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MC-10-2103Inspection Number: INSP - 153730 Scheduled Inspection Date: December 09, 2010 Inspector: Perez, JanPierre Owner: PEINADO, ULISES Job Address: 391 NE 103 Street Miami Shores, FL 33138 -2432 Project: <NONE> Contractor: PICON DESIGN CORP Building Department Comments REPLACEMENT OF AIR CONDITIONER, REFRIGERATION PIPING BATH EXHAUST AND SOME CM DUCTS Passed Failed Correction Needed Re- Inspection Fee December 08, 2010 No Additional Inspections can be scheduled until re- inspection fee is paid. Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspector Comments For Inspections please call: (305)762 -4949 Permit Number: MC -11 -10 -2103 Permit Type: Mechanical - Residential Inspection Type: Final Work Classification: A/C Replacement Phone Number (305)498 -0577 Parcel Number 1121360130290 Phone: (305)599 -8282 Page 10 of 13 11-101 I LCD. 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 -5-ip --D _LI SPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION FBC 20 Permit Type: MECHANICAL OWNER: Name (Fee Simple Titleholder): 4k1 G nd #C' / Address: 3 `? / � � ,/ ij /03` City: gym"/' VClered Tenant/Lessee Name: Phone #: Email: JOB ADDRESS: City: Folio/Parcel #: Is the Building Historically Designated: Yes NO y CONTRACTOR: Company Name: P'-€'), Q .Fi fri £2 (V rrx. be:4 Address:: 94E5 y Pt/ / City: Barad /'a n State: PL Qualifier Name: � � 1 Rat o /1 State Certification or Registration #: C / Contact Phone #: DESIGNER: Architect/Engineer: Value of Work for this Permit: $ Type of Work: ❑Address ❑Alterat n Description of Work: R 4- IRG in tb.-7 a i ! MAA d 1-044-f c-04 Miami Shores ? 5 O& * * * * * * **** ****** **** ***+x*************** F ****** ****************** * * * ** * ****+x** ** Submittal Fee $ Permit Fee $ Scanning Fee $ Radon Fee $ Miami Shores Village Building Department State: r'"t- 3a1 10 3 sT County: Miami Dade Ab 57 7 D 4O\ 2 9 Permit No.IV C )10 Master Permit No. L hadna,� 1, TOTAL FEE NOW DUE Phone#: 301 - VLF Sere 30r- q67- gq.r7 Zip: 33 /aJ 8 Zip: Flood Zone: Phone #: ,,SOS'. - 0192 Zip: 5 / 7-2 Phone#: J?" 9Z 9 2 Certificate of Competency #: Email Address: ZJC/Y plc an -a;rCOnG/f'k071rncJ. GO kr Phone#: Square/Linear Footage of Work: ❑New Rep r/Replace C/11 ek h ‘dY) e r -/ 1 .0-rA/A CCF $ CO /CC $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ ❑Demolition Bonding Company's Name (if applicable) Bonding Company's Address City 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 AN1N 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 ) 7 day of/11d ; 20/e, byety nor ' • who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: '!4 Nota Public State of Florida " CV Rio Hernandez -Forte o' My Commission EE019897 010, Exr:+res 08/23/2014 My Commission Expires: APPROVED B Ds; (.2),401364 +k***Ns*skds*******d *** ***sk**** (Revised 07 /10 /07)(Revised 05 /10/2009)(Revised 3/15/09) State ************ss.. * :..,,k 0 Plans Examiner Structural Review Signature Zip Co tractor The foregoing instrument was acknowledged before me this Z day of /V0 re b 20 / by JV ei I' �/�8 h who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: iralm° Virgilio IWQ� -Forte My Commission E8019897 °m ow Expires 08/23/2014 Zoning Clerk UNIT BEING REPLACED DATA NEW UNIT `: /Old kt dV1n MANUFACTURER 7 -.V E v/ 1i Alva' 1E 1 of AHU or PKG. UNIT MODEL # it Teri -13 F y88 /00 o 0 COND. UNIT MODEL # 4 7 S2 1 49 rf / mareA C' KW HEAT /0 /G v✓ / 0 (` t&) NOM TONS 4 hM- 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 / / /(fl SOM. EER/SEER / Gv 5.0..91(2. YES \C' NO REPLACING DUCTS yc uel YES x" NO YES ' NO REPLACING THERMOSTAT X yal YES )0 NO YES NO ' NEW 4"CONCRETE SLAB YES NO'S YES NO NEW ROOF STAND NO °C YES NO NEW RETURN PLENUM BOX _ YES YES N0 /C fir 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. n1 Job Address (where the work is being done): ` / //tf f l7 d� City: Miami Shores Village County: Miami Dade Zip Code: 03/38 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: YESr NO ❑ ARHI Sheet Attached: YES "NO ❑ Contract Attached: YES,J 1. Minimum Circuit Ampacity (Wire Size): 2. Maximum Overcurrent Protection (Fuse /Breaker Size): 3. Voltage of Circuit (208/240/480): 4. Size Disconnecting Means: Contractor's Company Name: R,,4 m Phone: ZDJ'- S 9— e2 & State Certificate or Registration N. Certificate of Competency N. GEC 18/ 5 (Qualifier's sicnature only) Date: e / e J 0 C-E RTi FI ,nnv�ahr_,idire`cfo Certificate of Product Ratings AHRI Certified Reference Number: 3937488 Date: 8/30/2010 Product: Split System: Air - Cooled Condensing Unit, Coil with Blower Outdoor Unit Model Number: 4TTR5049E1 Indoor Unit Model Number. 4TEH3F48B1 Manufacturer: TRANE Trade/Brand name: XR15 Cooling Capacity (Btuh): 45000* EER (Cooling): 13.00 SEER Rating (Cooling): 16.00 CERTIFICATE VERIFICATION The bdotmatlon forgo model cited on tits certifcate can be verified at w ww.ahridirectory org, click on "Verify Certificate° link and entertheAHRI Certified Reference Number and the date an which the certificate was issued, which is listed above, and the Certificate No., which is lister below. ©2010 Air- Conditioning, Heating, and Refrigeration Institute 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 TRANE 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 testing: • Ratings followed by an asterisk t) indicate a voluntary rerate of previously published data. unless accompanied with a WAS, which indicates an involuntary rerate. DISCLAIMER AHRI does not endorsethe product(s) wed 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 dish 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 Certifies Certified ratings are valid only for models and configurations listed In the directory at .ahtidlrectory.org. TERMS AND CONDITIONS This Certificate and its contents are proprietary products of AHRI. Tits Certificate shall only be used for indMduai, 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. i ® Air-Cond(#ioning, Heating, and Refrigeration Institute CERTIFICATE NO.: 12w/6681538712637 FROM Accurate (MON)NOV 29 2010 11 :17/ST.11:18/N ©.7500000977 P 1 A R� CERTIFICATE OF LIABILITY INSURANCE 1 11/29/10 PRODUCER Accurate THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 6300 West Stigler Suite 114 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND. EXTEND OR Miami, FL 33144 ALTER THE_COVERASzE A FF_ D 't�Y THE PDL1C E8LQ) Phone (305)226-8727 Fax (306)2264787 INSURERS AFFORDING COVERAGE NAIC INSURER A: American Builders Insurance Co INSURER B: Guarantee Insurance Company INSURED Picon Design Corp 9468 NW 13 Street Doral, Florida 33172 1(786) 385 -9257 COVERAGES f THE POLICIES OF INSURANCE USTED 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 CONDmONs OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 1 WI COMMERCIAL GENERAL LIABILITY A ® 00 CLAIMS MADE ® OCCUR ❑ GENT. AGGREGATE LIMIT APPLIES ❑ POLICY ❑ PROJECT ❑ AUTOMOBILE LJABIUTY ❑ ANY AUTO ❑ ALL OWNED AUTOS ❑ ❑ SCHEDULED AUTOS ❑ HIRED AUTOS ❑ NON OWNED AUTOS GARAGE UABIU Y ❑ ❑ ANY AUTO L PER LOC EXCESS/UMBRELLA LIABILITY ❑ OCCUR ❑ CLAIMS MADE ❑ DEDUCTIBLE ❑ RETENTION $ W ORKERS COMPENSATION AND EMPLOYERS' LIABILITY B ANY PROPRIETOR / PARTNER 1 EXECUTIVE OFFICER / MEMBER EXCLUDED? 11 yes. desenbe under SPECIAL PROVISIONS below CERTIFICATE HOLDER Village Of Miami Shores 10050 NE 2 Ave Miami Shore Fl 33138 1305 766 8972 ACORD 26 (2001105) OF 1028090001513 -01 GWGC100007093 - 10 INSURER C: INSURER D: INSURER E INSURER F: POLICY EFFECTNE 11/03/10 TYPE OF INSURANCE �POUCY NUMBER PATE 1�aDD1YY)_ N CATE GENERAL L1AEILITY 11/03/11 08/22/10 08/22/11 CANCELLATION AUTHORIZED REPRESENTATIVE Lucia Estrella EACH OCCURRENCE PREMISES aMAOEYO MED EXP (Any one Person) PERSONAL &ADV INJURY GENERAL AGGREGATE PRODUCTS - COMP1OP AGG COMBINED SINGLE LIMIT {Ea accident) BODILY INJURY (Per person) BODILY INJURY (Per geddent) PROPERTY DAMAGE (Per =Mont) AUTO ONLY • EA ACCIDENT OTHER THAN EA ACC AUTO ONLY: A EACH OCCURRENCE AGGREGATE OTHER DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS LIMITS �(] WQS ❑ ER E.L. EACH ACCIDENT EL DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT 1,000,000 100.000 5,000 1,000.000 2,000,000 1,000,000 100,000 100,000 500,000 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED 10 THE LEFT. BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. ® ACORD CORPORATION 1988 Miami Shores silage 10050 Northeast 2nd Avenue Miami Shores, Florida 33138 November 24 2010 Re: Authorization I, Ulises Peinado, D.L. P530- 854 -68- 204 -0, owner of the property located at 391 NE 103rd St, Miami Shores, FL 33138 -2432, authorize my sister Alejandra Libonatti to sign and/or or request any document related to the change /permit of the NC and induced operations for such property. Mrs. Libonatti is also authorized to appear on my behalf as necessary to represent me. Sincerely, Ulises N. Peinado Sia le 01 ALI York Cauk,j131 J/ei *or k U I I S E S N. P E I N A D O Notary a r ec�ea hi Queens 'County Filed in New York Commission Expires March 21, 391 NE 103RD Street, Miami Shores FL 33138 T: 305.498.0577 eMail: ulises391@yahoo.com ssign orp AIR CONDITIONING Miami, November 22nd, 2010 To: Mrs. Alejandro. Libonatti 391 NE 103rd St, Miami Shores, FL 33138 -2432 305 -467 -9457 alelibo @yahoo.com Estimate Alejandra -3 Subject: Air Conditioning System Sales and Installation Estimada Sra. Alejandra Nuestro estimado para Ia instalaci6n de su Sistema de Aire Acondicionado, segun solicitado, es el siguiente: Salidas (12 x $200.00) Tuberias de refrigeraci6n Demolici6n de conductos Bath Exhausts (3 x 150) Nuevos conductos Permiso de Ia Ciudad (max.) Remoci6n del aislante (min. $490.00) 4 ton 16 SEER TRANE XR15 Air Conditioner C/U 4TTR5049E1000A A/H 4TEH3F48B1000A Termostato programable Mod. TCONT600AF11 MA Total $8,970.00 Precio ajustado $8,740.00 Menos descuento de la FPL $780.00 - $780.00 $7,960.00 Gran total Este estimado cubre el permiso de Ia Ciudad. Saludos cordiales Neil Picon Presidente Picon Design Corporation 9468 NW 13 St - Doral, FL 33172 Ph: (305) 599 -8282 F: (305) 599 -8284 picondesigncorp @yahoo.com $2,400.00 $380.00 $360.00 $300.00 $360.00 $250.00 $600.00 $2,400.00 $380.00 $360.00 $450.00 $360.00 $250.00 (a confirmaci6n) $600.00 (a confirmacibn) $4,170.00 (AHRI 3937488) El conjunto de estas combinaciones califica para el tax credit asignado a Ia compra de equipos de alta eficiencia del 30% hasta $1,500.00.