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PL-13-2250Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 � �l3 -22�e Inspection Number: INSP- 200476 Permit Number: PL -10 -13 -2250 Scheduled Inspection Date: November 13, 2013 Inspector: Diaz, Osvaldo Owner: DOMBROWSKY, ALAN Job Address: 1420 NE 102 Street Miami Shores, FL 33138- Project: <NONE> Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Gas Phone Number 3051756 -5690 Parcel Number 1132050240220 Contractor: AROUND THE CLOCK GAS SERVICE Phone: 305 - 231 -3632 Idunaing uepartment comments NATURAL GAS CONNECTION TO GENERATOR Infractio Passed comments INSPECTOR COMMENTS False November 12, 2013 For Inspections please call: (305)762 -4949 Page 17 of 38 Inspector Comments Passed Failed F;; l Correction Needed Re- Inspection ❑ Fee No Additional Inspections can be scheduled until re- inspection fee is paid. November 12, 2013 For Inspections please call: (305)762 -4949 Page 17 of 38 DROP TEST CERTIFICATION Around The Clock Gas Service, Corp. 13117 NW 107 Ave unit 17 Hialeah Gardens, FL. 33018 Phone: 305- 231 -3632 ext 301 Fax: 305- 231 -418o STATE LIC# LPG.I 7356 CLASS# 803 November 11, 2013 To: Whom It May Concern in the City Of Miami Shores Plumbing Department. This is to certify thatAround the Clock Gas Service Corp. an authorized Advantage Dealer of Peoples Gas has performed a drop test at the following site and tested all the appliance connections. The gas line has been checked to the standards of the 2010 Florida building code, SECTION 406 (IFGS) INSPECTION, TESTING AND PURGING 406.1 GENERAL and properly tested to meet the standards of NFPA 54. The work was performed for. Alan Dombrowsky 1420 NE 102 ST Miami Shores Fl, 33138. Test Pressure: 8.0 Lock up pressure: 14.2 Operating pressure: 14.0 Test time: 10 Minutes If you should have any questions regarding this matter please do not hesitate to call us. Sincer Y. Amau, Gonzalez CEO Around The Clock Gas Service Corp. STATE OF FLORIDA COUNTY OF MIAMI DADE, SWOV TO & SUBSCRIBED BEFORE ME MIS DAYOF _ AID V 20,L3 AMAURY GONZALEZ, PERSONALLYKNOWN TOME EDWIN W*TU OFNOTARYPUBLIC *? MY COMMISSION # tE887375 9XPIRES January 22, 2017 (467}398+013 FlaidsiJOfay$ervice.00m Miami Shores Village Building Department OCT 0 4 2013 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 N o } � % 1 3 '��,'� PERMIT APPLICATION Master Permit No. " FBC 20 Permit Type: PLUMBING (� OWNER: Name (Fee Simple Titleholder): 1°t D 0 X19 '10 Phone #: 3 (DJr- Address: % 1-( '? 0 1-3 S- � ® --)" City: _ P% A-N� 8 0, 0 W 9- State: Tenant/Lessee Name: Phone #: Email: JOB ADDRESS: 33(3F City: Miami Shores County: Miami Dade Zip: 3-S 13 Folio/Parcel #: lb' S 0;) 4® 4ZD Is the Building Historically Designated: Yes NO 4/ Flood Zone: CONTRACTOR: Company Name: ` )N12 JIcI C (Q- 1 Phone #: 3 0S-C� 7 1 -3 (03 0-- Address City: �a`-� Q.','State• `-- Zip: 3 ® C Qualifier Name: Phone #:�G State Certification or Registration #: Z -v6 _- 071-3 Contact Phone #: 30 ✓ ° -,-)`Z - ( 54't�' Email Address: of Competency #: DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ G 50, S) ,:� Square/Linear Footage of Work: Type of Work: ❑Address UAlteration ONew ORepair/Replace ODemolition Description of Work: N, ft-t ��x��m��xxx�x��Fees��x��x��x��xxx�x��xxxxx�� Submittal Fee $ C `0 Permit Fee $ SV ° 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 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 pproved and a reinspection fee will be charged. Signature �7 Signature Owner or Agent U Contr ctor The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this a� day of , 20 i 3by A' N x �� Q ra -f y- c day of SOP , 20 �, by ��° v' a!v a� ( z. who is personally known tome or who has produced ✓' k a-4" w -s perso Ily known tome or who has produced -Z-"J`•s/4 f C Q -'( S, As identification and who did take a oath. 4v��• as identification and who did tie an oath. NOTARY PUBLIC: ® _o� NOTARY PUBLIC: Sign: Sign: �'`'�" • ' N L SILVER Print: *AMY COMMISSION p EES67375 Print: OCmpon SIGN # 2, 201 T5 EXPIRES January 22, 2017 My Commis { My Com Xi APPROVED BY _ d ��® ®ff° e 3 Plans Examiner Zoning Structural Review clerk (Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09) .• AROUNA OP ID: AN CERTIFICATE OF LIABILITY IN N E F DATE(MMIDDI1 -M 09/13/2013 THIS CERTIFICATE IS ISSUED 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 pollcy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject tD 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 MDW insurance Group Inc 362 Minorca Ave Coral Gables, FL 33134 Donald W McCartney Phone: 306444 - 2324' ' Annmarie MCC Fax: 306444 -4980 M- PHONE . rzxce 306 - 398 -4865 306444 -4980 INSURER A:ScottSdale Insurance Company INSURED Around the Clock Gas INSURER 8: Granite State insurance Co. Service Corp INSURER c :PROGRESSIVE COMMERCIAL 10193 13117 NW 107 Ave Unit 17 Hialeah Gardens, FL 33018 INSURER D: INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: 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, FXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. iNSR LTR TYPE OF INSURANCE POLICY NUMBER MmIDDY EFF MMIDD EXP LIMITS A GENERALLIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ® OCCUR CPS1708295 0211112013 0211112014 EACH OCCURRENCE $ 1,000,00C PREMISES Es occurrence $ 100100( NED EXP (Any one person) $ 6,00C PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 21000100( GEN'L AGGREGATE LIMIT APPLIES PER POLICY PRO LOC PRODUCTS - COMP /OP AGG $ 1,000100( s C ANY AUTO ALL OWNED SCHEDULED AUTOS x AUTOS N OWNED X HIRED AUTOS AUTOS CA01619906 -7 02/11/2013 02(1112014 COMBINED acciidentSINGL E LIMIT 1,0001000 BODILY INJURY (Par person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident) $ $ UMBRELLA LIAR EXCESS LIAR OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPMETOR1PARTNER/EXECUTIVE Y— OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, descdWe under DESCRIPTION OF OPERATIONS below NIA WC003 -63 -9248 09/11/2013 09111/2014 X WCYTATU 10TH- E.L. EACH ACCIDENT $ 1,000,00( E.L. DISEASE - EA EMPLOY $ 1,000,00( E.L. DISEASE - POLICY LIMIT $ 11000,001 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) Miami Shores Village 10050 NE 2nd Ave. Miami Shores, FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Donald W McCartney ©198&2010 ACORD CORPORATION. All rights reserved. ACORD 26 (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: 17356 Business Mailing Address AROUND THE CLOCK GAS SERVICE CORP. 13117 NW 107TH AVE STE 17 HIALEAH GARDENS, FL 33018 -1164 Licensed Location Address AROUND THE CLOCK GAS SERVICE CORP. 13117 NW 107TH AVE STE 17 HIALEAH GARDENS, FL 33018.1164 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 folder. 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 -1600. 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_corre0ons or chang2.s 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 Cut Here State of Florida Department of Agriculture and Consumer Services Division of Consumer Services License Number. 17356 Bureau of Liquefied Petroleum Gas Inspection Expiration Date: August 31, 2014 850 921 -1640 Date of Issue: September 1, 2013 License Fee: $200.00 POST LICENSE Tallahassee, Florida Type and Class: 0803 CONSPICUOUSLY Liquefied Petroleum Gas License LP GAS INSTALLER 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: AROUND THE CLOCK GAS SERVICE CORP. 13117 NW 107TH AVE STE 17 ADAM H. PUTNAM HIALEAH GARDENS, FL 33018 -1164 COMMISSIONER OF AGRICULTURE FIRST -CLASS U.S. POSTAGE PAID MIAMI, FI. PERMIT NO. 231 484274-7 THIS IS NOT A SILL — DO NOT PAY RENEWAL " M U GAS SERVICE CORP CC q-7356 505458 -0 13117 NW 107 AVE 17 33018 HIALEAH GARDENS OMAUND THE CLOCK GAS SERVICE COR ' 'f MTALLER TlpB O A LOCAL TAX NLY T. R OOEB NOT PEiD®T THE HOLDER TO YXXATE ANY 9)mn im RE4IRATORY at =0114 LAWS WAN DO NOT FORWARD COUNTY OR CMEB�. Nat cm R EXEYRI THE HOLDEN FROM ANY oiF�W FNNKWJW By LAW. TM 19 WT A 09RTNVATM OF AROUND THE CLOCK GAS SERVICE CORP OUAI94CA. AMAURY GONZALEZ PRES ymmom 13117 NW 107 AVE 17 PAYBOENTRECOM HIALEAH GARDENS FL 33018 TAX 09010094001 { 88 $j }}(( lilt gj( ((j j( }t ay}}{{ 11 j 000060.00 {il{�lii9#tl1SISMliltJii@ illicit }illiiilillat1IIIIIolllfi07 7 SEE OTHER SIDE Longest Run: 70 Feet ft New Generator {1 Total Load: 318,000 BTU's 234.000 BTU's 1" Outlet Type of Gas: Natural Gas 1" Shut Off valve Sediment trap Materials: Galvanized Pipe I Flex Connector New Outlet (S) 0 New Connection (S) 1 Existing Range 50,000 BTU's Existing 314" Outlet Existing 1" Existina 3/4" Shut Of Valve IStravoed to Florida Building Code - FUEL GAS 2010 Chart # 402.4 (2) (Galvanized Pipe) 112 - PSI to 7" W.C. Gas System 5' 11,3- OCT ® 4 2013 Existing Meter For Equipment New Outlet 1 -1/4" 1/2 - PSI to 7" W.C. Gas Svstem Around The Clock Gas Services Installation done in accordance with FBC 201 , ;; EDWIN L SILVER LPGO17356 / CCN 02P000369 NFPA 54 & 58 regulations as w as all local :•_ MY COMMISSION # EE8673 13117 N.W. 107th Ave Unit # 17 9/19/201313:54 - EXPI •2017 Hialeah Gardens, Florida 33018 Amaury Gonzalez ....... �^ Phone: 305 231-36321 Fax: 305 231 -4180 Job Address: 1420 2nd S 0 eet sometric • Mdr dt Chart # 40; 1/2 - PSI to N O R T H Around The Clock Gas Service: LPG017366 / CCN 02P000359 13117 N.W. 107th Ave Unit # 17 Hialeah Gardens, Florida 33018 231 Installation done in accordance with FBI NFPA 54 & 58 regulations as Vol as all 1 9/19/201313:54 Amaury Gonzalez EDWIN L SILVER mY f # EE867375 PIRES January 22, 2017