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MC-11-488Inspection Number: INSP - 157399 Scheduled Inspection Date: April 13, 2011 Inspector: Perez, JanPierre Owner: BREWSTER, INGRID Job Address: 723 NE 91 Street 4 -C Project: <NONE> Miami Shores, FL Contractor: AIRE DISCOUNT INC Building Department Comments REPALCE WALL UNITS 10,000 BTU Ve ) 3 1 ( Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments April 12, 2011 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 For Inspections please call: (305)762 -4949 Permit Number: MC- 3- 11-488 Permit Type: Mechanical - Residential Inspection Type: Final Work Classification: A/C Replacement Phone Number (305)244 -7542 Parcel Number 1132060440160 Phone: (954)394 -2843 Page 12 of 21 BUILDING PERMIT APPLICATION FBC 20 (0 CPO 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: (305) 762.4949 Value of Work for this Permit: $ _OO Square/Linear Footage of Work: Type of Work: °Address °Alteration °New *Repair/Replace Description of Work: 1 MAR 1 8 011 Permit No. 01(C-. Master Permit No. Permit Type: MECHANICAL OWNER: Name (Fee Simple Titleholder) — 1 in V V(� t cTe Phone #:2 (s -' LI L - : �r ? Li 2 Address lam" fl . ` E City: ` nr\ i S VN O V eS State: F1 - zip: 3 ( 3)1` 1 ) 1 R Tenant/Lessee Name: Phone #: Email: JOB ADDRESS: — I 2' WE , 1 s YC * 4 � City: Miami Shores County: Fl Miami Dade Zip: .3 Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: 1\ �\ �' l 1 ry Phone#: 91C--3P—i>9&? Addres City: f State: ! L Zip: Qualifier Name: WO 0 6Y10 g 1. Phone#: (c, �—,y 1(P—„, f State Certification or Registration #: r., 4 e...‘2139 Certificate of Competency #: Contact Phone #: g .5 T — 9 9Y - D-V4",..amai1 Address: DESIGNER: Architect/Engineer: Phone#: °Demolition I av ***************************************F ******** * ** * * * * * * * * * * * * * * * * * * * * * * * * * * ** Submittal Fee $ Permit Fee $ I/ t"/ `'►1 CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ 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 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 of conunencemen/ ust be posted at the job site for the first inspection which occurs seven (7) day after the buil ' permit is issued. In the a % ce of osted notice, the inspection will not approved and a reinspection /e will arged. Signature ; /t U'/ (� J& 4'✓' � � Signature The foreg rs day of NO Sign: Print: to me or 1 1, has produced s identification and who did take an e, � n'3 + 3 1 Structural Review Contrac The foregoing instrument was ac wledged before me this ` $ `/ day of t4 , 20 11 ,byP O NO VA /.I BA l2CL4 is personally known to me or who has produced. 1) - L as identification and who did take an oath. NOTARY PUBLIC: Sign: Zoning Clerk UNIT BEING EPLACED DATA NEW UNIT 19- MANUFACTURER ' AHU o(PKG. UNIT MODEL # LA f W6 O -A +4 i COND. UNIT MODEL # KW HEAT a NOM TONS AHU CU PKG 1) M.C.A AHU CU PKG AHU CU PKG 2) M.O.P AHU CU PKG AHU CU PKG 3) VOLTS AHU CU (p // ) PKG UNIT / / PKG UNIT / EER/SEER �• := , YES NO REPLACING DUCTS YES �+ .. YES NO REPLACING THERMOSTAT YES ' 1 YES NO NEW 4"CONCRETE SLAB YES r , ►! , � i � YES NO NEW ROOF STAND YES 1w1' " YES NO NEW RETURN PLENUM BOX YES • PERMIT NUMBER: MC This form must accompany ALL air conditioning replacement permit applications. Each unit change -out must be on its own data sheet. Multiple units on single sheets are not acceptable. Job Address (where the work is being done): ?� N . .. 9 I t re. a City: Miami Shores Village County: Miami Dade Zip Code: I ALL CONDENSING UNITS MUST BE ON A 4 INCH SOLID CONCRETE SLAB ALL UNITS MUST COMPLY WITH F.E.M.A MINIMUM FLOOD ELEVATION A COPY OF THE CONTRACT IS REQUIRED WITH ALL SUBMITALS ARI (AHRI) DATA SHEET REQUIRED Change Disconnecting means: YES ❑ NO Signature AIR CONDITIONING REPLACEMENT DATA 1. Minimum Circuit Ampacity (Wire Size): 2. Maximum Overcurrent Protection (Fuse /Breaker Size): 3. Voltage of Circuit (208/240/480): 4. Size Disconnecting Means: �o n Contractor's Company Name: ' ^ ��J CA1� till Phone: � �. �y `�d g 3 State Certificate or Registrati./ . 4 ) S Certificate of Competency N. Date: er's signature only) 1► ARHI Sheet Attached: YES ❑ NO Contract Attached: YES ❑ / JA [[ 1-� Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 ACORD,h CERTIFICATE OF LIABILITY INSURANCE 1 DATE(MM/DDI1'Y) 03/17/11 PRODUCER AMC INSURANCE PO BOX 15880 PLANTATION, FL 33318 Phone: (954)581-5800 Fax: (954) 791 -2300 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHT UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE INSURED AIRE DISCOUNT INC 41 NW 43RD TERRACE PLANTATION, FL 33317 INSURER A: North Pointe Insurance Company INSURERS: INSURER C: INSURER D: INSURER E: COVERAGE THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOT WITHSTANDING 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 BYTHE POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM/DDIYY) POUCY EXPIRATION DATE (MMIDDIVY) LIMITS A G ENERAL LIABILITY COMMERCIAL GENERAL LIABILITY =CLAIMS MADE © OCCUR D GENtL AGGREGATE LIMIT APPLIES PER: E POLICY 'PROJECT • LOC 8090015842 02/18/2011 02/18/2012 EACH OCCURENCE $ 300,000 DAMAGE TO PREMISES LIMIT {Any One Occurrence) $ 100,000 MED EXP(Any one person) $ 5,000 PERSONALANDADVINJURY $ 300,000 GENERAL AGGREGATE 6 600,000 PRODUCTS - COMP /OP AGG $ 600,000 AUT AUTO LIABILITY — ALL OWNED D AUTOS SCHEDULED AUTOS — HIRED — NON -OWNED AUTOS — COMBINED SINGLE LIMIT ea accident $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY R ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS UABILITY OCCUR DCLAIMS MADE DEDUCTIBLE ETENTI ON EACH OCCURANCE $ AGGREGATE $ $ $ $ WORKERS COMPENSATION AND EMPLOYERS LIABILITY ]WC STATUTORY LIMITS DOTHER E.L. EACH ACCIDENT $ E L DISEASE -EA EMPLOYEE $ EL.DISEASE - POLICY LIMIT $ O THER DESCRIPTION OF OPERATIONS /LOCATIONSNEHICLESfEXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS AIR CONDITION REPAIR, SERVICE & INSTALLATION 4 LoCiPirc, 13,6,- r s TA ( OCcARA-i 1 -- J_- LAC CERTIFICATE HOLDER I ADDmONAL INSUREDJNSURED LETTER: ) CANCELLATION MIAMI SHORES VILLAGE BUILDING DEPARTMENT 10050 NE 2 AVE MIAMI SHORES, FL 33138 Faxed to: 305 - 756 -8972 SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE • dr /0.- 03/17/2011 11:31 954-791 -2300 e -Bode Systgms Policy Send Form Preview http://amelia.e PAGE 1/2 Page 1 of 2 3/17/2011 ALEX SINK STATE OF FLORIDA CHIEF FINANCIAL OFFICER DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: PERSON: FEIN: BUSINESS NAME AIRE DISCOUNT INC 41 NW 43 TERRACE PLANTATION 07/01/2009 BARCLAY 200643966 AND ADDRESS: FL 33317 SCOPES OF BUSINESS OR TRADE: 1- CERTIFIED AC CONTRACTOR IMPORTANT: Pursuant to Chapter 440 . 05114), F.S., an officer of a corporation who elects exemption front this chapter by filing a certificate of election under this section may not recover benefits or compensation under this chapter. Pursuant 10 Chapter 440.05(12), F.S., Certificates of election le be exempt••• apply only within the scope of the business or trade listed on the notice of election to be exempt. Pursuant to Chapter 440.05(13), F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. DWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09 -06 EXPIRATION DATE: 07/01/2011 DONOVAN D 07 -01 -2009 QUESTIONS? (850) 413 -1609 AIRE DISCOUNT INC. 2831 Sunrise Lakes Drive East 303 Sunrise FL 33322 PHONE: 954 - 394 -2843 CAC# 1813954 954 DATE / /s /$/ IN Tro L / 14 NTRACT /ACCOUNT BER 1 I 4 1 I 1 PHONE 1 # — - k LAST NAME g n r u 2 FITT�NI I , MIDDLE STREET ADDRESS 7023 M. ` T_° (,� 1 C0 \9 f J ( r l TECH NAME BLDG. # APT. # TECH NUMBER DEVELOPMENT NAME CITY '• _ C U ZIP 3 3 / 3? NATURE OF SERVICE QTY. DESCRIPTION OF MATERIALS USED PRICE AMOUNT 1 L A e_C 1. Pi*L r AREI Z11 1 'i egs- _ DESCRIBE REPAIRS MADE TOTAL MATERIALS TOTAL LABOR OTHER (USE COMMENTS) METHOD OF PAYMENT: CASH O CHECK # O CREDIT CARD SUB TOTAL W TAX 41 Expiration Date TOTAL 600 �Z7 // Credit Card #, AO --- - Signature : constitutes acceptance of above service performed as INVOICE being .::. -.:.. .. - and that equipment has been left In good . PRINTED BY: CREATIVE GRAPHIC + PRINTING 954.394.9709