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MC-11-1104Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 161048 Permit Number: MC -6 -11 -1104 Scheduled Inspection Date: December 19, 2011 Inspector: Perez, JanPierre Owner: ROBERTS, BERYL BURKE Job Address: 801 NE 92 Street Miami Shores, FL 33138- Project: <NONE> Permit Type: Mechanical - Residential Inspection Type: Final Work Classification: A/C Replacement Contractor: COAST TO COAST AIR CONDITIONING & REFRIGERATION I Phone Number Parcel Number 1132060050110 Phone: (305)652 -5680 Building Department Comments EXACT CHANGE OUT OF 1 TON SPLIT SYSTEM INCLUDE AIR HANDLER, CONDENSER, HEATER AND NEW 4" SLAB & STAT 67-q vii 14 Inspector Comments Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. December 16, 2011 For Inspections please call: (305)762 -4949 Page 5 of 34 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 Permit Type: MECHANICAL Owner's Name (Fee Simple Titleholder) A"" 1 Owner's Address '5 6/ e Z. City d4 /J l 4/ >1(}� fgtate Tenant/Lessee Name N {ua ALZ', Email Permit No. ► ` 1 11°1 Master Permit No. ojed° f Phone # '30.5 "c-F—t2---93 Zip ) 3g -- ` ©g Phone 9 -7 2% Job Address (where the work is being done) 9 (� / Ai E /'2- 521 City Miami Shores Village County Miami -Dade Zip 33 I7 g qc' • FOLIO / PARCEL # 1 /— 3 . og`®D5 `C' I/O Ir GIs Building Historically Designated YES NO ✓r Flood Zone Contractor's Company Name � ®/9.5-i-- 146 ,4 Si 4/C a—A/c • Phone # 3675--(52-5467 Contractor's Address 2 S /�1.J • / a/_ City %?%/ %9'Y/�/ / I State_ Zi/ �9 Qualifier Nam5Cl /-/-0 w /9/71 Phone # ,54 �g 2.7:5' State Certificate or Registration No. Contact Phone Architect /Engineer's Name (if applicable) Certificate of Competency No. A E -mail �_f -�cs/Of!'GcL 47L..�Y,,7 Ike%. Phone # Value of Work For this Permit $ 13 c75` 00 Square f Linear F000taae Of Work: Type of Work: ['Addition ❑Alte ation New �' Repair/Replace Demolition Describ Work: i4„ x/90 A / y/ rte' ®e".-'7- ,ice r i '/J?' J• wavily * * **7 * *7 � * * * * * * ** * *** . * Fes * * * * * * * * * * * * * * * * * * * ***:** * * * * * ** * * * * * * * ** Submittal Fee $ Permit Fee $ 15 3 O CCF $ CO /CC $ Notary $ Scanning $ Double Fee $ Structural Review. $ Training/Education Fee $ Radon $ DPBR $ Technology Fee $ Bond $ Violation date: ry 4.16 Total Fee Now Due $ • See Reverse side --> f 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 co i = cement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issu„ e absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Sign. Print: r or Agent The foregoing instrument was acknowledged befor e(this aJ The fove oing instrument was ackn. cVI - dg before a tb� day o !4 p/ , 20 l I , by ge / 1<,,,..16110 er I ', day of !0,J �� , 20 L , b i' �� ;��`� 1 Y Y � Y who is personally known to me or who has produced 1�g. 0Wa)3who is and who did take an oath. N TAR UBLIC: I i ��Sign: �'�, �' .��,��.) rmt: i k� MY GQMM1SSION a OD 78 118 ! Print: '� 1r�� My Commis Contractor �' 4 Y I R My Commission Expires: •j��`.���'� .�i� �°�,f u� **************************** ** * * ** *** *,Y ****:Fd:9:�Y:F:FoY *k�F *ak* *ie9e�:e4 ******** ** *** : *k * *:F�F ,F :F:Fk:F & *�Ykk3c APPROVED BY', % "� Plans Examiner Zoning (Revised 07 /10 /07)(Revised 06/10/2009) Engineer Clerk checked 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): 50 / /V& 9 5' City: Miami Shores Village County: Miami Dade Zip Code93 f3g 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 VARHI Sheet Attached: YES Lfd' NO ❑ Contract Attached: YES Pr UNIT BEING REPLACED DATA NEW UNIT z--ei oie MANUFACTURER `% C ,Pa/ii !, _ AHU or PKG. UNIT MODEL # leiYa %!h®,, y5- Arr(;- alp , // COND. UNIT MODEL # ./ /-' 5' i 56. 1 KW HEAT / , A., ''T A?^ . NOM TONS - '% , AH CU 1® PKG 1) M.C.A . '. AH U PKG AH WO CU .0 PKG 2) M.O.P AHU - r'%%CUv® PKG AHU CU PKG 3) VOLTS AHU CU PKG PKG UNIT / / PKG UNIT / / EEP /6�S� � YES !I REPLACING DUCTS REPLACING THERMOSTAT A NO YES �E ` YES 0 NEW 4 "CONCRETE SLAB NO YES NEW ROOF STAND YES dD YES 407 7 NEW RETURN PLENUM BOX YES 1. Minimum Circuit Ampacity (Wire Size): i�' � 2. Maximum Overcurrent Protection (Fuse /Breaker Size 3. Voltage of Circuit (20: 4480): C 7o 4. Size Disconnecting Means: k /i t!c /got l /52 Contractor's Company Name: C..r d'�s � �C- Phenef/ (7 State Certificate or Rey + -lion N 13C/ V �� 9 ° Certificate of Competency N. 1/ ; Signature .. - (Qualifier's signature only) Date: OP ID: LR '446, -- CERTIFICATE OF LIABILITY INSURANCE (� 05,1`" 1 �`' 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(es) must be endorsed. If SUBROGATION 1S 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 800-742-1691 Hallandale Branch 954454-9552 Rimer Insurance Group PO Sox 250 Hallandale, 33008-0250 Akin Shaw CONTACT PHONE Na F 1 rNACX. Nok ar>ss COAT04 C S (D r: S INSURER(S) AFFORDING COVERAGE NAM I INSURED Coast to Coast Air Condition & Refrigeration, Inc. 25 NE 193 Street North Miami, FL 33179 INSURER A: Assoc. Industries Ins. Co. BULGER B: Tower Group Company C: INSURER D: INSURER E : 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 POUCY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDI)1ON OF ANY CONTRACT OR OTHER DOCUMENT WMTH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 1S SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. SAW LIR TYPE OF INS* ARMS ADDLE INSR WVD POLICY NIABER POL.hYY EFF nhMmwrYYY1 POUCY BLIP IMMIEDNYYYE B GEMERAL MINIM X COMMERCIALGENERALLIABILRY ICLA GBN L AGGREGATE LIMIT APPLIES PER POLICY n J n LOC CGLCL0004010 08109/10 08109111 EACH OCCURRFCE DAMAGE TO RENTED PREMISES EEa aaanrer e) MED EXP (Arty are person) a 1,000,000 a 100,000 a 5,000 PERSONALS ADV INJURY GENERAL AGGREGATE PRODUCTS- COMP/OP AGO $ 1,000,000 s 2,000,000 $ 2,000,000 a AUTOMOBILE UAEaJTY ANY AUTO ALL OWNED AUTOS SCHEDULED HIRED AUTOS NONOWP®AUrcs COMBINED SINGLE LOST (Ea ealded) a BODILY INJURY (Per person) a BODILY INJURY (Pm aoidero) a PROPERTY DAMAGE (Per a $ $ LtianF, L A LIAR EXCESS LEAB CL.NMSGIADE DEDUCTIBLE RETENTION a EACH OCCURRENCE AGGREGATE a a A WORKERS COMPENSATION AND EMPLOYERS LIABLi1Y Y I N ANY PROPRIEMRIPARTNER/EXECLRIVE OFFICERIMEMBER NH) EXCLUDED? Uyss, dasaibe under DESCRIPTEON OF OPERATIONS beia NIA AWC1005321 04/26111 04126/12 �LIMIT 1 10TH- 1 El EACH ALIT $ N,n EL DISEASE - EA EMPLOYEE $ 600,000 EL DISEASE- POLICY LIMIT $ S00,000 DESCRIPTEW OFFAMONS I T C I v (Aesh Aft 1W. AddhBmai Rm,mI Sc , If mme space Is aq k d) Air Conditioning g N Miami Shores Village Building Dept 10050 N.E. 2nd Avenue Miami Shores, FL 33138 MUWSHI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POUCY PROVISIONS. AUTHORMED REPRESENTATIVE tA4esv.,.. etekii..,....e.--%„_. ACORD 25 (2009109) m 1988 -2009 ACORD CORPORATION. AI rights reserved. The ACORD name and logo are registered marks of ACORD This combination qualifies for a Federal Energy Efficiency Tax Credit when placed in service between Feb 17, 2009 and Dec 31, 2011.1 AHRI Certified Reference Number: 3799471 Date: 6/14/2011 Product Split System: Air - Cooled Condensing Unit, Coil with Blower Outdoor Unit Model Number: 14AJM58 Indoor Unit Model Number: RHLL-HM6024 +RCSL- H*8024 Manufacturer. RHEEM MANUFACTURING COMPANY Trade/Brand name: RHEEM 14AJM SERIES Manufacturer responsible for the rating of this system combination is RHEEM MANUFACTURING COMPANY Rated as follows in accordance with AHRI Standard 210 /240 -2008 for Unitary Air•Condltioning and Air-Source Heat Pump Equipment and subject to verification of rating accuracy by AHRI - sponsored, independent, third party testing: Cooling Capacity (Btuh): 54000 EER Rating (Cooling): 13.00 SEER Rating (Cooling): 16.00 • Rates followed by an asterisk () a voluntary ,mate of predously puheshed date unless accompanied with a WAS. which Indicates an involuntary rents. DISCLAIMER Aids does not endorse the moderate) fisted on this Certificate and makes no representations, warranties or guarantees as to, and asswnes no rester for; t eproduct(s) listed on this Certify AMM expressly disclaims all fiat yfor damages of any kh,d arisbtg out pith use orb oft the product(s), ort a reauthorized afteraton of data fisted on this Certificate. CerUTied ratings are valid only for models and con II uiatans listed In the directory at l+ ww,a hndire -ao i.arcg. TERMS AND CONDmONS This Certificate and its contents are proprietary products ofAlfit. This Certificate shall only be used for tridual, personal and confidential reference purposes. The contents of this Certificate may not, In whole or In part, be ; copied; disseminated; entered into a computer database; or otherwise utilized, in any form or manner or by any means, except forte user's brdivkhed, personal and confidential reference. CERTIFICATE VERIFICATION The information for the model cited on tds certificate can be walled at click on "v",?: i'; ::-rr: it z e° link and enterers ANN! Certified Reference Number and the date on which the certificate was Issued, which I listed above, and the Certiticate No., which ls fisted bekns; ©2011 Air- Conditioning, Heating, and Refrigeration Institute CERTIFICATE NO.: Q, I ea'=ru, i' ? ire's; to ■ AIC & REFIliffERATION Licensed & Insure' nsured CAC# 1815168 "Success is Our Virtue" 25 NE 193rd Street • North Miami, Florida 33179 Cell: (954) 8 5 • Phone: (305) 652 -5680 • Fax: (305) 652 -6042 / Customer Name L Q? �J �jne 7 eg _7293 Date /� �i %/ LG Rio e 4/ Address '570 �� Job Address City " 1/1/ 11V j S` ' c'1 State Zip Code Work Phone We will fumish, install and service the equipment listed below at the price, terms and conditions outlined on this proposal. EQUIPMENT S/P : CIFI CATION$ e e )i Model Number(s)/ "�-� BTU C .ling Model umber(s) 6' ( 2 024in, - : 1 no ,0 1 • Make < Make Installation Jib 0 ANY AND ALL WORK NOT MENTIONED IS NOT INCLUDED. ❑ New weather resistant equipment stand ❑ New reinforced equipment pad Igigw vibration isolation pads ❑ New properly sized refrigerant line(s) ❑ Insulate,refrigerant suction line(s) Cnstall refrigerant drier(s) 9 omptete system start up nstall energy saving setback thermostat ❑ New return air filter grill ❑ New condensate drain system ❑ New condensate pump ❑ In -aux. condensate drain pan emo ❑ Clean work area to customer satisfaction emove eidsAng equipment from premises ❑ / () Year parts warranty ❑ / Year labor warranty ❑ / Ulear compressor warranty ❑ ❑ ❑ Instal Pli�ee $ 3 9595 Total Amount $ 51 0 Down Payment Due at Signing $ Authorization (Business)