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MC-09-1051-- . Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 117554 Permit Number: MC -6 -09 -1051 Scheduled Inspection Date: July 07, 2009 Inspector: Perez, JanPierre Owner: KLEIN, LESLIE Job Address: 534 NE 94 Street Miami Shores, FL Project: <NONE> Contractor: PALM AIR INC Permit Type: Mechanical - Residential Inspection Type: Final Work Classification: A/C Replacement Phone Number (305)876 -7514 Parcel Number 1132060140950 Phone: 305 - 758 -7545 Building Department Comments REPLACE ( CHANGE OUT) OF NC CONDENSER AND AIR HANDLER WITH HEAT 8KW. 3 1/2 TON Inspector Comments Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. For Inspections please call: (305)762 -4949 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 BUILDING PERMIT APPLICATION FBC 2004 Nmpip..7w7T1 JUN �� zoos J BY:_e!�J Permit No. VI& c ) Q I Master Permit No. Permit Type: Mechanical Owner's Name (Fee Simple Titleholder) LESL it �,�,� �A/ Phone # 3 43---`25 /' 99644 Owner's Address '53 ¥ ?1 L ci 41714 ST/C-,c�� -- City mmivit J State Zip 33 /3r Tenant/Lessee Name E -MAIL: Job Address (where the work is being done) o fThf A5 4 no [/46 Phone # City Miami Shores Village County Miami -Dade FOLIO I PARCEL # /1` 3,91-06 -0FT -ORSO Is Building Historically Designated YES NO V Contractor's Company Name ?#Ln /Al C., Phone # 3 a. - ° '7s-'8"- eig. s" Zip 33 /3g Contractor's Address 02s-7 /4' t ' /0.3 31 City (A'' `( R State Zip 33 /3 Qualifier Name / O l .0 0 77,4 Phone # 30-r°75?- i 33S State Certificate or Registration No. C 36 '783 Certificate of Competency No. E -MAIL: Architect/Engineer's Name (if applicable) Value of Work For this Permit $ Type of Work: ❑Addition ❑Alteration Describe Work: Phone # 4 _UN 2 2 N7 1) ................................Fe Square / Linear Footage Of Work: ['New VRep rt dcJ wxZto Submittal Fee $'".'O.OD Permit Fee $ (q`, 1,90 Notary $ 5.00 Training /Education Fee $ ' •-l./ Scanning $ 5-00 Radon $ DPBR $ CCF $ "5474° COO /CC Technology Fee$ Zoning $ Bond $ Code Enforcement $ Double Fee $ Structural Review. $ Total Fee Now Due $ na.m See Reverse side -4 Bonding Company's Name (if applicable) /0/ Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) �V 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. l 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged Signature Signature Owner or Agent The for oiinngeinstrument was know(eddged�befor�e ee this _ The for Ding instrument was acknowle..ed efore me is day of U, /I L , 2 bVTQ$ J+w A. o"�t!!/�� day o , 2 who is personally known to me or who has produced Contractor ersonall kn wn to me or who has produced • NOTARY4;UBLIC: Sign: Print: My Commission Expires: ntification and who did take an oath. *** * *+Fxxxxx *k*ak*#'k********* *** *417 APPLICATION APPROVED BY (Revised•02 /08/06) 91" �� G. ',1' „d1 Nry 6c0 � . oPao nlification and who did take a NOTARY PUBLIC: Sign: Print: My Commission Expires: * * * * * * * * ** i' c************ xxxxxx***** **** *******xxtetiw****x****** ** 2-3 /1 Plans Examiner Engineer Zoning t17',t;? 40% Pre.Conaumor Content • 10% Post - Consumer Content Propagai PALM AIR, INC. Air Conditioning Sales 81 Service • 257 NE 103rd Street MIAMI SHORES, FLORIDA 33138 (305) 758 -7545 State License #CA- C036783 PROPOSAL SUBMITTED TO Les Klein PHONE 0- 1 -• 66 DATE 6 22 0' STREET 534 N. E. 94th Street JOB NAME CITY, STATE AND ZIP CODE Miami Shores, Fl. 33138 JOB LOCATION ARCHITECT DATE OF PLANS JOB PHONE We hereby submit specifications and estimates for: Changeout existing A/C equipment: _.__._._... -Amer. Std. condenser Mod# 4A7A5042E1000A SEER 16.0 -Amer. Std. air handler Mod# 4TEE3F40B1000A -Amer. Std. heater Mods` BAYHTR1408PDCA - condensate safety switch 3'x4' slab - auxilliry A/H pan *permit extra**** Total Cost E ui __..�.._....._.. «.«__««««___..._«...«...._..._...» w«__. .____ «_._.......__. «..,...__... _._»« ......___....__._...__.._.. «. Less FPL Incentive_ M .,___..- Customer Net Cost 8 685 OO.,w___ $5148.00 proving. hereby to furnish material and labor -- complete in accordance with above specifications, for the sum of: Thousand Eight Hundred Thirty Three & no /100 - - -- 5833.00 dollars ($ ) • log Five Payment to ' be made as follows: 52917.00 De osit U on Acce stance 2._ ^' do . (... 916 00 5 .e0 Balance Upon Completion 685.00 FPL Incentive Ri gned upon nnmpl rchi nn • { All material manner according tons Involving extra charge or delays beyond Our workers is guaranteed to be as specified. Ail work to be completed In a workmanlike to standard practices. Any °iteration or deviation from above spacifica• extra costs will be executed only upon written orders. and will become en over and above the estimate. Ali agreements contingent upon strikes, accidents ow control. owner to carry tire, tornado and other necessary insurance. are fully covered by Workmen's Compensation Insurance. '1 (/( Authorized A Signature ,011611 a Note: sal This proposal my withdrawn by us it not accepted within be N/A days Arrtptattrr *d. proposal-rho above prices, specifications and conditions are satisfactory ai are hereby accepted. You are authorized to do the work as specifies?{ Paym nt will be made as outlined above. Co 1- Date of Acceptance' Signature a From: Gabriela Saavedra At Insurance Marketers, Inc. FaxID: To: Palm Air Date: 5/15/2009 03 :31 AM Page: 5 of 5 ACORD CERTIFICATE OF LIABILITY INSURANCE GPM GS PALMA -2 DATE (MM,DDIYrrY) 05/14/09 PRODUCER insurance Marketers, Inc. 2600 Douglas Road Suite 712 Coral Gables FL 33134 Phone:305- 442 -9507 Tax:305- 447 -8527 THIS CERTIFICATE I5 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 Palm Airi Inc. 257 NE 103th Street Miami Shores FL 33138 INSURER A. Nova Casualty Company INSURER 3 INSURER 0: INSURER Dr INSURER E_ • COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSUREC NAMED ABOVE =OR THE POLICY PERIOD INDICATED. NCTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TC WHICH --1-IIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. TF£ INSURANCE AFFORCED BY THE POLb_ ES DESCRIBED 1EREIN IS SUBJECT TO ALL -HE TERMS, EE,C_USIONS AND CONDITIONS CF SUCI- POLICIES AGGREGATE LIMITS SHOWN MAY I-AVE BEEN REDUCED BY PAID CL=JMS. lraeR LTR ADD t NSRD TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (TAMMY) POLICY EXPIRATION DATE IMhODD11'YI LIMITS GENERAL. $ LIABILITY COMMERCIAL GENERAL _ABILITY 09AL064571 03/06/09 03/06/10 EACH OCCURRENCE 61000000 PREMISESEeeocurence) 6100000 CLAIMS MADE X OCCUR MED EXP (Any cna person) :35000 PERSONAL & ADV INJURY S1000000 GENERAL AGGREGATE s2000000 GENII. AGGREGATE LIMIT APP_IESPER: X POLICY 7 ,;E° LOC PRODUCTS - COMP /OP ASS 52000000 AUTOMOBILE — — LWBILIIY AM qj-0 ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Esecoiden:) S BODILY INJURY (Far person S BODILY INJURY Per accidantl PROPERT'CAMAGE Par accidantl S GARAGE LIABdrrY ANY AUTO AUTO ONLY - EA ACCIDENT S OTHER EA ACC $ AUTO ONLY. AGG S EXCESS/UMBRELLA LI■BILRY OCCUR CLANS MADE DEDUCTIBLE RETENTION $ EACH OCCURRENCE S AGGREGATE S S 6 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY FROPRIE OR'PATTIER/EKECU -I'JE OF= ICER'MEMBER EXCLLCED? If yes, describe under SPEC AL PRCVISIONS DB!Ow OA, cL LIMITS U- V I H- TORY LIMITS I ER E.L. EACH ACCIDENT S E.L. DISEASE - EA Eb1F_OYEE S E.L. DISEASE - POLICY LIMIT S OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS Heating /Combined Heating & AirConditioning - Coverage are subject to the terms,conditions, deductibles and exclusions shown in the policy. CERTIFICATE HOLDER CANCELLATION vxi.i z.ui `Tillage of Miami Shores Building &Zoning Department 10050 NE 2nd Avenue Miami Shores FL 33138 -2382 SHOULD ANY OF DATE THEREOF, NOTICE TO THE IMPOSE NO OBLIGATION REPRESENTATIVES. THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN CERTIFICATE HOLDER NAMED TO THE LEFT, ELT FAILURE TO DO SO SHALL OR LIABILITY OF ANY HIND UPON THE INSURER. ITS AGENTS OR 1(L(li31i ' d D.-E'RESENTATIVE ACORD 25 (2001/08) © ACORD CORPORATION 1988