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MC-11-1376Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 162635 Scheduled Inspection Date: August 10, 2011 Inspector: Perez, JanPierre Owner: EVERETT, HENRY Job Address: 9600 NE 2 Avenue Miami Shores, FL 33138- Project: <NONE> Contractor: LARRABEE AIR CONDITIONER INC Permit Number: MC -7 -11 -1376 Permit Type: Mechanical - Commercial Inspection Type: Final Work Classification: A/C Replacement Phone Number (727)461 -4370 Parcel Number 1132060132510 Phone: (305)887 -1573 Building Department Comments 12.5 TON CONDENSER REPLACEMENT EXISTING AIR HANDLER REMAINING rs LO ( Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments 7 -l(- l37)-6 August 09, 2011 For Inspections please call: (305)762 -4949 Page 21 of 29 1 AI95!1 CERTIFIEDTM www.ahridirectory.org Certificate of Product Ratings AHRI Certified Reference Number 3541834 Date: 8/1/2011 tStatus: Active Product: Split System: Air - Cooled Condensing Unit, Coil with Blower Model Number: TTA150E3**A* Indoor Model Number: TWE150E3*"A* Manufacturer: AMERICAN STANDARD, INC. Trade/Brand name: AMERICAN- STANDARD Rated as follows in accordance with AHRI Standard 340/360-2007, Commercial and Industry Unitary Air - Conditioning and Heat Pump Equipment and subject to verification of rating accuracy by AHRI- sponsored, independent, third party testing: Cooling Capacity (Btuh): 150000/150000 EER Rating (Cooling): 11.00/11.00 IEER: 13.2/13.2 Heating Capacity at 47F (Btuh): COP at 47F: Heating Capacity at 17F (Btuh): COP at 17F: t Models with an 'Active' status are those that are currently in production. Modals with a'Discontinued' status are those that the manufacturer has elected to stop producing, yet stock is still available. Models with an 'Obsolete' status are those that the manufacturer Is required to stop manufacturing due to an AHRI certification program test failure. • Ratings Bowed by an asterisk (`) indicate a voluntary meta of previousty published data, unless accompanied with a WAS which indicates an involuntary rerate. DISCLAIMER AHRI does not endorse the product(s) listed on this Certificate anti 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$), or the unauthorized alteration o f d a t a listed on thls C e r t i fi c a t e . C e r t i fi e d ratings a r e valid o n l y for models and configurations Listed in the directory a t wwwahridirectory org. TERMS AND CONDITIONS This Certificate and Its contents are proprietary products of AHRL This Certificate :0100 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 foam or manner or by any means, except for the user's individual, personal and confidential reference. CERTIFICATE VERIFICATION cling information for the model cited on this certificate can be verified at www.ahufdir+ectory.org, click on "Verify Certificate" link and enter the AHRI Certified Reference Number and the date 00 Am ■m tII which the certificate was issued, which Is listed above, and the Certificate No., which Is listed below. Air - Conditioning, Heating, and Refrigeration institute ©2011 Air - Conditioning, Heating, and Refrigeration institute CERTIFICATE NO.: 129566744111051532 l,' d L£9 V6LZ-90C 6uluompuo3.ily eegauai aE£ :80 1.1. 1.0 6ny 1 1 Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Parcel Number Applicant 9600 NE 2 Avenue Miami Shores, FL 33138- 1132060132510 Block: Lot: HENRY EVERETT Owner Information Address Phone Celi HENRY EVERETT 188 DEVON Drive CLEARWATER BEACH FL 33767- (727)461 -4370 188 DEVON Drive CLEARWATER BEACH FL 33767- Contractor(s) Phone Cell Phone LARRABEE AIR CONDITIONER INC (305)887 -1573 Valuation: Total Sq Feet: $ 10,680.00 0 1 Tons: 12.5 Additional Info: CONDENSER UNIT REPLACEMENT ONLY Classification: Residential Approved: In Review Comments: Date Approved: : In Review Date Denied: Type of Work: MECHANICAL Scanning: 2 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Total: Amount $6.60 $4.81 $4.81 $2.20 $320.40 $6.00 $8.80 $353.62 Pay Date Pay Type Invoice # MC -7 -11 -41599 07/29/2011 Credit Card 08/02/2011 Check #: 4287 07/29/2011 Credit Card Amt Paid Amt Due $ 50.00 $ 303.62 $ 253.62 $ 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 02, 2011 Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy Date August 02, 2011 1 NOTICE OF COMMENCEMENT A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION PERMIT ` -7- If'j37 TAX FOLIO NV 3.Q 013`a5)b STATE OF FLORIDA: COUNTY OF MIAMI -DADE: STATE OF F 1 HEREBY CE THE UNDERSIGNED hereby gives notice that improvements will be made to %won property, and in accordance with Chapter 713, Florida Statutes, the following 'information is provided in this Notice of Commencement. 1. Legal description of property and street/address: WITNESS my HARVEY By 111111111111111111111111111111111111111111111 CFN 201 1 8051 1 842 OR Bk 27777 F's 1548; (1ps))) RECORDED 08 /i i2/2O11. 14:14:53 HARVEY RUVINr CLERK OF COURT MIPilhI— C'AG'E COLfl4T'Yr FLORIDA LAST F'AGE ORIDA, COUNTY OF DADE TI FY that this Itr s true copy of the otlico on 0 If Of AD20 1/ CourRy Cctes J" D.C. Space abo a reserved for use of recording office CI Loo N > E Prve , a Ao FlOOrz) Fl- /9 7;/.2.. lb Ai sip 2. Description of improvement 3. Owner(s) name and address: Interest in property: Name and address of fee simple titleholder: 4. Contractor's name, address and phone number: A. A)r1s £1- Th)i 5. Surety: (Payment bond required by owner from contractor, if any) Name, address and phone number. Amount of bond $ 6. Lender's name and address: 7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided by Section 713.13(1)(a)7., Florida Statutes, Name, address and phone number: -Voiv �2 GAp2ivP rev& a'Ah, F� , 337(.7 -ay.3� 8. In addition to himself, Owners designates the following person(s) to receive a copy of the Lienor's Notice as provided in Section 713.13(1)('0), Florida Statutes. Name, address and phone number: 9. Expiration date of this Notice of Commencement: (the expiration date is 1 year from the date of recording unless a different date is specified) WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713.13. FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PRO OTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU IN n FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR R • = • -►t�l��►.zsr�.1; NT. • , / irector/Partner /Manager Prepared By �.!dr% /i J g' Prepared By Print Name U_!,�;r �;?! Print Name Title /Office .,j Title /Office STATE OF CO RIDA OF MIAMI -DADE The foregoing instrument was acknowl By /-I6A» Y A aVaReTY ❑ Individually, or ! as c WN ❑ Personally known, or tt produced the following type of identification: Signature of Notary Public: Print Name: (SEAL) dged before me this '_ day of . .2011 for 1 NE IFIC ION PU Under penalties of p that the fa . stated i _. . he best of my knowledge and belief. E YEA E11 f3t,s9t.DJMG T TO SECTIO 9 525 FL • RIDA STATUTES e that I have read the foregoing and VCRtS Ll�,vre tmAcoilesisersrairsONINISIBIENI Oa N, JOSEPH L. ANDRE MY COMMISSION # DD910824 EXPIRES: Se l�O COQ t.6,2013 F Sep t.6,2013 998 -0153 Florida Notary Servioe aom Authorized Officer /Director /Partner /Manager who signed above: By F Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 JUL 2 5 RED 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 (Fee Simple Titleholder): FRAi 4 / 7 E-712-e7T Phone #: Q.S °- a ®03 Address: / 8 D Vcfie! bai civil-le/414u 1 %1 p._ BE State: t-Of -.1'1) Zip 31 L7 ail 3g Permit No. Mal I s7p Master Permit No. C7 e0 Tenant/Lessee Name: Email: EV Ea i/ a 0 A b y 0 am JOB ADDRESS: 1 (O O N t � C ND City: Miami Shores County: Folio/Parcel #: 3 D....G 6 0 3 - LS 10 Is the Building Historically Designated: Yes NO Phone #: Ver.ofziz -o4o Jl;T' FI00R. Z.-0W b ry1,-> Miami Dade Zip: �3 /3lS Flood Zone: (QS") Phone #: 8g7 9-/5 7.2 CONTRACTOR: Company Name: LA RR -BEE /42 C. 411 D J 1 NM- Address: 71 7/ Ay k! 7Y -S r' E-a 7- City: th / �p}��7-j ; State: F -70P-J n4 Qualifier Name: / W 0 R i Aiv LigaQ ere State Certificatii n or Registration #: CAC() ..) 309 Certificate of Competency #: Contact Phonek j 64) a52- D._0(:73 Email Address: N t' AR QL Bell SV LITIJ , IV Er DESIGNER: Architect/Engineer: Phone #: Zip: 33/ , Phone #tab) c a ,,043 Value of Work for this Permit: $ 10, 4 RO Type of Work: OAddress OAlteration Description of Work: / . 5- Square/Linear Footage of Work: ONew epair/Replace ®� I1z1 RJ��A�q 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 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 conzznencement must be posted at the job site for the first inspection which . _ , rs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not he ee will be charged. Signature or Agent The for- gins6ument was acknowledged b .re me this 2 9 dayok L.)' ,20 !� ,by heNR who is personally known to me or who has produced )Rtv R1S C I S As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: To SE en L. /I NA My Commission Expires: 011/ Contractor hi OikeNAN EEC The foregoing instrument nstt-r��u --ment was acknowledged before me this-7 L. day of sWly, 20 // , LA 4 e cv-tils personally known to nrsityr who has produced as identification and who did take an oath. NOTARY PUBLIC: APPROVED BY d � ton gn. JOSEPH L. ANDRE Pint: /_. MY Lommt6Stura, • DD910824 nom EXPIRES: Sept. 6,2013 y Commission €3 398-0153 Saida Notary SeMc..00m *a sk ******************************* ***************** ***** ********* Plans Examiner Structural Review (Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09) Zoning Clerk 7171 NW 74th Sired liana, FI. 33166 Flame: 305-887-1573: 887-5184 Fax: 885-0994 Proposal Date: July 29, 2011 Proposal submitted to: Henry & Fran Everett 9600 N.E. 2"Avenue Miami, Shores, Florida 33138 Suite 209 Phone: 786 - 382-1695 Job Name: Second floor 12-1/2 ton condenser change out Attn: Henry & Fran We propose hereby to furnish material and labor in accordance with specifications below, for the sum of Ten thousand six hundred and eighty dollars 00 /100 $10,680.00. Larrabee Air Conditioning, Inc. proposes to furnish labor and material necessary to install a new American Standard condenser for second floor offices at the above location as follows. 1. Demo: Remove the existing condenser from high roof and take to salvage yard. 2. Install new American Standard condenser model TTA150D300A back in same location as old equipment. 3. Install new roof stand and set new condenser on stand, secure unit to stand. 4. Install pitch pans on roof stand legs and make water tight. 5. Install new line jack and make water tight. 6. Install new 2 stage digital thermostat in same location as old stmt. 7. Reconnect new equipment back to the existing electrical, refrigerant piping and control system as before. 8. Check refrigerant piping for leaks. Pull vacuum on system, charge and check system for proper operation. 9. After completion this contractor will do a T&B on air flow to rooms. 10. Warrantee: This contractor will give one -year parts and labor for work performed under this contract and additional 4 years on compressor only as "per manufacturer warrantee. 11. Permit fees and crane are included in this proposal. 12. Price: $10,680.00. Note: This Proposal may be withdrawn if not accepted within 30 days. Authorized Signature All materials are gaarameed to be as . ; All wait to be completed in a e manner according to standard p . Any alraations or deviation fiom specifications above involving extra rust will be executed only upon written orders and will become an eta urge over and above the estimate. All agreements are contingent upon accidents or delays beyond our control Acceptance of Proposal: The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payment will be made as outlined above. Date of acceptance: Signature Signature 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): l='00 G Vc. Gvv° FJa oz.) City: Miami Shores Village County: Miami Dade Zip Code: 3'3 g 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 AlZ. t , a • MANUFACTURER AHU or PKG. UNIT MODEL # COND. UNIT MODEL # KW HEAT Q .S NOM TONS / .a-a �' l AHU PKG 1) M.C.A AHU CU PKG AHU 1 PKG 2) M.O.P AHU PKG AHU CU PKG 3) VOLTS 2.0,/2 3 co /mac, AHU CU., PKG PKG UNIT / / / ! PKG UNIT / / _ REPLACING DUCTS Y S REPLACING THERMOSTAT AYE NO e5 NEW 4"CONCRETE SLAB YES NO N NEW ROOF STAND 4t:,,-(� YES NO NEW RETURN PLENUM BOX S l N) 1. Minimum Circuit Ampacity (Wire Size): 2. Maximum Overcurrent P ection (Fuse /Breaker Size): 3. Voltage of Circu (2081240 y 80): 4. Size Disconnecting Means: Contractor's Company NameLARS State Certificate or Registration N.CI ..O /3 O Signature (Qual er's signature only) Ow 1), Jlll�., Phone00. ) 27- J3 Certificate of Competency N. Date: 7/ 774 REP ISOICOREP CERTIFICATE OF LIABILITY INSURANCE OP ID TM DATE(MMIDD/YYYY) 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 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 BROWN & BROWN OF FLORIDA INC 14900 NW 79th Court Suite #200 Miami Lakes FL 33016 -5869 Phone:305- 364 -7800 Fax:305- 822 -5687 6oN1 A(.I NAME: PHOE A/C, No, Ext): FAX No): ADDRESS: PRODUCER CUSTOMER ID #: LARRA -1 INSURER(S) AFFORDING COVERAGE NAIC# INSURED LARRABEE AIR CONDITIONING DBA KAR & LARRABEE MECHANICAL CONTRACTORS 7171 NW 74th STREET MEDLEY FL 33166 INSURERA: FCCI Insurance Company 10178 INSURER B : FCCI Couonercial Insurance Co 33472 INSURER C : 07/01/12 INSURER D $ 1 , 000 , 000 INSURER E : PREMSES(Eaoccurrence) 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 NSURANCE 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 11.. INSR SUEF WVD POLICY NUMBER POLitY -EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS A GENERAL LIABIU Y COMMERCIAL GENERAL LIABILITY OCCUR CPP00073905 07/01/11 07/01/12 EACH OCCURRENCE $ 1 , 000 , 000 X PREMSES(Eaoccurrence) $ 100,000 CLAIMS -MADE X MED EXP (Any one person) $ 5,000 X XCU NOT EXCLUDED PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2, 0 0 0, 0 0 0 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 2,000,000 7 POLICY X P RO T - LOC JEC $ B AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS CA00091175 07/01/1107/01/12 COMBINED SINGLE LIMIT (Ea accident) $ 1 r 000 r 000 X BODILYINJURY(Perperson) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ X X $ $ B X UMBRELLALIAB EXCESS UAB X OCCUR CLAIMS -MADE UMB00066794 07/01/11 07/01/12 EACH OCCURRENCE $ 3,000,000 AGGREGATE $ 3 , 000 , 000 DEDUCTIBLE RETENTION $ 10000 $ — X $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIy� OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, DESCRIPTI I N OF OPERATIONS / NI N / A WC11A59772 05/10/11 05/10/12 X TWCSTAITS X OER E.L EACH ACCIDENT $ 500,000 �Y I� below E.L. DISEASE - EA EMPLOYEE $ 500,000 E.L DISEASE - POLICY LIMIT $ 500 , 0 0 0 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) CERTIFICATE HOLDER CANCELLATION MIAMI55 Miami Shores Village Building Department 10050 NE 2nd Ave 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 OP . _"�•.!all, -.4 ACORD 25 (2009/09) © 1988-2009 ACORP CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD