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PL-14-1952Inspection Worksheet Miami Shores Village ' 10050 N.E. 2nd Avenue Miami Shores, FL )150 Phone: (305)795-2204 Fax: (305)756-8972 inspection Number: INSP-224042 Permit Number: PL -9-14-1952 Inspection Date: December 01, 2014 Permit Type: Plumbing - Residential Inspector: Diaz, Osvaldo Inspection Type: Final Owner: HURLEY, JAMES Work Classification: Gas Job Address: 685 GRAND CONCOURSE Miami Shores, FL 33138 - Project: <NONE> Contractor: FOREVER PROPANE SALES AND SERVICES INC Building Department Comments Phone Number Parcel Number 1132060172180 Phone: (954)566-3042 GAS PIPING TO GENERATOR LP TANK Infractio Passed Comments INSPECTOR COMMENTS False Passed Inspector Comments CREATED AS REINSPECTION FOR INSP-219187. NO ONE HOME � GATES OPEN NO DOGS Failed El '� �° `✓��j `2 Correction Needed Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. For Inspections please call: (305)762-4949 December 01, 2014 Page 1 of 1 11/19/2014 Drop Test Contractor Henry and Co John Cramer 757 SE. 17th St #176 Fort Lauderdale, FL 33318 954 605 6981 State LP Gas License 34892 Customer Hurley 685 Grand Concourse Miami Shores Florida Propane 9 inches of water column for 10 min. no drop NOTARY PUBLIC• jF FLORIDA bi Watson Com ,Cc- # EE058519 Es;:: FEB. 11, 2015 BONDED n U VC: BO`DNG CO.JNC- V ar Miami Shores Village REC-EnTD] Building Department s 2014 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 L:_ INSPECTION LINE PHONE NUMBER: (305) 762-4949 AHCEIIED FBC 20CZ �. BUILDING Master Permit No. PERMIT APPLICATION Sub Permit No.?�,1952, ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑■ PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 685 GRAND CONCOURSE City: Miami Shores County Miami Dade Zia• Folio/Parcel#:1132060172180 Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): JAMES HURLEY Phone#: Address: 685 GRAND CONSOURSE City: MIAMI SHORES State: FL Zip: Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: ALL GAS PROS Phone#: Address: 3325 GRIFFIN RD City: FT LAUDERDALE State: FL Zip: Qualifier Name: BRUCE J GILLIARD Phone#: State Certification or Registration #: Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $--N,3(1 7(1 Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration qzN, ew ❑ Repair/Replace ❑ Demolition Description of Work: GAS PIPING TO GENERATOR L—P Specify color of color thru tile: ge Submittal Fee $ Permit Fee $ Zz '`i CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ TOTAL FEE NOW DUE $ (RevisedO2/24/2014) Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip 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 apppWed and a reinspection fee will be charged. OWNER or AGENT The foregoing instrument was acknowledged before me this day of 20 by Y le<54A-f- 'e` who is ersonally known o me or who has produced as Signature TRACTOR The foregoing instrument was acknowledged before me this inan day of 20 by who i personall known o me or who has produced identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: as Sign: �4 l0_A x12. �C� C\ Sign. _L,—_X:j;hpa-V— Print: Print:�'�y OFFLORIIIA Seal: �elanje Watson Seal: NOTARY PUBLIC -STATE OFFLOT_tLY� a =Commission # EE058519 Melanie Watson Expires FEB, il, 2015 Commission # EE058519 B1I17EDTfRUATTA\TICB02ND COy1NC. %nn.••`•, EXplres: FEB'n INNQ APPROVED BY i l� Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) ` that 12-20-2012 JEFF ATWATER STATE OF FLORIDA CHIEF FINANCIAL OFFICER DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * e CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: PERSON! FEIN: 12/2012012 EXPIRATION DATE: 12/20/2014 GILLIARD BRUCE J 651070808 BUSINESS NAME AND ADDRESS: ALL GAS PRO'S INC DBA ALL GAS PRO'S INC 3325 GRIFFIN ROAD SUITE 126 FORT LAUDERDALE FL 33312 SCOPES OF BUSINESS OR TRADE: 1- OIL OR GAS PIPELINE CONSTRUCTI IMPORTANT: Pursuant to Chapter 440 . 05041, F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section may not recover benefits or compensation under this chapter. Pursuant to Chapter 440.05112), F.S., Certificates of election to be exempt... apply only within the scope of the business or trade listed on the notice of election to be exempt. Pursuant to Chapter 440.05(13), F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. QUESTIONS? (850) 413-1609 OWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01-11 PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS COMPENSATION 0�.-, CONSTRUCTION INDUSTRY CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS!COMPENSATION LAW EFFECTIVE: 12/20/2012 EXPIRATION DATE: 12/20/2014 PERSON: BRUCE J GILLIARD FEIN: 651070808 BUSINESS NAME AND ADDRESS: ALL GAS PRO'S INC OBA ALL GAS PRO'S INC 3325 GRIFFIN ROAD SUITE 128 FORT LAUDERDALE, FL 33312 SCOPE OF BUSINESS OR TRADE 1- OIL OR GAS PIPELINE CONSTRUCTI IMPORTANT F Pursuant to Chapter 440.05(14), F.S., an officer of a corporation who O elects exemption from this chapter by filing a certificate of election L under this section may not recover benefits or compensation under this D chapter. Pursuant to Chapter 440.05(12), F.S.. Certificates of election to be H exempt.. apply only within the scope of the business or trade listed on E the notice of election to be exempt R E Pursuant to Chapter 440.05(13), F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. QUESTIONS? (850) 413-1609 CUT HERE * Carry bottom portion on the job, keep upper portion for your records. OWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01-11 ,4c R CERTIFICATE O F LIABILITY INSURANCEF07/30/2014 DATE (MM/DD/YYYY) 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 Jamerson McLean Corporation Box 621149 825 Executive Drive Oviedo FL 32762 CONTACT Billie Tucker FAX PHONE 407-366-3482 FAX .407.366-8508 (Air NoP.O. EMAIL ADDRESS.. billi INSURERS AFFORDING COVERAGE NAIC # INSURER A: Scottsdale Insurance Company 41297 INSURED All Gas Pro's, Inc 3325 Griffin Road Ft. Lauderdale FL 33312 INSURER S: INSURER C INSURER D INSURER E INSURER F: nnVFRAnPA rFRTIFIr_ATF NIIMRFR 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 ADDLISUBRLTR imgR wyn POLICY NUMBER POLICY EFF POLICY EXP LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE Fx-1 OCCUR CPS2027831 0810112014 0810112015 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED $100,000 MED EXP (Any oneperson) $5,000 PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEML AGGREGATE LIMIT APPLIES PER: X POLICY PRO- LOC PRODUCTS - COMP/OP AGG s2,000,000 $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS COMBINED SINGLE LIMIT BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ (Par accident) UMBRELLA LUlB EXCESS LIAR OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION $__ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNER/EXECUTIVILJ � OFFICER/MEMBEREXCLUDED? (Mandatory in NH) If yes describe under DESCRIPTION OF OPERATIONS below NIA WC ORYSTATU- OTH- rR E,L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ —.L DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) Plumbing Contractor Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD Florida Department of Agriculture and Consumer Services Bureau of Liquefied Petroleum Gas Inspection P.O. Box 6700 Tallahassee, Florida 32399-6700 License Number: 16226 Business Mailing Address ALL GAS PRO'S INC. 3325 GRIFFIN RD STE 126 FORT LAUDERDALE, FL 33312 Licensed Location .Address ALL GAS PRO'S INC. 3325 GRIFFIN RD STE 126 FORT LAUDERDALE, FL 33312 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 be licensed. All LP Gas licenses must be renewed annually-. Any license allowed to expire shall become inoperafive"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, re. pairing, 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 Division of Consumer Services License Number: 16226 Bureau of Liquefied Petroleum Gas Inspection Expiration Date: August 31, 2015 1I850 921-1600 Date of Issue: September 1, 2014 l License Fee: $200.00 POST LICENSE Tallahassee, Florida Type and Class: 0803 CONSPICUOUSLY Liquefied Petroleum Gas License LP GAS INSTALLER 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: ALL GAS PRO'S INC. 3325 GRIFFIN RD STE 126 ADAM H. PUTNAM FORT LAUDERDALE, FL 33312 COMMISSIONER OF AGRICULTURE Florida Department of Agriculture and Consumer Services Bureau of Liquefied Petroleum Gas Inspection 3125 Conner Boulevard, Suite N Tallahassee, Florida 32399-1650 m Master Qualifier Mailing Address Licensed Location Address BRUCE JOSEPH GILLIARD ALL GAS PRO'S INC. 3325 GRIFFIN ROAD FT. LAUDERDALE, FL 33312 Certificate Number 06360 ALL GAS PRO'S INC. 3325 GRIFFIN RD STE 126 FORT LAUDERDALE, FL 33312 License Number 16226 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 sent to you in advance of your expiration date. A Master Qualifier Certificate may be renewed if certification of a minimum of 12 (twelve) 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: Bureau of Liquefied Petroleum Gas Inspection 3125 Conner Boulevard, Suite N Tallahassee, Florida 32399-1650 Cut Here ------------------------------------------------------ State of Florida Department of Agriculture and Consumer Services Division of Standards Certificate No: 06360 Bureau of Liquefied Petroleum Gas Inspection Exam Date: February 4, 1993 (850) 921-1600 Issue Date: May 20, 2012 Expiration Date: May 19, 2015 Tallahassee, Florida Exam: 0601 MASTER QUALIFIER CERTIFICATE This Certificate is issued under authority of Section 527.02, Florida Statutes, to: BRUCE JOSEPH GILLIARD Valid For Ucense Number: 16226 ALL GAS PRO'S INC. 3325 GRIFFIN RD STE 126 ADAM H. PUTN M FORT LAUDERDALE, FL 33312 COMMISSIONER OF AGRICULTURE BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895 — 954-831-4000 VALID OCTOBER 1, 2014 THROUGH SEPTEMBER 30, 2015 DBA: Business Name: ALL GAS PROS INC Owner Name: BRUCE J GILLIARD Business Location: 5197 SW 26 AVE FT LAUDERDALE Business Phone: 954-964-2937 Receipt #:I STALLATION LP GASS APPL/EQUP Business Ty pe:(INSTALLATION LP GASS) Business Opened:02/18/2001 State/County/Cert/Reg:93 -CLPG-123 -x/16226 Exemption Code: Rooms Seats Employees Machines Professionals For Vending Business Only Number of Machines: Vandina Tuna Tax Amount I Transfer Fee NSF Fee Penalty Prior Years I Collection Cost Total Paid 75.00 0.00 0.00 7.50 0.00 0.00 82.50 THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT This tax is levied for the privilege of doing business within Broward County and is non -regulatory in nature. You must meet all County and/or Municipality planning WHEN VALIDATED and zoning requirements. This Business Tax Receipt must be transferred when the business is sold, business name has changed or you have moved the business location. This receipt does not indicate that the business is legal or that it is in compliance with State or local laws and regulations. Mailing Address: BRUCE J GILLIARD Receipt #WWW -14-00000648 3325 GRIFFINS RD STE 126 Paid 10/15/2014 82.50 FT LAUDERDALE, FL 33312 2014 -2015 BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895 — 954-831-4000 VALID OCTOBER 1, 2014 THROUGH SEPTEMBER 30, 2015 DBA: ALL GAS PROS INC Business Name: Owner Name: BRUCE J GILLIARD Business Location: 5197 SW 26 AVE FT LAUDERDALE Business Phone: 954-964-2937 Receipt #: 262-9 Business Type: INSTALLATION LP GASS APPL/EQUP (INSTALLATION LP GASS) Business Opened: 02/18/2001 State/County/Cert/Reg: 93 -CLPG-123 -X/16226 Exemption Code: Rooms seats Employees Machines Professionals Signature For Vending Business only Number of Machines: V di T Tax Amount Transfer Fee NSF Fee Penalty an na Yoe: Prior Years Collection Cost Total Paid 75.00 0.001 0.00 7.501 0.001 0.00 82.50 Receipt #WWW -14-00000648 Paid 10/15/2014 82.50