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MC-11-1831Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 165171 Permit Number: MC -10 -11 -1831 Scheduled Inspection Date: October 11, 2011 Inspector: Perez, JanPierre Owner: LEBOWITZ, MAURICE Job Address: 1285 NE 102 Street Miami Shores, FL Project: <NONE> Contractor: UNLIMITED AIR INC Permit Type: Mechanical - Residential Inspection Type: Final Work Classification: A/C Replacement Phone Number Parcel Number 1132050250120 Phone: (954)968 -2873 Building Department Comments CHANGE OUT A/C SPLIT SYSTEM FROM/ TO 3 TON 13 SEER A/C � lD t l( Inspector Comments Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. October 07, 2011 For Inspections please call: (305)762 -4949 Page 14 of 22 Miami Shores Village Building Department 9OOhi 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 itb 16 l , r o A INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING Permit No I I & l PERMIT APPLICATION Master Permit No. FBC 200'1 Permit Type: MECHANICAL OWNER: Name (Fee Simple Titleholder): 't',Ai14 c€ It 6 660 77 Phone #( 30V 7 5-7/26-6- Address: 112 STIVE / 02 S7 . ° City: )41'1f, 51h010/ State: 4-1-471411°1 . Zip: 3310 . Tenant/Lessee Name: Phone #: Email: JOB ADDRESS: 120 ' NE /02 S7 City: Miami Shores County: Miami Dade Zip: 33/3 Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: 414/011114-14-e4° /li _ Phone #: (295-4,1966- c)P7-3 Address: 276 5 5.6 2 /2 ` City: /4101-1,0,0100 & lrf-f State: 1174 . Zip: 3 3062- Qualifier Name: /14-11C1 J 1-21.40 Phone #: C4 s7)9 . 3? 73 State Certification or Registration #: &CV 575-4V Certificate of Competency #: Contact Phone#: C 7:el 5'48 2 41' 73 . Email Address: DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ '400 42---)' Square/Linear Footage of Work: oltWgr1 OAddress DAlteration DNew t2Repair/Replace ODemolition '''-101.1-4140.,e m ®L/ P `` 77 5 P S yv vx y ti/70 3 rOoU es�riphon of Work: /3 "R e 4-/e____ Submittal Fee $ Permit Fee $ t/ CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ �, k 49 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 FI .ECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDmONERS, 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 he approved and a reinspection fee will be charged. The foregoing instrument was acknowledged before me this % The fore day of Aa 2Q .L , by ivimi 0 O) / , day of who s personally know,p)to me or who has produced who i As identification and who did take an oath. NOTARY PUBLIC: Sign: a Print: N ©Q Aij Sr My ** d Contrdctor was acknowle ged b . e this ,20 A, b` Y1. /_' C F kno me or who has produced _ joo etitification and who did take an oath. TARY PUBLIC: Sign: Print: My Co �' eg Commission # E Assn. ,P�' gonled Itoou9h National Notary ***** **+ six********** ******* s< *w+ x*****+s***** ** *** ********* ** x** ********* 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 1 PERMIT NUMBER: MC 1H ly✓ 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): /2A'(/O2- City: Miami Shores Village County: Miami Dade Zip Code: 33 4;G2-- 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 RE « RED ARHI Sheet Attached: YES I NO ❑ Contract Attached: YES' Change Disconnecting means: YES ❑ N �y1 UNIT BEING REPLACED DATA NEW UNIT °jV�/' MANUFACTURER TEdive. W036 tf,/Q,2 AHU or PKG. UNIT MODEL # lir-Pe 3FJ 6/OO7 44777-50.%0,1 c7k-t& r72v ©36 CJe O,3.3 COND. UNIT MODEL # 84-t, KW HEAT 3 . NOM TONS 3 AHU'/5CU 22 PKG 1) M.C.A AHUO CU ? PKG AHU gD CUSo PKG 2) M.O.P AHU 'CU'2 PKG AHUOOCU4t7PKG 3) VOLTS Allilib CU Z' PKG PKG UNIT / / PKG UNIT / / EER/ ErV 15,,2 YES REP G DUCTS YES YES 1 REPLACING THERMOSTAT YES 0 YES 41 � t." NEW 4 "CONCRETE SLAB YES fp 0 YES i NEW ROOF STAND YES dor,: YES AV NEW RETURN PLENUM BOX YES (V 1. Minimum Circuit Ampacity (Wire Size): 2. Maximum Overcurrent Protection (Fuse /Breaker Size): 5 73 3. Voltage of Circuit (208/240/480): 2c'.?3V2 *0 4. Size Disconnecting Means: 527 Contractor's Company Name: 0M/'"<' Phone: State Certificate or Regis -lion N. ®5 J Certificate of Competency N. Date: /0 .19$"°, /, Signature (Qualifier's s(nature only) ti kale ro u a i n AHRI Certified Reference Number: 3784717 Date: 10/3/2011 Product: Split System: Air - Cooled Condensing Unit, Coil with Blower Outdoor Unit Model Number: 4TTB3036D1 Indoor Unit Model Number: 4TEC3F36B1 Manufacturer: TRANE Trade/Brand name: XB13 Manufacturer responsible for the rating of this system combination Is TRANE 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): 33400 EER Rating (Cooling): 11.00 SEER Rating (Cooling): 13.00 Ratings followed by an asterisk (') indicate a vo4untary relate 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 guarani as to, and assumes no responsibility tor, 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 canftguratians listed in the directory at www. ahritiir ectCrrY. ory. TERMS AND CONDITIONS This Certificate and its contents are proprietary products of AHRI. his Certificate shall only be used for Individual, personal and co fidentlal reference purposes. The contents of this Certificate may drat, in whole or In part, be reproduced; copied; disseminated; entered bnto 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 atbvvraw <,hritlirectoryt,rg, - Air-Conditioning, Heating, click on "Verify Certificate" link and enter the AHRi Ceitlfied Reference Number and the date on and Refrigeration institute which the certificate was Issued, which is listed above, and the Certificate No., which is listed be low. ©2011 Air - Conditioning, Heating, and Refrigeration Institute CERTIFICATE NO.: 129621296736267517 MAINTENANCE INSPECTION CHECK UST CONDENSORS ❑ HEAD PRESSURE ❑ SUCTION PRESSURE ❑ COMPRESSOR AMPS ❑ FAN AMPS ❑ COIL CLEAN ❑ CONTACTOR POINTS O.K. BAD REPLACED ❑ RELAYS O.K. ❑ CAPACITOR O.K. THERMOSTAT ❑ O.K. ❑ REPLACE AYR FILTERS ❑ SIZE ❑ REPLACE NEXT INSPECTION ❑ CLEANED_ REPLACED DUCTWORK ❑ PLENUM TIGHT ❑ REPAIRED PLENUM ❑ DUCTWORK TIGHT ❑ REPAIRED DUCTWORK EVAPORATOR ❑ RINSE COIL (IF APPLICABLE) ❑ COIL CLEAN ❑ COIL DIRTY ❑ MOTOR AMPS ❑ MOTOR LUBRICATED ❑ DRAIN PAN CLEAN ❑ DRAIN PAN DIRTY ❑ DRAIN LINE BLOWN OUT ❑ METERING DEVICE O.K. ❑ CHECKED FOR REFRIGER- ANT LEAKS VISUAL LEAK CHECK ❑ ANY SIGN OF 011 ❑ LEAK CHECK TYPE MISCELLANEOUS o UNITS CLEAN o UNITS RUSTING ❑ ELECTRICAL CONNECTIONS TIGHT ❑ OPERATION OF ALL UNITS O.K. HEATING o TYPE ❑ ELEMENTS ❑ FUSES ❑ RELAYS ❑ AMPERAGE DRAW *1 92. *3 ITEM OR PART DESCRI13491ON PRICE iz> ,. 4_J UNLIMITET3 � !N 2765 SE 2nd Street- Pcmp nl B .ch FL ` 2062 - &?, £c aeeue -i •7 ce rt INANE STREET WORK ,�.� t BEEPER I ZIP d ` _...,. -�8�! n o!Li nar_ [l rnn IG MAKE MODEL SERIAL NULMBEII I WARRANTY _.. ' ❑ MAINT. POLICY PHONE CITY (J r • � T STATE A-/ /C141 JO8 1> 3 %s dpv ` L I LOCATION a 3(/ _ 65 r% DESCRIPTION OF WORK J ❑ CALLBACK J❑ VENDOR CONTRACT GOMMERCIAL 6709 0059CP / 1.11127 1 P; A(L1,-- ,220 lChre' TOTAL PARTS EXISTING EQUIPMENT AHU HANGING CRANE .__ STORIES SLAB SIZE FUSE WIRE SIZE BREAKER SIZE BREAKER TYPE THERMOSTAT O x DIGITAL 3.! NM.ENr CHECK CHRO. CODE TYPE REFRIG. RECOVERED? YES SYSTEM E OTY P M E N NO OTY T NO OTY RECYCLED? RECLAIMED? RETURNED TO THIS SYSTEM DISPOSAL YES n n YES NO OTY nn YES NO OTY CHANGED OUT (OR REPLACED)? DIS- MANTLED? YES NO YES NO REFRIGERANT DISPOSAL TRAVEL TIME 1 1M1 ARRIVED TIME COMPLETED -'i LABOR CHARGES TECHNICIAN SIGNATURE RS MN. - TERMS. DUE UPO ;L n NON USEABLE YES NO QTY DISPOSAL NOTES: PAYMENT TYPE p990 O /' /.oz). FLAT RAM TOT!IL PARTS PARTS DISCOUNT SAS Tr- 1H TOTAL LABOR LABOR DISCOUNT DEPOSIT i TOTAL AMOUNT'- DUE /4 ABOVE ORDERE • • RK HAS BEEN COMPLETED AND I ACKNOWLEDGE RECEIPT OF MY COPY Warran Part ear Labor 45 Days • n e Drains - 415 Days CUSTOMER ALEX SINK STATE OF FLORIDA CHIEF FINANCIAL OFFICER DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. 08 -19 -2010 EFFECTIVE DATE: PERSON: FEIN: 10/21/2010 EXPIRATION DATE: 10/20/2012 SZABO MARIUS 650794672 BUSINESS NAME AND ADDRESS: UNLIMITED AIR INC 2785 S E 2ND STREET POMPANO BEACH FL 33062 SCOPES OF BUSINESS OR TRADE: 1— AIR & HEATING SERVICES IMPORTANT:, Pursuant to Chapter 440 . 05(14), 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 or compensation under this chapter. Pursuant to Chapter 440.05(12), F.S., Certificates of election to be exempt... apply only within the scope of the basiness or trade listed on the notice of election to be exempt. Pursuant to Chapter 440.05(13), 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 on 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 an the certificate to meet the requirements of this section. QUESTIONS? (850) 413 -1609 OWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09 -06 BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A -100, Ft. Lauderdale, FL 33301 -1895 — 954 - 831 -4000 VALID OCTOBER 1, 2011 THROUGH SEPTEMBER 30, 2012 DBA: Receipt #:183-1500 Business Name: U yp e: NLIMITED AIR INC Business T HEATING /AIRCONDITION CONT ( AIRCONDITION CONTRACTOR) Business Opened:01 /05 /1998 State /County /Cert/Reg: CAC0 5 7 541 Exemption Code:NONEXEMPT Owner Name: MARIUS SZABO Business Location: 2765 SE 2 ST POMPANO BEACH Business Phone: Rooms Seats Employees 1 Machines Professionals For Vending Business Only Number of Machines: Vending Type: Tax Amount Transfer Fee NSF Fee Penalty Prior Years Collection Cost Total Paid 27.00 0.00 0.00 0.00 0.00 0.00 27.00 THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT This tax is levied for the privilege of doing business within Broward County and is non - regulatory in nature. You must meet all County and/or Municipality planning WHEN VALIDATED and zoning requirements. This Business Tax Receipt must be transferred when the business is sold, business name has changed or you have moved the business location. This receipt does not indicate that the business is legal or that it is in compliance with State or local laws and regulations. Mailing Address: MARIUS SZABO 2765 SE 2 ST POMPANO BEACH, FL 33062 2011 - 2012 Receipt #03A -10- 00011972 Paid 08/24/2011 27.00 10/03/2011 13:44 9549560555 COVER ALL INSURANCE PAGE 01/01 ACORD, CERTIFICATE OF LIABILITY INSURANCE PRO 0 VC ER DATE (MM/DD/YYYY) 10/0312011 COVER ALL INSURANCE 5800 W, ATLANTIC BLVD. MARGATE, FL. 33063 . PHONE# (954) 956_0006 FAX# (954J 956.0555 ItdSURED UNLIMITED AIR, INC. 2765 SE 2ND STREET POMPANO BEACH, FL 33062 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 INSURER A: AMERICAN VEHICLE INSURANCE COMPANY INSURER B: INSURER C INSURER 0: INSURER E COVERAGES I ANY MAY POLICIES. LTR A Ht POLICtGS REC)UIREMENT. PERTAIN, ,NSarL AGGREGATE OF INSURANCE LISTED BELOW HAVE EEEN ISSUED TO THE TERM OR CONDITION OF ANY CONTRACT OR OTHER THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSURED NAMED ABOVE DOCUMENT WITH 15 SUBJECT POLICY EFFECTIVE DATE IMM/DDIYYI FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING RESPECT TO WHICH THIS CERTIFICATE MAY 8E ISSUED OR TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH TypF AC Ia1ci!axs,nc pQLICY NUMBER POLICY DATE PtRATION Mreem) LIMR5 GENERAL X i C(=N't LIABILITY COMMERCIAL, GF -NERAL LIABILITY GL- 0504006521 -00 12 30 -2090 12 30 2011 EACH OCCURRENCE i 1,000,000 S 100,000 DAMAGE- TO RENTED PREMISES _Ea oecuraricgl L...1 CL AIM:1 MADE OCCUR ' AC,AHt,t.A 11. 1 IMi T APP PER POLICY . PHD. I"'•._ J;(::C ? LOC MEN EXP- (Any- orm,Per.on). A, ,PERSONAL, 8 ADV INJURY $ 5rODD . $ 1,000,000 , . „ -._ GENERAL AGGREGATE $ 1,000,000 $ 1,000,000 PRObUC1'S - COMP /OP AGO AUTOMOBILE LIABILITY ANY AUTO Ali OWNFf7 AiJ1 OR SCHF,DLII.ED AU I OS HIRED AUTOS NON -OWNED At DOS COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (per preen) BODILY INJURY (Per erxldenl) PROPERTY DAMAGE (Per =Meet) S GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT 5 EA ACC 5 OTHER THAN AUTO ONLY: AGE- S EXCESS/UMBRELLA LIABILITY ,1 OCCUR L-....-1 CLAIMS MAIN} __1 DCDUCTIr)1(. RI.TF.NTION $ EACH OCCURRENCE $ AGGREGATE_ $ 5 $ $ ^• WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRICTOR!PARTNFR/FXFCLITIVF 0I•1•IOI'R/MFMRFR rxci UI)I -ol Y yap, An• srnDa untlar SPI -CIAL PROVISI(NL nw _ WC STA- I TORY 1 IMTTA I IFlt E.L. EACH ACCIDENT 5 E.L. DISEASE - E11 EMPLOYEE 5 E.L. DISEASE - POLICY LIMIT 5 OTHER DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS AIR CONDITIONING CERTIFICATE HOLDER CANCELLATION MIAMI SHORES VILLAGE 10050 NE 2ND AVE MIAMI SHORES FL 33138 FAX: 305-756-8972 SHOULD ANY OF THE A ?OIE D$5CRI?ED POLICIES BE CANGELI.ED $EFQRE THE EXPIRATION DATE THEREOF, THE ISSUINOJ*SURER WILL ENDEAVO J MAIL m — DAYS WRITTEN NOTICE TO THE CERTIFIC HO D, N.AMEDTOTHE , UT FAILURE T13DOSOSHALL IMPOSE NO OBLIG ON OR BILITY OFpekr:KIND UPO INSURER, ITS AGENTS OR 4 "—• ( ■ REPRE$ENTATIVE5. \. AUTHORIZED REPRESENTATIVE ACORD 25 (2001/08) ACORD CORPORATION 1988