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MC-10-1658Inspection Number: INSP - 157657 Scheduled Inspection Date: March 30, 2011 Permit Type: Mechanical - Residential Inspection Type: Final Owner: HERNIQUEZ, ZAIDA & WILLIAM Work Classification: A/C Replacement Job Address: 9906 N MIAMI Avenue Miami Shores, FL 33138- Inspector: Perez, JanPierre Project: <NONE> Contractor: AG MECHANICAL INC Building Department Comments CHANGE OUT A/C UNIT 4 TON 15 SEER CONDENSED AIR HANDLER 10 KW HEATER Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments March 29, 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 -9 -10 -1658 Phone Number Parcel Number 1131010180540 Phone: (305)446 -1931 Page 16 of 24 ci I Miami Shores Village g BUILDING PERMIT APPLICATION FBC 20 Permit Type: MECHANICAL Owner's Name (Fee Simple Titleholder) Owner's Address City Al j/ 1v11 5A o 1 E State 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 Tenant/Lessee Name Phone # Email Job Address (where the work is being done) '426 1,/ • M , m/ / 9 if L City Miami Shores Village County Miami -Dade FOLIO / PARCEL # Is Building Historically Designated YES NO Contractor's Company Name A E 1 J)1 C' i Contractor's Address M31______61"1„, c 7 �� Architect/Engineer's Name (if applicable) Value of Work For this Permit $ Type of Work: ❑Addition Describe Work: Submittal Fee $SO Cl ' Notary $ Scanning $ Double Fee $ Structural Review. $ Radon $ 3 X5,5 400 Permit Fee $ Training /Education Fee $ Violation date: DPBR $ Master Permit No. Zip 33/.5d Flood Zone Permit Noll 10 '165B fl CAl one# ''": ( 1,Q > ''°` � f Zip ( Phone #3P5 # %( /93/ City )14 C. ,/L State F� Zip /3 2 Qualifier Name o t t 1 j o � w f} R C ;/ Phone # (.5 79 V- 6 34 State Certificate or Registration No./A. A O 57 4 1'76 Contact Phone 3 b 7fi 3 Certificate of Competency No. /_ n E -mail -C.{ ti APC t /9 $ m k 5eAD,< ts 0 e Phone # Square / Linear Footage Of Work: ❑Alteration - ❑New ❑ Repair/Replace ❑ Demolition * ** * *: * ** * ** * * * * * * * * * * * * * * * * * ** * * ** * ees *:� ***** * * * * * * * * * * * * * * * * * * * ** * * * * * * * * ** 'f� t CCF $ CO /CC $ Total Fee Now Due $ Technology Fee $ Bond $ 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. the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Owner or Agent / Contra, ilo t The foregoing instrument was acknowledged before me this / The foregoin_ instrument wars ackn w i acknowledged before me this 1� day of , 20 /0, by Ali �•lMt+y2] 6 1J(2., day of , , 20 ! 6 ) by AoikIAo (" 4l d-P who is personally known to me or who has produced / p who is personally known to me or who has produced ID As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: = 9%, � t; . �. o ° 0 tO Sign: Print: My Commission Expires: APPROVED BY \\\\ ,\,,,,,111000,, u i A F cA _ o o.N CD R IDA f, /y'� /!l Iflllll11�1` 1,. (Revised 07 /10 /07)(Revised 06 /10/2009) Plans Examiner Engineer Signature Sign: Print: My Commission Expires: 111 I 111 11,11, / , / Zoning Clerk checked UNIT BEING REPLACED DATA NEW UNIT MANUFACTURER , ' i ti 7 /3 /A N 7 AHU or PKG. UNIT MODEL # COND. UNIT MODEL # KW HEAT NOM TONS 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 PERMIT NUMBER: MC Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Signature AIR CONDITIONING REPLACEMENT DATA 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): 99e 6 iv / . (1 City:. Miami Shores Village County: Miami Dade Zip Code: . 3 3 /5' 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 NO ❑ ARHI Sheet Attached: YES NO ❑ Contract Attached: YES Change Disconnecting means: YES 1. Minimum Circuit Ampacity (Wire Size): �r i Jt2Z ' t'd2J4Lt Lunid . ,PIPA Ce- 2. Maximum Overcurrent Protection (Fuse /Breaker Size): G CJ i 3. Voltage of Circuit (208/240/480): 4 p‘g .V 4. Size Disconnecting Means: Contractor's Company Name: State Certificate or R- !stration N. 1 �L t , ryi.ukct,yu 4 ,, Certificate of Competency N. (Quaff u Phone: Date: V I //rt AI9R CERTIFIED www.ahridireclory.org Certificate of Product Ratings AHRI Certified Reference Number: 3404771 Date: 9/15/2010 Product: RCU -A-CB Outdoor Unit Model Number: 165ANA048 -B Indoor Unit Model Number: FV4CN(B,F)005 Manufacturer: BRYANT HEATING AND COOLING SYSTEMS Trade/Brand name: PREFERRED 15 PURON AC Manufacturer responsible for the rating of this system combination is BRYANT HEATING AND COOLING SYSTEMS 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): 47500 EER Rating (Cool ng): 12.90 SEER Rating (Cooling): 15.00 • 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 on this Certificate and makes no representations, warranties or guarantees as to, and assumes no responsibility for, the product(s) listed on this Certificate. I 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 + is 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 prop ry products of AHRL This Certificate shall only be used for individual, personal and confidential reference purposes. The contents of title Certificate may not, whole or in part, be reproduced; copied; disseminated; entered Into a computer database; or otherwise utilized, in any tam or manner or by any means, except • r the user's individual, personal and confidential reference. CERTIFICATE VERIFICATION The information for the model cited on th s certificate can be verified at www.ahrldirectory.org, click on "Verify Certificate" link and eat:. the AHRI Certified Reference Number and the date on which the certificate was Issued, which listed above, and the Certificate No., which is listed below. ©2010 Air - Conditioning, He ing, and Refrigeration Institute LIICIIP Air - Conditioning, Heating, U and Refrigeration Institute CERTIFICATE NO.: 129290477791128356 / flGm inc. 2; s RRtOIDRIOI96$ REIf116ERRTIOII MIAMI, (305) 446 -1931 Fax 016 BILL TO i 11 ; • HVAC SERVICE ORDER FLORIDA 33134 INVOICE �48�4181 N p 0 858 if 1 A , - 90 b j / W /�JA, y ,� ii- a/ / THIS WORK IS TO BE 1 ❑ C.O.D. ❑ CHARGE CHARGE • �' �' M ,// f J 4 /�� ❑ f NO ESE /���!�� �� f ✓(� MODEL MO j Ail* Mar 1 MOD V / 10405r @g RIAL N BER SERIAL NUMBER NAME J STREET fie. /g ENVIRONMENTAL CHECK UST WORK PERFORMED CITY > IS WORK PERFORMED QTY. TYPEJDISPOSmON CONDENSING UNIT COND'SATE DRAINS i RECOVERED LEVELED MAIN GRAIN PHONE CALL BEF RE ❑ A.M. AM I I P.M. I1 RECYCLED CLEANED COIL REPAIRED MAIN DRAIN TECHNICIAN // / AUTNOR12 D BY r -] RECLAIMED CHARGE DR PAN AI N Li RETURNED LEAK IN COIL P WORK TO BE RFORMED ❑ DISPOSAL REPAIRED LEAK IN COPPER FURN. OR FAN COIL ❑ DISMANTLED L] CHANGED OUTMEP1 ACED TOTAL $ • REF REPLACED BELT CHECKED MOTOR ADJUSTED BELT ON.. MATERIALS & SERVICES NIT PRICE AMOUNT G REPLACED N. n REFRIGERANT R LBS. 1 4 # ' / • - / . I / / `` / /�ur F/ A 0 !6 5- 1!A� %P' ��" ' �/�j/� /_J(// i eE� _ --I I ' r i1C x ^CC FILTE x x BELTS 1 1 1 1 REP LISTED / �`y�`! I y� '• v LISTED B ED ER .. ... ,_.., P ACTOR FtEPLACED BEARINGS PL. START OILED MOTOR k . ,. ! . . \. 1 .,,.. !,,, i \N; . , . START DA OILED BEARINGS REPLACED RUN TOR CAPACITOR CLEANED HEAT E%CH ADJ CONTACTOR HEAT E %CH REPAIRED ER G RE REPLACED FUSE A CED OR REPLACED THERMOCOUPLE PR COMPRESSOR VALVE EVAPORATOR COIL REPLACED A %J C BI L L R S T ALVE E VA VALVE DUCT REPLACED CAP TUBE REPAIRED CLEARED CAP TUBE ADJUSTED REPAIRED COIL LEAK THERMOSTAT REPAIRED COPPER CONN REPLACED RECOMMENDATIONS CLEANED COIL ADJUSTED TOTAL TERIALS i /2/7/ ..... . ........ � . t .. LEVELED COIL ELECT. HTR. CIO TOWER HRS. LABOR LABOR RATE A MOUNT REPLACED LINK CLEANED Azd der)<I• I ... REPLACED Kux REPAIRED WIRE PUMP(S) REPLACED CONT GREASED REPAIRED FILTERS I 0 CLEANED ❑ REPLACED TOTAL SUMMARY MATER AL56 LAMP NAY BE TO CONbNUEDONOTMERSCE AL LABOR LIMITED WARRANTY: All materials, parts and equipment are warranted by the manufacturers' or suppliers' written warranty only. All labor performed by the above named company is warranted for 30 days or as otherwise indicated in writing. The above named company makes no other warranties, express or implied, and its agents or technicians are e an y n ot authorized to make such warranties on behalf of above named company. ` TERMS O `� TOTAL/1 MATERIALS Q ��( U TOTAL LABOR 1 I I have to order the "roan outlined above which has � e satisfactorily completed. I agree that t made Seller retains title to egurpmenVmaterials furnished unfit final ts made. It t w not as agreed. seller can remove saw equipment/materials at Sees expense. Any damage resulting from said removal shall not be the respOnsibrlity of Seller. , �...� 5— TRAVEL CHARGE I 1 LI REGULAR ❑ WARRANTY TAX 1 ❑ SERVICE CONTRACT M TOW _. �"u' TOTAL-312 Q V , ' I f ©n TOMER 0 . A UPE DATE :curDate > <curTime >Work Comp Associates Inc.Elissa A Lucchese Work Comp Associates, Inc. Florida's Premier Source for Workers' Compensation Coverage & Information September 15, 2010 Miami Shores Village Building Dept. sent via: Fax 10050 N.E. 2nd Avenue Miami Shores Village, FL 33138 -2382 RE: A.G. Mechanical, Inc. Certificate of Insurance Dear Miami Shores Village Building Dept.: As you requested, we have issued a certificate of insurance for the above insured with your company listed as the certificate holder. If you have any questions or if you wish for the certificate of insurance to be modified in any way, please call us at 1 -800- 258 -9581. Thank you for your attention to this matter. Respectfully, Elissa A. Lucchese Customer Service Manager EAL:cg Attachment: Certificate of Insurance (See attached file: COl.pdf) Mailing Address: P.O. Box 33297, Palm Beach Gardens, FL 33420 -3297 Tel. #561- 863 -9581 Physical Address: 9250 Alternate A1A, Suite A, Lake Park, FL 33403 Fax. #561 -881 -9745 :curDate > <ourTime >Work Comp Associates Iac.Elissa A Lucohese PRODUCER Work Comp Associates, Inc. P.O. Box 33297 Palm Beach Gardens, FL 33420 -3297 USA INSURED A.G. Mechanical, Inc. 1132 N.W. 16 Terrace Cape Coral, FL 33993 -6613 CO LTR 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 POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. GENERAL UABILITY COMMERCIAL GENERAL LIABILTY CLAIMS MADE El OCCUR OWNERS & CONTRACTOR'S PROT AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS TYPE OF INSURANCE GARAGE LIABILITY ANY AUTO EXCESS LIABILITY R UMBRELLA FORM OTHER THAN UMBRELLA FORM WORKERS COMPENSATION AND EMPLOYERS' LIABILITY THE PROPRIETOR/ PARTNERS/ EXECUTIVE OFFICERS ARE: OTHER INCL EXCL DESCRIPTION OF OPERATIONS /LOCATIONSNEHICLES/SPECIAL ITEMS A 30 -day notice of cancellation applies for all reasons other than non - payment of premium. Miami Shores Village Building Dept. 10050 N.E. 2nd Avenue Miami Shores Village, FL 33138 -2382 106334.44 POLICY NUMBER 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. COMPANY A Florida Citrus, Business & Ind. COMPANY B COMPANY C COMPANY D POLICY EFFECTIVE POLICY EXPIRATION DATE (MM/DD/YY) DATE (MM/DD/YY) 4/1/2010 4/1/2011 COMPANIES AFFORDING COVERAGE GENERAL AGGREGATE PRODUCTS - COMP /OP AGC PERSONAL & ADV INJURY EACH OCCURRENCE MED EXP (Any are person) COMBINED SINGLE OMIT BODILY INJURY (Per Person) BODILY INJURY (Per Accident) PROPERTY DAMAGE OTHER THAN AUTO ONLY: EACH ACCIDENT AGGREGATE EACH OCCURRENCE AGGREGATE WC STATU- I 107H- TORY I Mali FR EL EACH ACCIDENT EL DISEASE - POUCY UMIT AUTHORIZED REPRESENTATIVE l �/f i4 UNITS FIRE DAMAGE (Any are firs) AUTO ONLY - EA ACCIDENT EL DISEASE -EA EMPLOYEE $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ 100,000 500.000 100,000 • SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. (DAL)