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PL-12-410Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 EL- (2- L409 Inspection Number. INSP - 170853 Permit Number: PL- 3- 12-410 Scheduled Inspection Date: June 04, 2012 Inspector. Hernandez, Rafael Owner: MCCREADY, JAMES Job Address: 1399 NE 103 Street Miami Shores, FL Project <NONE> Contractor: POWER HOUSE EQUIPMENT Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Gas Phone Number Parcel Number 1132050300190 Phone: (954)658 -4454 Building Department Comments INSTALLATION OF 20 KW GENERATOR CONNECTING TO EXISTING NATURAL GAS LINE Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments June 01, 2012 For Inspections please call: (305)762 -4949 Page 3 of 22 A ar �- 3 - / - ' P RMIT NUMBER THIS SYSTEM HAS BEEN MANOMETER TESTED FOR 15 MINUTES. START INCHES W.C. FINISH �- INCHES W.C. INSTALLER DATE 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) 762A949 BUILDING PERMIT APPLICATION FBC 20 141 1 0 7 Permit Type: PLUMBING OWNER: Name (Fee Simple Titlehohier):d h��'1��L �"�� Phone3 0� 1 �� Address: t 1C • 24 St- City: Nit3R;p State: f c315, zip: , 312 e Tenant/Lessee Name: pe Phone#: Finail• AM CA Ire % , �i �'�.�1 � �1�i coo\ JOB ADDRESS: 315 ,e- City: Miami Shores Folio/Parcel #: L l \ igalc� County: Miami Dade zip: '57 13e Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company 1qpm &e- i 4 phone: WJ Address: O w Ft- �!t L ) City: _ r ( 5 3 f v nr6 .S (� Qualifier Name: t Etc._ sic State Certification or Registration #: e:P&X Contact Phone #: fry '4 - W6'1 DESIGNER: Architect/Engineer: Zip: '63 07 C® Phone#: Certificate of Competency #: Email Address: Phone #: Value of Work for this Permit: $ 1 CO a a �2' SquareJLinear Footage of Work: ZS- Type of Work: °Address 1°_ Alteration °New ORepair/Replace °Demolition Description of Work: l /J 4cij 1�trla•ry 0 -" ("0 ,4 -.-,, =. ge troc-nt of NA VA( av /4( / (4 3 U Submittal Fee $ Permit Fee $ / J CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Tedmology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ l 09,* Bonding Company's Name (if applicable) Bonding Company's Address City State Tap 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 RICAL 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 t be appr ed and a reinspection fee will be charged k\ Owner or The foreg+ �J instrument was ac I jwledged before me thiss71441) day of .. , 201 -, by afli(i (6.,rood , who is personally .• i o to wn me or who has produced As identification and who did take an oath. NOTARY PUBLIC: t: My Commission Expires: APPROVED BY Contractor The foregoing instrument was acknowledged before me thiso9 i day of who is personally known to me or who has produced as identification and who did take an oath. NOTAR �' 1 ; LIC: 20 by S,4 , **** * * ** **sus **** *** ***** * **+m ** ass * *** ******s+e:e********* 3-12-42- (Revised 07 /10/07)(Revised 06/1012009)(Revised 3115/09) Plans Examiner Structural Review Zoning Clerk • • C ;I,• • 115 S. Andrews Ave., Rm. A -100, Ft. Lauderdale, FL 33301 -1895 — 954 - 831 -4000 VALID OCTOBER 1, 2011 THROUGH SEPTEMBER 30, 2012 DBA: Business Name: POWER HOUSE EQUIPMENT SALES SERVICES INC Owner Name: STEPHEN STAFFORD Business Location: 4900 NW 104 AVE CORAL SPRINGS Business Phone: 954 -581 -6437 Rooms Seats Receipt #: 2 6 0 - 72 & Business Type•DI3P,LER -LP GAS APPLIANCES ;);QUIP (DEALER -LP GAS APPLIANCEq Business Opened:07 /12/2006 State/County /Cert/Reg:223 05 Exemption Code :NONEXEMPT Employees Machines Professionals For Vending Business Only hives: Vending Tvpe: Tax Amount Transfer Fee NSF Fee Penalty Prior Years Collection Cost Total Paid 150.00 0.00 0.00 0.00 0.00 0.00 150.00 THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT This tax is levied for the privilege of doing business within Broward County and is non - regulatory in nature. You must meet all County and/or Municipality planning WHEN VALIDATED and zoning requirements. This Business Tax Receipt must be transferred when the business is sold, business name has changed or you have moved the business location. This receipt does not indicate that the business is legal or that it is in compliance with State or local laws and regulations. Mailing Address: POWER HOUSE EQUIPMENT SALES & SERV 4900 NW 104 AVE CORAL SPRINGS, FL 33076 2011 - 2012 Receipt #031 -10- 00003913 Paid 08/23/2011 150.00 tt CERTIFICATE OF COMPETENCY BRw., WARD W .RD STEPHEN STAFFORD GENERAL L. P. GAS CONTRACTOR POWERHOUSE EQUIPMENT SALES & SERVICE, INC. CC# 07- CLPG - 13664* Expires 8/31/13 Ref. 19383508 Ctrl# 13 6766 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: STEPHEN STAFFORD Valid For License Number. 22305 POWERHOUSE EQUIPMENT SALES & SERVICE, INC 4900 NW 104TH AVE CORAL SPRINGS, FL 33076 -1750 21877 July 10, 2006 July 10, 2009 July 9, 2012 0601 HARLES H. BRONS COMMISSIONER OF AGRICULTURE OP ID: YT ,,,,° °6 CERTIFICATE OF OF LI ILITY INSURANCE DA Q7 r�' `I•#iiS CERTWICATE IS 'SSW) AS A MATTER OF INFORMATION ONLY :CIWITIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, BELOW. mis CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS 1 BY THE POLICIES AUTHORIZED OR ALTER THE COVERAGE AFFORDED A CONTRACT BETWEEN THE ISSUING INSURERS), IMPORTANT: I the certif( holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain polices may require an endorsement. A statement an this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 954..4 -340 99551 INNOVATIVE INSURANCE 954-3404456 5481 UNIVERSIW CONSULTANTS, INC. CORAL SPRINGS, IFLL33487 BRIAN J. MAMO ACT 1 IAA, NM: f No �ma:POWER -4 AFFORD= COVE1MGE NArO# I POWERHOUSE EQUIPMENT SALES 8 SERVICE, INC. 4800 NW 104TH AVE CORAL SPRINGS, FL 33073 a A: t4AUTILUS INSURANCE CO. - HULL 17370 n a: EVANSTON INSURANCE CO. c :AMERICAN ZURICH INSURANCE CO @�tRER D: INBURER E : XISURER P: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE USTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR A iY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO A4.L THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAT) CLAIMS. LIR A TYPE OP INSURANCE ADEN liSSR MISR POLICY SUMMER POUCY MCP J UMWS CAMERAL UABILnY X COMMERCALGENERALUABILRY ( CLABAS -MADE { i o©cuR GENtAGGREGAfE L fAPPLIES ( PE!t —1 POLICY n i LOC A TOIAOLW.E LIA'ILIIY ANY AUTO ALL OWNS DAUTOS =maw AUTO HIRED AUTOS NON-OWNED AUTOS NN102988 NOADDMO NALROURO S UNLESS ENDORSED 07/25/11 07125112 EACH OCCURRENCE PREMISES (Ea �sre occurrence) �OW (Any �t»n) a 3 $ 1,000,000 50,000 EXCL PERSONAL &AI/INJURY c I- AGGREGGATE PRODUCTS - COMP/OP � $ 1,000,000 3 2,000,000 3 $0D0, 3 COMBINED SINGLE unrr (Ea oxides* 3 BODILYnaWet5'erpuma) S eaILYINJUR (Peracddmt) 3 PROPERTY MADE (Pere ) 3 S 3 B UMBtELIA UAB EXCESS UAB X OCCUR CLAIMS-MADE C DsruCTURE XOVA316311 07/25111 07125112 EACH SCE AGGREGATE 3 3,000,000 3 3,0003000 S 3 WORKERS CO,WENSATION AND EMPLOYERS* UMW/ Y/N ANY n 3 to NH) XreFSO:RttYtNONoFoE RAn b& EQUIPMENT FLOATER NIA I mRYI.AMMrrsI 1 ER EL EACH ACCIDENT 3 EL DISEASE -EA E RWLOYEE S EL DISEASE -PO -POLICY $ E�8919986 071281/1 07125,/12 DOICRIPAONO F OPERATIONS ILOCA 1 $M LL*ADOMD4DE, oealR ltsSehedule.Unmrespools FAX# 305 -756- 89721954 - 796. 5988/786.228 9 MIAMI SHORES VILLAGE 10050 NE 2 AVENUE MIAMI SHORES, FL 33132 I SHOIN.D ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELED BEFORE THE EXPIRATION D ATE 'rI-JEt2EOF, NOTICE WLL BE DELIVERED IN ACCORDANCE I ITHTHEPOUCYPROVISION& AurE ORR 3 K �t +rA tf4A;A' i 1(AsIr7 ACORD 25 (2009109) 01988 -2009 ACORD CORPORATION. Ali rights r The ACORD name and Logo are registered marks of ACORD CERTIFICATE OF LIABILITY INSURANCE Date 1 2/7/2012 Producer: Lion Insurance Company 2739 U.S. Highway 19 N. Holiday, FL 34691 (727) 938 -5562 This Certificate Is issued as a mailer of information only and confers no rights u p o n t h e Catificaba Holder. This Certificate does not rene d, extend or alter the coverage afforafforded or by the polities below. Insurers Affording Coverage NAIL # Insured: South East Personnel Leasing, Inc. & Subsidiaries 2739 U.S. Highway 19 N. Holiday, FL 34691 Insurer A: Lkx InsitarlceGornparuy 11075 Insurer B: Insurer O: Insurer D: Insurer E: Coverages The policies of insurance listed below lime been issued to the insured named abate for thepolo/period-Indicate. Meristarting any requirement, term or corditionotany contractor other document with respect toMit this certificate maybe issued or may pertain, the inrrance afforded byte policies described herein is subject to a0lte terns, euirsions and mrr8fions of such policies. Aggregate limits shown may haw been reduced by paid claims. INSR LTRRD ADDL Type of Instvance Poky Number Policy Effect he Date (MM/DD/YY) Policy Expiration Date (MM/DD/YY) Limits GENERAL Commercial UABILITY General Claims Made Liability • Occur Each O c n $ Damage b rented premises (EA occurrence) $ Med Ere $ Personal Adv Injury $ General aggregate Emit applies per 3 Policy ❑ Project ❑ LOC General Aggregate $ Pioducts - Cornpf0p Ago $ AUTOMOBILE ,■. e... ■ LIABILITY Any Auto AB Oared Au Scheduled Autos Marilee* Non.Oei dAutos Combined single Limit (EAAcdasn9 $ BWrliffuY (Per Person) $ SodaYftellY (Per Accident) $ Property Damage (PerAcdderg $ EXCESS/UMBRELLA LIABILITY ROwl ❑ Velma Made Dcu ble Each Occurrence Aggregate A Workers Compensatlon and Empbyers' Liability Any proprietoripattnerlexecrdiVe otficednamber excluded? If Yes, describe under special provisions below. WC 71949 01/01/2012 01/01/2013 X 1 WC Stain- tory Limes I I OTH- ER EL Each Accident $1,000.000 E.L. Disease- Ea Employee $1.000,1X8 E.L. Disease - Policy Limits $1,000.000 Other Lion Insurance Company Is A.M. Best Company rated A- (Excellent). AMB # 12616 Descriptions of Operatiors/LocatbnslVehlcles/Exchmlons added by Endorsement/Special Provisbns: Client ID: 41 -65-366 Coverage only applies to active employee(s) of South East Employee Leasing Services, Inc. that are leased to the following "Client Company": Powerhouse Equipment Sales & Service, Inc. Coverage only applies to injuries incurred by South East Personnel Leasing, Inc & Subsidiaries active employees) , while working in Florida. Coverage does not apply to statutory employee(s) or independent contractor(s) of the Client Company or any other entity. A list of the active employee(s) leased to the Client Company can be obtained by faxing a request to (727) 937 -2138 or by calling (727) 938-5562. Project Name: FAX: 305 -7513-8972 / ISSUE 02 -07 -12 (TD) Begin Date 11/6/2006 CERTIFICATE HOLDER CANCELLATION; VILLAGE OF MIAMI SHORES BUILDING DEPARTMENT 10050 NE 2ND AVENUE MIAMI SHORES, FL 33138 Should any of the abow desaibed policies be ono lied before the erpiraeai date thereof, the issuing insurer will endeavor to maU30 dayswittennotice to the certificate Wider mimed to Its ledt, btfttallure to dososhaftimposeno obligation its agents or