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PL-15-2957 q w a Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 e Inspection Number: INSP-248335 PermitNumber: PL-11-15-2957 Scheduled Inspection Date: January 28,2016 Permit Type: Plumbing - Residential Inspector: Diaz, Osvaldo Inspection Type: Final Owner: RIVERA, FRANZ AND JASMIN Work Classification: Gas Job Address:10255 BISCAYNE Boulevard MIAMI SHORES, FL 33161- Phone Number (305)799-0935 Parcel Number 1132050190070 Project: <NONE> Contractor: FLORIDA POWER HOUSE, INC Phone: (305)256-0241 Building Department Comments GENERATOR RELOCATION Infractio Pass d Comments INSPECTOR COMMENTS Falsel nspect r Comments Passed E�4 Failed �s Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. January 27,2016 For Inspections please call: (305)762-4949 Page 5 of 23 41 r tba ahks tka dark _ GAS DROP TEST NAME: AQ d1To L-a �� lr.��b P DATE: ADDRESS: Z i �� b(—v Start Time: DNe-A, End Time: r Starting Pressure: ll Ending Pressure: 2-`k �_ TEST DETAILS: State License#: LPG-27606 Qualifier: Guillermo Hernandez Technician: Sworn to and subscribed before me on Date: Z u q` Si ature ry Public ate of Florida Signature N ola! late o1 Florid! 4 n gg 837$Zfe18 Florida Power House—12300 SW 117'h Court—Miami, FL.33186-ph (305)256-0241—fx(786)362-7179 Perm 1ua^4 -15-2957 Miami Shores Village M Penn#,Typa -. ( tE '1:d1 10050N.E.2nd Avenue p e„ Work C ssl6t;etion as Miami Shores,FL 33138-0000 `— '� Phone: (305)795-2204 Perm#Status. oAiv� Iaac� �at> 124012014 Expiration: 0612712 16 Project Address Parcel Number Applicant 10255 BISCAYNE Boulevard 1132050190070 MIAMI SHORES, FL 33161- Block: Lot: FRANZ AND JASMIN RIVERA Owner Information Address Phone Cell 10255 BISCAYNE Boulevard FRANZ AND JASMIN RIVERA (305)799-0 35 MIAMI SHORES FL 33138-2648 10255 BISCAYNE Boulevard MIAMI SHORES FL 33138-2648 Contractor(s) Phone Cell Phone Valuation: $ 1,000.00 FLORIDA POWER HOUSE, INC (305)256-0241 _. .,. Total Sq Feet: 10 Type of Work:GENERATOR RELOCATION Available Inspections: Type of Piping: Inspection Type: Additional Info: Final Bond Return: Press Test Classification:Residential Scanning:3 Review Building Review Electrical Review Structural Review Plumbing Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $0.60 DBPR Fee InVOICe# PL-11-15-57862 $2.25 11/24/2015 Check#:2499 $50.00 $ 189.10 DCA Fee $2.25 Education Surcharge $0.20 12/30/2015 Credit Card $ 189.10 $0.00 Miscellaneous Fee $80.00 Permit Fee $150.00 Scanning Fee $3.00 Technology Fee $0.80 Total: $239.10 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 thereto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this 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: 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 dp the irk s ed. -December 30, 2015 Authorized Signature:Owner / Applicant / Contractor I Nfent Date Building Department Copy December 30,2015 1 Miami Shores Village Building Department 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 201 4 BUILDING Master Permit No. PERMIT APPLICATION sub Permit No. r_jBUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION EXTENSIO 4 ❑RENEWAL [PLUMBING ❑ MECHANICAL F-1 PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: City Miami Shores County: Miami Dade Zip: 331 30 Folio/Parcel#: � I—'1_Q0S'®«— 00-10 Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: ` rFFE: OWNER:Name(Fee Simple Titleholder): 4= 17r hAiW J AJCO&- Phone#: � �� / 9 T 7 0 Iq Address: ��2 IS C�1MN C3 • City: AlAml naDaz-s State: Rr Zip: 331 Tenant/Lessee Name: Phon Email: CONTRACTOR:Company Name:_4110 f jdGL PoW f i 1104AS!, Phon : 305- ;WO—00 L4 1 Address: 1 + City: IM i(1t'1'v� V,State: Zip: Qualifier Name: cit•i Wex rno !4rm, Phone#: State Certification or Registration#: L?C-i 31 ® U Certificate of Competency#: DESIGNER:Architect/Engineer: Phonel: Address: City: State: Zip: i Value of Work for this Permit: i Square/Linear Footage of Work: /® Type of Work: ❑ Addition EZI'Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: Specify color of color thru tile: Submittal Fee$ (3�N Permit Fee CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond TOTAL FEE NOW I UE$_ 9 (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 OW ER or AGENT C TRACTOR The foregoing instrument was acknowledged before me this The foregoi g instrument was acknowledged before me this day of (Or ,20 l,Q— ,by day of 'e w,6 20 o by N: 12 : A�k�1� ,who i know I Pr r� w-(who is personally kno in��to me or who has produced as me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY U4BLIC: Sign: x-L Sign Print: Print: G � �' Seal: My Commiss�n FF 081441 Seal: „pf/frf� oftCa L% Expim01WI2018 �ry+� 4C �► 0�� ' WMA"V.= ******************************************* *******************sus' APPROVED B, _ _ � w, Plans Examiner - Zoning J Structural Review Clerk (Revised02/24/2014) Florida Department of Agriculture and Consumer Services Division of Consumer Services 2005 Apalachee Parkway Tallahassee, Florida 32399-6500 Master Qualifier Mailing Address Licensed ocation Address GUILLERMO HERNANDEZ FLORIDA POWER HOUSE, INC FLORIDA POWER HOUSE, INC 12300 SW 117TH CT 12300 SW 117TH CT MIAMI, FL 33186-3919 MIAMI, FL 33186-3919 Certificate Number License Number 24066 27606 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 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 Division of Consumer Services 2005 Apalachee Parkway Tallahassee, Florida 32399-6500 ------------------------------------------------------ Cut Here State of Florida Department of Agriculture and Consumer Services Division of Consumer Services certificate No: zaoss Bureau of Liquefied Petroleum Gas Inspection Exam Date: February 18,2009 :3 (850) 921-1600 ue Date: January 18,2015 Expiration Date: January 17,2018 Tallahassee, Florida Exam: 0803 MASTER QUALIFIER CERTIFICATE, (NON-DESIGNATED) This Certificate is issued under authority of Section 527.02, Florida Statutes,to: GUILLERMO HERNANDEZ Valid For License Number: 27606 FLORIDA POWER HOUSE.INC A I.PUTN M MIAMI.FL FL 3311TH 86-3919 11CT COMMISSIONER OF AGRICULTURE MIAMI. Florida Department of Agriculture and Consumer Services P.O. Box 6700 Tallahassee, Florida 32399-6700 License Number: 27606 Business Mailing Address Licensed Location Address FLORIDA POWER HOUSE,INC FLORIDA POWER MOUSE,INC 12300 SW 117TH CT 12300 SW 117TH CT 12300 SW 117TH CT MIAMI,FL 331W3919 MIAMI,FL 33186-3 19 The liquefied petroieum gas license at the bottom of this form is valid ONLY for the company located at the address oil the license. Eact._business location of a company must be licensed. All LP Gas licenses must be renewed annually. Any license allowec.to Expire 8_81 2corni mopsiati`e becaoSB Jf llm e re t_ie.ew, The for restoration of a license is equal to the original license fee and must be paid before the licensee nay 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,i maintaining or installing LP Gas systems and/or equipment. For future correspondence,please make any needed corrections or changes to your business nailing address and/or your licensed location address and return the UPPER PORTION with corrections to: Florida Department of Agriculture and Consumer Services P.O. Box 6700 Tallahassee, Florida 32399-6700 Cut Here State of Florida Department of Agriculture and Consumer Services Division Of Consumer Services License Nun*erC 276M 7 Bureau of Liquefied Petroleum Gas Inspection E*plradon Dane: August 31,2016 850 921-1600 Date of Issue: September 1,2015 License Fee: $200.00 POST LICENSE Tallahassee, Florida Type and Class: 0408 CONSPICUOUSLY Liquefied Petroleum Gas License SPECIALTY INSTALLER C -APPLIANCES, EQUIPMENT AND PIPING 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: FLORIDA POWER HOUSE, INC , 12300 SW 117TH CT ADAM H.PUTNAM MIAMI, FL 33186-3919 COMMISSIONER OF AGRICULTURE 001229 _ fs7 Mi'l. r'- A OWNS" SEC.TYPE OF B _ PAYMENT HECENBU- FLORIO/l P 1WER HOUSE INC 2115 LPG tNSTALL< BV T"� t.t LPG27608 $lb0.00 09/04/2015 DITCARD-15-1144200 Tb�Bosittesa389� i ' '� Pt asbc Tba Racer �a a�a lia��, Re�}alt.s►rardflcaliide bald IRcaHa Hotdar � ny®overdmemal 1 ►lX+►ifa�pn►eafel[ u18mry i r the bum the AE b-pt N 0.ebovamtmi bad bn all cos aeroial � �s iia a-238 FortB Tritiatioa,.iia owls js 5995304 BUSINESS t>tnEhbc:iTitllst : A ct FLORIDA POWER 13�UN- INr, � y OPERATOM IN DRi31=C;Ouwfyft r Aauaae of bis MU►fUli FL 399 #o x�A�Art:�:$E'li3 OWNER SEC.TYPE OF B P.4YMBNT R@CHNED FLORIDA'OWER HOUSE INC 220 TANGIBLE PE# 1 lA1 P1 'DLR PY ME BECEME Employee(s) 0 $75.00 09/04/2015 CREDITCARD-15-094200 TMsiBa�►�essTa�teipton� lr�naPeY � Y�nsimssTax Tba;R�e IanotaU�ae, pelf�ar�:certiRi�beboldar' Hioau .Hobbt � any8over�,�m1 ar otal regofatory laarsra9lairami 1a�pYgto 9be buala6ea. 'the i[EcevrNo.snare resat be aiapl��redon all aoattharotal vai�tcles- s For�uDrefi�tlimatian,viaff�sir�rmiam! a�feetmr ��•� FLORII1 OP ID:AN ACORO' CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) 11/23/2015 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 endarsement(s). PRODUCER cCOONNT CT Annmarie McCartn y MDW Insurance Group Inc PHONE 305-444-2324 FAX 305-444-4980 362 Minorca Ave A/c No Ext): Arc No Coral Gables,FL 33134 E-MAIL DRIESS:amccartney@mdwinsurance.com Donald W McCartney _ INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Granada Insurance Company 1109730 INSURED Florida Power House Inc INSURER B:FCCI Insurance Group 12300 SW 117 Ct. Miami,FL 33186 INSURER C: INSURER D: 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 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 POLICY EFF POLICY EXP LIMITS LTR I POLICY NUMBER MM/DD MM/DD A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 CLAIMS-MADE �OCCUR 0188FL00015272 08/26/2015 08/26/2016 PREMISES(Ea occurrence $ 100,00 __. MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRO- JECT LOC PRODUCTS-COM P/OPAGG $ IncludedPOLICY PRO- OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Alia accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ NON-OWNED ! PROPERTY DAMAGE $ HIRED AUTOS _ AUTOS jeer accident $ UMBRELLA LIAB OCCUR j EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED 1 1 RETENTION$ TH-PER $ WORKERS COMPENSATION O AND EMPLOYERS'LIABILITY Y/N � _.._.._STATUTE 11—._ ___....._.._— B ANY PROPRIETOR/PARTNER/EXECUTIVE I001WC1SA72072 03/22/2015 03/22/2016 _E.L.EACH ACCIDENT $ 1,000,00 OFFICER/MEMBER EXCLUDED? El N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,00 If yes,describe under DESCRIPTION OF OPERATIONS belowE.L.DISEASE-POLICY LIMIT $ 1,000,00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) RE:License#LPG27606 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 g ACCORDANCE WITH THE POLICY PROVISIONS. Building Department 10050 NE 2nd Ave Miami Shores,FL 33138 AUTHORIZED REPRESENTATIVE A0. @ 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 26(2014/01) The ACORD name and logo are registered marks of ACORD