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MC-10-1755Inspection Number: INSP - 151963 Scheduled Inspection Date: November 04, 2010 Inspector: Perez, JanPierre Owner: ACKLEY, SUSAN Job Address: 1119 NE 99 Street Miami Shores, FL 33138- Project: <NONE> Contractor: NORTHWIND A/C PF DADE COUNTY INC Building Department Comments CHANGE OUT OF AIRHANDLER AND CONDENSING UNIT 4\ iD Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments November 03, 2010 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 -10 -10 -1755 Permit Type: Mechanical - Residential Inspection Type: Final Work Classification: A/C Replacement Phone Number (305)759 -2425 Parcel Number 1132050180050 Phone: (305)758 -0441 Page 4 of 9 tO) Miami Shores Village Building Department BUILDING PERMIT APPLICATION FBC 20 Permit Type: MECHANICAL Owner's Name (Fee Simple Titleholder) a) f) A4,Arlyr Phone # 705--759--/Ft Owner's Address ,/ // 9 iV' ` 5 Cit I I' ( Q, G5 State Zip 03135 Phone # Tenant/Lessee 4'A Email {�C ! tf©�/(� (�i be t,07 --t{ 4J� Job Address (where / the work is being done) / /19 E, 7 City iami Shores Villa le FOLIO / PARCEL # 1/ —&-X5 -0/8 Is Building Historically Designated YES County Miami -Dade Zip .331 6" NO X 1 Lill OCT 04210 AY L 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 Permit No. C O H - 65 Master Permit No. Flood Zone y6 Contractor's Company Name A/ tt J // >2 61 , Phone # ��-' 75 R ( Contractor's Address 9_ I/ 1 City / 4/ le y. w it State Zip 3 '/< Qualifier alifier Namme n/ [ L/ e 7 Phone # -3 05---1 I State Certificate or Registration No CAG 03 9 Certificate of Competency No ./ 95# 6, ( 3 5/ Contact Phone S OS -7 S8 e Y9/ E -mail fie rNwind C&C Gma / /.. C-4/I2 Architect/Engineer's Name (if applicable) Al }4- Phone # m Square/ Linear Footage Of Work: -� Value of Work For this Permit $ 5/g, Type of Work: DAddition ❑Alteration ONew tX Repair/Replace ❑ Demolition Describe Work: * * * * ** Scot * * * * ** * * * * ** * * * * * * * * * * * ** ** Submittal Fee $ Permit Fee $ Training /Education Fee $ CCF $ Notary $ Scanning $ Radon $ DPBR $ Double Fee $ Violation date: Structural Review. $ Total Fee Now Due $ **** * * * * * * *:t * * * * * * * * * * * * * * * * * * * * ** CO /CC $ Technology Fee $ Bond $ See Reverse side 1 Bonding Company's Name (if a pplicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) N/A //A 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 commencement must b • • d at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence such pi'ted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Signature ignature Owner or Agen P . ntractor The foregoing instrument was acknowledged before me this 26 I The foregoin ins - . as acknowledged befe;ne this0l/) day of [e ti.20(31 , by 5L) 5 a N A Ck !lQ. , day o - , 20 1v, by 4 who is personally known to me or who has produced FL. w - who is personally known to me or who has produced identification and who did take an oath. mission NOTARY S Print: My Co APPROVED BY (Revised 07 /10 /07XRevised 06 /10/2009) Notary Ftlbl■c, State of Florida Corivn:ssic74 D058838 My comm. expires June 24, 2011 Engineer as identification and who did take an oath. NOTARY PUBLIC: Print: eP Notary Public State of Florida Ronald E Welsandt • At My Commission DD916295 o , vs 1, 3 * * * * * * ** to Sign. o13 * * * ** * * * * * * * ** t0 //ians Examiner Zoning Clerk checked UNIT BEING REPLACED DATA NEW UNIT MANUFACTURER p.dc,opyl / 4✓yi. E,G.. AHU or PKG. UNIT MODEL #e yl94 49 7Z H y / -R I dirt COND. UNIT MODEL # rrpc y au, / may iy , � ' M �® KW HEAT .7p k3,29.4 /P>/� 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 PKG PKG UNIT / / PKG UNIT / / EERISEER YES NO REPLACING DUCTS YES NO YES NO REPLACING THERMOSTAT YES NO YES NO NEW 4 "CONCRETE SLAB YES NO YES NO NEW ROOF STAND YES NO YES NO NEW RETURN PLENUM BOX YES NO AIR CONDITIONING REPLACEMENT DATA PERMIT NUMBER: MC °-175 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): II) 9',1 /i � f S 7 City: Miami Shores Village County: Miami Dade Zip Code: 3.31 4' Change Disconnecting means: YES ❑ NO C( ARHI Sheet Attached: YES JI NO ❑ Contract Attached: YES JI 1. Minimum Circuit Ampacity (Wire Size): 2. Maximum Overcurrent Protection (Fuse /Breaker Size): 3. Voltage of Circuit (208/240/480): 04 VD 4. Size Disconnecting Means: / Contractor's Company Name: State Certificate or Registration N 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 Miami Shores Village Building Department 10050 N. E. 2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Phone: s3 (3.5 4y � Certificate of Competency N. Date: le " Policy Number Type of Insurance Policy Period Effective Date i Expiration Date Limits of Liability (at beginning of policy period) 98BFG3844 This Insurance includes: Comprehensive Business . X X — Liability Products - Completed Contractual Liability Personal Injury Advertising Injury 10/06/2010 04/06/2011 Operations BODILY INJURY AND PROPERTY DAMAGE Each Occurrence $ 1,000,000.00 General Aggregate $ 2,000,000.00 Product - Completed $ 2,000,000.00 Operations Aggregate Policy Number EXCESS LIABILITY Policy Period Effective Date ; Expiration Date BODILY INJURY AND PROPERTY DAMAGE (Combined Single Limit) ) II Umbrella ❑ Other Each Occurrence $ Aggregate $ Policy Period Effective Date i Expiration Date Part I - Workers Compensation - Statutory Workers' Compensation and Employers Liability Part II - Employers Liability Each Accident $ Disease - Each Employee $ Disease - Policy Limit $ Policy Number Type of Insurance Policy Period Effective Date f Expiration Date Limits of Liability (at beginning of policy period) THE CERTIFICATE OF INSURANCE IS NOT A CONTRACT nF Mg! IDANCC Arun mcrruco A L eeroeseTn�rl .. ..e &IP A S i A Tn V Certificate of Insurance This certifies that ■ State Farm Fire and Casualty Company, Bloomington, Illinois — State Farm General Insurance Company, Bloomington, Illinois State Farm Fire and Casualty Company, Aurora, Ontario State Farm Florida Insurance Company, Winter Haven, Florida State Farm Lloyds, Dallas, Texas insures the following policyholder for the coverages indicated below: Policyholder NORTHWIND AIR CONDITIONING OF DADE COUNTY, INC. Address of policyholder PO BOX 530719 MIAMI FL 33153 Location of operations 342 NW 171ST ST N MIAMI BEACH FL 33169 Description of operations C/C HERMAN RODRIGUEZ PRESIDENT STATE MUM INSUSANCt The policies listed below have been issued to the policyholder for the policy periods shown. The insurance described in these policies is subject to all the terms, exclusions, and conditions of those policies. The limits of liability shown may have been reduced by any paid claim AMENDS, EXTENDS OR ALTERS THE COVERAGE APPROVED BY ANY POLICY DESCRIBED HEREIN. 1001260 Name and Address of Certification Holder If any of the described policies are canceled before their expiration date, State Farm will try to mail a written notice to the certificate holder 30 days before cancellation. If we fail to mail such notice, no obligation or liability will be im ,,r; - - d on State Farm or its a nts or represe Signature of Authorized Representative Title ROBERT NAVA Agent Name Telephone Number (306) 945- -5004 Agent's Code Stamp FO DADE NAVA IBIS AGCY INC ,os ,o 2s2ooe A i 69 72c, ORTF�j ��� F606 09/20/10 Date