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MC-16-1163Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-259690 Permit Number: MC -4-16-1163 Scheduled Inspection Date: June 01, 2016 Permit Type: Mechanical - Residential Inspection Typ Owner: KAWACHIKA, JON & CYNTHIA Work Classif ion: Addition era ion Inspector: Perez, JanPierre Job Address: 179 NE 94 Street Miami Shores, FL 33138 - Project: <NONE> Contractor: TSE AIR CONDITIONER CORP Parce 'umber 1132060132930 Phone: (786)536-8517 Building Department Comments RELOCATE 1 NC VENT, INSTALL 2 BATH EXHAUST FANS Infractio Passed Comments INSPECTOR COMMENTS False Zi(t i6 Inspector Comments Passed Failed Correction Needed Re -Inspection Fee No Additional Inspections can be scheduled until re -inspection fee is paid. May 31, 2016 For Inspections please call: (305)762-4949 Page 19 of 45 Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Parcel Number n: Add APPR Expiration: 11/06/2016 Applicant 179 NE 94 Street Miami Shores, FL 33138- 1132060132930 Block: Lot: JON & CYNTHIA KAWACHIKA Owner Information Address Phone Cell JON & CYNTHIA KAWACHIKA 179 NE 94 Street MIAMI SHORES FL 33138-2821 (305)758-0927 Contractor(s) TSE AIR CONDITIONER CORP Phone Cell Phone (786)536-8517 Valuation: Total Sq Feet: Tons: 0 Additional Info: RELOCATE 1 A/C VENT, INSTALL 2 BATH Classification: Residential Approved: In Review Comments: Date Denied: Scanning: 1 Date Approved:: In Review Type of Work: Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Total: Amount $0.60 $2.25 $2.25 $0.20 $150.00 $3.00 $0.80 $159.10 Pay Date Pay Type Invoice # MC -4-16-59595 05/10/2016 Credit Card 04/29/2016 Credit Card Amt Paid Amt Due $ 109.10 $ 50.00 $ 50.00 $ 0.00 Available Inspections: Inspection Type: Final Rough Duct Review Mechanical Review Mechanical Underground 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 thorize the above-named contractor to do the work stated. Authoriture: Ovine) / Applicant / Contractor / Agent Building Department Copy May 10, 2016 Date May 10, 2016 1 , 1 BUILDING PERMIT APPLICATION Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHOS" " 'MBER: (305) 762-4949 APR 2'9 2016 FBC 20(4 Master Permit No. R C -T -lb- -1 Z.2_ Sub Permit No. 1 (6- 1(6_3 0BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ElRENEWAL ❑PLUMBING k MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: I T°k e 49,={ S 'tY± City: Miami Shores County: Miami Dade Zip: '3 3 ( 3 5( Folio/Parcel#: 11. 32 -OG- D U3 ., 2e;i3D Is the Building Historically Designated: Yes N.O-7 Occupancy Type: kz, Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder):c_,) « CIh _U.t i" --4t. F.wA. ck: k c, Address: I /or. C{ S - — Phone#: 395- 632-05 Sir City: �Ao.,V. Lvov—la-sr State: -F( C.,r Tenant/Lessee Name: Phone#: Email: Zip: 5 313 kr' CONTRACTOR: Company Name: Address: i o 3C) 3-117 Fv �. i`f etiocgil(10;i City: 1 State: FL n q il eilD Xi, I.,A'w' i rI tiT State Certification or Registration #: 2 ra / 2 V 6;1[•'iel Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ TSQ Square/Linear Footage of Work: Qualifier Name: Phone#: C� 3 i2 8b Zip: 33J9? Phone#: 3% /7 Type of Work: ❑ Addition rJ Alteration ❑ New ❑ Repair/Replace ❑ Demolition/r Description of Work: iZe(,o�c�A-e. i—A`c. vekAA- j by �(,l 2— '(^ arc . 1' T�-i—s Specify color of color thru tile: Submittal Fee $ 5O Permit Fee $ °G CCF $ 0 • 6C) CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ ' g Notary $ Technology Fee $ • Structural Reviews $ (Revised02/24/2014) Training/Education Fee $ 0 cam® Double Fee $ Bond $ cz) TOTAL FEE NOW DUE $ ( 0 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 OWNER or AGENT Signature CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of ja c � � . , 20 110. , by 9Cj day of �t � fit , 20 16• , by ) »... V4ur e ; ks., who is personally known to \c am N\nildun. , who is personally known to me or who has ro d 1 .1( 220ay30- by as me or who has produced as b ^ ®- identification and who did take an oath. NOTARY PUBLIC: identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: Sign: Print: Seal: ******************* **r,.********** *******j1aminer * ******************************************************** APPROVED BY �(/ Zoning Structural Review Clerk STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 MILIAN-PRIETO, PEDRO TSE AIR CONDITIONER CORP 7 ST 12230 NW 7 S MIAMI FL 33182 Congratulations! With this license you become one of the nearly one million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range from architects to yacht brokers, from boxers to barbeque restaurants, and they keep Florida's economy strong. Every day we work to improve the way we do business in order to serve you better. For information about our services, please log onto www.myfloridaticense.com. There you can find more information about our divisions and the regulations that impact you, subscribe to department newsletters and leam more about the Department's initiatives. Our mission at the Department is: License Efficiently, Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, and congratulations on your new license! DETACH HERE RICK SCOTT, GOVERNOR (850) 487-1395 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL. REGULATION CAC1816686 ISSUED 07/20/2014 CERTIFIED AIR COND:GONTR MILIAN-PRIETO, IEQRO TSE AIR CONDITIONER CORP . IS CERTIFIED under the provisions of Ch.489 FS. Expiration date : AUG 31, MI6 L1407200001197 KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD CAC 1816686 The CLASS AAIR CONDITIONING CONTRACTOR - Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2016 MILIAN-PRIETO, PEDRO TSE AIR CONDITIONER CORP 7 ST 12230NW7ST MIAMI FL 33182 ts*,lUFft 07/20/2014 DISPLAY AS REQUIRED BY LAW SEQ # L1407200001197 -THS IS NOTA bILL - - . -6736384TSE AIR CONDITIONER CORP12230 NW 7 STMIAMI FL 33182 OWNER TSE AR CONDITIONER CORP Worker(s) This Locel urellaiffluicreem#thms'n"i:iltduchilValY the b4'14tia141-' 276 mment:1:inulatory 17"' (F:!!! eisa_not a Local BushmtehurissiT.Ditaax. The cods ReCO3s: ' iii4infirms ess. Holder nuMttiriftf*th any government I iiieREcepT NO. &mite must be displeyed on all For niestsidurmation. visit unrow.miamistade.gottitaxmiltestai - - EXPIRES RENEWAL 30, 2016 , 7009947 Must be PT'EM5!C° displayed place of k :I:" P:auau'°:Cd:chaPter8A"° SEC•t°FB7e7PAYMENT,CI"P 196 sEcHAcAudurTAXCOLLECTOR CACI $75.O0 07/05/2015 CREDITARD 5-032963 0'11‘.. '11;."�`�' CERTIFICATE OF LIABILITY INSURANCE DATE(h1MIDDIYYYY) 04/28/2016 CHIS 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: 11 the ceitlflcate 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 endorsement(s). PRODUCER First insurance Group 10967 SW 40 St Miami, FL 33165 Phone (305)221-7878 Fax (305)554-7090 CONTACTMIRIAM PHONEFAX A1C Lo Ext): (305)221-7878 (NC. Not (305)554-7090 ADDREgs; miriammese@aoi.com INSURER(S) AFFORDING COVERAGE NAIC a INSURER A: UNITED SPECIALTY INSURANCE A INSURED T S E AIR CONDITIONER CORP 33 NW 108 ct MIAMI FL 33172- CMrFDArACe INSURER B : AMSTRUSTI NORTH AMERICA, INC PREMISES (Ea occurrence) INSURER C : 0 INSURER D: $ 5,000.00 INSURER E : PERSONAL & ADV INJURY INSURER F GEN L AGGREGATE LIMIT APPLES PER: ❑ POLICY 0 JECaT 0 LOC ❑ OTHER THIS INDICATED. CERTIFICATE EXCLUSIONS WOW._ .w.11mcfl. IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS MAY BE ISSUED OR MAY PERTAIN THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDLSUBR )NSR N WVD N POLICY NUMBER SI11005B21672 POUCY EFF rMMIDD/YYYY) 01/11/2016 POLICY EXP )MMIDDIYYYY) 01/11/2017 LIMITS EACH OCCURRENCE $ 1,000,000.00 A ® COMMERCIAL GENERAL LIABILrIY 1 CLAIMS -MADE OCCUR PREMISES (Ea occurrence) $ 1,000,000.00 0 MED EXP (Any one person $ 5,000.00 ■ PERSONAL & ADV INJURY $ 1,000,000.00 GEN L AGGREGATE LIMIT APPLES PER: ❑ POLICY 0 JECaT 0 LOC ❑ OTHER GENERAL AGGREGATE $ 2,000,000.00 PRODUCTS - COMPIOP AGG $ 2,000,000.00 $ AUTOMOBILE LIABILITYaB El ANY AUTO r-1 ALL SCHEDULED AUTOS ❑A ❑ HIRED Auras r--1 ❑ AUTOS WED SINGLE LIMB $ BODILYINJURY(Per person) $ BODILY INJURY (Per accident) $ P�tQOOPEAMAGE $ III $ • UMABRELLA UM 0 oc:cuR EACH OCCURRENCE $ • EXCESS UAB • CLAIMS -MADE AGGREGATE $ ❑ DED 0 RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y! N N I A AWC1029368 01/21/2016 01/21/2017 ❑ STATUTE ❑ ER ANY PROPRIETORIPARTNEFitEXECUTIVEL OFFICER/MEMBER EXCLUDED? ' EACH ACCIDENT $ 500.00 (Mandatory In NH) I yes, describe urWer DESCRIPTION OF OPERATIONS below EL DISEASE • EA EMPLOYE $ 500.00 E.L DISEASE -POLICY LIMIT • $ 500.00 DESCRIPTION OF OPERATIONS! LOCATIONS! VEHICLES GENERAL LIABILITY AIR CONDITIONED OPERATIONS LICENSE CAC1816686 (Attach ACORD 101, Additional Remarks Schedule, lr more space Is required) .0%X. F1ciRS?rpd�n ¢ a t%, l CANCELLATION MIAMI SHORE VILLAGE 10050 N E 2nd Ave MIAMI, FL 33138 -Q' t;+ 4 799, ',9' O y*� �� V o '+'a5 ��� a c_r el,, ,S,„ E 0>6' `S SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POUCY PROVISIONS. AUTHORIZED REPRESENTATIVE _ ti. 2E4 fI .ACORD 26 (2014/01) QF ©1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD