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MC-09-2000Inspection Number: INSP - 152961 Scheduled Inspection Date: November 16, 2010 Inspector: Perez, JanPierre Owner: NICHOLSON, GERALD Job Address: 153 NE 109 Street Project -7NONE> November 15, 2010 ITO /6002j Miami Shores, FL Contractor: CAPITAL AIR INC Building Department Comments Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 IiS4- 7'Z -41 'tZ Permit Number: MC -12-09 -2000 Permit Type: Mechanical - Residential Inspection Type: Final Work Classification: A/C Replacement Phone Number Parcel Number 1121360040510 Phone: 9541792 -4942 A/C REPLACEMENT NEW 4 TON TRANE SPLIT SYSTEM MODEL #4TTB4048EL000A AND 4TEEC10A1000A Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments For Inspections please call: (305)7624949 Page 14 of 23 SaDIA2iaS a-IMIA NVOS V,LVa 0£9L 599 008 T L£ :9T OTOZ /9T /TT BUILDING PERMIT APPLICATION FBC 20 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 Type: MECHANICAL OWNER: Name (Fee Simple Titleholder): G CJ'GLt Q Address: 1 3 N E 1© S S +Pe City: ikA. % A M 1 State: Tenant/Lessee Name: Email: JOB ADDRESS: 1 - 3 N. . E . 1 O -1 City: Miami Shores County: Folio/Parcel #: 11 x 1 3 tO 0 0 Li 0 5 1 0 Is the Building Historically Designated: Yes NO i/ Flood Zone: CONTRACTOR: Company Name: C. Cy 1 IJ 1 ^1P' (r) t i Phone#:9'1 'PO, , I '14 Address: a q CO l 1ki a 3 ' -e f v Cti (, e,., cea 1 41. 'o,. State Certification or Registration #: GA ex 3 9 L t (.0 Certificate of Competency #: Email Address: Opp ifek&AffYi.61 a CI 01 t• t Ov\ DESIGNER: Architect/Engineer: Phone*: Value of Work for this Permit: $ Square/Linear Footage of Work: Type of Work: DAddress 0 6 DAlteration ❑ ation New Description of Work: (e .. a �j 66 ref * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** N1L01s ®n Miami Dade JUL 1 ?Olt) Permit No. MC- -I - 0 ( 1 ,- 0 /000 Master Permit No. Phone#: 3 vicq )010 Zip: 33111 I ° Phone#: Zip: ORepair/Replace DDemolition * ********** * * * * * * * * * * * * * * * * * * * * * * * * * * * ** ** Submittal Fee $ Permit Fee $ J 1 CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE W1 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. 1 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 which occurs seven (7) days after the building permit is iss ,: In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged Contractor The foregoing instrument was acknowledged before me this 7 day of 4 4 _A ._, , 201 , by �e .lI l(//cL /Sah , day of Z1 t.1 , 20/0 , by f ?e, c c.„...4,3_.,,,, who is ' rson , ly known to mg or who has produced who i ovally kno o me or who has produced As identification and who did take an oath. as identification and who did take an oath. NOTARY ': : LIC: Owner or Age The foregoing instrument was acknowledged before me this `fit . NOTARY PUBLIC: Honor RESE MULLEMTE Sign: l ' 1 ! /_ ;> r , ,, n* DD0833028 Print:� st /MA (-..C..o A1Ire)t = Expires 1/13/2013 My Commission Expires: /— 1 —.c:?. t ' ti <Z,, r Fulda NOW ABM. MC ** * * ** * ** ***M***goiMN*** * NSA, ********* Nt******* ******W ip N** *go****k ******************* ***do**** +NM**** ******iMd APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised 07 /10/07)(Revised 06/10/2009)(Revised 3/15/09) Signa Sign: Print My Commission Expir ACOfDL CERTIFICATE OF LIABILITY INSURANCE I 9/1 9 PRODUCER (305) 714 -4400 FAX: (305) 714 -4401 AWN & BROWN INSURANCE -HBA DIVISION ._JO NW 79th Avenue Suite# 101 Miami FL 33122 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 Capital Air, Inc., DBA: Capital Air 2961 SW :23 Terr . Bay #2 Ft. Lauderdale FL 33312 INSURERA:AmeriSUre Insurance 19488 INSURER B: Technology Insurance 42376 INSURER C: INSURER D: INSURER E: COVERAGES 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 POL CIES 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 ADD'L INSRD • TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MMIDDIYY) POLICY EXPIRATION DATE (MM/DD/YY) LIMITS A GENERAL X' LIABILITY COMMERCIAL GENERAL LIABILITY GL2 064420AIC 9/16/2009 9/16/2010 EACH OCCURRENCE $ 1,000,000 PREMISES $ 50,000 MEDEXP(Anyoneperson) $ 5,000 CLAIMS MADE X OCCUR PERSONAL &ADVINJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP /OP AGG $ 2,000,000 GEN'L AGGREGATE IEC E LIMIT APPLIES PER: x — I POLICY I 1 I X I LOC A AUTOMOBILE X: X X XI LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS COMP &COLL DED:$1000 CA2064421AIC 9/16/2009 9/16/2010 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 $ A EXCESS/UMBRELLA X r OCCUR DEDUCTIBLE RETENTION LIABILITY $ CLAIMS MADE CU2064422AMI 9/16/2009 9/16/2010 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ $ $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER /MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below TWC3222694 1/1/2010 1/1/2011 TOR OR LIMIT Y LIMITS ER ER E.L. EACH ACCIDENT $ 100,000 E.L. DISEASE - EA EMPLOYEE $ 100,000 E.L. DISEASE - POLICY LIMIT $ 500,000 OTHER DESCRIPTION OF OPERATIONS /LOCATIONSNEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS CERTIFICATE HOLDER MIAMI SHORES VILLAGE 10050 NE 2 AVENUE MIAMI SHORES, FL 33138 ACORD 25 (2001108) INR(19S ,nina\ r1a. CANCELLATION 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 H INSURANCE GROUP /CIH © ACORD CORPORATION 1988 Pace 1of2 BUILDING PERMIT APPLICATION FBC 2004 Permit Type (circle): Building Electrical Plumbing Mechanical Roofing Owner's Name (Fee Simple Titleholder) Ger cd A e. lid i t;, o I 5 on Phone # Owner's Address I S' 3 G 1 0 C t ,S + City L( (1 m t . 1) n r e. 5 State Zip 3 3 1 4 1 Tenant/Lessee Name 5a yr) '2 Phone # Job Address (where the work is being done) 5 j N £ 10 5+, City Miami Shores Villas e County Miami -Dade FOLIO /PARCEL# i1' . 1 3( -OO - Q 51 0 Is Building Historically Designated YES NO ✓ Contractor's Company Name 2a ( 40-k, /4 C r Phone # 95 7f2 4f 7 Contractor's Address 02 q4 ! � ff LA) o " l e r 3 rc r-�. ,� 4 2 City L ,e ►r C( R. 1 State Zip q33 Qualifier Name? -e .t k a 14 a Y) Phone # State Certificate or Registration No. CA w-51' `7 1 1-(p Certificate of Competency No. Architect/Engineer's Name (if applicable) iV U Value of Work For this Permit $ Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Phone # Permit No. Master Permit No. Zip Square / Linear Footage Of Work: Type of Work: DAddition ❑Alteration ❑New Describe Work: 4 C Pt?, A eQ'ii* e 6 l ' c. ' epair/Replace ❑ Demolition �� S i --E ******** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** ees ************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Cr �( Submittal Fee $ 5� Al Permit Fee $ V CCF $ � • CO /CC Notary $ --- Training/Education Fee $ Technology Fee $ ■*&0 Scanning $ 5'00 Radon $ DPBR $ Zoning $ Bond $ Code Enforcement $ Double Fee $ Structural Review. $ Total Fee Now Due $ ) 1.15 +f C) See Reverse side -* 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 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. Owner or Agent Contractor The foregoing instrument was acknowledged before me this foregoing instrument was acknowledged before me this 3 R-C> day of 1 Z , 269 , b 1 _ • . a y of z,em t e , 20 ®1 , by - .....7 -- R Copt- 4 44 , who is personally known to me or who has produced who si person known to m or who has produced A 2,"' ` s iStification and who did take an oath. a identification and who did take an oath. ! THERESE I .IC: `� IR i p Expires 1/ � * NOTARY PUBLIC: Sign: Print: My Commission Expires: APPLICATION APPROVED BY: (Revised 02/08/06) My Commission Expires: f / 3 - 2 e' / *************************************************************** * * ** * * * * * * * * * *,r * * * * * * * ** * * * * ** rz, Plans Examiner Engineer Zoning Air conditioning -Heat Punips We Sell CAPITAL We install AIR CONDITIONING We Service 2961 SW 23 Terrace, Bay #2, Fort Lauderdale, FL 33312 (954) 792 -4942 Fax: (954) 797 -0029 PURCHASER NICHOI SON N E PURCHASER'S ADDRESS 153 NE 109 ST MIAMI SHORES PHONE SELLER'S PROPOSAL A/C REPLACEMENT REMOVE AND DISPOST OF EXISTING A/C SYSTEM INSTALL ONE NEW TRANE 4 TON SPLIT SYTEM 16 SEER CONNECT TO EXISTING FREON LINES . DUCTWORK AND ELECTRCAL ONE YEAR LABOR AND FIVE YEAR PARTS AND TEN YEAR COMPRESSOR WARRANTY We propose to furnish materials and/or Labor specified above in consideration of the Following Sums: $ Labor and/or Materials S Less Trade -In Allowance Sales Price $ Add for Options 13y 'Installation complete means when Use system is capable of operation as detemdned by Sethi; regardless of the availability of electrical power. General The seller agrees to assign to the Purchaser all numufacturets wansmHes, WHICH SHALL BE IN LEN OF ALL OTHER WARRANTIES EXPRESSED OR IMPLIES INCLUDING IMPLIED WARRANTEES OF MERCHANTABILITY AND FflNESS, WHICH ARE HERE EXCLUDED. The Purchaser agrees that title to the equipment shall remain with the Setter until all monies have been paid; and in the event of default that the seller may repossess or replevin the equipment without notice to the Purchaser, and In the event of a replevin action, the Purchaser waives a preliminary hearing. The Seller shall not be held responsible for delays in delivery and/or completion of the work for such delays as caressed by acts of others, strikes, riots, war, emergencies, inclement weather, casualty, or other contingencies beyond the Sellers control. All risk of loss or damage to the equipment, materials, and/or work shall be borne to the Purchaser; and Purchaser shall insure nil equipment, work, and materials an amount equal to the sales price against frrc, theft, casualty and windstorm. Purchaser releases Seller from any liability, toss, damages, or expenses as a consequence of the system malitmctloning. The Purchaser, if a tenant of a landlord, warrants to the seller That he has approval from the landlord for this installation, and that all of the Sellers mechanical equipment does not become pan of the realty and may be lively repossessed without permission form the landlord should replevin action become necessary. All delinquent payments shall bear interest of eighteen percent (I 1%j per annum. The Purchaser shall pay nil Attorneys' fees incurred by the seller by enforcing this contract, together with cost and any Attorneys' fees on appeal LIMITED WARRANTIES: Seller does not guarantee or offer a warranty au any parts or equipment. It is understood that all parts and equipment need are provided by the manufacturer and may be subject to a fell limited warranty by the mnnufnct uer, and Seller assumes no responsibility for defects of any kind on said parts and equipme nL Seller does warrant all necessary labor fora period of 1 YR from the completion of installation Said labor will be performed only during Seller's normal working hours, and, if Purchaser request a rtergency ser vice outside normal working hours, there will be an additional charge. Warranty work specifically excluded from this limited wnrrnnty is replacing blown fuses, resetting circuit breakers, replacing burned out disconnects, improper setting of thermostat, changing filters, any palls for service not directly related to mechanical equipment fntdts and normal m Wennnce outlined in the owners manual. Proposal Date 12 - - PURCHASERS- SELLERS ACCEPTANCE I/WE have read the proposal, have received as exact copy, and accept the proposal this day of subject to the provisions and conditions above; personally guaranteed by: This agreet subject to acceptance by an authorized officer of the seller. Authorized Signature • r Purchaser Personal Guarantee Air conditioning -Heat pumps Broward Palm Beach Dade LU'E1 Supply Grilles Return Grilles Payments to be made as follows: S Q........ % Non refundable Deposit with order (Received by ) • ...�. % Pymt. Installation of Ref & Drain Lines $ .... Pymt. Rough -In of Duet Work S. % Pymt. Delivery of Outdoor Equipment $.338.0 % Pymt. Balance when Installation is complete Effective Until Salesman PETE CALLAHAN Accepted By A , 20 Signa re for Seller Officer of Corp.