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PL-10-537
Scheduled Inspection Date: June 23, 2010 Inspector: Hernandez, Rafael Owner: GUEVARA, EDWIN Job Address: 25 NE 103 Street Project: <NONE> Miami Shores, FL 33138 -2326 Building Department Comments June 22, 2010 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 139402 Permit Number: PL -3 -10 -537 Contractor: AMERIGAS PROPANE AND SUBSIDIARIES For Inspections please call: (305)762 -4949 Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Gas Phone Number (305)775 -7095 Parcel Number 1121360130940 Phone: 305 - 883 -8600 Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments a GIZg /!e Page 2 of 19 Project Address Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 25 103 Street Miami Shores, FL 33138 -2326 1121360130940 Block: Lot: NICOLE GUILLET Owner Information Valuation: Total Sq Feet: NICOLE GUILLET Contractor(s) Phone AMERIGAS PROPANE AND SUBSIDIA 305 - 883 -8600 Cell Phone Type of Work: 200 TANK AND LINE TO RANGE Type of Piping: GAS Additional Info: PLUMBING Bond Retum : Classification: Residential Fees Due CCF Education Surcharge Permit Fee - Additions/Alterations Scanning Fee Submittal Fee Submittal Reversal Fee Technology Fee Total: Amount $0.60 $0.20 $150.00 $3.00 $50.00 ($50.00) $0.80 $154.60 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. Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy Address Expiration: 10 /03/2010 Parcel Number 25 103 Street MIAMI SHORES FL 33138 -2326 Phone Pay Date Pay Type Invoice # PL -3-10 -37445 04/06/2010 Check #: 4688 03/30/2010 Check #: 4677 Amt Paid Amt Due $ 104.60 $ 50.00 $ 50.00 $ 0.00 Applicant Available Inspections: Inspection Type: Final Press Test ROW 1 April 06, 2010 Date Cell April 06, 2010 1 30 'lam Kri (o&5 BUILDING PERMIT APPLICATION FBC20 Permit Type: PLUMBING G Owner's Name (Fee Simple Titleholder) Owner's Address 4 °Ye /68 City o l ' .8141210 State AZ— Tenant/Lessee Name Email Job Address (where the work is being done) City Miami Shores Village FOLIO / PARCEL # Is Building Historically Designated YES Contractor's Company Name Contractor' ddress / ®° a °V City Qualifier Name Contact Phone I Architect/Engineer's Name (if applicable) Value of Work For this Permit $ Type of Work: ['Addition Describe Work: Structural Review. $ Mia11 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 ounty Miami -Dade NO E -mail i teratio n ❑New L ®v It ` �e,4.�� cam Phone # Zip Phone # Scanning $ Radon $ DPBR $ Double Fee $ Violation date: Phone # Phone # Square / Linear Footage Of Work: Total Fee Now Due $ Technology Fee $ Bond $ NAR30„OP BY :........ Flood Zone . e8384 * * * * * *** ** * * * * * * * * * * * * * *** * * * * ** ******F Submittal Fee $53.0Z) Permit Fee $ � , � � � x roCCF $ P Notary $ Training/Educa on Fee $ CO /CC $ See Reverse side -* Permit No. � � 1 0—� Master Permit No. 9 z/o b 4 74 — Qua cate:cc a-L4) Zip Zip 3 S / ZS p,/ Phone # SO d 0 3Q tP ° State Certificate or Registration No. Certificate of Competency No. /Replace ❑ Demolition Bonding Company's Name (if applicable) Binding ompany'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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Print: My Commission Expires: Owner or Agent The foregoing instrument was acknowledged before me this day of 14412.-ek,20A,by who is personally known to me or who has produced k / 601 . I5 ` 5/616 As identification and who did take an oath. NOTAR PUBLIC: HIJBERT : MY COMMISSION # DD 894714 Bowed September s * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** APPROVED BY Plans Examiner (Revised 07/1 0/07)(Revised 06/10/2009) Engineer Contractor The foregoing instrument was acknowledged before me this ZS day of kk , 20 g , by e-j who is personally known to me or who has produced s identification and who did take an oath. Signature NOTARY LIC: Sign Print: My Commissio f�. �•a is HUBERT NUNEZ MY COMMISSION 4 00 894714 EXPIRES: September 11, ;?013 • Banded Thru Notary Public Undewalters :1S * * * * * * * * * * * * * * * * * * * * * * *� * * * * * ** Zoning Clerk checked 1 3UJ,/ 2 /2009 /THU 10:13 AM ameri PRODUCER • Aon Ri sk Services central, Inc. Phi 1 ad& phi a PA offi ce One Liberty Place 1650 market Street Suite 1000 Philadelphia PA 19103 U5A MOM- 86. 283 -7122 INSURED Merl Gas .Eagle Propane, LP PD Box 965 '.._,- Valley Forge PA 19482 IJSA INSk LTA A ADD .1, INSRD , n .. i in�tYLi7Y ® COMMERCIJLGENERhLiIAB)L)1Y 0.AIM5i+3ADE i" 1 oCCV • ADrOMI EU E LIABILITY ANYAUTO ALL OWNED Amos SCEI AUTOS. =ED ALfr05 NON ONNEP AUTOS • GARAGE LABILITY EXCESS/ U MEESLLA LIABILITY =at D mama MAus WO$KEA9 CDRSPEN9ATION AND tmetanRB'LIASIUrrY ANY PROPRIETOR IrARTNER/ 7VE kalif) Eas:rnvnEa7 A . - P4 nndamq� Ifyca, dw-cal umulor 6vbar DEDUCTIBLE RHTANTIDN DESCRTPION OP OPERATIONSILOCf. CER 1CAATE MU ER City Of Miami Springs 2 -01 Westward Drive Miami Springs, F1. ACORD 25 (2009/01) . CERTIFICATE OF LIABILITY INSURANCE DATE (SM17�7Jz�OD ) TEO CERTIFICATE IS ISSUED AS A MATTER OP INFORMATION ONLY AND cONV S NO RIGHTS UPON rEM CERTIFICATE HOLDER MS CEIrrfrICATE DOES NOT AMEND, XTENDD Olt ALTER. TES COVERAGE A1+FORDED BY TP1.E POLIcLGS R OVJ. FAX- 847 TYPE OP'INSURANCE Gam. AOGRt:Oarr P]:x: LINII t s1�PT.Dts )� LIL� ' 133CT LCL WDQ 2493259A 953 -5390 isAH09579908 WLRC456"59882 • ADS ' BcFC4S699870 Wa - WLRC45699869 cA TiON DCL135/EXCLUSIONS ADDED INSURERS AFFQItDTNG COVERAGE INSURER A: ACE American Insurance Company minas Indemnity Insurance co of North America NSURER MEURERD: INSURER E: FAX No. 610 992 3238 COVERAGES Tae POT Tr PB pF E SURANCE =ED H7 LOW HAVE WEN ISSUED TQ TIg INSURED IWLED .ANCIVE FOR THE POLICY PERIOD INDICATED. NOTWalisT/,yTiD I ANY REQUIRLMa rr, TERM OR. coMortIoN or ANY CONTRACT OR OTHER DOCUMBNP'Fr(1H RBSPECTTO WHICH TIES CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, TEE 1PTSURRNCE AFFORDED BY TEE POLICIES DESCRIBED HEREJN TS SUHJEGT TO ALL TM TES, EXCLUSIONS AND CQNrnTIQNS pF SUCH POLICIES. AOURECIATE LIMITS SHOWN MAY HAVE SEEN REDUCED HY PAID CLAWS.. UMiTB SHOWN ARE AS REQUESTED ratio riansER NA= aPSCTIYB POLICY EXPIRATIDN • mArma rionrrrYY) DATE TMTDn/YYYY) 07/01/2010 FACRODEUbBENCE 07/01/2009 07/01/2009 07/01/2009 U1 /U4WJ,U 07/01/2009_ 07/01/2010 07/01/2009 07/01/2010 BY ENDDRSEMHNIMPECIAL PROVISIONS CANCELLATION DAMAGE TO RIMED PAEMTBE9 (En outwv ss) MED ED (Pmyane p¢scn) MORAL k ADV DeImY - 9149=IIAL AO re PRODUCTS- COMP /0P ADO 07/0112010 COMBINED SINGLE MET Eta s BODILYPOURY (Perpc®n) BODILTDDI RY (ft - mid:4 MOPED? DAWAOE O'tsasddar9 AUTO DtTLY-FA ADD1DmiT. O EERTHAN AUTO ONLY: ACC BACH OCCURRENCE AOGREOATE x ITJc srAtti 1OYEI• PL EACHACDIDE•tr B IDISEASP-EABMPLOYEE ET-mu/as-policy P. 0a/00 - 1 NAICif 22667 43575 :t7 L 51,000,000 51,000,000 510,000 52,000,000 52,000,000 52,000,000 51,000,000 N t�^I e*i m 0 h z 51,000,000 51,000,064 $1,000,000 4 SHOULD ANY OPTHO ABOIrE DESCRIBED POLICIES SE CANCELLED BEFORE TAE EXTIVATION - y{ DATE THEREOP,THE SWIM DISUP£P.'9r14LSN0EAYORTO MAIL ,� �{ , • 39 DAYS Tvu- rf 1+ NN OTI CETo TffECEIPOTIDA _ TBBOILF$TTAMEDTOO THE U F. } Bar FAILottto DO ED SHALLIM?OSENO OBLIGATION 08 LTAB OP ANY I:INDUPONT 0e4SURBRIAGENTSDERE PRESETTI'ATIVBS. '3316'6 AUTAORIZED P. YRESENTATTYE ✓� o 44-,1 ©19$8.2009 A.CORD CLIReoRA3TAN•All 'TO ACORD llama and logo are registered marks 9fACORD POST UCENSE CONSPICUOUSLY State of Florida Department of Agriculture and Services 4t> - a ":08 Division of Standards Bureau of Liquefied Petroleum Gas Inspection (850) 921 -8001 Tallahassee, Florida License Number: Expiration Date: Date of Issue: License Fee: Type and Class: Liquefied Petroleum Gas License CATEGORY 1 LP GAS DEALER GOOD FOR ONE LOCATION ONLY ANY CHANGE OF OWNERSHIP OR SALE OF THIS BUSINESS RENDERS THIS LICENSE INVALID This license is issued under authority of Section 527.02, Florida Statutes, to: AMERIGAS EAGLE PROPANE 10052 NW 89TH AVE MEDLEY, FL 33178 -1444 SEE OTHER SIDE DO NOT FORWARD AMERIGAS PROPANE LP 10052 NW -89 AVE MEDLEY FL -33178 00899 August 31, 2010 September 1, 2009 $425.00 0601 HARLES H. BRONS COMMISSIONER OF AGRICULTURE 402 . DETERMINE NORTH . • . a • • • Amer/Gas, L ' 00899 1 0082 IM W 89 Ave., Medley, F1'33178" Tel. 308- 388 -8800 FaX 305- 884 -5891 JOB: • . ez06 a /0-6 DATE: 3/ 0 - REVISED: ' SCALE: ., f 5 DRAWN BY: A pvtri dj , C iv APPROVED BY: AFFIDAVIT: This installation shall comply wfh NFPA 54, NFPA 58, • as well as all state & local codes and regulations: GENERAL•SITE PLAN* Page . of • Sigrid of Qilafifier `=' PP.tNT NAME Qualifier I.-Pe. t7, $ C ' . Swom to and subscribed nie this day of L f��s � j '"' 29 20 j by. ;.,.,.u.. , HOBERT NUM *• . _ 141VCONIMISEIr "•:. (SEAL) I _ Ex?IRES: Sepi9mbei 11, 2013 ' - Bonded Do Notary Ringo Underwriters Personally Imam: or Produced Ideritn: r v ` - roduced• Type of idea ication Produced • • • • ••• •• •• • • • •• 0 • •• " T • ••• •• • • . • • • • • • • • • • • • ••• • s -, ••• • • • • • • • • • • • • • • • •• • • • • •• • • • • .• "`.- • • • • • •• • • •• • • •••_ •• 1 / • A„ it,414 t / c hi 45 o t) era 8 `.3 BY CT 10 i_ iANCE WITH ALL FEDERAL -Y AN 0, REGULATIONS Snores VW 4007 - / / / " w /e w Ut ( t 8S,00c tk.