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MC-11-682Inspection Number: INSP - 158519 Scheduled Inspection Date: April 25, 2011 Inspector: Perez, JanPierre Owner: HARPER, JOE Job Address: 78 NW 106 Street Miami Shores, FL Project: <NONE> Contractor: JJ AC SERVICE AND REPAIR CO Building Department Comments April 22, 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 L, Permit Number: MC -4 -11 -682 Permit Type: Mechanical - Residential Inspection Type: Final Work Classification: A/C Replacement Phone Number (407)971 -8144 Parcel Number 1121360050230 Phone: (305)984 -8016 REPLACE 2.5 TON CONDENSER & AIR HANDLER T--i Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments Page 22 of 26 BUILDING PERMIT APPLICATION FBC 20 Tenant/Lessee Name Email Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Permit No. APR 18 2011 U iYK- ( --Cc re_ Master Permit No. Permit Type: MECHANICAL ----, / 11 Owner's Name (Fee Simple Titleholder) c oS )� f � 4 , Phone # 401 - 1' 1 2 /44- IS Owner's Address / S tJ L 0 C 5 t City P, CO2. S k r S State Ft r c rJ c4 Zip Phone # Job Address (where the work is being done) '7 k iv. pv. /0 . S City Miami hores Village County Miami -Dade Zip 75 / e' FOLIO / PARCEL # Is Building Historically Designated YES NO Flood Zone Contractor's Company Name -TT c ..e ‘R�' � CLt f Co. Phone # 3013 i 84- -3616. Contractor's Address `',S® Q B 0 W A /€42 City • 4 V a 4 State /— ( 0 r t ca q Zip S l a s" Qualifier Name .,: V a Wen e-y ctS Phone # 305 9B+ + £D I State Certificate or Registration No CAL' /2 1 S Q b I Certificate of Competency No. Contact Phone Architect/Engineer's Name (if applicable) Phone # Value of Work For this Permit $ 2 - Square / Linear Footage Of Work: Type of Work: ['Addition ['Alteration ❑New ❑ Repair/Replace ❑Demolition Describe Work: (ZE /-47 t ; ald Pr�a / 1 ` - d- /<1,-ot.Er• Submittal Fee $ Permit Fee $ CO° '' CCF $ CO /CC Notary $ Training/Education Fee $ Technology Fee $ Scanning $ Radon $ DPBR $ Zoning $ Bond $ Code Enforcement $ Double Fee $ Structural Review. $ Total Fee Now Due $ See Reverse side 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 F.I.RCTRIC,&, 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 Owner or Agent The foregoing instrument was acknowledged before me this i day of L , 20 ! ( , by SOSfi3t fY111.7teNs kkfla who is personally known to me or who has produced --1 1� As identification and who did take an oath NOTARY PUBLIC: Sign: Print: Bonding Company's Name (if applicable) Bonding Company's Address City State Zip 9 1 c O '1 / , / ' :if: 0fF�0 / 11111�� ********* * ******* ** ***** **** ***** * * **** :k,'• *,ke *** My Commission Expires: APPLICATION APPROVED BY � �� PI (Revised 07 /10/07) t ow nult DD 1 Contractor S� The foregoing instrument was acknowledged before me this ) day of (Lt — , 20 _, b t' t o e-Ac la who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: * * Engineer Signature iner Sign: Print: My Commission Expires: 0 0111 11 1111/N / y av ryvd, I f l l l l 11 \0\‘`‘ �```~ ******* #*B*** ** ******* **u' *** ** ******* ** Zoning Clerk checked UNIT BEING REPLACED DATA _ NEW UNIT MANUFACTURER Go.0 AHU or PKG. UNIT MODEL # lki LL- N N . (l, t COND. UNIT MODEL # 1 4- ILT 4 ;D KW HEAT '7 NOM TONS Ya AHU CU PKG 1) M.C.A AHU CU PKG AHU CU PKG 2) M.O.P AHU CU PKG AHU CU PKG 3) VOLTS AHU CU PKG PKG UNIT / / PKG UNIT / / EER/SEER ( 6 ,,- -`E, 1 ,,a . YES NO REPLACING DUCTS YES NO YES NO REPLACING THERMOSTAT YES NO YES NO NEW 4 "CONCRETE SLAB YES NO YES NO NEW ROOF STAND YES NO YES NO NEW RETURN PLENUM BOX YES NO Signature City: Miami Shores Village County: Miami Dade 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 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): 7 3 Ni ' S L ® Co St Zip Code: 0 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 ❑ ARHI Sheet Attached: YES 1 NO ❑ Contract Attached: YES ❑ 1. Minimum Circuit Ampacity (Wire Size): 2. Maximum Overcurrent Protection (Fuse /Breaker Size): 3. Voltage of Circuit (208/240/480): . 4. Size Disconnecting Means: \\\\ 4 Contractor's Company Name: AC, f ;.� G .r�JJ ,� o r L,, Phone: O 4 c Q l�. State Certificate or Registration N. SAC (IS Certificate of Competency N. Date: 4 ° (Qualifier's signature only) JJ A/C SERVICE & REPAIR CO. Residential • Commercial Ph: 305-984-8016 Fax: 305-643-2311 www.jjacservice.com Bill To: C/ a " Two WORK 18 TO 9E ❑ C.O.D. STATE CERTIFIED CONTRACTOR L ICENSED & INSURED & Ins: CAC1815967 NAME l.r e, .. °. isF o..t:v\ . Sri d 10 b s`r CTTE7-i CALLSE NI AUTHORIZED BY WORK TO BE PERFORMED E -MAIL: oo > REFRIGERANT R. LBS. SOD( 2_3 D O 0vT t} FILTERS FILTERS BELTS MATEWALRM LABOR myna CONTNUED ON OTHER ROE TERMS K x TOTAL MATERIALS ❑ A.M. 0 P.M. C I !k/ // OATI 1 S OD ID aeawaty to We to e� furnished wee anal psyRluD made. 11 IwYmert a nal made as agrsst saw can remote said medals at 8,atrs Manse Any damwpe 101u10 D from said nowt! DWI not w tM Tafper 0S8y a SPEW ❑ RECOVERED ❑ RECYCLED ❑ RECLAIMED ❑ RETURNED ❑ DISPOSAL ❑ DISMANTLED ❑ CNANOED ouwasaLACEO W \ &Y Dp C-D f TOTAL S LIMITED WARRANTY: All materials, parts and equipment are warranted by the manufacturers' or suppliers' written warranty only. All labor performed by the above named company is warranted for 30 days or as otherwise indicated Inrwriting. The above named Company makes no other warranties, express or implied, and its =agents or technicians are not authorized to make any such warranties on behalf of above named company. No Warranty Water Leaks And Refrigerant Leaks ❑ REGULAR ❑ WARRANTY ❑ SERVICE CONTRACT MAKE MODEL SERIAL NUMBER ❑ CHARGE MARE MODEL SERIAL NUMBER CONDENSING UNIT LEVELED CLEANED 000. CHECKED CHARGE REPAIRED LEAK IN COIL REPAIRED LEAK IN COPPER cHEcKED MOTOR MOTOR • EO REPLACED BELT 15EADJ STED LT REPLACED CONTACTOR . REP. REPL. START. REAL START CAPACITOR REPLACED RUN CAPACITOR CLEANED OR ADM CONTACTOR REPAIRED WIRING REPLACED FUSE • S SOR EVAPORATOR COL REPLACED ADJUSTED EXP VALVE REPLACED CAP TUBE CLEARED CAP. TUBE REPAIRED COIL LEAN REPAIRED CONN CLEANED COIL LEVELED COIL ELECT. HTR REPLACED LINK REPLACED NIA. REPAIRED WIRE REPLACED CONT FILTERS TOTAL MATERIALS TOTAL LABOR TRAVEL CHARGE TAX TOTAL ❑ NO CHARGE • Sales • Service • Installation PERFORMED COND'SATE DRAINS CLEANED MAIN DRAIN REPAIRED MAIN DRAW AN DRAIN REPAIRED PAN DRAIN FURN. OR FAN CO L REPLACED BELT ADJUSTED BELT REPLACED PULLEY ADJUSTED PULLEY CLEANED R REPLACED BEARINGS OILED MOTOR OILED BEARINGS CLEANED NEAT EXCH. REPLACED NEAT EACH CLEANED OR AO. PILOT REPLACED THERMOCOUPLE REPAIRED VALVE REPLACED VALVE CLEANED BURNERS REPAIRED ADJUSTED REPLACED ADJUSTED CLEANED DUCT THERMOSTAT CLG TOWER PUMPS) GREASED REPAIRED 0 CLEANED 0 REPLACED APR -18 -2011 12:57 From: To:1 800 685 7530 P.1/1 Ai - !RI 0 IHrt Fi ED, www.nlindin: tory,ory Certificate of Product Ratings AHRI Certified Reference Number: 3412355 Date: 4/18/2011 This combination qualifies for a Federal Energy Efficiency Tax Credit when placed in service between Feb 17, 2009 and Doc 31, 2011. Product: Split System: Air - Cooled Condensing Unit, Coll with Flower Outdoor Unit Model Number: 14AJM30 Indoor Unit Model Number: RHLL- HM3817 +RCSI - -H "3617 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 210/240.2008 for Unitary Air - Conditioning and Air- Source Heat Pump Equipment and subject to verification of rating accuracy by AHRI- sponsored, independent, third party tasting: Cooling Capacity (Btuh): 29200 EER Rating (Cooling): 13.00 SEER Rating (Cooling): 16.00 • Ratings followed by an asterisk (•) Indicate a voluntary rotate of prevloualy published deia, mesa accompanied with a WAS, Wen Indicates at Involuntary taste. DISCLAIMER ANR! does not endorse the product(*) listed on this Ceedfloste and makes no representations, warranties or guarantees as to, and twines no rapanslbility for, the productlsb listed on tt+la Certificate. AKRI aspmetry disclaims all liability for Mimeses of any kind wising out of fits use ar parf r msn0a erne produatls), ar the uhautherbted alteration vitiate hated on MID CaNflaate. Certified ratings are valid only far models and configurations listed in the dlreotary at www.ahri flr00tory err, TERMS AND CONDITIONS This Certificate and ib Conbhts ors proprietary products of AHRI, This Certltlaata shall only be tread far Individual, personal and confidential refaranCe purpoaea. The contents of this Certificate may not, In whale or In part, be reproducadi copied: disseminated; entered Inm b computer database; or otheIw ee utilised, In any tom or manner or by any means. except for the user's indlv►dasl, personal and confidential reference. CERTIFICATE VERIFICATION rt e ON � � Tha e Info brformatlon for the model at an this oordtlCRte can be verified www 611t1d1roCtoryorg, AR-Conditioning, Reefing, tact on "Verity Certificate" link and radar the AHIti Certified Rearm* Number and the dab on I ` r and Refrigeration Institute Whbeh the eeitlficate was issued, which le dated above, and the Certificate No., which Is listed below. ©2011 Air - Conditioning, bleating, and Refrigeration Institute CERTIFICATE NO.: 129476214636389380 MIAMI -DADE COUNTY 1 40:W , #LAGLER ST. ts"t FLOOR "11Aa�Ill „FL 33130 631105 - 4 BUSINESS NAME / LOCATION JJ A/C SERVICE & REPAIR COMPANY 3098 NW 4 TERR 33125 MIAMI OWNER JJ A/C SERVICE & REPAIR COMPANY Sec. Type of Business THIS IS 196 SPEC MECHANICAL CONTRACTOR BUSINESS TAX RECEIPT. IT DOES NOT PERMIT THE HOLDER TO VIOLATE ANY EXISTING REGULATORY OR ZONING LAWS OF THE COUNTY OR CITIES. NOR DOES IT EXEMPT THE HOLDER FROM ANY OTHER PERMIT OR LICENSE REQUIRED BY LAW. THIS 18 NOT A CERTIFICATION OF THE HOLDER'S QUALIFICA- TIONS. PAYMENT RECEIVED MIAMI-DADE COUNTY TAX COLLECTOR: 0 7/06/2010 09 010308001 000045.00 SEE OTHER SIDE 2010 LOCAL BUSINESS TAX RECEIPT 2011 MIAMI -DADE COUNTY STATE OF FLORIDA SEPT. MUST BE DISP AT PLACE OF BUSINESS PURSUANT TO COUNTY CODE CHAPTER. 8A - ART. 9 &, 1!0. THIS IS NOT A BILL — DO NOT PAY "RENEWAL RECEIPT NO. 486515 - STATE* CAC1815967 WORKER /S 1 DO NOT FORWARD JJ A/C SERVICE & REPAIR COMPANY JUAN J REYES PRES 3098 NW 4 TERR MIAMI FL 33125 146 FIRST -CLASS U.S. POSTAGE PAID MIAMI, FL PERMIT NO. 231 3.4' _ CERTIFICATE OF LIABILITY INSURANCE I DATE(MSVOINYYYY) 04/18/11 THIS CERTIFICATE 15 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(lea) roust be endorsed, If SUBROGATION IS WANED, subject to the terms and conditions of the policy, certain policies may require en endorsement. A statement an this certificate does not confer rights to the certificate holder In Ilea Of such endorseMent(s). PRODUCER Gb Gomez Insurance, Inc, 14335 SW 120th Street Suite 102 Miami, FL 33188 Phone (305)358.7474 Fax (305)388 -7787 INSURED J J NC SERVICE AND REPAIR COMPANY 3098 NW 4th Terrace Miami, FL 33125- (305) 9848016 INSURER F : COVERAGES _ CERTIFICATE NUMBER: - REVISION NUMBER: 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 AU. THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED DY PAID pp CLAIMS. - TYPE OF INSURANCE POLICY NU BER (MM/DINTYYY1 „(MM/ DD /YYI YJ — LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY ❑ ❑ CLAIMS -MADE © OCCUR ❑ _._ GEN'L AGGREGATE LIMB APPLIES PER: El POUCY ❑ PRO- n LOC h AUTOMOBILE LIABILITY n r � L_I 0 ❑ 04/18/2011 01:4$ 3053887787 ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON.OwNED AUTOS UMBRELLA LIAO 00 ❑ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY OFFICER/MEMBER P E ( � (Mandatory In NH) U yyes decoding under DESCRIPTION OF OP ' ATONE • . Iow N/A DESCRIPTION OF OPERATIONS / LOOATIONS I VEHICLES AIR CONDITIONING INST /SERV /REP NOT VALID MORE THAN 30 DAYS CERTIFICATE HOLDER MIAMI SHORE BUILDING 10050 NE 2 AVE MIAMI, FL 33138 ACORD 25 (2009/09) OF 02L 0000494 00 TBA INSU D: INSURER E • 09/14/2010 04/18/2011 09/14/2011 (Attach ACORD 101, AdditionaI Remarkt; Schad chadule, Ir more epees le required} GB GOMEZINSURANCE PAGE 01/01 NONE CT MARILUS TAVAREZ PHONE o per (305) 388 -7474- tlivo Nay a-M R ESS ..... MARILUS@GBGOMEZINSURANCE.COM PRODUCER USIOMES_It . INSURER _ITECIRDIN9 COVERAGE INSURER A NATIONAL GROUP INSURANCE COMPANY INSURER B ASCENDANT GROUP INSURANCE COMPANY INSURER C CANCELLATION EACH OCCURRENCE DAMAG 10 NTED PREMISE w_oacurrenoe) MED EXP (Any one person) PERSONAL 8 ADV INJURY 3 GENERAL, AGGREGATE $ I PRODUCTS - COMP/OP AGO $ COMEINED SINGLE LIMrr (Ea medal BODILY INJURY (Per person) BODILY INJURY (Per aeeldeM) PROPERTY DAMAGE (Per acciden() EACH OCCURRENCE AGGREGATE 9 $ OR IM IT • ❑ JB E.L EACH ACCIDENT $ DISEASE • EA EMPLOYE $ (305) 388 -7787 NAIC d 1,000,000' 100,000 5,000 1,000,000 2,000,D00 1,000,000 500,000 500 Alk SHOULD ANY OF THE ABOVE DESC I = ■ - r / _ - - , ` ?� C LED BEFORE THE EXPIRATION 9 THEREOF, � - - ACCORDANCE �0 HE P - P • .. / ,1 .. li 1,�+ IN /iI AUTHO'' TATAME rr iF _____i v { �.osomdl !low / i ` 198 ' , , ; >2 ;�7 • - . T1: . All rights reserved. e ACORb _ - : � ;.: rag; • -red marks of ACORD