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PL-14-2422 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-222817 Permit Number: PL-11-14-2422 Scheduled Inspection Date: August 27,2015 Permit Type: Plumbing - Residential Inspector: Diaz,Osvaldo Inspection Type: Final Owner: BUCKLAND, CASSIDY Work Classification: Gas Job Address:358 NE 94 Street Miami Shores, FL Phone Number (786)797-0522 Parcel Number 1132060136150 Project: <NONE> Contractor: AROUND THE CLOCK GAS SERVICE Phone: 305-231-3632 Building Department Comments NATURAL GAS LINE AND CONNECTIONS TO RANGE Infractio Passed Comments AND TANKLESS WATER HEATER INSPECTOR COMMENTS False -Inspector Comments Passed Failed Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. August 26,2015 For Inspections please call: (305)762-4949 Page 1 of 44 L AROUNDTHE Around The Clock Gas Service, Corp. 1.3117 NW sol Ave unit 17 Hialeah Gardens, FL.33018 GAS SERVICE Phone: 305-231-3632 ext 301 Fax:305-231-418o STATE LIC# LPG17356 CLASS# 803 DROP TEST CERTIFICATION August 24,2015 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 Teco 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 2014 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: Cassidy Buckland 358 NE 94 ST Miami Shores Fl,33128 Test Pressure: 8.0 Lock up pressure: 8.2 Operating pressure: 8.0 Test time: 10 Minutes If you should have any questions regarding this matter please do not hesitate to call as. =c=�`" EDWIN L SILVER Sincerely, ' MY connnnlssloN#EE867375 EXPIRES January 22,2017 iAr1I,398-0'S3 FlocitlallofaryService mm A ury Gonza $ STATE OF FLORIDA COUNTY I DADE� WORN TO& 1 CEO SUBSCRIBED BEFORE ME TH[ °�AY O 201 Around The Clock Gas Service Corp. AMAURYGONZALEZ,PERSONALLYKMOWNTO SIGNATURE OF NOTARY PUBLIC • Miami Shores Village rz Building Department NOV ® 4 2014 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 13Y' Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20 c BUILDING Master Permit No. C� PERMIT APPLICATION Sub Permit No.IPL — Z/-/2Z ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL WLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP �y CONTRACTOR DRAWINGS JOB ADDRESS: 359 N C -! Com: Miami Shores County: Miami Dade Zip: *33 1 c)- F Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name(Fee Simple Titleholder): S57` Y , Y`� '�® Phone#: 6' d�� 6 Address: b City: fi`''t c kr'Gk S Wo r e_S State: (- Zip: Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: P`(/1 t0 h., `� 4�Yak C�0 L Phone#: 3 0 24 Address: vl'�-\ �� L O 'DI" orye- t City: State: �� Zip: 33618 Qualifier Name:- rl p' '�� t�t0 "$�rArl�-- Phone#: 3os—';>I t 5� State Certification or Registration#: L C b, �� S 1� Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ ��®� Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration lew ❑ Repair/Replace ❑ Demolition Description of Work: 0 0,It,) r1'( 6 s )_i a 'k a r- '_'j t C,Tc' `-I- 0 Specify color of color thru tile: ice . Submittal Fee$— •�� Permit Fee$ CCF$ ® CO/CC$ Scanning Fee$ cz Radon Fee$ DBPR$ �" Notary$ Technology Fee$ Training/Education Fee$ ` P� Double Fee$ Structural Reviews$ Bond$ _ TOTAL FEE NOW DUE (Revised02/24/2014) r 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 ELECTRIC, PLUMBING, SIGNS, POOLS, FURNACES, BOILERS,HEATERS,TANKS,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 OWNER or AGENT CONT CTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of /A d1 20 i q ,by day of Al/UL/ ,20 % "( , by Gn'S5SA1 P k,1""vt who is personally known to � � �" ZA--t—,&Who is personally known to me or who has produced i�/ �� as me or who has produced y�`d b'd�a trl w. as identification and who did take an oath. eggs-104---�S— identification and who did take an oath. NOTARY PUBLIC: II s® NOTARY PUBLIC: Sign: v' EMN Sign: Print: *' My 60 AGVAMN# Print: 'a A9Y-r-OMMIS14 'Fos�st,.�' EXPIRES January 22,2017 '-; !4,•' EXPIRES January 22,2017 Seal: cao� i9eo+sa Seal: t40r:i 153 �an� �eoom F�allomryservi 00M APPROVED BY ®®-14—YV Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) Florida Department of-Agridulture and Consumer Services Bureau of Liquefied Petroleum Gas Inspection P.C . Box 6700 Tallahassee, Florida 32399-6700 r License Number: 17356 a• Business Mailing Address Licensed Location Address AROUND THE CLOCK GAS SERVICE CORP. AROUND THE CLOCK GAS SERVICE CORP. 13117 NW 107TH AVE STE 17 13117 NW 107TH AVE STE 17 HIALEAH GARDENS,FL 33018-1164 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 he 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 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)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,andlar equipment. For future correspondence,please make any needed corrections or changes 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 Daft. August 31,2015 Date of issue. September 1,2014 (850)921-1600 License Fee: $200.00 POST LICENSE Tallahassee, Florida Type and class: 0603 CONSPICUOUSLY Liquefied- Petroleum Gas License -1P GAS INSTALLER FOOD FOR ONE LOCATION ONLY ANY CHANGE OF OWNERSMP 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 NVQ 1077TH AVE STE 17 ADAM N.PUTNAM HIALEAH GARDENS, FL 33018-1164 COMMISSIONER OF AGRICULTURE �-� AROUN-1 OP ID:AN ACOR 0 DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 09/17/2014 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 policy(les)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 nCj,OgryNT CT Annmarie McCartney MDW Insurance Group Inc PHONE FAX 362 Minorca Ave Arc No Ext:305-398-4865 A/c Ne:305.444-4980 Coral Gables,FL 33134 ADDRESS: Donald W McCartney amccartney@mdwinsurance.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Scottsdale Insurance Company 42197 INSURED Around the Clock Gas INSURER 8:Granite State Insurance Co. 23809 Service Corp 13117 NW 107 Ave Unit 17 INSURER C:PROGRESSIVE COMMERCIAL 10193 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, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCEADDL POLICY EFF POUCY EXP LIMITS LTR POLICYNUMBER MM/DD MM/DD GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED A X COMMERCIAL GENERAL LIABILITY CPS1906378 02/11/2014 02/11/2015 PREMISES Ea occurrence $ 100,00 CLAIMS-MADE Fx]OCCUR MED EXP(Any one person) $ 5,000 PERSONAL BADVINJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'LAGGREGATE LIMITJEUAPPLIES PER: PRODUCTS-COMP/OP AGG $ 1,000,000 POLICY PRO- LOC g AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 Ea acadent $ C ANY AUTO CA01519906 02/11/2014 02/11/2015 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS X AUTOS X HIRED AUTOS X NON-OWNED PER ACCIDENCE $ AUTOS UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATIONX WC STATU- I OTH- AND EMPLOYERS'LIABILITY TORY LIMITS ER B ANY PROPRIETOR/PARTNER/EXECUTIVE Yr N WC003-63-9248 09/11/2014 09/11/2015 E.L.EACH ACCIDENT $ 1,000,000 OFFICERIMEMBER EXCLUDED? N r A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If as,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,H more apace is required) Plumbing Contractor CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN g ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2nd Ave. Miami Shores,FL 33138 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Local Business-Tax Receipt Miami-Dade County, State_ of Florida -THIS IS NOTA BILL - DO NOT PAY 4842747 C . .ISINESS NAMEA.00ATION RECEIPT NO. EXPIRES Ai auND THE cLocr,Gas sEma coRp RMEWAL SEPTEMBER 301 2015 13117 NW 107 AVE 17 60845180 Must be displayed at place of business HIALEAH GARDENS R.33018 Pursuant to CountV Code Chapter 8A-Art 9&10 OWMER SEC.TYPE OF BUSINESS PAYMENT RECEIVED AROUND THE CLOCK GAS SERVICE 205 LPG INSTALLER BY TAX COLLECTOR CORP LPGO17356 $60.00 08/26/2014 CHECK21-14-054729 This Local Business Tax Receipt only camifirms payment of the local Business Tax The Receipt is not a license, permit are cerdficationof the holder sqquualificetions,to do business.Hohler must comply with any governmental or noullovermnentell regollatory lawseudrequiremeets which apply to the business. The RECEIPT NO.above musthe displayed on efi commercial vehicles—PMami-0ade Code Sec 8a—M. For more Information,v&itwww.miemidade.aovRaxcoNeator