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PL-16-1105Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 9(› Vo- 9 (2-2. Inspection Number: INSP-265897 Permit Number: PL -4-16-1105 Scheduled Inspection Date: August 23, 2016 Inspector: Hernandez, Rafael Owner: KAWACHIKA, JON & CYNTHIA Job Address: 179 NE 94 Street Miami Shores, FL 33138 - Project: <NONE> Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Addition/Alteration Contractor: TWIN BROTHERS PLUMBING CONTRACTORS CORP Phone Number (305)758-0927 Parcel Number 1132060132930 Phone: (305)332-1969 Building Department Comments TWO BATH REMODEL, 1 -TUB, 1 SHOWER, 2 TOILETS, 2 SINKS AND INSTALL. CHANGE STOP VALVES. Infractio Passed Comments INSPECTOR COMMENTS False Passed 5i Failed Correction Needed Re -Inspection Fee No Additional Inspections can be scheduled until re -inspection fee is paid. Inspector Comments CREATED AS REINSPECTION FOR INSP-257500. called to cancel inspection August 22, 2016 For Inspections please call: (305)762-4949 Page 33 of 36 Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 05 Parcel Number .at1ott::a l dit# I1 �e Permit'Sta%s.'Aid ± Expiration: 11/06/2016 Applicant 179 NE 94 Street Miami Shores, FL 33138- 1132060132930 Block: Lot: JON & CYNTHIA KAWACHIKA Owner Information Address Phone CeII JON & CYNTHIA KAWACHIKA 179 NE 94 Street MIAMI SHORES FL 33138-2821 (305)758-0927 Contractor(s) Phone TWIN BROTHERS PLUMBING CONTR (305)332-1969 CeII Phone Valuation: Total Sq Feet: $ 3,800.00 0 Type of Work: TWO BATH REMODEL, 1 -TUB, 1 SHOWER, Type of Piping: Additional Info: Bond Return : Classification: Residential Scanning: 1 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Total: Amount $2.40 $4.50 $4.50 $0.80 $300.00 $3.00 $3.20 $318.40 Pay Date Pay Type Amt Paid Amt Due Invoice # PL -4-16-59522 04/25/2016 Credit Card $ 50.00 $ 268.40 05/10/2016 Credit Card $ 268.40 $ 0.00 Available Inspections: Inspection Type: Top Out Final Review Plumbing 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. Futher re, I au ize the above-named contractor to do the work stated. rYl `Gc,wrQ ignatur Owne' / Applicant / Contractor / Agent Building Department Copy May 10, 2016 May 10, 2016 Date 1 Miami Shores Village Building 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 RECEIVED AP. 26 2►16 BY- FBC 20 I LI U I LDI NG Master Permit r No. Sub Permit No. ?�,.. - (( ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION D EXTENSION ❑RENEWAL PLUMBING ❑ MECHANICAL El PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP -�� G�' CONTRACTOR DRAWINGS /.7 JOB ADDRESS: ` 7 • .arizerivr. PERMIT APPLICATION City: Miami Shores County: Miami Dade Zip: 3'3 /VS - Wim,/ Follo/Parcel#: i (_ 31_0 h - 01 g ` 2S' 3o- • Is the Building Historically Designated: Yes NO Occupancy Type: kPS> Load: Construction Type: C,,t.dU Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): v �C, C.0 1��. Phone#: 33,.5 --6 3 Address: 9 LIC Q(' S -f- 35) 35s -- City: CCity: A t SIN 04--e- State: V L zip: 33 i 3 tr• Tenant/Lessee Name: Phone#: Email: cJ,J k 6 q e .4 -1t - CONTRACTOR: Company Nam,: Address: -0-4141 drA0 4000,01 ,ba . City: 441 State: Zip: 33/ WS. Qualifier Name: f es b;4v. State Certification or Registration #:G Pl 104 Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ 3 r cos -O ' Square/Linear Footage of Work: Type of Work: ❑ Addition 0 Alteration ❑ New ❑ Repair/Replace 0 Demolition Description of Work: TL`, .''-...% -V'ye. ,r' %�-.-a A e.1 ° s i - A. -u S i I - S 44, t.a.,- o Y k)esku��, Specify color of color thru tile: Submittal Fee $ so . cx Permit Fee $ .3 cs ® CCF $ a - CO/CC $ Scanning Fee $ 3 ` Radon Fee $ DBPR $ `-E • C'C's Notary $ Technology Fee $ Training/Education Fee $ 0 - e3 Double Fee $ Structural Reviews $ P Bond $ 0 TOTAL FEE NOW DUE $ 268 `'4 0 agerweae`Yet Phone#: *9S" v30- Igo Phone#: `3ot f 7 /(P. m (Revised-CO/24/2014) 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 J 0,1 / ' ( Signature ' W' 1/NorAGENT The foregoing instrument was acknowledged before me/this ,20 �Y ,by is personally known to /0,040) 1 as me or who has produced identification and who did take an oath. NOTARY PUBLIC: day of CONTRACTOR The foregoing instrument -` as acknowledged before me this /9 day of 4' U , 20 /4 by 2) 4V/) �4 dL , who is personally known to me or who has produced identification and who did take an oath. NOTARY PUBIJC: Sign: Print: Seal: GUADALUPE DE LEON .. Commision a FF 020033 Sign: Print: Seal: 111%704031 as • QUA LUF'J DE LEON y ,Mate of Florida My Com'r Exp res May 21, 2017 µ' Coma ssi;t r =F 020033 ***i*********************•****************************i*******•*********************+Fitt******************** APPROVED BY Plans Examiner Zoning Structural Review Clerk STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 DIAZ, DAVID TWIN BROTHERS PLUMBING CONTRACTORS CORP 3890 NW 2 TERRACE MIAMI FL 33126 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.myfloridalicense.com. There you can find more information about our divisions and the regulations that impact you, subscribe to department newsletters and team 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 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CFC1429174 ISSUED: 11/18/2014 CERTIFIED PLUMBING CONTRACTOR DIAZ, DAVID TWIN BROTHERS PLUMBING CONTRACTORS IS CERTIFIED under the provisions of Ch.489 FS. Expiration date AUG 31, 2016 L1411180001178 KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD LICENSE NUMBER CFC1429174 The PLUMBING CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2016 DIAZ, DAVID TWIN BROTHERS PLUMBING CONTRACTORS CORP 2040 NW SOUTH RIVER DRIVE MIAMI FL 33125 ISSUED: 11/18/2014 DISPLAY AS REQUIRED BY LAW SEQ # L1411180001178 005175 Local Business Tax Receipt Miami—Dade County, State of Florida, -THIS IS NOTA BILL - DO NOT PAY 6355481 BUSINESS NAME/LOCATION RECEIPT NO. TWIN BROTHERS PLUMBING CONTRACTORS CORPRENEWAL 2040 NW SOUTH RIVER DR 6622915 MIAMI FL 33125 OWNER TWIN BROTHERS PLUMBING CONTRACTOR Worker(s) 1 [LBT, EXPIRES SEPTEMBER 30, 2016 Must be displayed at place of business Pursuant to County Code Chapter 8A - Art 9 & 10 SEC. TYPE OF BUSINESS 196 PLUMBING CONTRACTOR CFC037112 PAYMENT RECEIVED BY TAX COLLECTOR $45.00 07/09/2015 FPPU02-15-016138 This Local Business Tax Receipt only confirms payment of the Local Business Tax The Receipt is note R amse. oorr� Wnan9osrsro �l regulatory laws and requ rreements which do business. App � � comply erN tl governmental The RECUPT NO. above must he displayed on all commercial vehicles - Miami -Dade Code Sec Sa-218. For mare infonation, visit www.miamidade.gavhaxcnflaCtmt ARB® CERTIFICATE OF LIABILITY INSURANCE TE DAoa/1si2o1�s 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 V.P. INSURANCE LLCCNN 1841 S State Rd 7 PLANTATION FL 33317 CONTACT Doraimys Perez Est):954-5838857 AIC, No): 866-700-3762 ADS, vpinsurance@comcast.net INSURERS) AFFORDING COVERAGE NAIL # INSURERA: Federated National Insurance LIABILnY COMMERCIAL GENERAL LIABILITY INSUREDINSURER Twin Brothers Pluming Contractors Corp. 2040 NW South River Drive Miami, FL 33125 B : Normandy Harbor Insurance Company GL -0000024177-01 INSURER C : 9/25/2016 INSURER D : $ 1,000,000 INSURER E : $ 100,000 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 LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF (MM/DDIYYYY) POLICY EXP IMM/DD/YYYY) LIMITS A GENERAL X LIABILnY COMMERCIAL GENERAL LIABILITY GL -0000024177-01 09/25/2015 9/25/2016 EACH OCCURRENCE $ 1,000,000 DAGE TO PREM SES (EaENTED occurrence) $ 100,000 MED EXP (Any one person) $ 5,000 CLAIMS -MADE X OCCUR PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE 7 POLICY LIMIT APPLIES O - JET PER: LOC PRODUCTS - COMP/OP AGG $ 1,000,000 $ AUTOMOBILE LIABILM 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) $ $ UMBRELLA LIAB EXCESS LIAB _ OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ $ DED RETENTION $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ECUTIVE OFFICER/MEMBER PROPRIETOR/PARTNER/EXECUTIVE (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N N / A NHFL002747015 09/27/2015 09/27/2016 WC STATU- TORY LIMITS OTH- ER E.L. EACH ACCIDENT $ 100,000 E.L. DISEASE - EA EMPLOYEE $ 500,000 E.L. DISEASE - POLICY LIMIT $ 100,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule If more space Is required) L 1-`- i CERTIFICATE HOLDER CANCELLATION CITY MIAMI SHORES VILLAGE BUILDING DEPARMENT 10050 NE 2nd Ave Miami FI 33138 L 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 (2010/05) © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ACCP ®® CERTIFICATE OF LIABILITY INSURANCE r ` DATE(MM/DD/YYYY) 04/26/2016 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 lieu of such endorsement(s). PRODUCER V.P. INSURANCE LLC 1841 S State Rd 7 PLANTATION FL 33317 CNE CT Doraimys Perez PHONENC Est)* 954-583-8857 MICNo):FAX 866-700-3762 ADDRESS: vpinsurance@comcast.net INSURER(S) AFFORDING COVERAGE NAIC # INSURERA: Federated National Insurance INSURED Twin Brothers Pluming Contractors Corp. 2040 NW South River Drive Miami, FL 33125 INSURER B: Normandy Harbor Insurance Company 09/25/2015 INSURER C : EACH OCCURRENCE INSURER D : DAMAGE TO RENTED PREMISES (Ea occurrence) INSURER E : MED EXP (Any one person) 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 LTR TYPE OF INSURANCE ADDL INSR SUER WVD POLICY NUMBER POLICY EFF (MMIDDIYYYY) POLICY EXP (MMIDD/YYYY1 UMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY GL -0000024177-01 09/25/2015 9/25/2016 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) $ 100,000 MED EXP (Any one person) $ 5,000 CLAIMS -MADE 1rOCCUR PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 1,000,000 GEN'L AGGREGATE 7 POLICY F LIMIT APPLIES JECT PER: LOC $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS SCHEDULED AUTOS NON -OWNED AUTOS COMBINEDBISINGLE LIMIT $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA UAB EXCESS LIAR OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ $ DED RETENTION $ A WORKERS COMPENSATION ANDTORY EMPLOYERS' LJABILn'Y OFFICER/MEMBANY EREEXCLUDED?ECUTIVE (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y/N N/A NHFL002747015 09/27/2015 09/27/2016 WC STATU- LIMITS OTH- ER E.L. EACH ACCIDENT $ 100,000 E.L. DISEASE - EA EMPLOYEE $ 500,000 E.L. DISEASE - POLICY LIMIT $ 100,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, H more space Is required) PLUMBING CONTRACTORS CERTIFICATE HOLDER CANCELLATION CITY MIAMI SHORES VILLAGE BUILDING DEPARMENT 10050 NE 2ND Ave Miami FI 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 (2010105) © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD