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MC-11-1048Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 160773 Permit Number: MC -6 -11 -1048 Scheduled Inspection Date: June 29, 2011 Inspector: Perez, JanPierre Owner: DAILEY, RICHARD Job Address: 10402 NE 2 Avenue Miami Shores, FL 33138- Project: <NONE> Contractor: RAINBOW AIR CONDITIONING INC Permit Type: Mechanical - Residential Inspection Type: Final Work Classification: A/C Replacement Phone Number (786)395 -3369 Parcel Number 1121360130650 Phone: 305 - 216 -4594 Building Department Comments REPLACEMENT OF EXISTING 4 TON CENTRAL A/C SPLIT SYSTEM Inspector Comments Passed Bo Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. June 28, 2011 For Inspections please call: (305)762 -4949 Page 19 of 38 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 BUILDING PERMIT APPLICATION FBC 20 Permit NoM0 f I' I 04 Master Permit No. Permit Type: MECHANICAL OWNER: Name (Fee Sim p le Titleholder): �h &/ d G�tl Phone# 0 3 3369 Address: /0 City: /' (/) State: I Zip: Tenant/Lessee Name: Phone #: Email: JOB ADDRESS: i o +LocA, WE. 03 Ct Zip: 3 3 /3 6 City: Miami Shores County: Miami Dade Folio/Parcel #: / I — a=9-/-3 — O / i3 — 0 (x3 Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: tV Ai/la Phone#: Address: / 5 7 6 A f) 17 City: )1 a,'z , t C) state: Qualifier Name: , Jt ' s - !�%GCG''e2e Zip: 00/‹.cz,. Phone#: 74() 246— 6114() State Certification or Registration #: Mao 0 -ea Certificate of Competency #: Contact Phone#: Email Address: DESIGNER: Architect/Engineer: Phone #: C-� Value of Work for this Permit: $ 'CO ° Square/Linear Footage of Work: Type of Work: ❑Address ❑Altefation ❑New )4Repair/Replace ❑Demolition Description of Work: /CL� -L% .9 777 01 I *** ***+x************** ** ***** ****+x **** *Fees** *7*+a **** , **+ x* ********** **** * **+x+x+x+xx *** Submittal Fee $ Permit Fee $ r Al b CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ B CD\ • 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 FT.FCTRICAL 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 foregoing instrument was ac wledged befor me s day ofs, , 20 LL, by � Char i)aU , wh personally known °� me or who has produced Y P As identification and who did take an oath. NOTARY, Sign: Contracts r The foregoing instrument was acknowledged be ore me this a' day of `\JGtoe • , 20 1 , by (JO. (,2 , who is ersorpo me or who has produced as identification and who did take an oath. Print: `1/�or? ja My Commission Expires: �d VIVIAN M. FAIARDO 4 ; MY COMMISSION N EE 006856 EXPIRES: July 8, 2014 Bonded Thru Notify Public Undemiters ** ** * * * * * * * * * * * * * * * ** **** * ** APPROVED BY Mans Examiner MMISSION M EE 006858 EXPIRES: July 0, 2014 Bonded Thru Notary Public Undenurfere *+ x*****n=**** * *** * * * * * * * * * * ** *gyp * * * * * ****** *** * * ** Structural Review (Revised 07 /10 /07)(Revised 06/10/2009)(Revised 3/15/09) Zoning Clerk 08/01/2011 15:41 CERTIFICATE OF LIABILITY INSURANCE PRODUCER Litwin Insurance Agency, Inc 1216 E. Atlantic Boulevard, Suite#2 #8723 P.001/002 DATE (1 IIDD/YYYr) 06/01/2011 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. Pompano Beach, FL 33060 TQI: (954) 630- 9844/Fax: (954) 630-0376 INSURERS AFFORDING COVERAGE INSURED RAINBOW NC INC. INSURER A: CACACITY INSURANCE COMPANY 15476 NW 77TH CT BAY 434 INSURER B: CASTLEPOINT INS MIAMI LAKES, FL 33016 INSURER C: INSURER D. INSURER E: NAIC # THEPOLICIESOF INSURANCEUSTEDBELOW HAVEBEENISSUEDTOTHEINSUREDNAMEDABOVEFORTHEPOLICYPERIODINDICATED , 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 BYTHE POLICIES DESCRIBED HEREIN ISSUBJECTTOALLTHE TERMS, EXCLUSIONSANDCONDITIONS OF SUCH POuCIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD' LTR INSR. TyDE h POLICY NUMBER I POLICY EFFECTIVE DATE INIMl CI "'=”' POLICY EXPI7jON -TE M�,RII'XY'V) LENTS A GENERAL „IN'3IJRANCE LIABILITY COMMERCIAL GENERAL LIASnUTY 2020149 04/14/2011 04/14/2012 EACH OCCURRENCE $1,000,000 X =Tar maw) MED EXP (Any one Deleon) $ 100,000 I CLAIMS MADE X OCCUR S 5,000 PERSONAL & ADV INJURY $ 1,000,000 ■ GENE _.._... GENERAL AGGREGATE S 2,000 000 . .-- AGGREGATE LIMIT APPLIES PER: POLICY I I Pi9 1 S J I LOC PRODUCTS - COMPIOP ACG S 2.00000 X AUTOMOBILE U ABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT ■ BODILY INJURY (Per Per") S ■ Y INJ BOeDILY U ■ ■ ■ (PROPERTY DAMAGE GAGE LIABILITY ANY AUTO AUTO ONLY • EA ACCIDENT $ LA ACC S ■ OTHER THAN AUTO ONLY: AGO $ EXCESS! UMBRELLA LUOILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE S DEDUCTIBLE RETENTION $ S a B WORKERS AND EMPLOYERS' ANY PROPRIETORIPARTNER/SXECUT (Mend tall If yr, deeOtibe SPEC COMPENSATION LIABILITY WC07077978 07/06/2010 07/06/2011 I TWI1 C STAU rq ) , I0TFR H. EL. EACH ACCIDENT 1 OOO,OQO $ , EXCLUDED? E.L. DISEASE - EA EMPLOYEE. $ 1,000,000 n NH under 1 I • beloly P VI I. E.L. DISEASE - POLICY LIMIT S 1,000,000 ;.., OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENIT! SPECIAL PROVISIONS GERTl II.A I c nul.ur.R MIAMI SHORES VILLAGE FAX: 305 - 7568972 10050 NE 2ND AVENUE MIAMI SHORES, FL 33138 Phone: Fax: ..........__ ..._._ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES Be CANCELLED BEFORETHEEXPIRATION THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3O DAYS WRITEN DATE THEREOF, NCf)CR TO THE CERTIFICATE HOLDER NAMED TO THE 68PT, FAILURE TO 120 ISO SHALL IMPOSE N0 OBLIGATION OR LIABILITY OF ANY KIND U • INSURER. ITS AGENTS OR REPRESENTA a -Alk ,. AUTHORIZED R.37�', �/ of. !....0 , _ ..., �d. _ •��� ���� i. i.�■ ∎TIA•1 ,11 ..3_L4.... ___ ■.■.., ACORD 25 (2009/01) The ACORD name and !ago are registered marks of ACORD • t.,, •,Y + +VV +cv`r+,..v. 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): ®0 .0 A A16 ° City: Miami Shores Village County: Miami Dade Zip Code: J? ��� ° 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 AR! (AHRI) DATA SHEET REQUIRED Change Disconnecting means: YES ❑ NO ARHI Sheet Attached: YES NO ❑ Contract Attached: YES UNIT BEING REPLACED DATA NEW UNIT L 0 1 M ,. MANUFACTURER R�°�fr �� ;j m 44 AHU or PKG. UNIT MODEL # Rt°fL — /► 7 / 2' ®1(� 1= - L U(!, 2.p COND. UNIT MODEL # - _ I 'IA TMrrq 0 f KW HEAT 10 1 4 TOMS NOM TONS y To .i3 AHU CU PKG 1) M.C.A AHU CU -PKt- AHU CU PKG 2) M.O.P AHU CU -PKG - AHU CU PKG 3) VOLTS AHU CU -P14$ PKG UNIT / / / I LI 'F . P. EER/SEER r (4, YES NO REPLACING DUCTS Vii1' YES NO REPLACING THERMOSTAT YE NO YES NO NEW 4 °CONCRETE SLAB E� 0 YES NO NEW ROOF STAND YES NO YES NO NEW RETURN PLENUM BOX YES ° 1. Minimum Circuit Ampacity (Wire Size): 2. Maximum Overcurrent Protection (Fuse/Breaker Size): �6/�® 3. Voltage of Circuit (208/240/480): 26e .2 V 0 4. Size Disconnecting Means: ( C) Contractor's Company Name: /n r'. /'? o //J ( • Phone: 786) 2ciO ° 644 State Certificate or Re • istration N. Ca C 0 3 Sii- G'(' Certificate of Competency N. r #1 /.. Signature �/� 44/56 (Qualifi gnature Date: 476P This combination qualifies for a Federal Energy Efficiency Tax Credit when placed in service between Feb 17, 2009 and Dec 31, 2011. Certificate of Product Ratings AHRI Certified Reference Number 3799429 Date: 6/6/2011 Product: Split System: Air-Cooled Condensing Unit, Coil with Blower Outdoor Unit Model Number: 14AJM49 Indoor Unit Model Number: RHLL- HM4821 *RCSL -W4821 Manufacturer. RHEEMMANUFACTURING COMPANY TradeBrand name: RHEEM 14AJM SERIES Manufacturer responsible for the rating of this system combination Is RHEEM MANUFACTURING COMPANY 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: Cooling Capacity (Htuh); 46000 EER Rating (Cooling); 13.00 SEER Rating (Cooling): 16.00 ' Rennes raptured by an astcMsk (') Indloatu o tutu/nary wale of pre Needy pueushed data, unlew eoconmdedod with a WAIL which Indicates an Mammary rands. DIBCWMER AHRI does not Indorse the product(a) listed d on this Certificate and makes no tp,teasntetbns, warranties or euersntess as to, and assumes tat rpponslhlllty , the peoduaf(e) listed on this Certificate. AMRI oIrprossty dissldms sll esbillb+ for dsmsges dew/ kind arising out of the use or pufameatas of the produdls), or tits euwufhortssd alteration of data bated on this OPIUM'S,. Certified ratings are valid only far models end cmtfiywttkmaliste d b7 tits directory etwww.ddaldirectory.ory. TERMS AND CONDITIONS This Cattlflade and fig conteib are proprietary products otANRI, This Cordflosts shall only be used far Individual, parsond and confidential niataae. purposes. The (them of edible or by uil mesos, a� for eta ewrIn Iput be reproduced; and copied' disseminated: dated :n Into • computer database) or ethepwlw utilized. In any CERTIFICATE VERIFICATION il Air-Conditioning, Hooting, The Information for the model end on this cettliloats pen be verified of wwmahMdireetary,orn. L `. and Refrigeration d g, Hooting, click on UMly Cu tifkata" fink and enter the AIM Certified Reference Number and the data end which the ouWkstit was hued, which b Ibbd above, and the Certificate No., which Is listed bWO, ©2011 Air- Conditioning, Heating, and Refrigeration Institute CERTIFICATE NO.: 126818568623315180 T /T'd 6£8ti26SS0£ : °1 ;woad 20:£ti titi02- 90 -N(1t 06/09/2011 03:54 .11AiNtiblitt . . • ..16476'NW 7'7 Ot • • MIAMI)::FL .33016 . •,ph--(7802,46.8440 •.05)592,4835 . •••• LieiCAC035406 • . • • . . • .. • . ••••Fekkranitteiley'8&4111 10402 INIE2ncl Ave • .Miami.fl33138 • • • :. 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