PL-12-1129Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 174995
Permit Number: PL -6 -12 -1129
Scheduled Inspection Date: August 06, 2012
Inspector: Hernandez, Rafael
Owner: HANSON, DONALD
Job Address: 490 NE 103 Street
Miami Shores, FL
Project: <NONE>
Contractor: MULLINS PLUMBING
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Gas
Phone Number
Parcel Number 1132060170700
Phone: 954 - 473 -8162
Building Department Comments
INSTALL GAS MAIN FOR A STOVE WATER HEATER AND
FUTURE WASHER.
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comment
August 03, 2012
For Inspections please call: (305)762 -4949
Page 18 of 61
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
PERMIT APPLICATION
FBC 20 tp
Permit Type: PLUMBING
BY:
JUN 2 0 2012
Permit No. (t I i Z-9
Master Permit No.
OWNER: Name (Fee Simple Titleholder): L% .✓. m f ,/ ,WAL,v <s` b Phone#: s'
Address: 149 0 /tJ . / 0 7
City:
Tenant/Lessee Name:
Email:
State: �'L
JOB ADDRESS: 4 9 0 / ®•_
City: Miami Shores County: Miami Dade
Folio/Parcel#:
Is the Building Historically Designated: Yes
Phone#•
zip: 33 I 3 8'
Zip: 3 ?/3 8'
NO Flood Zone:
CONTRACTOR: /Company Name: f%f i t 8/1+144 F4. .0 `J� 60
Address: ;,, P �` A Ire
Phone #: �''d7' fP3" 87
City: elAal/,z► �� State:
Phone#:
T «
Qualifier Name: /`vi- A4' Cl ,S fsu` //4 f
Zip: 332 3
...:3
State Certification or Registration #: �'"/'� ` 4),/.4 S ? 2 Certificate of #:
Contact Phone#: Email Address:
DESIGNER: Architect/Engineer:
Phone#:
Value of Work for this Permit: $ /, boo
Type of Work: ❑Address ❑Alteration
Description of Work: /iYs7 /fit/ cots /VAIN
ear Footage of Work:
❑Repair/Replace ODemolition
tt.).4%r
57-7;//g,
********** * * * * *** * * **** * * * ***** * * * * ** * *F *** *81t** * ** * * **
* * * * * * * * * * * * * * * * * * * * * * * * * * **
Submittal Fee $ 3 16' dr Permit Fee $ loo 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 CONDPfIONERS, 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.
Owner or Agent
The foregoing instrument was acknowledged before me this 1
day of5LL , 20 a., by %ilbl Gllsorl
who is personally known to me or who has produced TL tL
As identification and who a'd
NOTARY PUBLIC:
JERELYN M. PETERS
t Commission # EE 101737
E>tiles June 9, 2015
spawn= Tlay Faln Insurance 800,385-7019
Sign:
Print: — + e tip ,
My Commission Expires:
ts
* * * * * * * * * * * * * * * * * * * * * * * * * * **
APPROVED BY Plans Examiner'
J
Structural Review
(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09)
..,.. , • tor j 4f
The foregoing instrument was acknowledged before me this 1 nrvi
day of 6 ,20 2 by P 1Jt1S /fat L AIS
who is personally known to me or who has produced PL
as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
•
Print '4zFr ,
My Co �,,�`
# DD 965899
-�� ' res February 25, 2014
Bonded 1Iua Trost Fab 800886701.
Zoning
Clerk
a • to.
•
Pipe Sizing Table - Natural Gas
Schedule 40 Metallic Pipe
Inlet Pressure: less than 2 psi (55 inches W.C.)
Pressure Drop: 0.3 inches W.C.
Specific Gravity: 0.60
cubic feet per hour
Length
Pipe Size (Inches)
3/4 1
10
273 514
20
188 353
30
151 284
40
129 243
50
114 215
80
104 195
70
95
80
90
89
83
100
125
150
79
70
63
175
58
200
179
167
157
148
1E111
1E=
IEEE
1 1/4
1060
726
583
499
442
406
368
343
322
304
269
119
109
102
1 1/2
1580
1090
873
747
662
600
552
514
482
455
403
366
336
209 313
473410
BY:
EIV
.E,L4
JUN 2 0 2012
APPROVED
70NING DEPT
nO DEPT
SV-io(es Village
iViarn1
SLIRJECT 1.0 C,C,MPIIP/ E \M PH Al L FEDERAL
fiLLT-1--v; 1.1LATIO,:•6
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24,1,600
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From:Donna Uzzi FaxID:WF Roemer Insurance
Page 1 of 1 Date:6/ 13!2012 04:35 PM Pager1 of 1
CERTIFICATE OF LIABILITY INSURANCE
MULLI -1 OP ID: DZ
DATE t MM!UD■YYYY)
06f13112
THIS CERTIFICATE 19 ISSUED AS A MATTER OF INFORMA1ION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(5), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate 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 policies may require an eidorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such etldorsement(5).
PRODUCER
W.F. Roemer Ins(orance Agency
4752 W. Commercial Blvd
Fort Lauderdale, FL 33319
William F. Dowd
INSURED
Mullins Plumbing Inc of Miami
2841 SW 86 Way
Ft Lauderdale, FL 33328
954 - 731 -5566
954- 731 -8438
CONTACT
NAME
PN'ONE FAX
JAiC No, Ent): ._,aC No):
EMAIL
ADDRESS:
INSU RER(S) AFFORDING COVERAGE
INSURER A • Mid - Continent Casualty Co
INSuREK d •
INSURER C
INSURER D :
INSURER 6:
INSURER F
N AC
23418
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER;
THIS IS TO CERTIFY 'HAT THE POLICIES OF INSURANCE LISTED DEL.CW 1tAt_ Of:EN ISSUED TO THE INSURED NAMED ABOVE FOR THE (-II ICY P1- 721U(T
t ' EUC>1TzL7 NO I\ 1IHSTANDIN ; AVY 4ECUIREMENT, TERM OR CONDITION OF ANY CONTRACT QR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY H17. ISSUED OR MAY PERTAIN. THE NSURANCE AFFORDED EY TIE PCLICIES DLSCRBED HEREIN IS SI.:BJECT TO .AL;, – HE 'ERMS
EXCLUS•ONS AND CONDITIONS :7F SU(:H PUL•`,;ES. L:AMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS
tNSR IADO.7SUBR1 l POLCY EFF PQEi EXP
LTR TYPE OF iNSLKANGt INSP. END POLICY NUMDER i 1 OMiDOrYYYY} LAMMtDDNYYYi LIMITS
GENERAL LIABILITY
EACH 01: :CUIUILNC:-: a 1,000,000
A X CCwa;nCIRLGLV£RAtLAB11[IY 1 040L000a47034 04I18/12 04!18113 UA'A(:L TU RENT °t —
_rREmiti.5:,Far : :_:,:M::�_ $ 100,000
t P.!NPr. MAI +I- X i O,:.GI!R
6A=1:1 XP ale :wr_ar.�, '3 Excluded
PERSONAL 3 ACV NJu Y 0 1,000,000
GENERAL AGGRE:tiiTF 6 2,000,004
I)"N L AC •CR T- ,: V,: L N111 A -''I S Orr: PROD-_U:� .;*0 " COMP,..-.r ACC . $ 2,000,00D
P iI CY I I .. JLCT l I • 8
AUTOMOBILE LIABILITY
Asir AUT"I
A..t (^,NLL:I
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SCI ILJULE')
AUTO
NON OWNEC:
All IOC
UMBRELLA LIAB
EXCESS I TAR
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CONIBINFD EINGLF LIMIT
13OUILYIN.II)HY:P t: r:nri R
ffOCILY INJURY ::P' xc 1 n1,
PROVER I DAN7 AB
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WORKERS CONWEN5ATION
AND EMPLOYERS' UA81LIrY Y ! N
AP:T r':: )PR IO ?, ?AP. -NER:: ?L .;L; VE
rJp F•C0R1LA•.VIDER
(Mandatory in NH)
(IFcrs±I,7 "ION OF ()PER ^.`��1tJ:i
WC' STATI. hill-
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UESGKIP `ON OF OPERATIO F.S 1 L OCATICNS 7 VEHICLES !Attach ACORD 101. Add,tienai ?v rnari,a Schcdr,Ic, d more spccu Is required)
CERTIFICATE
MIAMIS2
Village of Miami Shores
10050 NE 2 Ave.
Miami Shores, FL 33138
SHOULD ANY OF THE ABOVE DtSCRIBED POI TOES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF. NOTICE WILL HE DELIVr RED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE r
ACORD 25 (2010105)
T) 1988-2010 ACORD CORPORATION.
The ACORD name and logo are ragi5tered marks of ACORD
1 rights reserved.
06 -18 -2011
446,1 s vs 1
JEFF ATWATER STATE OF FLORIDA
CHIEF FINANCIAL OFFICER DEPARTMENT OF FINANCIAL SERVICES
niVIcinN OF WORKERS' COMPENSATION
* * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW
rnNSTRUCTION INDUSTRY EXEMPTION
This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law.
EFFECTIVE DATE 08/03/2011 EXPIRATION DATE 08/02/2013
PERSON: MULLINS FRANCIS
FEIN: 592814291
BUSINESS NAME AND ADDRESS:
MULLINS PLUMBING INC OF MIAMI
2841 SOUTHWEST 86TH WAY
FT LAUDERDALE FL 33328
SCOPES OF BUSINESS OR TRADE
1- PLUlliIN6
IMPORTANT: Pursuant to Chapter 440. 051141, F.S., as officer of a corporation who elects exemption from thls comer by film a certificate of election under this
section may not recover benefits or compensation under this chapter. Pursuant to Chapter 440.051121, F.S., Certificates of election to be exempt— apply only wide the
scope of the business or trade listed on the notice of election to be exempt Pursuant to Chapter 440.05113L F.S., Notices of election to be exempt and certificates of
election to be exempt shall be subject to revocation if, et any time after the filing of the notice or the issuance of the certificate, the pwsoa named on the mice or
cwttficate no longer meets the requirements of this section for issuance of a certificate. The depwunent shall revoke a certificate at any time for failure of the person
named on the certificate to meet the requirements et this section. QUESTIONS? 1850) 413 -160'.
DWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01 -11
6591 -SW 45 STREET
DAVIE, FL 33314
BUSINESS TAX RECEIPT
NAME ;A LOCAT ON • ...BUS: TAX RECIE `T
MULUNS PLUMBING
2841 SW 86 WAY
DAVIE FL 33328
12- 00005125
1
1 HOME OCCUPATION PHONE AND MAIL USE ONLY
05804
CONTRACTOR: PLUMBING
Reference:
FRANCIS MULUNS
TO:
i..{{. �f{{ ���I{. n�• 14i• tiu�l6 {I���1� {� +I��L1,�6s�1{I {�.E
103 2568748 00 353 353
MULUNS PLUMBING
2841 SW 86TH WAY
DAVIE FL 33328 -1654
OR
BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT
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: MULLINS PLUMBING INC OF MIAMI
Owner Name: MULL INS FRANCIS
Business Location: 2841 SW 86 WAY
DAVIE
Business Phone: 473 - 8162
Rooms
Seats
Receipt it:182 -433
Business Type :PLUMBING /LFiN SPRNKL /CONT'
(PLUMBING CONTR)
Business Opened:09 /13/1995
StatelCountylCertlReg :CFCO2 6532
Exemption Code:NONEXEMPT
ogees Machines Profession¢,
1
For Vending Business Only
Number of Machines:
Vending Type:
Tax Amount
Transfer Fee
NSF Fee
Penalty
Prior Years
` Collection Cost
Thai Paid
27.00
0.00
0.00
0.00
0.00 1
0.00
27.00
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 VAUDATED 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:
MULLINS FRANCIS
2841 SW 86 WAY
DAVIE, FL 33328
2011 - 2012
Receipt 4103A -10- 00011220
Paid 08/04/2011 27.00