT E.I.. DISEASE -Policy LIMIT 1,000,000 Z000,000 100.000 1 00,000 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/ E� SPECIAL PROVISIONS C NCELLATION NAIC # SHOULD ANY OF THE Abavr? OE,OcrNEED P'9LICIE9 BE CANCELLED BEFORF. THE EXPIRATION DATE THEREor, THE ISSUING INSURER WILL ENDEAVOR To MAIL ID DAYS WRITTEN NOTICE TO THE CER IRCATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL tMPO5E NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER. ITS AGENTS OR REPRESENTATNES, AUTHORIZED REPRESENTATIVE ACORD CERTIFICATE OF LIABILITY INSURANCE PRODUCER Phana; (904) 0600 FBk: (RAI731 7Q72 DONOVAN INSURANCE INC P 0 BOX 24980 JACKSONVILLE FL 32241.4969 INSURED MIAMI GAS CORP 3235 NW 41 STREET MIAMI FL 33142 C ` TIFI TE HOLDER Miami Shores village 10050 NE 2nd Avenue Miami Shores FL 33138 Attention: ACORD 25 (2001/08) Certificate t' 16541 INSURERS AFFORDING COVERAGE INSURER A; The insurance Co of the State of PPnnsylvanla INSURER e: TRAVELERS PROPERTY CAS CO OF AMERICA TRAVELERS IND CO NSURER C: NSURER 0: NSURER E: ® ACORD CORPORATION 1988 PAGE 01/02 DATE (MM/DDNYTY) 11!0412009 This CERTIFICATE 18 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, ExTEND OR RACE AFFDRnp 95999 25658 04/07/2010 09:30 POST LICENSE CONSPICUOUSLY License Number 05528 Business Mailing Address MIAMI t3AS CORPORATION 3235 NW 41ST 3T MIAMI, FL 33142 -4303 3056346442 Florida Department of Agriculture and Consumer Services Bureau of Liquefied Petroleum Gas Inspection P.O. Box 6720 Tallahassee, Florida 32399 -6720 Licensed Location Address MIAMI GAS CORPORATION 3235 NW 41ST ST MIAMI, FL 33142 -4303 The liquefied petroleum gas license at thf. bottom of this form is valid ONLY for the company located at the address on the license. Each business location of a company must be licensed. All LP Gas licenses must be ferenewed or restoration on o a Any license ense is equal to he expire riginall license become inoperative be mouse of r e t tc w. The nee - resume operations, paid before the licensee may IN THE EVENT OF AN OWNERSHIP CHA A T THIS S ISI NESS LOCATION: This license may be transferred to any person, firm or corporal ion for the remainder of the current license year upon Wr request to the department by the original license h older. License transfers must be approved by the department. All licensing requirements must be met by the transferee and a transfer fee of $50 will apply. To apply for a transfer, contact the Bureau of LP Gas Iri pectlons at 85 0/921 -8001. Pursuant to Chapter 527, Florida Statutes LP Gas` licensees must present proof of licensuee to any consumer, owner, or end user upon request when enl'aged in the business of servicing, testing, repairing, maintaining or installing LP Gas systems and /or equipment For future correspondence, please make a ny needed corrections or changes to your business mailing address and/or your licensed location address and •eturn the UPPER PORTION with corrections to: Florida Department of Agriculture and Consumer Services Bureau of Liquefied Petroleum Gas Inspection P.O. Box 6720 • Tallahassee, Florida 32399 -6720 Cut Here State of Department of Agriculture and Consumer Services Division of Standards Bureau of Liquefied Petroleum Gas Inspection Manse Date: (850) 921 -8001 Data of issue: Tallahassee, Florida License Fee: Liquefied Petroleum Gas License CATEGORY 1 LP GAS DEALER GOOD FOR ONE ANY CHANGE OF OWNERSHIP R SALE OF THIS BUSINESS ONLY THIS LICENSE INVALID This license is issued tinter authority of Section 527,02, Florida Statutes. to MIAMI GAS CORPORATION 3235 NW 41ST ST MIAMI, FL 33142- 4303 05528 August 31, 2010 September 22, 2009 $425.00 0801 HALES H. 8RON COMMISSIONER OF AGRICULTURE PAGE 02/02 Protect Address 330 97 Street Miami Shores, FL 33138- 1132060135850 Block: Lot: LILLIAN & ALBERT BRAZIS Owner Information LILLIAN & ALBERT BRAZIS Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Address Parcel Number 330 97 Street MIAMI SHORES FL 33138 -2406 Contractor(s) MIAMI GAS CORP Phone (305)634-6646 Cell Phone Fees Due CCF Education Surcharge Permit Fee - Additions/Alterations Scanning Fee Submittal Fee Submittal Reversal Fee Technology Fee Amount $0.60 $0.20 $150.00 $3.00 $50.00 ($50.00) $0.80 Total: $154.60 Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy Phone Applicant Valuation: Total Sq Feet: Type of Work: GAS PIPE INSTALLA WITH ABOV GROUND Type of Piping: GAS Additional Info: PLUMBING Bond Retum : Classification: Residential Pay Date Pay Type Amt Paid Amt Due Invoice # PL -3-10 -37451 03/31/2010 Credit Card $ 50.00 $ 104.60 04/07/2010 Credit Card $ 104.60 $ 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 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. April 07, 2010 Date Expiration: 10/02/2010 Cell $ 800.00 0 Available Inspections: RO April 07, 2010 1 Inspection Type: Final Press Test ROW 1 Tenant/Lessee Name Email Is Building Historically Designated YES Contact Phone Miai Shores Village Building Department 10050 N.E.nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION Master Permit No. FBC 20 Permit Type: PLUMBING Owner's Name (Fee Simple Titleholder) a ` �t , G' ocf' Phone # 0/227– v3Z? Owner's Address City /i /* - 777r ! S'AArZ State 337:ig Zip '7 Job Address (where the work is being done) ,c}C ,'7 s/ City Miami Shores Village County Miami -Dade FOLIO / PARCEL # Contractor's Company Name 44 /Ate! A .4- 421 Contractor's Address ,/' �tt_rr e� •�-- City . ...GAP e .d .c f statee . Qualifier Name �� ^C ,¢,. pep State Certificate or Registration No. NO E -mail Phone # Certificate of Competency No. liDO Vr . Architect/Engineer's Name (if applicable) Phone # Zip 33/38 Zip 53TY L Submittal Fee $ .W Permit Fee $ /Ira — 2 -VT, CCF $ a( Notary $ Training/Education Fee $ V Scanning $ 'FY on Radon $ DPBR $ Double Fee $ Violation date: Violation Review. $ Total Fee Now Due $ 1 04'00 Bond $ See Reverse side --> P4MM3 .i2W i . " Permit No. L, 0 Flood Zone Phone# 'or-6 3 Y'-6i ifeb Phone # iO r C 7 i f —6 6 %� C Value of Work For this Permit $5 C/ Square / Linear Footage Of Work: Type of Work: ❑Addiction ❑Alteration ❑New ❑ Repair/Replace / ,�5� ,/� // El Demolition Describe Work: l,�J . / 7 -,S 47��`d,' G ' 4' 0 c j ***** * * * * * * * * ** * * * * * * * * * * * * * * * * * * * ** F ees* * * * ** * * ** **** * **** * * * * * * ** * * * ** * * * * * *** * ** CO /CC $ Technology Fee $ 0' 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 reinspection fee will be charged. The fore in day o .l' a is NOT Sign: Print: APPROVED BY 20 My Commission Expires: ***** * (Revised 07 /10 /07)(Revised 06/10/2009) Owner or Agent ent was ac ow edge dbefore r e thi 0 ,bYV1 0 1 to me or who has produced identification and who did take an oath. 4 J a4*4 1 ' a �w ; r �, ° - 0 � �'�.:�., , CSC' �.A. �, 1 0 3 49 Plans Examiner Engineer Contractor The foregoing instrument was acknowledged before me this 6 y ofeetip a 4 , 20/0 , by who is personally known to me or who has produced as identification and who did take an oath. NOT ' PUBLIC: Sign: Prin My Comm ACSS10N k D0947571 pii I February 10, 2014 1400.3410TARy . r1 Navy Dis ., aa ******** ************** *********** ************** ** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Zoning Clerk checked SKETCH OF SURVEY SCALE th 00' Ni TO THE NATIONAL FLOOD INSURANCE PROGRAM : SUBJECT PRIPERTT FALLS IN FLOOD RIND EEPPRINI TY No.' /20 b52 94/-2429 >c. PANEL Not 030 I'T - 7171 3. : 311 11■111 ELEV. Costumer name : Victoria Novack Address : 3340 NE 97 St Miami Shores Phone: 305- 323 -9723 Total Btuh : 70 000 Btuh Longer run : 60' 100 gallons about ground tank GALV SCH 40 Corrugate stainless steel tubing (osst] EHD 25 3/4" 28' Integral regulator Pressure 11" we Miami Gas Corp 3235 nw 41 st Miami,FI 33142 Ph : 305 -634 -6646 Corrugate stainless steel tubing (cast] EHD 25 3/4" 18' %" 8' GALV SCH 40 Licence # 005528 Soy *A" ea Sov % " Cook top 35 000 Bthu • ' 3/4" GALV SCH 40 Dryer 35 000 Btuh Gas table : 402.4(30)- EHD 25 402.4(26)