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PL-16-1126 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores,FL Phone: (305)795-2204 Fax:(305)756-8972 inspection Number INSP-257634 Permit Number: PL-4-16-1126 Scheduled Inspection Date:June 15,2016 Permit Type: Plumbing-Residential Inspector: Hernandez,Rafael Inspection Type: Final Owner. SPIRK,BRANDON MYLES Work Classification: Gas Job Address:269 NE 103 Street Miami Shores,FL 33138- Phone Number (305)519-3007 Parcel Number 1121360130430 Project: <NONE> Contractor. PRESTIGE GAS SERVICES CORP. Phone: (305)300-0608 Building Department Comments NEW 25 GALLON PROPANE TANK AND GAS LINE TO InfracdoPassedComments STOVE. INSPECTOR COMMENTS False Inspector Comments Passed Failed Correction a Needed Re-Inspection a Fee No Additional inspections can be scheduled until re-inspection fee is paid. 3y E eek y Miami Shores Village f 10050 N.E.2nd Avenue NE F ' Miami Shores,FL 33138-0000 Phone: (305)795-2204 Project Address Parcel Number Applicant 269 NE 103 Street 1121360130430 BRANDON MYLES SPIRK Miami Shores, FL 33138- Block: Lot: Owner Information Address Phone Cell BRANDON MYLES SPIRK 269 NE 103 Street (305)519-3007 MIAMI SHORES FL 33138- 269 NE 103 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone Valuation: $ 1,270.00 PRESTIGE GAS SERVICES CORP (305)300-0608FF_ Total Sq Feet: 0 Type of Work:NEW 25 GALLON PROPANE TANK AND GAS 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-4-16-59547 DBPR Fee $2'25 05/0412016 Credit Card $121.70 $50.00 DCA Fee $2.25 Education Surcharge $0.40 04/27/2016 Credit Card $50.00 $0.00 Notary Fee; $5.00 Permit Fee, $150.00 Scannin6ioe $9.00 Technology Fee $1.60 Total:;, $171.70 In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining ttpereto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting*s permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for-ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: cert' that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating constructi6i,'and zoni . Futh rmore,I authorize the above-named contractor to do the work stated. May 04,2016 /iatho ignatu Own r / Applicant / Contractor / Agent Date Building epa ent Copy May 04,2016 1 (V I(G Miami Shores Village APR 27 2016 Building Department By: =14� 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 , L-4 BUILDING Master Permit No-13L 16" 112.6 2.6 PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL PLUMBING ❑ MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP &,45 CONTRACTOR DRAWINGS JOB ADDRESS: 269 NE 103rd Street City: Miami Shores County: Miami Dade Zip: Folio/Parcel#:11-2136-013-0430 Is the Building Historically Designated:Yes NO X Occupancy Type: R3 Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder):Brandon M. Spirk Phone#:305-516-3007 Address:269 NE 103rd Street City: Miami Shores State: FL Zip: 33138 Tenant/Lessee Name: NSA Phone#: Email: mylestec@gmail.com n � CONTRACTOR:Company Name: � S�tC,� /c./C -S Phone#: 3353 a�'OY' Address: 15 (l SfrJ C C T City: !E'j lg' l/ State: r—�- Zip: 5:� I Qualifier Name: eA7oA7/Z:2 �ff - Phone#: State Certification or Registration#: �3�3� Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ 2 7�U• Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration New ❑ Repair/Replace ❑ Demolition Description of Work: it/-ee✓ 25' e-c Z_e q�5 <:�-/<'n Ue— Specify color of color thru tile: Submittal Fee$ Permit Fee$ CCF$ 4D CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ !Z!S— Notary$ 5 IJIJ Technology Fee$ 60 Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ 2 e � (Revised02/24/2014) t S Bonding Company's Name(if applicable) N/A 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. 4Signa Signature OWNER or AGENT VIC CO RACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this G day of A P(L L 020 1 by day of A-*'F-L ,20 l by who is personally known to ��-� .� f�p - !90 is personally known to me or who has produced as me or who has produceaC':- 1.(CEt\91�s identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign:_ ^, f Print: Al A A fro Print: Seal: ��-�+�9 Seal: •�""""'�� ANA L CHAPARRO to��"�e Notary Public5tateofFlorida oti.* roa�i °•° `� Commission#FF 108556 ;° 4; 5india Alvarez c My Commission FF 158750 $ys . My Commission Expires Expires 0910312018 * � APPROVED BY W ` Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) Florida Department ref Agriculture and Consumer Services P.O. Bax 6700 Tallahassee, Florida 323$9-6730 Ucertse Number., 32634 Badness Mailing Address Licensed Location Address PRESTIGE GAS SERVICES CORP. PRESTIGE GAS SERVICES CORP. 1511 SW 71 ST CT 1511 SW 71ST CT MIAMI,FL 33144-5440 MIAMI,FL 33144-6440 The liquefied petroleum gas license at the bttttorh.of thisform is valid ONLY for the company located at the address on the lice. Eeds basin doe on of a payny M. ust be licensed. All LP Comas Ncen,as M. I bell cae annually. An license allowed to e)tpira shad�rrte:'nvpera#ive because of failure to renew,:The tee fctr restoration of a license is equal to tfte origln0i#w6se=relive must be paid before the licensee may resume: operations. IN THE EVEAtTOF AN OWNERSHIP CHAN . AT THIS BUSINESS LOCATION This license may be transferred to any person,firm or c orporation for the remainder of the carrent license year upon written request to E`au nt bythe anal license holder. License transfers must be.approved by the departm�All licensing must be m byy the transferee and a transfer fee of$60 will apply. To apply for a transfer,contact the .of LP Gas Inspections at(860)921-1600. Pu(suant to�Itapter 527,Florida Statutes,LP Gas licensees must present pn of.of I nsure to any consumer, owner,ter end.:user upon request when engaged in the business cif aervic ng;,. >re/pairirig,maintaining or installing LF Cas syatems.and/pr equipment: For future correspondence please make any needed corrections or Om*. .I 'your business.maliing address and/or yourlt0i$nOd doe on acidrese and return the UPPER PORTIt714.Q cor ecitons to: Florida Department of Agriculture and Consumer Services P.O, Box 6700 Tall ahbespe,Florida 32399-6700 Isere .' Florida. DepartmentdfAgikWtUre and Consumer Servic Division of Consumer Services License Number 32634 Bureau of Liquefied Petroleum Gas Inspection F.xphaft Date: August 31,2016' (860)921-1600 Date of Issue: September 1,2016 co sTLIu v Tallahassee, Florida Lleense Fee: $200.00 Type and Class: 0803 Muefled Petroleum LP CAS INSTALLER, GOOD FOR ONE LOCATION ONLY ANY CHANGE OF OWNERSHIP OR SALE OF THIS SUSiNIESS RENDERS THIS LICENSE INVALID This tcense Is Issued under authortty.of Section 527:62,Florida Statutes,to. PRESTIGE GAS SERVICES CORP. 1611 3W 71 ST CT AAM Haw,_. MIAMI,I, (^I. ! 'I . COMMISSIONER<.)F AGRICUL'T'URE a 001,4,86 \ 4 vo1 sr ` a r �� x ,�,�" iikR{wi+lff 1�'�� d�j� 5. J � � Y +4 � Y 64, h Oyu SEC.T"IE OF� � 0, SERVICES CQR . :205 LPA fl S fAl3�' avanE r t EcEtu LPG3263v rmx r#ouECr+ '$.,I 10.00 0/09/1015 itED 1TrARD—i 6—tl 461 1 ;Bttsitre9s3�ttieaailN � ` �EB1�im�sTaa�t T1�a isn�alirensa, �x�.p cettifiaf tits IHf �4 Ha �� ,aay 8o�i t�rna►eaml n�datary rea�retts twhfa W tits u , Tka Iti CHF1 N0. mti as all�arciai tali#CIe�R � e Sm-278 3 fdi �rtirjratatiaa,Wit`` �� Y.. .. i s t ° CERTIFICATE OF LIABILITY INSURANCE DATED 27/1'6 YY' /2 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 policypes)must be endorsed. M SUBROGATION IS WAIVED,subject to the terns and conditions of the policy,certain policies may require an endorsement Astatement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT CLAUDIA M DE LA ROSA Claudia's Insurance P NE , (786)298-9141 FAX No; (786)293-9142 18901 SW 106th Ave 132 LESS. claudia@ciaudiasinsuranoe.com Miami,FL 33157 INSURER AFFORDING COVERAGE NAIC# Phone (786)293-9141 Fax (786)293-9142 INSURER A: ATLANTIC CASUALTY INSURANCE COMPANY 42846 INSURED INSURER B: INFINITY COMMERCIAL AUTO 22268 Prestige Gas Services Carp(LAZARO PAZ) INSURER C: COMMERCE&INDUSTRY 19410 1511 SW 71 Ct INSURER D: Miami,FL 33144 (305)300-0608 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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. ITR TYPE OF INSURANCE POLICY NUMBER POLICYEFF POUCHY EXP OMITS GENERAL LIABILITY uu EACH OCCURRENCE $ 1,000,000.00 © COMMERCIAL GENERAL LIABILITY PRE MISES Ea�encs $ 100,000•00 ❑ ❑ CLAIMS-MADE 0 OCCUR AC11498252PC MED EXP(Any one person $ 5,000.00 A ❑ N N 12/10/2015 12/10/2016 PERSONAL&ADV INJURY $ 1,000,000.00 ❑ GENERAL AGGREGATE $ 2,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 1,000,000.00 © POLICY IPECT ❑ LOC $ AUTOMOBILE LIABILITY a acct anMBIN ant SINGLE LIMIT 1,000,000.00 E ❑ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED 509800013843001 BODILY INJURY(Per accident) $ B ❑ AUTOS ® AUTOS N N 11/12/2015 11/12/2016 NON-OWNED PROPERTY DAMAGE HIRED AUTOS © © AUTOS Per accident $ ❑ ❑ $ UMBRELLA UAB ❑OCCUR EACH OCCURRENCE $ 1,000,000.00 EXCESS LIAR EBU 044212153 C © El N N 05/07/2015 05/07/2016 AGGREGATE $ 1,000,000.00 ❑ DED ❑ RETENTION $ WORKERS COMPENSATION ❑WC STATU- ❑DTH- AND EMPLOYERS'LIABILITY Y/NORYLIM ANY PROPRIETORIPARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICERIMEMBEREXCLUDED? N/A (Mandatory in NH) ❑ E.L.DISEASE-EA EMPLOYE $ If yyes describe under DESdRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ N DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,It more space Is required) GAS APPLIANCE INSTALL AND SERVICE RESIDENTIAL AND COMMERCIAL LICENSE LPG32634 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 10050 NE 2ND AVE ACCORDANCE WITH THE POLICY PROVISIONS. MIAMI SHORES,FL 33138 AUTHOR®REPRESENTATIVE r� ©1988-2010 ACORD CORPORATION. Ali rights reserved. ACORD 25(2010/05)OF The ACORD name and logo are registered marks of ACORD �9 19 10D% JEFF AIWATER CHEF CIAL OPMElt STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF ERS'COMPENSATION CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA KERS`COMPENSATION LAWS CONSTRUCTION INDUSTRY EXEMPTION • This cadfies that the individual tisted below has elected to be exempt from Florida Workers`Compensation law. EFFECTIVE DATE: 2123/2415 EXPIRATION DATE: 2/2212017 PERSON: PAZ L:AZARO FEN: SM72716 BUSINESS NAME AND ADDRESS: PRESTIGE GAS SERVICES CORP 1511 SW 71 CT MIAMI FL 33144 SCOPES OF BUSINESS Oft E: GAS MAIN OR CONNECTION?CONST aas��r., axsai,�.s..mrammr�remo,+� �n, �cas saga , �rwtrrec�c,�pm>�grBRe .f9ns�adAtCtrQAO.i�t2}.F.S-. � �tiet�.:>�Yplgy' @4381 �' 2f�S W hN89tdtlFt�fBfl001C8��Sgt�i08;i .PtasN0t8 ADCtf 44�.1.��3}F.&. ��C�pt�1l� @Xffiut L�'~a1�be1'� ka� �rff.��gr6mb�t�B�ngoffliallo��riBieeN9�e �ePer�e'rlart¢dat�tw�08ot rgla�rmA� dCdssme6atfa'lsota `tt®dgp�bner� rwutcea DFS*243WC 29 CERTIFICATE OF ELECTMN TO BE E IST REVISED W13 QUESTIONS?(8W)413-1i i t i i t jf 23 i } { i t t Longest Run: 25 Feet Total Load: 120.000 BTU's Florida Building Code - FUEL GAS 2014 Chart#402.4(28) (Schedule 40 metallic pipe) Type of Gas: Propane Gas Chart#402A(3120)CSST pipe Chart#402,4051 Poly PI c PI Materials: Schedule 40 metallic pipe CSST EHD25-3/4" Poly Pipe New stove(36") New Outlet(S) 1 120.000 BTU's ••.. 1/2"Outlet • + .•.. ...... New Connection (S) 1 1/2"Shut Off Valve •• • ••+• •• Poly Pipe 3/4" .++.+. .+.. +....+ + New Propane Tank 10013ound Undo round •••••• + 11'WIC Gas System •••• •• 10' .... .. ....+ New stove(36") •••••• ••• • ••... 120.000 BTU's 15' •• •• •• ••.... 1/2"Outlet s e r u a or• •••• .' . ....:. 1/2'Shut Off Valve 1/2"Galvanized pipe •• • etre to the wall 3/4"Csst pipe 10FT away from any In the crawl space source of Ignition 1EHD#25 POO Poundn �L. r G - l - ��+ cCEI Miami Shores Village AP 2 7016 Sim APPROVED BY DATEBY: J ZONING CREPT IT9 P1 DG DEPT Y-27-14 . COPYi-11 r;I IO(:n^iI" !IWC;F J,AI_LFFnFRAL Prestige Gas Services Installation done in ac ance with FBC 2010, LPG32634 NFPA 54&58 regul ti ns s well as all local codes 1511 S.W. 71 t CT 4/25/2016 22:44 Miami, Florida 33144 Lazaro Paz Phone: 305 300-0608/Fax: 305 356.4332 Job Address: 2 9 E 03 S Isometric Florida Building Code - FUEL GAS 2014 Chart#402.4(28) (Schedule 40 metallic pipe) Chart#402.4(3120)CSST pipe Chart#402.4(35)Poly Plastic Pipe Pound Lf n 1 OFT away from any \� ••• source of i nation Q ••• I 3/4"Csst pipe •• •. .' In the crawl space •.•••• •••.• •• 600 EHD#25 4.0.00 0 0 . 12 stage re u a or 15' 0•••• •• e••• • •• •• •• • 444.4• ••• s• •• Poly Pipe 314 10' ••0••NORTH ee •• •••' Underground ;••�•� .0 New stove(36") ; ••• • ;• •• 120.000 BTU's •• • •••• • 1/2"Outlet •• 1/2"Shut Off Valve Front of House Prestige Gas Services Installation done In accordance with FBC 2010, LPG32634 NFPA 54&58 regulat as well as all local codes 1511 W. 71th CT 4/25/2016 22:44 Miami, Florida 33144 Lazaro Paz Phone: 305 300-06081 Fax: 305 356-4332 Job Address: 2 Floor Plan Steel 100,200,420 lb.Specifications r ' Ste' el 100, 2005 420 1b. Specifications Oil FdOw sd Nmsf Mo LPJL A""611MIRF [405mm] A:AAO-vie W4")OFT B1 WT PAd emp "")wr 43jV [7092mm] 100 RL 200 W. I ] r of , U A, Safely FlelIef Valve(1")NPT 1kFAI Valve(W)NPT C=NPT Roat Gauge(1")NPT W.Vapor ServL-e Valve(3/4")NPT •2r LOU—] OA B 016 C 4W Ib. LPG Water Tare We inder Footring Dia. • capacity ight Collar Height Capacity C�101klme 04"s Specificatio Cyfindetr 9a1� Ib. Ib. cu.in. inches inches Mode! 1 118 - lime a . • s .• 23.6 239.0 71.0 8829 • 5.1: • : : : '. DOT-4BW240 X3.3 108.4 32.2 't06.7 1 47.2 474 147.0 13147 •.6.6 , �, 18 �T-48W240 - 1T85 '�5;# � 215.5_°' _� �� .;`�` ».';:. i. '► 99.1 1000 272.0 27737 • ;&6 ••• • 22.0 • T-4BW240 375.1. 2 , 454.8: 1H. : • •• •• • • • •• ••