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PL-16-997Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 (2C- (S-( sem`l nspection Number: INSP-256874 Permit Number: PL -4-16-997 Inspection Date: April 27, 2016 Inspector: Hernandez, Rafael Owner: UKAZIM, UCHENNA Job Address: 960 NE 97 Street Miami Shores, FL 33138 - Project: <NONE> Contractor: GARCA GROUP LLC Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Gas Phone Number (561)901-3471 Parcel Number 1132060143160 Building Department Comments GAS PIPE INSTALLATION FROM PROPANE TANK TO 2 APPLIANCES. lnfractio Passed Comments INSPECTOR COMMENTS False Passed rxi Inspector Comments Failed Correction Needed Re -Inspection Fee No Additional Inspections can be scheduled re -inspection fee is paid. until Coss. InQnnw+i"nt /4nG%7C7 AAAA GA RCA GROUP, LLC.® GAS t'LUMI lNG TECHNOLOGIES YOL 1 . PROPA?JEAN D. NATKRAL C• AS . 0Lt4TION P.O. BOX 651468, MIAMI, FLORIDA 33265 DIRECT 305-303-4733 - FAX 305-402-3888 - E-MAIL gasptech@aol.com ADDRESS G F O3 mi cJh o (e S F J t??,? PERMIT NUMBER 7'C -41/ 99 3 THIS SYSTEM HAS BEEN MANOMETER TESTED FOR 15 MINUTES. t START INCHES W.C. " FINISH /l INCHES W.C. INSTALLER' %i Name DATE 0 1//ao%� This installation will meet all Florida Statutes 527.06 LP Division rule 4B-1.01 The South Florida Bldg. code NFPA 54, NFPA 58, and regulations of The State Fire Marshall QUALIFIER t%9 o Number C ? a 33�d' w A .. A a S A AAA A a ,••"r"n"'' FLAVIA M. RIBOT REYE Notary Public - State of •'�5 My Comm. Expires °:" Commission # 'O t�` Bonded Through Nation Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Project Address 960 NE 97 Street Miami Shores, FL 33138 - Permit NO. PL -4-16-997 ■ Permit Type: Plumbing - Residential ' Work Classification: Gas Permit Status: APPROVED Issue Date: 4/19/2016 Expiration: 10/16/2016 Parcel Number ............._.................................... 1132060143160 Block: Lot: Applicant UCHENNA UKAZIM Owner Information Address 960 NE 97 Street MIAMI SHORES FL 33138- 960 NE 97 Street MIAMI SHORES FL 33138- Phone CeII Contractor(s) GARCA GROUP LLC Phone CeII Phone Valuation: Total Sq Feet: $ 2,890.00 0 Type of Work: GAS PIPE INSTALLATION FROM PROPANE Type of Piping: Additional Info: Bond Return : Classification: Residential Scanning: 1 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Notary Fee: +� Permit Free Scanning ii ee Technology Fee Total: Amount $1.80 $2.25 $2.25 $0.60 $5.00 $150.00 $3.00 $2.40 $167.30 F-+ Pay Date Pay Type Invoice # PL -4-16-59404 04/14/2016 Credit Card 04/19/2016 Credit Card Amt Paid Amt Due $ 50.00 $ 117.30 $ 117.30 $ 0.00 Available Inspections: Inspection Type: Final Press Test Review Plumbing 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 pertainingthereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting�tNis permit 1 assu e responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for:ELECTRICAL, PL BING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS:'AFFIDAVIT: 1 certify e foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futh=.m. e, 1 horize the above-named contractor to do the work stated. Authorized Signature. Applicant / Contractor / Agent Building Depa m April 19, 2016 Date April 19, 2016 1 J9) BUILDING PERMIT APPLICATION 0BUILDING ❑ ELECTRIC Miami Shores Village Budding 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 ❑ ROOFING PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS JOB ADDRESS: O t E 0) 5T c. tk)1/4-1 ►�^� RIVED R 14 2016 FBC201U Master Permit No. ( 5- - 58 v, Sub Permit No. T U 6 - ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑ CHANGE OF CONTRACTOR ❑ CANCELLATION ❑ SHOP DRAWINGS City: Miami Shores County: Folio/Parcel#: Occupancy Type: Load: Miami Dade Zip: 33 (3e Is the Building Historically Designated: Yes NO fr BFE: FFE: `75--L) '''s2 -2,-:12.s— 6 Phone#: (51\ 10 1 'I - Construction Type: Flood Zone: OWNER: Name (Fee Simple Titleholder): UC +�J Address: I 0 1 5 City: l �-'6"A N 5 f$O.& TS State: Tenant/Lessee Name: Email: U AA a cryIC`1 1 CONTRACTOR: Company Name: GiPelCfi 6 eco) , LLC- Address: % 3$Cl M v4 54 E het City: M 1 k4 M State: FL -- Qualifier LQualifier Name: 7 Jit_ J . • r (G U Phone#: Zip: '3"313. Phone#: —) O 1 — 3 49-) Phone#: ZOS— 424 —g(p 42 State Certification or Registration #: L 02 3 �9 ' (a 0 DES' c-►+� r"SOO COUL INIS 6'\Vt,I sU1 I G 2 2 v Value of Work for this Permit: $ c ?, U ( 0 • DESIGNER: Architect/Engineer: Address: Zip: 331 licit? Certificate of Competency #: •. Phone#: 3o S 14o S s City: Sk-laf rJ 1 S 3 State:41- Zip: X31 6 a Square/Linear Footage of Work: Type of Work: ❑ Addition [`T Alteration ❑ New Description of Work: ❑ Repair/Replace ❑ Demolition C-, PTS Pw�► 8 �,ss c‘ \ T. G A s ' � Pc (NS—TA.UA (1 G�.1 ,--F\2_3 6TA2 4 1 L1R-Nc S'. Specify color of color thru tile: Submittal Fee $ b0 6 Permit Fee $ _ Radon Fee $ Scanning Fee $ , Ci Technology Fee $ - q 0 Structural Reviews $ (Revised02/24/2014) Training/Education Fee '$ CCF$ •c9D DBPR $ a2g CO/CC $ Notary$ 5 - Double Fee $ Bond $ TOTAL FEE NOW DUE $ ! ( `,� Bonding Company's Name (if applicable) -- •�� Bonding Company's Address City , ri 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 OWNER or AGENT The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day o Q—t l__ , 20 f'cz by 1344^ day of �, , 20 1(4 , by tt .a�-1 (�Q 19 (� O{SI Nca � (M , v7F10 Is personally known to ikkefa V i r , who is personally known to Signature me or who has produced FL-. pet V L (0 me or who has produced -by identification and who did take an oath. NOTARY PUBLIC: identification and who did take an oath. NOTARY PUBLIC: 410 Sig ��� Signo. 1It• Print: ( ND LA Print: AV I A t`iV-111). $ { as s a S Shwa s ... Seal: 80" k°G Notary Public State of Florida SealFLAVIA M. RIBOT REYES 11 Sindia Alvarez 404;e'%, is .1; My Commission FF 156750 �2° '`� �C' Notary Public State of 10 coo Expires 09/03/2018 •� �� `c My Comm. Expire ay Commission # *************************** *******************************#k„...r A� o® CERTIFICATE OF LIABILITY INSURANCE . DATE(MM/DD/YYYY) 03/18/2016 ISI 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(ies) 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 Anchor Underwriters Inc. 10350 SW 50th Street Miami, FL 33165 ICI AMEACT Flavia M. Ribot Reyes PHONE o, Ext): 305-239-8996 FAX(A//C No): 305-239-8988 AD E-MAIL info@anchorunderwriters.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Nautilus Insurance Company COMMERCIAL GENERAL LIABILITY 17370 31470 INSURED Garca Group LLC dba Gas Plumbing Technologies PO BOX 651468 Miami FL 33165 INSURER B : NorGUARD Insurance Company INSURERC: 03/16/2017 INSURER D : $ 1,000,000 INSURER E : INSURER F : X 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 LTR TYPE OF INSURANCE I NSD SUBR WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY BN963991 03/15/2016 03/16/2017 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GE X 'L AGGREGATE POLICY OTHER: LIMIT APPLIES PR PER: LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 BI/PD Deductible $ 1,000 AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS SCHEDULED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ A X UMBRELLA UAB EXCESS LIAB OCCUR CLAIMS -MADE AN026522 03/15/2016 03/16/2017 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 2,000,000 DED RETENTION $ $ B WORKERS COMPENSATION EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N s, T N / A GAWC700117 02/15/2016 02/15/2017 X PER STATUTE OTH- ER ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1 ,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) *********************************PLUMBING NOC & DRIVERS************************************************ License # 23823 CERTIFICATE HOLDER CANCELLATION Miami Shores 10050 NE 2nd Ave Miami Shore, 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 ACORD 25 (2014/01) © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD