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MC-11-2215
Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 167144 Permit Number: MC -11 -11 -2215 Scheduled Inspection Date: December 21, 2011 Inspector: Perez, JanPierre Owner: Job Address: 79 NW 92 Street Miami Shores, FL Project: <NONE> Contractor: UNIVERSAL AIR & HEAT Permit Type: Mechanical - Residential Inspection Type: Final Work Classification: A/C Replacement Phone Number Parcel Number 1131010170150 Phone: 954/581 -7110 Building Department Comments AC CHANGE OUT 3.5 TONS l Inspector Comments Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. December 20, 2011 For Inspections please call: (305)762 -4949 Page 11 of 35 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: Name (Fee Simple Titlehoold r): Address: � AM / f2 $i NOV `.."-a 1 ;11 BY: Permit No. �1'1�I I "-2'Z 15 Master Permit No. '4E44 /41.4•47 �, inWel ' Phone #: %�� ' 5'43. 51087 City: �¢LG� // State: !• Zip: X53/5-6 Tenant/Lessee Name: �.e4t143r 4 oA it/so Phone #:�a �o • .554.5* Email: JOB ADDRESS: 7'9 /1/4/ 92. d City: Miami Shores County:) mbE Miami Dade Folio/Parcel #: //3/ 0 /CV 'ye'SO Zip: �3 i6G Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: ( ,i' /% Address: 540 W sT /V 11/ # /Z City: P% /E State: f7. Qualifier Name: /i4 17,44905 DA/ State Certification or Registration #: ontacfPhone #` /T ig • %/1d Email Address: Phone #: /.1//6 Zip: X331' Phone #: 9511 • a/• 7 /le �Q�/ Certificate of Competency #: eroe db'84.. DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ g 903 - Square/Linear Footage of Work: Type of Work: Address UAlteration UNew epair/Replace ODemolition.; Description of Work: :714 egowdfrot v -• � Submittal Fee $ Permit Fee $ C 3 \- CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW D vtr-q-74 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 COIVIMENCEMET MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORN_ EY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.' Notice to Applicant: As a condition to the issuance of a building permit with an estimaie.value`exadedingg $250t,` ahe 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 ndt, be, approved and a reinspection fee . will be charged. The foregooin day of who is kerst Owner or Agent instrument was acknowledged before me this 00 , 20 I, by tzorsr Z AL%4A4 , me or who has produced As identification and who did take an oath. Signature Contractor The foregoin 4 instrument was acknowledged before me this day of /1/ 20 l (, by . � L 7-010-0,1, 7-010-0,1, who is personally known to me or who has produced as identification and who did take an oath. APPROVED BY II Di l I Plans Examiner Structural Review (Revised 07 /10 /07XRevised 06 /10/2009)(Revised 3/15/09) 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): 1' NCl/ 2-- fr. City: Miami Shores Village County: Miami Dade Zip Code: 33/ SD 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 __WIT BEING REPLACED DATA NEW UNIT • MANUFACTURER Xi f. AHU or PKG. UNIT MODEL # ,/f /1113g?../7' ��,,.., � %� oxe- COND. UNIT MODEL # faArm 424 a KW HEAT NOM TONS ,3• S AHU ` U i. PKG 1 M.C.A AHU 'KG AHU i. U ' PKG 2) M.O.P AHU CU '> PKG AHU CU PKG 3) VOLTS AHU CU PKG PKG UNIT / / PKG UNIT / / /4' EER/SEER /4 YES NO REPLACING DUCTS YES 0 YES NO REPLACING THERMOSTAT NO YES NO NEW 4 °CONCRETE SLAB ES YES NO NEW ROOF STAND YES YES NO NEW RETURN PLENUM BOX YES . i010► 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: State Certificate or Regist Signature i-cd3 42_ (Qualifier's signature only) Phone: "54� . 87.71/ Certificate of Competency N. COOS 8'li/Z Date: // 9/t CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDNY) 12/16/11 PRODUCER Marlins Insurance 850 S.W. 40 Ave. Plantation, FL 33317 Phone (954)587 -7850 Fax (954)587 -7778 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 POLICIES BELOW, INSURERS AFFORDING COVERAGE NAIC # INSURED Universal Air & Heat 5460 West State Road 84 SUITE 12 Davie, FL 33314 (954) - INSURER A: Capacity Insurance Company POLICY EXPIRATION DATE Z INSURER B: GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY INSURER 0: 11/00/2011 INSURER D: EACH OCCURRENCE INSURER E: REMISES (Es ocaurmro) COVERAGES THE POLICIES OF INSURANCE LISTED HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCY 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 POUOIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR A AMYL Ilil$RD ❑ TYPE OF INSURANCE POLICY NUMBER POLICY art-MOTIVN DATE IMMIGDIYYYY POLICY EXPIRATION DATE Z LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLM01001665A 11/00/2011 11/09/2012 EACH OCCURRENCE 1,000,000,00 REMISES (Es ocaurmro) 100,000.00 ❑ • CLAIMS MADE E]/ OCCUR MED EXP (Any one person) 5,000 PERSONAL BADVINJURY 1,000,000.00 • • GENERAL AGGREGATE 2, 000, 000.00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGO 1,000,000.00 J POLICY • PROJECT ❑ LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea =Went) • ANY AUTO ❑ ALL OWNED AUTOS BODILY INJURY (Per person • • SCHEDULED AUTOS 0 HIRED AUTOS BODILY INJURY (Per accident) • NON OWNED AUTOS • PROPERTY DAMAGE ar aceldent) • GARAGE LIABILITY • ANY AUTO ■ AUTO ONLY - EA ACCIDENT • OTHER THAN EA ACC AUTO ONLY: VG EACH OCCURRENCE EXCESS / UMBRELLA LIABILITY • OCCUR • CLAIMS MADE • DEDUCTIBLE • RETENTION $ AGGREGATE WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR / PARTNER / EXECUTIVE Y!<V OFFICER / MEMBER EXCLUDED? (Mandatory In NH) 'flea, PEC APR under Flaw ❑ WCSTATU- • QTH- LOCH LIMBS ER EJ., EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POUCY LIMIT OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS Mechanical A/C contractor CERTIFICATE HOLDER CANCELLATION MIAMI SHORES BUILDING DEPT, VILLAGE HALL 10050 NE 2ND AVE. MIAMI SHORES, FL 331382382 - ____ _- __ �� SHOULD ANY OF THE ABOVE DESCRIBED POLICIES 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 r40 OBLIGATION OR LIABILITY OF ANY KIND UPON TIME INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Barbara Garcia 01986.2008 AGORA CORPORATION. AEf rights rase The ACORD name and loge are registered rnartcs of ACORD Miami -Dade My Home -Text My Home Show Me: Property Information -Text Search By: Select Item itGo to property map 1jPropertv Appraiser Tax Estimator I jProperty Appraiser Tax Comparison Summer : Print friendly version Folio No.: 11- 3101- 017 -0150 Property 79 NW 92 ST Mailing Address: BARBARA M TATCHER & VIRENA J MILLAZO PO BOX 3821 HIALEAH FL 33013 -0821 Pro uerty Information: Primary Zone: 0800 SINGLE FAMILY RESIDENCE CLUC: 0001 RESIDENTIAL - SINGLE FAMILY Beds/Baths: 2/1 Floors: 1 Living Units: 1 AdJ Sq Footage: 1,334 Lot Size: 7,500 SO FT Year Built: 1940 Legal CANADAY EXTENSION PB 41 -71 LOT 15 LOT SIZE 75.000 X 100 OR 13017 - 28480988 6 OR 017701 Assessment Information: Year 2011 2010 Land Value: $80,088 $80,0613 Building Value: $101,822 $101,822 Market Value: $161,888 $161,688 Assessed Value: 6161,688 6181,888 Taxable Value Infonmtion: Year 2011 2010 Taxing Authority: Applied Exemption/ Taxable Value: Applied Exemption/ Taxable Value: Regional: $0/$181,688 $0/$181,688 County: $0/$161,688 $/$161,688 City. $0/$161,688 $0/$181,688 School Board: $0/$181,888 $0/$161,688 Sale Infoomtation: Sale Date: 1/1977 Sale Amount $1 Sale O/R: 000130 -OOQO Sales Qua Description: on Sales which are disqualified as a result of examination of the deed View Additional Sates Additional Wont/anon: Click here to see mom information for this property: Community Development District Community Redevelopment Area Empowerment Zone Enterprise Zone Zoning Land Use Urban Development Boundary Zoning Non-Ad Valorem Assessments Environmental Considerations My Home /Property Information 1 Property Taxes 1 fly Neighborhood 1 Property Appraiser Home 1 U91rn Our Site 1 Phone Directory I Privacy I FIKOah7fer Page 1 of 2 MIAMI -DADE) Questions and Comments webmaster a(7.miamidade.gov Property Appraiser Home Page Property Information Online Help Property Information Home Page http: / /gisims2 .miamidade.gov /myhome /proptext .asp ?folio= 1131010170150 &vbMakeLink= 11/29/2011 This combination qualifies for a Federal Energy Efficiency Tax Credit when placed in service between Feb 17, 2009 and Dec 31, 2011. Certificate of Pro u f .t Ratinis AHRI Certified Reference Number 3806012 Date: 9/12/2011 Product Split System: Air - Cooled Condensing Unit, Coil with Blower Outdoor Unit Model Number 14AJM42 Indoor Unit Model Number. RHLL- HM3821 +RCSL -W3821 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 2101240 -2008 for Unify Air- Conditioning and Air- Source Heat Pump Equipment and subject to verification of rating accuracy by AHRI -sponsored, independent, third n: Cooling Capacity (Btuh): EER Rating (Cooling): SEER Rating (Cooling): 40000 13.00 16.00 • Ratings followed by an asterisk (•) indicate a voluntary relate of previously published data, unless accomparded with a WAS witch Indicates an involuntary relate. DISCLAIMER AHRI does not endorse the product(s) aid or this Certificate and makes no representations, wairandes or guarantees as to. and assignee no responsibility tor, the p s) fisted onthis Certificate. AIM expressly disclaims all itabOlty for dam of any Idnd arming out of the use or performance of the prima►, orate unauthorized action of data iced on this Cam. CertMed ratings are valid only for models and configurations listed In the directory atwww.ahridirectory.org. TERMS AND CONDITIONS This Certificate and Ita contents are proprietary profits ofAHM. This Certificate shall only be used for bnvidual, personal and cordiderdial reference purposes. The contents adds Certificate may not, in whole or in part, be reproduced; dlasen lid; entered into a computer database; or otherwise rimed, in any turn, or manner or by any means, except forth') user's Indlvlduai, personal and confidential rte. CERTIFICATE VERIFICATION The bdorration for the model rid on ttds certificate can be verified at www.ahridirectory.org, Air - Conditioning, Heating, dick or "Verify Certificate" fink and enter the AHRI Certified Reference Number and the date on z ® affli and Refrigeration Institute which the certificate was issued, which Is listed above, and Ore Certificate No., which Is listed below ©2011 Air- Conditioning, Heating, and Refrigeration Institute CERTIFICATE NO.: 129603227659093880 • • ' - .: . ,..... - - - - 0# sate :..._. : `_y -_ - _;_� -_ _ .- per�_ _�� ... _ ..yep • -..:.- _ �' 'm_ -9•'' =~ a - -_; ?i - ._ 5 �, ,, 2 T_ r s 1 r ra i 1 _ . $ I`- : Lp swiss To 'mil 8 : 2if 2 1 — • . ... ..,. ! 1`. '1. 1 - . X54: N% 3 1 78' . : -- -- :__ . • . . , -. .._` _ ` is _ BCiWAS!r-7 r _ RAf • -* --ot ii � _ - wt y kby- -P�la tLI • s =acmes �msgssiar�ns �_ . x- Ism Ji nDiiv ei* • teVitiniONOMiA :,i., i:�:.,.^+•..�f: i,:l. M;s, t, 'i.:'3' 's(T i Z �- .•. •� �, ].3.a-5;.- ^...1e't Power of Attorney for Finances (Limited Power) 4\411)L- I' ° ' Q Nf� l 4Z14.2. tiffeluk of 3/.3 - it /Ad; Awl&ob %DUX; 3A-i , appoint 11 to act in my place for the purposes of: LL This power of attorney takes effect on or until No il, 1Q 01(} /y and shall continue until terminated in writing , whichever comes first. I grant my attorney -in -fact full authority to act in any manner both proper and necessary to the exercise of the forego- ing powers, and I ratify every act that my attorney -in -fact may lawfully perform in exercising those powers. I agree that any third party who receives a copy of this document may act under it. Revocation of the power of attor- ney is not effective as to a third party until the third party has actual knowledge of the revocation. I agree to indemnify the third party for any claims that arise against the third party because of reliance on this power of attorney. Signed: This day of G71 State of: ift 4 Signature: County of: a��a�.ut�3Principal Social Security number: `J Witnesses On the date written above, the principal declared to me that this instrument is his or her financial power of attorney and that he or she willingly executed it as a free and voluntary act. The principal signed this instrument in my pres- ence. W' ess 1- Wiiiiess "Z' Si Printed Name \ ?„, Street Address t\ City, State, Zip Cod 4 City State, i ip Co LF240 Limited Power of Attorney 1-09 Onolo www.nolo.com Certificate of Acknowledgment of Notary Public State of Lk,,,, County of \A X f S0y\ On f O\ j p' c9.0 I t before me, Wt k�V\ ij , a notary � V public, personally appeared V% roAo. a PY , who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is /are subscribed to the within instrument and acknowl- edged to me that he /she /they executed the same in his/her /their authorized capacity(ies), and that by his/her /their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of (WS that the foregoing is true and correct. Witness my hand and official seal. Signature . • J .... • .MISS • AR'�Nrr• • • rJ►l • i{��'NOTARY PUBLIC '�•d • • *: No. 47694 : * . 1,:My Comm. Expires. s. 7 Nov. 23, 2014. E: • eS0 e Coo Acltfiewketdgment of Attorney -in -Fact By accepting or acting under the appointment, the attorney -in -fact assumes the fiduciary and other legal responsibili- ties and liabilities of an agent. Name of Attorney -in -Fact: Signature of Attorney -in -Fact: