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MC-10-612Inspection Number: INSP - 140436 Scheduled Inspection Date: April 27, 2010 Inspector: Perez, JanPierre Owner: GARCIA, RAFAEL Job Address: 125 NE 104 Street Project: <NONE> Miami Shores, FL 33138 -2028 Contractor: ANACHRIS A/C & REFRIGERATION INC 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 Number: MC -4 -10 -612 Permit Type: Mechanical - Residential Inspection Type: Final Work Classification: A/C Replacement Phone Number Parcel Number 1121360130720 Phone: 305 -899 -1187 change out 4 ton a/c system with 10 kw heat 4„ Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments April 26, 2010 For Inspections please call: (305)762 -4949 Page 9 of 29 Project Address Owner Information Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138-0000 Phone: (305)795 -2204 Fees Due CCF Education Surcharge Permit Fee - Additions/Alterations Scanning Fee Submittal Fee Submittal Reversal Fee Technology Fee Total: Amount $3.60 $1.20 $202.30 $3.00 $50.00 ($50.00) $4.80 $214.90 Building Department Copy Address Parcel Number 125 NE 104 Street Miami Shores, FL 33138 -2028 1121360130720 Block: Lot: RAFAEL GARCIA Phone 125 NE 104 Street MIAMI SHORES FL 33138 -2028 Contractor(s) Phone ANACHRIS A/C & REFRIGERATION IN 305 - 899 - 1187 CeII Phone Tons: 4 Additional Info: NC SYSTEM REPLACEMENT Classification: Residential Approved: In Review Comments: Date Denied: Date Approved: : In Review Type of Work: Authorized Signature: Owner / Applicant / Contractor / Agent Pay Date Pay Type Invoice It MC-4-10 -37564 04/16/2010 Credit Card 04/12/2010 Credit Card Amt Paid Amt Due $ 164.90 $ 50.00 $ 50.00 $ 0.00 Applicant Available Inspections: Inspection Type: Final In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS 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. Futhermore, I authorize the above -named contractor to do the work stated. April 16, 2010 Date Expiration: 10 /13/2010 CeII April 16, 2010 1 BUILDING PERMIT APPLICATION FBC 2001 Permit Type: MECHANICAL Miami Shores Village INCISEVED Building Department APk 1 of 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.WCI 111 (01 t9 Master Permit No. Owner's Name (Fee Simple Titleholder) RhFA-e.I_ t -A-e C.c. A Phone # 3n5 - fo O (o - 9 339 Owner's Address 1.25 IJE 1 0 4 Sr City miq-m t t.SNoP S State rt. Zip 33 1 3 55 Tenant/Lessee Name Phone # Email Job Address (where the work is being done) 1.2S 145 / 0 4 Si City Miami Shores Village County Miami -Dade Zip 33 13 g FOLIO / PARCEL # Is Building Historically Designated YES NO )X Flood Zone Contractor's Company Name A NA C1-IK.15 Ale. Contractor's Address &2-I (45- 109 ST City I51 S (-Ad r( PA R.K. State Zip 33/(o/ Qualifier Name 3E i o {2 . n�%�(EZ Phone # 3©b r- 4- ( State Certificate or Registration No. !.ACQ 4_9_5c/ F Certificate of Competency No. Contact Phone 4 05 - +q0 - igO0 E -mail 5rnurlcZ.® bUUSotS . nef Architect/Engineer's Name (if applicable) Phone # 5 -7 Value of Work For this Permit Square / Linear Footage Of Work: Type of Work: ['Addition ❑Alteration ['New ®. Repair/Replace ❑ Demolition Describe Work: C.Pd -Aptc f_OL1T 4 i1 4 A l C. SJSTE 1 yIIi T}I 10 Kid l-/ r ******** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** F * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** `00 Fee $ -21 ) 2 "' L 3 f 2 CCF $ 3 CO /CC $ Submittal Fee $ Training/Education Fee $ I' g,() Notary $ Scanning $6' Double Fee $ Phone # 305 - f39 N -1187 Technology Fee $4'Y0 Radon $ DPBR $ Violation date: n � • q � Structural Review. $ Total Fee Now Due $ d Bond $ See Reverse side --> 13 T-9 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 reins _ pection fee will be charged. Signature NOTARY PUB Sign: /I t1 Print: C!i My Commission Expires: 3/4/ * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** APPROVED B.Y. (Revised 07 /10 /07)(Revise i 06/10/2009) lans Examiner Engineer Signature Sign: Ore 414 ntract Owner or Agent t The foregoing instrument was acknoowled:ed beforeme this /Z The fore oing strument was acknow dged b-° • a thi }s,� ! fl� day of /Orr 1 , 20 10, by ea I ' ') (( � day of 1 , 201.1 by a • 01 , who is personally known to me or who has produced who is pe sonall known to me or who has produced As identification and who did take an oath. l� ation and who did take an oath. NOTARY PUBLIC: A ELIZABETH RUR Print: 4 �,,,1!i( �i� S NOTARY PUBLIC My Commission Expire .� 1 1 STATE OF FLORIDA .e V. .�'" res 3/14/2014 6, Comm# DD971160 r 4 ;1�g CV l * * * * ' 1* * * * * * * * * * * * * * * * * * ** * * * * * * * * ** a °� * * * * * * * * * ** b� Zoning Clerk checked Date Estimate# 4/8/2010 26 A na Timis Air Conditioning and Refrigeration Inc. 821 N.E. 109 Street • Miami, FL. 33161 • Tel.: (305) 899 -1187 • Fax: (305) 899 -1187 Name / Address Rafael Garcia 125 NE 104th St. Miami Shores, FL 9,31sS Estimate Description We respectfully propose to supply and install one 4-ton super high efficiency 16 SEER American Standard air conditioning system consisting of condensing unit model #4A7A5048E1000A coupled with air hrndler model #4TEE3C09A1000A and 10 kw heat strip model #BAYHTR1410PDCC in replacement of existing unit. Install new touch - screen programmable thermostat. Disconnect and remove existing system and refrigerant lines. Run new refrigerant lines, install new system and connect to existing electrical, ductwork, and condensate. Attach hurricane clips as per engineering specs for American Standard. Contractor will remove and dispose of existing equipment. System comes with a registered 10 -year warranty on compressor and parts. Installation warranty is one year from date of start-up. This unit qualifies for the federal tax credit. Total price is $5780.00. Manufacturer gives a $500 rebate and FPL gives a $780 rebate. Total amount due from customer is $4500. Permit fees not included. Z l c — 4 $° D- Il �o 60% due on acceptance, and balance due upon completion. Total Total 4,500.00 $4,500.00 LOCAL BUSINESS TAX RECEIPT 2010 MIAMI-DADE COUNTY STATE OF FLORIDA SEPT, 30, 2010 MUST BE DISPLAYED A;T PLACE OP BUSINESS PURSUANT TO COUNTY CODE CHAPTER ; 8 A - ►R ,0 & 10 THIS IS NOT A SILL - DO NOT PAY 272405 -3 RENEWAL BUSINESS NAME / LOCATION RECEIPT AC NO. 2598 285385-2 ANACHRIS AIR CONDITIONING & STATES C04 REFRIGERATION INC 821 NE 109 ST 33161 BISCAYNE PARK OWNER ANACHRIS AIR COND & REFRIG INC Sec. Tiw of Business _ 196 SPEC MECHANICAL CNTRACTOR 1 THIS re ONLY A OSA BUSINESS TAX . I T Boer NOT PEEWIT ThE LEEM TO VIOLATE f REGULA FRO AN 071191 P � B , . m HO mm� 110115. P E CO TAX 09/18/2009 09010083001 000045.00 SEE OTHER SIDE MIAMI -DADE COUNTY TAN COLLECTOR 1 40 W. FLAGLER ST. 1 FLOORp MIAMI, FL 33130 DO NOT FORWARD ANACHRIS AIR CONDITIONING & REFRIGERATION INC SERGI0 R NUNEZ 821 NE 109 ST MIAMI FL 33161 11 1 111111 , 111111111111111 ,111111111111,111Atl FIRST-CLASS U.S. POSTAGE I PAID MIAMI, FL PERMIT NO.231 _ ...a�, C 0$80474 d '�. CACQ425` Named A AIR CONDITIO below IS NXNG C under ' the" z CERTIFIED . u p n of Chap , ' ExPiratiQ 1 ., date. AUG 3 P,te� 20:10 I-9 /��. ` i xTrAafa f `P'£' '' • x w V r R y { _._Jr !f �¢? A4 AN lE ER QIC. RI , lARCO1�TDIT BI'SC,AYNE 0 ST N w , w �, �� ` s I n zr � �3 ync� t c •9a' * s`a ai)A°�•. � orr"�'±i .,,,, .�i, .t � � .ate II �ti CH�YR�, E �, ti i y ply $k 1 ANY MAY POLICIES. INSR nc rvs.iutca yr ini uKANlit Ll:i I tU BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. '• DD' LTR A NS - • TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE IOLCY DATE IMM /DD/Y P EXPIRATION T DA (RAMIDD/ LIMITS GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY BLA54089691 06/03/09 06/03/10 EACH OCCURRENCE $1,000,000 $300,000 $10,000 DAMAGE ES Eaoccurrencel CLAIMS MADE X OCCUR M ED EXP (Any one person) © PD Ded:500 PERSONAL & ADV INJURY GENERAL AGGREGATE $1,000,000 $2,000,000 $2,000,000 ■ GEM_ AGGREGATE LIMITAPPLIESPER: POLICY n JEQT [1 LOC PRODUCTS - COMP/OP AGG A AUTOMOBILE X ■ ..■, X X ■ LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS BAA54089691 06/03/09 06/03/10 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 B erpera n) (Per parson) $ (Per accident) Seraccd accident) $ PROPERTY DAMAGE (Per accident) $ ',■ GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ AUTO ONLY: AGO $ ..■ EXCESSAJMBRELLA LIABILITY OCCUR CLAIMS MADE ■ EACH OCCURRENCE $ AGGREGATE $ $ DEDUCTIBLE RETENTION $ $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? It yes, describe under SPECIAL PROVISIONS below I ORV ULT./TITS 1 I EL. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS 1 LOCATIONS / VEHICLES/ EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION Miami Shores Village - Building Dept 10050 NE 2nd Ave Miami Shores, FL 33138 Annon9Rr9nniins* _L A SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 1 n 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. UT. ORIZED R PRE E 1 . E f tte: 4/12/2010 Time: 11:06 AM To: 13057568972 M 13057568972 COVERAGES Client#: 21339 NUNEZ ACORDTV CERTIFICATE OF LIABILITY INSURANCE PRODUCER Luce, Smith & Scott, Inc. 6860 W. Snowville Road Suite 110 Brecksville, OH 44141 INSURED Anachris Air Conditioning & Refrig Inc. 821 NE 109th Street Miami, FL 33161 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 COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE INSURERA: Ohio Casualty INSURER B: INSURER C: INSURER D: INSURER E: DATE (MM/DD/YYYY) 4/12/2010 NAIC # JLF Page: 002 0 ACORD CORPORATION 1988 FROM :ANACHRIS A/C SCOPES OF BUSINESS OR TRADE: 1— REPAIR SERVICE 3- CERTIFIED AC CONTRACTOR MAW -Oc' reDTtetrnrr nF ti r•THtM Tf1 P. FXFMPT REVISED 09 FAX NO. :3058991187 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 we 09/18/2009 EXPIRATION DATE: 09/18/2011 PERSON: NUNEZ SERGIO R FEIN: 650403009 BUSINESS NAME AND ADDRESS: ANACHRIS AIR CONDITIONING & REFRIGERATION INC 821 NORTHEAST 109TH STREET MIAMI FL 33161 2— A/C MAAINTENANCE Apr. 16 2010 03:25PM P1 09 -18 -2009 IMPORTANT Pursuant to Chapter 440 . 05(14), F.S., an officer of a corporation who elects exemption from Ibis chapter by filing a certificate of medium ender this section. may not recover benefits or compensation under this chapter. Pnrotani 10 Chapter 440.05112), F.S., Certificates of election to be exempt... apply only within rho . scope of the business er trade listed on the notice el 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 ar certificate ho 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 01 this section. QUESTIONS? (850) 413 -1809