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MC-10-15649 Ig11 -gt4 3071RICI Miami Shores Village a N ''' `' Liu Building Department BY:.. 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING Permit No. n I 0 - 15 0 PERMIT APPLICATION Master Permit No. FBC 20 Permit Type: MECHANICAL OWNER: Name q (Fee Simple Titleholder i-r tObc) kp Phone#:& 7 1 ` ( Address* - la Pto l City: _ State: r l,. e� Q Tenant/Lessee Name: Phone# /' b Email: JOB ADDRESS: W / b7 (If City: Miami Shores County: Miami Dade Zi 33I L l Folio/Parcel #: � t 716) 1 ®'4t Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: f -A t. F l.` Q . Phone#: al�` 5102 \Q(t Address: 401\ ��1 170,„P City: .■EE State: — Zip: 3 52-5 Qualifier Name: /, nn t>� � -- Phone#:9j L S2 2f ) State Certification or Registration #: LF aciLl2a Certificate of Competenc #: Contact Phone# blew mail Address: . f.2 J I 1 A3 DESIGNER: Architec Phone-#: Square/Linear Footage of Work: Value of Work for Type of Work: DAddress/,��s ■ tor. UNew URepair/Re. lace Description of Work: �x�x •x �u a��x• •� �a a�x +�x �xe� a* n ax�a av�axwF a��x s �x+aa��x�x�x au�x •x �x�.s,��xa�•t a�•t�c x� *,x Submittal Fee $ Permit Fee $ _(/]((/� 4 CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ 14.2 1PI‘6 wiz Scheduled Inspection Date: September 28, 2010 Inspector: Perez, JanPierre Owner: BISHOP, PATRICIA Job Address: 89 NE 107 Street Project: <NONE> Contractor: JUST AIR INC September 27, 2010 Miami Shores, FL Building Department Comments Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Phone Number Inspection Number: INSP- 150673 Permit Number: MC -9 -10 -1564 For Inspections please call: (305)762 -4949 b// Permit Type: Mechanical - Residential Inspection Type: Final Work Classification: A/C Replacement Parcel Number 1121360070400 Phone: 305 -620 -9601 AC CHANGEOUT 3 TON 16/13 SEER /EER Passed 1E, Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments Page 10 of 22 Bonding Company's Name (if applicable) Bondmg 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 FILECFRICAL 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature t.J Owner or Agent The foregoing instrument was acknowledged before me this day 1 71 10, by Rtirici n13ishn p , Sign: Prin who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: .1 1J L1 v My Commission Expire * ** * * * ** * * **** *** * ** * APPROVED BY (Revised 07 /10 /07)(Revised 06/10/2009)(Revised 3/15/09) Notary Public State of Florida Jennifer Ann Hemandaz My Commission DD653320 Ex fires 04 /10/2011 Plans Examiner Structural Review Signature Contractor C The foregoing instrument was acknowledged before me this_ dayo %$bi 1141 who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: idelUtitAgity My Commissi 20 by S f FpW I&, o Exoirrii Notary Public of Florida Jennifer Ann Hernandez . My Commission DD653320 Expires 04/10/2011 4,d*.Y�,R,A 4+! ... .,.fl. ......T4.4. -e4 ** Zoning Clerk UNIT BEING REPLACED DATA N UNIT d MANUFACTURER X 0 a 'b i AHU or PKG. UNIT MODEL # _ �� (�g AO M COND. UNIT MODEL # `7 KW HEAT 9 j NOM TONS 7 AHU Lis CU W PKG -- 11) M.C.A AHU > CU PKG °— AHU 9CU.. PKG — CU 2.+l® PKG °- 2) M.O.P 3) VOLTS AHLHIS CU PKG — AHUei CUZL/f PKG — AHU 240 PKG UNIT— / — / — PKG UNIT— / — / q EER/SEER ) YES NO REPLACING DUCTS YES r 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 { AIR CONDITIONING REPLACEMENT DATA PERMIT NUMBER: MC Iii_Scrk+ 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. 'q Job Address (where the work is being done): / � q � `'®7 ° ter City: Miami Shores Village County: Miami Dade Zip Code: 3Sifol Signature FM =X52. 7K2 M(O 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 eARHI Sheet Attached: YES 7NO ❑ Contract Attached: YES 1. Minimum Circuit Ampacity (Wire Size): q M 2. Maximum Overcurrent Protection (Fuse /Breaker Size): )5 / rS 3. Voltage of Circuit (208/240/480): 2 4. Size Disconnecting Means: Contractor's Company Name: State Certificate or R- atio (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 Phone;PitQ rA Certificate of Competency N. Date: 9-110 www.ahridirectory.org Certificate of Product Ratings AHRI Certified Reference Number 3589328 Date: 8/31/2010 Product: Split System: Air - Cooled Condensing Unit, Coil with Blower Outdoor Unit Model Number 14AJM36 Indoor Unit Model Number RHPN- HM3624 +RCSN- H*3624A* Manufacturer: RUUD AIR CONDITIONING DMSION Trade/Brand name: RUUD 14AJM SERIES This combination qualifies for a Federal Energy Efficiency Tax Credit when placed in service between Feb 17, 2009 and Dec 31, 2010. Manufacturer responsible for the rating of this system combination is RUUD AIR CONDITIONING DIVISION 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): EER Rating (Cooling): SEER Rating (Cooling): 39500 13.00 16.00 • Ratings followed by an asterisk ( *) 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), or the unauthorbred aiteraton 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 AMR,. This Certificate shall only be used for individual, personal and confidential reference purposes. The contents of this Certificate may not in whole or In part, be reproduced; copied; disseminated; entered Into a computer dame; or otherwise utilized, in any form or manner or by any means, except forme 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, click on "Verify Certificate" Zink and enter the AHRI Certified Reference Number and the date on which the certificate was issued, which is listed above, and the Certificate No., wt,Ich is listed below. ©2010 Air - Conditioning, Heating, and Refrigeration Institute ®A Air- Conditioning, Heating, All MI IL® and Refrigeration Institute CERTIFICATE NO.: 129277356184488348 Certificate of Insurance This certifies that State Farm Fire and Casualty Company, Bloomington. Illinois State Farm General Insurance Company, Bloomington, Ionia State Farm Fire and Casualty Company, Aurora, ontsrio State Farm Florida Insurance Company, winter Haven, Florida State Farm Lloyds, Darin, Texas insures the following policyholder for the coverages Indicated below: Policyholder JUST AIR, INCORPORATED Address of policyholder 14511 SW 17TH CT, DAVIE FL 3332 922 Location of operations Dante as above Description of operations air conditioning The policies listed below have been issued to the policyholder fot the policy periods shown subject to all the terms, exclusions, and conditions of those policies. The limits of liability sh Policy Number Type of Insurance 98 BF - J4345 Comprehensive Business Uabpity This insuranw includes• Policy Number 1001260 Product - C o m pleted Ope rations Contractual Liability Persona) Injury Advertising Injury EXCESS UABIL11 T ❑ Umbrella ❑ other Workers' Compensation and Employers Liability Polley Numb Tsbe of In surance DAWN WAGNER, Agent Smite rarm Insurance Weston Town Canter 1990,9ell Tower R Wagfen, FL seam P% 1 ► aaagoo7 F. (t9 i) 389 -7o0$ Panay Period Effective Date ! Expiration Date 07/26/2010 I 07/25/2011 Policy Period Effective Date I Expiration Date Polley Period Effective Date 1 Expiration Date . The insurance dMerited in these Aides is own may have been reduced by any paid claims. Each Occurrence m ate Agars i Code Sam .4erncadB WA &NER Aro Cads BROWARD A275282 Limits of Liability (at beginning of policy period) BODILY INJURY AND PROPER'I Y DAMAGE Each Oocurrence General Aggregate Product - Completed Operations Aggregate Policy Period Limits of Liability Effective Date Expiration Date nning of policy porl Au8lorized Representative Agent Title Dawn Wagner Agent Name Telephone Number (954) 389.7007 $ 1,000,000.00 $ 2,000,000.00 $ 2,000,000.00 BODILY INJURY AND PROPERTY DAMAGE (Combined Single Limit) $ $ Part I - Workers Compensation - Statutory Part II - Employers laabinRy Each Accident $ Disease - Each Employee $ Disease - Policy Limn $ THE CERTIFICATE OF INSURANCE IS NOT A CONTRACT OF INSURANCE AND NEITHER AFFIRMATIVELY NOR NEGATIVELY AMENDS, EXTENDS OR ALTERS THE COVERAGE APPROVED BY ANY POLICY DESCRIBED HEREIN. Name and Address of Certification Holder If any of the described policies am canceled before Miami Shores Village • their expiration date. State Form will try to mail a 10050 NE 2nd Ave written notice to the certificate holder 30 days Miami Shores, FL 33138 = - Nation. limit fad to mail such notice, no pabifity will bo imposed on Slue Farm or presentatives. 08/31/10 Date 59 -2416 THIS IS TO CERTIFY THAT THE POUCIES 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 POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POUCIES. UMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LIR TYPE OF INSURANCE ALM INSR SLBR WW1 POLICY NUMBER POLICY Erb (NINIMDITYYYI POLICY IMP IMMNDD/YYYYI LIMITS INSURER(S) AFFORDING COVERAGE GENERAL IMBUIIY COMMERCIAL GENERAL -MADE I LLABILTY OCCUR INSURERC: INSURERD: EACH OCCURRENCE $ INSURER F : DAMAGE T RENTED PREMISES (EE a occurrence) $ CLAIMS I MED MP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GENT AGGFI POLICY LIMIT I J APPLIES PER PRODUCTS - COMP /OP AGG $ I I LOC $ 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) $ $ UMBRE1A LIAB EJrIESSLL9B OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DEDUCIBLE RETENTION $ $ $ A WORKERS COMPENSATION AND EMPLOYEES' LIAWLITY ANY PROPRIETOR/PARTNER/EXEC D7 O(l AMI If DESCRIP ON OF OPERATIONS Y / N N/A 76 WEG JA3 771 05/11/2010 05 /11/2011 X T Ill TU- ° R - E.L EACH ACCIDENT $100,000 ❑ below E.L. DISEASE - EA EMPLOYEE $ 10 0 , 0 0 0 E.L DISEASE - POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS /LOCATIONS/ VEHICLES (Attach ACORD 107, AddMernal Remarks Schedule, II more space ls+wItrkedl Those usual to the Insured's Operations. 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, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POUCY PROVISIONS. aunroRZEDAnvE • 7- 7 dI A CERTIFICATE OF LIABILITY INSURANCE 1�4sA : 0 -31 -2010 THIS CERTIFICATEIS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. 71-1I5 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 ADDITIONALINSURED, the policy(ies) must be endorsed. If SUBROGATIONIS 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 PAYCHEX INSURANCE AGENCY INC/PHS 210703 P:(877)287-1312 F:(888)443-6112 PO BOX 33015 SAN ANTONIO TX 78265 CONTACT MANE PHONE Fax (877)287 -1312 (ac,No): (888 )443 -6112 m ADDRESS: CUSTOMER ID $: INSURER(S) AFFORDING COVERAGE NAIC d INSURED JUST AIR INC. 14611 S.W. 17TH CT. DAVIE FL 33325 INSURER A : Hartford Underwriters Ins Co INSURER B INSURERC: INSURERD: INSURER E : INSURER F : COVERAGES RTIFICATE HOLDER ACORD 25 (2009109) CERTIFICATE NUMBER: REVISION NUMBER: NCELLATION 0 1988 -2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD