PL-15-3028 r 4 07-
Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores,FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-248823 Permit Number: PL-12-15-3028
Scheduled Inspection Date:January 06,2016 Permit Type: Plumbing - Residential
Inspector. Diaz,Osvaldo
Inspection Type: Final
Owner. GRIMALDI, KARINA Work Classification: Gas
Job Address:1125 NE 91 Terrace
Miami Shores,FL Phone Number (786)285-5527
Parcel Number 1132050010140
Project <NONE>
Contractor: ALL GAS SERVICE, INC. Phone: (954)3447945
Building Department Comments
NATURAL GAS LINE TO POOL HEATER lnfraatio Passed Comments
INSPECTOR COMMENTS False
Inspector Comments
Passed Ed
�L
6
s
Failed
1
Correction ❑
Needed
Re-Inspection
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid
January 05,2016 For Inspections please call: (305)762-4949 Page 14 of 35
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POST OFFICE Box 649
SERVICE CALL, INVOICE
L MAO PALM CrM.FL 34991-0649
x SERVICE.INC BRMMD 954,344.3945
�— — — — PnuwHEAcH 561.361.6900
Date:
mm 772.824.8587
nn
Fax 954.940.1587
Home# cell#
B111 To: (-) f115 YrAJ�1 4
Email:
,A ,"Lr I/ re irrae w- Job Location:
Z"!am TYR [I S ap Test �rop t "W.C.for/� mina.
I
Date I ++
f - T Phu Name
Service Call: El Initial El Return
$
Appliance: ❑ Pool Heater ❑ BBQ ❑ Water Heater Fire Tested: ❑
El Range/Cooktop ❑ Fire Place ❑ Generator Unit Left:
❑ Fire Bowl ❑ Fire Pit ❑ Dryer ❑On El Off ❑Operational
❑ Other: ❑Red Tag ❑Off for Safety
Manufacturer: Year:
Model: SN:
Customer Complaint:
�I
kr,,ro
1
Resolution Found Needed:
04
Quanft Description Unit Price Aknount
`dN
PLEASE PAY FROM THIS INVOICE
EMAIL:ALLGASSERVICEINC(_WGMAIL.COM
W W W.ALLGASSERVICEINC.COM
LICENSED & INSURED TOTAL
Received by(piems print): Signature: Ef Not Home
NOTE:Phase keep your credit card up to date to ensure gas delivery after an outage
The ""A_ ordable S Com an
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Y
Miami Shores Village` "
10050 N.E.2nd Avenue NE
Miami Shores,FL 33138-0000
Phone: (305)795-2204
Project Address Parcel Number Applicant
1126 NE 91 Terrace 1132050010140
KARINA GRIMALDI
Miami Shores, FL Block: Lot:
Owner Information Address Phone Cell
KARINA GRIMALDI 1125 NE 91 TERR (786)285-5527
MIAMI SHORES FL 33138
Contractor(s) Phone Cell Phone Valuation: $ 1,200.00
ALL GAS SERVICE,INC. (954)344-7945 Total Sq Feet: 0
Type of Work:NATURAL GAS LINE TO POOL HEATER Available Inspections:
Type of Piping: Inspection Type:
Additional Info: Final
Bond Retum: Press Test
Classification:Residential Scanning:3 Review Plumbing
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $1.20 Invoice# PL-12-15-57959
DBPR Fee $2.25 12/10/2015 Check*872 $121.70 $50.00
DCA Fee $2.25
Education Surcharge $0.40 12/04/2015 Check#:0859 $50.00 $0.00
Notary Fad' $5.00
Permit Fn $150.00
Scannin0se $9.00
Technology Fee $1.60
Total $171.70
JJ
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In consld�gition of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining�lliereto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting;fis permit i assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required f6FELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work.
OWNER"FFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zoning. Futhermore,I authorize the above-named contractor to do the work stated.
December 10,2015
orized Signature:Owner / Applicant / Contractor / Agent Date
Builc4'ng Department Copy
December 10,2015 1
t '
Building Department DEC 04 2015
vl) 10050 N.E.2nd Avenue,Miami Shores,Florida 33138
• Tel:(305)795-2204 Fax:(305)756-8972
LBY:
' INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 20 -
BUILDING Master Permit No l Jam' l 41
PERMIT APPLICATION Sub Permit
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
]PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP
(� CONTRACTOR DRAWINGS
f
JOB ADDRESS: I 2-6 xj�� ' 9 Trp-g erc�
City: Miami Shores County: Miami Dade Zin,
FoRo/Parcel#: 1 1 • -3'W-% b 01. 101(fo Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
P Ls!��6
OWNER:Name(Fee Simple Titleholder): � T I 1 ® � �r4**/d Phone#: LT✓ q 2
Address: 2q5OJ(�r 1$r I-r A.&k C, rr 2
City: 1, S 4 0qk-e State: r Zip: 7 3 45
�7
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Com any Name: !' �S C X u(c 1/J G Phone#:
Address: G 4
City: vl ° State: H Zip:
"3`f q
I
Qualifier Name: iOT �A Pt.-s Phone#• TZ S 7 31( 16
State Certification or Registration#: o'A J*,A I Certificate of Competency#: t �'L 1'7 t
DESIGNER:Architect/Engineer. Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ 2 O Square/Linear Footage of Work:
Type of Work: ❑ Addition Alteration�^ New Repair/Rept a [I Demolition
Description of Work: J fL vA I C",v
Specify color of color thru tile:
Submittal Fee$ Permit Fee$ �Q. �`-� CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$ CD
TechnohW Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$ (��• .
(RevbeWM4/2014)
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 Z►p
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_Z4( Signature
OWNER or AGENT CONTRACTOR
The forlegoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
�1
U day of BUZ— ,20 IS ,by U�-t day
Qooff��'E���20 ,by
KbL.F6 is personally known to Nom' t>�t ,who is personally known to
me or who has produced �Jlj, as me or who has produced Nei 1`eetifl�_
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: Sign:
Print: �(�1D(��;C..0 Print:
Seal: Seal: " Notary Public Slate or Florida
.^1'� Sindia Alvarez
matt Notary Pule of FWa My co natission FF 188750
�F Sindia A{y8r8Z �s Expires 09/0312018
IN
My rnmmisaiMl FF 1WINO
? . u: inn+a
APPROVED BY g Plans Examiner Zoning
Structural Review Clerk
(RevkedOM4/2014)
9U■ �' Miami shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
CONTRACTORS' REGISTRATION Fax; (305) 756.8972
IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR:
A. COPY OF QUALIFIER'S STATE LICENCES
B. COPY OF LOCAL BUSINESS TAX RECENT
C.j<COPY OF LIABILITY INSURANCE'
D. COPY OF WORKERS COMPENSATION INSURANCE*
(Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit)
IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY:
A. COPY OF CERTIFICATE OF COMPETENCY OF QUALIFIER
B. COPY OF LOCAL BUSINESS TAX RECEIPT
C. COPY OF STATE REGISTERED CONTRACTOR LICENSE OR MIAMI DADE COUNTY MUNICIPAL
CONTRACTOR'S TAX RECEIPT.
D. COPY OF LIABILITY INSURACE*
E. COPY OF WORKERS COMPENSATION INSURANCE'
(Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit)
*YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE AS FOLLOW:
Certificate Holder:
MIAMI SHORES VILLAGE BLDG DEPT
10050 NE 2ND AVE
MIAMI SHORES, FL 33138
Certificate must specify the description of operations or contactor license number.
BUSINESS NAME: f 5 ekq f c /tic .
BUSINESS ADDRESS: 0 �� �' CITYt—VSTATE-ZIP
BUSINESS PHONE: ( ` I ) 3 � FAX NUMBER 26e U ?t
CELL PHONE(��� QUALIFIER'S NAME:
QUALIFIER'S LIC NUMBER: C) 3 L4 47
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Florida Department of Agriculture and Consumer Services
Division of Consumer Services
2005 Apalac hee Parkway
Tallahassee, Florida 32399-6500
Master Qualifler Mailing Address Licensed Location Address
RODNEY ROSADO
ALL GAS SERVICE,INC. ALL GAS SERVICE, INC.
PO BOX 649 5453 NW 24TH ST STE 5
PALM CITY,FL 34991-0849 MARGATE,FL 33063-7776
CertiflcaW Number License Number
06376 04347
This Master Qualifier Certificate is issued pursuant 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 notes 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 N 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 aq changes in writing to:
Florida Department of Agriculture and Consumer Services
Division of Consumer Services
2006 Apalachee Parkway
Tallahassee,Florida 32399-6500
------------------------------------------------------
04 Here
State of Florida
Department of Agriculture and Consumer Services
Division of Consumer Services CwUlkate Na 08375
Bureau of Liquefied Petroleum Gas Inspection EMM DoW. May 24,Asea
(850)921-1600 o� June 25,2015
4a Tallahassee, Florida Exphad°"EUM OWI 2a,zoos
MASTER QUALIFIER CERTIFICATE
This Certificate is issued under authority of Section 527.02,Florida Statutes,to:
RODNEY ROSADO
VMd FW
ALL G�Nva RVI W. ea
ADAM H.P�
ALL GAS SERVICE,W.
MM
SM NW 24TH ST STE b COMMLSSIONER OF AGRICULTURE
MARGATE,FL 33083-7776
� �t City of Margate,Florida
Local Business Tax Receipt
901 NW 66 111 Avenue
CITY OF Marpte, FL 33063
MARGATE (954)979-6213
Torow%ftmammared
Busimw .Name: ALL GAS SERVICE,INC. Receipt Nbr: 16-00007130
Location address: 5453 NW 24TH ST BAY 5
Issue Date/Class: CONTRACTOR IMC OTBER
Effective Date: October 01,2015 Expiration Date.September 30,2016
Receipt Fees: 130.00
Comments: CATEGORY 1 LP GAS DEALER(GAS CONTRACTOR)
For Home Local Business Tag Receipt: No CDrornercial Vehicles Permitted at Itesidenm No Inventory,
Stock of Trade,Sales or Display, Permitted.
Commercial and all others: No Outside Sales,Service,Display,Stock or Storage without prior
City Commission AppuvaL
CWSD78 ALL GAS SERVICE,INC. l F49CEPr eltbrl3E7
PO BOX 649 WFINBLIMIMISIMADORS01.11
PALM CITY FL 34991 (Fimsmi Cfftbm)
Not This Receipt in a Conspicuous Place Minoru Cjc• N/A
s
ACORD CERTIFICATE OF LIABILITY INSURANCEDATE(MLIDDIYYYY)
T1210212015
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
COVER ALL INSURANCE ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
5600 W.ATLANTIC BLVD. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
MARGATE,FL.33063
PH 954 956.0006 FX LIN 956.0555 INSURERS AFFORDING COVERAGE MAIC#
INSURED ALL GAS SERVICE,INC. INSURER A: MID-CONTINENT EXCESS&SURPLUS INS CO
5453 NW 24RD STREET UNIT 5 INSURER S: PROGRESSIVE INSURANCE COMPANY
MARGATE FL 33063 INSURER C: FRANK WINSTON CRUM INSURANCE CO.
INSURER D:
INSURER E
COVERAGES
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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR ADDLPOLICY NUMBER POLICY EFFECTIVE EXPt 110N LIMITS
GENERAL.LIABILITY EACH OCCURRENCE $1,000,000
A X PRM.SES(pa o=nmcw
OMMERCIAL GENERAL LIABILITY 0981.000006321 01!06!2015 01108!2016 DAMAGE TO RENTED $100
CLAIMS MADE ❑OCCUR MED EXP An oma er n EXCLUDED
PERSONAL&ADV INJURY $1,000,000 i
NERAL AGGREGATE s2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $4000,000
7XPOLICY PRO Loc
AUTOMOBILE LIABILITY
B ANY AUTO 01324887.1 0112312015 01123/2016 (CEOaMB�s SINGLE LIMIT $
ALL OWNED AUTOS
BODILY INJURY $10,0100
X SCHEDULEDAUTOS (Per pe—n)
HIRED AUTOS
BODILY INJURY $20,060
NON-OWNED AUTOS (Per accident)
PROPERTY DAMAGE $10,00
(per accitleM)
J'ANYAUTO
E LIABILITY AUTO ONLY-FA ACCIDENT
OTHER THAN EA ACC $
AUTO ONLY: AGO $
CESSIUMBRELLA LIABILITY EACH OCCURRENCE $
OCCUR CLAIMS MADE AGGREGATE III
DEDUCTIBLE $
RETENTION $
WORKERS COMPENSATION AND X WC STATU- 0TH-
C EMPLOYERS'LIABILITY FAFL150023 07!26!2015 07/2612016 E.L.EAG"ACOi ENT $100 000 :
ANY PROPRIETORIPARTNEWEXECUTIVE
OFFICEPJMEM13ER EXCLUDED? E. .DISEASE.EA EMPLOYE $100,000
ltyes descdbeur .- --
SP PROVISIONS bWm E.L.DISEASE-POLICY LIMIT $5001000
OTHER
DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
t
,
Gas Contractor Stem 804847
CERTIFICATE HOLDER CANCELLATION
[AUTN
HOULD ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE THE EXPIRATION
MIAMI SHORES VILLAGE:BUILDING DEPT ATE THEREOF,THE ING WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN
10050 NE 2ND AVENUE OTICE TO THE CERTI H 1 FT.BUT FAILURE TO DO 80 SHALL
MIAI SHORES VILLAGE FL 33138 MPOSE.NO OBLIGATION Y IQ AGENTS OR
EPRESENTATI
ORI7FA REPRESENTATIVE
ACORD 2b(2001!08) OACORD CORPORATION 1988
10/9/2015 Codes and Standards I ICC"icACCESS
TABLE 402.4(28) SCHEDULE 40 METALLIC PIPE
Gas Undiluted Propane .°, ••••••
Inlet Pressure 11.0 in. w.c. ••••
Pressure Drop 0.5 in. w.c. ••••.. •
Specific Gravity 1.50 ,
.... •••• •••••
INTENDED USE Pipe sizing between single-or second stage(low pressure) regOttor and appiNance. •...�.
PIPE SIZE (inch) •
Nominal 1/2 3/4 1 11/4 11/2 2 21/2 : A :...4. •
Actual ID 0.622 0.824 1.049 1.380 1.610 2.067 2.469 8 •'4:026 •
Length (ft) Capacity in Thousands of Btu per Hour
10 291 608 1,150 2,350 3,520 6,790 10,800 19,100 39,000
20 200 418 787 1,620 2,420 4,660 7,430 13,100 26,800
30 160 336 632 1,300 1,940 3,750 5,970 10,600 21,500
40 137 287 541 1,110 1,660 3,210 5,110 9,030 18,400
50 122 255 480 985 1,480 2,840 4,530 8,000 16,300
60 110 231 434 892 1,340 2,570 4,100 7,250 14,800
80 101 212 400 821 1,230 2,370 3,770 6,670 13,600
100 94 197 372 763 1,140 2,200 3,510 6,210 12,700
125 89 185 349 716 1,070 2,070 3,290 5,820 11,900
150 84 175 330 677 1,010 1,950 3,110 5,500 11,200
175 74 155 292 600 899 1,730 2,760 4,880 9,950
200 67 140 265 543 814 1,570 2,500 4,420 9,010
250 62 129 243 500 749 1,440 2,300 4,060 8,290
300 58 120 227 465 697 1,340 2,140 3,780 7,710
350 51 107 201 412 618 1,190 1,900 3,350 6,840
400 46 97 182 373 560 1,080 1,720 3,040 6,190
450 42 89 167 344 515 991 1,580 2,790 5,700
500 40 83 156 320 479 922 1,470 2,600 5,300
550 37 78 146 300 449 865 1,380 2,440 4,970
600 35 73 138 283 424 817 1,300 2,300 4,700
650 33 70 131 269 403 776 1,240 2,190 4,460
700 32 66 125 257 385 741 1,180 2,090 4,260
750 30 64 120 246 368 709 1,130 2,000 4,080
800 29 61 115 236 354 681 1,090 1,920 3,920
850 28 59 111 227 341 656 1,050 1,850 3,770
900 27 57 107 220 329 634 1,010 1,790 3,640
950 26 55 104 213 319 613 978 1,730 3,530
1,000 25 53 100 206 309 595 948 1,680 3,420
1,100 25 52 97 200 1 300 578 921 1,630 3,320
1,200 24 50 95 195 292 562 895 1,580 3,230
1,300 23 48 90 185 277 534 850 1,500 3,070
1,400 22 46 86 176 264 509 811 1,430 2,930
1,500 21 44 82 169 253 487 777 1,370 2,800
1,600 20 42 79 162 1 243 468 746 1,320 2,690
1,700 19 40 76 156 234 451 719 1,270 2,590
1,800 19 39 74 151 226 436 694 1,230 2,500
1,900 18 38 71 146 219 422 672 1,190 2,420
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All work done to code:
SBC: Fuel Gas 20 16_f'
NFPA 54&NFPA N
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work done to code:
C: Fuel US 2010
PA 54& NFPA 58