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MC-10-1688Inspection Number: INSP - 153203 Scheduled Inspection Date: February 02, 2011 Inspector: Perez, JanPierre Owner: MILLER, JEFFREY Job Address: 1217 NE 100 Street Project: <NONE> Miami Shores, FL Contractor: AIR ON DEMAND, INC. Building Department Comments February 01, 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 -9 -10 -1688 Permit Type: Mechanical - Residential Inspection Type: Final Work Classification: A/C Replacement Phone Number Parcel Number 1132050090631 Phone: 3051259 -5669 EXACT REPLACEMENT AC SYSTEM 4 TON AH AND COND Passed 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- 151539. C/U NOT SECURED RIGHT JPP Page 6 of 17 NOTICE OF COMMENCEMENT A RECORDED COPY MUST BE POSTBD ON THE ICS MEAT TIME OF FIRST INSPEC ITON PERMIT NO. TAX FOLIO NO. 11.32 - 05.009 -0631 STATE OF FLORIDA: COUNTY OF AMI. DA 3E: WITNESS my hen HARVEY 6 Stay` (1'r:ynrent bond required 10 ownwiromeogractur; 'i1 1 Name and address: N/A Amount ofband $ STATE OF FLORIDA,OOLIOY OF DANE I HEREBY CERTIFY that this . cfte original filed in ; is . #ice an ; /i i thy f 111111111111111111111111111111111111111111111 CFI4 201080657471 OR Bk 27435 Ps 3919; (1oa) RECORDED 09/28/2010 13:03 :08 HARVEY RUVIN, CLERK OF COURT MIAMI —DADE COUNTY, FLORIDA LAST PAGE THE UNDERSIGNED hereby gives n that hrmuntements will be made to certain red property, and ib ice with Chapter 713, Florida Statutes, o n 1s provided in Ws Nett of Commencement. 1. L+`noJpealp $ 53 42 E LETGN SIIORES PO 43-80 2 MO LOS' SIZE IRREGULAR OR 20104150 04 2CO2 1 OR 27195.0129 0210 30 2. Desalption ofbnpr r Exact age out of existing air conditioning equipment. 3. s) name acrd *Wrens: Je ey4 Mier cord John 8onderon, 1217 NE 100 Street. Miami Shores, Florida 4. Int d in;pr : Owner N diress of s e 'e r: N/A 5. ContrueMes tra ando e _ A1t 1068 SW. 186 Street :.s ., da.33157 7. Lender's tome and : N/A PINIONS within &estate of rtda designated by Owner upon whom stokes of other doeurnmrrla new beser as by Seams mug*" VW* • Norte and NIA • + re a ago OJ► 4the- Memos 10. Expiration date Ws Notice siCortaininosintrar fthe' date 1 yaw- encorartg tiniest a date ROSA C AUCEA h9 w of Ftodda ■ Commie My.Co AI. Ex{ ,Dec 26, 2012 d DD 832497 Bonded Tlu l .' it: 14 f. Preparedly: n Blaylock Air On Demand WW2 S r1S6 Street Ploridit 33157 i BUILDING PERMIT APPLICATION FBC 20 JOB ADDRESS: 1 Z1'1 e 100 St' 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 1 .o SEP 2 2 2010 Permio. filci (42-)--r Master Permit No. Permit Type: MECHANICAL OWNER: Name (Fee Simple Titleholder): le f4 f C l ' lee Phone#: 1 3‘9 ° 21 g * 531 Address: 1 2-11 141. 1100 S-F- City: t+u i ct tit .- sin ore S State: F l Zip: 3 31 1$ Tenant/Lessee Name: i 1 A Phone#: Email. City: Miami Shores County: Miami Dade Zip: S3 1 3 g Folio/Parcel#: 11 ° 32 ° OS 00 q . l.(0 21 Is the Building Historically Designated: Yes NO X Flood Zone: CONTRACTOR: Company Name: Air 0 ra cC7e' An 8 Phone#: 3O5 • Z54 . 540(0'5 Address: 10 (o ' 13 (® S f Zip: 33 151 City: f1 i s rn t State: r 1 Qualifier Name: 51 t‘OL n riO "4 4 " Lex.ir 10 CSC State Certification or Registration #: 6 A-c, L ' 1 31 Certificate of Competency #: Contact Phone#: 30 S' Z Sa • 5 ( Pug Email Address: S n nz r. a a. i ✓ m rt. C &Min n ci . MA- DESIGNER: Architect/Engineer. S "YC11f n 1 P. Phone#: ..:. N . v Value If VVo . a� fo t ' r i ni tT 0 .fr Square/Lin ! ^ y 3 . sti a Type of Wo Ad fr s a�as�;l a ONew Description of Wo i. .k ..... I ` • �j r 1"' a f elG ; Phone#: FootNOWW6rl 6Cito to 3/*,5 fittu5 vs e *** **** Mk** ****$*******ffi********* * * W** ********* ***** ***** ***** **************** Submittal Fee °`' r::� Permit Fee $ I, ' ► X1 CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ Bonding Company's Name (if applicable) A, l 4 Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Al t A Mortgage Lender's Address City State ZAP Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or insokitatlon 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, BEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S AFFIDAVIT: I comfy 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 der the building permit is issued In the absence of such posted notice, the inspection will t be approved and a refrspectiara e will be charged Signature The J ath.. 4 • .for or Agent instrument was ackn wl day of _,.p , ZUL., by who is personally .., « •• 5 wh« r =.. «• �,�:. (.i'.. As identification and who did take an oath. NOTARY P C: Sign: L :? Print My commi t • o0 NWT r '` II�MI!!wn/i1Mrw1 I 14 APPROVED BY Structural Review (Revised 07/10/07XRevised 06/10 /2009)(Revised 3 /15/09) *** 1 Contractor The foregoing instrument was acknowl day of , 2010,by who is y kao to the or o has produced as iden . }�`. on and who did take an oath. NOTARY PUB ************************ ***** *****ss*sses*ss*s* ****wswe ip Plans Examiner Zoning Clerk Certificate of Product Ratings AHRI Certified Reference Number: 3935108 Date: 9/22/2010 Product: Split System: Air - Cooled Condensing Unit, Coil with Blower Outdoor Unit Model Number: 4TTX6048E1 Indoor Unit Model Number: 4TEE3C09A1 Manufacturer: TRANE Trade /Brand name: XL16I Manufacturer responsible for the rating of this system combination is TRANE Rated as follows in accordance with AHRI Standard 210/240 -2006 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): EER Rating (Cooling): SEER Rating (Cooling): 48500 13.00 17.00 *Ratings followed by an asterisk ( *) indicate a voluntary rerate of previously published data, unless accompanied with a WAS, which indicates an involuntary rerate. DISCLAIMER AHRI does not endorse the product(s) listed on this Certificate and makes no representations, warranties or guarantees as to, and assumes no responsibility for, the product(s) listed on this Certificate. AHRI expressly disclaims all liability for damages of any kind arising out of the use or performance of the product(s), or the unauthorized alteration of data listed on this Certificate. Certified ratings are valid only for models and configurations listed in the directory at www.ahridirectory.org. TERMS AND CONDITIONS This Certificate and Its contents are proprietary products of AHRI. This Certificate shall only be used for individual, personal and confidential reference purposes. The contents of this Certificate may not, In whole or in part, be reproduced; copied; disseminated; entered Into a computer database; or otherwise utilized, in any form or manner or by any means, except for the user's individual, personal and confidential reference. CERTIFICATE VERIFICATION The information for the model cited on this certificate can be verified at www.ahridirectory.org, click on "Verify Certificate" link and enter the AHRI Certified Reference Number and the date on which the certificate was issued, which is listed above, and the Certificate No., which Is listed below. 02010 Air - Conditioning, Heating, and Refrigeration Institute This combination qualifies for a Federal Energy Efficiency Tax Credit when placed in service between Feb 17, 2009 and Dec 31, 2010. ILICO Air - Conditioning, Heating, >Al U■ a/ and Refrigeration Institute CERTIFICATE NO.: 129296445253158891 UNIT BEING REPLACED DATA NEW UNIT go®ti lam& n MANUFACTURER fa ' e eu ;(®.1 l 4 81 AHU or PKG. UNIT MODEL # 47f. tr 3 C 09 6,5c,/ 3er)($ 44 COND.UNITMODEL# 4 Tjx tog 4 KW HEAT /t.3 NOM TONS 4 AHUSt CU.j i PKG 1) M.C.A AHU63 CU 29 PKG AHU /o® CU I PKG 2) M.O.P AHU6 n CUS3 PKG r AHU CU PKG 3) VOLTS AHU945 CU Z PKG PKG UNIT / / PKG UNIT / / EER/SEER /-1.J 1 1 YES NO REPLACING DUCTS YES I YES NO ^ REPLACING THERMOSTAT NO YES NO ,, NEW 4 °CONCRETE SLAB E NO YES NO NEW ROOF STAND YES NO A YES NO NEW RETURN PLENUM BOX NO 09/22/2010 12:09 FAX 1 800 685 7530 DATA SCAN FIELD SERVICES Signature 45 C049 o01/001 Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 .6 _Rsq Tel: (305) 795.2204 Fax: (305) 756.8972 AIR CONDITIONING REPLACEMENT DATA PERMIT NUMBER: MC LO - Y 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): 11. I . 1 k3 f o (O() 3+ M i �. m ' b red ?313? City: Miami Shores Village County: Miami Dade Zip Code: 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 HRI) DATA SHEET REQUIRED i A Change Disconnecting means: YES El RHI Sheet Attached: YES [ } N ❑ Contract Attached: YES r_V 1. Minimum Circuit Ampacity (Wire Size): tC � — nind g 2. Maximum Overcurrent Protection (Fuse /Breaker Size): 3. Voltage of Circuit (208/240/480): 4. Size Disconnecting Means: Contractor's Company Name: Phr f n 0-evna n d Phone: 3 - Z5q • $G 1.091 State Certificate or Registration N. e d4(', 1 $ / 3U 0y Certificate of Competency N. Date: C I .. j ,i(� THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTVATHSTANDINO ANY REQUIREMENT, TERM OR CONDMON OF ANY CONTRACT OR OTHER DOCUMENTMTH 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 8Y PAID CWMS. INSR LTR TYPE OF BNSURANcE ADDL WM 8UBR VOM MUM NUNBER MUM EMF (UBUDDIYYYW1 MUM EXP MUMMY) LWI1S A MMERU LTABILm CO/DERMAL GENERAL U ABILJT OCCUR CPPP00103422 08/18/10 08/18/1 EACH OCCURRENCE 5 1,000,000 X PRBIASESTammmilaN 5 100,000 CLAIMSMADE X MED DT (Any o pmmn) $ 5,000 PERSONALS AN MOW $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENI AGGREGATE UMITAPPUES PER PRODUCTS - COMP/OP AM $ 2,000,000 FRO- POLICY JECT LOC B AUTOM BILE LMBUJTY ANY AUTO ALL OYAJED AUTOS SCHEDULED maw HIREDAUTOS NM-OWNED TOS AU CA00141552 08/18/10 08/18/11 COMBINED SINGLE LMT (Ea mWdmd) $ 1,000,000 X MOW' MUM (Pmpmmn) $ BODILY INJURY (Peramtl0N) $ PROPERTY DMMOE (Pm =Nerd) $ X X $ UMBRE MALIAR EXCESS UM OCCUR CLAMS-MADE EACH OCCURRENCE $ AGGREGATE $ DEDUCTIBLE RETENTION $ $ $ c WOMMS DOIMBATION A M EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNER/EXECUTIVE OFFICERMEMBER EXCLUDED? UANIWA,yn UYee, demnLe under DESCRIPTION OF OPERATIONS Wow Y/ N N/A 830 -34786 07/19/10 07/19/11 X WC TATU- MR- TORY L MTTS ER EL EACH ACCIDENT $ 100,000 El. Melee NF_ EA EMPLOYEE $ 100,000 E.L DISEASE - POLICY MR $ 500,000 DESCRPTIONOFOPERAT IONS ILOCA1ION8 / VEWcLE$ (AUSNACORO 187 Add@ImMIRmmilm mm Ode. If mmaepnm pregeUed) MIA -138 MIAMI SHORES VILLAGE BUILDING DEPARTMENT 10050 NE 2ND AVENUE MIAMI SHORES 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. AUTHORED REPRESENTATIVE OW ACORb CERTIFICATE OF LIABILITY INSURANCE OP 1138t4 1 °A'E'°EM°°"""' 09/15/10 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 pollcy(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 BROWN & BROWN OF FLORIDA INC 8000 GOVERNORS SQUARE BLVD 400 MIAMI LAKES FL 33016 -1588 Phone: 305- 364 -7800 Fax: 305 - 822 -5687 INSURED AIR ON DEMAND, INC. SHANNON BLAYLOCK P.O. BOX 973085 MIAMI FL 33197 CONTACT NAME: PHONE (A/C, No, Ems: FAX (A/C, No): EMAIL ADDRESS: FRATM ER AIRON -1 cuaTDBIER m m. UNSCREWS) AFFORDING COVERAGE IR$URERA: FCCI INSURANCE COMPANY INSURER B: mLRT®v. EMMY ffimAIMM 03 INSURER C: =MD EMPLOYERS 00 CO INSURER D: WSURER ENSURER F : NAIC 8 10178 20141 10701 COVERAGES CERTIFICATE HOLDER ACORD 25 (2009109) CERTIFICATE NUMBER: CANCELLATION The ACORD name and logo are registered marks of ACORD REVISION NUMBER: © 1988-2009 ACORD ORPORATION. All rights reserved.