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MC-11-1857Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 165336 Permit Number: MC-1 0-11-1857 Scheduled Inspection Date: November 07, 2011 Inspector: Perez, JanPierre Owner: GREEN, GIL & DEANNA Job Address: 113 NE 101 Street Miami Shores, FL 33138- Project: <NONE> Contractor: SUNSHINE AIR INC Permit Type: Mechanical - Residential Inspection Type: Final Work Classification: A/C Replacement Phone Number Parcel Number 1132060131910 Phone: (786)488 -1200 Building Department Comments REPLACE CENTRAL AC SYSTEM C\-2g Inspector Comments Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. November 04, 2011 For Inspections please call: (305)762 -4949 Page 18 of 42 • BUILDING PERMIT APPLICATION FBC 20 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 Permit Type: MECHANICAL RECEIVED OCT 112011 BY: Permit No. ik' Master Permit No. OWNER: Name (Fee Simple Titleholder): De/ailn a 4e-em Address: [ 13 N . I b 15%ree-t City: Nli ainit 5hou5 Tenant/Lessee Name: Email: Phone#() 310g — 5g-30 Zip: 3 313 Fl Phone#: State: dnne9 Teen 5nriai 1. cap► J O B ADDRESS: 113 N 1 , 6 ( 0 1 e Pi- City: Miami Shores County: Folio/Parcel #: 11 307 0 c„," 0/ 3— 1 61 J Is the Building Historically Designated: Yes IV- Miami Dade zip: 3 3131 NO Flood Zone: CONTRACTOR: Company Name: 5 V n 5h 1' ne Pick( TY . Phone#: 2312 --1/6 9 — 1100 Address: LI S f I,) ) 9 3 city: V) ja ,z, i &4 d e>7 s State: ,/ o,r; Aa Zip: 33) 6 9 Phone#: Qualifier Name: S-I AGy Pooh genn f State Certification or Registration #: C i� L / i, / 5 ' Certificate of Competency #: C o n t a c t P h o n e # : / 0 6 — Y 8 B — I ° 0 Email Address: ) h (vg, sun Ski) i e — Air o C Dc'7 DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit .900 it Type of Work OAddress OAlteration Description of Work: RQ. pLG (st Cen+al eftsic� room c�)C S+1f, $ Sgnare/l inear Foopge of Work: UNew 4* /Replace N1 L- sit s- ft7•1_ %A m Luca );u 'CoN► UDemolition `**** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Submittal Fee iKe7 Permit Fee $ CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ ( -' \13)\i‘A C)-Y 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 reinspection fee will be charged signature A' De..a1t-a-, Owner r Agent The foregoing instrument was acknowledged before me this I day of CS ,20 II ,by ID eavIna G fen who is personally known to me or who has produced FL Dr 'mot LS taA4s42.. NOTARY PUB Sign: Print: II Al u A, (407) tifi R , MY COMMISSION # EE082242 EXPIRES April 10, 2015 COM ath. L.tk4-. My Commission Expires: ***iB*** * * ** * ** * ** *** APPROVED BY t* Signature .I ,„ Contractor The foregoing instrument was acknowledged before me this I day of 0C4010cr , 20 .L, by ¶ 1 "t.0 13 en h N 44- who is personally known to me or who has produced n bL. as identification and who did take an oath. Structural Review (Revised 07 /10 /07XRevised 06/10/2009XRevised 3/15/09) Sign: Print: My Commission Expires: 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 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): 113 f e" 10/ S+ City: Miami Shores Village County: Miami Dade Zip Code: 33/38 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 ❑ ARHI Sheet Attached: YES NO ❑ Contract Attached: YES 27 UNIT BEING REPLACED DATA NEW UNIT Copt -r i eiZ„ MANUFACTURER -"r » e... AHU or PKG. UNIT MODEL # 1 E3 F �9 ft ) too A 'MI-A.036300 COND.UNITMODEL# iq7 TRSo?,6Clt1ov KW HEAT 10 WI 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 / / EERISEER j 6 YES NO REPLACING DUCTS (� 00 NO YES NO REPLACING THERMOSTAT S NO YES NO NEW 4°CONCRETE SLAB _ YES (NO YES NO NEW ROOF STAND YES NO YES NO NEW RETURN PLENUM BOX YES 1. Minimum Circuit Ampacity (Wire Size): 2. Maximum Overcurrent Protection (Fuse/Breaker Size): 3. Voltage of Circuit (208/240/480): 4. Size Disconnecting Means: Contractor's Company Name: 0kj 5h State Certificate or Registration N. 6AC. Signature { Phone: 7619- L/ 3 --lad y 8) $tedi cate of Competency N. Date: 000 6 11� ?.o a 1 SUNSHINE AIR A/C, DUCT & INSULATION SUNSHINE AIR P.O. Box 972166 Miami FL, 33197 Tel. (786)488 -1200, Fax (305)255 -7337 Email: info ®Sunshine- air.com Web: www.sunshine- air.com PROPOSAL 1533 CUSTOMER anna G-r , STREET 1/3 N. I Q 1 CITY, STATE AND ZIP CODE fr )6- 5/10110 �L 33130 PHONE --I 5830 JOB NAME Ue-6.n ,i/. DATE OC* ber 11, 2a11l1 JOB LOCATION ��/� i ' 1 ira.WI I• Shores We, SUNSHINE AIR INC, propose to furnish, install and service under warranty heating and/or air conditioning products and related equipment for you in accordance with the conditions and specifications set forth in this proposal. SYSTEM EQUIPMENT AS FOLLOWS: Tian r an e Model # L/ rri 5Q3 C IodoP Tons Heat Kw. /0 7( 3 rigq OooA S.E.E.R. 16 Ductwork Number of Supplies: Note: Rerslot.);:i OCd, av M Perri -t 10-1-1c Attic Insulation: R- SQ Feet x INSTALLATION AS FOLLOWS: ❑ CONCRETE SLAB BASE X METAL BASE ❑ HEAT & COOL THERMOSTAT ❑ CONDENSATE DRAIN LINE ❑ CONDENSATE PUMP ❑ REFRIGERANT LINES ❑ OTHER $ $ TOTAL COST $ 1 t-� 0 0 0 IEC REMOVE EXISTING EQUIP. REMOVE EXISTING,DUCT WORK ❑ CUTTING HOLES HOOK -UP TO EXISTING ELECTRIC ❑ NEW ELECTRICAL SERVICE ❑ CONTROL WIRING ❑ OTHER ❑ OTHER ❑ OTHER COMMENTS: - lt- INSTALLATION SCHEDULE: We will be ready to begin installati approximately BUYER'S ACCEPTANCE: .2,4-, 8 days. Authorized Signature Buyer Irrevocably accepts equipment detailed above and assumes responsibility of same and of payments specified herein, as of date of i ailatfon, and rding to the terms of this contract. SELLER APPROVAL: WHITE COPY: File DATE: • ` r v >m Y r 0! f "L �/ INSTALLATION DATE: d c.l- � q', -2-02/ SELLER NAME:.�ACNL LL ra. YELLOW COPY: Customer A19R1 CERTIFIED,. wvdv�.ahr tIir;ectoiyor,;g 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: 3432361 Date: 10/11/2011 Product: Split System: Air - Cooled Condensing Unit, Coil with Blower Outdoor Unit Model Number: 4TTR5036E1 Indoor Unit Model Number: 4TEE3F39A1 Manufacturer: TRANE Trade /Brand name: XR15 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): 33600 EER Rating (Cooling) ,..... 13.00 SEER Rating (Cooling): 16.00 Ratings followed by an asterisk (') indicate a voluntary rerate of previously published data, unless accompanied with a WAS, which Indicates an involuntary rerate. DISCLAIMER AHR1 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(s) listed on this Certificate. AHRI expressly disclaims ag 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 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 atwww.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. LIBA Air - Conditioning, Heating, MN S' and Refrigeration Institute ©2011 Air - Conditioning, Heating, and Refrigeration Institute CERTIFICATE NO.: 129628292062067156 10/11/2011 09:14 2396932522 A RR EDISON BACKFAX CERTIFICATE OF LIABILITY INSURANCE THIS CERTIFICATE 1S ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS AFFORDED BY THE POUCHES BELOW. THISDOES RRTIFICATE OF INSURANCE DOES NOT CONSTITUTE CONTRACT BE1WEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. must be endorsed. N SUBROGATION IS WANED. subje0t W IMPORTANT: If the certificate holder i an ADDITIONAL INSURED. She pollcy(ies) the terms and conditions of the policy, certain policies may require an endoraeitI0 . A statement Olt the a :alt does not confer rights to the csrdt ® holder In lieu of such endDneemeflt(S). — PRODUCER Edison htavranca Agency, inc. rPalm �e 0 I Boulevard FL 1 AA PAGE 01 431,10: JK I ems (trN►I 10111/11 Sunshine Air Inc. 40 NW 193rd Terrace Miami, FL 33169 stimassats COVERAGE OISUReht a :Old Dominion Insurance Com 402.31 MAIO MBURER INSURER D SCR E! MIME" CpyEFtAGES CERTIFICATE NUMBER: THIS IS TO CERTIFY THAT THE POUCIES OF INSURANCE LISTED BELOW HAVE BEEN JSSUED TO THE INSuq INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR COMMON OF ANY CONTRACT OR OTHER CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POUCIES (*SCR/Bi EXCW_SIONS AND CONDITIONS OF SUCH POLICIES. L)MITS SHOWN MAY HAVE SEEN REDUCED BY PAID C1AIMI 1YP80FSiRtRAlIOE W MID POLICTIUSISER _,ntNI 1 RieE1 A GENERAL usauww X CONM ERCIAL GENERAL Lu ury cw aE E0 oMQUR OEM AGGREGATE U TAPF S PER �I n nLOC MITORDSILE UABIUTY ANY AVID ALL OWNED AUTOS SCHEDilED AUTOS HIRED AUTOS NON-0WKEDAmos • MPG299BA XXX X XXXXX MO= XXXXX UNIMELhA UAB EXCESS UAa CIAINISMAIDE OSOUCTWLE ,ETENTION > . WORKERS SOMPENSATIOr AND EMPLOYeR$ UAIRRY Y ANY tN ; B AR Y p1 UDEDI yy�� in DE8CIUPT1DN OF OPERATIONS MOIAv NIA 02127111 X0DOC m DESCRMMON a RA nMS (ARM A O 1DA a1 RmeastsSCdg If e Air conditioning or equipment N lied) 02127112 CERT SATE M1AM021 Village of Miami Shores Building Department Fax: 305-756-8972 10050 N.E 2nd Avenue Miami Shoes- FL 33138 ACORD 25 (2009109) CANCELLATION • A NAMED ABOVE FOR THE POUCY PERIOD )OCUMENT WITH RESPECT TO WHICH THIS HEREIN IS SUBJECT TO ALL THE TERMS, UMTS EACH OCCURRENCE a 1,000,000 %$1:11 EFJ S 500,000 gg MED DCP (My one Imo) a 10,000 PERSONAL b ADV INJURY 5 190009000 GENERAL ACIEMEGATE $ 2+000,000 PRODUCTS - COMP1OP AGG 5 2,000.000 S COMONEO sINELE LQATT (Ee WAIN) $ VOW B O D I L Y IMW Y (Peer Pte) S BODS.Y INJURY (Par smicterte $ XXXID* PITY DAMAGE (Par acmaaRit) $ MOM $ — • ._r � OCCURRENCE ---9 ACORES= s *XXXX S S ` 1.SgQy I t Eta __Mt' 0 Ei.. EACH ACCIDENT $ EL. MARE -EA EMPLOYEE S 700 EL DISEASE • POLICY LN01T S 1 SHOULD loin► OP TIME ASWS OBBiouBED POL CIES BE CANCI e a so BEFORE THE EXPRIATION DATE TN>EMDF. NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POUCYPROVISIDN i. A/ KO MO REFRESENTATIVE M 1 ACORD CORPORATION. All rights reserved. The ACORD name and logo are.gletersd marks of ACORD