PL-15-2460 Miami Shores Village
10050 N.E.2nd Avenue NE
Miami Shores,FL 33138-0000
Phone: (305)795-2204
Expiration: 0410212016
M1
Project Address Parcel Number Applicant
9105 NE 5 Avenue
1132060141210
ALEJ
ANDRO PINO
Miami Shores, FL 33138- Block: Lot:
Owner Information Address Phone Cell
ALEJANDRO PINO 9105 NE 5 Avenue 305 302-5770
MIAMI SHORES FL 33138- (305)302-5770)
9105 NE 5 Avenue
MIAMI SHORES FL 33138-
Contractor(s) Phone Cell Phone Valuation: $ 2,450.00
GARCA GROUP LLC Total Sq Feet: 00
Type of Work:GAS PIPE INSTALLATION FROM ABOVE GR 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 $1.60 Invoice# PL-9-15-57225
DBPR Fee $2.25 10/05/2015 Credit Card $168.30 $0.00
DCA Fee $2.25
Education Surcharge $0.60
Permit Fee $150.00
Scanning Fee $9.00
Technology Fee $2.40
Total: $168.30
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this pe it I as
responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELEC CAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work.
OWNERS AFFIDAW y that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zormore,I authorize the above-named contractor to do the work stated.
October 05,2015
Authorized :Owner / Applicant / Contractor / Agent Date
Building De a ment Copy
October 05,2015 1
Miami Shores Village
Building Department S P 252015
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 BY: -----
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949
F�IBC 20
BUILDING Master Permit No. `-I f 7ct-AW
PERMIT APPLICATION Sub Permit No �- 21
BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑EXTENSION E]RENEWAL
r-JPLUMBING ❑ MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP
+ CONTRACTOR DRAWINGS
JOB ADDRESS:QI D Iy •S — aT 4W-
City: Miami Shores 'A County: Miami Dade Zip:
Folio/Parcel#:I I•-?r}U,,,,`O—01�r ) c)4 U Is the Building Historically Designated:Yes NO
Occupancy TypAWbad: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Title�h-older):-Ak�►T Phone#��' 3D3-_7g4'D
Address: JARS"N>&i\L Vii•
h �
City: State: Zip:
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR.Company Name.' ILL Phone#:- -4"�Sfp 42.
Address•-I-J� •� 'C
City: State: •0_ Zip: �✓3�`t�
Qualifier Name: Y Phone#::42.$ .-�S104L 4-702.
State Certification or Registration#: Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ro)' Square/Unear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑��R��ep��ai``r/Replace ❑ Demolition
Description of Work
Specify color of color thru We:
Submittal Fee$ Permit Fee$ < �`''� CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$
(Revised02/24/2014)
Florida Department of Agriculture and Consumer Services
Bureau of LiquefiedPetroleum Gas Inspection
3125 Conner Boulevard,Suite E
Tallahassee, Florida 32399-4.6-50'... .
Mester Qualifier Mailing Address Licensed Location Address
YUREK VIGO
GARCA GROUP,LLC GARCA GROUP.LLC
PO BOX 651468 9980 SW 37TH ST
MIAMI,FL 33265-1468 MIAMI,FL 33165-3950
Certificate number License Number ..
23368 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 terrninauon of apioyrrent)must be reetut;rcl to the Bureau of LP Gas Inspection
at(850).921-1600 immediately.
The Master Qualifier Certificate is valid only through the d0ta.nbted-on the Certificate. A notice of
renewal will-be sent to you In advance of your expiration dato. A Master Qualifier Certificate may be
renewedIf certification of a minimum of 16(sixteen)hours continuing education is provided along with
the renewal form. if training cannot be documented,aftexaminlation 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 E
Tallahassee, Florida 32399-1650
Cur Hee
-----------------------------------
State of Florida
Department of Agriculture and Consumer Services
Division of Consumer Services Gertficate No: 23"s
Bureau of Liquefied Petroleum Gas Inspection ExamDaW: ►21,2007
850 921-1600issue Date: J0/18,2M
>. E.xpiradm Date: July 17,2016
Tallahassee, Florida Exam: 0601
ASTER QUALIFIER CERTIFICATE
this Ceruficate is issued under authority of Section 52T.02,Florida Statutes,to:
VUREK VIGO
Land se
� aianber: 23823 _
GARCA GROUP,LLC ADAM H.PUTNAM
8980 SW 3rm ST COML41SSlO M OFAGRICULiUR6
MIAtAr,FL 33165-3990
i
Florida Department of Agriculture and Consumer Services
P.O. Box 6700
Tallahassee, Florida 3239&6700
License Number: 23823
Business Malting Address Licensed Location Address
GARCA GROUP,LLC GARCA GROUP,LLC
PO BOX 651466 YUREK VIGO 7389 NW 54TH ST
MIAMI,FL 33265-1468 MIAMI,FL 33166-4831
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
sannuany. Any licenseaM mw tr.-aacpira shall Mme into :tive be;ause-offailure to rentrii The fee for
restoration of a license isequal to the original license Yee and must Ise paid,before the G 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$50 will apply. To apply for a transfer,contact the
Bureau of LP Gas Inspections at(850)921-1600.
Pursuant to Chapter 527,Florida Statutes,LP Gas licensees must prP.sertt.proof of licensure to any consumer,
owner,or end user upon request when engaged in the business of servicing,testing,repairing,maintaining or
installing LP Gas systems and/or equipment
For future correspondence,please make any needed corrections or changes to your business mailing address
and/or your licensed locatiomaddress and.retum the UPPI iR PORTION with corrections to:
Florida Department of Agriculture and Consumer Services
f P.O. Box 6700
Tallahassee,Florida 32399-6700
Cut Here
- State cif Florida
�J Department of Agriculture and Consumer Services
Division of Consumer Services License Number: 23823
Bureau of Liquefied Petroleum Gas Inspection Expiration Date: August 31,2018
(850)921-1600 Date of Issue: September 1,2015
POST UCIRM Tallahassee, Florida Type an cmc 0603
CONSPICUOUSLY (Liquefied Petroleum-Gas License
LP GAS INSTALLER
GOOD FOR ONE LOCATION ONLY
MY CHANWQF QVVNEWW o,Wsal'E of TPS$V�INESS RENDERs.D0 UCENSE
This Ucemm Is les ped,under authority of Section 527.02,Florida Statutes,to:
GARCA GROUP, LLC
7389 NW 54TH ST a6zdc�e
MIAt1A1, FL 33186-4831
COMMISSIONER OF AGRICULTURE
001612
Local Business Tax Rece;pt
Miami-wade County. State of Florida'
TMS IS NOTA BILL - DO NOT PAY
607935
8Ct81tt168$NAMElLOC4►TiON REC"PT N4 E.flE
15. C GROUPue ` 5 MEMBER 30, 2016
99843 51813'7 ST lylust to displayed at place of business
MWAI R 33165 Pursuant to County Code
Chspter 8A`-ArL 9&10
OWNER BEC.TYPE OF BUSINESS PAYMENT RECEIVED
GARCA GROUP LLC 205 3 EAI ERtDISTF/96TALLATION BY TAX CO LECTOR
$450.00 07/31/2015
CREWCARD-15-039126
Tl�!mel Busiaese Ta>f tietmi Daly- rtns pe t tim Laeai Ba�oess Tax The Becelpt is aot a license,
p ieftaracerWi eilev ofthe ae aims ichappiis. comply
vftmy govemmeolal Q
The RECEIPT N0.abode mast be d1epIqW an all commercial vehWea-Mioml--Qaia Cade Sec Be-ML
Far awe 6dmmethm visit
a
I
® DATE / )AC RUCERTIFICATE OF LIABILITY INSURANCE 0t25/2015
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 Ileu of such endorsement(s).
PRODUCER CONTACT
NAME: Pablo M.Conde
A&A Underwriters, Inc. PHONE 305-220-7447 FAx No:3055-220-4821
8778 SW 8 St pmc@aaunderwrfters.com
Miami, FI 33174 INsu s AFFORDING COVERAGE MAIC#
INSURERA:Nautilus Insurance Company 17370
INSURED INSURER 6:Ma fre Insurance Company of Florida 34932
Garca Group LLC DBA Gas Plumbing Technologies wsuRmc:RetailFirst 10700
PO BOX 651468 INSURER D:
INSURER E
Miami FL 33165 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 A BR POLICY NUMBER POLICY EFF MPS EXP LIMA
X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
-UA—MAGM RENTED
CLAIMAME a
S OCCUR PREMISE Es occurrence) $ 100,000
A BN954178 03/14/2015 03/14/2016 MED EXP(Any one person) $ 5,000
PERSONAL&ADV INJURY $ 1,W0,000
GERL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
X POLICY a JEC F LOC PRODUCTS-COMP/OP AGG $ 1,000,000
OTHER. Deductible $ 1,000
AUTOMOBILE LIABILITY aCOMBINEDNG
ILE LIMIT $ 1,000,000
ANY AUTO BODILY INJURY(Per person) $
B ALL OWNED SCHEDULED 4150130008099 04/12/2015 04/12/2016 BODILY INJURY(Per accident) $
AUTOS AUTOS
X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $
AUTOS Per acddent
P.I.P $ 10,000
X UMBRELLA UAB X OCCUR EACH OCCURRENCE $ 1,000,000
A EXCESSI.IAscLaMSMaoE AN019212 03/14/201503/14/2016 AGATE $ 1,000,000
DED RETENTION$ $
WORKERS COMPENSATION X PER THAND EMPLOYED'LIABILITY YIN -------70
ER
C' ANY PROPRIEfORIPARTNERJEXECUTIVE Y/N 520-43901 02/15/2015 02/15/2016 E.L EACH ACCIDENT $ 1,000,000
OFFICERIMEMBER EXCLUDED? ❑Y N I A
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000
If under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached H more space is required)
GAS PIPE INSTALLATION, SERVICE & REPAIR (PLUMBING)
CERTIFICATE HOLDER CANCELLATION
Miami Shores SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
10050 NE 2nd Ave THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Miami Shore, FL 33138 ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHOREW REPRESENTATIVE �✓�.
®1988-2013 ACORD CORPORATION. All rights reserved.
ACORD 26(2013104) The ACORD name and logo are registered marks of ACORD
4
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$2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In th a Bence of such posted notice, the
Inspection will not be approved and a reinspection fee will be charged.
•
Signature—v-,44& Signature ` -
OWNER or AGENT OR
re
The foregoing instrument was acknowledged before me this The fooing instrument tackkwledged before me this
day of 20 /I> ,by day of 'ems 9 f 20 by
• who is personally knowats- e3f2e.4 0� � ,who is personally known to
asa as
identification and who did take an oath. identification and who did take an oath.
NOTARY P BLIC: NOTARY PUBLIC:
Sig SigIf. B
R
ary til tat
Pri Pri *
* -
Sea =' •= �Y Comm.Expires may S.20 Commission#FF 016324
X59 o-X: Commission#FF 018324 Sea -; moo?;. Bonded Through National Notary Assn•
''• ,°;, `�`' Bonded Through Natlonal Notary Assn.
Besssssssssssssssssssssssssssssssssssssssssssssssssss$ssssssssssssssssssssssssssssssssssssssssssssssssssssss
APPROVED BY G- Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)