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MC-11-1409Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 L Inspection Number: INSP - 162796 Scheduled Inspection Date: August 10, 2011 Inspector: Perez, JanPierre Owner: RANDLE, JULIA Permit Number: MC -8 -11 -1409 Job Address: 150 NE 103 Street Miami Shores, FL 33138- Project <NONE> Contractor: CENTRAL COMFORT AIR CONDITIONING Permit Type: Mechanical - Residential Inspection Type: Final Work Classification: A/C Replacement Phone Number Parcel Number 1132060131740 Building Department Comments REPLACEMENT OF 3 1/2 TON CONDENSING UNIT Inspector Comments Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. August 09, 2011 For Inspections please call: (305)762 -4949 Page 24 of 29 1505 1-P7 le‘f Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 �I Q INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION FBC 20 AUG 0 2011 Permit No. ° ))—/4c51 Master Permit No. Permit Type: MECHANICAL OWNER: Name (Fee Simple Titleholder): I�.l A..1 0i QL (-La. 1. `€ Phone #: 30 �^ 7 % =� 3 ) Address: cg c E 1 O City: i i) x rA:k c ® ri 5 State: A— / Zip: 33 `` i 3 LS Tenant/Lessee Name: / Phone #: Email: t S't o r., E Ch-c� , . C 0 JOB ADDRESS: \ t\ \ D 3 St City: Miami Shores County: Miami Dade Zip: 1 3 S Folio/Parcel #: Is the Building Historically Designated: Yes NO X Flood Zone: tV (� CONTRACTOR: Company Name: C.an- t Pal. C'0 rr, 4;4 ail ( Phone #: SO f S ' 8) S `, 5 Address: °I-) -Li C .\J 1 0 0, e.,P City: V"*"•■ M State: Zip: ,3311 J Qualifier Name: (3-5---1 Phone #: 307 Scg'1 S 7V State Certification or Registration #: - C_b 51 '' -2.-. Certificate of Competency #: Contact Phone #: .$ r `?--1\ "1 s 9 T Email Address: DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ V-943 '() 0 Square/Linear Footage of Work: Type of Work: ❑Address ❑Alteration ❑New 4IRepair/Replace ODemolition Description of Work: c62.eiFo., fi 3`j'Z, +#31•,, Q.0rt to erg Ort ** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** **** es************* ** ** **** * * ** **** * ****** ***s ** ** Submittal Fee $ Permit Fee $ �' ' �CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ 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 AFF'IDAVIT: 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. Sign The day of w139 is 1 Signature NOT 101 rersona Owner or Agent ment�was ac o edged before , 201L._, by 0 01'' y7 gknoowp to me or who has produced �% The fore day of erson y kno s identification and who did take an oath. Contract ent was ackno, ed • e s� ,20,by �.. �.Ih to me or who has produced • ntification and who did take an oath. LIC: .)( PUBLIC: Sign: Print: My Commission Expires: * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** ell Sign: :�� : . A AW L4W ► 1l %1» h Print: r"., ('' 1.3 (,().' My Commission Expires: T` ; `CL0'.. U 717 v : �t :. ��, : :03e2' is � r• il Qca,y ****** *** ** *** ***** * * ****** ** * * **** ** *********** * **** APPROVED BY 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): \ SO t" I 0 3 City: Miami Shores Village County: Miami Dade Zip Code: 3 '3 t 3ls 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 E. NO ❑ Contract Attached: YES UNIT BEING REPLACED DATA NEW UNIT ara 1,45 tLt 241L\--2._ MANUFACTURER AHU or PKG. UNIT MODEL # COND. UNIT MODEL # KW HEAT NOM TONS .61kii +0., 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 NO REPLACING DUCTS YES NO YES NO REPLACING THERMOSTAT YES NO YES NO NEW 4"CONCRETE SLAB YES NO YES NO NEW ROOF STAND YES NO YES NO NEW RETURN PLENUM BOX YES NO 1. Minimum Circuit Ampacity (Wire Size): 2. Maximum Overcurrent Protection (Fuse/Breaker Size): 3. Voltage of Circuit (208/240/480): 2.M,0 °UO ti 4. Size Disconnecting Means: Contractor's Company Name: C..@ 4k AL C.o ,.CQ,� talc C°` ' Phone: State Certificate or Registration N. C AC-t) SI5 2, Certificate of Competency N. Signature C3St-4 Date: 4 ` \ 1 (Qualifier's sign ire ly) 08/04/2011 13:42 305 - 220 -2263 EUI PAGE 01/02 ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE (M o""YTY) PRODUCER (305)220-2280 Eastern United Insurance 175 Fontainebleau B Ivd. Suite 2A -1 MI am I , FL 33172 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # MUM' CENTRAL COMFORT AIR CONDITIONING, CORP. 9721 SW 102 AVE. RD. MIAMI, FL 33176 (305)281 -7597 Ext. INSURERA:NATIONAL GROUP INSURANCE CO. 12216 INSURER s: CASTLE POINT FLORIDA INS. CO. f!NERAL INSURER O! 0110003334 01 INSURER ICE INSURER E; $ 141:10 000 COVERAGES 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. INBH LTR AMC NSRD. TYPE OF INSUIIANr� POLICY NUMBER POLICY EFFE6TIVE DATE rmm POLICY T)ON BATE t�Al LOWS A f!NERAL LIABILITY COMMERCIAL GENERAL LABILITY 0110003334 01 _ F_ACH ooCURRENCE $ 141:10 000 X a o�sts s =UMW 8 100,000 CLAIMS MADE X OCCUR MEP EXPOrty one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 8 1,000)000 $ 1,0001000 GEN'L GENERAL AGGREGATE AGGREGATE LIMIT APPLIES PER: l POLICY n j R n LOC PRODUCTS - COMP/OP AGG AIn'CNdOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULEDAUTOS HIRED AUTOS NON•O NNED AUTOS COMBINED SINGLE LIMIT (Ea aaard) 8 6.-- BODILY INJURY (Perparrran) 8 --- BODILY INJURY (Per Reald,mi) ffi --- PROPERTY DAMAGE $ GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ AUTO ONLY: A4� $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR �- CLAIMS MADE RETENTION $ AGGREGATE $ RDEDUCTIBLE $ $ B WORKERS COMPENSATION AND ENYPR ER PROPRIETOR/PARTNER/EXECUTIVE ANY PROPRIETORtPARTNERrEXEC�.ITIVE OFFICER/MEMBER EXCLUDED? e � under SPECIAL PROVISIONS below WCP780521900 10/01/2010 10/01/2011 S TOOT TATU- I ( °Fa ELEAOHAOCIDENT $ 100,000 EL DISFJUSE - EA EMPLOYEE $ 100,000 E.L DISEASE • POLICY UM' $ 500.000 OTHER DISSORIPTION OF OPERATJOR3 / LOCATIONS (VEHICLES( EXOLUSIONS ADDED BY ENDORSEMENT f SPECIAL PROVISIONS AIR CONDITIONING CONTRACTOR. $500.00 DEDUCTIBLE B.I. A P.D. PER CLAIM APPLIES. WRITTEN NOTICE FOR WORKER'S COMPENSATION SHOULD READ 30 DAYS IN LIEU OF 46. CANCELLATION MIAMI SHORES VILLAGE 10050 NE 2 AVE. MIAMI SHORES FL 33138 (305)756 -8972 Ext. ACORD 25 (2001/08) SHOULDANYOPTREAsoVEDERMAIDEDpoLimeRnscANcELLMSBEFORETHERENHATION DATE THEREOF, THE ISSUING INSURER WILL K NDEAVOR TO MAIL 45 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR r.1ABU y -NO UPON THE INSURER, ITS AGENTS ON REPRESENTATIVES. ��■ AUTHORED REPRESENTA AC • RD CORPORATION 1988 Aug 04 11 01:09p Central Comfort Air Condi 3055988210 p.2 MIAMI -DADE COUNTY. • •.� :2011 * ` • ' LOCAL:BUSINESS TAX RECEIPT•.'• .•. 2012 • • FIRST -CLASS • TAX COLLECTOR . • ' " .. MIALU -DADS COUNTY - STATE OF FLORIDA ' U.S. POSTAGE 140 W. FLAGLER S7 EXPIRES SEPT. 30, 2012• PAID 1st FLOOR MUST SE DISPLAYEO.AT PLACE OF BUSINESS MIAMI, FL MIAMI, FL 33130. PURSU'ANTTO COUNTY CODE CHAPTER OA - ART. 9 & 10 PERMIT NO. 231 387053 -3 7::ii: idt:: 6aLi- — D.:.3 1' s' IP :.V 'RENEWAL... . "VgFei t E6biN� AIR CONDITIONING STATE EOLi 7552 ' 404086 -1 -CORP 9721 Sid 102 AVE RD *EE 33176 UNIN-DADE COUNTY D CENTRAL COMFORT AIR COND CORP se.gRL. "CHANICAI CONTRACTOR NORKE1 /5 as IS OW.Y A LOCAL BUSINESS TAX RECEIPT. IT DOES NOT PERMIT THE HOLDER TO VIOLATE ANY EXISTING- REGOLATORT CIR - . 201411/0 LAWS OF 'THE DO NOT FORWARD COUNTY OR CITIES. NOR DOES THE CENTRAL COMFORT AIR CONDITIONING HOLDER r .EXEMPT ANY 111E PERMIT OR LICENSE REOLMEO BY LAY /. THIS IS CORP THE H aunua cA. ALEX MARTINEZ PRES TiQ13' • 9721 SW 102 AVE RD PAYMENT RECEIVP,D MIAMI FL 33176 ?SIAM -DACE COUNTY TAX COLLECTOR. . 07/12/2011 60050000465 -- 000075:00- SEE OTHER SIDE 11I HISS th1f IJll111lMi III 111111t1I ILI11 1111>r11,d1I 1111 1 3055988210 Central Comfort Air Condi Aug 04 11 01:09p •... • *STATE OF FLO