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MC-08-537Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP -79019 Scheduled Inspection Date: July 11, 2011 Inspector: Perez, JanPierre Owner: AGOSTA, MARY Permit Number: MC -3 -08 -537 Job Address: 200 GRAND CONCOURSE Miami Shores, FL Project: <NONE> Contractor: PAN AM AIR CONDITIONING INC Permit Type: Mechanical - Residential Inspection Type: Final Work Classification: A/C Replacement Phone Number Parcel Number 1132060133540 Phone: (305)259 -2008 Building Department Comments Replacement of 4 ton a/c air handler and condenser Bounce check since April 1/2008. Talked to Healen on May 12, 2008 and no body have come in to pay the check either the bank fee. CANNOT PLACE ANY INSP UNTIL THIS AMOUNT IS PAID. $ 149.80 (permit) 30 (bank fee) 1 1 L Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments CONTRACTOR CALLED FOR INSPECTIONS ON 7/7/11 July 08, 2011 For Inspections please call: (305)762 -4949 Page 31 of 32 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 ,p°1_ 05a01i Permit No. Al C cr P Cr."3 Master Permit No. Permit Type: MECHANICAL - CHANICAL ,A/ A, --,, OWNER: Name (Fee Simple Titleholder): /114✓�f� / 6S5. Phone #: Address: � C,i/ 0.1 1 City: /171 ;Am; j'L - � State: �� Zip: Tenant/Lessee Name: Phone #: Email: JOB ADDRESS: 1e Clev CoVee -S� City: Miami Shores County: Miami Dade Zip: Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: p,,,,„ £ AA._ Phone #: Address: (? 9 < N- /z_ C 7- / � City: !t / � State: f"' An Qualifier Name: 'r"'— State Certification or Registration #: Co Co (/ /!q aj Contact Phone #: 365'. 2 r "ZGa Y Email Address: Zip: - 31 Phone #: Certificate of Competency #: DESIGNER: Architect/Engineer: /✓6 Phone #: Value of Work for this Permit: $ Square/Linear Footage of Work: Type of Work: ❑Address DAlteration Description of Work: ONew ORepair/Replace ODemolition Submittal Fee $ Permit Fee $ Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ ** *** * * * ******** **** *** ** CCF $ CO /CC $ DBPR $ Bond $ Technology Fee $ TOTAL FEE NOW DUE Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip 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 promise in good faith that a copy of the notice of commencement and construction lien law bro whose property is subject to attachment. Also, a certified copy of the recorded notice of coma for the first inspection which occurs seven (7) days after the building permit is issued. 1 inspection will.not be approved gild a reinspection fee will be charged. Signature wner or Agent The foregoing instrument was acknoowled before me this day of u I.f ,2011_by /-I knU't y :;s U C 4 who is personally known to me or who has produced As identification and who did take an oath. ex„ eding $2500, the applicant must e will be delivered to the person nt must be posted at the job site bsence of such posted notice, the NOTARY PUBLIC: Sign. My ission Expires: * * * * * * * * * * * * * * * * * * * * * ** APPROVED BY T,. NOTARY PUBLIC STATE OF FLORIDA Comm# EE095931 **0014#014044********************************* * The foregoin day of who is personally known p Drl ✓Gr' oC • as identification and who did take an oath. NOTARY PUBLIC: Contractor was acknowledged before me this 5 ,20 ,bY .opret m orIwlo has produced wn to e Si mission Expire Plans Examiner Structural Review (Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09) Nowa NOTARY PUBLIC STATE OF FLORIDA Comm# EE095931 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): -7-4:2° �7��.a [,�ouCr✓� S'� . 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 (AHRI) DATA SHEET REQUIRED Change Disconnecting means: YES ❑ NO ARHI Sheet Attached: YES ❑ NO 4 Contract Attached: YES ❑ UNIT BEING REPLACED DATA NEW UNIT MANUFACTURER 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 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: 0, Phone: *TO s %' ' 20,05r State Certificate or 11,-4 on N. e.4 Co, c/ / (Q 3 Certificate of Competency N. ---c Signature �f i /i ,r (Qualifier's signature only) Date: /r/ 4.48 iTc0- Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 BUILDING- Permit No. h G 08 -531 PERMIT APPLICATIO 2004 'Master Permit No. Permit Type: Mechanical Owner's Name (Fee Simple Titleholder) Mary Ross Ago s to Phone # 30 Tj — 76 2-s /O' Zt1 O 24 . Owner's Address 200 Grand Concourse City Miami State FL Zip 330188 Tenant/Lessee Name Phone # E -MAIL: Job Address (where the work is being done) City Miami Shores Village County Miami -Dade Zip 301-- 710- get / `Ate,, FOLIO / PARCEL # 11 3206 013 3540 Is Building Historically Designated YES NO X Contractor's Company Name Pan Am Air Conditioning Phone # 305-259-2008 Contractor's Address. = 12 916 . SW 132 ct City Miami State FL Zip 33186 Qualifier Name Jorge L Lopez Phone # State Certificate or Registration No. CAC041193 Certificate of Competency No. E -MAIL: PanAmJLL(dbellsouth.net Architect/Engineer's Name (if applicable) N/A Phone # Value of Work For this Permit $ 3100.00 Square / Linear Footage Of Work: Type of Work: ^ ['Addition ❑Alteration ['New ® lace Re air /Re p p ❑Demolition Describe Work: Replace 4 ton A/C units (Air handler and condenser) . Identical equ9pment location. ******* w** xxxxxxwww*'* ww wxxx*xx xxxxxwwFeeSxxxxxwww* xxxx xxxxxxxxxxxxxxxxx *xxxxxxxxxxxxx Submittal Fee $ Permit Fee $ Notary$ s'oo Scanning $3' Bond $ Training /Education Fee $ Radon $ CCF $ i .gyp CO /CC 5 AO Technology Fee $ DPBR $ Zoning $ Code Enforcement $ Double Fee $ Structural Review. $ Total Fee Now Due $ 1 .W See Reverse side -* ‹b-Ps Bonding Company's Name (if applicable) N/A . Bonding Company's Address N7A City State Zip Mortgage Lender's Name (if applicable) N/A Mortgage Lender's Address N/A 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 AN AN PROPERTY. BEFORE URECORDINC BTAIN NOTICE FINANCING, OF CONSULT WITH YOUR LENDER OR 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 a , he job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absen ' of su h p.J� notice, the inspection will not be approved and a reinspection fee will be charged. Signature Signature Owner or Agent Co ctor The foregoing instrument was acknowledged before me this 10 The foregoing instrument was ad nowledged before me thisve75TL day of /(a'd(l ,20Ug,by J14ff 'joss 466374 , day of AV cueL ,200g,by who is personally known to me or who has produced ?? tt. LGwho is personally known to me or w o h produced FL 47 61/3. v As identification and who did take x -114 NOTARY PUBLIC: Sign: Print: My Commission Expires: s, My Commi 1:** tex** xxSew** xxxxx xxx xxxxxxxxxxxxx, Yx acxaex* Iedcdeacdcierxaex xwxxxxxxacxxxwxxxxxxx :3/3W e Ian NOT Si Print: identification and who did take an oath. IC: ' K� • ISSIDN # DD 548423 res: EXPIRES: June 29, 2010 , ;, ; Bonded mrouo�ypublcu,.: APPLICATION APPROVED BY: (Revised 02 /08106) Plans Examiner Engineer Zoning Jul. 1. 2011 1:09PM No. 2911 P. 1 OP(D :CiVI r DATE (MWDDMfYY) CERTIFICATE OF LIABILITY INSURANCE THIS CERTIFICATE 15 ISSUED AS A MATTER OF INFORMATION ONLY CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to A statement on this certificate does not confer rights to the IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the the terms and conditions of the policy, certain policies may require an endorsement- certificate holder in lieu of such endorsement(s). PRODUCER Financial Insurance Brokers 306441-9932 2555 Ponce de Leon Blvd # 200 305 - 441-8632 Coral Gables, FL 33134 Christian Monnar CONTACY -_ NAME: . AJc N . Ex): _ AC. No): E -MAIL ADDRESS: CUSSTOMER ID Oil PANAM 2 - -! INSUR. 0 AFFORDING COVERAGE NAICN INSURED Pan Am Air Conditioning 12916 SW 132 Court Miami, FL 33186 r'^t/=15 A 2e6. .._,_._.__..__.,.___� INSURERA:Ascendant Underwriters GENERAL INSURER 8: INSURER C: BINDER INSURER 0 : 07/01/12 INSURER E : S INSURER F: - - - • • THIS INDICATED. CERTIFICATE EXCLUSIONS INSf2 ISM V1011,61111 19u1YIpCPC: IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. e: TYPE OF INSURANCE Y• • §Ctlgfi "'- POLICY NUMBER �� i MMMill • EXP LIMITS A GENERAL LIABILITY COMMERCIAL GENERAL LLABILIIY BINDER 07/01/11 07/01/12 EACH OCCURRENCE S 1,000,000 X PRISES ( a Er ence) S _ 100,000 CLAIMS -MAbE Ell OCCUR MED EXP (Any one WOW S 5.000 PERSONAL SAM, INJURY $ 1.000.000 GENERAL AGGREGATE $ 2,000,000 GEML AGGREGATE LIMIT POLICY 7 .74 APPLIES PER: PRODUCTS • COMP /OP AGO $ 2,000,000 7 LOC 3 AUTOM08u E UAD1LlT1f ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS .. --__. COMBINED SINGLE L IMrr (Ea =Went) S -- BODILY INJURY (Per person) $ 90DILY INJURY (Per acclden0 $ PROPERTY DAMAGE (Per accdent) 0 _ $ $ — UMBRELLA LIAR EXCESS LIAR OCCUR CLAIMS-MADE . EACH OCCURRENCE $ AGGREGATE S DEDUCTIBLE RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' UA$IUTY OFFlCER/MEMBEREXXCLUDED (Mandatary In NH) If es, describe under • RIPTI • N • F • P RATI • N Y NIA BINDER 07/01/11 07101112 WC STAT s- %- �( TORY11Mlr5 PR C below ELEACttACC10ENT $ 100,000 E.L DISEASE - EA EMPLOYEE $ 100,000 E.L. DISEASE •POLICY LIMIT a 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101. Additional Remarks Schedule If more apace Is required) Air Conditioning COIDTICir_A= ur nen 'Y _ CELLATION VIL.MIAM Village of Miami Shores Building Dept 10050 NE 2 Avenue Miami Shores, FL 33138 SHOULD ANY of THE ABOVE DESCRIBED POLICIES 8E CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2009/09) ®1988 -2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Jul. 1. 2011— 1:10PM x * It * tt * x * : * * * * * * * * * * * MIAMI -DADE COUNTY TAX COLLECTOR 140 W. Flagler Street Miami, Florida 33130 Please keep your receipt for future reference. Thank you and have a nice day. 7/1/2011 1300/221/001ML42 0006 -0001 Last Seq. 0:0001 WI LBT#:00 133387 -1 Local Business Tax $75.00 CK CHANGE $75.00 $0.00 MIAMI -DADE COUNTY TAX COLLECTOR LOCAL BUSINESS TAX SECTION 140 W. Flagler St. - 1st Floor Miami, Florida 33130 TEMPORARY RECEIPT 2011 -2012 LOCAL BUSINESS TAX Local Business Tax#:00133387.1,1 State /CC # :CAC041193 Issued to: PAN AM AIR CONDITIONING INC Type of Business: SPEC MECHANICAL CONTRACTOR THIS RECEIPT IS ISSUED AS EVIDENCE OF PAYMENT FOR YOUR LOCAL BUSINESS TAX OR PERMIT, YOUR OFFICIAL RECEIPT WILL BE MAILED TO YOU WITHIN 10 DAYS FROM THE VALIDATION DATE ON THIS RECEIPT. Payment Received es Certified Above Miami -Dade County Tax Collector PAN AM AIR CONDITIONING INC JORGE LOPEZ PRES 12916 SW 132 CT MIAMI FL33186 No. 4510 fEP. 2), 2009 USINESS T REVERSE SIDE FOR MORE'INF.0•RMA•Y10•y MIAM1•DADE COUNTY TOTAL N'O OF; R; C; I;P7S ;,,r ;.STAT'E. /CClt :.. Business Location :• 12916SW'132Cf 11Mai11ngAddress:• • `1291$5W.132GT :'ItIf1AMl'FL 331.86 ' 1 OF 1 CAC041193 Municipality Uninc. Miami Dade Oasliless Type 196 SPEC MECHANICAL CONTRACTOR NAres:CQde 23.8990 , ' knife. 10 WORKER/S ' ION OF.TAXES • T.A'X E S L:E,V I D Current Year 2010 County Wide Tax Beacon Council - Economic Dev Unincorporated Area Tax taxcollector 30.00 15.00 30.00 MBER 20% JANUARY 25 °Po 90.00 93.75 FOR YOUR REC•ORD5 T Amount DM b Se tember 30, 2009 $75.00 FEBRUARY 25% +8100 193.75 1 fr, DETACH HERE AND•.RETURN TWIS PORTION WITH YOUR PAYMENT 4, Phone Number Employees /Units Owner Name * Employer Identification Number or Social Security Number T RETAIN FOR YOUR RECORDS ,r AND RETURN THIS PORTION Wire YOUR PAYMENT $+ I Ee ��W1F L •133367 -1r `2009 -10 LOCAL BUSINESS TAX 2Q% JANUARY 25% FEBRUARY 25% +$1001 93.75 193.75 ,Jj 0153552 Provide NAICS Cade if different from above Amount Due by September 30, 2009 $75 :oo • Make checks payable to: Miami -Dade County Talc Collector (in U.S. funds drawn on U.S. banks) SIGNATURE REQUIRED Application Is hereby made fora receipt or permit for the busLness polemical or occupation described hereon. I sweayatfirm that the information Is true and correct 00600 0100 001333871 00007500 00000000 PAN Air Conditioning 1 291 6 S.W.,1 32 Court • Miami, Florida 331 86 f. (305) 259 -2008 • FAX (305) 259 -7881 QTY. DESCRIPTION EACH PRICE JOB NAME /A Dgg��SS �/!% r t�l i %�+ . CITY, STATE , , , <Gi TECHNICIAN �7 PHONE ZIP DATE OF DER DATE OF COMP. TIME SERVICE FIELD ❑ SHOP ❑ C.O.D. ❑ WRTY LI CHARGE PUR. ORDER NO. //- 3x6 -O/3 -35 7 O 1c e NATURE OF DEN MODEL NO. SERIAL NO. SERVICE REQUEST BILL TO NAME ADDRESS ;1 z e'i9 r'1(t. • DESCRIPTION OF WORK PERFORMED: SERVICE WORK STRICTLY CASH, UNLESS CREDIT ESTABLISHED, ALL CREDIT ACCOUNTS PAYABLE IN 10 DAYS. PAST DUE ACCOUNTS SUBJECT UP TO 11/2% PER MONTH SERVICE CHARGE. / -r. ()2; Z( /,r / /.//q I have authority to order the work, which has been satisfactorily performed, as outlin- ed above. It is agreed that the seller will retain title to any equipment o material that may be furnished until final payment is made, and if settlement is not made as agreed, the seller shall have the right to remove same and the seller will be held harmless for any damages resulting from the removal thereof. Purchaser shall pay all costs and damages, including a reasonable attorney's fee for collecting this account, whether suite be brought or not. We are pleased to guarantee air parts installed by us against normal service failure for a period of UPON INSPECTION OUR TRAINED SERVICE PERSONNEL RECOMM .ENDS: CUSTOMER'S SIGNATURE /4-7.4 71 Total Material Technical Service Time SUB. TOTAL TAX View 17 id ?,/ hile,vaor