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MC-11-1373
Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 162626 Scheduled Inspection Date: August 15, 2011 Inspector: Perez, JanPierre Owner: ROBERTS, JOHN Job Address: 9500 NE 6 Avenue Miami Shores, FL Project: <NONE> Contractor: MAYOLI A/C & REFRIGERATION INC Permit Number: MC -7 -11 -1373 Permit Type: Mechanical - Residential Inspection Type: Final Work Classification: A/C Replacement Phone Number Parcel Number 1132060140770 Building Department Comments REPLACE 3 1/2 TON AIR HANDLER, FLEX DUCT HOSES IN ATTIC DAMAGED BY RATS Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments August 12, 2011 For Inspections please call: (305)762 -4949 Page 22 of 36 Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Parcel Number Applicant Owner Information Address Phone Cell JOHN ROBERTS 9500 NE 6 AVE MIAMI SHORES FL 33138 -2739 Asyssr Contractor(s) Phone MAYOLI A/C & REFRIGERATION INC Cell Phone Valuation: Total Sq Feet: $ 4,000.00 0 1 Tons: 3 1/2 ton Additional Info: A/H & COND UNIT SPLIT SYSTEM Classification: Residential Approved: In Review Comments: Date Denied: Scanning: 1 Date Approved: : In Review Type of Work: MECHANICAL Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Total: Amount $2.40 $2.10 $2.10 $0.80 $140.00 $3.00 $3.20 $153.60 Pay Date Pay Type Invoice # MC -7 -11 -41596 08/03/2011 Credit Card 07/29/2011 Credit Card Amt Paid Amt Due $ 103.60 $ 50.00 $ 50.00 $ 0.00 Available Inspections: Inspection Type: Final 1 In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS 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. Futhermore, I authorize the above -named contractor to do the work stated. August 03, 2011 Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy Date August 03, 2011 1 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 JUL 2 9 2011 �Na rrCA1-1313 Perna Master Permit No. Permit Type: MECHANICAL A OWNER: Name ( F e e Simple Titleholder): A 1 , - ( 14-) t 1 c Phone #: 7S6- 1/12— 73 / of, Address: c9640 i E Ca 4 vE- City: £4 / 4 #1,-t ( S.14611-&- S State: 'F-1— Zip: 3.,/ 3co/ Phone* Tenant/Lessee Name: Email: A J1 � E L) LA-3 2 / e > G.C3 (1st JOB ADDRESS: D N ,44, City: Miami Shores County: Miami Dade Zip: 3s / 3 Folio/Parcel#: Is the Building Historically Designated: Yes NO Flood Zone: 4/ ) CONTRACTOR: Company Name: /(.14 Yoh At fks ,,,,dat a to 'Ii-i.- Phone #: & '/7 9,24 Address: f' 93 2 .. -e—) j,-3 H-✓e" State: % Zip: _ - / 7' -c Qualifier Name: 8s9 i/4✓i 14 771 / L ° Phone #: ` ,aa-9 /s--9D State Certification or Registration #: C Z ‘-2)...1 .6 ,3 Contact Phone#: ®S. t g---..c' / g Email Address: en/stye) L` & a_ Cz Ai is ■ 7; L er /J 5 'v7/j, DESIGNER: Architec i n in h , Phone #: II Value of Work for this Permit: $ n�I_Ar) �' Square/Linear Footage of Work: Type of Work: ❑Address DAlteration DNew tigRepair/Replace DDemolition Description of Work: /? /tomes° 3 (4,„..)V �..) A-i kr-- hi 13 "b % j 4 8,/- , / .IC/ eq.-7 2. IS ti esl [ ..C. e- ' ..-, e14- l r C. D r 1,-, Ly. l43-7- City: i-„ n-, Certificate of Competency #: ** * * * * ****** ******* ***** ****W**** *lea i1Y Submittal Fee $ Scanning Fee $ Notary $ Double Fee $ Permit Fee $ Radon Fee $ Training/Education Fee $ Structural Review $ Vey************************************ CCF $ CO /CC $ DBPR $ Bond $ Technology Fee $ TOTAL FEE NOW DUE $ e104rT 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 ECTRICAL 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 Owner or Agent The fo , o ',: instrument was • owled I day of 1,.'; ,201,b��.J identification and wlio did take an oath. s .a7) The foreg • ing instrument was acknowledged before me day of tI�� ,20 % 1 , by ' ' 't My Commission Expires: a * ** * * * * * * * * * * * * * * * * * * *,, * ** APPROVED BY ill \i * * *********************************************************** o is p: -' sonally own to me or who has produced identification and who did take an oath. NOTARY PURL : Sign: Print: My Commission Expir Plans 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. Job Address (where the work is being done): "?.<---d Ls- 6.0Va- City: Miami Shores Village County: Miami Dade Zip Code: .3 > 3 S' 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 D NO ES. ARHI Sheet Attached: YE NO ❑ Contract Attached: YES UNIT BEING REPLACED DATA NEW UNIT A i4--� T L MANUFACTURER 3 iiT0."- AHU or PKG. UNIT MODEL # f2/ia iii°1 3 14_11) COND. UNIT MODEL # ®LI AIv 1 '-t . 1 0 KW HEAT 3 %t.. 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 roCU��PKG PKG UNIT / / PKG UNIT / / EERISEER 4 � V YES NO REPLACING DUCTS E NO YES NO REPLACING THERMOSTAT S NO YES NO NEW 4 °CONCRETE SLAB Y S Q YES NO NEW ROOF STAND YES YES NO NEW RETURN PLENUM BOX YES 1. Minimum Circuit Ampacity (Wire Size): 2. Maximum Overcurrent Protection (Fuse /Breaker Size): 60 3. Voltage of Circuit (208/240/480): ,.,z 4f 0 4. Size Disconnecting Means: e oPf --re, 71-6 m4,1,--) S • ✓. j Contractor's Company Name: n1 a47D 1; 09-i aL ( 4,3b; ; ,� Phone: 9 c.). State Certificate or Registration N. C t 36.3 Certificate of Competency N. Signature (Qualifier's sign Date: -- a- 7 -- )) AC Search i 1 atd•ReEiagemTS Idea At IOW AC Search till HMO ® Mod* ® E*pod dick on a row to viewl dntAHRI . fazB are not available tor O eACandHPegWtanent. Slants ofANNe means markt ate antently In maiden. lasootalnued means that the l ter has elected tostoppre .yetstaokIsea aveRatte. 'Obsotete' mare that the inamdaeuter Is moulted to Mop manuladuthg duo to a test Sedate in the AHRICedEcatonProwants. • .. -- -. Page 1 of 2 Ate Maltatenerma I Sum In I Ate Ce Model j ManatB�aK Tta4wena d e # 1 Type Name 1 OutdoorUnt I Indoor Unit MatedecAaer Model Manutemms Mad& RHEEM RhEEM RHU, 3806012 Robe System 14AJM MANUFACfl ING 14A11442 H1438214RCS1 SERIES COMPANY 411821 dsptaybtg meads 1.1 oft total Furnace !, Capaaib EER SEER Modal i 08ttdr) 40000 13.00 1 &00 AHM Phase ) Type RCU 1 ••A- C13 Bobsleds brExport Est. Memel Ere Annual Fedetel Operating Tax Cooling dedx Cost 291 Yee Copyrgt 2011 At-Cn tateg. a and Ro Rb tf At Malts reserved http:// www. abridirectory. org/ ahriDirectory/pages/ac /defaultSearch.aspx 7/28/2011 AG# Ie DATE 07102/2010 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROESSSIONAL R G�TION CONSTRUCTION INDUSTRY LICENSING $D SEi# L10010200615 BATCH NUMBER 0970-80528 The CLASS. A AIR CONDITIONING CONTRACTOR Named below IS CERTIFIED i Under the provisions of Chapters Expiration date: ATJG 31, 2012. LICENSE i E:R.. CAC050363 "r MAYOLI, ARMANDO bIAYCLI A/C & = 14.EFRIGERATION INC 1937 SW -123 AVE 3 MIAMI 33175 CHARLIE CRIST GOVERNOR DISPLAY AS REQUIRED BY LAW MJAMI- DADE'COUNTY TAX. COLLECTOR 140 W. FLAGLER SL 7st FLOOR MIAMI, FL 33130 228642-5 BUSINESS NAME 1 LOCATION • tIAYOLI.AIR CONDITIONING & REFRIGERATION INC 1937 SW 123 AVE 33175 UNIN DADE'COUNTY CHARLIE iIEM- INTERIM HECRETAR3C_. 2010 LOCAL BUSINESS TAX RECEIPT 2011 MIAMI -DADE COUNTY- STATE OF FLORIDA EXPIRES SEPT. 30, 2011 MUST BE DISPLAYED AT PLACE OF BUSINESS PURSUANT TO COUNTY CODE CHAPTER BA - ART. 9 & 10 THIS IS NOT A BILL - DO NOT PAY RENEWAL RECEIPT NO. 240365 -7 STATED CAC050363 FIRST -CLASS U.S. POSTAGE PAID PERNMM ITT�NNO 1 OWNER MAYOLI AIR CON& & REFRIG INC See. Type of Business WORKER /S 196 SPEC MECHANICAL CONTRACTOR 1 mIS IS ' ONLY A LOCAL BUSINESS TAX RECEIPT. IT DOES LOT PERMIT THE HOLDER TO VIOLATE ANY DUSTING REGULATORY OR ZONING IAMB OF THE DO NOT FORWARD COUNTY OR CITIES. NOR DOES IT EXEMPT THE HOLDER FROM ANY OTHEFI PERMIT CR LICENSE REGUIRI D BY LAW. MS IS NOT A CERTIFICATION OF THE HOLBER`$ OUALUFICAA. PAYMENT MEWED UTAMdt DADE MINTY TAX COLLECTOR: 07/06/2010 09010364001 000075.00 SEE OTHER SIDE MAYOLI AIR CONDITIONING & REFRIGERATION INC ARMANDO MAYOLI PRES 1937 SW 123 AVE MIAMI FL 33175 180 ACCORD 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. CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 7/28/2011 IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(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 ANDYS ASSURANCE AGENCIES 1441 W Flagler St Miami, FL 33135 cNAME: Rodolfo J. Patiflo (NC"No,Ex(). (305) 262 -2200 (aC,No):305 -2 62 -2227 ADDREss:rodolfojpatino@netscape.net INSURER(S) AFFORDING COVERAGE NAICS INSURER A: COlOny Ins CO INSURED Mayoli A/C & Refrigeration, Inc 1937 SW 123RD AVENUE' MIAMI, FL 33175 INSURER B : Granada Ins Co INSURER C : INSURER D : INSURER E : INSURER F : 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. INSR LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY N N GL- 3329564 07/01/11 07/01/12 EACH OCCURRENCE $ 1,000,000 DAMAGE TO REN rED PREMISES (Ea occurrence) $ 100 , 000 CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 5,000 X $500 Ded BI /PD per Claim PERSONAL &ADVINJURY $ 1,000,000 GENERAL AGGREGATE $ 2 , 000 , 000 GEN'L AGGREGATE X POLICY LIMIT APPLIES JET PER: LOC PRODUCTS - COMP /OP AGG $ INCLUDED $ $ AUTOMOBILE — LIABILITY ANYAUTO ALL OWNED AUTOS HIRED AUTOS X SCHEDULED AUTOS NON -OWNED AUTOS N N 0110FL00003380 08/31/10 08/31/11 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ – PROPERTY DAMAGE (Per accident) $ PIP, Zero Ded $ 10,000 UMBRELLA LIAB EXCESS LIAB — OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below YIN — N/A I TORY LIMITS I I OTH 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) Air Conditioning Installation & Service. CERTIFICATE HOLDER Miami Shores Village Building Department 10050 N.E. 2nd Ave Miami Shores, Fl 33138 (305) 756 -8972 1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 4 AUTHOR D -EPRESE; ATIVE `''� ): '' 011111111k ACORD 25 (2010/05) ©19010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of /4CORD ALEX SINK CHIEF FINANCIAL OFFICER DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW a: * CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: PERSON: FEIN: 06 -17 -2009 08/11/2009 EXPIRATION DATE: 08/11/2011 MAYOLI ARMANDO 650389576 BUSINESS NAME AND ADDRESS: MAYOLI AIR CONDITIONING & REFRIGERATION INC 1937 SW 123RD AVE MIAMI FL 33179 SCOPES OF BUSINESS OR TRADE 1- CERTIFIED AC CONTRACTOR IMPORTANT: Pennant to Chapter 440. 051141, F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section may not recover benefits at campens,NOn under this chapter. Pursuant to Chapter 440.05(121 F.S., Certificates of election to be exempt... apply only within the scope of the business or trade listed on the notice of election to be exempt. Pursuant to Chapter 440.05113), F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person named an the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements at this section. QUESTIONS? (8501 413 -1609 DWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09 -06 MAYOLI AIR CONDITIONING & REFRIGERATION INC. 1937 SW 123 AVE MIAMI, FL. 33175 TEL. 305 -485 -1926 FAX. 305 -485 -1531 CAC050363 July 28, 2011 PROPOSAL SUBMITED TO: Angel Diaz 9500 NE 6 Ave. Miami Shores, Fl. 33138 786 - 412 -7310 WORK TO BE PERFORMED AT: Same We propose to furnish labor for the completion of: Replacement of a 31/2 ton a/c system and air duct hoses in attic damaged by rats. Install a new Rheem air handler with 10 kw heater model: RHLLHM3 821 Install a new Rheem 31/2 ton condenser unit model: 14AJM42A01 Replace thermostat and refrigerant under house. Connect to existing electrical and drain pipe. Units and all materials provided by customer. The above work to be completed in a work like manner for the sum of:$1000.00 With payments made as follows: 50% initial deposit Balance upon completion The above price and conditions are accepted. You are authorized to do the work. Payments will be made as outlined above. Customer signature Date