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MC-10-1987Inspection Number: INSP- 153196 Permit Number: MC -11 -10 -1987 Scheduled Inspection Date: November 16, 2010 Inspector: Perez, JanPierre Owner: BAIN, KEENAN Job Address: 19 NW 99 Street Project: <NONE> Miami Shores, FL Contractor: NEW SERVICE COMPANY Building Department Comments Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 - 2204 Fax: (305)756 - 8972 Permit Type: Mechanical - Residential Inspection Type: Final Work Classification: A/C Replacement Phone Number Parcel Number 1131010180530 Phone: (305)324 -754_ 4 TON REPLACEMENT 11 Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments November 15, 2010 TT0 /800(3] For Inspections please call: (305)762 -4949 Page 15 of 23 sammias tnaId ANDS VSVU OC L 999 009 T %VA L£ :9T OTOZ /9T /TT e Miami Shores Village Nov o 2010 BUILDING PERMIT APPLICATION FBC 20 Permit Type: MECHANICAL OWNER: Name (Fee Simple Titl�lder Address: City: Tenant/Lessee Na Email: .._ 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 JOB ADDRESS: City: Miami Shores Folio/Parcel #: / /.c/ ®f® /��.�f? Is the Building Historically Designated: Yes NO Permit No. 1CAO V Master Permit No. 'J /i A�/'% Phone #3 Zip: . /.2 Phone #: County: Miami Dade Zip: 3' 3/50 Flood Zone: a CONTRACTOR: Company Name: JJ I AA) ` Q/ E C€r. pAqu y Phone #: 3 01 7 -7 3 Address: � O I S UJ Q$ 3 0 2- r�-+ City: , A a State: t c - 9 Qualifier Name: r n (1.0 T Z Phone #: Zip: 3 313 J 3 o rs 79s--733 State Certification or Registration #: Cam. 1 81 tA Certificate of Competency #: Contact Phone#: '3 4 r— k - "2 3 CI' i Email Address: ) S Co 3) 2 , Q y4 )$o®. &a y" DESIGNER: Architect/Engineer: r � Phone#: Value of Work for this Permit: $ ' v = ' Square/Linear Footage of Work: Type of Work: °Address °Alteration °New tepair/Replace °Demolition Description of Work: 0 N G(c P .... k• Aex+ kekw �k�MekeNek�k�k�k�k�kd��xd�N�d�ekk�d� +R�xs�de�x�ka....I. ** ....................................... Submittal Fee $ � _ 0 Permit Fee $ CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ I ° b k 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 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. Owner or Agent The foregoing instrument was acknowledged before me this 2 day of _ e. G1. , 20 10 , by NOTARY PUBLIC: Sign: Print: My Commission xpires: APPROVED BY keen'. (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) IA■ who is personally known to me or who has produced K^, -- e•Q As identification and who did take an oath. JESUS LOPEZ MY COMMISSION #D0724887 EXPIRES: OCT 14, 2011 Signa Contractor The foregoing instrument was acknowledged before me this 2 day of mod.. L � � , < , 20 , b Pr.Gp41v Q4.. who is personally known to me or who has produced 4 as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: JESUS LOPEZ MY COMMISSION #DD724887 non through 1st St Insurance * * * * **** * ******* ****** ******** Plans Examiner Zoning Structural Review Clerk UNIT BEING REPLACED DATA NEW UNIT 7 MANUFACTURER E g YA 1-4 f' -- II AHU or PKG. UNIT MODEL # Ai N b op G A C. B n l-p � - A 21S COND. UNIT MODEL # L Avv4 ®ctszt ® l 0 KW HEAT 7 NOM TONS AHU CU KG 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 (1_, YES NO REPLACING DUCTS YES NO) YES NO REPLACING THERMOSTAT Fg NO YES NO NEW 4 "CONCRETE SLAB 6.E.S3 N • YES NO NEW ROOF STAND YES IT YES NO NEW RETURN PLENUM BOX (Y NO 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): l q w (fl) 9 oj.' S 1 City: Miami Shores Village County: Miami Dade Zip Code: / S 0 Change Disconnecting means: YES ❑ NO 12 ARHI Sheet Attached: YES] NO ❑ Contract Attached: YES .j 1. Minimum Circuit Ampaciity (Wire Size): `2 7. -5" C7 > 0)' '' P• »'Z5& 2. Maximum Overcurrent Protection (Fuse/Breaker Size): -( o / m C . O. / be ,4y-iP 3. Voltage of Circuit (208/240/480): 2 O - 2 '3 0 4. Size Disconnecting Means: — '1 0 ✓4 P C4i J 4 / e 444-1- Contractor's Company Name: /Z0 S /f c6 l_ ern ✓v/ Phone: `" &T- 7 PP- 73e 3 State Certificate or Registration N. L' 1fc /Pt C( Cr c. / Z Signatur 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 (Quad AIR CONDITIONING REPLACEMENT DATA Miami Shores village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 PERMIT NUMBER: MC Certificate of Competency N. ' Date: / / ',/ b 1wv4;ahri direclory,org Certificate of Product Ratings AHRI Certified Reference Number: 3485260 Date: 11/9/2010 Product: Split System: Air - Cooled Condensing Unit, Coil with Blower Outdoor Unit Model Number 167ANA048 -A Indoor Unit Model Number. FV4CNB006 Manufacturer BRYANT HEATING AND COOLING SYSTEMS Trade/Brand name: PREFERRED 17 PURON AC Manufacturer responsible for the rating of this system combination is BRYANT HEATING AND COOLING SYSTEMS Rated as follows in accordance with AHRI Standard 210/240-M6 for Unitary Air - Conditioning and Air-Source Heat Pump Equipment and subject to verification of rating accuracy by AHRI -sponsored, independent, third party testing: Cooling Capacity (Btuh): 49500 EER Rating (Cooling): 13.40 SEER Rating (Cooling): 17.00 This combination qualifies for a Federal Energy Efficiency Tax Credit when placed in senvlce between Feb 17, 2009 and Dec 31, 2010. • Ratings totawed by an asterisk (1 indicate a vokutary rents of prerkunty published data. unless accompaded with a tARS. which Indicates an 6rvokolealy relate. DISCLAIMER AHRI does not endorse the product(s) fisted en this Certtficate and makes no remesentatkins, wanatales or guarantees into, and resumes no responsibMty tin the product(s) Listed on this Cerf .AHRI a ydlsdakns al aridity for damages of any Ike arming curt of the use or perforrt a otitis product(s), were unauthorized a l t e r a t i o n o f d a t a l i s t e d on t h i s C e p C e r t i f i e d r a m w e v e fl d o n l y for models and configurations listed In the dheetony at wwwadt idirectory.org. TERMS AND CONDITIONS This Cie and Its contents am proprietmy produds ofAHRL This Certificate siren only be used for Indlekkad, personal and t imps The cotrtorrts of this Certificate may trot, In whole or in part, be mprodtroe copied dissrenl ndad erdresd bdoa =War database; Or otherwise utlgzsd. ht any form or mariner orby any means, exceptforthe users Individual, personal and confidential rte. CERTIFICATE VERIFICATION A P The hdonnatlon for the model dted on this certificabs can be verified at wnwv etutd rectoroarg, _ . - A Air Conditioning, Heating, click on °Verify Certificate° Mc and enter Csrtithid Reference Mortar and the date on aus and Refrigeration Institute which the certificate was Issued, which Is lied above, and the Cie No., width Is listed below. ©2010 Air- Conditioning, Heating, and Refrigeration Institute CERTIFICATE NO.: 129337858088370248 New Service Company 501 SW 1st Street Suite # 302 Miami, FL 33130 Name / Address Bain 19 NW 99 St Miami Shores Florida 60% at acceptance,40% at install New Service Company nsc33126 @yahoo.com P.O. # Terms Due Date 10/27/2010 Other Description Installation of a 4 Ton 17 seer/ 13 eer Bryant Model Fv4cnb006,167ana048000 2 speed Labor Install new retum at hallway FP& L Rebate Permits cost extra 2nd option 4 Ton 16 seer Model 116 bna 48000,Fx4dnf049t00 1 speed After rebate $ 4400.00 QtY 305 - 324 -7504 305 - 468 -6357 Date 10/27/2010 Estimate # 559 Rate Total 4,150.00 4,150.00 1,500.00 1,500.00 200.00 200.00 - 1,020.00 - 1,020.00 Subtotal $4,830.00 Sales Tax (0.0%) $0.00 Total $4,830.00 "A CERTIFICATE OE LIABILITY INSURANCE ICCARGO THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COV AFFORDED BY.THE POLICIES BELOW PRODUCER Superior Insurance Group, Inc. 13311 S.W. 42nd St. Miami, FL 33175 Phone (305)220 -2500 INSURED NEW SERVICE COMPANY 501 SW 1 ST # 302 Miami, FL 33130 COVERAGES THE POUCIES OF INSURANCE LISTED 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. AGGREGATE UMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. nil POLICY EFFECTIVE POLICY EXPIRATION Lts INs^-R, TYPE OF INSURANCE POUCY NUMBER DATE MIyIDD DATE MMID B E ❑ GENERAL UABIUTY , Ej COMMERCIAL GENERAL LIABILITY 0 CLAIMS MADE ❑ OCCUR 0 GEN'L AGGREGATE LIMIT APPLIES PER ❑ POLICY ❑ PROJECT ❑ LOC AUTOMOBILE LIABILITY ❑ ANY AUTO ❑ AU. OWNED AUTOS ❑ SCHEDULED AUTOS ❑ HIRED AUTOS ❑ NON OWNED AUTOS ❑ r� GARAGE LIABILITY ❑' ANY AUTO . ❑ EXCESSIUMBRELLA LIABILITY ❑ OCCUR 0 CLAIMS MADE ❑ DEDUCTIBLE ❑ RETENTION CERTIFICATE HOLDER ACORD 26 (2001108) QF ORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR / PARTNER 1 EXECUTIVE OFFICER / MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below MIAMI SHORES VILLAGE 10050 NE 2 AVE MIAMI SHORES, FL. 33138 ex (305)221 -8070 INSURERS AFFORDING COVERAGE INSURER A; WESTERN WORLD INS CO INSURER W. INSURER C: INSURER D: INSURER E: INSURER F: NPP985283 08/04/10 CANCELLATION 08/04/11 OTHER F D OF OPERATIONS 1 LOCATIONS 1 VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT 1 SPECIAL PROVISIONS 305 - 756-8972 LIMITS EACH OCCURRENCE DAMAI E NTED PREMISES (Ee ocaurence) MED EXP (Any one person) PERSONAL & ADV INJURY GENERAL AGGREGATE PRODUCTS - COMP /OP AGG COMBINED SINGLE LIMIT (Es accident) BODILY INJURY (Perperson) BODILY INJURY (Per accident) AUTO ONLY: AGG EACH OCCURRENCE AGGREGATE E.L. EACH ACCIDENT PROPERTY DAMAGE (Pet accident) AUTO ONLY - EA ACCIDENT OTHER THAN EA ACC Td WW1% ❑ Og E.L. DISEASE - EA EMPLOYEE EL DISEASE - POLICY LIMA DATE (MM/DD/YY) 11/09/10 NAIC # 1,000,000 50,000 5,000 1,000,000 2,000,000 1,000,000 AUTHORIZED REPRESENTATIVE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 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. ACORD CORPORATION 1988