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MC-11-1806
Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 165044 Scheduled Inspection Date: October 31, 2011 Inspector: Perez, JanPierre Owner: RUDNICK, GREGORY Job Address: 544 NE 93 Street Miami Shores, FL 33138- Project: <NONE> Contractor: HARRIS AIR CONDITIONING INC Permit Number: MC -10 -11 -1806 Permit Type: Mechanical - Residential Inspection Type: Final Work Classification: A/C Replacement Phone Number (305)758 -7791 Parcel Number 1132060141070 Phone: (305)261 -8812 Building Department Comments REAPLCE 2 TON AC UNITS AND AND CONDENSING UNIT Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments October 31, 2011 For Inspections please call: (305)762 -4949 Page 11 of 18 ‘4k-lJjk PEST APPIJ.CATJON FBC 20 Permit Type: MECHANICAL OWNER:Name 'ee Shnple Titlelidlder): 44E4_ c ci . 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) Z62 Permit No. r ' ` c' f l - I C-DC° liastar.RamiOlo, Address: Y° 92 City: ______/2214_22 Amt / fe'� State: 3 ©S r 167`- / �J Tenant/Lessee Name: Zip: � I Phone#: Email: JOB ADDRESS: ,56' e q ?. O City: aa Miami Shores County: Miami Dade Zip: Folio/Parcel#: / L _204 -0,y_ /026) Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: /i06e1%S / /Qd. Li/ Phone#;, Address/01i .S.14.9 7� H City: /17 /-A V State: S L Zip :3.3 1 V V Qualifier Name: - �� _! ®_ Phone#: 3 ©s:- 469-/j 5 State Certification or Registration #: Certificate of Competency #: Contact Phone#: Email Address: DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ 5A 15 , c)' Footage of Work: Type of Work: °Address °Alteration Description of Work: iee-it�4e' 2 D. /El /c CJ' ,v >r S. /0 At e t9 `i / 1/6,4-4t- °New URepair/Replace °Demolition ******************************* Submittal Fee $ ,,,<.\- 4i9 Permit Fee $ Scanning Fee $ lr� 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 it this jurisdiction. 'understand that a separate must be secured for ELECTRICAL. WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S Ali t 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 Iv Applicant. As a contrition to the issuance of a butlding permit -with an estimatedwitue exceedlslg $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 t. achment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection w ' ccurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be j and a reinspection fee will be charged. Signature Owner or Agent The foregoing instrument(( was acknowledged before me this day of Del- , 20 l l , by who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: KYNE ISSION i DD 961625 My Commission ,Tires: *** ** **** *** **** ***way * ** * * ** APPROVED BY Signature Co ctor The foregoing instrument was acknowledged before me this day of �"- ,20(L_.,by who is personally known to me or who has produced as identification and who i . take an oath. NOTARY PUBLIC- "If P% KYNE ISSION 1 DD 961625 Sign: IRES: Ma 6 2014 Print: My Commis on fire s: ********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Plans. Examiner Structural Review (Revised 07 /10/07)(Revised 06 /10/2009)(Revised 3/15/09) Zoning Clerk HARRIS AIR CONDITIONING, INC.' 1011 SW 72nd Ave MIAMI, FLORIDA 33144 TO: Mr. & Mrs. Greg Rudnick 544 NE 93 Street Miami, Shores, Fl 33138 PROPOSAL 82 ibT.758 -7791 JOB NAME / LOCATION JOB NUMBER JOB PHONE We hereby submit specifications and estimates for: Replacement of 2 -2Ton A/C systems. Supply and install 2 -2Ton RUUD split systems with 5KW electric heat. Upstairs - 1.2Ton split system, (SEER 16.5) Air handler in attic with new secondary pan and water cut off switch. Replace T -Stat with White/Rodgers non programmable digital. Condensing unit to be on new 4 inch concrete pad, anchored down with 1.5 inch x 1/4 inch Tapcons. Downstairs - 1-2Ton split system, (SEER 15.0) Air handler in closet with water cut off switch. Replace T -Stat with White/Rodgers non programmable digital. Condensing unit to be on new 4 inch concrete pad, anchored down with 1.5 inch x 1/4 inch Tapcons. Job price $5175.00 plus permit. Warranty: 1 Year labor. 10 Year all parts. We Px ppose he a furnish material d caI a in apc,or ancR wiWh bove specifications, for the sum of: eve 1 housand Oe Hundred Seventy Five and 00/100 Do s dollars ($ Payment to be made as follows: 5,175.00 ). Upon completion. All material is guaranteed to be as specified. All work to be completed in a professional manner according to standard practices. Any alteration or deviation from above specifications Authoriz involving extra costs will be executed only upon written orders, and will become an extra Sign charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control. Owner to carry fire, tomado, and other necessary insurance. Our workers are fully covered by Worker's Compensation Insurance. Acceptance of Proposal —The above prices, specifications and con- ditions 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: PRODUCT 13128G USE WITH 771C ENVELOPE Note: This proposal may be withdrawn by us if not accepted within 15 days. Signature Signature Deluxe For Business 1 -800- 225 -6380 or www.nebs.com PRINTED IN U.S.A. M DO NOT FORWARD HARRIS AIR CONDITIONING INC DAVID J HARRIS PRES 1011 SW 72 AVE MIAMI FL 3 144 11A11,11 ►1111111,111111111 ►,!1111„111 ►1111►► „11MIIIIM SEE OTHER SIDE HARRI -2 OP ID: KC '4i�..- -- R°'° CERTIFICATE OF LIABILITY INSURANCE DA 09119/11 ` ' 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 POUCIES 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 305 - 670 -6111 InSource, Blvd.,#400 3054704699 9�FAX P.O. Box 561567 Miami, FL 33256 -1567 InSource, Inc. N kcT ( tel: o c, Not ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC# INSURERA : Hartford Casualty Insurance Co 29424 INSURED Harris Air Conditioning, Inc. 1011 S. W. 72 Avenue Miami, FL 33144 INSURERS: 21 SBM BM 1406 INSURER c : 08/05/12 INSURER D : $ 300,000 INSURER E : 300,000 $ � INSURER F : $ 1 0,000 COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS 1S 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 POUCIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS INSR LTR TYPE OF INSURANCE ADDL PISA SUER WVO POLICY NUMBER POLICY EFF fMMMDD/YYYY1 POLICY EXP IMMIDD/YYYYI LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY 21 SBM BM 1406 08/05/11 08/05/12 EACH OCCURRENCE $ 300,000 DAMAGE TO RENTED P REMISES (Ea oacurrenael 300,000 $ � MED EXP (Any one person) $ 1 0,000 CLAIMS -MADE X OCCUR PERSONAL & ADV INJURY $ 300,000 GENERAL AGGREGATE $ 600,000 X EPU$5,000 PRODUCTS - COMP/OP AGG $ EXCLUDED GEM. AGGREGATE 7 POLICY LIMIT APLP�IE�S PER: 1Fr.T I ( 1 LOC AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS SCHEDULED AUTOS AUTOS (O COMBINED SINGLE LIMIT - $ BODILY INJURY (Per person) BODILY INJURY (Per accldent) $ PROPERTY $ UMBRELLA LIAR EXCESS LIAR OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ $ DED RETENTION$ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? LI (Mandatory In NH) Ryes, describe under DESCRIPTION OF OPERATIONS below N / A WC STATU- TORY UMITS 0111- 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, I more space is required) ON Miami Shores Village 9 Building Department 10050 NE Second Ave Miami Shores, FL 33138 1 MIAMSH3 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 !�� ACORD 25 (2010/05) ©1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD .a p„ 1/ ALEX SINK STATE OF FLORIDA CHIEF FINANCIAL OFFICER DEPARTMENT OF °FINA144CIAL SERVICES DIVISION OF WORKERS' COMPENSATION * * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW JSIFtcTJN ADIJISTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. 03 -04 -2010 EFFECTIVE DATE: 03/04/2010 EXPIRATION DATE: 03/03/2012 FVUW I: -ASSON SERE A FEIN: 592790757 BUSINESS NAME AND ADDRESS: HARRIS AIR CONDITIONING INC 1O11 SW 12ND MIAMI FL 33144 SCOPES OF BUSINESS OR TRADE: 1- CERTIFIED AC CONTRACTOR 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 ender this chapter. Pursuant to Chapter 440.05(12), 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 440.05(13), F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation 1f, 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 aoy time for failure of the person named on the certificate to meet the requirements of this section. QUESTIONS? (850) 413-1609 DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09 -06 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 (.p..$ 7- 9 Jdt-S 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): , 9 V X5 City: Miami Shores Village County: Miami Dade Zip Code: 3 1 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 94 ARHI Sheet Attached: YESp NO ❑ Contract Attached: YES UNIT BEING REPLACED DATA NEW UNIT € // MANUFACTURER /2#64/4 (iC �= 4 ' • • AHU or PKG. UNIT MODEL # : [ R.A- l4 (tom a 4 �� < COND. UNIT MODEL # / el 4„TM 2 q aC! i, q KW HEAT vi K LA, --- ,Z---- NOM TONS ®1—, AHU CU PKG 1) NLC.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 /3) 6 [ (a,, S YES NO REPLACING DUCTS YES NO YES NO REPLACING THERMOSTAT YES V 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): . /' f9 2. Maximum Overcurrent Protection (Fuse/Breaker Size): 3 C71°,0167 3. Voltage of Circuit (2 /240/41): 110 4. Size Disconnecting Means: 313,411f Contractor's Company Name: / ,4 I4 /I G4/./e 6' ' -I Phone:3 S _ 2cP'/ 1' %L State Certificate or Registration N.,574/ o 7 j Certificate of Competency N. CP CO Signature / 45°— Date: j 9 (qua's signidure I 3 This combination qualifies for a Federal Energy Efficiency Tax Credit when placed in service between Feb 17, 2009 and Dec 31, 2011. AHRI Certified Reference Number: 3412764 Date: 9/24/2011 Product: Split System: Air - Cooled Condensing Unit, Coil with Blower Outdoor Unit Model Number: 14AJM24 Indoor Unit Model Number: RHLL- HM2417 +RCSL -H *2417 Manufacturer: RUUD AIR CONDITIONING DIVISION Trade/Brand name: RUUD 14AJM SERIES Manufacturer responsible for the rating of this system combination is RUUD AIR CONDITIONING DIVISION Rated as follows in accordance wtfi AHRI Standard 214/246- for -Ui itary 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): 24400 EER Rating (Cooling): 13.50 Sttak ng feodflr gg: 16:60. * Ratings followed by an asterisk (*) indicate a voluntary rerate of previously published data, unless accompanied with a WAS, which indicates an involuntary rerate. DISCLAIMER AffIX does not endorse the producdis)listed or this Certificate and maces no represtnttralons, warrandes or guarantees as to, and assumes no msponSIblity toy the product(s) listed or this Certificate. AHRI expressly disclaims ad liability for damages of any kind arising out of the use or performance of the product(s), or the unauthorized alteration of data listed an this Certificate Certifed ratings are valid only for models and configurations listed in the directory at wvdw.ahridirectorycorg. TERMS AND CONDITIONS This CedH1cate and its contents are pmpdetary products of AHRL This CertMcate shad 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;dlssendnated; entered Into a computer database; or otherwise utilized, In any form or manner orby any mans, except forth* uses-MOMMA personal and cotfidenthd reference. CERTIFICATE VERIFICATION The information for the model cited on this certificate can be verified at www.ahridirectory.org, click on "Verify Certificate" link and enter the AHRI Certified Reference Number and the date on which the certificate was issued, which Is Mal above, and the Certificate No., which Is listed below. .2011 r a C t i t e r d i t t if1g, AftdRefftgeffittem t t to CERT4PICATE Air - Conditioning, Heating, and Refrigeration Institute 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 0 AO �'�A J 41—$ 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): j"— 4/C7 City: Miami Shores Village County: Miami Dade Zip Code: 3 / 3 2 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 (j ARHI Sheet Attached: YES C J NO ❑ Contract Attached: YES E I UNIT BEING REPLACED DATA NEW NIT R ki- 6-6 AI MANUFACTURER El e g r_ ti CP-4 1- or PKG. UNIT MODEL # le L. ii V/ ¢)_ (.3 (./ T..°1-5 COND. UNIT MODEL # / y 4 a'/ / 2'/,4 ®1 �� � KW HEAT .2_ 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 UN / / EER/SEER /2.i.ri /6i YES NO REPLACING DUCTS YES ter- ,, YES NO REPLACING THERMOSTAT YES NO YES NO NEW 4ACONCRETE SLAB YES s- NO YES NO NEW ROOF STAND YES NO YES NO NEW RETURN PLENUM BOX YES NO 1. Minimum Circuit Ampacity ire Size): ./e7 2. Maximum Overcurrent Protection (Fuse/Breaker Size): ,3 ®A9 /2jd� 3. Voltage of Circuit (208/240/480): cp2 �O 4. Size Disconnecting Means: / 3C449 P Contractor's Company Name: /4 4 [I4/5 (10,v IS Phone:. — State Certificate or Registration N..S./c/ ®1 61 Certificate of Competency N. CA Signature (Qualifier's sign a only) AHRI Certified Reference Number: 3849904 Date: 9/24/2011 Product: Split System: Air- Cooled Condensing Unit, Coll with Blower Outdoor Unit Model Number: 14AJM24 Indoor Unit Model Number: RHBL -FR24T Manufacturer RUUD AIR CONDITIONING DIVISION Trade/Brand name: RUUD 14AJM SERIES Manufacturer responsible for the rating of this system combination is RUUD AIR CONDITIONING DIVISION Rated as follows In accordance with A11RfStandard"2'i = fortlnitary Alr-tondftioning and`AfrSource Heat Pump Equipment and subject to verification of rating accuracy by AHRI- sponsored, independent, third party testing: Cooling Capacity (Btuh): 24400 EER Rating (Cooling): 12.50 EER1a thg oaiirigj: ¶5.00 • Ratings followed by an asterisk (•) indicate a voluntary rerate of previously published data, unless accompanied with a WAS, Mich indicates an involuntary rerate. DISCLAIMER AHRI does not endorse the prod-twits) fisted an this Certificate and makes no representations, wananttes or guarantees as to and assumes no responsib5ty for, the product(s) listed at this Certificate. AHRI expressly disclaims ag liability for damages of any ldnd arising out of the use or performance of the pnoduct(s), or the unauthorized aeration of data listed an this Certificate. Certified ratings are vend only for models and configurations listed hr the directory at www.ahNdirectorKorg. TERMS AND CONDITIONS This Certlflcate and Its contents are proprietary products of AHRI. This Certificate shag only be used for individual, final and confidential reference purposes. The contents of this Certificate may not, In whole or in part, be reproduce!; copied; disserdnated; entered into a computer database;.or otherwise utlllzed, in any form or Wanner orby any mans, except for the user's individual, personal and confidenfkd reference. CERTIFICATE VERIFICATION The information for the model cited an this certificate can be verified at www.ah rid l recto ryorg, dick an "Verify Certificate" link and enter the AHRI Certified Reference Number and the date on which the certificate was issue!, which is listed above, and the Certificate No, which is listed below. ©2201 1 Air- Candittiorrtng, f leafing, and Reffigeratiod firistiti% CERTi tCATE ice:: 12R6117332/4784606 Air- Conditioning, Heating, and Refrigeration Institute