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MC-10-1556Inspection Number: INSP- 150610 Permit Number: MC -8 -10 -1556 Scheduled Inspection Date: October 12, 2010 Inspector: Perez, JanPierre Owner: LOPEZ, J TOMAS Job Address: 346 NE 105 Street Miami Shores, FL Project: <NONE> Contractor: PRIDE AIR CONDITIONING & APPLIANCES INC Building Department Comments Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 CHANGE OUT NC SYSTEM TRANE 5 TONS 16 SEER tO to October 08, 2010 For Inspections please call: (305)762 -4949 Permit Type: Mechanical - Residential Inspection Type: Final Work Classification: A/C Replacement Phone Number Parcel Number 1121360130040 Phone: (954)977 -7433 Page 7 of 30 BUILDING z372,9&z PERMIT APPLICATION FBC 20 JOB ADDRESS: 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 Permit No. IvIC)10M Master Permit No. Permit Type: MECHANICAL OWNER: Name (Fee Simple Titleholdec): i o rnol2z) LOW--. phondk37-cr7-.345 Address: 1 05 bb- St% City: 1 & State: __2....-- Zip: 331____ Tenant/Lessee Name: Phone#: Email: 32410 M IC5 8L 1/45? City: Miami Shores County: Miami Dade Zip: .331 Folio/Parcel#: 11" 21 - 01370040 Is the Building Historically Designated: Yes NO Ott ille, I i Address: 1 It. a • 1 0 I i aree.5) Pine : C l54 — q77 44 3-3 CONTRACTOR: Company Name: 1 f City: a • 1' ,. State: Zip: at5C10q Qualifier Name: talirdi '.P 0,r I Phone#: (jq3:774a3 State Certification or Registration #: , Certificate of Competency #: ell -,,,-;-.0.15,4- - - Address: pertepLrmits a grnai 1 • 0 om Contact Phone#: DESIGNER: Architect/Engi Phone#: k A Value of Work for this Perim - iiir*A4( Square/Linear F7tage of Work: Type of Work: ClAddress Description of Work: LIDemolition oi* s Ireeur. T 1 La a.cr 41 000 New Repair/Replace A ODo ********************************* -* * ******************************************** 1 , ! Submittal Fee $ Permit Fee $ Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ 30ZIEWSD AUG 3 1 2010 P)) BY: Flood Zone: CO/CC $ Bond $ CCF $ DBPR $ Technology Fee $ 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 ET FCTRICAL WORK, PLUMBING, SIGNS, WELLS. POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S AIN'IWAVIT: 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 $2500, the applicant must promise in good faith that a copy of the notice of commence • nt and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified cop of the recor' ' otice of commencement must be posted at the job. site for the first inspection which occ rs seven (7) days after a bui - : permit is issued. In the absence of such posted notice, the inspection will not b pproved d a reinspection fee 1 • NOTARY PUBLIC: Sign: Pri My Commission Expir The fore ?'ng instrument was ackn',wledged befo am this. The fore oing instrument was �tacknow dged before me thi day of i. i ' , 2/ . , by Wm b f I C � (-- day of V , 20 /aby� who is personally known to me or who has produced who is personally knQ w n t m or who has produced as identification and who did take an oath. As identification and who did tak F4 MY COMMISSION N DD 890873 Q EXPIRES: July 28, 2013 4•p" Bonded Thfu Notary Public Und21Wdters ********** ** **** *** **** ; ' ** ' '' ik *�k$?k�k�R ` X��k#��k APPROVED BY �L V ath. (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) / Structural Review NOTARY PUB,. C: Sig y Comm ires: J. WAYNE HURD :14 MY COMMISSION a DD 890873 , J EXPIRES: July 28, 2013 Bonded Teu Notary Public Underwriters * ��jl(` �k= k*Y*Ks*% ��k*�k�k�k %�$��k�8'k$<*AR*XL�KM*%�•k A�lk;F�X�rKV*�FsFT..mx� -nm. **sk*+i�#� 'Id Examiner Zoning Clerk UNIT BEING REPLACED DATA NEW UNIT �N� A) ,f • MANUFACTURER AHU or PKG. UNIT MODEL # TF ,., 1i714 COND. UNIT MODEL # L ' ' ' _ /0 in KW HEAT NOM TONS 5 AHU CU PKG 1) M.C.A AHU CU PKG AHU,')CUt AHU CU PKG AHU CU PKG 2) M.O.P AHU CU PKG 3) VOLTS PKG UNIT / / PKG UNIT 1 / EERISEER ,f YES NO REPLACING DUCTS N YES NO REPLACING THERMOSTAT Y N! YES NO NEW 4 'CONCRETE SLAB YES ' + YES NO NEW ROOF STAND YES r � YES NO NEW RETURN PLENUM BOX YES 08/31/2010 10:49 FAX 1 800 685 7530 DATA SCAN FIELD SERVICES Li001 /001 Miami Shores village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 AIR CONDITIONING REPLACEMENT DATA PERMIT NUMBER: MC 10 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. #4 °°/� Job Address (where the work is being done): 310 . /0 JU lQ m 1 ( C 5 ' City: Miami Shores Village County: Miami Dade Zip Code: 83113 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 A (AHRI) DATA SHEET REQUIRED Change Disconnecting means: YES ❑ NO ! 7I ARHI Sheet Attached: YES [4 NO ❑ Contract Attached: YES p 1. Minimum Circuit Ampacity (Wire Size): 2. Maximum Overcurrent Protection (Fuse/Breaker Size): 3. Voltage of Circuit (208/240/480): 4. Size Disconnecting Means: Contractor's Company Name: 240 Phone: V-977 State Certificate or Registration N. C MOS Z Certificate of Competency N. Signature (Qualifier's signature on y Date: Toll Free Service: 1- 800 - 955 -1086 Sales: 1-866-205-0467 CUSTOMER NAME ADDRESS 3 CITY, STATE, ZIP i nq WE WI RNISH, INSTALL, AN OUTLINED ON THIS PROPOSAL. THE EQUIPMENT LISTED BELOW A7- • T �1s �s3 AL. PLEASE REVIEW SIGN, AND RETURN THE PRICE N ETURN TO YOU PRIDE TERMS AND CODITI MAKE M.n� ®`anical Permit ©ectnlcal Permit ❑ Disconnect Box CI Crane Notes: ,1-1) 5 (STALLED PRICE 'ECIAL REBATES 'L REBATES JSTOMER SIGNATURE D os iw -s f>S - 54 ,0 P ROPOSAL S AND AGREEMENT �� Z_ PHONE 3D- F�4 CSIMILE ORDER # S SEER RATING Float Switch �uquid Line Drier ❑Smoke Detector ENres �J Pride Air Conditioning & Appliance Inc. 2150 NW 18th St. Pompano Beach, FL 33069 'Since 1974• EQUIPMENT SPECIFICATIONS DE SALES REP. A/C TONS I_J "igita l Thermostat w iunicane Strapping ®Slab E l‘ernoval and Disposal of Old Equipment NAL PRICE 9 -2- Z.., YEAR (S) PRIDE WARRANTY FOR FULL LABOR (SERVICE) :POST C, 0 BALANCE DUE 3 3 q 4YMENT IS DUE UPON COMPLETION OF JOB. IF FINANCING IS DESIRED, ARRANGMENTS MUST BE MADE IN ADVANCE. RICES ARE GOOD FOR 30 DAYS. CALL YOUR PRIDE SALES REP WITH ANY QUESTIONS CONCERNING THIS PROPOSAL iersL Sales Representative CFCO5765 CACO5722 3 YDS-DATE // // BEATING / L JS 121 of New uipment ip i-N :ondenser Model # : 4 -5'3bI r ! Air Handler Model # : TOTE; ALL EQUIPMENT IS ATTACHED TO 3 � 6 TATED OTHERWISE. THIS PROPOSAL DOES NOT INCLUDE ANY E ERICAL UPGRADES R PIPES, AND ADES O ELECTRICAL ELEC TRICAL UNLESS ERMIT FEES. IF REQUIRED BY THE CITY, THESE FEES MUST BE PAID BY THE CUSTOMER. TOTAL INVESTMENT I WARRANTIES YEAR (S) LIMITED MANUFACTURER'S WARRANTY ON COMPRESSOR 112__ YEAR(S)LI.l TEDMANUFACTURERS W.N iYONALLPAWSFORCONDE S% uNIT J YEAR (S) LIMITED MUMMER'S WARRANTY ON PARTS FOR AIR HANDLER ONS 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 -AWOL INSR . -Fi VIVD POLICY NUMBER (MM/D DNYYF1) (M P M/DD Y /YYYI P ) LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY OCCUR EACH OCCURRENCE $ PR 1 U Kt c I rr PREMISES (Es occurrence) $ CLAIMS -MADE MED EXP (Any one person) $ GEN'L PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ AGGREGATE LIMIT APPLIES PER: LOC PRODUCTS - COMP /OP AGG $ POLICY JET $ AUTOMOBILE LIABILITY 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 UAB EXCESS UAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DEDUCTIBLE RETENTION $ $ $ A AND WORKERS COMPENSA ERS UAB LITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVEn OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A Z065/S340 04/01/10 04/01/11 X TORY LIMITS OTH- ER E.L. EACH ACCIDENT $ 500000 E.L. DISEASE - EA EMPLOYEE $ 500000 EL DISEASE - POLICY UMIT $ 500000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES Attach ACORD 101, Additional Remarks Schedule, if more space Is required) 5 CERTIFICATE OF LIABILITY INSURANCE OP ID S9 08/19/10 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 policy(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. 5900 N. Andrews Ave. #300 P.O. Box 5727 Ft. Lauderdale FL 33310 -5727 Phone:954- 776 -2222 Fax:954- 776 -4446 INSURED Pride Air Conditioning & 2.0 Pompano Beach FL 33069 VUN I AI.I NAME: PHONE (A/C, No, Ext): E -MAIL ADDRESS: FAX (A/C, No): PRODUCER CUSTOMER ID #: PRIDE -1 INSURER(S) AFFORDING COVERAGE INSURER A: Zenith Insurance Company INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : DATE (MM/DD/YYYY) NAIC # 13269 COVERAGES CERTIFICATE NUMBER: CERTIFICATE HOLDER Miami Shores Village 10050 NE 2nd Avenue Miami Shores FL 33138 MIAMISH CANCELLATION REVISION NUMBER: 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 ©1988- 200WACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD ACORD,. CERTIFICATE OF LIABILITY INSURANCE 1 DATE 0 PRODUCER (954)724 -7000 FAX: (954)724 -7024 Reyes Coverage, Inc. 5900 Hiatus Road Tamarac FL 33321 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 NAIC # INSURED Pride Air Conditioning & Appliance, Inc. 2150 NW 18th Street Pompano Beach FL 33069 INSURER A: Tudor Insurance Co 37982 INSURER B: Tokio Marine & Nichido 12904 INSURERC:Mt. Hawley Ins. Co 37974 - INSURER D: 10/19/2009 INSURER E: EACH OCCURRENCE 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR ADM_ INSRD TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM/DD/YY) POLICY EXPIRATION DATE (MM/DD/YY) LIMBS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY GL00006496 *Automatic Owners, Lessees or Contractors [on –going & premises] Primary &Non – Contributory 10/19/2009 10/19/2010 EACH OCCURRENCE $ 300,000 PR EMISES (Ea occurrence) $ 50,000 CLAIMS MADE I X I OCCUR MED EXP (Any one person) $ Excluded X DED: $2,500 BI /PD PERSONAL&ADVINJURY $ 1,000,000 X GEN'L CG2033 ADD'L INSURED GENERALAGGREGATE $ 2,000,000 AGGREGATE LIMIT APPLIES PER: PRODUCTS- COMP /OP AGG $ 2,000,000 POLICY I JECT I LOC B AUTOMOBILE X X X LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS CA5250001 01 10/19/2009 10/19/2010 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ AUTO ONLY: AGG $ C EXCESS/UMBRELLALUU3IUTY NOCL0368837 10/19/2009 10/19/2010 EACH OCCURRENCE $ 5,000,000 I OCCUR I CLAIMS MADE AGGREGATE $ 5,000,000 DEDUCTIBLE RETENTION $ 0 COMPLETED OPERATIONS $ 5,000,000 X $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTNE OFFICER/MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below g 7U 7 1 TORY LIMITS 1 I O ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS /LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION Miami Shores Village 10050 N.E. 2nd Ave Miami Shores, FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 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. AUTHORIZED REPRESENTATIVE Carey Keyes /SB ACORD 25 (2001/08) INCf17C !Winos no.. © ACORD CORPORATION 1988 Donal of 7