MC-11-648v
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
L.--
Inspection Number: INSP - 162764 Permit Number: MC -4 -11 -648
Scheduled Inspection Date: August 08, 2011
Inspector: Perez, JanPierre
Owner: BUENO, FABIOLA
Job Address: 9250 NE 12 Avenue
Miami Shores, FL
Project: <NONE>
Contractor: ALLSTATE A/C INC.
Permit Type: Mechanical - Residential
Inspection Type: Final
Work Classification: A/C Replacement
Phone Number
Parcel Number 1132050070171
Phone: 786- 236 -9875
Building Department Comments
REPLACE 3 TON CENTRAL SPLIT A/C SYSTEM
b I
Inspector Comments
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
August 05, 2011
For Inspections please call: (305)762 -4949
Page 27 of 37
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 Type: MECHANICAL
Permit No.F
Master Permit No.
Owner's Name (Fee Simple Titleholder) 6`Et u_-" Phone #
Owner's Address'" ° "`° '�. �t�,
-rte
APR 1 2 2011
City rY R` 01"-an State p Zip ? 1 3 g
Tenant/Lessee Name Phone #
Email ■ a 4) t " `" . y4,41.44.
Job Address (where the work is bein g done) S O
)
City Miami Shores Village County Miami -Dade Zip
FOLIO / PARCEL #
Is Building Historically Designated YES
Flood Zone
Contractor's Company Name ,s.--ii--- Icy icsA j (a ,$ i . Phone # 9 t- ci 1 2, 1 9 C � t
Contractor's Address 5-R09 L j- Ps4,1.,4,,,ciL 4,4._ 13 i if e9 .
City ar — / " P tz State 1L Zip 3 3 0 7,3
Q ualifier Name yZ. l C.c.,-6-'�+
0 0 L.if e Phone #
State Certificate or Registration No. 0/72 C 067.5411/7 Certificate of Competency No.
Contact Phone E -mail Ott (T rTla '' fa.- i dn. CA-1,A; T1 ca✓► a7 -`rvic
Architect/Engineer's Name (if applicable) Phone #
klik.., # .,..._.__a__$°61 4-,
Value of Work For this Permit $ Square / Linear Footage Of Work:
Type of Work: ❑lAddition ❑Alteration f New `k.. Repair/Replace ❑ Demolition
Describe Work: 2e 1 3 '��7i . a ,
r .
Submittal Fee $ Permit Fee $
Notary $
Scanning $ Radon $
Double Fee $
Training/Education Fee $
Structural Review. $
CCF $ CO /CC $
DPBR $
Violation date:
Technology Fee $
Bond $
Total Fee Now Due $
See Reverse side
6)
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. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged
Owner or ,age Contra '`'.r
The foregoing instrument was a w ledged before me` this /. The foregoing instrument was acknowledged before me this /2
day of 7 , 20 1/ , ! i.-'6 --e,../ �1 per; day of i , / , 20 1/, by I t C 'Jl,./ `
who is personally known to me or who has produced who is personally known to me or who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
Sig
Print:
My Comm
`'' Notary Expires Dec
is s` My Comm. s ee 9i._ •. Commission Notary Assn.
S. ' "'' through National
80
•:,1P Fh *S Bonded '•num"
* * * * * * * * * * *
APPROVED BY
as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
P
* * * *II* * * * * * * * * **
,Plan § Examiner
Engineer
(Revised 07 /10 /07)(Revised 06/10/2009)
******* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Zoning
Clerk checked
• • sr
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): ?.:2- 5-0 t 1.2
City: Miami Shores Village County: Miami Dade Zip Code: 3 3 / 3
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 ❑ Contract Attached: YES ❑
UNIT BEING REPLACED
DATA
NEW UNIT
Q. e ,yy
MANUFACTURER
6,1-7
Ei4A L. AC03 4 t4ZJ
AHU or PKG. UNIT MODEL #
12 L 4 ,443 SSA.
kik-X.
COND. UNIT MODEL #
jW%' rn.3C„40 /
/ 0
KW HEAT
10
'3
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 ! •V
REPLACING DUCTS
YES
YES ► a -
REPLACING THERMOSTAT
NO
YES ®
NEW 4 "CONCRETE SLAB
S
YES moo
NEW ROOF STAND
YES iya,..)
YES N •..
NEW RETURN PLENUM BOX
YES NO
1. Minimum Circuit Ampacity (Wire Size): 6
2. Maximum Overcurrent Protection (Fuse /Bre ker Size):
3. Voltage of Circuit (208/240/480): 94 c0
4. Size Disconnecting Means: �''� e S
Contractor's Company Name: 4449114-7-W i;'77 ®4-1. Phone: ci —1 >o V-1-
State Certificate or Re • tration N. 6 en c ,a53-(16' Certificate of Competency N.
Signature
0
(Qualifier's signature only)
Date: Y//3/nd-o
DBPR Professions - Construction Industry Licensing Board - Codes Page 1 of 2
CA and RA - A "class A air - conditioning contractor" means a contractor whose
services are unlimited in the execution of contracts requiring the experience,
knowledge, and skill to install, maintain, repair, fabricate, alter, extend, or design
central air - conditioning, refrigeration, heating, and ventilating systems. Class A
Contractors may also execute contracts requiring experience In the Installation,
maintenance, repair, fabrication, alteration, extension or design of duct work in
connection with a complete system but only to the extent that such duct work is
performed by the contractor as is necessary to complete an air - distribution system,
boiler and unfired pressure vessel systems, and all appurtenances, apparatus, or
equipment used in connection with them. A "class A air - conditioning contractor"
shall not perform any work such as liquefied petroleum or natural gas fuel lines
within buildings, potable water lines or connections, sanitary sewer lines, swimming
pool piping and filters, or electrical power wiring.
CA and RA - A "class B air- conditioning contractor" means a contractor whose
services are limited to 25 tons of cooling and 500,000 BTU of heating In any one
system in the execution of contracts requiring the experience, knowledge, and skill
to install, maintain, repair, fabricate, alter, extend, or design central air -
conditioning, refrigeration, heating, and ventilating systems, including duct work in
connection with a complete system. A "class B air - conditioning contractor" shall not
perform any work such as liquefied petroleum or natural gas fuel lines within
buildings, potable water lines or connections, sanitary sewer lines, swimming pool
piping and filters, or electrical power wiring.
CA and RA - A "class C air - conditioning contractor" means a contractor whose
business is limited to the servicing of air - conditioning, heating, or refrigeration
systems, including any duct cleaning and equipment sanitizing which requires at
least a partial disassembling of the system, and whose certification or registration,
issued pursuant to this part, was valid on October 1, 1988. NOTE: No person not
previously registered or certified as a "class C air - conditioning contractor" as of
October 1, 1988, shall be so registered or certified after October 1, 1988.
CM and RM - A "mechanical contractor" means a contractor whose services are
unlimited in the execution of contracts requiring the experience, knowledge, and
skill to install, maintain, repair, fabricate, alter, extend, or design central air -
conditioning, refrigeration, heating, and ventilating systems, including duct work In
connection with a complete system. A "mechanical contractor" shall not perform
any work shall not include any work such as liquefied petroleum gas fuel lines
within buildings, potable water lines or connections, sanitary sewer lines, swimming
pool piping and filters, or electrical power wiring.
http : / /www.myfloridalicense.com/dbpr /pro /cilb /codes.html
4/15/2011
ACORD.. CERTIFICATE
OF LIABILITY INSURANCE .
DATE(MM/DD/YYYY)
04/12/2011
POLICY NUMBER
PRODUCER
Moody Insurance
1939 Tyler Street
Hollywood, FL 33020
Phone: (954)476-0907
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND NO
HOLDER. TH SOCERTIFICATE IDO S NOTAMEND,CEXTEND OR IFICATE
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE
NAIC #
INSURED
All State Air Conditioning Inc.
5809 Hallandale Beach Blvd
West Park, FL 33023
I
ACP5904970652
INSURER A: Nationwide Insurance Company of America
INSURER B:
MED EXP (Any one person)
INSURER C:
INSURER 0:
PERSONAL & ADV INJURY
INSURER E:
GEN'L
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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR ADD'L
LTR INSRD
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE (MM/DD/YYI
04/11/2011
POLICY EXPIRATION
DATE (MM/DD/YYI
04/11/2012
LIMITS
EACH OCCURRENCE
$ 1,000,000
$ 100,000
A '
GENERAL
X
LIABILITY
COMMERCIAL GENERAL LIABILITY
ACP5904970652
PREMISES (Ea ence)
CLAIMS MADE X OCCUR
MED EXP (Any one person)
$ 5,000
PERSONAL & ADV INJURY
$ 1,000,000
GEN'L
GENERAL AGGREGATE
$ 1,000,000
$ 1,000,000
AGGREGATE LIMIT APPLIES PER:
POLICY f JF : I LOC
PRODUCTS - COMP /OP AGG
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
COMBINED SINGLE LIMIT
(Ea accident)
$
BODILY INJURY
(Per person)
$
BODILY INJURY
(Per acddent)
$
PROPERTY DAMAGE
(Per accident)
$
GARAGE
LIABILITY
ANY AUTO
AUTO ONLY - EA ACCIDENT
$
THAN EA ACC
$
OTHER
AUTO ONLY: AGG
$
EXCESS/UMBRELLA
LIABILITY
OCCUR CLAIMS MADE
DEDUCTIBLE
RETENTION $
EACH OCCURRENCE
$
AGGREGATE
$
$
$
$
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
If yes, escribe under
SPECIAL PROVISIONS below
WCSTATU- OTH-
TORY LIMITS ER
E.L. EACH ACCIDENT
$
E.L. DISEASE - EA EMPLOYEE
$
E.L. DISEASE - POLICY LIMIT
$
OTHER
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISION
FOR EVIDENCE OF INSURANCE ONLY
--- -- -- - - - - - - - - -__ .
EVIDENCE OF INSURANCE
FL
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
AUTHORIZED �REPRREESSENTTAATIVE
y
ACORD 25 (2001/08)
ACORD GENIM /KATION 1=1:1
Printed by MJG on April 12, 2011 at 09:49AM