MC-11-1260Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 161986
Scheduled Inspection Date: July 27, 2011
Inspector: Perez, JanPierre
Owner: QUICK, IOU NAN
Job Address: 1626 NE 105 Street A -5
Miami Shores, FL
Permit Number: MC -7 -11 -1260
Project: <NONE>
Contractor: ALFRESCO AIR INC
Permit Type: Mechanical - Residential
Inspection Type: Final
Work Classification: A/C Replacement
Phone Number
Parcel Number 1122300530050
Phone: (305)541 -3827
Building Department Comments
EXACT CHANGE OUT 3.5 TON A/H & CONDENSING UNIT
ON SPLIT SYSTEM
�Iz`),ll
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
July 26, 2011
For Inspections please call: (305)762 -4949
Page 17 of 30
MIAMI -DADE COUNTY
TAX COLLECTOR
140 W. FLAGLER ST,
1st FLOOR
MIAMI, FL 33130
2011 LOCAL BUSINESS TAX RECEIPT 2012 FIRST -CLASS
MIAMI -DADE COUNTY - STATE OF FLORIDA U.S. POSTAGE
EXPIRES SEPT. 30. 2012 PAID
MUST BE DISPLAYED AT PLACE OF BUSINESS MIAMI. P1,
PURSUANT TO COUNTY CODE CHAPTER 8A - ART, 9 & 10 PERMIT NO. 231
^''4I'= 1$tvOT^A FALL -DO NOT PAY
510219 -9 RENEWAL
BUSINESS NAME! LOCATION RECEIPT NO. 532967-7
ALFRESCO AIR INC STATE# CAC1813490
1442 NW 2 ST
33125 MIAMI
OWNER
ALFRESCO AIR INC
Sec. T at sadnes WORKER /S
19v6 e SPEC Ms ECHANICAL CONTRACTOR 4
'MS iA 7NL7 A 6BCAL
StISAIES£ :A;WOE= -
& EA ,:OT OEPRAT
■ vZEP "C wea.A:E AY.
a:$^: -o 01:0UL.A'11 ' :N
ZONANa Aws ^o Ti-E DO NOT FORWARD
COUNTY O R CRIES. NOP
ODES IT EXEMPT THE
HOLDER PROM W. OTHER
PRRMIT qR iGENSC
REQUIRED BY LAW. THIS t$
NO? P CERTIFICATSON OP ALFRESCO AIR INC
1:3THE HOLDER'S CUALIFICA. AOUSTINE ALVAREZ PRES
4s HOLDER'S
NW 2 ST
PAYMENT RECEIVED MIAMI FL 33125
MIAM•D4DE COUNTY TAX
COI,4RcTOR.
07/06/2011
60040000317
000045.00
SEE OTHER SIDE
I)
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
BY: __!______e______o_m
Permit No. I\ I 2C00
Master Permit No.
Permit Type: MECHANICAL �j /
, / /�Ut
OWNER: Name (Fee Simple Titleholder): / 2 %� �' i %G.G" /d'ete'r? Z -Phone#:
--5..
City: 41 0(9 ' A' '6411) State: Zip:
Tenant/Lessee Name: Phone #:
Email:
Address: /626: /' ,/ /65 ,,- IP/
JOB ADDRESS:
6 �4 A/f /05 5'
City: Miami Shores County: Miami Dade
Zip:
Folio/Parcel #:
Is the Building Historically Designated: Yes NO `;4
Flood Zone:
CONTRACTOR: Company Name: /2/"?'2_C?
Phone #:
z.igf'e
Address: ( ( /ei? 't_ d c_i—
City: 41/ /' ryry State: �� Zip: 3/ �5 7 5
Qualifier Name: ( C} 7Lf d'' �C%q' Phone #: �/ / / f c
State Certification or Registration #: c.: 49e. '/5 (/7b Certificate of Competency #:
Contact Phone#: Email Address:
DESIGNER: Architect/Engineer: Phone #:
Value of Work for this Permit: $ Square/Linear Footage of Work:
Type of Work: Address
Description of Work:
�_ 5 ,
OAlteration
CINew Repair/Replace�
ODemolition
- 'S
*** * * * * * * * ** * * * ** ** * * * * * * ***** * * **
Submittal Fee $'50- VO Permit Fee $
Scanning Fee $ Radon Fee $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $
**
#%
CCF $ CO /CC $
DBPR $ Bond $
Technology Fee $
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, BORERS, 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 144.-:,
The foregoing instrument was acknowledged before me this )) ' The foregoin
day of )1 N /� 20 A ?' day of
personally to or o '�
who is rsonall known w
NOTA
- As identification and who did take an oath.
Sign:
Print:
My Commission
* * * * * * * * * * **
Notary Pubic - State of Rattle
My Commission E Nov 27, 2011
4 Commission a W 7.1969
, Assn
**
APPROVED BY
Contractor
ins ment was acknowledged efore m%`this6
, 20 /i, by
who is personally kn A 'to me or who has produced F'
N, ttlikiktification and who did take an oath.
�*. „....^,?eliM'
ssion Ex 08011149- n
10 oy 31VJ.S 9178 �a1110N
ans Examiner
Structural Review
(Revised 07 /10 /07)(Revised 06 /10/2009)(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.
Address (where the work is being done): �Q6 6 fO 5 �` t 4- C
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 ❑ Contract Attached: YES ❑
UNIT BEING REPLACED
DATA
NEW ,UNIT
MANUFACTURER
L
AHU or PKG. UNIT MODEL #
g
''
i '
COND. UNIT MODEL #
1
1 2, 0
KW HEAT
�- 6
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 I. J.
EER/SEER
./V- .,4/
4
YES
NO
REPLACING DUCTS
YES
YES
NO
REPLACING THERMOSTAT
YES ( j
YES
NO
NEW 4 "CONCRETE SLAB
YES iffillio
YES
NO
NEW ROOF STAND
YES
YES
NO
NEW RETURN PLENUM BOX
YES C -)
1. Minimum Circuit Ampacity (Wire Size):
2. Maximum Overcurrent Protection (Fuse/Breaker Size):
3. Voltage of Circuit (208/240/480): i ) / 2._ .3 6)
4. Size Disconnecting Means:
Contractor's Company Name: /0t, 4 / Phone: e L ir& 6 / ,
State Certificate or Registration N (t /3 C fe) Certificate of Competency N.
7
Signature
j
Qualifier's signature only)
Date:
June 23, 2011
harbourc1ub.vi1ias
1530 N.E. 10S1h street, 141433.
lw+ol Shores, Ho Tda 33135 6 Phone 803•O175
•
Please be advised that Peggy Rodriguez has permission to install a new air conditioning unit at
her residence.
Bob Stobs
President.
Jul 13 11 03:40p
CERTIFICATE OF LIABILITY INSURANCE
THIS CERTIFICATE 15 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFI
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURE
I 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, aup)
the terms end conditions of the policy. certain polities may require an endorsemont. A statement on this certlftcate does not confer rights
certificate holder In lieu of ssuch esdorsamem(s),
PRODUCER
' Pinnacle Insurance Group Inc.
2525 S.W. 27th Ave. Suite 100
Miami, FL 33133
L Phone (305) 854 -9898 Fax (305) 854 -9899
! INSURED .•• - •
Alfresco Air, Inc.
1442 NW 2nd ST
Miami. FL 33125
• GONTACT. -_,
NAMES
PHONE
E-MAIL
AOPRODRESSt DUCER -_ -.
CUSTOMER ID Of
INSURER(SI AFFORDING COVERAGE
INSURERA: Ascendant COmmeroial Insurance. Inc
w9URER e : Ascendant Commercial Insurance, Inc
INSURER C ; -- --
INSURER Ds.
- -�
INSURER E :
p.1
OATS(MM/DB/YYYY) 7
07/13/11
ATE HOLDER. 11415
Y THE POLICIES
(S), AUTHORIZED
to
the
x
COVERAGES INSURER F : • -•- . .
CERTIFICATE NUMBER: REVISION NUMB
THIS 15 TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE-BEEN IS$UCD TO THE INSURED NAMED ABOVE FOR TH
INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPEC
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
IN$R j - — ° ;ADDI�SUBR POLICY EFF— POLICY cm.
IN$R WVD , POLICY NUMBER (MM(DDrryYY) (MMIODIYYYY)
LTR I TYPO OF INSURANCE
GENERAL LIABILITY
cOMMERCIAL GENERAL LIABILITY
A ! u CLAIMS -MADE EZ OCCUR
Wi• 8500 deductible
Ifl
GEM% AGGREGATE LIMIT APPLIES PtN;
• LJ POLICY RI jPgC ❑ Lot
AUTOMOBILE LIABILITY
L
L.'
8 If -1
U
171
❑ UMBRELLA LIAR ❑ OCCUR
8
ANY AUTO
ALL OWNFO AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON - OWNED AUrOS
U. OtDUCTIBLE
_Ill RETENTION
WORICERS COMPENSATION
AND EMPLOYERS' LLIBILITY
ANY PROPRIETOWPANTNF -R/�,CUTIV[YrN WC_02492-0
OFFICER/MEMBER EXCLUUI•U7 I Y I N /a
lUandatory ►n NH)
I( Anr..cribe uncle(
D ESCRIPTION OI_OPr.RATIONS below
EXCESS LIAR CLAIMS•MADC
n
GL- 35719 -0
07/28/2010
EACH OCCURRENCE
OAMAtr rO RENTFD
PREMISES (Ea eccurre
[LIED EXP (Any one pe
07/28/2011 PERSONAL A anV IN
• GENERALACCREGA
– PRODUCTS- COMP/O AGG
Na):
R: —
POLICY PERIOD •
TO WHICH THIS
THE TERMS,
NAIL
LIMIT$
1 -
E. 1.000,000
en)__ -$ 100,000
J s 5,000I'
RY 0 1,000,0001
$ - 2,000,00011
0 1,000,0001
$
COMBINED SINGLE Lt
(Ea accident)
BODILY INJURY (Par
BODILY INJURY (Pet a
PROPERTY DAMAGE
(I'er accident)
FACH OCCURRENCE
j__
..1-. -
1 09/10/2010
09/10/2011
DESCRIPTION OF OPERATIONS / LOCATIONS IOw►9 / VEHICLES (Attach ACORD 107, Atltll0osal Remarks SchedutO, N mare apa�w E6 +dpulred)
Air Conditioning Contractor
Job Location: 11626 NE 105 ST Apt, 5
CERTIFICATE HOLDER
City of Midml Shores
10050 NE 2nd Ave
Miami Shores, FL 33138
Fax:(305)795.2204
ACORD 25 (2009/09) QF
CANCELLATION
WC ST •rI r-I
rr $
TORY LIMIT5 „- r,-
EL EACH ACCIDENT
•
E.L. DISEASE - EA EMP OYEIf $
E.L DISEASE .POLICY •IMrr _$
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES
THE EXPIRATION DATE THEREOF, NOTICE WILL BE D LIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
1,000,000
1.000,000
1,D00,000
E CANCELLED BEFORE
AUTHORIZED R!PR
I Marcia C. Alvarez
SNTA1IVE
.
1988- 9 ACORD CORPORAT ON. All r .. reserved.
The ACORD name end logo are rag stored marks of ACORD
Jul 21 11 02:41p
AC 4953230
p.4
STATE OF FLORIDA
DEPARTMENT I SRLIIGL REGULATION
VTRYCENSNBA SEQ# L100603
DATE BATCH NUMBER
LICENSE NBR
06/03/2010j090461659 ,CAC1813490
The CLASS a AIR CONDITIONING CONTRACTOR
Named below IS CERTIPIED
Under the provisions of Chapter 489 FS.
Expiration date: AUG 31, 2012
ALVAREZ, AGUSTINE
ALFRESCO AIR INC
MIAM/ 1442 FL2 ST.
MIAMI
CHARLIE ST
FL 33125
CHARLIE LIEM
INTERIM SECRETARY
DISPLAY AS REOU1RD BY LAW _ ••