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MC-10-1932Inspection Number: INSP- 152820 Permit Number: MC -11 -10 -1932 Scheduled Inspection Date: December 14, 2010 Inspector: Perez, JanPierre Owner: LLOYD - GODSK, MARGARITA Job Address: 120 NW 105 Street Miami Shores, FL 33150 -1244 Project: <NONE> Contractor: COOL WAVE AIR CONDITIONING Building Department Comments December 13, 2010 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 C f� Permit Type: Mechanical - Residential Inspection Type: Final Work Classification: A/C Replacement Phone Number Parcel Number 1121360131300 Phone: 786/236 -3441 EXACT REPLACEMENT OF 4 TONS CENTRAL AIR CONDITIONING Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments Page 18 of 30 BUILDING PERMIT APPLICATION FBC 20 Permit Type: MECHANICAL //`` OWNER: Name (Fee Simple Titleholder): A Z :q Zi A 0 /o /id Phone#: 0 a Address: /414:7 A/W /0c---C City: A' PX-2e77.44.e State: 4 Tenant/Lessee Name: vi /1 JOB ADDRESS: /ole , &4 /' ' = `J'S ?- City: Miami Shores Is the Building Historically Designated: Yes DESIGNER: Architect/Engineer: 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 County: Notary $ Training/Education Fee $ Double Fee $ Structural Review $ MEEWEn NOV 0 2 010 Permit NoTyi Q 1°02_ 2_ Master Permit No. Phone#: Phone#: Zip: / Email. Miami Dade Zip:j'� Folio/Parcel #: Flood Zone: CONTRACTOR: Company Name: a - e`''�%0 Phone#: Address: ,/i,%' 7` Sit 974 City: State: 55. Zip: 3/ Qualifier Name: S � a 1.4....ke Phone*. g &5 State Certification or Registration #: CAC- /S Certificate of Competency #: Contact Phone* .. Jgre ° Z 3 Email Address: ZA 6,ha ivezc, Value of Work for this Permit: $ �' !.- Square/Linear Footage of Work: Type of Work: Address °Alteration ONew ZIRepair/Replace °Demolition D e s c r i p t i o n o f Work: E ' 3 — ' a 4 (.. ∎ 1 = . ° y r e r ) 4 / . 6Ad i G J . - ) - O f-ifO9 ******* * *** x******* ***+s*****.x x+ x*****+ x******+ x*+ x+ x*a****+x*+s*+x******+ *** Submittal Fee $ Permit Fee $ CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Technology Fee $ TOTAL FEE NOW DUE $ Rolls <Y\O Bonding Company's Name (if applicable) x 14 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 FT ECTRICAL 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. Signature Sign: Print: wne or Agent The foregoing instrument was acknowledged before me this' The foregoing day of 0060 , 20 by /1i»Wi4R/T4 &DM - (rO,&5k day of who is personally known to me or who has produced i)/h( L As i d e n t i fi c a t i o n a n d whQ 6 . NOTARY IC ` \ \ 00.. oomis My Commission Expires: 6 7 • * ` �Rtl�+ kA��k�NN�+ N+ N�NN��N�N�N�N�kN��k +itN�N�>kN��RN�>k*** ** *** N�N� *** Aaffi>K*****+k**** APPROVED BY Plans Examiner Structural Review (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) J Signature who known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Contractor ent was ac • u ~• edged before 20 by o �, ubii Rosario RoOn9pez c State of Florida Q .g Expires D0773833 ns e e Expires ,-, c 1-3R,2f,t: * * * * * * * * *' *ill0 * * * * * * * * * * * ** Clerk UNIT BEING REPLACED DATA NEW UNIT MANUFACTURER 7 ,® l'a . , AHU or PKG. UNIT MODEL # ,40_ov„p c Li ,P t/4 w V 9 COND. UNIT MODEL # ,pe 2.112/ h'l‘i V KW HEAT 7 te" NOM TONS 9 -ro,mr �F{t PKG 1) M.C.A AH PKG AHU CU PKG 2) M.O.P AHU CU PKG AHU CU PKG 3) VOLTS 20 3 r 64 r- AHU CU PKG PKG UNIT I 1 / PKG UNIT I EERISEER /40 0 .,o' e.0 E-- YES NO REPLACING DUCTS YES :Na YES NO REPLACING THERMOSTAT o[• YES NO NEW 4 "CONCRETE S 6, —Azid YES • YES NO NEW ROOF STAND . YES !! YES NO NEW RETURN PLENUM BOX YES NO 10/26/2010 14:55 FAX 1 800 685 7530 DATA SCAN FIELD SERVICES x001 /001 AIR CONDITIONING REPLACEMENT DATA PERMIT NUMBER: MC 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 Add (where the work is being done): /me City: Miami Shores Village County: Miami Dade Zip Code: 331 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 0 NO 0 ARM! Sheet Attached: YES NO ❑ Contract Attached: YES (al 1 Minimum Circuit Ampacity (Wire Size): e 2. Maximum Overcurrent Protection (Fuse/Breaker Size): i P 3. Voltage of Circuit (208/240/480): 4, Size Disconnecting Means: Signature (Qualifier's signature only) Miami Shores village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Contractor's Company Name: . ° „ ' A/c State Certificate or Registration N. CAC, ,V /��ele_ 0 Certificate of Competency N. Phone: Date: o0 /fe IN II TM ww ahcid :r Certificate of Product Ratings AHRI Certified Reference Number 3799429 Date: 10/26/2010 Product: Split System: Air - Cooled Condensing Unit, Coil with Blower Outdoor Unit Model Number: 14AJM49 Indoor Unit Model Number RHLL- HM4821 +RCSL -H *4821 Manufacturer: RHEEM MANUFACTURING COMPANY Trade/Brand name: RHEEM 14AJM SERIES Manufacturer responsible for the rating of this system combination is RHEEM MANUFACTURING COMPANY 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): 46000 Eg ating (Cooling): .BQ SEER,Rating (Cooling): This combination qualifies for a Federal Energy Efficiency Tax Credit when placed in service between Feb 17, 2009 and Dec 31, 2010. • Ratings followed by an asterisk (1 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), orthe 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 to part, be reproduced; copied; disseminated; entered Into a computer database; or otherwise utilized, in any form or manner or by any means, except forth 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, Lilco Air - Conditioning, Heating, click on "Verify Certificate" link and enter the AHRI Certified Reference Number and the date on NE ®® and Refrigeration Institute which the certificate was Issued, which is listed above, and the Certificate No., which Is listed below. ©2010 Air - Conditioning, Heating, and Refrigeration Institute CERTIFICATE NO.: 129326130091501196 1 Residential Commercial Industrial 16371 S.W 83 Ln. Miami, Fl 33193 Telephone: 388 -5236 • Fax: 388 -5236 • Beeper. 881 -4566 Toll Free: 1 -888- 525 -5467 Licensed & Insured CC#96M0001 71 PROPOSAL SUBMITTED TO 4 f s:- / 4 4 - ' T - , h , . a € 0 1 1 ) . STREET 420 /Vw / .g-r" CITY, STATE AND P CODE ARCHITECT DATE OF PLANS PHONE 3a —CVO/ JOB NAME JOB LOCATION ��3 5G3$" DATE /0v JOB PHONE We hereby submit specifications and estimates for Cool Wave Air SEER - PRICING GOOD TIL AIR CONDITIONING SYSTEM ® Gond nd itloning shall install a 4 tons. Make lefC 24- . Model -NH ,according to the following speciifications, terms and conditions on the premise above described. EQUIPMENT HEAT OUTSIDE CONDENSER SLAB CONCRETE INSIDE AIR HANDLE (H) DRAINAGE LINE HEAT & COOL THERMOSTAT SELF - CONTAINED PACKAGE REMOVE EXISTING EQUIPMENT REFRIGERANT LINES REPLACEMENT WARRANTY: YEARS ON COMPRESSOR YEAR PART _L_ YEAR LABOR // 0 ( WE Jn- zo/zo ereb h to mish material nd labor - complete in accordance with above specification, for the sum of: *-'- dollars ($ 3 -9 0 ) ) Payment to be made as f • ` • ws: ' #'Z taw 78 50% at commencement of installation and balance upon completion. igivied,tor/A,49 lyeat'71/iee od, All material is guaranteed to be as specified. All work to be completed In a workmanlike manner according to standard practices. Any alteration or deviation from above specifications involving cost will be executed only upon written orders., and will become extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control. Owner to carry fire, tornado and other necessary insurance. Our workers are fully covered by Workmen's Compensation insurance. Rte`$• / Authorized Signature Note: This proposal may be withdrawn by us if not accepted within DUCT WORK 4.1 ,+;" f r f2! SUPPUES & 1 RETURN a LIVING ROOM ® DINNING ROOM KITCHEN BEDROOM FAMILY ROOM BATHS ® HALL cc- ELECTRIC WORK EXISTING SERVICE " ELECTRIC HOOK UP 30 days. Acceptance of Proposal - The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payment will be made red ve. t\ Date of Acceptance: �`� fit? /0 Signature Signature - -- Mil M r , (305) 596 -5840 L ia Atamdaniolgiecineuronce.com _____ NNeURER(a) AFFORDING c OVERAtiE swum A : Marv= ItmeRAN 5 CO. /CM MEWL AMMAN 1 INOJRER C : INDuNeR C s MOM p 10/27/2010 10:02 3055965820 IFC INS PAGE 01/01 Policy Number, ArG Date En :trod: 10/27/2010 4I,_.... -' CERTIFICATE OF LIABILITY INSURANCE o; tIVO ER NO RIGHTS UPON CERTIFICATE �G THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS ' I .1G 1LDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEUATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY 7I III POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), i •1 IHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the cedlfloate holder Is en ADDmONAI. INSURED, the poltcyr(les) must be endorsed. If SUBROGATION IS Wu 7 ►ED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does nut canter rights to the certificate holder In Ilea of such endoroemont(s). PRODUCER Insurance Financial Cantors 10300 SW 72 St. Suite 0 232 Miami, Florida 33173 mune LCIS BLANCO ABA COOL WAVE AIR CONDITIONING, CORP. 16371 SW 83 LANK MIAMI, FL 33193 COVERAGES CERTIFICATE NUMBER: COaMMERCUU. GENERAL UACILRr ® OCCUR CLAIMS.MADE GEWLADGR EUMAP,P.{,IESPER 7 PDLICY! IT I am AUTOrO WLS LIABLnY „ ANY AUTO _ wino AMOR SOHEDUI.ED AMC _ HMEO AUTOS NON.OWNEDAUTOS UMIERELkA UAC WIRERS Imo DEDUCTIBLE RETENTION E WOMEN COMPBNaAIICW ARO EMPLOYERS' UABIUTY ANY pROPRIETOR/PARTNER/EXE OPROER EMEER EX LuDEO? rrionsacm DI RR) ff oaseren under AIR CONDITIONING OCCUR CLAIMO.IMIADE IN VXLLAGE OF NMI MORES BUILDENC DEPARTMENT NIA 02L 0000432 01 CESCRIP?ION OF OP@IATIDNA I LOCACON S l VENICLl8 memo mono 101. Adllrentl Nemoks Schedule. U mere end Is HELMS) CERTIFICATE HOLDER CANCELLATION THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE P01, i5' " PERIOD INDICATED. NOTWR'HSTANDINO ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO'WI CM THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT' TO ALL THE 1 ERNS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAO CLAIMS MN e rrvs OPNIPU*ANCE SVBR P srw P GENERAL LNINUTY . 9/23/2010 9/23/201% Ai/ROAMED NePRESENTAIws 1305)596 -5828 VEIN EACHOCCUR(NCE 11,000,000 ° E1.D r 100,000.00 .Eti@ d4.E�oo�asxa� f MED gcP (Pm env 5eseen) PERSONAL NA MV INJURY GENEMAL csoneeAIE mecum - COMP oiscoo 11 COMET NCO JINGLE LIMNT sixadwo 8CDI.Y INJURY (Par perm) I BODILY INJURY (P!r oneldeni I I PROPERTY DAMAGE (Per sadden) EACH OCCURIkENCE AGGREGATE t3'rATUI• O �.. f li 116. EACH ACCIf1ENt El, DISEASE • EA EMPLOYER • L DISEASE •POLI,y 00 U • 5,000.00 11,000,000 31,000,000 31,000,000 D ANT ... t? *- - ? •. : �. _,; X _F ®e T C ILL@D THE EXPIRATION DATE THEREOF. NOTICE WILL BB OE1E1EI1 I & M Daniel rAwrzL PEENAT ;= ar (9 1988 -2009 ACORD CORPORATION. ,ti d right) reserved. Protl acin ACORD 28 g P (2009109) Nnuw no ACORD namA0e 0 197r tocd tar are registered marks of ACORD � � Phew solAreNNL � @�.� N PdrYol+inp