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PL-13-100905-31-'13 06;24 FROM- T-473 P0001/0004 F-456 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795,2204 Fax: (305)756-8972 Inspection Number: INSP-191155 Permit Number: PL -5-13-1009 Scheduled Inspection Date: May 30, 2013 Permit Type: Plumbing - Residential Inspector: Hernandez, Rafael Inspection Type: Final Owner: TIMS, DONALD & MELANIE Work Classification: Gas Job Address: 301 NE 93 Street Miami ,Shores, FL 33138 - Project: <NONE> Contractor: GARCA GROUP LLC Comments Phone Number Parcel Number 1132060136230 GAS PIPE LINE INSTALLATION FROM LP TANK TO infractio Passed comments RANGE I INSPECTOR COMMENTS False Inspector Comments Passed Failed Ll Correction Needed Re -Inspection Fee No Additional inspections can be scheduled until re -inspection fee is paid. May 29, 2013 For Inspections please call: (305)762.4949 Page 6 of 18 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: (3057 762.4949 BUILDING PERMIT APPLICATION Permit Type: PLUMBING JOB ADDRESS: 3�1 NG q3 mi sfyee"I - MAY 0 9 M3 Y�': �I FBC 20 Permit No. I f 1 j 0M Master Permit No. FA 2 City: Miami Shores County: Miami Dade zip: .5-3138 Folio/Parcel#: Is the Building Historically Designated: Yes NO x Flood Zone: K OWNER: Name (Fee Simple Titleholder): DONA -D xot4N -rim's Phone#: ij&o —912. -0001 - Address: 301 NE 9-3v" G-} e — City: M A lam! I 5'tto o -e-1 State: FL' zip: 3 313 f? Tenant/Lessee Name: Email: J'1 Q V wr%M CONTRACTOR: Company Name: G4A,,„ ,, �Q ?, i -Z- C- Phone#: 30G -303 -47'� Address: 9 p1(a() SW a," Sl i kz City: tA t MA %' State: zip: Qualifier Name: �1% 9-GrK VW --0 Phone#: 30 3 747�53 State Certification or Registration #: 3 eZ 3 Certificate of Competency #: Contact Phone#: 3o E - 303 — 9 } 3 3 Email Address: 9?AS PTUCA P, &0 L • Qn"M DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $_ . TYPe of Work QAddress , . . Description of Worm Submittal Fee Scanning Fee $ Permit Fee $ /Joe Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ ./Linear Footage of _r ORep*/Replace• CCF $ CO/CC $ DBPR $ Bond $ Technology Fee $ ODemolition TOTAL FEE NOW DUE $ ' 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 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 ofcom encement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. I .the absence of such posted notice, the inspection will n e d and a reinspection fee will be charged. a Signature Signature or Ag retractor The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of , 20 13, by day of 4 , 20 3 by kPau, who is personally known to me or who ha roduced who is personally known to me or who has prluced Sign: As identification and who did take an oath. LEONOR as identification and who did take an oath. NOTARY PIALIC: Sign: ' Print: ��T , r°, e�� : ADRIXNA LEONOR CLAVIJO MAORI My C sion Expire ;t9 0; My Comm. Expires Mar 2, 2014 My Co ssion Ex ,�;, MY Comm. Expires Mar 2, 2014 111 � ��q:�•` Commission i DD !67123 ' %,,,°F �;;tp••` Commission # DD 967123 APPROVED BY -Plans Examiner Zoning f - Structural Review Clerk (Revised3/12/2012)(Revised 07/10/07)(Revised 06/10/2009XRevised 3/15/09) �► '� CERTIFICATE OF LIABILITY INSURANCE 1>y,�,�• DAT 05/09/2013 05/09/2 13 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 pollcy(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 A&A Underwriters, Inc. 8796 SW 8 St Miami, R 33174 CONTACT NAME: Pablo M. Conde PHONE 305-220-7447 � N.)- 305-220-4821 ADDRESS: pmc@aaunderwritem.com INSURER(S) AFFORDING COVERAGE NAICII INSURERA: Scottsdale Insurance company 41297 INSURED Garca Group LLC DBA Gas Plumbing Technologies PO BOX 651468 Miami FL 33165 INSURERS: Progressive 10193 iNsuRERc: Scottsdale Insurance Company 41297 tNsuRERD: RetailFirst 10700 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. INTER TYPE OF INSURANCE ADDL POLICY NUMBER EFF POLICDY EXP LIIVOTS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OX OCCUR CPS1708594 03/14/2013 03/14/2014 EACH OCCURRENCE $ 1,000,000 -GWME TO RENTED PREMISES Ea oc Larence $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEHLAGGREGATE LIMIT APPLIES PER X POLICY JET LOC OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGC, $ 1,000,000 Deductible $ 1,000 B AUTOMOBILELUIBRnY X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NONHIREDAUTOS AUTOS 02085017-0 02/25/2013 02/25/2014 COMBINED SINGL LIMIT $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPS lyn Aj GE $ PIP $ 10,000 C' X UMBRELLA LIAB EXCESSLIM X OCCUR CLAIMS -MADE XBS0028206 02/01/201303/14/2014 EACH OCCURRENCE $ 3,000,000 AGGREGATE $ 3,000,000 DED RETENTION $ $ D WORItERS COMPENSATION AND EMPLOYERS LIABILITY YIN ANY PROPRIETOR/PARTNER/EKECUTIVE OFFICER/MEMBER EXCLUDED? ❑Y PManddM In NH) K yyaap�, desaibe under DESCJPTIONOFOPERATIONSE aw N / A Y 520-43901 02/15/2013 02/15/2014 X PER STAME ER E.LEACH ACCIDENT $ 1,000,000 EL DISEASE - EA EMPLOY $ 1,000,000 E.LDISEASE- POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached K more space Is required) Miami Shores Village 10050 NE 2nd Ave Miami Shores, FL 33138 ACORD 25 (2013/04) I lV li SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORDED REPRESENTATIVE ©198&2013 ACORD CORPORATION_ All rinhtc na r arl The ACORD name and logo are registered marks of ACORD PDF created with pdfFactory Pro trial version www.pdffactory.com I GARCA GKUUr ILLS 2428 SW PL NID 33165 UNI ADE COUNTY OWNER AR 6 Bss�a ss LLC Sec` ER/DISTR/INSTALLATION THIS Is ZO AD BUSINESS TAX RECEIPT. IT DOES NOT PERMIT THE HOLDER TO VIOLATE ANY REGULATORY OR �® NOT FORWARDEXISTING, ZONING LAWS OF THE COUNTY OR CITIES. NOR DOES IT EXEMPT THE HOLDER FROR AN LICENSE PERMIT REQUIRED BY LAW. THIS IS GARCA GROUP LL NOT A CERTIFICATION ,cu.lc THE HOLDER YUREK VIGO TIONS. p 0 BOX 651468 PAYMENT RECEIVED MIAMI FL 33265 NTY TAX MIAMI -DADS COU COLLECTOR: 10/16/2012 09010018001 195 000495.00 QFr- CITHER SIDE Florida Department of Agriculture and Consumer Services Bureau of Liquefied Petroleum Gas Inspection P.O. Box 6700 Tallahassee, Florida 32399-6700 License Number. 23823 Business Mailing Address GARCA GROUP, LLC PO BOX 651488 MIAMI, FL 33265-1468 Licensed Location Address GARCA GROUP, LLC 9960 SW 37TH ST MIAMI, FL 33165-3990 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 c.Qmpany must be licensed. AILLI? Gas- licenses -must -bay - renewed annually: AnyTtcense allowed to expire shall become inoperative because of failure to renew. The W for wtoration of a licon98 ig equal t0 the 8mCinal limw 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 (1350) 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, 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 0 glate of Florida r - Department of Agriculture and Consumer Services Division -of Consumer Services License Number. 23823 '� Bureau of Liquefied Petroleum Gas Inspection Expiration Date: August 31, 2013 850) 921-1600 Date of Issue: September 1, 2012 POST LICENSE License Fee: $200.00 CONSPICUOUSLY Tallahassee, Florida Type and Class: 0803 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: GARCA GROUP, LLC r .+ 9980 SW 37TH ST ADAM H. PUTNAM MIAMI, FL 33165- 3990 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 Master Qualifier Mailing Address GARCA GROUP, LLC PO BOX 651468 MIAMI, FL 33265-1468 Certificate Number 23368 Licensed Location Address GARCA GROUP, LLC 2428 SW 113TH PL MIAMI, FL 33165-2258 License Number 23823 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 (3as Inspection at (850) 921-8001 immediately. The Master Qualifier Certificate is valid only through the date noted on the Certificate. A notice of reg �ev;►al will be-serlt'to you-In-advanceV, yuur-expirationi date. master Qualifier Cerrificete 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: Qureau 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 Divisiw 8f Standards cerifficate No: 23368 Bureau of Liquefied Petroleum Gac Inspection Exams Date: May 211, 2007 (850) 921-8001 Expiration ue Dae: July 18, 2010 uly 17, 2013 Tallahassee, Florida Exam: 0601 MASTER QUALIFIER CERTIFICATE This Certificate is issued under authority of Section 527.02, Florida Statutes, to: YUREK VIGO Valid For Ucenss Number. 23823 �Jti GARCA GROUP, LLC MAW IF 2428 SW 113TH PL 4ZHAPLE, S H. BR SW MIAMI. FL 33165-2258 COMMISSIONER OF AGRICULTURE