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PL-13-145WQRKKORDER CSC No::. 3 CSC / Cust Acct No:: f Customer Name PFidne • t{ stallattoh /address Work to be done r� Date'' -.>✓ -11.. �•,��3°�= . Time 1 r Comments State • Street :. • city By.....:. Activity Code Equipment Code'.. .. _ Work done Billable ❑ Yes ❑ -No �x . Date ;�e -6°.. Arrive . sr d, Left �Y "Ple a Activity Code. Equipment Code . . NAAKE :MODEL NO. SERIAL NO. - • Co ments T/C # 1 Serial No:0-5_,: T/C # 2 Serial No. T/C # 3 Serial No. OTHER VESSEL TSI1E DATE. -, CERT DATE ® + "RECERT TYRE BOILER SPACE HEATER WATER HEATER RANGE 17-Z J T J c tc; to ra. MOMR MOIYR LP 'NO Mark LI 1 No Ma k° ❑2 s° yyLl2 s ❑ 3 -°E° 3 °E° El ❑ 1 No Mark. ❑ 2 s° 3 E CLOTHES DRYER FIREPLACE LOGS OTHER SYSTEM TESTS SINGLE STAGE LEAK TEST 3 Min. INTEGRAL TWO STAGE PRESSURE TEST (10 Min. START I1- FINISH—I {SIN61�t rs 'ct OUIP. USED n'MA'• TB OTHER JI STAACL�r' _ TIME f r•± Vvt f _ �Et1UfF_ USE[} N1AP4 ,' T81 OTHER„ TIME )„ , D PS1 EQUIP., USEL} • TIME Li PSI EQUIP; USED HP,.GMU • TILIE:-7 --�, • EQUIP. USED HP C�AUC�E`"" • TIAlE THREE STAGE START ( • FINISH -4'= • HP GA.ITGE . EOthF USED t9AtT.tHP -GAUGE FLOW • . LOi KUP_- EQUIP. USED MAN HF.G IidE DU; Ps � � • LOCKUP OPERATING TEST EQUIP. L1SLI1 MAN '.iB -, :OTHER " u�.c Li DIX Li PSI OTHER l Mfg. 1 Mnde1 Date -Code .` OT. ER The undersigned: Knows how to tum off the pro- pane gas supply vaive in case of emergency. Has smelled propane and Can detect its odor. Under - stands the service that has been performed. Has road and and fs` tands the .abpire Cements and OTHER 'mac safe inf mation,00lbe " - o'Tthis form. Regulator Data era: t 2rt ,are= 3rd QUIP._USED MAN • H� GAUQE n \N0 'L.__ blN = 'GREEN - Office Copy YELLOW - Customer Copy WH • Em oyes Copy • GnsTOMLT,TIGNA'T URE- • ITEM NO 15192.5 ORR- 51680210- CUSTOMER: READ AND PROVIDE THIS IMPORTANT SAFETY INFORMATION TO ALL END USERS! PROPANE AWARENESa: - Propane is highly flammable when mixed with air. Severe "freeze burn" or frostbite can result if propane liquid comes in contact wittlyour skin. Propane smells like rotten eggs, a skunk's spray, or a dead animal Some people may have difficulty smelling propane due to their age; a medical condition; or the effects of medication, alcohol, tobacco, or drugs. To familiarize you and your family or employees with the smell of odorant, call Suburban at 1-888-223-0029 to request a Scratch and Sniff sample of what propane smells like or order any Propane Education &.Research Council pamphlet. Propane odor can fade making it difficult to smell. Although ram, several situations can cause odor fade: at The presence of air, water, or rust in a propane container. • The passage of leaking propane through soil • The exposure to building materials, masonry or fabrics, Since there is a possibility of odor fade or problems with your sense of smell, you should respond immediately to even a faint odor of gas. Propane gas detectors can provide an additional measure i if aecurity in homes with little-used areas or with occupants who have difficulty smelling propane. IF YOU SMELL HEAR OR SEE GAS: 11 IMMEDIATELY put out all smoking materials and other open flames. Do not operate lights, appliances, telephones, or cell phones. 2) IMMEDIATELY LEAVE the building oai area where you suspect gas is leaking. 3) SHUT OFF THE GAS at the main gas supply valve on your propane tank if it is"safe to do so. 4) REPORT THE LEAK from a height)! ir's home or another nearby building away from the gas leak. Call your propane retailer, 911 or your local fire departmem. -5) DO NOT RETURN TO THE BUILDING 011 AREA until it is determined it is safe to do so. 6) GET YOUR SYSTEM CHECKED by your propane retailer or a qualified service technician for leaks before you attempt to use any of your propane appliances. CARBON MONOXIDE (C0) AWARENEFSS: — You can't taste, see or smell CO. CO CAN BE DEADLY! High levels of CO can come from faulty appliances or venting system. Symptoms of CO Poisoning include:* Headache o Shorness of breathe Dizziness • Nausea •Fatigue. Signs of high CO levels:. Sooting, especially on appliances and vents •. Unfamiliar or burning odor • Increased moisture inside of windows. To reduce the risk of high CO levels: • Check your appliances and related venting systems annually. l► Install UL- listed CO detectors on every level of your home. is Never use non- approved portable heaters indoors. • Never use a barbecue grill indoors. IT FOIL SP1SPECT CO IS PRESEJ'4T: a Immediately get everyone out of the building to fresh air. • Call 911 or your local fire department from outside the building: If it is safe to do so, open windows to allow entry of fresh air, and turn off any appliances you suspect may be releasing CO. • Do no reenter the building until it is determined it is safe to do so. • Get system checked by a qualified sLrvice technician. L1 TIN ILOT,IGHTS: If a pilot light repeatedly goes out, or is very difficult to light, there may be a safety problem. DO NOT try to fix the problem yourself. It is strongly recommended that only a QUALIFIED SERVICE TECHNICIAN light any pilot light that has gone out. YOU ARE TAKING THE RISK of starting a fire or an explosion if you light a pilot light yourself. Carefully follow ail of the manufacturer's instructions and warnings concerning the appliance before attempting to light the pilot. DON'T RUN OUT OF GAS; SERIOUS HAZARDS, INCLUDING FIRE OR EXPLOSION CAN OCCUR. Prior to refilling an empty propane container, a leak test must be performed by a Qualified Technician prior to turning on the gas to determine if any equipment or lines remain open after the run out. Suburban is not liable for injury or property damage resulting from a supply sun out. EQUIPMENT AWARENESS; Know how la shut off the gas supply to your premises and where the valve(s) is located. Tank and cylinder valves must be turned to the -right (in a clockwise direction) to stop the flow of gas. Manufacturer instructions are included with all propane appliances and equipment. Keep and consult them for correct operating and maintenance procedures, Contact the appliance manufacturer for replacement instructions, if needed. Do not store propane cylinders inside buildings. E, OODING: - If flooding is predicted for yi er area or your gas -fired appliance(s) or equipment have been submerged: • Turn off the gas valve at the container. • DO NOT turn the gas back on until a qualified technician ha i checked the system. REAVY SNOW OR ICE: - Heavy snow or .ce on propane equipment may cause damage resulting in a leak. Regulator and appliance vents must remain clear of snow'aird ice, expecially appliance vents on roofs of mobile homes. When removing snow: • Use care around tanks, piping, tubing, valves, regulators and other equipment to prevent damage. • Use a broom instead. of a shovel "o Do. not shq`'el snow from roofs onto propane equipement. SAFE ACCESS: provide structurally "sound access to propane equipment free from snow, ice, debris or other obstructions. P RTII.ER CONSUMER SAFETY INFOR M %TION; - This is an abbreviated version of Suburban's Safety Tips. We urge you to visit y ±".tb t nproi ctnn for the full text and for Consumer Safety information prepared by the Propane Education & Research Council (PERC). Pamphlets call "Important Propane Safety Information for. You and Your Family," "Important Propane Safety Information for Users of Small Cylinders" (including cylinder transportation, storage and inspection edures , an expansive � peer ) xpansive "Propane Safety" booklet, weather/natural disaster information, and Suburban's Material Safety Data Sheet (MSDS) may be read and downloaded online. These documents are also available free of charge by calling Suburban at 1 -888- 223 - 0029 or can be purchased through PERC at i- 866 -905 -1075 or www,p,Lgganecatalog.com. Each pamphlet contains a Scratch and Sniff Test to learn what propane smells like. Para infarmacidn de seguridad en Espafol, flame al 1- 888 -223 -0029, Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 184747 Permit Number: PL -1 -13 -145 Scheduled Inspection Date: March 20, 2013 Inspector: Hernandez, Rafael Owner: GLINN, MacDAM & DENISE Job Address: 1201 NE 102 Street Miami Shores, FL 33138- Project: <NONE> Contractor: SUBURBAN PROPANE Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1132050250160 Phone: 305 - 891 -8393 Building Department Comments SET TANK FOR GAS LINE Infractio Passed Comments INSPECTOR COMMENTS False Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments March 19, 2013 For Inspections please call: (305)762 -4949 Page 16 of 49 s_sts_Acy B IlOlta IOW G 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 No. 1" ► 1 —140 }11 © ric v g JAN2 33 I PERMIT APPLICATION Master Permit No. FBC 20 Permit Type: PLUMBING Owner's Name (Fee Simple Titleholder) i%%! �6� 6d/ Phone # ,%'i5 el 7 9� - �4 Owner's Address ,010 / ) Jr /�,,%, 5' 9 City /AN/ State Tenant/Lessee Name Email Zip 3 Phone # Job Address (where the work is being done) City Miami Shores Village FOLIO / PARCEL # Is Building Historically Designated YES NO X Contractor's Company Name 6 V /U`4,4 7I Contractor's Address /9/ `1 /e-- /3® A4' 6/- County Miami -Dade Zip 3.3/3( Phone # Flood Zone City JV •�'J/ # ® State . % Zip 3 / G 1 Qualifier Name 6'4/at i) C/ 9 Phone # 30 e' 8-5/-1'35" 's State Certificate or Registration No. ' I /96 0® l /qc Contact Phone E -mail Certificate of Competency No. Architect/Engineer's Name' (if applicable) Phone # Value of Work For this Permit $ Type of Work: DAddition EAlteration Describe Work: Square / Linear Footage Of Work: I�New ❑ Repair/Replace ❑ Demolition 444 ° O '3.90Ct1.-9d0. 7t; ` ;:.dm • :WEPPI sat. r ', v fir] t lRti 'mrio:i, ,a a7.Et54i11 IF;9;S.vlf?,�", or,u -rw? **********9 keY**d*t4* 9t9c*rok9e9e *** **de*k7k*de*** tkvit7ktkoh9tdroir4n4 �Y *3: �Y �t brie Y�Y:fre 4 iYAreh:* Fees Submittal Fee $ Permit Fee $ /a0' Notary $ Training/Education Fee $ Scanning $ Radon $ DPBR $ Double Fee $ Violation date: Structural Review. $ Total Fee Now Due $ CCF $ CO /CC $ Technology Fee $ Bond $ See Reverse side -+ 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days afier the building permit is issued. In the absence of such posted notice, the inspection will not be ap$roved and a reinspection fee will be charged. Signature Owner or Agent The foregoing instrument was acknowledged before me this v'2 day of , 20 13, by ila.G 461,v- •- �L L who istpersonally known to e or who has produced who is personally known to me or who has produced' Signature .,./74..,-°e". Contractor The foregoing instrument was acknowledged before me this d e , 201,X, by 5u, l I No r\ 1 t i. As identification and who did take an oath. Sign: Print: My Comm entification and who did take an oath. NOTARY PUBLIC: Si Print: My Commission EXPIRES��:�,J,}}u,nl�e 15, 2915 4 _ F,. `be, Bended NU cwle` NNSt Y SeMY1.Ei ��OFF�� * * * * * * * * * * * * * * * * * * * * * * * * * * ** ************************************************ *********** **************** **** APPROVED BY Plans Examiner Zoning Engineer Clerk checked (Revised 07 /10107)(Revised 06/10/2009) 6 ,LJ . c jt%i I L 6 ),"S MLJ- Lia ■f s M"' 4- -e 710 71-,9-4)/1/4-- Less io.,,- 4 r '•1- G 1 ho 4h A hv.° e r ja te a, v- - j ,L, /7.4,4 4 10 1/1! .,./ /..- . 6-4,, -5-j- i9-.�` /:. A 1 rcA mac c DATE Suburban Propane 1491 N.E. 130th Street N. Miami, FL 33161 305- 3 Qualifier Job Address 6 vc vow 370 Waymoat Couot • Lake Mary, FL 32746 • Voice 407.688.7631 • Fax 407.688.7641 • sandpsmveying@gmaiLcom Lot 8, Block 186, BAY BREEZE SEC77ON - ML4M1 SHORES, according to the plat thereof as recorded in Plat Book 42, Page(s) 25, ofthe Public Records ofMiami-Dade Camay, FL. Community number: 120652 Panel: 0306 Suffix: L F.LRM. Date: 9/11/2009 Flood Zone: X Date offteld work: 9/28/2012 Completion Date: 10/1/2012 Certified to: Macadam Gunn; Denise Minn; Law Offices of Evan M Rosen, P.A.; Old Republic National Title Insurance Company; JP Morgan Chan its' successors and/or assigns 212 1/2" • M4100 SDale Oft / -)26 4544€ ' Lf'6/Js �itl.�✓ l�4 168 6 LOT 7 BLOCK 186 EAST 130.0 0.0' SCALE: (P& M)D.o =30' FIR 1/2" 0. -' 14.1' LOT 5 /BLOCK 186 FlR 1,(2" WEST 33.28' WEST (ASSUMED) B.R. 130' (P&M) FIP 1" o1VE57 ;;185!87 (P FD DRILL HOLE M) •` LEGEND �. Woad Felroa F !Fled —0— Where= W.M. lWaterMeter C.LF Chain Ljnk Pence TEL Telephone Fac3lIas 1 /vm13i4uu ' Covered Area CONC Canruefe B. Dearing Reference M PladMeaswed CH Chord Asphalt. RAD Radial ENOR Pna08Qhment AlO Air Conditioning Centerilna B.M. Bawl Mark Cotar000 C. Calculated Property Line A Central 420180elta Cornett) Monument D.B. Deed Book Pound lion Rod D. Description or Deed Foroul Iron Pipe 0.11. Drat Hole Right of Way DAN Driveway Nan & Dtek EBMf Easement Drainage Easement EL Elma8on U.E. Utiaty Element • FP.. Fkdshed Floor F0. Foam] ' EWA. Found Concrete Monument T.0.B. 2 Pod .. F.P.K. Found Parker•Kalon Nal 1'YR D.U.E Duane &UthyEmmett L Length W.O. PP. Power Pole L.8. Licensed Business 10.05 TK 7hem13108 •-1. -- lire Break Not to Scale EC.W. CATV Cable Riser M.H. Menhde RC.0. C8 Chord Searing OHL Overhead L6�s PI W.F. Wood Fence N.T.S. Not to Scale T.B.M. CD CD CR.M. FJ.R. P12. RAN N&D • D.E. NE 102ND STREET 75' R/W (IMPROVED) 20.5' ASPHALT PAVEMENT 0.4.. P.C.P. P.R.M. Pd PVMx: E.O.P. 2.0. 2.02. P.O.C. 2..OJ_ P.C. 2.9.0. P.T. 2. R.O.E. 8.1.R. 8NV O8ibIel Re0003421 Opel ReooNo Book Permanent Control Point Permanent Reference Monument Page Pavement Edge of Pavement Plat Bodo Point of Beginning Point of Commencement Pope on line RUM of Curvature Point of Rename Cravatue Point ofTangemy. Rao (Radial) Roof Overhang Easement Set bon Rod & Cap Sidewalk Top of Bank Typical Witness Caner Eating Elevation Edge of Water Point ol Compound Curvy Prim of Intersection Temporary Satoh Mark EDGE OF ASPHALT Property Address: 1201 Northeast 102nd Street lifiiami Shores, FL 33138 GENERAL NOTES 1. Legal desalplon plodded bYothera 2. The lands mown hereon were not abstramedlor e8Gemenlsorotherrecarded enctentnanoes not 81cvm on the 3. Underground porlptsdfootings, ar other lmprowmenbs were not 4. Vial tlas are to the face 5. Orgy vlsiWe S. No 0enloaaon unless noted. 7. Dimensions shown unless alhendse noted. 9. 7119 Oa =MARY 5. Not veld unless surveyors 10. p embossed deed measured, 1Me shat ba3Mge, unless 11. AT Ones erenetfadef 'Survey number SL 126756 12. FLOOD ZONE DETfRMINET QNS ARE PROVIDED AS A COURTESY ONLY, AND ARE DERN®FtOMi8E 8ESTSOURID;S AHAt1ABLE 30 THE SURVEYOR. MS INFORMATION SHOULD NOT BE RETIED UPON FOR FLOOD 143URALFCE 211520808, AND MAY DIFFER FROM rota r,.; +.,;; •N PROVIDED BY OTHERS. 00/i/or drah+field locations are dog MUST ke verified by only unless Viand Land ee update. watt the promulgated I fweayeenTyapregs lend Ralph 7192 LendeuvaprNa 9411