PL-16-20 Inspection Worksheet
Miami Shores Village �y�Q
10050 N.E.2nd Avenue Miami Shores,FL VIC, 1� 0
- v 1
Phone:(305)785-2204. Fax:(305)7568972
Inspection Number INSP-250434 Permit Number. PL-1-16-20
Scheduled Inspection Date:April 04,2096 Permit Type: Plumbing -Residential
Inspector: Hernandez,Rafael Inspection Type: Final
Owner CAMPBELL,MARK Work Classification: Gas
Job Address:373 NE 82 Street
Miami Shores,FL Phone Number (305)7542398
Parcel Number 1132060936400
Project <NONE>
Contractor: SUBURBAN PROPANE LP Phone:(305)6354427
Building Department Comments
lnrractlo ments
SET TANK AND RUN GAS LINE TO STOVE AND BBQ INSPECT COMMENTS False
inspector Comments
Passed
Failed El
Correction
Needed
Re-Inspection
Fee 1 i
No Additional lrmpections can be scheduled until
re-Inspection flee Is paid
Caw In-,tea+-Nlasea ws11.l'1 M7Q9-IOA0
SUBURBAN, PROPANE-1770 PO BOX 889248 ATLANTA, GA 30356-.1248 305-891-8393
RSN:006 MISCELLANEOUS
* [15].1' whole saw, glav 3/4", fittings,nipples, reg, pigtail and quick
disconnect
***********************************************************************************
**
WO# 51964 <LOG>03/29/16 12:22 <SCHED>03/30/16 07:29 Tech: 15
ACCT#:222612 S#:1 DIV:1 TYP:1 ZONE:33138 16:27 29-Mar-16
MARK CAMPBELL TEL: (305)528-3037 4� „ �
373 NE 92 ST h.- (�
MIAMI, FL 33138 SCY: 90 LTX PTX
SAD: MARK CAMPBELL 373 NE 92 ST MIAMI, FL 33138
SVC INST: COOKING BBQ
slzE EQUIPMENT DATA OAL
#1 #2 #3 CODE DESCRIPTION OF WORK DONE
WATER
WATER Les LP DOT ASMEDOT ASME DOLT ASME
L
pp
CAPBS # GVVC # GWC # GWC m" P.,'_.__ g' P °^V
238 100 2B ❑ ❑ ❑
357 150 42 ❑ ❑ ❑
ie 200 57 ❑ ❑ 4
714 300 85 ❑ ❑
1000 420 120 ❑ ❑ ❑ -
- 200V 57V ❑ ❑ CODE ESCRIPTION AM
420V 120V ❑ EL-0 ,❑ ❑ �1
125
El ❑ 1L 4 K �;
250 ❑ ❑ ❑
325 ❑ ❑ ❑
500 ❑ ❑ ❑
1000 ❑ ❑ ❑
OTHER r�
VESSEL TYPE C T C T C
MFG DATE om YR MO/YR YR MO/YR YR
a•
•RECERT DATE MO/YR - mum MO/YR
❑ 1 'No Marts ❑ 1 'No Mark'
RECERT TYPE ❑ 2 'S' :❑ 2 'e' ❑ 2 V t..
❑ 3 'E' ❑ 3 'E' ''❑ 3 'E'
SCHEIXIE FOR Tare Twat Total Material
❑ ❑ Hfs.
SUMCE
TANK/GYLINDERISTALLED DATE Total Labor .
MFG. SERIAL NO ` A 6FIU� T/C#1 Serial No. Material/Labor Tax `+
6/
/ 2 Serial No. Gels.Propene(_9F$
T1NK/CYUNDER LVED 'CIJI I E Serial No. Sales/LocaUMuni Tax'
MFG. �SERIAL NO. ,%FULL . • A •
.�...
CHECK HERE IF ❑ PAYMENT TYPE CASH VISA ElDISC ❑ �
ADDITIONAL SHEETS CHECK M c ElAMEx 11 CC Authorization T
FURNACE FILER SPACE HEATER WATER �- RANGE CLOTH SSRYER FIREPLACE LOGS
MAKE/MFR
MODEL NO.
SERIAL NO.
SINGLE STAGE INTEGRAL TWO STAGE - THREE STAGE PAMulator Data
1 I ill FIT,111111111101' A•I S[rgjff&stage 2nd Stage 3rd Stage
START FINISH START FINISH EQUIRUSED M /HPGAUGE/OTHER Mfg. �'j
AN '
Si LE/ EQUIP.USED MAN TB THE EQUIP.USED P E OWC FLOW Model
1 T TAGE TIME .-Z/'D TIME ❑PSI LOCKUP Date/Code
E(WC ❑PSI .(9 []psi The undersigned: Knows how to tum off
E(XUIP.USED MAN/HP GAUGE/OTHER the propane gas supply valve in case of
2ND EQUIP.USED MAN/TB/OTHER EQUIP.USED HP GAUGE 0 WC FLO emergency. Has smelled propane and
can7and
its od . U the
STAGE TIME TIME ❑PSI UP sg ce has bor.. pe ormed. Has
❑WC ❑ .read u d ds the v
statements the, fe info n
EQUIP.USED MAN R EQUIP. D H GE E .USED MAN/HP GA /0 the back o s
RD TIME TIME WC FLOW ,
STAGE
❑WC ❑PSI ❑PSI P1 LOCKUP i
Date
DISCLAIMER:The scope of Suburbans work Is set forth above.it does Mt 1)include an Inspection of equipment,piping,the Internal workings of sealed eq&pMM an �, ¢
structural components for latent,manufacturing or other defects;2)cover items not visible and accessib�to the service testi nician5 3)attempt to determine if any hem is subject to 3p
a recall.Customer further acknowledges that Suburban's work cannot be construed to detect or prevent future delta or happenings arising from aging,use,casualty or othe
PLEASE SEE REVERSE SIDE FOR IMPORTANT.SAFETY INFORMATION, jhqnkYGtI1`1_
(1) Office Copy (2) Customer Copy (3)Employee,C ITEM#1522813 SPP-OPR-5212 0414
I
CUSTOMER: READ AND PROVIDE Tms IMPORTANT SAFETY INFORMATION TO ALL END vs !,
IBJ TT IS PROPANE?Propane is highly flammable when mixed with air(oxygen)and can be ignited by many sources,including open flames,
smoking materials,electrical sparks,and static electricity. Severe"freeze bum"or frostbite can result if propane liquid comes in contact with
your skin.
IF YOU SMELL,HEAR OR SEE GAS: 1)IMMEDIATELY put out all-smoking materials and other open flames.Do not operate lights,
appliances,telephones,or cell phones. 2)IMMEDIATELY LEAVE the building or area where you suspect.gas is leaking. 3)SHUT OFF
THE GAS at the main gas supply valve on your propane tank if it is safe to do so. 4)REPORT THE LEAK from a neighbor's home or another
nearby building away from the gas leak. Call your propane retailer, 911 or your local fire department. 5) DO NOT RETURN TO THE
BUILDING OR AREA until it is determined it is safe to do so. 6)GET YOUR SYSTEM CHECKED by your propane retailer or a qualified
service technician for leaks before you attempt to use any of your propane appliances.
CAN YOU SMELL GAS? Propane smells like rotten eggs, a skunk's spray, or a dead animal. Some people may have difficulty smelling
propane due to their age (older people may have a less sensitive sense of smell); a medical condition; or the effects of medication, alcohol,
tobacco,or drugs.Consider purchasing a propane gas detector as an additional measure of security.
ODOR FADE is a reduction in the concentration of propane odor making it difficult to smell.Although rare,several situations can cause odor
fade: •The presence of air,water,or rust in a propane container.•The passage of leaking propane through soil,•The exposure to building,
materials, masonry or fabrics. Since there is a possibility of odor fade or problems with your sense of smell, you should respond
immediately to even a faint odor of gas.To familiarize you and your family or employees with the smell of odorant,call Suburban at
1-888-223-0029 to request a Scratch and Sniff sample of what propane smells like or order any Propane Education & Research Council
pamphlet.
PROPANE GAS DETECTORS ARE RECOMMENDED: Propane gas detectors sound an alarm if propane is detected in the air. Suburban
recommends the installation of UL-listed propane gas detectors in basements and where recommended by the manufacturer to provide an additional
warning of the presence of propane.They can provide an additional measure of security in structures with little-used areas and for individuals who
have difficulty smelling propane. •Buy only units that are listed by Underwriters Laboratories(UL).•Follow the manufacturer's instructions
regarding installation and maintenance.•Never ignore the smell of propane,even if no detector is sounding an alarm.
CARBON MONOXIDE(CO)—WHAT IS IT? You can't taste or smell CO,but it is a very dangerous gas,producgi when any fuel burns.
High levels of CO can come from faulty appliances,or from a venting system or chimney that becomes blocked.CO CAN BE DEADLY!High
levels of CO can make you dizzy or sick(see below).In extreme cases, CO can cause brain damage or death. Symptoms of CO Poisoning
include:•Headache•Shortness of breath•Dizziness•Nausea•Fatigue.
IF YOU SUSPECT CO IS PRESENT,ACT IMMEDIATELY!•If you or a family member shows physical symptoms of CO poisoning,get
everyone out of the building and call 911 or your local fire department.•If it is safe to do so,open windows to allow entry of fresh air,and turn
off any appliances you suspect may be releasing CO. • If you suspect that CO is present, call your propane,retailer or a qualified service
technician to check CO levels and your propane equipment.
TO HELP REDUCE THE RISK OF CO POISONING: • Have a qualified service technician check.your appliances and related venting
systems annually.•Install UL-listed CO detectors on every level of your home.•Never use portable heaters indoors unless they are designed
and approved for indoor use.•Never use a barbecue grill indoors for cooking or heating.•Regularly check your appliance exhaust vents for
blockage.SIGNS OF IMPROPER APPLIANCE OPERATION THAT CAN GENERATE HIGH CO LEVELS:•Sooting,especially on
appliances and vents•Unfamiliar or burning odor•Increased moisture inside of windows.
LIGHTING PILOT LIGHTS: If a pilot light repeatedly goes out,or is very difficult to light,there may be a safety problem.DO NOT try to
fix the problem yourself.It is strongly recommended that only a QUALIFIED SERVICE TECHNICIAN light any pilot light that has gone out.
YOU ARE TAKING THE RISK of starting a fire or an explosion if you light a pilot light yourself.Carefully follow all of the manufacturer's
instructions and warnings concerning the appliance before attempting to light the pilot.
DON'T RUN OUT OF GAS: SERIOUS SAFETY HAZARDS,INCLUDING FIRE OR EXPLOSION CAN OCCUR.Prior to refilling
an empty propane container,a leak test must be performed by a Qualified Technician prior to turning on the gas to determine if any equipment
or lines remain open after the rum out.Suburban is not liable for injury or property damage resulting from a supply run out.
EQUIPMENT AWARENESS: KNOW HOW TO SHUT OFF THE GAS SUPPLY to your premises and where the valve(s)is located.Tank
and cylinder valves must be turned to the right(in a clockwise direction)to stop the flow of gas.
sraoar valve mere Meller stet
1Owed V"Hese unft 0
WWpadldmv
M
MANUFACTURER'S INSTRUCTIONS are included with all propane appliances and equipment.Keep and consult them for correct operating
and maintenance procedures. Contact the appliance manufacturer for replacement instructions. If needed DO NOT STORE PROPANE
CYLINDERS OR CONTAINERS INSIDE BUILDINGS.
FLOODING—If flooding is predicted for your area or your gas-fired appliance(s)or equipment have been submerged:•Tum off the gas valve
at the container.•DO NOT turn the gas back on until a qualified technician has checked the system.
HEAVY SNOW OR ICE—Heavy snow or ice on propane equipment may cause damage resulting in a leak.Regulator and appliance vents must
remain clear of snow and ice,especially appliance vents on roofs of mobile homes.When removing snow:•Do not shovel snow from roofs onto
propane equipment.
SAFE ACCESS: Provide structurally sound access to propane equipment free from snow,ice,debris or other obstructions.
F[TRTHER CONSUMER SAFETY INFORMATION: —This is an abbreviated version of Suburban's Safety Tips. We urge you to visit
www.suburbanpropane.com for the full text and for Consumer Safety Information prepared by the Propane Education & Research Council
(FERC).Pamphlets called"Important Propane Safety Information for Your find Your Family,""Important Propane Safety Information for Users
of Small Cylinders" (including cylinder transportation, storage and inspection procedures), an expansive. "Propane Safety" booklet,
weather/natural disaster information,and Suburban's Material Safety Data Sheet(MSDS)may be read and downloaded online.These documents
are also available free of charge by calling Suburban at 1-888-223-0029 or can be purchased through PERC at 1-866-905-1075 or
www.prQpanecatalog.com Each pamphlet contains a Scratch and Sniff Test to learn what propane smells like.
Para informaci6n de seguridad en Espanol,flame al 1-888-223-0029. ITEM#15=13 SPP-0PR-5212 0414
c'
o Miami Shores Village
10050 N.E.2nd Avenue NE
Miami Shores,FL 33138-0000fr
Phone: (305)795-2204
Expiration: 07/09/2016
Project Addrm Parcel Number Applicant
373 NE 92 Street 1132060136400
Miami Shores, FL Block: Lot: MARK CAMPBELL
Owner Information Address Phone Cell
MARK CAMPBELL 373 NE 92 Street (305)754-2318 (305)528-3037
MIAMI SHORES FL 33138-3133
373 NE 92 Street
MIAMI SHORES FL 33138-3133
Contractor(s) Phone Cell Phone
Valuation: $ 500.00
SUBURBAN PROPANE LP
(305)635-4427
Total Sq Feet: 00
Type of Work:SET TANK AND RUN GAS LINE TO STOVE 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 $0.60 Invoice# PL-1-16-58237
DBPR Fee $2.25
DCA Fee $225 01/11/2016 Cash $115.10 $50.00
Education Surcharge $0.20 01/06/2016 Check#:3985 $50.00 $0.00
Permit F e' $150.00
Scanninal.ee $9.00
TechnolagnFee $0.80
Total: $165.10
�t
r7-..
In consid~tion of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertainingreto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting Rs permit I assume onsibiiity fo all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required I LECTRICAL,PL BING,MEC ICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work.
C-1
OWNERS FI rtify that all oing information is accurate and that all work will be done in compliance with all applicable laws regulating
constructi i uthe th above-named contractor to do the work stated.
61 January 11,2016
Authoriz gnature: r / plicant / Contractor / Agent Date
Bulldlng Dep m Copy
January 11,2015 1
t a Miami Shores Village --
Building Department JAN 0 6 2015
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 M
Tel: (305)795.2204 Fag:(305)756.8972 BY: ),. T�
INSPECTION'S PHONE NUMBER:(305)762A949
BUILDING Permit No. ,��- 2Q` ' '
+i PERMIT APPLICATION Master Permit No.�'/ / �--
FBC 20
Permit Type: PLUMBING Aa r
Owner's Name(Fee Simple Titleholder) Y"�A�l Aa.- - �MP90� ?ne# J 6J 526, 3,63-7
Owner's Address 9-IS Al 2 S
City M l Awl( S AUYA( -' State {2 Zip -33/540
Tenant/Ussee Name Phone#
Email
Job Address(where the work is being done)
City Miami Shores Village County Miami-Dade Zip 3 3 ) J 9
FOLIO/PARCEL# L I - 3?.lib "D 13 " (ayo d
Is Building Historically Designated YES NO X Flood Zone
Contractor's Company Name '5000060w )91K6,0W be Phone# sat— 4 3 f`- 44!oZ;L
Contractor's Address -3T00 4144 ell d k
City !?Z//��/ State_
Qualifier Name oe6 01- .8Ae1-0 Phone# 3,0 C- 63 S'
State Certificate or Registration No, Certificate of Competency No. 19 X3
Contact Phone E-mail
(thitec ngineer's Name(if applicable) V v l&940,A,+1pC 1 f9 FL L Phone# 3 OS-7 0-/' Z'3 j j
6-0
Value of Work For this Permit$ oma- Square/Linear Footage Of Work:
Type of Work: []Addition ❑Alteration []New ❑ R air/R
ep eplace
El Demolition
Describe Work: S-e- I-dA),a G�96 411,9 /0 g/dar
0, ftidkm
C.�Y' iN'e OC 9016141 'N94 VSMN
!Pet V VV 81J440,
Su rmit ee$ 41so. CCF$ ®� GO CO/CC$
Notary$ Training/Education Fee$ 0- 2-0 Technology Fee$ O"
Scanning$ Lp Radon$ 09 a5 DPBR$ -1 Bond$ _ 'r
Double Fee$ Violation date: 0
Structural Review.$ Total Fee Now Due$
See Reverse side-�
R
Bonding Company's Name(if applicable)
4
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 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 A 1* As a co dition to the issuance of a building permit with an estimated value exceeding$2500, the applicant must
promise in od f t hat copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose p perty is je att c ent. , a certified copy of the recorded notice of commencement must be posted at the job site
for d, first ins ti is s days after the building permit is issued. In the absence of such posted notice, the
insp ction will r d p tion fee will be charged.
S atur Signature
weer Agent f4A4X & C4ART E-tom.- Contractor
The foregoing instrument was acknowledged before me this Z-- The foregoing instrument was acknowledged before me this a?7
day of _,20 by ArV4kc A t k_^J*k L- day of V ,20 /1,by
who is personally known to me or who has produced who Gonally kn to me or who has produced
As identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: Sign:
Print: V\ Print:
CVV
CPJKCAWML
My Commission Expires: tWCONAMOF20M My Commis Eq*n JW fF a
EVX&Feb"17,019 COMM /FF 2Q87S
BaadedTlgeNNrliPul�atAr est ASW
APPROVED BY �-6-1, 7 Plans Examiner Zoning
Engineer Clerk checked
(Revised 07/10/07XRevised 06/10/2009)
DEC/31/2015/THU 09:39 AM FAX No. P. 002
Florida Department of Agriculture and Consumer Services
Bureau of Liquefied Petroleum Gas InsRer_tion
2005 Apalachee Parkway
Tallahassee, Florida 32399-6500
Master Qualifier Mailing Address Licensed Location Address
ALEX 1. BRITO
1205 NW 10TH ST
DANIA BEACH, FL 33004-2340
Certificate Number License Number
29839
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 noted on the Certificate. A notice of
renewal will be seat 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 Gals inspection
2005 Apalachee Parkway
Tallahassee, Florida 32399-6500
----- --------------------cucr— -----,-----------------------
State of Florida
Department of Agriculture and Consumer Services
Division of Consumer Services : 29839
No
Certificate Bureau of Liquefied Petroleum Gas Inspection Exam a NO: May 2a,2013
(850)921-1600 Issue Date: July 29.2014
Tallahassee, Florida ExPiratio»Data. July 28,2017
Exam: 0601
MASTER QUALIFIER CERTIFICATE
(NON- DESIGNATED)
This C411flcate is issued under authority of Section 527.02, Florida Statutes,to:
ALEX 1. BRITO
Valid For
Woenae Number:
ADAM ti.PUTN M
COMMISSIONER OF AGRICULTURE
DEC/31/2015/THU 09;39 AM FAX No, P. 001
A
CERTIFICATE OF LIABILITY INSURANCE °ATEtAdfdlDOlYYYY1
t19�2670}b
THIS CIERTIPICATE 18 ISSUED AS A MATTER OF INFORMATION ONLY ARID CONFERS NO RIG14YS UPON THE C$RTIFICATE HOWER.THIS
CERTIFICATE D0I98 NOT AFFIRIWA't'IVlaLY OR NEGATIVELY AMEMb, HXTt ID OR ALTER YAP- COVERAGE AffFORDED BY TJJE POLICIES
BELOW. THIS CERTIFICATE 01, INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHOREMD
REPRI=SE)1 TATM OR PRODUMK AND THE CERTIFICATE HOLDER.
IMPORTANT: if the cerh'f belt tivider l8 an ADDITIONAL INSURED,the polhsy(ies)must be endorsed, If SU$ROGATION IS WAIVED,subject to
the terqu;and conditions of the policy,certain Policies may mquire an endomement. A statement on this ceettficate does not confer rights to the
cortfaate holder In lieu of such endomement(s).
PRcnxw R �pI�
MAR(IH USA,INC. NATiE:
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240 ROUTE 10 WEST _ _. ..
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COVERAGES CERTIp'IICATE NUMBER: NYC-007656662.12 REVISION NUMBER:2
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAve airm ISSUED TO THE INSURED NA9AEO ABOVE FOR THE POLICY PERIOD
INDICATED, NOTWri'HSTANDING ANY REQUIREMENT,TER,4 OR CONDITION OF ANY CONTRACT OR OTTER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY 81E ISSUED OR MAY PERTAIN. THB INSURANCE AFlpORDED BY THF POLICIES DESCRIBED HEREIN Is SUt3JEey TO?ALL THF TERMS.
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMI r8 SHOWN MAY HAVE SEEN REDUCED BY PAID CL•41I,tS.
TYPE OF INSURANCE
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RE:LICENSE f5:01198 LP GAS DeALBR {ACORD let,Addrt)onat Reman,.sanaaure,may be aaaahep I,mora apace to rogt,vm!)
GERTIFICATf. LD CANCELi-�1 IOM
MIANA SHORES MLLAGE
ATTM BULDING 06PARTt4E)y7 SHOULD ANY OF THE ABOVE OncRIBED POLICIES BE CANCELLED BEFORE
70WOI62NQXV NLE THp EXPIRATION DATR THEREOF, NOTICE IMLL BE DELiVERSp IN
NORTH NMI[[SF,ACR FL 33138 ACOORDANCE WITH 7tIB FOL,ICY PROVISIONS.
AUTHORIMO REpR M"AYiVE I'I
Of M&Kh USA Inc.
t oneehr Mu'RMenee _Mauam►.� ,a 4. u „a`�
ACORD 2S(21]4dlU�} 0 99613-2014 ACORD CORPORATION. All Tights reservsd.
The ACORD name and logo ars registered marks of ACORD
DEC/31/2015/THU 09:40 AM FAX No. P. 003
.Q
tocial Business Tax Receipt--
.
Miami—Dade County, State of Florida
—THIG I3 NOTA BILL. — DO NOTPAY
41.90310.
L B T.
Auall-leSB Rawielt oca►Ttonl weer No. : EXPIRES
SUBURBAN PROPANE LP RBIVkV11AL SEPTEMBER 3OF201 G
3800 NW 59 ST• •• 991!5978 Must be displayed at place of business
HIALEAH FL 3.3142 Pursuant to County Code
Chapter&A—Art.9&10
OWNS SUM TYPE OF BUSINESS PAYMENT iiRCE1V8D
.SUBURBAN PROPANE LP 205 DEALER/DISMNSTALLATION PATAx T RICRIV13
Li'G001198 BY LLEVrOlk
$270.00 07/24/2015
FPPU02-15-017175
This!foal Business Tux Receipt only owdhras payment of the t oCal uusln*"Tax.The Receipt is not a license,
permlt nr a ae►dtloadoo offfie hoidoes uatriicatium%to do fumiaeas.Bolder oust oampty wish any govermcental
or"overmm ntal regulatory Ism and requireo1*Mp which 8pptyto the business.
The RECEIPT NO.above most he dis h"d on 811 ommaercial vehiotee—Miami—ilade CadeSea 8a-278
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Suburban Propane
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Job Address v73 IVC-. y'aS�
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ALL BEARINGS AND DISTANCES SHOWN HEREON ARE OF
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`S�RECORD AND MEASURE UNLESS OTHERWISE NOTED. r
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WOOD FENCE 8' ASPHALT 15'ALLEY AS PER
0.3' EASTy9 PAVEMENT WOOD FENCE;'. .. 2
0.2' SOUTH °� {P.B. ��:�PG.70} A'
0A' WEST
S89047'36"E , s.os' 100.00' 0.6' SOUTH
CHAIN LINK FENCE /� ��—��—��—��—��
WOOD FENCE ,,.,7 C
0.2' WEST J 0.8' SOUTH WOOD FENCE
0.2' NORTH {, I {�Y 0.8' SOUTH
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( IN FEET )
I inch = 20 ft. 26.70' 9�
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0000•• • • • °' ` 37.90' 10.69'
0000•• • • 41,VN INK FENCE
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• • • ••W.PIFO ENCE 1 .9 10.50 ONE-STORY C.B.S. BUILDING
•••�•• 0000 • AST , No. 373
•0000 0000•• 00000• \ ,$O HIGHEST FLOOR ELEVATION: 11.37 W
• • ••0• •••• LOWEST FLOOR ELEVATION: 10.87 _
•••••• R�)' 0 GARAGE ELEVATION: 9.27 M
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WIRE FENCE
0.2' WEST 14 46 20.40' �o 33.22' 10.43'
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Suburban Propane
Qualifier
Jou Address 3.7;4 N441 07,9 SA
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