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PL-11-824r Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 161731 Permit Number: PL -5 -11 -824 Scheduled Inspection Date: July 08, 2011 Inspector: Hernandez, Rafael Owner: LEBOWITZ, MAURICE Job Address: 1285 NE 102 Street Miami Shores, FL Project <NONE> Contractor: SIEGEL GAS Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Gas Phone Number Parcel Number 1132050250120 Phone: (305)691 -4411 Building Department Comments INSTALL 1 -120 GALLON TANK & RUNNING LINE TO EQUIPMENT Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments July 07, 2011 For Inspections please call: (305)762 -4949 Page 7 of 7 JOB LONGEST RUN LOAD 33 'T t fans-4a TOTAL BTU LOAD v36.00 L-2 GAS Q i''►N -lc. (J PC L Cvl CIO 7 4 0 0 NW A & 6TN Cook TOdp . f36. coo » L) - 1? Ca w C LP GALLONS TANK STAbf AEA X201(7 TAiVI< co LP430183ad Avo \J; 156.00' r FND 1/2" IP NO ID LOT 6 BLOCK 186 Q, 106' 81.0' ASPHALT DRIVEWAY POOL UTIUTY P 75.0' JAE 0 Lt) ONE STORY ? STRUCTURE! #1285 0 5.0' LP tank k>c8n to comply ; ; NFPA War 5 BLOCK 186 FND 1/2" IP NO ID TILE CONCRETO DECK 2' CBS WALL ' FND 3/4" IP NO ID 6' CBS WALL 6' BS x WALL LOT 4 BLOCK 186 PLANTER 81.0 156.00' 38.1' +-- NO FND ID IP NO ID O/S 4.75' WEST z INVOICE NO.: 11 -35514 PROPERTY ADDRESS: 1285 NE 102 STREET, MIAMI SHORES, R. 33138 LL COUNTJ URYEYOR. Y 12. • LICENSE N0. 66 , 7 Office: (954) 777 -4747 Fax: (954) 777 -2707 5950 W. Oakland Pk. Blvd. - Suite 309 - Lauderhill, FL 33313 LEGAL DESCRIPTION: LOTS 4 & 5, BLOCK 186 OF "BAY BREEZ SECTION MIAMI SHORES" ACCORDING TO THE PLAT THEREOF, AS RECORDED IN PLAT BOOK 42, PAGE 25 OF THE PUBLIC RECORDS OF MIAMI -DADE COUNTY, FLORIDA. CERTIFICATIONS: MAURICE LEBOWITZ FLOOD ZONE DATA: COMMUNITY NUMBER: 120652 PANEL AND SUFFIX: 0306 L DATE OF FIRM: 9/11/09 BASE FLOOD ELEVATION: AE 8 LOWEST FLOOR ELEVATION: 10.92 u2 i NE 102nd STREET 75' RMI 21 ASPHALT I�J 125:00' BLOCK CORNER SE CORNER OF TR 186-C (NOT A PART OF THIS PLAT) FND 1/2" IP NO ID MAP OF BOUNDARY SURVEY SCALE: 1 " =20' GENERAL NOTES: (1) THIS SURVEY IS BASED UPON RECORDED INFORMATION AS PROVIDED BY CLIENT. NO SPECIFIC SEARCH OF THE PUBLIC RECORD HAS BEEN MADE BY THIS OFFICE. (2) UNDERGROUND IMPROVEMENTS HAVE NOT BEEN LOCATED EXCEPT AS SPECIFICALLY SHOWN. (3) ELEVATION ARE BASED UPON NATIONAL GEODETIC VERTICAL DATUM 1929 (N.G.V.D. 1929). (4) IN SOME CASES, GRAPHIC REPRESENTATIONS HAVE BEEN EXAGGERATED FOR CLEARER ILLUSTRATION. MEASURED RELATIONSHIP SHALL HAVE PRECEDENCE OVER SCALE POSITIONS. (5) ALL DIMENSIONS SHOWN ARE FIELD MEASURED AND CORRESPOND TO RECORD INFORMATION UNLESS SPECIFICALLY NOTED OTHERWISE. (6) UNLESS OTHERWISE SPECIFIED, THIS SURVEY IS NOT TO BE USED FOR CONSTRUCTION PURPOSES. (7) WELL- IDENTIFIED FEATURES IN THIS SURVEY AND MAP HAVE BEEN MEASURED TO AN ESTIMATED HORIZONTAL POSMONAL ACCURACY OF 0.10 NOTE: "I HEREBY CERTIFY" 1S UNDERSTOOD TO BE AN EXPRESSION OF PROFESSIONAL OPINION BY THE SURVEYOR AND MAPPER BASED ON THE SURVEYOR AND MAPPERS KNOWLEDGE AND INFORMATION, AND IT IS NOT A GUARANTEE )R WARRANTY EXPRESSED OR IMPLIED. ATTENTION IS DIRECTED TO THE FACT THAT THIS SURVEY MAY HAVE BEEN REDUCED OR ENLARGED IN SIZE DUE TO REPRODUCTION THIS SHOULD BE TAKEN INTO CONSIDERATION WHEN OBTAINING SCALED DATA. (8) (9) I HEREBY CERTIFY THAT THIS BOUNDARY & PARTIAL TOPOGRAPHIC MEETS THE MINIMUM TECHNICAL STANDARDS FOR SURVEYS, AS SET FORTH BY THE FLORIDA BOARD OF SURVEYORS AND MAPPERS IN CHAPTER 61G17 -6 OF THE FLORIDA ADMINISTRATIVE CODE, PURSUANT TO SECTION 472.027, FLORIDA STATUES. DATE OF ORIGINAL FIELD WORK; 4/11/11 GINO FURLANO, PRO ESSIONAL SURVEYOR & MAPPER FLORIDA REGISTRATION NO. 5044 (NOT VALID AIITHOUT SIGNATURE AND ORIGINAL RAISED SEAL OF THE FLORIDA LICENSED SURVEYOR AND MAPPER SHOWN ABOVE) XAMMU. SW514awg, 4115iP011 2 rw. G ,teeur osom PO. s< AMIII■■• Florida Department of Agriculture and Consumer Services Bureau of Liquefied Petroleum Gas Inspection P.O. Box 6720 Tallahassee, Florida 32399 -6720 License Number. 02586 Business Mailing Address Licensed Location Address HERITAGE OPERATING, L.P. DBA SIEGEL GAS PO BOX 470267 MIAMI, FL 33247 -0267 HERITAGE OPERATING, L.P. DBA SIEGEL GAS 2900 NW 75TH ST MIAMI, FL 33147 The liquefied petroleum gas license at the 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 renewed annually. Any license allowed to expire shall become inoperative because of failure to renew. The fee for restoration of a license is equal to the original license fee and must be paid before the licensee may resume operations. IN THE EVENT OF AN OWNERSHIP CHANGE AT THIS BUSINESS LOCATION: This license may be transferred to any person, firm or corporation for the remainder of the current license year upon written request to the department by the original license holder. 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 Inspections at 850/921 -8001. Pursuant to Chapter 527, Florida Statutes, LP Gas licensees must present proof of licensure to any consumer, owner, or end user upon request when engaged in the business of servicing, testing, repairing, maintaining or installing LP Gas systems and/or equipment. For future correspondence, please make any needed corrections or changes to your business mailing address and/or your licensed location address and retum 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 POST LICENSE CONSPICUOUSLY State of Florida Department of Agriculture and Consumer Services • 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 I 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: HERITAGE OPERATING, L.P. DBA SIEGEL GAS 2900 NW 75TH ST MIAMI, FL 33147 02586 August 31, 2011 September 1, 2010 $425.00 0601 LES H. BRONS COMMISSIONER OF AGRICULTURE Florida Department of Agriculture and Consumer Services Bureau of Liquefied Petroleum Gas Inspection 3125 Conner Boulevard, Suite N Tallahassee, Florida 32399 -1650 Master Qualifier Mailing Address Licensed Location Address LEO KIRBY HERITAGE OPERATING, L.P. PO BOX 524228 MIAMI, FL 33152 -4228 HERITAGE OPERATING, L.P. 7400 NW 30TH AVE MIAMI, FL 33147 -5904 Certificate Number License Number 16336 02586 This Master Qualifier Certificate is issued pursuant to Chapter 527, Florida Statutes. This certificate is valid only for the person and licensed holder listed. Any changes to the Master Qualifier status (such as transfer or termination of employment) must be reported to the Bureau of LP Gas Inspection at (850) 921 -8001 immediately. The Master Qualifier Certificate is valid only through the date noted on the Certificate. A notice of renewal will be sent to you in advance of your expiration date. A Master Qualifier Certificate may be renewed if certification of a minimum of 12 (twelve) hours continuing education is provided along with the renewal form. If training cannot be documented, an examination must be taken. If there are any errors on the certificate, please submit all changes in writing to: Bureau of Liquefied Petroleum Gas Inspection 3125 Conner Boulevard, Suite N Tallahassee, Florida 32399 -1650 Cut Here State of Florida Department of Agriculture and Consumer Services Division of Standards Bureau of Liquefied Petroleum Gas Inspection (850) 921-8001 Tallahassee, Florida Certificate No: Exam Date: Issue Date: Expiration Date: Exam: MASTER QUALIFIER CERTIFICATE This Certificate is issued under authority of Section 527.02, Florida Statutes, to: LEO KIRBY Valid For Ucense Number. 02586 HERITAGE OPERATING, L.P. 7400 NW 30TH AVE MIAMI, FL 33147 -5904 16336 May 17, 2002 April 15, 2009 April 14, 2012 0601 LES H. BRONS COMMISSIONER OF AGRICULTURE ACORN `.,,,--- CERTIFICATE OF LIABILITY INSURANCE 9/1/2011 DATE (MINDDIYYYY) 8/18/2010 DDUCER LOCkton Co S, LLC-1 Kansas �y 444 W. 47th Suite 900 Kansas C MO 112 -1908 may 960 •,rll THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POUCIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED HERITAGE OPERATING, LP. 16740 DBA: SIEGEL GAS CORP. #920 010 ENERGY TRANSFER PARTNERS, LP. 7400 NW 30TH AVENUE MIAMI, FL 33147 I INBURERA: LIBERTY MUTUAL INSURANCE COMPANY** INSURER B: * *AM BEST RATING OF A XV INSURER C: USURER D : INSURER E: DOES EENT NOT CONSTITUTE PRODUCER R A CONTRACT BETWEEN CERTIFICATE THE ISSUING HIS CERTIFICD RE R&ENT�ATIVB OR C AND THE CERTIFICATE HC N- COVERAGES ENETR01 YA THE �� THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED ABOVE FOR THE L.= PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POUCIES. AGGREGATE IJIIAI re SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR AUDI. IPSO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM CIDIYY)� POLICY EXPIRATION DATE (MMIDDIYYI LIMITS A EBl- 641 -436528 -030 9/1/2010 9/1/2011 EACH OCCURRENCE $ 5 000 000 GENE X LIABILITY 11 -..- "T` �TT',�� 8 1 000 000 COMMERCIAL GENERAL LIABILITY ICLAIMS MADE X OCCUR LIED EXP (Any are person) $ MX PERSONAL a ADV INJURY $ 5,000,000 GENERAL AGGREGATE $ 5,000,000 '— PRODUCTS- COMP/OP AGO $ 4 000 000 GENL AGGREGATE LIMIT APPLIES PER X} Pou0Y n & fLOG A AUTOMOBILE X _ X X UABILfl ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNED Alms AS2 -641- 436528-040 9/1/2010 9/1/2011 COMBINED SINGLE LIMIT $ 5,000,000 BODILY INJURY r $ XXXXXXX ( $ XXXxlOQC PROPERTY DAMAGE Ter stamp $ X100000( GARAGE LIABILITY R ANY AUTO NOT APPLICABLE AUTO ONLY - EAACCIDENT $ )0XXXXX OTHER THAN EA *cc $ X7XXX)CX AUTO ONLY: AGO $ XXXXXXX INECESINUMBRB.LA LNEWTY OCCUR El CLAIMS MADE NOT APPLICABLE EACH OCCURRENCE $ X AGGREGATE $ 3 $ XXXXXXX UMBRELLA DEDUCTIBLE FORM RETENTION $ $ XXX3UC s =MOO( A A WORKERS COMPENSATION AND WA7- 64D- 436528-020 WC7 -641. 436528-010 9/I2010 9/1/2010 9/1/2011 9/1/2011 WC STATU- OTH- X •::: t. EMPLOYERS' LIABILITY Y IN EL EACH ACCIDENT $ 1,000,000 mypR mP�g UOED? D(MFI` la E.L. DISEASE .EA EMPLOYEE $ 1,000,000 NH) o3PECC t barn E.L. DISEASE - POLICY war $ 1,000,000 OTHER DESCRIPTION OF OPERATIONMLODATIDNWVEHICLES !DICLUSION8 ADDED BY ENOORSEMENTISPECIAL Ntovadoes THE $5, 000,000 LIMIT EVIDENCED FOR GENERAL LIABILITY INCLUDES A $3,000,000 SIR. CERTIFICATE HOLDER 10476620 MIAMI SHORES VILLAGE 10050 NE 2ND AVENUE MIAMI SHORES FL 33138 I ACORD 25 (2009/01) SHOULD ANY OF THE ABOVE DEED POLICIES BE CANCELLER BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER W0.L ENDEAVOR To EAU. 30 , DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIAR LITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED ®1989.2009 D CORPORATION. All rights reserved The ACORD name and lo!o are registered marks of ACORD Poraaeotions Feaa . oa thts comaetthe number In the Traineer section show end saeette the client code VW::TM.. 2010 LOOAE: EBUSINES4 TIl 1 4904 ausINES5:'IYAME ILOCATION -SIEGE ,30, .AVE ;UN N` DADE COUNTY MIAMwI` O RS. UANTT THIS IS NOT A BILL — DO NOT PAY OWNER` .. -OPERATING LP /DTSTR /INSTALLATION MEW, PESA".." REQUSiEt PA :.THI IS -. xaa ECE�►REMr:oF TiiE _ttor ERR umdara. PAYMENTi CaS}N},`1'TA7F II8/05/2:010 60000342 080450. DO SEE OTHER SIDE FIRST -CLASS U.S. POSTAGE PAID MIAMI, FL PERMIT NO 231 RENEWAL RECEIPT NO:. 511818 -7 CC # LPG00;586 DO NOT FORWARD SIEGEL GAS LEO KIRBY MGM 7400 NW 30 AVE MIAMI FL 33147 l: illt} iYtt{ ii11{t itl Lii} i{ Ifl *hi f61 Isla ilf{Illfiilit]64d1 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION FBC 20 Permit No. IJ i MAY 0 2111 BY: _ . Master Permit No. Permit Type: BUILDING / OWNER: Name (Fee Simple Titleholder): ML1Ut21 C.. L L7t rz.. Phone #: 7-85-3-10 f 12 Address: 1 Z$G tJ E 10241) 37-i City: (`i t J1- 104_1F5 State: - Zip: 65 :1_ Tenant/Lessee Name: Phone #:3 05 • /-• 1755 Email: r . Y'" A •-• •► . tel JOB ADDRESS: / 2.175 D✓ 6 / f[ t 5-T. City: Miami Shores County: Folio/Parcel #: f/ ' 3,2 06' - 025 - 0420 Miami Dade Zip: 33/ 3 7 Is the Building Historically Designated: Yes NO CONTRACTOR: Company Name: 57 E b C., v1 s Address: G(o o N W City: t Qualifier Name: C-€ 0 E State Certification or Registration #: Contact Phone #: 07 DESIGNER: Architect/Engineer: 30 Prue Flood 77e: Phone #: 34425 C , ( k I 1 State: Zip: 33/ • V-4 ,(43y Phone #: 305- 641 L Y l 0 Z.7 Bb G -0 K.,52j) Phone #: , Certificate o Competency #: C' 3 •email AddressalK X .So iW41 i f 7 /. p Value of Work for this Permit: $ Jl 0 0 Square/Linear Footage of Work: Type of Work: ❑Address ❑Alteration New ❑Repair/Replace ❑Demolition Description of Work: ( NS T • T E9 uIr. Tig-ft 14. fit NN 1 N E COLOR THROUGH ROOF TILE IS REQUIRED acknowledged by: ***************************************F ***** * *** **** **** * * *** * *** * * * ** *** * * * *** ** Submittal Fee $ ` Permit Fee $ / ® CCF $ CO /CC $ Scanning Fee $ Radon Fee $ _ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ 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 Signature Signature �- The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this le day of 20V , by /141K I C C" L (b Owdg day of v-f , 20 , by /Leo . k,° a k who is personally known to me or who has produced who i sona y cno o me or who has produced as identification and who did take an oath. As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: MY Commsnfon Expires May 6, 2012 Commission # DD 771282 Bonded By National Notary Ate, NOTARY PUBLIC: * * * * * * * * * * * * * * * * * * * * * * * * * * *I *. **** * * * * * * * * *** * * * * * ** * * * * * * * * * * * ** **** * * * * * * * * *** * * * * * * * * * * * ** APPROVED BY c- '-4- Plans Examiner 1 (Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09)(rev6/4/10) Structural Review Zoning Clerk