MC-11-135Inspection Number: INSP - 155287
Scheduled Inspection Date: March 21, 2011
Inspector: Perez, JanPierre
Owner: FEE, JAMES
Job Address: 295 NE 94 Street
Miami Shores, FL
Project: <NONE>
Contractor: KENDALE AIR CONTRACTING
Building Department Comments
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
EXACT REPLACEMENT INCLUDING LOCATION OF
EQUIPMENT AND DUCT WORK
Passed
ll�
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
March 18, 2011
For Inspections please call: (305)762 -4949
Permit Number: MC -1 -11 -135
Permit Type: Mechanical - Residential
Inspection Type: Final
Work Classification: Addition /Alteration
Phone Number
Parcel Number 1132060133840
Phone: (305)232 -3000
Page 18 of 37
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLCY
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, T THE INSURANCE AFFORDED BY THE POUCIES DESCRIBED HEREIN IS SUBJECT
TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. OMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
R
LTR
TYPE OF INSURANCE
ADDLSUBR
%MD
POLICY NUMBER
- POLICY EFF
(MMIDD/YYYY)
POLICY EXP
(MMIDD/YYYM
wars
A
GENERAL
UABIUTY
COMMERCIAL GENERAL UABLf7Y
OCCIAR
CPS1326663
1/28/2011
1/28/2012
FAaioccuRRENcE
$1000000
X
PREMISES(RENTED pn
PREMISE8 (Eaartenaal
$10, 000
$
CLAIMS•MADE X
MED EXP (Any one person)
$5, 000
pEssoNAL A ADy thuURy
$1, 000, 000
GENERAL AGGREGATE
$2000000
GENL
— I
AGGREGATE UMIT APPLIES PER:
FOIJCY Fn JECT n LOC
PRODUCTS - =SWOP AGO
$2000000
$
B
AUTOMOBILELIABIUTY
ANY AUTO
ALL OWNS AUTO
SCHEDULED AUTOS
HIRED AUTOS
NON-OWNED AUTOS
PHPK593093
7/1/2010
7/1/2011
COMBINED SINGLE LIMIT
(Ea accident)
$1,000,000
X
BODILY INJURY (Per pmson)
$
—
BODILY INJURY aodded)
$
PROPERTY DAMAGE
r
$
X
X
$
$
UMBRELLA UAB
EXCESS UAB
OCCUR
CLAMWMADE
EACH OCCURRENCE
$
_
AGGREGATE
$
DEDUCTIBLE
RETENTION $
$
$
c
WORKERS COMPENSATION
AND EMPLOYERS' UABIUTY
ANY PRDPFBETORIPART
OFRC EXCLUDSM
(Mandatory M NH)
II yes, describe under
CESCRIPBON OF OPERATIONS
CUTME Y /N
N r A
TRC3271039
1/28/2011
1/28/2012
X WCBTATU 19 V I -
1 TORY LIMITS
EL EACH ACCIDENT
$1000000
EL DISEASE - EA EMPLOYEE
$1000000
babe
EL DISEASE - POLCY OMIT
$1000000
DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarks Schedude, If more space le required)
Miami Shores Village
Building Dept
10050 NE 2nd Ave
Miami 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
e'' 4 4 a te ...- -.
Awful CERTIFICATE OF LIABILITY INSURANCE
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 certMcate holder b an ADDITf0NAL INSURED, the poIIcy(les) must be endorsed. 9 SUBROGATION IS WAIVED, subject to
the teens and coedffon s of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holler in lieu of such mss).
PRODUCER
GBP Risk Solutions
www.GBPrs.com
2260 E. Brown Rd, Ste 2 East
Mesa AZ 85213
INSURED
Central Mobile Air of Miami Inc.
dba: Kendale Air Conditioning
12091 SW 117 Court
Miami FL 33186
CONTACT
NAME. Flower
NA
PHONE 480- 775 -1 811 1 (. Net 480- 668 -1 936
E -ArAIL
ADDRESS: teresa @ labors.com
C PRODUCER IDs: 10511
INSURERS) AFFORDING COVERAGE
INSURER A:Scotts Indemnity Company
N URERB:Philadelphia Insurance Company
MWURERC :Wesco Insurance Company
MEURER D :
INSURER E :
INSURER F:
DATE (ADB!DDlYYYY)
1/28/2011
NAIC R3
18058
25011
COVERAGES
CERTIFICATE HOLDER
ACORD 25 (2009/09)
CERTIFICATE NUMBER: 775
1999-2009 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are neglstered marks of ACORD
A \
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949 `
BUILDING Permit No. IV C) 1 t ® 0
PERMIT APPLICATION Master Permit No.
FBC 20
Permit Type: MECHANICAL
OWNER: Name (Fee Simple Titleholder): ! 44 661 Phone #: 79t g ? P7
Address: 8 9 s, 9 ✓ gc7
City: /1? /..qs z`w '-, State: Zip: 33/37
Tenant/Lessee Name: Phone #:
Email:
9,.5' /f./: 9 Ske A
City: Miami Shores County: Miami Dade Zip: 3?/ 37
Folio/Parcel #: / f— 3 ZO C, - 0) 0 3 3 g c/ o
Is the Building Historically Designated: Yes NO Flood Zone: A/O /
CONTRACTOR: Company Name: � g�"�� 4 o/
At-7 Phone #: .40, r ' 7, 3 7 ° .3 C0 a
Address: / / G(.o // 2 (742G,
City: ,i1/.+/�/✓,%.+' State:
del Zip: 3 3 /1‘
Qualifier Name: , kk ,6�P,e` s. 4 eiv Phone#: .?of 237 - :3 a a
State Certification or Registration #: 4 2) i -e Certificate of Competency #:
Contact Phone #: 30 • L 3 L' 3 0 0 °e) Email Address: .'v 1 e A 9 dtr L.® i - 1"/ -1 . C 44 ()(" P6 P( Led a t Dt 4
DESIGNER: Architect/Engineer: Phone #: A / A
cot&
JOB ADDRESS:
Miami Shores Village
pOIERVISA
JAN $ 6 2011 lui
Building Department
CO
Value of Work for this Permit: $ (0 in/ Square/Linear Footage of Work:
Type of Work: Address ❑Alteration ❑New 2epair/Rep ace ❑Demolition
�ir'e
Description of Work: 4,k h� ,%eeru-e•` t/ . i2 4-k4l 1 y ' J gee' 6 !s // fr
A i As./2. d)!i'l/ li
****m+ u*******m +x***mm**m+x+x**** FA*** �n�xwa�a�x�+ xmm�ux� +�x��u�x *+x�xx�x�x��x�x�x
Submittal Fee $ Permit Fee $ ti
CCF $
Scanning Fee $ Radon Fee $ DBPR $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
CO/CC $
Bond $
TOTAL FEE N DUE $
IR)
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 AFI WAVIT: 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 b1 apprred and a fee will be charged.
Signature*
NOTARY PUBLIC:
APPROVED BY
Owner or Agent
The foregoing instrument was acknowledged before me this Of
day t a .20 ,by 3 - 4 111 P - TEE, ,g
who is personall known to me or who has produced
As identification and who did take an oath.
Sign: cic LT
Print: NOR! new Pn rhess
NMI!
Commission Expires: 1,;,• =Commissiof #DD865073
` ••...• ••'' Expires: APR. 13, 2013
BONDED .. THRD ATLANTIC BONDING CO., INC.
+ t6i4+ 8Z**+ kM+*sh+H¢}*+'Rd.�tg.Y** **..+ a y ;;.: #; : •. s3k+ : % **** * E+£ aa' F *tai} *•"S*Ste *** ****
Plads Examiner
Structural Review
(Revised 07 /10/07)(Revised 06/10/2009)(Revised 3/15/09)
Signature
Sign:
Print:
My Commissi
Contractor
The foregoing instrument was acknowledged before me this .
day of ,20 a., by S G",.0� --�1« ,
who . personally kn wn to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
Notary Public - State of Ronda
' y
• My Comm. Expires Oct 4, 2018
Commission # 0D 827184
Bendel through Woad
Zoning
Clerk
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
ADM
INSR
bU W SF
VD
POUCY NUMBER
— POLICY EFF
(MM/DD/YYYY)
POUCY EXP
(MM/DDIYYYY)
OMITS
A
GENERAL
UABIUTY
COMMERCIAL GENERAL LIABILITY
OCCUR
CPP00070473
01/28/10
01/28/11
EACH OCCURRENCE
$ 1,000,000
X
P
$ 100,000
CLAIMS -MADE
X
MED EXP (My one person)
$ 5,000
PERSONAL &ADVINJURY
$ 1,000,000
X
BLANKET WOS
GENERAL AGGREGATE
$ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP /OP AGG
$ 2,000,000
— 1 POLICY PR- LOC
$
AUTOMOBILE
LIABIUTY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED 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
$
DEDUCTIBLE
RETENTION $
$
$
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUT
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS
Y/N
N / A
57510
02/01/10
02/01/11
X WC STATU- OTH-
TORY LIMITS ER
E. L. EACH ACCIDENT
$ 500000
E.L. DISEASE - EA EMPLOYEE
$ 500000
below
E.L. DISEASE - POLICY LIMIT
$ 500000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
MIAMI S2
Miami Shores Village
Building Dept
10050 NE 2nd Avenue
Miami Shores FL 33138
I
SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DEUVERED IN
ACCORDANCE WITH THE POUCY PROVISIONS.
AUTHORIZED REPRESENTATIVE
A► b® CERTIFICATE OF LIABILITY INSURANCE OP ID AA
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
Kahn-Carlin &.Company, Inc.
3350 S. Dixie Highway
Miami FL 33133 -9984
Phone:305 -446 -2271 Fax:305- 448 -3127
INSURED
Kendale Air Conditioning
Central Mobile Air of Mia Inc
12041 SW 117 Court
Miami FL 33186
LAM I Al. I
NAME:
PHONE
Est):
FAX
(A/C, No):
ADDRESS:
PRODUCER
CUSTOMER ID #: K NDA - 1
INSURERS) AFFORDING COVERAGE
INSURER A : FCCI Insurance Company
INSURER B :
INSURER C :
INSURER D :
INSURER E :
INSURER F :
DATE (MM/DD/YYYY)
01/12/11
NAIC #
10178
COVERAGES
CERTIFICATE HOLDER
ACORD 25 (2009/09)
CERTIFICATE NUMBER:
CANCELLATION
REVISION NUMBER:
20 AC I All rights reserved.
The ACORD name and logo are registered f ACORD
proposal **Alec! bx
t
Street
NEW EQUIPMENT:
SYSTEM 1: Rh
uctuts e 212.
.4 H 2.ya Tarnow T1 it Au: I- atal
to 16 .0 SEER O
Ton (Model. 14 A.ims o
Btutt l _ Heal Sldp•
• Maximum KW site allowable on ate eiitaing electrical clrtatit to exiSHng Unit.
❑
0
ELECTRICAL AND CONTROLS:
(W'Five Function healing a cooling thermostat PeCinb.Mf able.
(Reconnect existing electrical to new une(s)-
geKendale Air Conditioning, Inc. will not provide eny electrical work other
than to reconnect the existing electrical service to the new equipmetd.
W'tn the event that the Waling electrical service Is inadequate in any way
or dies not meet ail electrical codes. the customer will be responsible
for at expenses. Including. but not Hotted to permits mid itispectbn fees.
and any other costs necessary for any additional electrical wok.
0
0
❑ .
DUCT SYSTEM:
❑ Reconnect to existing duct system
O Ai' Handier of metal stand
gyAh Cleaner with disposable elemeidsOne i earSuppt
❑
We rtereay propose to Iwmtsp the above. es *WW* torthe sweat
4r t
Peymonl terns sal be*
ACCEPTANCE OF PROPOSAL:
1 accept FMS proposal and ail the terms and conditions on the face end back 1 understand
that the terms. condttlona and warranties : a kmlied to Horse sated in ads proposal. t am
the owner et the art have been givers authority by the owner Of
and hereby dosobystgnalWO.
1
said property to order
( error
The Qpaaty Is The Di f eretue
V I C1 t -U atirene
PIPING:
arikeconnect existing piping 0 New condensate piping
0 New oo densate pump- 0 New liquid tine she
❑ New auction line wth thermal barrier size
D Other
GENERAL:
11l will be consistent mail existing codes al the time at Installation.
(D equipment web be removed from promises.
Peecaetconcrete slab provided iF teeded.3‘ X%
VAS work to be performed In a neat& atonal manner 6rcloding cleaning up
end debris lemavalupon lob crmipletion.
(g price below is after rebate P applicable) end is to be paid dtremy to the
O
WARRANTY:
no len Yoga) ma uera warrant/cm compressor
& Ten Years) rnantdactu'ere wane* on parrs
®' Two Year(s) materiel and later
t Maintenan ee agreement complete systems came with a tree one year
rnaintenerve agreement.
0 Renewal maim tithe purc aser Mends et renews Oh mahtenarma agreement
within one year el lids agreement, Kendate Aft Conditioning will extend the
warranty on all labor, material end Neon for en equal number of Veen ap to
tour (4) more years to tun cortawirenUYw with Maintenance Agreement for no
extra charge.
❑
Signature:
She:
contract=
• 12041 SW 117th Court • Miami, Florida 3318E .• (305) 232 -3000
{Customer) fate)
on day of Gnslattetion.
CAC 016540
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Home Contact Us [Terms and Conditions License AliRlDirectory Data
Copyright CO 2010 Air-Conditbning, Heating, and Refrigeration Institute. All rights reserved.
1 of 1 1/12/2011 9:59 AM
UNIT BEING REPLACED
DATA
NEW UNIT
MANUFACTURER
AHU or PKG. UNIT MODEL #12 //C C/ , i.I
I
COND. UNIT MODEL # /Y,4 J/' 3c)
KW HEAT -a.S /LL„
NOM TONS 3
AHU C
PKG
1) M.C.A
AH
PKG
HU CU
PKG
2) M.O.P
U CU
PKG
AHU CU
PKG
3) VOLTS 30 0 /¢
AHU CU
PKG
PKG UNIT
/ /
PKG UNIT
/
/
tYES)
N o n a 1/4 6) C- V °
REPLACING DUCTS i /,t
YES
NO
fE
NO
REPLACING THERMOSTAT' /
YES
NO
NO
NEW 4 "CONCRETE SLAB
YES
NO
ES
NO
NEW ROOF STAND
YES
NO
ES)
NO b 0- Gyx)• GL° tr
NEW RETURN PLENUM BOX
YES
NO
AIR CONDITIONING REPLACEMENT DATA
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): (99S "i✓ 9 j / Ga, (2 G1
Ci ty. Miami Shores Village County: Miami Dade Zip Code: 3 / F
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 ❑ ARHI Sheet Attached: YES IdNO ❑ Contract Attached: YES
C)lvla`\
1. Minimum Circuit Ampacity (Wire Size): ) b
2. Maximum Overcurrent Protection (Fuse /Breaker Size): 3 0 r;
3. Voltage of Circuit (208/240/480): 290
4. Size Disconnecting Means:
Contractor's Company Name: ✓® /% 5/ %�.7
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
Phone: 3 ,3 - .700 e
State Certificate or Registration N. (74(b 4, j V C3 Certificate of Competency N.
Signature Date: / /2 //
(Qualifier's signature only)