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PL-10-1038Project Address 10562 NE 4 Avenue Miami Shores, FL 33138- 1122310130210 Block: Lot: THOMAS L GARRIGAN i Owner Information Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Address Parcel Number Phone THOMAS L GARRIGAN 10562 NE 4 AVE MIAMI SHORES FL 33138 -2014 (786)269 -5871 i Contractor(s) GAS CONNECTION, INC Phone Cell Phone Type of Work: SPACE HEATER VENT Type of Piping: VENT Additional Info: FIRE PLACE GAS VENT Bond Return : Classification: Residential Scanning: 0 Fees Due CCF Education Surcharge Miscellaneous Fee Permit Fee - Additions/Alterations Technology Fee Total: Amount $0.60 $0.20 $3.00 $100.00 $0.80 $104.60 Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy Pay Date Pay Type Amt Paid Amt Due Invoice # PL -6 -10 -38134 06/11/2010 Check #: 4061 $ 54.60 $ 50.00 06/08/2010 Check #: 4057 $ 50.00 $ 0.00 Applicant Date Cell Available Inspections: Inspection Type: Final Press Test ROW 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 do the work stated. June 11, 2010 June 11, 2010 1 Email (Iio /►o /Nibe Job Address (where the work is being done) FOLIO / PARCEL # PIa 2 3 it) / 3 OR to Is Building Historically Designated YES Contractor's Address City / CPOt; State Qualifier Name State Certificate or Registration No. c2 3 9 6 S` Contact Phone (3.P..6") 95 Value of Work For this Permit $ 350 U■ Type of Work: ❑flAddition Describe Wor / k: �, Submittal Fen/ 50 • C l7 IVO Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION FBC 20 Permit Type: PLUMBING / Owner's Name (Fee Simple Titleholder) ✓f�d/t°fas C c /', Co- Rhone # Owner's Address /o (6 Z ,(/E City MI aft; TA Q /PJ State Pl Zip Tenant/Lessee Name A-#I4 Phone # City • Miami Shores Village County Miami -Dade Contractor's Company Name 69.1 red-i/vec. .2l o 4 /42 A'.A, Ali 'e' ❑Alteration /k ei." M 'moo Permit Fee $ 0.40 Phone # Permit No, /0 f(2. /tit 4aCft Zip 3 ,2/ .? CCF $ ©(oD CO /CC $ Notary $ Training/Education Fee $ Scanning $ 4 Radon $ DPBR $ Double Fee $ Violation date: 544(1) Structural Review. $ Total Fee Now Due $ J ECERVisn g JUN 0 ?11; NJ BY: . PLUD H oBu Master Permit No. / 3U r ),r7-2, J 1 ?/ 2 , gam` hi- NO ' Flood Zone 30r 7 - -ecezo Zip .??/ 4 ,'-- /?- Phone #(3-2 c) 5 - 2 Z Certificate of Competency No. , F Pd ®o 55 3 E -mail 5a5' c eie7 Q7 ca 3 3 04re/%reX7`6 we-7 Architect/Engineer's Name (if applicable) /VA Phone # Square / Linear Footage Of Work: ['New ❑ Repair/Replace ❑ Demolition �1 ******** * * * * * * * * * * * * * * * * * * * * * * * * * * * **** F *** * * * * * * * * * * * * * * * * * * * ** * * * * * ** Technology Fee $ Bond $ See Reverse side -* 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 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 Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a rei ction fee will be charged. Signature Contractor e foregoing instrument was acknowledged before me this 54 , of ,20 ,9•t/'tx /f. '97 Signature Sign: Print: My Commi Owner or Agent The foregoing instrument was ac day of 5 , 20/ ( D, by owledged before 13Q this YVIOS who is ersonally to me or who has produced 62- `' + As identification and who did take an oath. (Revised 07 /10 /07)(Revised 06/10/2009) Engineer who is personally known to me or duced „� �� v ,FAJAR, 4 as identitio . �+ i" Ice an oath. . ( 0,0m/04/4 . .. NOTARY PUBLIg r +$ 2 49, 0 i • VA 1 Sign: ' / � � • o i. i ce \ Print: O / 7�® 4l%e Alt My Commission Expires: � Ifoi iiiiiii t * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** ******************************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** APPROVED BY e "I"'"Plans Examiner Zoning Clerk checked Class Category Category Description Expiration Date PLUM I 2 GAS FITTING 09/30/2011 Miami -Dade County - Building Code Compliance Office Page 1 of 1 Home I Product Control I Contractors Building Officials I Contact us Contractor License Information 01P000553 GAS CONNECTION INC 462 NE 146 TERR NORTH MIAMI (305) 940 -8820 Contractor Number: Contractor name: Address: City, St, Zip: Phone: Other Phone: Fax: Email: D/B/A: Contractor Status: WOW ACTIVE CONTRACTOR INQUIRY COMPLETE BCCO Contractor Inquiry and Complaint Search I BCCO Home Pace I State License Search Menu Home I Usina Our Site I About I Phone Directory I Privacy I Disclaimer E -mail your comments or questions to BCCO © 2001 Miami -Dade County. All rights reserved. FL 331612128 http: / /egvsys. metro- dade.com: 1608 / WWWSERV /ggvtBNZAW941.DIA ?CNTR= 01P000553 6/8/2010 CHARLES H. BRONSON COMMISSIONER OF AGRICULTURE CT Construction Trades Qualifying Board BUSINESS CERTIFICATE OF COMPETENCY 01 P000553 GAS CONNECTION INC Jai "ii D.B.A.: Alb MANUEL Is certified under the provisions of Chapter 10 of Miami -Dade County VALID F CONTRACTI (SID° JTIL.09!30!20jI State of Florida Bureau of LP GasJnspection , f ...' 6ERTfF!CATIE OF F X AM MAT! ON Manuel M. Ato 08 -03 LP Gas Installer A This qualifier Identification card is evidence that this person has passea a competency examination administered by the State of Florida, and may act as QUALIFIER for an LP gas company. licensed in the category above pursuant to Chapter 527, Florida Statutes. This -card is NOT A LICENSE TO DO BUSINESS IN THE STATE OF FLORIDA. •i' CERT NO: 23965. ryi Expicp' Oct. 22, 2010 ?s • MIAMI DADECOU ':;TAX COLLECTOR' 340 W FLA ; xr. at FLOOR MV Y- • aX�" K ,�" 'dam r �h'�. ' .+ `� n S EE.BACK OF RECEIPt,FOR v :L'IST4OFNON PARTI ` - ,MUNICIPAL MJJNICIPA1- CO INTRACT Ft' , `" T A C RECEIPT' '€ II DADS ;CQy1V TY OT ATE O S J P R , ? 2010 0�20t.Q OT A -BII' t • �RECEIPT,; N1AY DO 4 BUSINESS AS A CONTRACT CBIPT`N " , BUSIN ESS NAM tOC N t,0 CONNE IN C` � 4462�NE146 'TERR R 1 G AS C OW OW NE i ecelpt holder M14 u in tha city_ where Mork is to be IS10R i`Is�`4 .r_d;. 02 : 001200 000 "00 MIAMI -DADS COU .'TAX COLLECTOR x, -140 W. FLAGLER ST. '1st FLOOR MIAMI, FL 33130 13452 __ BUSINESS _NAME AMR GAS CO NNECTION ZINC ;E 462.'NE.. TERR• IT.- '33161;UNIN DADE 000NT S CONN 'IN See T ' Business _SPEGIAL.TY PLUMBING CON 11119' 18'ONLY .A LOCAL " BUSINESS TAX RECEIPT. 1 1.. - HOLDER TO VIOLATE ANY EXISTING REGULATORY OR ZONING LAWS OF. THE " COUNTY OR CITIES. NOR DOES : IT • EXEMPT ''•THE HOLDER FROM ANY OTHER • . PERMIT OR_ • UCENSE'- REQUIRED BY LAW. THIS IS' NOT A CERTIFICATION OF, THE HOLDER'S QUAUFICA r llcrts 4 �� r�r t ' (PAYMENT RECEIVED. ,"• - IMAM- DADECOUNTYAX' T' COLLECTOR: ;- s ! r' �' • t s.1 -w��'. 4 , ;08/05/2009 102280032002 000075`00 SEE OTHER SIDE DO NOT FORWARD GAS CONNECTION INC MANUEL M ATO PRES 462 NE 146 TERR MIAMI FL 33161 1,111, 1111111 11111111 11 lit 1,111111 „ 1 II 111k 111 LOCAL 'BUSINESS TAX RECEIPT IAMI DADE COUNTY STATE OF. FLORID ;t ± EXPIRES SEPT. 30, 2010 •MUST BE DISPLAYED AT PLACE OF BUSINESS PURSUANT. TO COUNTY CODE CHAPTER 8A - ART. 9. & i" GAS CONNECTION INC MANUEL M ATO PRES 462 NE 146 TERR MIAMI FL 33161 1 „11,1111,,,,11111 Il „1, 1,,,11,,,1,11,11 „11,,,11,111, DO NOT FORWARD FIRST=CCASSS 1J,3 POSTA ICE PAID:'' 3 MIAMI,;FL W PERMIT NI0 231? .___..' ^'1 . Ro ® ' CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YY) 05/28/10 PRODUCER Annette Willis Insurance 18401 N.W. 27 Ave Miami, FL 33056 Phone (305)625 -2403 Fax (305)625 -6472 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLIC ES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED GAS CONNECTION, INC 462 N E 146 TERR MIAMI, FL 33161- I INSURER A: PENN - AMERICA INSURANCE INSURER B: KINGSWAY AMIGO INSURANCE INSURER C: INSURER D: INSURER E: COVERAGES INSURER F: THE POLICIES OF INSURANCE LISTED 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 LTR ADD'L can -IQ o O Li TYPE OF INSURANCE GENERAL LIABILITY v COMMERCIAL GENERAL LIABILITY ❑ ❑ CLAIMS MADE [] OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: EI POLICY III PROJECT ❑ LOC POLICY NUMBER PAC6853123 POLICY EFFECTIVE DATE (MMIDDIYY) 05/25/10 POLICY EXPIRATION DATE (MM /DDNY) 05/25/11 LIMITS EACH OCCURRENCE 1,000,000 DAMAGE S (Ea PREMISES (Ea occurence) 50,000 MED EXP (Any one person) 5,000 PERSONAL & ADV INJURY 1,000,000 • ! GENERAL AGGREGATE 1,000,000 PRODUCTS - COMP /OP AGG 1,000,000 B ❑ AUTOMOBILE LIABILITY ❑ ANY AUTO ❑ ALL OWNED AUTOS V SCHEDULED AUTOS ❑ HIRED AUTOS ❑ NON OWNED AUTOS ❑ UM 10/20 CA- 110332 -00 09/23/09 09/23/10 COMBINED SINGLE LIMIT (Ea accident) BODILY INJURY (Per person) 10,000 BODILY INJURY (Per accident) 20,000 PROPERTY DAMAGE (Per accident) 10,000 n ❑ GARAGE LIABILITY ❑ ANY AUTO ❑ AUTO ONLY - EA ACCIDENT OTHER THAN EA ACC AUTO ONLY: AGG ❑ EXCESS /UMBRELLA LIABILITY ❑ OCCUR U CLAIMS MADE ❑ DEDUCTIBLE ❑ RETENTION $ EACH OCCURRENCE I AGGREGATE WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR / PARTNER / EXECUTIVE OFFICER / MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below ' P WC STATU- n OTH- TORY_LIMIIS ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE 1 E.L. DISEASE - POLICY LIMIT OTHER L____ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS , CERTIFICATE HOLDER .ACORD 25 (2001/08) QF MIAMI SHORE VILLAGE BLDG. DEPARTMENT 10050 N E 2ND AVENUE MIAMI SHORES, FL 331382382 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE © ACORD CORPORATION 1988 ALEX SINK CHIEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * * 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: 08/13/2009 EXPIRATION DATE: 08/13/2011 PERSON: ATO MANUEL M FEIN: 650851684 BUSINESS NAME AND ADDRESS: GAS CONNECTION INC 462 NE 146TH TERRACE MIAMI FL 33161 SCOPES OF BUSINESS OR TRADE: 1- GAS /ELEC APPLIANCE INST (3724) IMPORTANT: Pursuant to Chapter 440 . 05(14), 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 440.05(12), 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 NC -252 CERTIFICATE OF ELECTION TO tBE EXEMPT REVISED 09 -06 08- 13-2009