MC-10-1742Scheduled Inspection Date: April 13, 2011
Inspector: Perez, JanPierre
Owner: CHURCH, ST ROSE OF LIMA CATHOLIC
Job Address: 415 NE 105 Street
Project: <NONE>
Miami Shores, FL
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Contractor: ASSOCIATED BUILDING & AIR PRODUCTS
Building Department Comments
April 12, 2011
For Inspections please call: (305)762 -4949
Inspection Number: INSP- 151880 Permit Number: MC-1 0-10-1742
Permit Type: Mechanical - Residential
Inspection Type: Final
Work Classification: A/C Replacement
Phone Number (305)758 -0539
Parcel Number 1122310430010
Phone: (954)217 -1080
REPLACE 4 TON CHAPEL CONDENSING UNIT
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
Page 5 of 21
100
BUILDING
PERMIT APPLICATION
FBC20
Permit Type: MECHANICAL
Tenant/Lessee Name
Email
Job Address (where the work is being done) d 7 4 / 1
c■lit / Y d
City Miami Shores Villa. e County
FOLIO / PARCEL # // 3 t '1'5 o O I O
Is Building Historically Designated YES
Contractor's Company ^( Name
Contractor's Address Q /// // ex
• �'" ( /e C 9i�/
City C'3�1 dL State FA. ,-
Qualifier Name dl e:Pe. ov capt) +id A_ -
Architect/Engineer's Name (if applicable)
s
Value of Work For this Permit $ R9 r 0 . e;)-
Structural Review. $
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * ***
Submittal Fee $ Permit Fee $
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
NO
Miami -Dade
Permit No. \ ` C
l - 1
Master Permit No.
497;104e_
Owner's Name (Fee Simple Titleholder) sr • R 0 5.E 0 ( c 4 iec€ /9 Phone # 3 o 3' 7 6" c9
Owner's Address y I -1 /tie (O ,3 3 7:
City re1091!tC ( 5 ha R C• Xtate /� •
Phone #
Zip 53 3 �- co
Phone #
CCF $ CO /CC $
Total Fee Now Due $
OCT 1
0 1 2010 tg
* * * * *Fe s *'
1,9 ,
See Reverser
V
3 ?
Zip 33
Zip
Flood Zone
1 35 • �fje c Jiv Phone #�.3 &c0 4 7.73-6
Phone # J' k
State Certificate or Registration No. cite O /16'3 / Certificate of Competency No.
Contact Phone 9.5 E 6 7 7S7-2 E -mail
Square / Linear Footage Of Work:
Type of Work: ❑Addition ❑Alteration ❑New Repair/Replace ❑ Demolition
Describe Work:
P/ Ac 7 - 7 ; rA,4 G G N/si.ti) axl
Notary $ Training /Education Fee $ Technology Fee $
Scanning $ Radon $ DPBR $ Bond $
Double Fee $ Violation date:
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 $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection occurs se 7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not . - approve a r d a reinspec .. n fee will .,barged.
/Signature
Sign:
MAIO l
er or Agent
The foregoing instrument was acknowledged befo me this 18
day of LP PT , 20 Al, by �f j
who is personally known to me or who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
Print: , /V∎fl — 27444 ✓Lc
My Commig°ivn Pvrir• 3 /2 2,/ ,
:l'•' RONALD R LANEVE
': MY COMMISSION # OD973720
* * * * * * *4 * ,. *ktF�:filPk• �F*.lye9l�lYi i24Z044 *
( 398.0153 i, ,. dallotary$orv .com
APPROVED BY
(Revised 07 /10 /07)(Revised 06/10/2009)
G� >
* * * * * * * * * * * * * * * * * * * * **
Plans Examiner
Engineer
Contractor
The foregoing instrument was acknowledged before me this
day of ,20 ,by
who is personally known to me or who has produced
as identification and who did take an oath.
VNOTARY PUBLIC:
Signatur
Sign:
Print:
l'Co/ e-20 tY- }/E ✓C
3 /6zo/zoi.
M , ;n �'Orrlryigcy�n Fivrira�
RONALD R LANEY!
MY COMMISSION # ODOM 20
(407)398.0153
* * * * * * * * * **
Zoning
Clerk checked
UNIT BEING REPLACED
DATA
NEW UNIT
7iR I fk
MANUFACTURER
Y' 0 iz-
AHU or PKG. UNIT MODEL #
4 k- -- � -; ," ---
Ai PM-! E ,J ®r
COND. UNIT MODEL #
®y- J RA t.40/4 z3 .-- 67 _
1-- E 14.- $. t Q
KW HEAT
,,
NOM TONS
AHU CU PKG
1) M.C.A
AHU CUai� PKG
AHU CU PKG
2) M.O.P
AHU CU 3c PKG
AHU CU PKG
3) VOLTS
AHU CU -41/4
PKG UNIT / /
PKG UNIT / /
EER/SEER
/ �a
YES O
REPLACING DUCTS
YES 4►4±
YES O)
REPLACING THERMOSTAT
NEW 4 "CONCRETE SLAB
YES
YES
YES qo
YES 0)
NEW ROOF STAND
YES 4�
YES
NEW RETURN PLENUM BOX
YES NO'
Signature
AIR CONDITIONING REPLACEMENT DATA ,, yy
PERMIT NUMBER: MC ��IVb f 3 -ii
a
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 f c L.
Job Address (where the work is being done): qi AJ/ (0.3 I
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 (AHRI) DATA SHEET REQUIRED
Change Disconnecting means: YES ❑ NO Er ARHI Sheet Attached: YES ❑ NO`( Contract Attached: YES ❑
1. Minimum Circuit Ampacity (Wire Size): /0
2. Maximum Overcurrent Protection (Fuse /Breaker Size): S a a P
3. Voltage of Circuit (208/240/480): 4 1 0 3 0
4. Size Disconnecting Means: " p
Contractor's Company Name: f � 6 • < : D 5 z ti, c C Ai c Phone: -1 ) ( (g'
State Certificate or Registration N.
( i)
(Qualifier's signature only)
Miami Shores Village
oCT 1 010 Building Department
10050 N.E. 2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
31'4
Certificate of Competency N. C 47 C ,1 3 I
Date: i ty, ? J' 0
04 -11 -11 09:38 From-ASSOCIATED AIR
`' CERTIFICATE OF LIABILITY INSURANCE
PRpou (g $) 724 -7000 F'Ag: OATE
( 956) 7$4 -1A,26 THIS CER77FfCAS ISSUED AS A MTTER OF p 7/8/2010
ONLY AND CONFERS INFORMATION
'-Yas C overage, Inc.
00 Hiatus Road
ALTER g OVERA F7CATE DOES NOT AMEND (�tT OR
Tamarac FL 33321
INSURED Face # 954 389 9881) — — — —
Aesoc iated Air Products LC d/b /
Associated Building Services
2111 North Ccsnerce Parkway
Weston FL 33326
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED va FOR THE CPCLI Y PERIOD I ICATED NOTWITMST AND11NCa
MAY P P
ANY E R -. INSURANCE AFFORDED OF ANY
P CONTRACT I 'r O OTHER HEREIN M NT Wall RESPECT ALI. THE TAE
ES. A K THE INSU ARR NCE AFFORDED DESCRIBED OR TMER RE IS LENT ITM RESPECT TO
WHICH THIS CE RTIFICAT ISSUED OR
WSR IA
LICI —.— — — SHOWN MAY HAW BEEN REDUCED O
M BY PAID CLAIMS.
EXCLUSIONS AND E CONDITIONS Y SE OAyIlCH
POL ICI* POLICY
— —
I l — —
LIAM
pima
G ENERAL uAEUTv
X , 10OMMEntAL NBIAL
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AGGREGATE LIMRAr PP1JEN PE t
GARAGE UABIU y
ANY Am I
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RETENTION S
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rannunry le MN
I! S PRDv1E iNuS
MI N I
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DESCRIPTION GP CATIONS /LOCATIONSft S/ E XCLUSIONSAMORY ENDO I SPECIAL PROVISIONS
:ERTIFICATE HOLDER
CITY OF MIAMI SHORES
10050 N2 2ND AVE
MIAMI SHORES, PI 33138
;ORO 2s (2009/01)
5025 mown
8 #8.1016 00
1
oi- EC1.OA •60208
9543849880 T - 843 P.01/02 F - 818
ON LYEA. This NFER1 NO mows UPON THE CERTIFICATE
GE AFFO,W BY THE FOL LIES BELOW.
INSURERS AFFORDING COVERAGE _
+!rtau a Saao 14rmer Ins G`O — ,— �NAIC — —
�INS ER E EaAover T I a6ose-
nsulralYCe 3� --1 z��x — — •
I INSUR — —
u gyReRc re= ZosCo — — — _
I INSURER — -- — — I
I r�oG� — $ _1_,..902, 000
1 5/15/2010 J 1 5/15/2011 *xi • 7 � �
}— iES
Arty ; 5 000
1 I PERSONAL 1 •000
r' - - — ,000
1. .AG GATE _ 0 0 0 000
r? rnfCrs- conwA3P AGO I S — 2000 000
I
I I a frE Bw0LE LINT
d�n • a.,aoo,aoa
5/15/2010 5/15/2011 I cnr,Iuum. — $
FwDILY
(P _ _ Viz_
I MAGE
(Per scanent)
I : AUTD 4NLY - EA ICC LENTT I S — — —
III I — --
I �� AUTO ONLY: S ASS S - �_
II — PACH OCCURRENCE I $ _ i i _g0o 000
i A _ GGREGATE — i_,000 X00
II
j 5/15/2010 +5/15/2011 1 — - - -'�i - --
I f r -• - - -+ - --
1 Y I We 3rATU- 01.1 -
I EL MOHACOiDENT — $ 500,000
1 ± 7/16/2011 FEL QISA96 - EA s — —
I , — 500 X00
I E D POLICY MST I $ 500 000
CANCELLATION
SHOULD ANY OFTHEABOVEDECO POLICIES DE CANCELLED BEFORE TIEFXPWATION
DATE TNEREOF, T N BLUING INSURER W1U. ENDEAVOR TO MA/. DAYS viltrnm
NOTICE TO THE CEETNICATE HOMER NAMED TO THE LEFT. BUT FAILURE TO OO SOSHA{.L
NO OBLIOATE R OR LIABILITY OF ANY IONS UPON THE SNCURE SB AGENT'S UR
REPRSEENTATIvER
AuThoREEV AgpITETENTATNE
Carey Keyes /MS
018884009 ACORD CORPORATION. A0 rights reserved.
The ACORI) name and loge are registered marks of ACORD
City of Weston
17200 Royal Palm Boulevard
Weston, Florida 33326
(954) 385 -2000
City of Weston
Business Tax Receipt
Receipt Effective: Name and Address of Business:
10/01/2010 - 09/30/2011
Contact Information:
Name: Walter C. Dickinson, President
Phone: (954) 217 -1080
Business Tax Category: General Business (all other Businesses)
RECEIPT NO. 2011-5293
Associated Air Products, LC
2111 N. Commerce Parkway
Weston, Florida 33326
1. This receipt MUST be renewed on or before September 30th of each year. Business Tax renewals are the
responsibility of the business and shall occur during the 90 -day period prior to September 30th of each
year. Renewal notices are provided as a courtesy and are not required for renewal purposes.
2. This receipt MUST BE DISPLAYED within 10 FEET of the entrance inside your business establishment.
3. The City of Weston must be notified of any changes of name, address or ownership.
10/27/2010
Date Issued
City of Weston Business Tax Receipt
detach and keep this section for your records
- D0.4.1eiturno6
Darrel L. Thomas, City Treasurer
General Business (all other Businesses) $236.25
RECEIPT NO. 2011 -5293 TOTAL BUSINESS TAX: $236.25
Associated Air Products, LC
Walter C. Dickinson, President
Atten: Ms. Ettie Schwartz
2111 N. Commerce Parkway
Weston, FL 33326
Fiscal Year 2011
Associated Air Products, LC
Walter C. Dickinson, President
Atten: Ms. Ettie Schwartz
2111 N. Commerce Parkway
Weston, FL 33326
Description
City of Weston
17200 Royal Palm Boulevard
Weston, FL 33326
City of Weston
17200 Royal Palm Boulevard
Weston, FL 33326
Business Tax Invoice
Warehouse, Manufacturing Facility or Pharmacy between 10,000
— 19,999 Sq. Ft.; Apartments or Timeshares with 100 -249 units;
Hotels or Motels with 150 -249 rooms; Country Clubs and Golf
Course(s); AthletidFitness Club with Pool
Business Tax Invoice
Paying by credit card or check?
You can renew online at: www.westonfl.org /renew
Location Address:
2111 North Commerce Parkway
Due No Later Than: September 30, 2010
Receipt Number: 2011 - 5293
Amount Due: $1,312.50
Category: 10,000 - 19,999 sq. ft.
'k ** Detach and Return This Portion With Your Payment * **
Fiscal Year 2011
Paying by credit card or check?
You can renew online at: www.westonfl.org /renew
Location Address
2111 North Commerce Parkway
Due No Later Than: September 30, 2010
Receipt Number: 2011 - 5293
Amount Due: $1,312.50
Category: 10,000 - 19,999 sq. ft.
Amount
$1,312.50
Payable upon receipt or no later than September 30, 2010
I hereby declare that no alterations have been made to the physical space of the business since the issuance of the Certificate of Use; and/or that
alterations have been made to the physical space of the business since the issuance of the certificate of use, and that I have provided the City with a
description of the alterations and the building permit number, as applicable.
State licensed professionals and contractors must provide a copy of current state license or contractors license.
No business tax receipt will be issued until all prior year balances are paid.
Tax Amount
Transfer Fee
NSF Fee
Penalty
Prior Years
Collection Cost
Total Paid
45.00
5 . 0 0
0 . 0 0
0.00
0.00
0 . 0 0
0 . 0 0
0.00
0 . 0 0
0.00
0 . 0 0
0.00
4 5 . 00d 0
45.00
„1 ..:111.7... BIB AN Vir Y_111∎1 i a► ....11 I 1 .111■. —+.ter.
DBA: Receipt #:377 -14335
Business Name: ASSOCIATED AIR PRODUCTS LC Business Type :OFFICE /SALES /BUSINESS/
(SALES OFFICE)
Owner Name: WALTER DICKSON Business Opened:08 /17 /2007
Business Location: 2111 N COMMERCE PKWY State /County /Cert/Reg:
WESTON Exemption Code: NONEXEMPT
Business Phone: 954-527-0341 k
Rooms
WHEN VALIDATED
115 S. Andrews Ave., Rm. A -100, Ft. Lauderdale, FL 33301 -1895 — 954 - 831 -4000
VALID OCTOBER 1, 2010 THROUGH SEPTEMBER 30, 2011
Number of Machines:
THIS BECOMES A TAX RECEIPT
Mailing Address:
WALTER DICKSON
2111 N COMMERCE PKWY
WESTON, FL 33326
Seats
Employees
For Vending Business Only
2010 - 2011
Machines
•
Professionals
THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS
This tax is levied for the privilege of doing business within Broward County and is
non - regulatory in nature. You must meet all County and /or Municipality planning
and zoning requirements. This Business Tax Receipt must be transferred when
the business is sold, business name has changed or you have moved the
business location. This receipt does not indicate that the business is legal or that
it is in compliance with State or local laws and regulations.
Receipt #WWW -09- 00425641
Paid 08/19/2010 45.00