PLC-13-2180*r
Inspection Workshrset
Miami Shores Village
10050 N.L: 2nd Avenue Miami Shorts, FL
Phone: (305)796.2204 Fw. '(300766 -f37'2
inspection Number IN$P' 199$0 PorthiiNumber. PLC-9-1
Scheduled lnspeciion Date: October 64, .2013 Permft Type: Plu mbirrg • Commercial
Inspector- Diaz, Osvttdo Inspection Typa: Firval
Owner: INC, PU B-. SUPERMARKi:TS,,:
Work ClaeS #ficattorl; Gas
Job Addrew 9060 BISCAYNE Boulevard
Miami Shores, fl~. 31138-
Phone Ntt�ber �`863���7_.
Project, <,NONE>
Contractor PINNACl g Pt,UMBIMG It C
Parcel Number 11g0$Q1200f0
Phone: (9 i4)'420-5555
ALPINNACLE PLUMBING, , INC.
1056 SW 1st Way Deerfield Beach, FL 33441
,£ Phone [954] 426 -5555 Fax [9541426 -9909
Publix Supermarket Store # 794
9050 Biscayne Blvd
Miami Shores, FL
Permit # PLC -2 -13 -260
General Contractor: Oak Construction
September 23rd, 2013
To Whom It May Concern:
A drop test was performed at l ! L� O�— The following procedures
were performed.
1. A drop test for the natural gas system was performed for 30 minutes with 14" of water column.
2. The system was found to be free of leaks.
Test performed by: &�\ of Pinnacle Plumbing, Inc.
State License # CFC 057845
Technician's Signature: t
Print Name: - �f-
Date:
Project Manager -
Print Name:
State of Florida
County of Broward
Subscribe and sworn before me this o�3 day ofi , 2013
Notary Publi X010'
My Commission Axpires
" '`` " L• VONDER STRASSE
a Commission # EE 42567
MY Commission Expires
�" ` November 16, 2014
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
BUILDING
PERMIT APPLICATION
Permit Type: PLUMBING
JOB ADDRESS: 9050 BISCAYNE BLVD.
FBC 20
Permit No.
Master Permit No.
City: Miami Shores County: Miami Dade Zip: 33138
Folio/Parcel #: 1132060100010
Is the Building Historically Designated: Yes
NO Flood Zone:
OWNER: Name (Fee Simple Titleholder): PUBLIX SUPERMARKETS, INC.
A,1,4—...PO BOX 407
City: LAKELAND State: FL Zip: 33802
�rt
Tenant/Lessee Name: Phone #:
Email:
CONTRACTOR: Company Name:
49dress: 1056 SW 1 ST WAY
City: DEERFIELD BEACH State: FL Zip: 33441
Qualifier Name: MICHAEL NECAISE Phone#: (954)426 -5555
PINNACLE PLUMBING, INC.
(954) 426 -5555
State Certification or Registration #: _
Contact Phone #: (954) 426 -5555
Certificate of Competency #: CFC057845
Address: laverne @pinnacleplumbinginc.com
DESIGNER: Architect/Engineer: Phone #:
x•
Value of Work for this Permit: $6 60 Square/Linear Footage of Work:
Type of Work: ❑Address ❑Alteration ONew ❑Repair/Replace
Description of Work: PLUMBING GAS ( NATURAL)
❑Demolition
Submittal Fee $ Permit Fee $ CCF 05 CO /CC $
Scanning Fee $ �� Radon Fee $ 3 VBPR $ Bond $
Notary $ Training/Education Fee $ (0 Technology Fee $ -a °
Double Fee $ Structural Review $
TOTAL FEE NOW DUE: e J
Ell
4
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 $2500, the applicant must
promise in good./aith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature
Owner or Agent
The foregoing instrument was acknowledged before me this
day otSEDi _ 201, by P C
who i ersonally known me or who has produced
As identification and who did take an oath.
NOTARY PUBLIC: o�PRY PbB� JODI L SLOAN
* MY COMMISSION I EE 056616
EXPIRES: February 5, 2015
sT
Si FL�P\oP Bonded Thru Budget Notary Services
Print:
My Commission Expires: c) 5`15
Signature
Contractor
The foregoing instrument was acknowledged before me this 29
day of AUGUST , 20 L, by 1 ",4 el— A",4LLt-
who is personally known to me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign: drill �, ,
Print: *
Com sion # EE 42567
My Com s` it
November 16, 2014
APPROVED BY 7- 6 f Plans Examiner Zoning
Structural Review
(Revised3 /12/2012)(Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09)
SEP -26 -2013 12:07 FROM:PINNACLE PLUMBING
TO:305756B972 P.2/2
-1 PINNA -1 OP ID: HG
AC¢Ril7` oATS•tn
�.,-- CERTIRCATE OF LIABILITY INSURANCE 06,24/3
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AF FIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR AL MR THE COVERAGI! AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOE$ 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(les) must bo ondomad. If SUBROGATION IS WAIVED, siubjiiif to
the tames 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 endoraoman s ,
sI�ATON INSURANCE Phone, 661.683,4383 Heldi McGuire
P.O.. Box 220637 Fax: 561 ■684 -5995 PH 0 561- 721 -1305 A . E61- 684 -689&
West Pal eyma , Jr. 36422 hmc ul latonrisskservices.com _
Richard Noyman. r. ��_9 _,� „ ^{'
INSU"S) AFFORDING COVERAGE I N1U0 Y N^
elsuFm A :Irrte,�on National Insurance Co. 29742•
INSURSC• Pinnacle ' rum ing; Inc. �.,.._�_ S .._... �. ..._ _ w.. �. _ ....— _ . �........._. "4.
Pinnacle Mgmt Group, Inc•. wsu11>•Ra ; First Mercu Insurance Co. 10667
1066 SW lot Way nrsuRSRa,North River insurance Co 21105
Deerfield ac 33441 INsuwma D I Grid afield Em to errs In1s.Co. 10701
INSURMRI;:Federal Insurance09mpany r� 20281
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THIS IS T,O CERTIFY THAT THfr POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEQ ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDIN43 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 00 SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED l3Y PAID CLAIMS.
lYPL�ORINSURMICE y PGLICYNUM>IER P
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/!G�TIQII+ATL• un. non _ _
MIASHOR
Miami Shores Village
10050 NE 2nd Ave
Miami Shores, FL 33138
SHOULD ANY OF THE ABOVE DESCRIBED POLICIUS BE CANOEMEO BEFORE
THE EXPIRATION DA'Z'E TH9R9OF, NOTICE WILL BE 09UVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
)THORI010 MPR95CNTATPM
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SEP -26 -2013 12:07 FROM:PINNACLE PLUMBING TO:3057568972 P.1/2
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EROW,ARD COUNTY LOCAL SU$INESS TAX RECEIPT
115 Sr Andrews Ave., Rm. A 100, Ft. Lauderdale, FL 33301 -1895 « 954 - 831 -4000
VALID OCTOBER 1, 2013 THROUGH SEPTEMBER 30, 2014
DBA: BINNACLE PLVI mi � TNC Receipt #-182-929 sPRiJi{L /CONTR
Business Name: Business Type: (MUTER PLLiMBTR)
Owner Name: MICIMEL E tfECAIg£ Business OpOn@d:14 /12/1 ggp
Business Location: 3.056 SW 1 wAy State /County /CervReg.CFC057045
DaHR?X LD $EACH Exemption Code:
Business P.hOne: 305 -849 -630.6
Rooms befits Employe" Machin"
Professionals
1
Tax Amo. Transfer Fee tuSP Fee Penalty F71or Years ColleCklcn Cost Total Pa�G
oti An n ttA 0.100 0' +00 0.00 d.Od 27.00