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PL-14-2337 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-223900 Permit Number: PL-10-14-2337 Scheduled Inspection Date: December 09,2014 Permit Type: Plumbing - Residential Inspector: Diaz, Osvaldo Inspection Type: Final Owner: BOURNE, ROBERT Work Classification: Gas Job Address:490 NE 101 Street Miami Shores, FL 33138-2449 Phone Number Parcel Number 1132060170430 Project: <NONE> Contractor: MIAMI PROPANE GAS CORP Phone: (305)637-7575 Building Department Comments PROPANE GAS INSTALL. Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-222178. NOT READY PAY 1:0 REINSPECTION FEE Failed Correction hilt -R Needed L Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. December 08,2014 For Inspections please call: (305)762-4949 Page 19 of 48 L REC I' TESTING AND ENGINEERING SERVICES JUL 16 2014 FIELD) DENSITY TEST REpOR11B Client: Saladino Design Studio Date: July 11, 2014 7251 NE 2 Ave #107 Job: -140757 Miami, FL 3313 Residence 490 NE 101 St., Miami Shores, FL PROCTOR ATA tt�ctor lea . So><1 seri on 105857 Brown Sand W/Coral Rock Traces 108.9 11.0 95% 12" FIELD DENSITY TEST RESULTS t Ply L� I3 i 071-1 estin C �. Deity : 1 105857 West Area of Slab EY ansion Footing 1.05.1 9.0 96.6 Pass 2 105857 Center Area of Slab Ex ansion Footing 1 105.6 1 10.6 97.0 Pass 3 105857 East Area of Slab Expansion Footing 1 105.0 10.3 96.4 Pass t7i Comments: VinayagarM.1hrhTkrishnan Professional Engineer No.63107 State of Florida 13370 S.W. 131 Street,Suite 105,Miami,FL. 33186 (305)259-9779 PERMIT #:13-SC-1535730 APPLICATION #:API 145065 STATE OF FLORIDA DATE PAID: DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM FEE PAID: 4D CONSTRUCTION PERMIT RECEIPT #: DOCUMENT #:PR942207 CONSTRUCTION PERMIT FOR: OSTDS New APPLICANT: Robert Boume PROPERTY ADDRESS: 490 NE 101 St Miami,FL 33138 LOT:j; 1 BLOCK: 90 SUBDIVISION: [SECTION, TOWNSHIP, RANGE, PARCEL NUMBER) PROPERTY ID #: 11-3206-017-0430 [OR TAX ID NUMBER] SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF SECTION 381.0065, F.S., AND CHAPTER 64E-6, F.A.C. DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE SATISFACTORY PERFORMANCE FOR ANY SPECIFIC PERIOD OF TIME. ANY CHANGE IN MA'T'ERIAL FACTS, WHICH SERVED AS A BASIS FOR ISSUANCE OF THIS PERMIT, REQUIRE THE APPLICANT TO MODIFY THE PERMIT APPLICATION. SUCH MODIFICATIONS MAY RESULT IN THIS PERMIT BEING MADE NULL AND VOID. ISSUANCE OF THIS PERMIT DOES NOT EXEMPT THE APPLICANT FROM COMPLIANCE WITH OTHER FEDERAL, STATE, OR LOCAL PERMITTING REQUIRED FOR DEVELOPMENT OF THIS PROPERTY. SYSTEM DESIGN AND SPECIFICATIONS T [ 900 1 GALLONS / GPD Septic CAPACITY A [ 1 GALLONS / GPD N/A CAPACITY N [ } GALLONS GREASE INTERCEPTOR CAPACITY [MIILXIMUM CAPACITY SINGLE TANK-.1250 GALLONS] K [ } GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ } D [ 375 ] SQUARE FEET Trench confiquratbon drain SYSTEM R [ ] SQUARE FEET N/A SYSTEM A TYPE SYSTEM, [x] STANDARD [ ] FILLED [ ] MOUND ( ] - I CONFIGURATION: [x] TRENCH [ ] BED [ ] N F LOCATION OF BENCHMARK: CL NE 101 St., 10.22-NGVD I ELEVATION OF PROPOSED SYSTEM SITE [ 4.80 ][ INCHES FT ][ABOVE BELOW BENCHMARK/REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ 34.80] [ INCHES FT ][ABOVE BELOW BENCHMARPC/REFERENCE POINT L D FILL REQUIRED: [ 0.00] INCHES EXCAVATION REQUIRED: [ 72.001 INCHES *invert elevation of drainfield to be no less than 7.82'NGVD. 0 *Bottom of drainfield elevation to be no less than 7.32'NGVD. T The system is sized for 2 bedrooms with a maximum occupancy of 4 persons(2 per bedroom),for a total estimated flow H of 300 gpd. The licensed contractor installing the system is responsible for installing the minimum category of tank in accordance with E s.64E-6.013(3)(f),FAC. R SPECIFICATIONS BY: GpIU3 SVAREZ TITLE: APPROVED BY: TITLE: Dade CHD C os Iaaz DATE ISSUED: 06/1 01 EXPIRATION DATE: _ 12/12!2015 DH 4016, 08/09 (Obsoletes all previous editions which may not be used) Page 1 of 3 Incorporated: 64E-6.003, FAC �ry, „7¢►,kcQntractor(or designees 4iViV red to perform a SE931074 soli boring adjacent to the drainfield excavation at the time of final inspection.Prior to Final Approval,the DOH Inspector shall witness the soil boring and compare the results to the original site evaluation submitted.A reinspection tee will be assessed if the contractor is not at the jobsite at the arranged time. STATE OF FLORIDA APPLICATION # AP1145065 DEPARTMENT OF HEALTH PERMIT # 13-SC-1535730 ONSITE SEWAGE TFXATMENT AND DISPOSAL SYSTEM DOCUMENT # SE931074 SITE EVALUATION AND SYSTEM SPECIFICATION APPLICANT: Robert Bourne CONTRACTOR / AGENT: Allstate Diversified LOT: 1 BLOCK: 90 SUBDIVISION• ID#,. 11-3206-017-0430 xrra TO BE COMPLETED BY ENGINEER, HEALTH DEPARTMENT EMPLOYEE, OR OTHER QUALIFIED PERSON' ENGINEERS urrcI PROVIDE REGISTRATION NUMBER AND SIGN AND SEAL EACH PAGE OF SUBMITTAL. COMPLETE ALL ITEMS• PROPERTY SIZE CONFORMS TO SITE PLAN: [X]YES [ ]NO NET USABLE AREA AVAILABLE: 0.14 ACRES TOTAL ESTIMATED SEWAGE FLOW: 300 GALLONS PER DAY I RESIDENCES-TABLET / OTHER-TABLE 2 ] AUTHORIZED SEWAGE FLOW: 349.g8 GALLONS PER DAY [ 1500 GPD/ACRE OR 2500 GPD/ACRE ] UNOBSTRUCTED AREA AVAILABLE: 563.00 SQFT UNOBSTRUCTED AREA REQUIRED: 563.00 SQFT BENCHMARK/REFERENCE POINT LOCATION: CL NE 101 St.,10.22'NGVD ELEVATION OF PROPOSED SYSTEM SITE 4.80 [ INCHES / FT J [ ABOVE / BELOW ] BENCEMARK/REFERENCE POINT THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES SURFACE WATER: FT DITCHES/SWALES: FT NORMALLY NET: [ ]YES I INO WELLS: PUBLIC: FT LIMITED USE: FT PRIVATE: FT NON-POTABLE: FT BUILDING FOUNDATIONS: 5 FT PROPERTY LINES: 5 FT POTABLE WATER LINES: 4 FT SITE SUBJECT TO FREQUENT FLOODING? L ]YES IX]NO 10 YEAR FLOODING? I ]YES IX]NOj 10 YEAR FLOOD ELEVATION FOR SITE: FT I MSL / NGVD ] SITE ELEVATION: 9.82 FT I MSL / NGVD SOIL PROFILE INFORMATION SITE 1 SOIL PROFILE INFORMATION SITE 2 USDA SOIL SERIES: Udorthents, limestone substrat USDA SOIL SERIES: Udorthents, limestone enbstrat Munsell#/Color Texture Depth Munsell#/Color Texture Depth 10YR 3/3 Fine Sand 0 TO 6 10YR 3/3 Fine Sand 0 To 8 10YR 512 Fine Sand 6 To 72 10YR 5/2 Fine Sand 8 To 72 OBSERVED WATER TABLE: INCHES [ ABOVE / BELOW ] EXISTING GRADE TYPE: I / APPARENT ] ESTIMATED WET SEASON WATER TABLE ELEVATION: 75 INCHES I ABOVE /L] EXISTING GRADE HIGH WATER TABLE VEGETATION: I ]YES IX]NO MOTTLING: [ ]YES IX]NO DEPTH: INCHES SOIL TEXTURE/LOADING RATE FOR SYSTEM SIZING: Fine Sand/0.80 DEPTH OF EXCAVATION: 72 INCHES DRAINFIELD CONFIGURATION: [E] TRENCH I ] BED [ ] OTHER (SPECIFY) REMARKS/ADDITIONAL CRITERIA SITE EVALUATED BY: DATE: 06/13/2014 SUAREZ,pUILLERNO(Tide:)(0.SUAREZ SEPTIC TANK) DH 4015, 08/09 (obsoletes previous editions which may not be used) Incorporated: 64E-6.001, FAC Page 3 of 4 AP1145066 E(D1636730 v 1.03 NOTICE OF RIGHTS s A party whose substantial interest is affected by this order may petition for an administrative hearing pursuant to sections 120.569 and 120.57, Florida Statutes. Such proceedings are governed by Rule 28-106, Florida Administrative Code. A petition for administrative hearing must be in writing and must be received by the Agency Clerk for the Department,within twenty-one(21)days from the receipt of this order. The address of the Agency Clerk is 4052 Bald Cypress Way, BIN#A02,Tallahassee, Florida 32399-1703. The Agency Clerk's facsimile number is 850-410-1448. Mediation is not available as an alternative remedy. Your failure to submit a petition for hearing within 21 days from receipt of this order will constitute a waiver of your right to an administrative hearing, and this order shall become a'final order'. Should this order become a final order, a party who is adversely affected by it is entitled to judicial review pursuant to Section 1.20.68, Florida Statutes. Review proceedings are governed by the Florida Rules of Appellate Procedure. Such proceedings may be commenced by filing one copy of a Notice of Appeal with the Agency Clerk of the Department of Health and a second copy, accompanied by the filing fees required by law, with the Court of Appeal in the appropriate District Court. The notice must be filed within 30 days of rendition of the final order. 2�� Miami Shores Villa e APPROVED BY DATE I DEPT IUD2�"s4 BLDG DEPT SUIkIFCT TO COMPLIANCE W M ALL FEDER& STATE AND COUNTY RULES AND REGULAXONS NDI 0000.. 0000.. .. 0000 ��-c.. 0000.. 0000 0000.. S ' .0000. � 0000 ... 0. � . 0000 .. 0000. 0000.. :0 . 00000. 00 .. . . 00000. .0000. . 0000.. 1-40 0000.. . AUITY =`. . 0000.. 9 j 0 . 00000 0. �C • �� .... c ry H2O EXW tF j a••^eto 14.20 C) i�09Eke b A. W`. `� A=t- 7-00 'TL? (-\\IORVrv) SIA\ 40 5J�N 4T VA VC) �,� •• • 0449 • �' 0444•• 0044• .. • ••.4• ••9..• • •6099.' 0444 • a• •••.4 ✓jam • . �J 0440.• •• • .•••s •. •• . •• 0•000.0 0400•• • • c7�i (� 0044•• *see 0 '� • • • 4004•. 'd.\.0 tWL= CL fl � Approved VA�Z _ 16L b� = W S I FF 150466 i8 Miami Shores Village Building Department �� 1 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 � — INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20 BUILDING Master Permit No. Io- -23''a�-- PERMIT APPLICATION Sub Permit No. — ` ' 23 BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 4496 Aj E I®15 T City: Miami Shores County: Miami Dade Zia: 33 343r Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: mseFlood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): �b5... " °n-� Phone* Address: "47tO 'lac COC 1 City: V-A-VV�wl_k � (� State: F 7--1 Zip: 7s`)A >' Z Tenant/Less�ele_Name: Phone#: Email: `��e�✓� (�j�-� C�i P�k �� •V\. .+ CONTRACTOR:Company Name: (lel I"41 99C96(NL (7M Phone#: �-b3-7—•7�^7_9_ Address: 31,� ?JW !4I Sri— city: icity: "Inild 1 State: -FL Zip: 331L42 Qualifier Name: XAJOE-Z 52° Phone#: '-f 3 State Certification or Registration#:i_P(_-7 005154S Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address City: State: Zip: Value of Work for this Permit:$ �1 Square/linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration New ❑ Repair/Replace ❑ Demolition Description of Work: f eGPAvUL_ C-7A,5 j'W STAt_L_ Specify color of color thru tile: Submittal Fee$ Permit Fee$ '• CCF$ ' ` CO/CC$ WN Scanning Fee$ (? Radon Fee$ DBPR$ Notary$ Technology Fee$ ® Training/Education Fee$ G ° E>b Double Fee$ Structural Reviews$ Bond$ _ TOTAL FEE NOW DUE$ ° (Revised02/24/2014) 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 CONTRACTOR The foregoing instrument was acknowledged before a this The foregoing instrument was acknowledged before me this day of ,20 I by day of OCA-0 20 14 by o 1 who isersonall known to wh N .. Y is ersonal own me or who has produced byt ya S L-4eLinse as me or who has produced as identification and who did take an oath. identific ion and who di a an oath. NOTARY PUBLI NOTARY U C: s Sign: Sign: cr- Print: Print: ' % ;� BoededThMN*ry Pu* ikde rs Seal: Ro8l1ulARYPtAA Seal: ' WI COMMIS ZION F 2018 r BMW r"Nosy PU*Umlwhm ��**�M��x�wwwr ***��*+rrr�w*�s��r�r��**��*�***�►�x�**��r��*�**��*r****a�wM�* **�rr�r+�w� APPROVED BY ®����"`°� Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) Florida Department of Agri=culture and Consumer Services Bureau of Liquefied Petroleum Gas Inspection P.O. Box 6700 Tallahassee, Florida 32399-6700 License Number: 05528 Business Mailing Address Licensed Location Address MIAMI PROPANE GAS CORP. MIAMI PROPANE GAS CORP. 3245 NW 41ST ST 3235 NW 41ST ST MIAMI,FL 33142-4303 MIAMI,FL 33142-4303 The liquefied petroleum gas license at the bottom of this form is valid ONLY for the company located at the address on tho 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 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 and/or 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 f Division of Consumer Services License Number: 05528 I, Bureau of Liquefied Petroleum Gas Inspection Expiration Date: August 31,2015 (850) 921-1600 Date of Issue: September 1,2014 License Fee: $425.00 POST LICENSE Tallahassee, Florida Type and Class: 0601 CONSPICUOUSLY Liquefied Petroleum Gas License CATEGORY I LP GAS DEALER 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: *, MIAMI PROPANE GAS CORP. 3235 NW 41 ST ST ADAM H.PUTNAM MIAMI, FL 33142-4303 COMMISSIONER OF AGRICULTURE u Florida Department of Agriculture and Consumer Services Bureau of Liquefied Petroleum Gas Inspection 2005 Apalachee Parkway Tallahassee, Florida 32399-6500 Master Qualifier Mailing Address Licensed Location Address ANGEL L. FERNANDEZ SR. MIAMI PROPANE GAS CORP. MIAMI PROPANE GAS CORP. 3235 NW 41 ST ST 3235 NW 41 ST ST MIAMI, FL 33142-4303 MIAMI, FL 33142-4303 Cartificate Number license Number 04699 05528 This Master Qualifier Certificate is issued pursuarit to Chapter 527, Florida Statutes. This certificate 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)921-1600 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 16 (sixteen) 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: Florida Department of Agriculture and Consumer Services Bureau of Liquefied Petroleum Gas Inspection 2005 Apalachee Parkway Tallahassee, Florida 32399-6500 Cut Here ------------------------------------------------------ State �i I•�fir'da w�� ; 5 Department of Agriculture and Consumer Services c. rY Division of Consumer Services Certificate No: 04699 Bureau of Liquefied Petroleum Gas Inspection Exam Date: May i-i,1987 (850) 921-1600 Issue Date: August 9,2012 .:ti :»" Expiration Date: August 8,2015 Tallahassee, Florida Exam: 0601 MASTER QUALIFIER CERTIFICATE This Certificate is issued under authority of Section 527.02, Florida Statutes,to: ANGEL L. FERNANDEZ SR. Valid For License Number: 05528 l MIAMI PROPANE GAS CORP. 3235 NW 41ST ST ADAM H.PUTN M MIAMI,FL 33142-4303 COMMISSIONER OF AGRICULTURE Local Business Tax Receipt Miami—Dade County, State of Florida -THIS IS NOT A BILL-DO NOT PAY 4999414 BUSINESS NAME&OCATION RECEIPT NO. MIAMI PROPANE GAS CORP RENEWAL EXPIRES 3235 NW41 ST SEPTEMBER 30, 2015 MIAMI, FL 33142 5220348 Must be displayed at place of business Pursuant to County Code Chapter BA-Art.9&10 OWNER SEC.TYPE OF BUSINESS MIAMI PROPANE GAS CORP 220 TANGIBLE PERSONAL PAYMENT RECEIVED C/O ANGEL L.FERNANDEZ JR. PROP DLR BY TAX COLLECTOR Employee(s) 1 82.50 10/16/2014 0225-15-000156 This Local Business Tax Receipt only coaff ms payment of the local Business Tax.The Receipt is nota license, Permit or a certification of the holders qualifications,to do business.Holder must comply with any goveramentaI ur nongovernmental regulatory laws and requirements which apply to the business. MIAMF The RECEIPT N0.above must be displayed on all commercial vehicles-Miami-Dade Code Sec 8e-276. For more Information,visit www niamldadegmftWollecmr F CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) 10 22 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 terns 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 CONT NAME:CT Michelle A. Kalicharan Gulfshore Insurance, Inc. PHONE FAX 4100 Goodlette Rd N ac No E-MAIL-MAIL Naples FL 34103-3303 ADDRESS: INSURERS AFFORDING COVERAGE NAIC 4 INSURER A:HDI-Gerl'nq America Insurance Compa. INSURED FLOPR2 INSURER 8: Miami Propane Gas Corp. INSURER C: 3235 NW 41 st Street INSURER D: Miami FL 33142 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER:466894080 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 INSURANCE ADOLSUBR POLICY EFF POLICY EXP LIMITS LTR INR WVO POLICYNUMBER M D M D A GENERAL LIABILITY EGGCDO00136214 /9/2014 /9/2015 EACH OCCURRENCE $2,000,000 NcOM MERCIAL GENERAL LIABILITY AGE TO RENTED PREMISES Ea occurrence $100,000 CLAIMS-MADE 15F]OCCUR MED EXP(An one person) $Excluded PERSONAL&ADV INJURY $2,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGO $2,000,000 X I POLICY M PRO LOC $ A AUTOMOBILE LIABILITY EAGCD000136214 /912014 /9/2015INED SINGLE LIMT Ea accident I $2,000,000 X ANYAUTO BODILY INJURY(Per person) $ ALL OWNEDSCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PP OPER! DAMAGE X HIRED AUTOS X AUTOS $ X MCS90 X Pollution Li $ A UMBRELLA LIAR HOCCUR EXAGD000136214 /9/2014 /9/2015 EACH OCCURRENCE $3,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $3,000,000 DED I I RETENTION $ A WORKERS COMPENSATION EWGCD000136214 /9/2014 /9/2015 X WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTNE E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBEREXCLUDED? a N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yea 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 space is required) Licence#LPG 005528 I I CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Shore Village Bldg Dept. ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2nd Avenue Miami Shore FL 33136 AUTHORIZED REPRESENTATIVE i ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD I v • W �w — qP 4C R,ERM STING BARREL TILE G ROOF JOISTS 'RACKED BEAM WITH 2•#5 STING ROOF JOISTS a BARS POUR WITH 3000 PSI 'RACKED BEAM WITH 2•#5 •' . ., .. CONCRETE BARS POUR WITH 3000 PSI ' s TO ROOF DECKAS PER FBC 2010 CONCRETE . , R4405 FOR RACKED BEAMS TO ROOF DECKAS PER FBC 2010 R4405 FOR RACKED BEAMS . . • • EXIST.TRUSS J .t _ Q STUCCO PE'X'�•GYP BLOCK TO BE INSTALLED WI 41- BOARD � TOP COURSE TO BE CMU U-BLOCK W!1#5 DOWELED INTO EXIST.TIE 4 EXIST.TIE BEAM —I BEAM.WALL IN NOT LOAD BEARING. Q NG TIE BEAM MU BLOCK TO BE INSTALLED NEW BLOCK WALLAPPROVEo BY STRUCTURAL MSHORES W/TOP COURSE TO BE CMU U-BLOCK W/1#6 DOWELED }�•p(q JOINT INTO EXIST.TIE BEAM.WALL C CONC.SLAB W/6X610X1R IN NOT LOAD BEARING. REVOM VAPO CONC.SLAB WI 6X61WELDED WIRE MESH ON 0X10 WELDED TOP OF CONC.SLAB WIRE MESH ON VAPOR BARRIER BARRIER OVER WELL COMPACTED _ OVER WELL COMPACTED FILL FILL :.. : :;::.•:.: TOP OF CONC.SLAB 6 MILL POLYETHILENE FI PLACE FILL&BACK FILL IN 6'X6' _ • ' "'••. .:. a;'• .' .. %'•• •,'•..: , ::': ' ` •p. •' LAYERS,COMPACT TO MIN.OF Lv •'s ' 95%OF MAX DENSITY @ § ' : •�' U s=, •: r : A ••: :�• OPTIMUM MOISTURE A.S.T.M. r �4aar Z D-1557-70 W w rA"*' DEMISING WALL DETAIL — %" - I'-o° B C SCALE— MU WALL SECTION TYP. w 1 . 1 - - NTS 0 pq A-1 . 10