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MC-11-155Inspection Number: INSP - 155968 Scheduled Inspection Date: February 23, 2011 Inspector: Perez, JanPierre Owner: UNIVERSITY, BARRY Job Address: 190 NW 111 Street Miami Shores, FL 33168- Project: <NONE> Contractor: SUNSHINE STATE AIR CONDITIONING Building Department Comments February 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 Permit Number: MC -1 -11 -155 Permit Type: Mechanical - Commercial Inspection Type: Final Work Classification: A/C Replacement Phone Number Parcel Number 1121360030480 Phone: 305 -474 -8484 CHANGE OUT 3 TON CONDENSING UNIT ONLY. Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments CREATED AS REINSPECTION FOR INSP- 155390. need to use 22 ga metal to strap down unit jpp Page 20 of 29 BUILDING PERMIT APPLICATION FBC 20 Permit Type: MECHANICAL Address. / ?d N G✓ / 1/ 5 -7. City: i40-i �` �/S ' 2(Y 4 State: Tenant/Lessee Name: JOB ADDRESS: /90 /11 eki / // �T Miami Shores Village Building Department City: Miami Shores County: Folio/Parcel #: 11 "' 12 ce- ®c) 3- Ditko Is the Building Historically Designated: Yes NO J AMOMEVI JAN 31 2011 JJ BY: "C--S 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 t r Permit No. \M, C 1 k a 153 Master Permit No. OWNER: Name (Fee Simple Titleholder): '\ U ( 1 \ /°`c Miami Dade CONTRACTOR: Company Name: S 0 J ? 4 ' , ' .54 rc A f G Address: 9` lc O f L) 1 (DS �'4 ., S -Fe_ 611 City: t1 l P-4 State: Qualifier Name: -k L)CiCq C ® rte. State Certification or Registration #: CA C 1 k 1 LP 23cJ Certificate of Competency #: Contact Phone #: ( 0 )m i c Email Address: d 1 C4 . 1z 1'kctC DESIGNER: Architect/Engineer: /v /yq TOTAL FEE NOW DUE $ Phone #: 3° s Y??- 3 3 Fir) Zip: 33 (b 1 Phone #: 3 °S ° ?? _ 7770 Email: Flood Zone: Zip: 3 31 to Phone #: 'f7' -6'44- / Zip: 1'4 Phone #: 303) y — 8 -i &41 Phone #: Value of Work for this Permit: $ • 6) Square/Linear Footage of Work: Type of Work: Address ❑Alteration UNew I�Repair/Replace Description of Work: C hC..wx c3‘fik 4 Cc\e all irk5 utli+ . O U't- ODemolition * * * * * * * * * * * * * * * * * ** *. * * * * * * * * * * * * ** Submittal Fee $ u 1D Permit Fee $ k v CCF $ Scanning Fee $ Radon Fee $ DBPR $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ / V _Aga-- Structural Review $ CO /CC $ Bond $ 3 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. Signature NOTARY PUBLIC: Sign: APPROVED BY Owner or Agent The foregoing instrument was acknowledged before me this r day of ?iAka , 20 / I , by 1), ? zLe e ✓ � who is personally known to rue or who has produced As identification and who did take an oath. Print: My Commission Expires *** ***************** 1 "4 Notary Public State of Florida Cheryl Saida Gerber My Commies on 00988128 0 • of 05/08/2014 (Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09) * k **4eoY **** t *4: Plans Examiner Structural Review Contractor The foregoing instrument was acknowledged before me this 2 day of C r , 20 I k , by MCA LA I C who is personally known to me_or who has produced as identification and who did take an oath. NOTARY PUBLIC: JENNIFER A. DIAZ 1W MY COMMISSION 0 DD834850 '. EXPIRES: October 28, 2012 vY* r leiciailticallictot J Ct'lnk -Fcli A ° d Go2 es• c k-'2- ******** * *kY *** **** *Y* Zoning Clerk UNIT BEING REPLACED DATA NEW UNIT gIruz. MANUFACTURER 9 0 10 AHU or PKG. UNIT MODEL # IQ P COND.UNITMODEL# I‘bliclTr13(c 01.. N® ¥- .e_ e4;to-I,i.�_. 6 Pt- KW HEAT HIPP 3-h- , NOM TONS 3 to ( 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 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 1 AIR CONDITIONING REPLACEMENT DATA (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 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): lq 0 - i l l City: Miami Miami Shores Village County: Miami Dade Zip Code: 3' I (.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 Er ARHI Sheet Attached: YES ❑ NO ❑ Contract Attached: YES ❑ 1. Minimum Circuit Ampacity (Wire Size): 6 0 2. Maximum Overcurrent Protection (Fuse /Breaker Size): 3. Voltage of Circuit (208/240/480): 4. Size Disco'rci Y ) necting Means: �j�15�`f� C_ Contractor's Com an Name: S`� i ne " � - Ai r C it e ""Phone: 3 )411- INN p State Certificate r egistration N. „1I t' 11P239 Certificate of Competency N. Signature ,141[ , FAA,. Date: i 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 ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INbK LTR A ADD L INSRC GENERAL TYPE OF INSURANCE UABILITY COMMERCIAL GENERAL LIABILITY POLICY NUMBER GL0149419 POLICY EFFECTIVE DATE MM/DD 03/31/10 POLICY EXPIRATION DATE MM/DD 03/31/11 LIMITS EACH OCCURRENCE $1,000,000 X PREMISES(Ea $100,000 INSURER C: CLAIMS MADE I X I OCCUR MED EXP (Any one person) $ 5,000 INSURER E: PERSONAL BADVINJURY $ 1,000,000 GENERAL AGGREGATE $2,000,000 GENT. AGGREGATE LIMIT APPLIES PER: POLICY I JECT Fi LOC PRODUCTS - COMP /OP AGG $ 2,000,000 B AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS CA0014072 03/31/10 03/31/11 SINGLE LIMIT COMBINED BIaccident) $1,000,000 X BODILY INJURY (Per person) $ X BODILY INJURY (Per accident) $ X PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ AUTO ONLY: AGG $ B EXCESS/UMBRELLA LIABILITY UM0149419 03/31/10 03/31/11 EACH OCCURRENCE S1,000,000 X OCCUR I CLNMS MADE AGGREGATE $1,000,000 DEDUCTIBLE RETENTION $10,000 $ $ X $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? if yes d under SPECIAL PROVISIONS below 001 —WCO9A -61597 03/31/10 03/31/11 X I TO Y I X I ER E.LEACHACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000 , 000 OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS ACORD CERTIFICATE OF LIABILITY INSURANCE OP ID CF SUN SH05 DATE(MMIDD/YYY) 03,30/10 EXTEND OR BELOW. PRODUCER BROWN & BROWN OF FLORIDA INC 80 GOVERNORS SQUARE BLVD 400 " 1MI LAKES FL 33016 -1588 one: 305 - 364 -7800 Fax: 305 - 822 -5687 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, ALTER THE COVERAGE AFFORDED BY THE POLICIES INSURERS AFFORDING COVERAGE NAIC # INSURED SUNSHINE STATE AIR OND INC.' OR SUNSHINE STATE A/C INC 4960 NW 165 ST B -11 MIAMI FL 33014 INSURER k. FCCI INSURANCE COMPANY 10178 INSURER B: NATIONAL TRUST INSURANCE co 20141 INSURER C: INSURER D: INSURER E: HOLDER ACORD 25 (2001/08) CITY OF MIAMI SHORES 10050 NE 2ND AVENUE MIAMI SHORES FL 33138 CIT -138 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 00 SO SHALL IMPOSE NO OBLIGATION OR UABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. © ACORD CORPORATION 1988