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MC-11-1527Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 o, Inspection Number: INSP - 166838 Permit Number: MC -8 -11 -1527 Scheduled Inspection Date: November 21, 2011 Inspector: Perez, JanPierre Owner: , BARRY UNIVERSITY Job Address: 11300 NE 2 Avenue Health & Sports Miami Shores, FL 33138 -0000 Project BARRY UNIVERSITY Contractor: HILL YORK SERVICE CORP Permit Type: Mechanical - Commercial Inspection Type: Final Work Classification: A/C Replacement Phone Number Parcel Number 1121360010160 -23 Phone: (305)756 -6501 Building Department Comments EXACT REPLACEMENT OF A 4 TON RTU Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments CREATED AS REINSPECTION FOR INSP - 163573. cancel by hill york jpp ) November 18, 2011 For Inspections please call: (305)762 -4949 Page 39 of 47 Miami Shores Village Building Department (0050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 BUILDING PERMIT APPLICATION FBC 2004 AUG 1 9 2011 BY :. ...............o. Permit No. ! v D 1 I I✓ 2 7 Master Permit No. Permit Type: Mechanical Owner's Name (Fee Simple Titleholder) 8a 0/01i .1 Phone # Owner's Address /13cx) City many \Shbtrs State FA Tenant/Lessee Name E -MAIL: ,,� /y� ��/,� 40-41 /� Job Address (where the work is being done) 11300 �I � Oi ) �a.,f't7) ( JeK Coun Miami -Dade Zi County P zip 33 it Phone # City Miami Shores VilL e FOLIO / PARCEL # Is Building Historically Designated YES NO Contractor's Company Name 4-14 Contractor's Address A1 City I--I )44,164 Qualifier Name MOIL State Certificate or Registration No. E -MAIL: /1 4n rays State PA Phone # .6) . .9`')r I Zip 3331 (I Phone # 0,1i0 0245 0 Certificate of Competency No. 1 LU -c` U / I cl Architect/Engineer's Name (if applicable) Phone # Value of Work For this Permit $ 10 a-5 Square / Linear Footage Of Work: Type of Work: ['Addition Alteration New // II r !% �Repair/Replace El Demolition Describe Work: EY (}i ek at) 1 oa nf tea, ) 4 Ion RTLC *** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Submittal Fee Snr) - Permit Fee $ Notary $ Scanning $ Bond $ Training/Education Fee $ Radon $ DPBR $ Code Enforcement $ Double Fee $ Structural Review. $ Total Fee Now Due $ /-Lo •qa CCF $ CO /CC Technology Fee $ Zoning $ See Reverse side - 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 A}FIUAVIT: 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 apr 'd and a reinspection fee will be charged. /-7:95 Signature Owner or Agent The foregoing instrument was acknowledged before me thi day of 7t6 (r • , 20 11 , by /), him g, who is personally known to me or who has produced As identification and who did take an oath. Notary Public State of Florida Cheryl Baida Gerber gg My Commies on DD986128 of i ites 05/08/2014 My Commission Expires: Signature The fore day o who is person oing instrument was acknow�(e�dgeedd before me this S 20 _, by Mart, �.., Ur 4 ly known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: YARISMAR CASTRO aNMEtir •'= MY COMMISSION #EE103308 . .4l�. 39841153 My Commission Ex FlorklallotaryService.com * **** *** *** ***4c4c4c***** * **kka4a44r4r* ** *k** k*d:4e4e>r9eie*otdeaYdr le & &atrit*etra *** 9:**3r** 3r3ai: 4:4:4:4e4r4r**3r**** * ** k** *** ** APPLICATION APPROVED BY: (Revised 02/08/06) Plans Examiner Engineer Zoning 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 9— )511 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. ,'J Job Address (where the work is being done): / 1300 �� e��) ja 1L 1 Comp& )( City: Miami Shores Village County: Miami Dade Zip Code: 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 I ARHI Sheet Attached: YES f NO ❑ Contract Attached: YES UNIT BEING REPLACED DATA NEW UNIT TY MANUFACTURER I (It AHU or PKG. UNIT MODEL # Z- 0 43A- COND. UNIT MODEL # t C.) KW HEAT 12--9- 05 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 / / EE SEE ' 16 YES NO REP ING DUCTS YES YES NO REPLACING THERMOSTAT YES V YES NO NEW 4 "CONCRETE SLAB YES I • YES NO NEW ROOF STAND Y YES NO NEW RETURN PLENUM BOX ' 10 eurip irck 1. Minimum Circuit Ampacity (Wire Size): ' 2. Maximum Overcurrent Protection (Fuse /Breaker Size): 45 3. Voltage of Circuit (208/24 iiw 4. Size Disconnecting Means: l� 0 & Contractor's Company Name:. ,�11 L Phone: State Certificate or Registration N. _CAC �3 _/ , Certificate of Competency N. /J — Signature (QudIIfler's slgitifure only) Date: HILL YORK SERVICE CORPORATION P.Q. Bur 22838, Fort Iaxdre, FL 33335 -0155 Phone: 954- 525.4280 - Fas 954- 763-7548 - Tat Frees 1-877-525-4200 Project Estimate Re: 11SC Men's Locker Room unit Date: August 17, 2011 To: )carry university 11300 Ne 2nd Ave Minn Shores, FL 33161 Attn: Julia Diaz, Phone: 305 -899 -3787 Fax: Pro ect Sco Hill York is pleased to provide the labor and materials to complete the following: remove one existing Trane 4 ton roof top package unit and replace with one York 4 ton roof top package unit. Installation includes demo and proper removal of existing unit, setting of new unit on existing curb with new curb adapter, electrical connections from existing disconnect to new unit, reconnect to existing condensate line, crane, start up, and mechanical permit. Prolusions: Smoke detector (if not existing) NOTE: Any building code upgrades that may be required are excluded. All work must be done during normal business hours. "ilrbeeothe Mee ofamla tel. equipment, at energy &memos a18dfleamtydacfnnehe cormofthecontractthnagbaoMhof tiecaw.dWeam[am gen Mall beconk* byohategeorder. a4tung A signintant pace increase oceans acbange in ogee from the MD doe to tbe gas of paramagnet, byan ego= exceeding 5% pwwat. Sorb price bagmen WW1 be docamededby vendor quires. tnvdoe. egdog% rouipteor otherroeameoisdeomesereelkse." Where tlmdefeery of gnu nt,. Including but not Moiled to heat pumps, Cooling towers, Pipe. Valves. Pl hgs. Dee m& Pans Air 67stribudon.lwms. Pumps. MIstellaneaus Stelfor &ppmaorbracMms.ornapWhnf>mn, coutofcorn ,isdalayedthroupbemlanknftce ammeter, the owner sball not bald get mower Ruble ter cogs noseband with such decay." Onr Price Is If we complete project during after hours Our Price Is Payment Terms: 35% deposit with Are balance due upon completion We accept MastfsrCerd, Visa. Discover Card, American Express Submitted by: Danny Denaro, HVAC Consultant $6,927.00 $7,$03.00 This estimate is valid for 30 days General Conditions: I have authority to order the work as outlined above. It is agreed that the seller will retain tide to any equipment or materials that may be furnished until final payment is made. In case the total charges are collected by suit or upon demand of an attorney, the purchaser hereby agrees to pay reasonable attorney's fees for the making of such collection. Signature Authorization to Proceed 7/20// Date: AV■olI CERTIFIED TM www.ahrldinectory.org Certificate of Product Ratings AHRI Certified Reference Number: 4057540 Date: 8/19/2011 Product: Single- Package Air - Conditioner, Air - Cooled Model Number: D2EZ048A46 Manufacturer: YORK, UNITARY PRODUCTS GROUP - COMMERCIAL Trade /Brand name: AFFINITY Manufacturer responsible for the rating of this system combination is YORK, UNITARY PRODUCTS GROUP - COMMERCIAL Rated as follows in accordance with AHRI Standard 210/240 -2008 for Unitary Air - Conditioning and Air - Source Heat Pump Equipment and subject to verification of rating accuracy by AHRI- sponsored, independent, third party testing: Cooling Capacity (Btuh): 48000 EER Rating (Cooling): 11.90 SEER Rating (Cooling): 13.00 Ratings followed by an asterisk (*) Indicate a voluntary rerate of previously published data, unless accompanied with a WAS, which Indicates an Involuntary rerate. DISCLAIMER AHRI does not endorse the product(s) listed on this Certificate and makes no representations, warranties or guarantees as to, and assumes no responsibility for, the product$) 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 fisted 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 AHRL 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 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 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 listed above, and the Certificate No., which is listed below. ©2011 Air - Conditioning, Heating, and Refrigeration Institute Pi ®' Air - Conditioning, Heating, "NI MN A/ and Refrigeration Institute CERTIFICATE NO.: 129582336536533750 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487 -1395 1940 NORTH MONROE STREET TALLAHASSEE FL 32399 -0783 KERNEY MARK HILL YORK SERVICE CORPORATION 2125 S ANDREWS AVE FT LAUDERDALE FL 33316 Congratulations! With this license you become one of the nearly one million Floridians licensed by the Department of Business and professional Regulation. Our professionals and businesses range from architects to yacht brokers, from boxers to barbeque restaurants, and they keep Florida's economy strong. Every day we work to Improve the way we do business in order to serve you better] For information about our services, please log onto www.myfloridalicensa.com. There you can find more information about our divisions and the regulations that Impact you, subscribe to department newsletters and team more about the Department's initiatives. Our mission at the Department is: License Efficiently, Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, and congratulations on your new license! DETACH HERE ATE OF FLOi DEPART9 TT9TRi<T F NAIRI RoF 10 =Ann= urdik.. t the pri ola,ot'Ca 489 as susi:lttul Jaee =+ ATM 31, 30 1400603.00 84 3 The CLASS ` A . AIR ` CONDITIONING C©N Net ed be3ow IS CERTTFIET3 .Under thy' prav'isi. .a .of MaP iration..date: AUG; 31, 201; RERNEY MARK HILL YORK CORPORATION:- 2/24 $ ANDREWS AitrE -: FT LAUDERDALE- FL 33316 DISPLAY:AS REQUIRED SY.L . N r 4 E I SE TARR BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A -100. Ft. Lauderdale, FL 33301 - 1895 -- 954- 831-4000 VALID OCTOBER'', 2010 THROUGH SEPTEMBER 30, 2011 Receipt 0:183- 239619 Business Type :{ xxo/AIRCONDITIoN c• DBA: Busing Name: RILL YORK SERVICE CORPORATION Owner Name: NARK Kamm Buelne & LOC9tlOn: 2125 8 ANDREWS AVE FT LAUDERDALE Business Phone: 954-525-4200 Rooms Seats Employees 10 . Business Opened:o3/03/2011 St 9ICou nty/Cerf/Reg :CAC 0 2 9 3 6 0 Exemption Code:NceExEmPT Professionals Number of Elechinew Per View Bins They THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT This tax Is levied for the privily of doing business within Broward County and is non - regulatory In rte. You must meet all County and/or Municipal ty 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. Malting Address: HILL YORK SERVICE CORPORATION PO BOX 22838 FORT LAUDERDALE, FL 33335 Receipt #03A -10- 00006014 Paid 03/03/2011 27.00 - - ----w •Jr- Tex A+> urt Trettsfier Fee NSF Y, . ► ° prior ll rs Coffin Cest Tatsl Pei! 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 privily of doing business within Broward County and is non - regulatory In rte. You must meet all County and/or Municipal ty 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. Malting Address: HILL YORK SERVICE CORPORATION PO BOX 22838 FORT LAUDERDALE, FL 33335 Receipt #03A -10- 00006014 Paid 03/03/2011 27.00 �'il P ACCIR°® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYY1f) 3/31/2011 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(les) 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 Seitlin Insurance 6700 N. Andrews Avenue #300 Ft. Lauderdale FL 33309 CONTACT NAME: (AIC PHONE (954) 938 -8788 FAX (954) 938 -8566 E-MAIL ADDRESS: INSURER(8) AFFORDING COVERAGE NAIC # INSURERA:PA Manufacturers' Assoc Ins. Co. 12262 INSURED Hill York Corporation 4427 Mercantile Avenue Naples FL 33942 INSURER a: National Union Fire Ins Co. PA 19445 INSURER C: 4/1/2012 INSURERD: $ 1,000,000 INSURERE: $ 300,000 INSURER F : $ 10,000 COVERAGES CERTIFICATE NUMBER: Cert In 28243 REVISION NUMBER: THIS IS 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 POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSR SUBR W VD POUCY NUMBER POLICY EFF (MMIDDIYYYY) POUCY EXP (MM/DDIYYYY) LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY 301175 33- 95 -25 -8 4/1/2011 4/1/2012 EACH OCCURRENCE $ 1,000,000 PREMSES(Ea occurrence) $ 300,000 MED EXP (Any one person) $ 10,000 CLAIMS -MADE X OCCUR PERSONAL BADVINJURY $ 1,000,000 X Per Proj/Per Loc Agg GENERAL AGGREGATE $ 2,000,000 X Contractual Liab. PRODUCTS - COMP/OP AGG $ 2,000,000 GEM. AGGREGATE UMITAPPLIESPER: POLICY n Ea n LOC $ A AUTOMOBILE X X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS g SCHEDULED AUTOS NON -OWNED AUTOS 151100 33- 95 -25 -8 4/1/2011 4/1/2012 COMBINED SINGLE LIMIT (Ea accident) 1,000,000 $ BODILYINJURY(Perperson) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ B X UMBRELLAUAB EXCESS LIAR X OCCUR CLAIMS -MADE BE26159447 4/1/2011 4/1/2012 EACH OCCURRENCE $ 10,000,000 AGGREGATE $ 10, 000, 000 $ DED X RETENTION$ 10,000 A WORKERS COMPENSATION BIU AND EMPLOYERS'LIATY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below YIN N / A 201100 33- 95 -25 -8 4/1/2011 4/1/2012 „ STATU- TORY UMITS OTH- ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1, 000,000 $ $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) PROOF OF INSURANCE ONLY. TION City of Miami Shores 10050 N.e. 2nd Avenue Miami Shores FL 11111 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 L ACORD 25 (2010/05) © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD NOTICE OF COMMENCEMENT A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION PERMIT NO. TAX FOLIO NO. STATE OF FLORIDA. COUNTY OF MIAMI -DADE: THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property, and in accordance with Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement. 11111111111111 1111111111111111111111111111111 c FN 2011R055$620 OR Bk 27797 Fs 4329; (1ps ) RECORDED 08/19/2011 11:51:41 HARVEY RUVIH, CLERK OF COURT MIAMI-DADE COUNTY, FLORIDA LAST PAGE 1. Legal description of property and street/address: 11300 NE c %' iCt I/ t K) nq, cur)) vas 2. Description of improvement: Istkon r 3. Owner(s) name and address: ►eS . f :331140 Interest in property: Name and address of fee simple titleholder: 4. Contractor's n - me and address: AA/ �o ciba. 5. Surety: (Payment bond required by owner from contractor, if any) Name and address: Amount of bond $ 6. Lender's name and address: 7. Persons within the state of Florida designated by Owner u provided by Section 713.13(1)(a)7., Florida Statutes, Name and address: 8. In addition to himself, Owners designates the following person(s) to - eive a copy of the Lienor's Notice as provided in Section 713.13(1)(b), Florida Statutes. Name and address: 9. Expiration date of this Notice of Commencement: (the expiration date is 1 year from the date of recording unless a different da . - ` a.!Z ij ed) Signatu - of wner Print Owner's Name ���Q�GS Prepared by 441 ) 1 \ Ort- Sworn to and subscribed before me this /' day of PraCee 1-- , 20 _a. _ Address: 4��dt tin C 'o • Notary Publi Print Notary's Name/./0.47/ 54-K14 6,2-e My commission expires: 123.01 -52 PAGE 4 W02 ,�' Notary PuW'o Stat* of Fiords ;7 Cheryl Baia Oatoor �. My Comrtllas an bo9e6128 Ito toy Expires 0516912014