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MC-11-1983Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 li Inspection Number: INSP- 167002 Permit Number: MC -10 -11 -1983 Scheduled Inspection Date: November 23, 2011 Inspector: Perez, JanPierre Owner: WEST, DALE Job Address: 1640 NE 104 Street Miami Shores, FL Project: <NONE> Contractor: COOL BREEZE AIR COND CORP Permit Type: Mechanical - Residential Inspection Type: Final Work Classification: A/C Replacement Phone Number Parcel Number 1122320320430 Phone: 305 - 226 -2665 Building Department Comments EXACT AC CHANGE OUT OF 4 TONS SPLIT SYSTEMS C-17-6 Lt7Z3h/ Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments CREATED AS REINSPECTION FOR INSP- 165887. November 22, 2011 For Inspections please call: (305)762 -4949 Page 28 of 30 . " 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 RECE[VED OCT 2 61011 BY. Permit No r \ Ct� Master Permit No. Permit Type: MECHANICAL OWNER: Name (Fee Simple Titleholder): D A-1 e- W Phone #: 3°5- 61 r 7-4.16 Address: 16.140 A 1 `T S-1- City: i A "X 5 kC WAS State: L Zip: SS 13 Tenant/Lessee Name: Phone #: Email: — JOB ADDRESS: 16 14 4 1 0 ST City: Miami Shores County: Miami Dade Folio/Parcel #: 1 1 2_1- 3 — — 0 L'♦ 3 C.) Is the Building Historically Designated: Yes NO Flood Zone: zip: 3 3138" CONTRACTOR: Company Name: C 001-11) r ea. Ze- A/ C.- Phone #: Address: 1 3 i Z 0 S 141 1 3 0 + & City: rA J2vyv'1 r. State: PL. zip: 3346 Qualifier Name: &- t ' ^rAt... "-�' Phone #: ,405- i� �- State Certification or Registration #: - �^ C� Z ( 3 Z- Certificate of Competency #: Contact Phone #: 3 0 6- Z 1 r? (® t4 -% 5- Email Address: e O'p e.- LI 1 - b f .G A.c , e--C-141 3°3." ZZ.b 2.66 DESIGNER: Architect/Engineer: Phone #: L Value of Work for this Permit: $ Square/Linear Fe of Work: ONew Type of Work: ❑Address DAlteration Desc N ption of Wo k: A c 4 epair/Replace UDemolition ********* * * * * * * * * * * * * * * * * * * *x: * * * * *** *** Fees` * ** * * * * * * * * *** ** * * * ** x** * * * * *** * * *** * * *** ** Submittal Fee $ Permit Fee $ ,` l;, d U CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ _ Structural Review $ TOTAL FEE NOW DUE $ , / J 4 s`0 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 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 reinfection fee will be charged. Signature `L Owner or Agent The foregoing instrument was acknowledged before me this a G The foregoing instrument was acknowledged before me this day of , 20 it , by • 5—t— , day of �,'.• ��, 2011 by who is personally known to me or who has produced P'vtofe S who i r who has produced NOTARY PUBLIC: Signature Contractor As identification and who did take an oath. )- 3 O — C 6 /— �' /m c�a ca Sign: Print: My Commissi a ° o +� ` S Notary • . s`, es 'ec 2'12 n' . 1;r- oy Commission # DD 832497 ,, %,,a"'s Bonded Through National Notary Assn. WI of Florida ersonally known to me as identi jicati' NOTARY PUB Sign: Print: My Co and who did take an oath. omm. Expires Dec 26, 2012 Commission # 00 832497 Bonded Through National Notary Assn. ** o******** ** * * ** *......* * ***m ** **,*****+s .* �****............******......********** *** * **** *****a= *** *** * **o ****** VV (� tpians Examiner APPROVED BY Zoning Structural Review Clerk (Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09) 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 I ~ 1 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 , . w• •s being done): 16 40 U �� Zip Code: 3 3 1 S t/ County: Miami Dade 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 ( I) DATA SHEET REQUIRED Change Disconnecting means: YES ❑ NO ARHI Sheet Attached: YES El<10 ❑ Contract Attached: YES UNIT BEING REPLACED DATA NEW UNIT -j' iZ• t/4 h >r MANUFACTURER 1-e.A v■ E 4 4 4. P e.. 1 Flr CI A AHU or PKG. UNIT MODEL # -r .106 vv 1 A oc.451n L *+)( 4 0 £4 l o l- COND. UNIT MODEL# Li 142- Ov qS, 1jo )A lo 44,- KW HEAT Iv Lit- 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 / / EER/SEER / Cr / / 3 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): 1N', tr. 6 2. Maximum Overcurrent Protection (Fuse /Breaker Size): l\--1 h C / J 3. Voltage of Circuit (208/ 80): Z L. 0 Prdu0cd - J /ti e- 0c0 1^ P �- A' / Phone: 3 0 s 2-2 G 2663- State Certificate or Re • istration N. Certificate of Competency N. �v ? ISO 4. Size Disconnecting Means: Contractor's Company Name: 40 Signature (Qualifier's signature only) Date: This combination qualifies for a Federal Energy Efficiency Tax Credit when placed in service between Feb 17, 2009 and Dec 31, 2011. Certificate of Product Ratings AHRI Certified Reference Number: 4385646 Date: 10/24/2011 Product: Split System: Air - Cooled Condensing Unit, Coil with Blower Outdoor Unit Model Number: 4TTZ0048A1 Indoor Unit Model Number: *AM7A0C48H41 Manufacturer: TRANE Trade /Brand name: XL201 Manufacturer responsible for the rating of this system combination is TRANE Rated as follows in accordance with AHRI Standard 210/240 -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): 47500 EER Rating (Cooling) 13.00 SEER Rating (Cooling): 18.00 Ratings followed by an asterisk ( *) indicate a voluntary rerate of previously published data, unless accompanied with a WAS, which indicates an involuntary rerate. DISCLAIMER AHRI does not endorse the products) listed on this Certificate and 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(s), or the unauthorized alteration of data listed on this Certificate. Certified ratings are valid only for models and configurations listed in the directory at www.ahridirectory.org. TERMS AND CONDITIONS This Certificate and its contents are proprietary products of AHRI. This Certificate shall 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 utiru ed, 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 at wvwvahridirectoty.org, click on "Verify Certificate" link and enter the AHRI Certified Reference Number and the date on which the certificate was issued, which is listed above, and the Certificate No., which Is listed below. ©2011 Air - Conditioning, Heating, and Refrigeration Institute Air - Conditioning, Heating, IRO ®® and Refrigeration Institute CERTIFICATE NO.: 129639466933213931 �l►Vrrao% C16.1-I Air Conditioning Corp? U� YY 'W� f/ llTM 1312030 Terrace • Miami, FL 33186 Dade: 305 - 226 -2665 • Broward: 954 - 797 -0067 • Fax 305 - 253 -4420 www.cool - breezeac.com CACO 24325 (Licensed and Insured) Proposal and Acceptance PROPOSAL SUBMITTED TO T PHONE JOB PHONE DATE l / STREET I641°o 0 4 )d% �� J "4 JOB NAME • • CITY, STATE and ZIP CODE JOB LOCATION ON .A S e5 o /- 32 Lis- PLAN #, DATE & ARCHITECT MAIN CONTACT: Scope of work: (attach additional description and/or drawings if necessary) _D ti c A-- - X6)(-4: 4-1 +. ... . eLd4 L--Th -t 5 vi c., I `t, ..J 4- 11 G', t..,--° +01,1 6 r e- c� % el-t4, L P ii- -�- �-, 4.t.) 1� 70 ° fi r�-� -( f ..fir,,, 0_ Nie 11 2,01 4 4- `1 13 c f2 / )5 3/Z L4 H }4- 049Li l A loc.. )A T-Ae°'i 7 -A 0C 4 -+ 4DSI Proposed Start Date: Expected Completion Date: RESPONSIBILITY SHALL BE ASSUMED AS INDICATED BELOW: Coal Breeze Sub- Others Not Cool Breeze Sub - Others Not Air fDntr. Applicable Air Contr. Applicable Remove and haul away existing system ❑ ❑ ❑ Service Change from Amps to Amps ❑ ❑ _.,111r" Installation of equipment -Mir ❑ ❑ ❑�/ Wiring from existing disconnect to equipment , ❑-, ,Als ❑ IlKe Drain piping ❑ ❑ ❑ �7/ Thermostat installation 4.I ❑ ID Refrigerant piping ❑ ❑ ❑ �1 Install condensate pump ❑ ❑ ❑ L Water piping heat recovery ❑ ❑ ❑ Connect to existing duct system ❑ ❑ ❑ lam' Install ducts and grilles ❑ ❑ ❑ ,I±` Cutting ❑ ❑ ❑ k Duct repair ❑ ❑ ❑ U Patching ❑ ❑ ❑ Bath exhaust fans / ducts ❑ ❑ ❑ Access & clearance for ducts, grills & equip ❑ ❑ ❑ Structural supports for equipment ❑ ❑ ❑ IJ Masonry ❑ ❑ ❑ UK- Pitch pans and or roof supports ❑ ❑ ❑ lair__ �/ Carpentry ❑ ❑ ❑ 0 Thermostat wiring ❑ ❑ ❑ Painting ❑ ❑ ❑ ,�m�' Install new emergency drain pan Li ❑ Li lar Start up and balancing equipment ❑ 1:3 0 0T Warranty: I) Year manufacturer on thermostat i 0 Year manufacturer on parts. Year Cool Breeze Labor. 2 -Year manufacturer on compressor. Extended labor warranty. Warranty effective during regular working hours, excluding general maintenance (filters, breakers, drain lines, accessories, fuses.) Overtime warranty calls to be at prevailing rates. I was offered an extended warranty and Accepted Rejected I have been informed that the deposit given on this special order system(s) will not be refunded after three (3) days right to cancel period. I acknowledge that I will forfeit my deposit if I cancel after the third day. Sign here acknowledging statement above: Comments: t 9 p, A �S5 ,Ai� 1 1 r yoc: 0 Total Investment + $ FPL Rebate - $ 1 I -7 5 eil 9 ✓n VI 11 L � � 0 �/ a- /2... p U c...\--s Ij`(„ �= P` ` s vN 6 � (( ry y y��+�) V ^ Dealer Credit Rebate - $ f i9°4-) �+��,. nc- Customer Balance SI y� Down Payment - Remaining Balance $ 1 - a--,. Prices quoted will be VALID for a period of 60 days from the proposal date of this contract. Mail in Rebate - $ NOTICE TO OWNER: DO NOT SIGN THIS CONTRACT IF BLANK. Other Credit - $ YOU ARE ENTITLED TO A COPY OF THIS CONTRACT AT THE TIME YOU SIGN. Net Cost to Customer $ Payment to be made upon job completion and final inspection as required as follows: U CC#— EXP: _ c) / —� Terms: 5-6 ik 0 i' L,.' e 6 4; V PO A C—C) ✓vt .e. ❑ Personal Check or Money Order ❑ Visa ❑ Mastercard ❑ Discover ❑ American Express Ac -stance (Custo er) Acceptan.'=. (Contracting Firm) By � ;,. ,r _- Date % I 1) By jr —Bette-t..)' i ' reeze A/C Corp. Representative 10/26/2011 WED 10:36 FAX MgORAW 185666'-6.. nISINESS NAME]' OCATION ..: , • . COOL BREEZE•AIR CO.NOITION IP 13120 SW 130 TERR:` 33186 UNIN DADE .COUNTY OWNER COOL BREEZE AIR.GOND CORP.'- Soc. Ty of business • 196 SPEC MECHANICAL CQNTRACTQR. THIS IS ONLY A LOCAL ... • • BUSINESS TAX RECEIPT. tY DOES NOT PERMIT THE HOLDER TO VIOLATE ANY EXISTING REGULATORY OR ZONING LAWS OF THE COUNTY OR CITIES. NOR DOES IT EXEMPT THE HOLDER FROM ANY OTHER PERMIT OR LICENSE REQUIRED XY LAW. THIS IS NOT A CERTIFICATION OF THE HOLDER'S OUAIJF%CA• TONS. PAYMENT RECE MIAMI.DAD£ COUNTRY TAX COLLECTOR: 07/12/2011 60010000123 000075.00 :..RENE.WA EDEIPT::NO:' 6. GAGO24.325 FIRS' U.S F MIL PERMI 6 -6. SEE OTHER SIDE DO NOT FORWARD COOL BREEZE AIR CONDITIONING CORP 13120 SW 130 TERR MIAMI FL 33186 il: liE,/ II: IE) 1 I)/,I:,I111+illli :Ii :III„li :I:I IIII)111 :)14,1 �j001 /001 �® CERTIFICATE OF LIABILITY INSURANCE PRODUCER Tropical Insurance Agency Inc. iiiiii:i 24 Coral Way mi FL 33165 one:305- 221 -2400 Fax:305- 552 -5360 INSURED Cool- Breeze Air Conditioning Corp Insurance Dept 13120 SW 130 Terr Miami FL 33186 OP ID NR COOLB -1 DATE (MMIDD/YYYY) 03/23/11 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 POUCIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURER k NATIONWIDE PROP 6 CASUALTY INS INSURER B: Bridgefield Employers Ins . INSURER C: INSURER D: INSURER E: 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. IN3R LTR INSRD INSRD TYPE OF INSURANCE -POLICY NUMBER D DATE M►y DDIYYYY) DATE (MMIDDIYYYY) LIMITS A GENERAL LIABILnY COMMERCIAL GENERAL LIABILITY 77- BA831775 -0003 01/01/11 01/01/12 EACH OCCURRENCE $ 2,000,000 X S(Eaoocurence) PREMSE tc $100,000 CLAIMS MADE X OCCUR MED EXP (Any one person) $ 5,000 $ 2,000,000 PERSONAL & ADV INJURY GENERAL AGGREGATE $ 2,000,000 GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 2,000,000 POLICY X JECT LOC A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS COMP $1,000 77- 831775 -0002 01 /01 /11 01/01/12 COMBINED SINGLE LIMIT (Esacddent) $ 1,000,000 X BODILY INJURY (Per person) X X BODILY INJURY (Per accident) X X PROPERTY DAMAGE (Per accident) X COLL $1,000 GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ AUTO ONLY: AGG $ A EXCESS / UMBRELLA LABILITY 77- 831775 -0003 01/01/11 01/01/12 EACH OCCURRENCE $ 5,000,000 X OCCUR CLAIMS MADE AGGREGATE $ 5,000,000 DEDUCTIBLE RETENTION $10,000 $ $ $ X B WORKERS AND EMPLOYERS �ICROERIMEMBEREXCLUDE/E (Mandatory K describe SPECAL PROVISIONS COMPENSATION LABILITY ECUTIV1 0830 -34065 04/01/11 04/01/12 X WC S IAI U- ()M - TORY LIMITS ER E.L. EACH ACCIDENT $1,000,000 $ 1,000,000 $ 1,000,000 -j In NH) l E.L. DISEASE - EA EMPLOYEE under below E.L DISEASE - POLICY LIMIT A OTHER Property 77BA831775 -0003 01/01/11 01/01/12 BUS PER'P 850000speci ded 1000 DESCRIPTION OF OPERATIONS /LOCATIONS / VEHICLES /EXCLUSIONS ADDS] BY ENDORSEMENT / SPECIAL PROVISIONS CERTIFICATE HOLDER City of Miami Shores Village 10050 NE 2 Ave ami Shores Village FL 33138 ACORD 25 (2009/01) CITYMIS SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABI UPO INSURER, ITS AGENTS OR REPRESENTATIVES. �/J . AUTHORIZED REPRESENT Alfredo Gonz © 1988 -2009 The ACORD name and logo are registered marks of ACORD RPORATION. All rights reserved.