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PL-13-95 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FIL I Phone: (305)795-2204 Fax: (305)756-8972 inspection Number: INSP-184325 Permit Number: PL-1-13-95 Scheduled Inspection Date: July 09,2013 Permit Type: Plumbing - Residential Inspector: Hernandez, Rafael Inspection Type: Final Owner: MORGAN, MARY Work Classification: Gas Job Address:307 NE 95 Street Miami Shores, FL 33138- Phone Number (305)606-2098 Parcel Number 1132060136000 Project: <NONE> Contractor: ADVANCE EXCAVATING LLC Phone: (561)602-5354 Building Department Comments INSTALL 1000 GALLON UG PROPANE TANK SERVICE TC INSPEC Passed Comments GENERATOR, BBQ, 2 WATER HEATERS, DRYER AND INSPEC TOR COMMENTS False COOK TOP Inspector Comments Passed Failed Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. July 08,2013 For Inspections please call: (305)762-4949 Page 3 of 31 .lam` Miami Shores Village Buildin g Department artment 90050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795.2204 Fax:(305)756.8972 INSPECTION'S PHONE NUMBER:(305)762.4949 FBC 2 t C) BUILDING Permit No. L 0 PERMIT APPLICATION Master Permit Permit Type: PL/UMBING JOB ADDRESS:_ &) Ak City: Miami Shores County: Miami Dade Zip: Folio/Parcel#Is the Building Historically Designated:Yes NO Flood Zone: OWNER:Name(Fee Simple Titleholder): W11 Address. 07 k] r City: d i'lti(s � �� State• Zip: L Tenant/Lessee Name: Phone#: Email: Company Name: 6d1AM,& , Phone#ti�,L ' V Address: City: bftyij AAn State: Zip: Qualifier Name: Phone# — State Certification or Registration#: Certificate of Cvqmpetency#: Contact Phone#: OVE 3D Email Address: Pj -f DESIGNER:Architect/Engineer: Phone#: Value of Work for this Permit:$ C1 Square/Linear Footage of Work: Type of Work: OAddress OAlteration ONew ORepair/Replace ❑Demolition D eripti n of Work: V, 1600 6. ial t4-1 , 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$ op 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 ryit.� Owner or Agent Contractor y� The foregoi g instrument was acknowledged before me this l�J The foregoing instrument was acknow ged re me s °� day of 20 a by w day of ZAq 201ta,by , who is p sonally kno o me or who has produced who is personally known to me or who has produced As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign Sign: Print: Print: f My Commission Ex My COMMISSION#DD W77 My Commission September 10,2014 .N,,,,, PEt�E EXPIRES:Septe p MY COMMISSION#DD X77 EXPIRES:September 10,2014 APPROVED BY <' �° Plans Examiner Zoning Structural Review Clerk (Revised3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) Miami Shores Villagea , - Buildin g Department artment 1 013 p , 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel: (305)795.2204 Fag:(305)756.8972 INSPECTION'S PHONE NUMBER:(305)762.4949 FBC 20 LD BUILDING Permit No.? PERMIT A/BING N Master Permit No. °l Permit Type: PJOB ADDRESS• Sr City: Mi ni Shares County: Miami Dade Zip: Folio/Parcel#: ® _ �®fA Is the Building tonically Desi ted:Yes NO Flood ne: OWNER:N e(Fee Si a itleholder): Pho # �. Address: "'' City B s State Zip: Tenanuq,essee Name: Phone#: Email: CONTRACTOR:Comp y Name: N% C� Phone#: �` Address: /�� City: State Zip: ' fl Qualifier Name: Phone#: State Certification or Registration#: Certificate of Competency#: 67 C�, l �— Contact Phone#: 1� �S Email Ad dre s: d` ) o DESIGNER:Architect/Engineer: one#: Value of Work for this Permit:$ Square/Lin ootage of Work: Type of Work: DAddress DAlteration ONew ORepair/Re*ce ODemolition Descripti n of Work: ��xxx��F�xx�m�xx�axxr�x��x�x�x��x�x�x�x�x�� ������������x������ Submittal Fee Permit Fee$ CCF$ CO/CC$ Scanning Fee Radon Fee$ DBPR$ Bond$ Notary$ Training/Education Fee$ Technology ee$ Double Fee$ Structural Review$ i TOTAL FEE NOW DUE$ Li L ` Miami Shores Village Building Department 10050 N.E 2nd Avenu Miami Shores, Florida 3313 Tel: (305) 795 220 Fax: (305)756.897 Permit No. Job Name 9� PLUMBING CRITIQUE SHEET Ae,1 ' AgX,60*-r" el r' i I Miami-Dade My Home Page 1 of 2 My Home ry ry MIAMt•r) ...,-r ym Show Me: Property Information ydV Legend Search By: µy: Property Select Item:. .I, Boundary Selected w Property Text only NE 98TH*f Property Appraiser Tax Estimator Street Property Appraiser Tax Highway Com arp ison Miami-Dade y County ,t Summary Details: $„ 5 t . Water Folio No.: 11-3206-0 3- 00 Property: 307 NE 95 ST Mailing ANDREW LEMKE tE'9C�T T Address: MARY ELIZABETH MORGAN W E 307 NE 95 STREET MIAMI SHORES FL r 33 138- Property Information:,, 1400 SGL FAMILY- Primary Zone: 001-3250 SO CLUC: 0002 MULTIFAMILY 2 E 84T $T LIVING UNITS Beds/Baths: /3 ra, Floors: 1 't*s -ivinci Units: 12 d'Sq Footage: 2,943 Lot Size: 13,373.56 SQ FT Aerial Photography-2012 0 114 ft Year Built: 1942 1 53 416 53 42 MIAMI SHORES SEC 1 AMD Legal PB 10-70 LOT 10&LOT My Home I Property Information I Property Taxes Description: 11 LESS 1 BLK 4 LOT SIZE IZE 94.94.180 X I My Neighborhood I Property Appraiser 142 OR 12682-2504 Home I Using Our Site I Phone Directory I Privacy I Disclaimer 10851 Assessment Information: , Year: 2012 1 2011 Land Value: $192,502 $167,393 If you experience technical difficulties with the Property Information application, Building Value: $184,710 $202,530 or wish to send us your comments,questions or suggestions Market Value: $377,212 $369,92i please email us at Webmaster. Assessed Value: $377,212 $154,457 Exemption Information: ear: 2012 1 2011 Web Site Homestead: $0 $25,000 ®2002 Miami-Dade County. 2nd Homestead: NO YES All rights reserved. Taxable Value Information: < ear: 2012 2011 Applied Applied Taxing Authority: Exemption/ Exemption/ Taxable Taxable Value: Value: Regional: $0/$377,212 $50,000/ $104,457 County: $0/$377,212 $50,000/ $104,457 City: $0/$377,212 $50 000/ $104,457 School Board: $0/$377,212 $25,000/ $129,457 Sale Information: Sale Date: 9/2011 Sale Amount: 406.000 http://gisims2.miamidade.gov/myhome/Propmap.asp 1/15/2013 OR I y1 :oil _ .,..irm Miami shores Village Building Department filOR1D� 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION FORM ALL CONTRACTORS MUST PROVIDE COPIES OF LICENCES AND INSURANCES EACH TIME A PERMIT IS SUBMITTED OR THE VILLAGE MAY MAINTAIN A FILE WITH YOUR INFORMATION FOR A$30.00 FEE PER YEAR. IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. COPY OF QUALIFIER'S STATE LIC CARD B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF LIABILITY INSURANCE (CERTIFICATE HOLDER TO BE MIAMI SHORES VILLAGE BLDG DEPT) D. COPY OF WORKERS COMPENSATION (EITHER CERTIFICATE OR EXEMPTION) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER B. COPY OF MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT C. COPY OF LIABILITY INSURACE(CERTIFICATE HOLDER MUST BE MIAMI SHORES VILLAGE BLDG DEPT) D. COPY OF WORKER COMP INSURANCE(EITHER CERTIFICATE OR EXEMPTION) YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE HOLDER AS FOLLOW: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 COMPLETE CONTRACTOR'S INFORMATION BUSINESS NAME: Qt fit (—(= "f N\-((A�C k C+ �°),- C- BUSINESS ADDRESS: kA l-t0 y-f- '2`31*-rN PLc( L CITY $' �c `�-' ' kA STATE L ZIP CODE "3—� C-C 4 BUSINESS PHONE: ( 56k ) ( 6 >-- 5-35-4 FAX NUMBER( 4 3 iii CELL PHONE & 0 '2- ` �iQUALIFIER'S NAME: , \ QUALIFIER'S LIC NUMBER: �- �'G- 9 E-MAIL ADDRESS(IF APPLICABLE): Created on 3119109 BY MLDV!RV 3128109 MLDV :. DRIVER LICENSE LA� E V B220-51':-63-384-0 KVT14 MICHAEL BtlCES 1140 NE 23RD PL POMPANO BEACH,FL 33064-"" r DOB':10-24-4 3 SEX:M MOTORCYCLEALSG ' '. af•awRSra�slreL COeyewscomweum avgsatc�sk mva+e¢u�d!lrMr. h. kr State of Florida " Bureau of LP Gas Inspection Keft M.Bikes 08-03 LP Gas installer A This qualifier identification card is evidence thatthis person has passed a competency examination administered by the State of Florida,and may act as QUALIFIER for an LP gas company licensed in the category above pursuant to Chapter 527,Florida Statutes.This card is NOT A LICENSE TO DO BUSINESS IN THE STATE OF FLORIDA CERT NO: 23006 CHARLES H.EIRONSON Expires:Mar.22,2013 COMMISSIONER OF AGRICULTURE II _ ACC MV CERTIFICATE OF LIABILITY INSURANCE °ArE(MM►DD,YYYn I 1/4/2013 THIS CERTIFICATES ISS I LIED AS A MATTER OF INFORMATION 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(S), 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 endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Gateway Insurance WC,No.Erd:9 735-5500 Al N,)954-735-2852 2430 W.Oakland Park Blvd. E-MAIL Fort Lauderdale FL 33311 ADDRESS.ce INSU AFFORDING COVERAGE NAIL# INWRER ANid-Conbrient Casuafty Co. INSURED ADVEX01 INSURER B: Advance Excavating,LLC. INSURER C: Attn:Mr.Keith Bikes 1140 N.E.23 Place INSURER 0: Pompano Beach FL 33064 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:746208128 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED 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 MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. I�jR TYPE OF INSURANCE WVD POLICY NUMBER POLICY EFF POLICY EXP A GENERAL LIABILITY GL000816485 /21/2012 /2112013 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES(Ea occurrence) $100,000 CLAIMS-MADE lxl OCCUR MED EXP(Any one person) $Exduded PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN1-AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $1,000,000 X POLICY PRO- LOC $JECT AUTOMOBILE LIABILITY IT Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident A UMBRELLA LIAB X OCCUR 04XS170842 /21/2012 312112013 EACH OCCURRENCE $4,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $4,000,000 DED X i RETENTION$10,000 $ WORKERS COMPENSATION WC STATU- 0TH- AND EMPLOYERS'LIABILITY YIN E ANY PROPRIEPORIPARTNER/EXECUTNE❑ NIA EL.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ V ,desarbe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additlonai Remarks Schedule,Ill more space is requked) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Shores Village ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2nd Avenue Miami Shores FL 33138 AUTHOREMO REPRESENTATIVE ©1888 2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD Florida Department of Agriculture and Consumer Services Bureau of Liquefied Petroleum Gas Inspection P.O. Box 6700 Tallahassee, Florida 32399-6700 License Number. 23069 Business Mailing Address Licensed Location Address ADVANCE EXCAVATING,LLC ADVANCE EXCAVATING,LLC 1140 NE 23RD PL 1140 NE 23RD PL POMPANO BEACH,FL 330645546 POMPANO BEACH,FL 33064-5546 The liquefied petroleumgas license at the bottom of this form is valid ONLY for the company looted at the - address-ntha license--Efucti buelness- o-n of a compari ffifigr ffdn§W-AK-LP Gas licenses mush - renewed annually. Any license allowed-to expire shalt become Inoperative because of failure to renew. The fee for restoration of a license is equal to the original ficense fee'and must be paid before the licensee may resume operations. IN THE EVENT OF AN OWNERSHIP CHANGE AT THIS BUSINESS LOCATION: This license maybe 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)9214600. 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 chan9es to your business mailing address and/or your licensed location address and return the UPPER PORTION with corrections to: Florida Department of Agriculture and Consumer Services Bureau of Liquefied Petroleum Gas inspection P.O. Box 6700 Tallahassee, Florida 32399-6700 (Lit Here State of Florida Department of Agriculture and Consumer Services Division of Consumer Services License Number: 23069 Bureau.of Liquefied.Petroleum Gas Inspection Expiration Date: August 31,2013 860`)921-1600 Date of Issue: September 1,2012 POST LICENSE E License Fee $200.00 CONSPICUOUSLY Tallahassee, Florida Type and Class: OM Liquefied Petroleum Gas License LP GAS INSTALLER, s 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,Ronda Statutes,to: AMANCE EXCAVATING, LLC 1146 KE*231RID:PPL ADAM H.PUTNAM POKPANO BEACH, FL 33064-�5546 COMMISSIONER OF AGRICULTURE �FjoLida Depertmertt-of A�riaultur9 and_Consume�tServices Bureau of Liquefied Petroleum Gasspection 3125 Conner Boulevard,Suite N Tallahassee, Florida 32399-1650 Master Qualifier Mailing Address Licensed t. ©n Address KE"M BIKES �a : ADVANCE EXCAVATING,LLC ADVANCE EXCAVATING,LLC 1140 NE 23RD PL 1140 NE 23RD PL _ P60PANO BEACH,FL 33064-5546 POMPANO BEACH,FL 33064-•5546 Certficate Number License Number 23006 4 23069 4 - ;yi`his aster i�al'rfier eilyfirafe is issudd pursuant fo_Chapter 527,"Plorida S#atutes. This certiflCato 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 32399-1-650 Cut Here ------------------------------------------------------ State of Florida '13epartrnent Vt ie ulture and Corsiurr�er Services Division of Standards ce�l11cate Nw.. 23M Bureau of Liquefied Petroleum Gas Inspection Exam Date: February 28,2W7 x (850)921-8001 Ismse Dift: March 23,2010 Tallahassee, Florida � °" March zz•2013 MASTER QUALIFIER CERTIFICATE This CeMcate is issued under authoritpof Section 527.02,Florida Statutes,to: KEITH M BIKES Valid Eru License Number. 23069 ADVANCE EXCAVATING,LLC 1140 NE 23RD PL H_BRON POMPANO BEACh,FL 33064-5546 COMMISSIONER OF AGRICULTURE i ' 'Apr 25 12 10:33a Amerigas 5618441488 p,1 02-14-2012 -4 v JEFF ATWATER STATE OF FLORIDA CHEF FINIWCIALOFFICER DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERW COMPENSATION CERTIFICATE OF ELECTION TO SE 10(10" FROM FLORIDA WOMUM COWENSATION LAW CONSTRUCTION INDUSTRY EXEMPTION This certifies that 1")e individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATA 0411712012 EXPIRATION DATE: 04117/2014 PERSON= BIKES KEITH FEIN: • 020771433 BUSiNEhS NAME AND ADDRESS: ADVANCE EXCAVATINQ LLC 1140 ME 23RD PLACE POMPANO REACH FL 33064 SCOPES OF BUSINESS OR TRADE= 1- GAS MAIN OR CONNECTION - CONST IMPORTAitT, Pent lo'Chapler 4W . 65114). F.S. as dI&er d a anrparatlas who elects mc®optleo kom fait chater W Rliag a Ce"HICS110 of election NWW Iais Octim way not recover baselia or Ceeiveasailan elder tills denptae: Poraaant to L739pter 44&09123, F.S..CartIIhides of decano to be emempt... a" edy aim one score of the business or tra4o listed oa the notice at election to be e:esept. Psrsueat in Metter 440.06113% F.S., Notices of election to be earl aM cwMcatm ai election to be eeeaia ahelf be select to revocation a, at may than after the tiring of twee oath* or me iasomm of tba ceofficete, Me Person gamed On the OWce or certutcale as longer meets tee regsirewats of tills %colon for isseaace of a CarliNCate. The departmerrt shall revile a Cettplita[a IS any than for 18115ra of ft Poo= called on the cedilieesa to areft Ore re`nknoteals at this Section QeIEST[ONSf 1850? 413-1608 OWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01-11 PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE STATE OF FLDRIDA IMPORTANT DEPARTMENT OF i MANC1AL Si RVICEs OWN=OF WCOUCE At-COWENSATION F Pursuant u Chaplet- 440.05041. F.S„ an officer of a corporation who CONSTRUCTION IMUSTRY 0 elects exemption from this chapter by filing a canifieme of election cotTIF1CATE OF ELECTKNti TO Be EXEMPT Iii=FLORIDA L under, this section it y raft rww2r benefits or coonpensadion under this WORKERS COMPENSATION LADY ` — D doter. EFFECTIVE 04/17/2012 EXPIRATION DATE: 04/17/2014 Pursuant to � 4411.0502} F.S.. Certificates of election to be PERSicf1t KEITH BIKES H exempt.. apply only within Me scope of the business or trade listed all FEIN: 020771433 R ft notice of election to be exempt. BUSINESS ]NAME AND ADDRESS: E Pursuant to Chapter 44(1.0513). F S.. Notices of election to be exempt ADVA19CE EXCAVATING uC and certificates of etection to be exempt shall be subject to revocation 1140 ME 23M nACE if, at any, time after the filing of the notice or the issuance of the POMPAM BEACH.VL 33064 certificate, the person named on the notice or certificate no longer meets the rertuirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the WOPE OF BUSiNESS OR TRADE: person named an the certificate to meet the requirement of this 1- cos NAM OR CONOtECreOla - ZoasT section. allMMUT (00) 413-1609 CUT HERE +� Carry bottom portion on the job, keep upper pordoe for your records. OWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01-11 BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S.Andrews Ave., Rm.A-100. Ft. Lauderdale, FL 33301-1895—954-8314000 VALID OCTOBER 1,2012 THROUGH SEPTEMBER 34,2013 DBA:ADVANCE:EXCAVATING LLC Receipt#:INSTALLATION LP GASS APPL UP Business Name: Business Type:(INSTALLATION LP LASS APPL/SOUP) Owner Name:KEITH BIKES Business Opened:11/05/2007 Business Location:1140 NE 23 PL State/County/Cert/Reg:23069 POMPANO BEACH Exemption Code: Business Phone:561-602-5354 Rooms Seats j Employees Machines Professionals For Vend&V Business Ordy Number of Machines: Vending Type: Tax Amount Transfer Fee I NSF Fee Penalty Prior Years Collection Cost Total Paid 75.00 0.00 " 0.00 0.00 0.00 0.00 75.00 i i 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 rei t does not indicate that the business is legal or that A is in compliance with State or local laws and regulations. Mailing Address: KEITH BIKES Receipt #13B-11-00007378 1140 NE 23 PL Paid 07/05/2012 75.00 POMPANO BEACH, FL 33064 2012 - 2013 _ m ;. Q ko Otl0 IWT T v II` poo a VOO f4-�v d b0 wvj DAT-E '�c�-•r;�', ; �' � ,� � � �; _' '- ____ �a' _:�-.. _.._ u ` Q 1 pep �1'V pupJ. °AP„�"�' Il'il���!!t 45'lpL LL)C' ! •�7 Lei JF'i. °�� "�"1`Ci� L.be� - 16) Ram. � ���, �� � �LE,►�I+f�/mac ���i s � �\t� '� �s� �� �7'��}� ;� j T ! p VNQ pJ�J cll ltl�� A��'q+' U�( ��'l� i ' J'�`� '•�'7� ' r,'a„a 41[� L . U P^J' 111T" r C, t al ` T C �R ... �� "��a.g� fit?`q�•S 1 v. :acya ITO)"D �'N 000 s�rwd LO ry b°a J ` �'' • 1,ii 300T r , -T 1 �r installation Wit Be installed i.A.1Ah, �, F�at�t31�P� o Ed. Underground Tank VVID Be installed Appr Flame 8uttding CadeEd. Minimum 10 Feet From Supoing& Polyetflytene Pipe Buried 18° NOT 1°0 6CAL1= NFPA ,National Fuel cis Qc�is Source of Ei®c hael ignition Withh Chas Treo v 1'ep®' NFPA 88,Uqusfted Petroleum Gas Cade „jO,g�-Ed. fluty' {1 NEW ADJUSTED OPENING Mi- MA r / f A _ ( _ � !�►��!_4�_�,SIC 1�1 ' v _■ . NATIONAL FUEL GAS CME Te 6.3(1) ]Polyeftylme Plaiic Gm U UPK%ftdPropa- w>w° 0:14. e % 4 4A E 1 x x!/+ 1 1% 2 2 3 3 ESM9.33 s sDxu 5 5DRU y yx1 s � 1Wt I.s2s 1 1.�4 x x� 2 28r� ABM s s.6� 1 2012 ROM `Table 6.3{d) Sc 1"te 40 Mbnc Pipe N .ba I - IA 1 i::;b 4 Ash 0.R 929fi 1 0 CAPUM Y 1.610 2 W zoo 10 291 IV 1,M 21 20 -161) 33 632 100 So 19.100 13 loo f 541 1,1x0 50 5010 20 480 I'M 104 110 231 � 892 821 30 -101 2jW sn 763 89 125i � X770 6 Gf0 6,210 84 175 1.2 ► 1.140 2PO 150 74 iss 292 60o 175 � so 250 62 129 227 465 � 58 i07 2AW 412 BOB 551 814 749 182 2.3m 400 46 97 as 6'97 344 4550 42 40 as 156 300 so so 37 78 188 283 600 35 73 269 650 39 70 66 I31 131 .25.7 700 32 30 499 449 120 246 236 751 8041 29 61 5.1 115 111 227 850 5,190 4,401 l07 405 900 27 26 I 104 213 206 950 1,p0 25 1.150 197 201 , IAN 25 so 93 19Tr e 1 341 so lea 1'700 29 46 86 176 169 IAN 21 44 S2 79 162 1 20 a 76 1 58 L-700 19 921 05 1,M 151 1 P8 Lq is 39 71 1� 145 142 30M is 57 fig 850 8777 2000 2-qw 2.W 540 487 1.370 1.90 2,690 233 243 466 746 • ?812 Et C'm u mwwlpmmm lb4 $ 3 4 ; 2AW 8.086 4 1.610 2 W 19ug� Sim 5,%5! 10'O 7,430 19.100 13 loo 21.5w 4.60 3.750 5010 AM 9 I'M 104 SX0 5 4.M 8.M 16{0 low 2jW 1,540 2,570 $'�70 X770 6 Gf0 6,210 1 1.2 ► 1.140 2PO 3, 10 3SA1$ x1,2ao 100 IPO t 1010 2,70 4PO 9, 9,oxo 09 L570 2AW �� 4AW BOB 814 749 lAw 2.3m 31780 9.710 6 im 6'97 1.340 %M 618 1.190 6 'dW 5� Ism 1,7 5.7w SPO 515 4 ,970 gn LOA 2.440 499 449 m 1,0 2 300 4.700 424 819 5,190 4,401 405 um 1,140 4, 400 9� 1.150 jjq2D 5,920 3" 68 iso loo %7" 341 656 1.790 3.640 so 4S4 9780 1.730 SADD 319 w 05 m `., IAN I 309 30 578 921 05 1,M 3.00 292 so 1� 30M 277 sm 850 8777 1.450 2-qw 2.W 540 487 1.370 1.90 2,690 233 243 466 746 1'470 2.580 2% 45i1 1 i Z,SrpB 436 am 13W 2.421 2,950 219 422 652 I'150 212 -409