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MC-11-679Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 158509 Permit Number: MC -4-11 -679 Scheduled Inspection Date: July 13, 2011 Inspector: Perez, JanPierre Owner: OLARTE, MARY Job Address: 9200 NE 12 Avenue Miami Shores, FL Project: <NONE> Permit Type: Mechanical - Residential Inspection Type: Final Work Classification: A/C Replacement Contractor: AFFORDABLE AIR & HEAT & ELECTRIC CONTRACTOR Phone Number Parcel Number 1132050150260 Phone: 305 - 770 -4167 Building Department Comments REPLACEMENT 5 TON NC SPLIT SYSTEM Inspector Comments Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. July 12, 2011 For Inspections please call: (305)762 -4949 Page 6 of 26 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 OWNER: Name Address: City: ee Simple Titleholder): Permit No. APR 1 S 2011 BY: .....:aa: aa.oae.. o..... Master Permit No. Phone #: State: Zip: 0 W" Tenant/Lessee Name: Phone #: Email: JOB ADDRESS: ,2 Aif2- /2- v City: Miami Shores County: Miami Dade Zip: _aatai:_ Folio/Parcel #: / i° t211' ®2 6 9 Is the Building Historically Designated: Yes NO ,•'- Flood Zone: CONTRACTOR: Company Name: !.4-7).2.--)-- Phone #: )1I/00772 Address: Ai --r- City: `1 State: /ry Zip: Qualifier Name: Jo /' i-7a. /--) Phone #: 02-77 State Certification or Registration #: J �/ Certificate of Competency #: Contact Phone #: Email Address: DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ %�. ®67 Square/Linear Footage of Work: Type of Work: DAddress ❑Alteratiion� New /Replace Description of Work: A y 5 1° ®T, r DDemolition **** *�xx�� *** x� *�x�x�x**** * * * ** * * **�x�x ***** Fees * *** x * ***** ** * ***�x**** **** *** *** ** * ***:x� * ** CJ,16‘. Submittal Fee $ ✓ 0 . Permit Fee $ t i2 111 CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ ? / • 15 i 7g 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 issue In the absence of such posted notice, the inspection will not be approved reinspection fee will be charged. Signature Signature Owner or Agent � Contractor The foregoing instrument was acknowledged before me this /1 The foregoin instrument was acknowledged before me this %� , day of , 20 i', by Jen o"? day of 12_, , 20 ��, by YfQJr/la4- who is per....„.sotalfyinown to me or who has produced w o ' r �ussV 6teloN leuolle�g6n As identification and who did take an oath. �disislgiui% �$$io 4 o � .d take an oath. �� NO AufiYOP I U � IN wn,to.meor who has ,roduced elON leuolleN Ono.U% P8PuO9 .%%,% 90 ,% 8668 as # sst 1 011 _.boa �s�l My Commission Expires: APPROVED BY * *.....; * * ** ** * - * . >:, ** ep!Jol1 10 alel3 - ollgnd AJe)oN =, 0A1V1NOW My Commission Expires: Pla s Ex miner Zoning Structural Review Clerk (Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09) R ®® CERTIFICATE OF LIABILITY INSURANCE OP ID VR DATE (MM/DD/YYYY) 03/21/11 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 poiicy(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 lieu of such endorsement(s). PRODUCER Kahn- Carlin & Company, Inc. 3350 S. Dixie Highway Miami FL 33133 -9984 Phone:305- 446 -2271 Fax:305- 448 -3127 l•UN17R, l NAME: PHE (EA/CNNo, Ext): (A /C, No): ADDRESS: PRODUCER CUSTOMER ID A: AFFOR -3 INSURER(S)AFFORDINGCOVERAGE NAICU INSURED Affordable Air & Heat, Inc. Affordable Electrical 515tNEc190sStreet Miami FL 33179 INSURER A: Scottsdale Insurance Company INSURER B: INSURER C: EACH OCCURRENCE INSURER D: X INSURER E : $ 100000 INSURER F : CIAIMS -MADE COVERAGES CERTIFICATE NUMBER: REVISION 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. LTR TYPE OF INSURANCE AUU INSR b - W VD POLICY NUMBER POLTCYEI -F (MM /DD/YYYY) POLICYEXP (MM /DD/YYYY) LIMITS A GENERAL LIABILITY COMMERCIAL GENERALLIABILITY EACH OCCURRENCE $ 1000000 X • E • • PREMISES $ 100000 CIAIMS -MADE X OCCUR • $ 5000 PERSONAL : • • $ 1000000 GENERAL AGGREGATE $2000000 GEN'LAGGREGATELIMITAPPLIESPER: POLICY n PRO- n LOC JECT PRODUCTS • •' ' $ 2000000 $ AUTOMOBILE LIABILITY ANY AUTO ALL OW NED AUTOS SCHEDULED AUTOS HIRED AUTOS NON OWNED AUTOS COMBINED SINGLE LIMIT accident) $ BODILY INJURY (Per person) $ BODILY $ PROPERTY DAMAGE - $ $ $ UMBRELLA LIAR LIAB OCCUR EACH • $ ■EXCESS ■CLAIMS -MADE AGGREGATE $ DEDUCTIBLE RETENTION $ $ WORKERS COMPENSATION ANY PROPRIETOR/PARTNEFUEXECUTIVEn OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below / A OT - TORY LIMITS ER E.L. EACH ACCIDENT $ E.L. DisEAsE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) CERTIFICATE HOLDER CANCELLATION MIAM -04 City of Miami. Shores Village 10050 N.E. 2nd Avenue Miami Shores 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 25 (2009/09) 2005 ACC The ACORD name and logo are registered mark ACORD All rights reserved. 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. J Job Address (where the work is being done): 9' �0 / / 5� / / Z& Zip Code: 4ft8'-' City: Miami Shores Village County: Miami Dade 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 (A DATA SHEET REQUIRED Change Disconnecting means: YES ❑ NO ARHI Sheet Attached: YES NO ❑ Contract Attached: YES UNIT BEING REPLACED DATA NEW UNIT MANUFACTURER ,.r/ C13( ®B AHU or PKG. UNIT MODEL # iovp--.4 &o p, 66x L06,0/ / 1-4-511-1- 6S I COND. UNIT MODEL # /6 KW HEAT NOM TONS 5— AHU CU PKG 1) M.C.A AHU CU ' ` PKG AHU CU PKG 2) M.O.P AHU _r #CU ;0 PKG AHU CU PKG 3) VOLTS AH ` r UKG PKG UNIT / / PKG UNIT EER/SEER /� YES 1Q REPLACING DUCTS YES YES 11,Q REPLACING THERMOSTAT YES NO (?E NO NEW 4"CONCRETE SLAB NO YES NEW ROOF STAND YES YES NO NEW RETURN PLENUM BOX YES NO 1. Minimum Circuit Ampacity (Wire Size): 10 ) neo 4' 2. Maximum Overcurrent Protection (Fuse /Breaker Size): 3. Voltage of Circuit (208/240/480): g 4. Size Disconnecting Means: Contractor's Company Name: ottfeVifilket6 A112--19 M Y to Phone: )qol7 � State Certificate or Registration N. Certificate of Competency N. 1/Z24"'/ �1 Date: .il8/ // Signature (Qualifier's signature only) 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): • p 1 5, / 2 41/e- Zip Code: ff°'% City: Miami Shores Village County: Miami Dade 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 (A DATA SHEET REQUIRED NO ARHI Sheet Attached: YES NO Contract Attached: YES IV Change Disconnecting means: YES ❑ ❑ UNIT BEING REPLACED DATA NEW UNIT beV1d1PY,/ MANUFACTURER �� /r Gi3I AHU or PKG. UNIT MODEL # IF = '. 0 11-s f (oS ( COND. UNIT MODEL # 65x O1?0 l c, KW HEAT NOM TONS 5 AHU CU PKG 1) M.C.A AHU CU PKG AHU CU PKG 2) M.O.P AHU r CU 0 PKG AHU CU PKG 3) VOLTS AH `. <R' UZ 1'KG PKG UNIT / / PKG UNIT EER/SEER I2 YES REPLACING DUCTS YES NO YES N9 REPLACING THERMOSTAT YES N4, ekl NO NEW 4 "CONCRETE SLAB l NO i YES NEW ROOF STAND YES YES (NQ, NEW RETURN PLENUM BOX YES NO 1. Minimum Circuit Ampacity (Wire Size): W) 40 2. Maximum Overcurrent Protection (Fuse /Breaker Size): 0 3. Voltage of Circuit (208/2401480): 4. Size Disconnecting Means: Contractor's Company Name: etd2_ W'.� Phone: 3 q 17 17 State Certificate or Registration N. Certificate of Competency N. L 44 / /1 Date: ‘S/ /81// Signature ire --�- -- (Qualifler's signature only) www.ahridirectory.org Certificate of Product Ratings AHRI Certified Reference Number: 1492506 Date: 4/18/2011 Product: Year -Round Air - Conditioner, Remote Air - Cooled Condensing Unit Outdoor Unit Model Number: GSX130601A* Indoor Unit Model Number: AR *F486016B* Manufacturer: GOODMAN MANUFACTURING CO., LP. Trade /Brand name: GOODMAN, JANITROL, AMANA DISTINCTIONS, EVERREST, ONE HOUR AIR CONDITIONING AND HEATING, ENERGI AIR Manufacturer responsible for the rating of this system combination is GOODMAN MANUFACTURING CO., LP. 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 (Btuh): 57000 EER Rating (Cooling): 11.10 SEER Rating (Cooling): 13.00 Ratings followed by an asterisk ( *) indicate a voluntary rerate of previously published data, unless accompanied with a WAS, which indicates an involuntary rerate. DISCLAIMER AHRI does not endorse the product(s) listed on this Certificate and makes no representations, warranties or guarantees as to, and assumes no responsibility for, the product(s) listed on this Certlflcate. AHRI expressly disclaims all liability for damages of any kind arising out of the use or performance of the product(s), or the unauthorized alteration of data listed on this Certlflcate. Certified ratings are valid only for models and configurations listed in the directory at www.ahridirectory.org. TERMS AND CONDITIONS This Certificate and Its contents are proprietary products of AHRI. This Certificate shall only be used for individual, personal and confidential reference purposes. The contents of this Certificate may not, in whole or In part, be reproduced; copied; disseminated; entered into a computer database; or otherwise utilized, in any form or manner or by any means, except for the user's individual, personal and confidential reference. CERTIFICATE VERIFICATION The Information for the model cited on this certificate can be verified at www.ahridirectory.org, color Air - Conditioning, Heating, click on "Verify Certificate" link and enter the AHRI Certified Reference Number and the date on IIIII `® and Refrigeration Institute which the certificate was issued, which is listed above, and the Certlflcate No., which is listed below. ©2011 Air - Conditioning, Heating, and Refrigeration Institute CERTIFICATE NO.: 129476088193781060 i iii ,ICERTIFIEC v -- www.ahridirectory.org Certificate of Product Ratings AHRI Certified Reference Number: 1492506 Date: 4/18/2011 Product: Year -Round Air - Conditioner, Remote Air - Cooled Condensing Unit Outdoor Unit Model Number: GSX130601A* Indoor Unit Model Number: AR *F486016B* Manufacturer: GOODMAN MANUFACTURING CO., LP. Trade /Brand name: GOODMAN, JANITROL, AMANA DISTINCTIONS, EVERREST, ONE HOUR AIR CONDITIONING AND HEATING, ENERGI AIR Manufacturer responsible for the rating of this system combination is GOODMAN MANUFACTURING CO., LP. Rated as follows in accordance with AHRI Standard 2101240 -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 (Btuh): 57000 EER Rating (Cooling): 11.10 SEER Rating (Cooling): 13.00 • Ratings followed by an asterisk (') indicate a voluntary rerate of previously published data, unless accompanied with a WAS, which indicates an Involuntary rerate. DISCLAIMER AHRI does not endorse the product(s) listed on this Certificate and makes no representations, warranties or guarantees as to, and assumes no responsibility for, the product(s) listed on this Certificate. AHRI expressly disclaims all liability for damages of any kind arising out of the use or performance of the product(s), or the unauthorized alteration of data listed on this Certificate. Certified ratings are valid only for models and configurations listed in the directory at www.ahridirectory.org. TERMS AND CONDITIONS This Certificate and its contents are proprietary products of AHRI. This Certificate shall only be used for individual, personal and confidentiat reference purposes. The contents of this Certificate may not, in whole or in part, be reproduced; copied; disseminated; entered Into a computer database; or otherwise utilized, in any form or manner or by any means, except for the user's individual, personal and confidential reference. CERTIFICATE VERIFICATION The information for the model cited on this certificate can be verified at www.ahridirectory.org, click on "Verify Certificate" link and enter the AHRI Certified Reference Number and the date on which the certificate was issued, which is listed above, and the Certificate No., which is listed below. ©2011 Air - Conditioning, Heating, and Refrigeration Institute co ®A Air - Conditioning, Heating, Aria ® ® and Refrigeration Institute CERTIFICATE NO.: 129476088193781060 Mar 18 11 09:12a CAC048111 r p.2 Air Ccndi ioelir s Electrical Contractors able 1 © i,,.. 1 BI WHERE QUALITY IS AFFORDABLE 515 N.E. 190th Street • Miami, FL 33179 Dade (305) 910 -0777 Eroward (954) 987-9943 ECOD01140 HOME # CELL • j ; / WORK a OTHER a: NAME: 011, / - JOB NAME: STREETn2 ^ r' /2 Ate ''j't�//1l (�/ STREET: ti/n6 CITY f/f O MANUFACTURER STATE: ZIP / EQUIpMENT:SCHEDULE� CONDENSER! PACKAGE MODEL CITY: SEER STATE: ZIP: pppRA G ACOST HEATER TONS AIR HANDLER MODEL upon start-up. eiVi 10419 65)( 13401 itWaimoik, ill acceptance within days and is void there after at the '7 6 13 c JOB DESCRIPTION: 9, . - [� r7 A G /0 0 nidu .'slab S kr " and / /d. DESCRIPTION OF SERVICES PERFORMED AIR DISTRIBkTION: Ductwork will be designed, fabricated and installed in accordance with accepted engineering practices and in compliance ith all building codas in force on above date. nuc1VrQ : bed 1511 System of flex/fiber andfbr ductwork w outlets and returns. Subject to modification according to strut or other requirements. LABOR WARRANTY: Service will be provided free by us fora period of A 1 B� C_ yearls) from date of installation during regular working days 8 hours. Ii*NUFACTURER WARRANTY: Parts Warranty (Yrs.) Compressor Warranty (Yrs.) gXTENDED WARRANTY:. Provided through_.. C C C..- -• for; year(s). AFFORDABLE AIR & HEAT. INC. WILL PROVIDE: YES NO EXISTING INSTALLATION OF EQUIPMENT �I REFRIGERATION LINES ( ) OR FLUSH ( V) GRILLES ( )RETURNS( ) PERMIT FEELS) & PLANS, IF REQUIRED DRAIN PIPING ( ) OR FLUSH { Vr AIR HANDLER SUPPORTS CONDENSATION PUMP EMERGENCY FLOAT SWITCH HURRICANE 11E-DOWNS CONCRETE SLAB 'Gnat* the above merchandise remains with Affordable Air and Heal, Inc . (seller) until paid for in lull. In case of default in any terns ut this contract. the sslsr Shall have the right to lake Immediate possession of said merchandise and full amount of the purchase (rice then unpaid shall become immediately dueand payable atthe seller's option without notice or demand. All monies paid shalt remain with the setter as liquidated damages. In the event the services of n attorney are required to enforce the interest of the seller. the purchaser she° be required to pay all reasonable attorney's fees together with interest and as Costs thereto. No warranty service shall be performed on accounts with an outstanding balance. Labor warranty excludes. existing ductwork. existing electrical systems. and maintenance related repairs. In the event the purchaser refuses to allow seller to commence work after toe contract has been executed. purchasershaU be responsible to the seller for 25% of the total prtce as r uldated and agreed damages. Seller shall not bo respans°Ileforany existing bu°dingoreleclrical code violations. All material is guaranleedto be as specified. AD work to be completed in a workmanlike manner according to standard practices. Any alteration or deviation from the contract specifications involy • - . costs will be executed upon written orders and will be subject to ,. . and above this estimate. in YES THERMOSTAT CARPENTRY ✓ BALANCE AIR FLOW REMOVAL OF JOB SITE DEBRIS ELECTRICAL WIRING (POWER CONTROL) CONNECT TO EXSTINGSERVICEJPANELS INCREASE ELECTRICAL SERVICE AMPS t� OTHER OTHER OTHER _ -. Hero NONEXISTING COST ` REBATES/CREDITS �TO TALL/C/OOSTT , /TA. __ 12.71 / Y,f�kI - {-?oo e C Payment to be made FINANCING A AILABL as follows: %{9' ? a 211L... deposit, balance upon start-up. This THE Option Authorized Company proposal subject to ARMIE PRICES, SPECIFICATIONS A°° Chosen Signatu Signature Date 1./ acceptance within days and is void there after at the option of the seller. Wilt RE MAIM AS OIf(LI AA AS C°Ilnm ■ . 11 y BY .•., r . Y Mi► BEZD TO .,.. , WD&( CIPIED. PAYMENT erai. �,, , j� �, /, iii j' , ,/ Date `i