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MC-10-2080Inspection Number. INSP - 153616 Scheduled Inspection Date: May 11, 2011 Inspector: Perez, JanPierre Owner: HOGAN, DAVID Job Address: 42 NW 110 Street Miami Shores, FL 33138-4319 Project: <NONE> Contractor: REYES AIR CONDITIONG & PARTS Building Department Comments REPALCE EXISTING 4 TON SPLIT AIR CONDITIONING Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments May 10, 2011 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 <v6/7 For Inspections please call: (305)762 -4949 Permit Number: MC -11 -10 -2080 Permit Type: Mechanical - Residential Inspection Type: Final Work Classification: A/C Replacement Phone Number Parcel Number 1121360030040 I' Phone: (786)426 -9812 1l Panes d of 25 e • BUILDING PERMIT APPLICATION FBC 20 Email: JOB ADDRESS: 4a N w. Roth st City: Miami Shores Folio/Parcel #: 11 - 1/36 —06 -0 ®4v Is the Building Historically Designated: Yes V:k of Worktor bi_cPer-mi • 'f 0 . 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: Address: -1-1 X) • 10, //O S'T,eczr City: Mir/ State: F-P zip: 3J/3 Tenant/Lessee Name: Phone#: Permit No. IYV C--t° Master Permit No. Permit Type: MECHANICAL OWNER: Name (Fee Simple Titleholder): D4 1/ /A /40G Phone #: 30S— 793.q860Z Miami Dade Zip: l 6*) NO X Flood Zone: ►rl 0 CONTRACTOR: Company Name: 17,E- y'C-:S 'C ine•pmAJC, MOM, . IPC Phone #: 786- 426 - 98/a- Address: 7P 7PC, (tf tei /& a92.6 4C City: /4/ ./ //A/G • State: r.,e Zip: _7,3e0.' Qualifier Name: 44 74 ,12 Phone#: Y1 -4, Z6 State Certification or Registration #: L®/c) 70 a 00/0 Certificate of Competency #: 0 7C45a. Contact Phone#: Wo 42-C. - Email Address: e mlYeyes iglve a k..- Gom DESIGNER: Architect/Engineer: Phone #: Type of Work: °Address °Alteration ONew epair/Replace °Demolition Description of Work: PEN_ Ace 7'R 577,u& 47 SPL l r Ali C4raTt6UoarG -, 5r5'1'L -may ** * ******* ****** **** *** * ** ****s** **** ******** **** *** ** * *** * * ****** ** *** * **** Submittal Fee $ Permit Fee $ : 1 1ThCCF$ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ 0 \\V12 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 FI.RCTRICAL 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Signature Owner or Agent The foreg ing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of foreg 1�e , 20 t 0, by 11 fl J� ' 6 AA) , day of , 20 _, by who is personally known to me er- prnduced---- who is personally known to me or who has produced As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: 1 ( A 111-1. -b b E COVhfl J Sign: Lem / /7 *re j .�/ Print: � - Wet') h /A R ' hens My Commission Expires: * * * * * * * * * * * * * * * * * * * * * ** APPROVED BY 4 4 (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) ei VPje., P TAkNA J 1 i! ' HE t9 CO M(2 f ON ; nr„ 0j iji ':Re S: May 139, 2011 v C. UK, i ccu sA;E �► **** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** ans Examiner Structural Review Sign: Print: My Commission Expir LOURDES Q. QUESADA MY COMMISSION # DO 823395 .:# EXPIRES: Decanter 27, 2012 Bonded Pim N Zoning Clerk UNIT BEING REPLACED DATA NEW UNIT B d if I MANUFACTURER CA iz A 4-is I t sT111 X AHU or PKG. UNIT MODEL # FLT 4-A4.d Fern LJAM -®4z- COND. UNIT MODEL # a.zi. 40A 74$A l�3 KW HEAT AD NOM TONS 4 AHU CU PKG 1) M.C.A AHU Uagq -PKG AHU CU PKG 2) M.O.P AHU60 CU40 PKG AHU CU PKG 3) VOLTS AHU CU,73O PKG PKG UNIT / / PKG UNIT / / EER/SEER YES NO REPLACING DUCTS YES (NI YES NO REPLACING THERMOSTAT (YET NO YES NO NEW 4 °CONCRETE SLAB YES C _ YES NO NEW ROOF STAND YES YES NO NEW RETURN PLENUM BOX YES •. Signature — AIR CONDITIONING REPLACEMENT DATA Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 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): 4 y / 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 ❑ ARHI Sheet Attached: YES dNO ❑ Contract Attached: YES ❑ 1. Minimum Circuit Ampacity (Wire Size): 4 O 2. Maximum Overcurrent Protection (Fuse /Breaker Size): 60 3. Voltage of Circuit (208/240/480): a-3 CJ 4. Size Disconnecting Means: PULL. ® L3'( Contractor's Company Name: .EYES A(12 am c,c, 4147 C- Phone: TR4 - 426 - `V4 /1._ State Certificate or Registration N. Certificate of Competency N. (Quallfl s signature only) Date: .. C ERTiFIE www.al)ridirectory.org T Certificate of Product Ratings AHRI Certified Reference Number: 1249611 Date: 11/18/2010 Product: Split System: Air - Cooled Condensing Unit, Coil with Blower Outdoor Unit Model Number: 24ANA748A30 Indoor Unit Model Number: FE4AN(B,F)005+UI Manufacturer: CARRIER AIR CONDITIONING Trade /Brand name: INFINITY 17 PURON AC Manufacturer responsible for the rating of this system combination is CARRIER AIR CONDITIONING 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): 48000 EER Rating (Cooling): 11.50 SEER Rating (Cooling): 15.70 ' 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 products) 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 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 In part, be reproduced; copied; disseminated; entered into a computer database; or otherwise utilized, in any form or manner or by any means, except for the user's individual, personal and confidential reference. CERTIFICATE VERIFICATION A unil The Information for the model cited on this certificate can be verified at www.ahridirector Air Conditioning, Heating, click on "Verify Certificate" Zink and enter the AHRI Certified Reference Number and the date on ®® a � 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.: 129345641329487856 11/18/10 Thu 08:16 Co: 1 Carrier Enterprise, LLC Carrier Corporation Unpick Orders /Uncommit Inventory Funct: oeepz Start Dt /Time: 11/18/10 8:16 AM Store As: 29787382 Group: Options: 1 List Orders? yes 2 Change Promise Date To 11/19/10 3 Warehouse 2523 List Of Order #'s: 15714955 -00 oeepz Oper: d055 Page: 1 AC �° DATE (MMIDD/YY) �..... CERTIFICATE OF LIABILITY INSURANCE i 11/16/10 PRODUCER Lakes and Country General Insurance 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. 8555 NW 186th Street Hialeah, FL 33015 -2557 Phone (305)829 -2777 INSURED REYES AIR CONDITIONING PARTS iNC , 7761 NW 106 Terr Miami Lakes, FL 33016- INSURER E: COVERAGES ' INSURER F: THE POLICIES OF INSURANCE LISTED 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 I MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH j POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'L TYPE OF INSURAN I POLICY NUMBER POLICY EFFECTIVE I POLICY EXPIRATION LTRI LN$RD DATE .� M/DD/YYJ DATE (MM/DD/YY) i I A ❑ GENERAL LIABILITY ❑❑ CLAIMS MADE 0 OCCUR I ❑ ❑ GENERAL AGGREGATE + 1,000,000 PRODUCTS - COMP /OP AGG _I__ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: I L 11 POLICY ❑ PROJECT ❑ LOC AUTOMOBILE LIABILITY ❑ ANY AUTO ❑ ALL OWNED AUTOS ❑ ❑ SCHEDULED AUTOS ❑ HIRED AUTOS ❑ NON OWNED AUTOS GARAGE LIABILITY ❑ ❑ ANY AUTO EXCESS/UMBRELLA LIABILITY ❑ OCCUR ❑ CLAIMS MADE ❑ DEDUCTIBLE ❑ RETENTION $ ' WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR / PARTNER / EXECUTIVE OFFICER / MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below OTHER L DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS AIR CONDITIONING SERVICE & REPAIR, INSTALL & PARTS CERTIFICATE HOLDER COMMERCIAL GENERAL LIABILITY MIAMI SHORES VILLAGE 10050 NE 2ND AVE MIAMI SHORES, FLORIDA 33138 FAX# 305 - 756 - 897205 - 795 -2204 ACORD 25 (2001/08) QF Fax (305)829 -0782 INSURERS AFFORDING COVERAGE NAIC # ' INSURER A: NOVA INSURANCE COMPANY INSURER B: INSURER C: INSURER D: CH OCCURRENCE 1,000,000 » IAMA TO j 09AL068169 12/06/10 12/ 06/11 PREMISES (Ea RENTED occurencel 1,000,000 MED EXP (Any one person) i 5,000 PERSONAL & ADV INJURY I 1,000,000 rt I (Ea accident) 1 EACH OCCURRENCE LIMITS BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) AGGREGATE COMBINED SINGLE LIMIT ❑ WC STATU- ❑ OTH- TORY LIMITS ER AUTO ONLY - EA ACCIDENT OTHER THAN EA ACC AUTO ONLY: AGG E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT 1 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 © ACORD CORPORATION 1988 7 ALEX SINK STATE OF FLORIDA CHIEF FINANCIAL OFFICER DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORMS' COMPENSATION LAW CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation taw. EFFECTIVE DATE 01/04/2010 EXPIRATION DATE- 01104/2012 PERSON: REYES LAZARO E FEIN: 260792492 BUSINESS NAME AND ADDRESS: REYES AIR CONDITIONING & PARTS INC 7761 NW 180TH TERRACE MIAMI LAKES FL 33018 SCOPES OF BUSINESS OR TRADE 1- REPAIR SERVICE 2- REGISTERED BUILDING CONTRACTOR IM NagTAMT._ Mown to Chapter 449'. 05f114l FS., an officer of it rorpofattes tube efts eft Inns t ii chsptet b2 filing' e tenUssto t elettiea thta ssctia0 may tmt reco.ar iieaefiti ar "Ciiinieistilffint end tide ebopter, PiMellell to Mmptev 441105114 CS leilas ei election is fie ems. -. apply a* wind i scope of the babiasss er trade Tinted on the notice of election to be exempt. Peruadt le Cbajtt 440.05113?, F.S., Philtres of election to be exempt and certificates of election to be exempt shall be subject to revoatoa if, at any time attar the filing of the notice or the ism of the certificate, the person named on the notice or certificate no Langer teats the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time ter failure of the person named on the certificate to meet the regoiremeats of this settles. QUESTIONS? (8501 413 -1801 NC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09 -06 PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE IMPORTANT F Pursuant to Chapter 440.05(141, F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election L ranter this section may not recover benefits or compensation under this D chapter. Pursuant to Chapter 440.05119, F.S. . Certificates of election to be H exempt_ apply only within the scope of the business or trade listed on R the notice of election to be exempt E Pursuant to Chapter 440.05(13). F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person named an the certificate to meet the requirements of this section. QUESTIONS? (850) 413 -1609 STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION LION INDUSTRY CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS COMPENSATION LAW EFFECTIVE 01/04/2010 EXPIRATION DATE: 01/04/2012 PERSON: LAZARO E REYES FEIN 260792492 BUSINESS NAME AND ADDRESS: REYES AIR CONDITIONING & PARTS INC 7761 NW 160TH TERRACE MIAMI LAKES, FI. 33016 SCOPE OF BUSINESS OR TRADE 1 - REPAIR SERVICE 2- REGISTERED BUILDING CONTRACTOR WC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09 -06 CUT HERE 12-07 -2009 * Carry bottom portion on the job, keep upper portion for your records. QTY. BRAND AIR COCOOS COND. UNIT DEL MODEL COND. UNIT VOLTAGE AIR HANDLER MODEL AiR HANDLER VOLTAGE SEER EER STRIP HEAT. SIZE TONS PACKAGE UNIT MODEL 1 1 ��� �/ R-4-1-0:2V6— /� JO 4 CC# 07M001252 09CML15571R NAME STREET CITY /LJ /7444/ , )✓ / PROPOSAL SUBMITTED TO: („J /// ; ( `� l STATE Zit' CODE /- C- EQUIPMENT SCPfEDULE WILL BE: ❑GLASS FIBER ❑ FLEX DUCT ❑ GALVANIZED I'J EL CONTROLS: ECTRIC ❑ OTHER THERMOSTAT HEAT & COOL SERVICE: Will be provided free by us fora period of from date of installation, during regular working days at regular working hours. PARTS WARRANTY: Manufacturer's year warraury on parts. Manufacturer's year warranty on compressor. RESPONSIBILITY: OTHE�t Delivery i/ Installation of Equipment Installation of Thermostat & Controls Refrigeration Piping Af Ductwork A) //a Grilles (S- )(R- Hoist Equipment Permits Fee * Price goad unto ACCEPTED: Return Air by Grille ❑ or Louver Door (by other) R We hereby propose to furnish labor and materials - a=JCL , ptet 1 , r T r /,zf5t-!fi, -3.6 t ircoliIaiittia miing & Parts, inc 7761 rgi.W. 160 Tffdtrrdilce I iial i -GLak s, Fi iri da 33016 (Phone: (7 6) 426-9612 PHONE -'!; Z JOB NAME STREET CITY STATE 1 CU57�1Li 13' ge-t- ; Ii fc -- ?k G up -A-I c i N!/Z&=c -TL 1 "" ez e AfZia z , 7 S /4 /c 4 75 act i y 46 1_H 5012 rotz 77tc .i5TH1 77 00 AIR DISTRIBUTION: Ductwork & Grilles as per our design will be fabricated and installed in compliance with ail applicable bull ding codes in force on above date. DUC'TW O RK: Title to the above merchandise remains with the Vendor until paid in fun. in case of any default In any terns of this Order - Contract. the Seiler shall have the right to take immediate possession of said merchandise and the full amount of the purchase price then unpaid shall become Immediately due and payable at the sellers option without notice or demand. All monies paid shall remain with the Vendor as liquidated damages. In the event of default under the terms of this contract, requiring the services of an attorney to protect the in rest of the setter. the Purchaser agrees to pay reasonable attomeys fee together with interest thereon at the rate of 18% per annum, payable monthly, plus ail cost Incident thereto. The Seller shall not be liable for delays in delivery or installation resulting from strikes. embargoes. fires. floods. Acts of God, labor troubles or other causes beyond the control of the Seiler. This Proposal to the Purchaser In offer, and Is Subject to acceptance by seller. That in the event the purchaser repudiates this contract after executions and refuses to allow seller to commence work under contract provisions, then and in that event, the purchaser shall pays to and be responsible to the seller in the sum of the contract prices and for liquidated and agreed damages and not as penalty. RESPONSIBILITY: Drain Piping Air Handler Supports Warehouse Exhaust C. Units Supports Painting Decorating & Patching Hest Recovery /A Kitchen Exhaust Vent Pipe all /at} Bathroom Exhaust /UM Dryes Exhaust ,(f r 4 Smoke Detector Aril Electrical Wiring (Power & Control) N/"A complete in accordance with the above specifications, for the sum of: `/ oilers ($ Y 1'" , o air - .P.)T4GL,4rc J Purchaser is responsible for all equipment and materials oeiivered to Job site. Alt wont to be completed in a workmanlike manner according to standard practices. Any alteration or deviation from above specifications involving extra coals wilt be executed only upon written orders, and will become an extra charge over and above the estimate This proposal subject to acceptance withing 6 ,days andir_qd,thereafter at the option of the undersigned. Authorized Signature SALES SERVICE INSTALLATION DATE OTHER ZIP CODE tiro ) with payment to be made as follows: ACCEPTANCE OF PROPOSAL The above prices, specifications and conditions are hereby accepted. You are authorized to do the work as specified. Payment will be made as outline above. Signature Date Signature ter This Proposal does not reflect futpre price increases from equipment and material suppliers. Any and all price increases will be added to this agreement after date Stated above.