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MC-10-1917.r Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: I NSP- 152759 Permit Number: MC -10 -10 -1917 Scheduled Inspection Date: June 01, 2011 Inspector: Perez, JanPierre Owner: GYNELL, JHON Job Address: 560 NE 95 Street Miami Shores, FL 33138- Project <NONE> Contractor: CENTRAL AIR CONTROL Permit Type: Mechanical - Residential Inspection Type: Final Work Classification: A/C Replacement Phone Number (305)775 -0771 Parcel Number 1132060140800 Phone: (305)822 -1551 Building Department Comments AC CHANGE OUT 4 TON Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments C�- May 31, 2011 For Inspections please call: (305)762 -4949 Page 1 of 25 ■),(3\ko-v\-\° 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 Permit No. Master Permit No. BUILDING PERMIT APPLICATION FBC 20 Permit Type: MECHANICAL OWNER: Name (Fee Simple Titleholder): Address: SO C fr City: 1Kr1 e6i-h)01--__S OT7 oc-r 2 9 2010 BY: .141119:5(3 Phone#: State: Zip: 3-4 g Tenant/Lessee Name: Phone#: Email: JOB ADDRESS: b ) City: Miami Shores County: Miami Dade Folio/Parcel#: U ?...n s-3 Is the Building Historically Designated: Yes NO V Flood Zone: zip: 133 CONTRACTOR: Company Name: Address: J•ti City: iuilifieI4ame: .4,V1 iVg17,re kr:6 Statp Cprdfication or Registration #: (0241,-Hr#, h r Phone#: State: Zip: 3301k) Phone#: Certificate of Competency #: Contact Phone#: ?:04 Email Address: DESIGNER: Architect/Engineer: 4 Phone#: Value of Work for this Permit: $ 6(7,1—e77-6-al Square/Linear Footage of Work: Type of Work: ClAddress CIAlteration Description of Work: UNew DRepair/Replace CIDemolition ************************** **** **i****Fee Submittal Fee $ 0 ...00 Permit Fee $ 10 3 V. DCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ \\.\\1 ******************************************** ' V . 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 commenc whose prope is subjec s attachment. Also, a certi for rst inspectio c occ , seven g, days nt and construction lien law brochure will be delivered to the person of the recorded notice of commencement must be posted at the job site uilding permit is issued. In the absence of such posted notice, the Owner or Agen The foregoing instrument was acknowledged before me this 2 S day of 0¢ t ,20 %O ,by Pfd_. , who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: • I�ii�lir, /�� i 1 'ss on Expires: oVLik .i 12012 f Y ti .N.y.*B�HS&>k.3>H>k>k�k*** Cow ' -r i.;' DO %.qTE� ..... ` � \‘``. Signature Contractor The foregoing instrument was acknowledged before me this day of �� C+ , 20 V), by Y �` ec,_ who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: ANN FESSER , My Commission Expir :°_ MY COMMISSION # DD999642 • x,i „.• EXPIRES June 23, 2014 (407) 398 -0153 F +ridallotaryService.com * *Mm+P'25****...* *.,. As. ksBNa******+ ksis* Hssk+ hN+ *S:**** *= k**Hk***sk**** ***+k***ik+ *** * * * * * ** ** MY C C;h IISSION # DD999642 ~� EXPIRES June 23, 2014 (407) 3980163 Fl oridallotaryServlce.c om i‘ Plans Examiner Structural Review (Revised 07 /10 /07)(Revised 06 /l0/2009)(Revised 3/15/09) Zoning Clerk Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 AIR CONDITIONING REPLACEMENT DATA 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): So a 3 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 IAHRI) DATA SHEET REQUIRED Change Disconnecting means: YES ❑ NO [ ARHI Sheet Attached: YES n NO ❑ Contract Attached: YES ❑ UNIT BEING REPLACED DATA NEW UNIT MANUFACTURER F- ai �r 0 "ID 0 -1 AHU or PKG. UNIT MODEL # F1/0- t29!; t 07P,cM t COND. UNIT MODEL # A it-1 i 0 KW HEAT 4- NOM TONS °r 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 t 0 YES NO REPLACING DUCTS YES (9 YES NO REPLACING THERMOSTAT eE NO YES NO NEW 4 "CONCRETE SLAB (9'E NO YES NO NEW ROOF STAND YES lqg YES NO NEW RETURN PLENUM BOX YES 1. Minimum Circuit Ampacity (Wire Size): L' 2. Maximum Overcurrent Protection (Fuse/Breaker Size): 6', 3. Voltage of Circuit (208/240/480): 1 4. Size Disconnecting Means: P3(�? Contractor's Company Name: eavl 4 Y; *IC n'tro State Certificate or Registration N. P-A (')) - Certificate of Competency N. Signature (Qualifier's signature Phone: 3° This combination qualifies for a Federal Energy Efficiency Tax Credit when placed in service between Feb 17, 2009 and Dec 31, 2010. Certificate of Product Ratings AHRI Certified Reference Number: 3636982 Date: 10/29/2010 Product: Split System: Air - Cooled Condensing Unit, Coil with Blower Outdoor Unit Model Number: 24ACE748A"30 Indoor Unit Model Number: FV4CN(B,F)005 Manufacturer: CARRIER AIR CONDITIONING Trade/Brand name: COMFORT 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): 48500 EER..Rdting.(OOoling): , 13.10 SEER Ratng (Cooling): 16.50 • • Ratin s folkmard by an aetedak ('ry Indicate a voluntary rerate of previously published data, unless accompanied with a WAS. which indicates on involuntary rerete. DISCLAIMER , . ANRI coos not endorse the ptoduct(s) listed on this Certificate and makes no representations, warranties or guarantees as to, and mums no the product(s) listed on this Certi�e.AHRI expressly discbuns all liabb$y for damages of any kind arising out Offer use or performance of the responsibility unauthorized alteration of &delisted on this Certificate. Certified ratings are valid only for modals and configue:diona fisted In the directory at www.shridireetan erg. TERMS AND CONDITIONS This Certltieam and Its contents are proprietary products of ARM. This Certificate shag only be used for Individual, personal and confidential rsf trance purposes. The contents of lids Certificate may not In whole ft in pert, be reproduced; copied; di weminated; entered Into a computer database; or othenedsc utilized, In any Vann or manner or by any means, except for the user's Indivlduat, person I and confidential reference. CERTIFICATE VERIFICATION The information for the modal cited on this certificate can be verified at ww .aluidlrectory erg, click on MIerIj Certificate" link and enter the AHRI Certified Reference Remitter and the date on Which the certificate Issued, which Is listed above, and the Certificate No, which is listed below. ©2010 Air - Conditioning, Heating, and Refrigeration Institute A Air - Conditioning. Heating, A� ■r �I and Refrigeration Institute CERTIFICATE NO.: 129328549120712380 CAir Conentening a Heating jiit Sewing South Florida for over 30 . ga e° toil free 1-- 888 -648 -0681 www. Centra lAl rCo ntro l -cam central! AIR CONTROL icootA 7E6 / Corsi- • Proposal to: 6 A ,'4OSic "e e . Date:. ft /3 £o/O Job Address: 3'6O AZ- 95- s/ Phone: 33 5- 01-7/ * • Capacity SEER (Efficiency) j /6.vo Brand LCCASMilli .1.0. �v°4 40e. Indoor Model fr V �C ba ' "�• , -(A' `o ` r . .::' *Outdoor Mode) ,r ` ' = .or ,4 Zvi C r Thermostat Model g' a/ Warranty (CompressorPar*) /6 /0 /b / s /p . • • Warranty (ter`) . r' +..., •:TotshCost E worm $. CO FPL Rebate � ' r ..; 4 t'aclr/s /4 U i /.34176 7Px 444. IIMIIMIlliiP Net Cost /A 0,0 ,,� A11 Net Costs • //7 t; ' . j-) 9' 4 ,: • Duct Leak Test (Required for Energy Startei} Residential HVAC Rebate) `' • • 9 ^• • i Balance Due (rex find Penult tee tuelt ed) • t• $1500 Florida Enemy Start ®Residential IiVAC Rebate A/C Units Qualify for Federal Tax Credit (30% of the Purchase Price up to $15001 Scope of WD /ore . •IP•1 • -year limited Parts Warranty when properly registered lomecwner. Iptianal Extended Lobar warranty to 10 years might be Available. •' kesWhitset to change in event of special location for AHU or CU. propOsal enplreS On Deomber 241, 2010. Sales Rep Sign: FPL Potstoatlna temematmA convenor etr es Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION FORM ALL CONTRACTORS MUST PROVIDE COPIES OF LICENCES AND INSURANCES EACH TIME A PERMIT IS SUBMITTED OR THE VILLAGE MAY MAINTAIN A FILE WITH YOUR INFORMATION FOR A $30.00 FEE PER YEAR IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. COPY OF QUALIFIER'S STATE LIC CARD B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF LIABILITY INSURANCE (CERTIFICATE HOLDER TO BE MIAMI SHORES VILLAGE BLDG DEPT) D. COPY OF WORKERS COMPENSATION (EITHER CERTIFICATE OR EXCEMPTION) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. a COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER B. 'COPY OF MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT C. COPY OF LIABILITY INSURACE (CERTIFICATE HOLDER MUST BE MIAMI SHORES VILLAGE BLDG DEPT) D. COPY OF WORKER COMP INSURANCE (EITHER CERTIFICATE OR EXEMPTION) YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE HOLDER AS FOLLOW: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 COMPLETE CONTRACTOR'S INFORMATION BUSINESS NAME: @ n frq L I R2- 4 iv'c L r I Jc BUSINESS ADDRESS: 2i L, 57- CITYI1 STATE -F L ZIP CODE ,3301-& BUSINESS PHONE: (- 5) 22.,24 S51 S FAX NUMBER (_0) S TSB Z 5 CELL PHONE ("M ) 72H 17, Irk QUALIFIER'S NAME: QUALIFIER'S LIC NUMBER: 'A O °� E -MAIL ADDRESS (IF APPLICABLE): Created on 3119109 BY MLDV I RV 3126109 MLDV r 14 R ® CERTIFICATE OF LIABILITY INSURANCE OP ID JV ' DATE (MMIDD/YYYY) 10 10/28/ THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. if SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in Ileu of such endorsement(s). PRODUCER BROWN & BROWN -HBA DIVISION 2500 NW 79TH AVE, SUITE 101 MIAMI FL 33122 WN IA41 NAME: PHONE FAX (EAIC, No, Ex": ADDRESS: CUSTOMER ID #: CENTR16 INSURER(S) AFFORDING COVERAGE NAIC # INSURED Central Air Control Inc. 2651 West 79Th Street Hialeah FL 33016 INSURER A: National Trust Ins. Co. OCCUR INSURERB: National Trust Ins. Co. INSURER C: Fcci Commercial Insurance Comp INSURER D : Foci Insurance Company 05/14/11 INSURER E : $ 1 , 000 , 000 INSURER F : PREMSES(E ociccurrence) ES CERTIFICATE NUMBER: THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MM/DD/YYYY) (MM/DDD�) LIMITS A GENERAL LIABILITY COMMERCIAL GENERALLIABILI1Y OCCUR GL00042174 05/14/10 05/14/11 EACH OCCURRENCE $ 1 , 000 , 000 X PREMSES(E ociccurrence) $ 100,000' CLAIMS -MADE X MED EXP (Any one person) $ 5 , 000 PERSONAL &ADVINJURY $ 1,000,000 GENERAL AGGREGATE $2,000,000 $ 2 , 000 , 000 GENII AGGREGATE LIMIT APPLIES PER: n LOC PRODUCTS - COMP /OP AGG POLICY — ROT- JP $ B AUTOMOBILE LUUiIUTY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS CA00073264 05/14/10 05/14/11 COMBINED SINGLE LIMIT (Ea accident) $ 1 OOO OOO r X BODILYINJURY(Perperson) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ X X $ C X UMBRELLA LIAB EXCESS UAB X OCCUR CLAIMS -MADE UMB00041554 05/14/1005/14/11 EACH OCCURRENCE $2,000,000 $ 2 , 000 000 AGGREGATE $ DEDUCTIBLE RETENTION $ 10,000 $ — X D WORKERS COMPENSATION AND EMPLOYERS' UABIUTY ANY PROPRIETOR /PARTNER/EXECUTNE—� (Mandatory In N ER EXCLUDED? (Mandatory In NH) If yes describe under DESCRIPTION OF OPERATIONS Y / N I ` N / A 62011 07/01/10 07/01/11 X TO PUMA S 0ER E.L. EACH ACCIDENT $ 500 , 000 E.L. DISEASE - EA EMPLOYEE $ 500 , 000 below E.L DISEASE - POLICY LIMIT $ 500 , 000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) CERTIFICATE HOLDER Miami Shores Village 10050 NE 2nd Avenue Miami FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD