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MC-11-919Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 166766 Permit Number: MC -5 -11 -919 Scheduled Inspection Date: November 16, 2011 Inspector: Perez, JanPierre Owner: BARBARA BONDRA, RANDALL KING Job Address: 10634 NE 10 Place Miami Shores, FL 33138- Project: <NONE> Contractor: I8J COLLING SYSTEMS Permit Type: Mechanical - Residential Inspection Type: Final Work Classification: A/C Replacement Phone Number Parcel Number 1122320280850 Phone: (954)983 -8234 Building Department Comments REPLACE 5TON A/C SYSTEM Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments CREATED AS REINSPECTION FOR INSP- 160000. seal a/c closet, flex needs tape, missing hangers, matic inside of boots jpp November 15, 2011 For Inspections please call: (305)762 -4949 Page 41 of 43 5196(t1 moef' 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 N o . M C - ! L -7°1(21 Master Permit No. Permit Type: MECHANICAL n / OW 2 NER: Name (Fee Simple Titleholder): Q. n d a ! I e / 6,/19 Phone #: 7/ 7-3 8" 9S3 Address: City: ;L. a r 3 h O r-e_S State: Tenant/Lessee Name: n r) 1 Email: ran & l I c R. Rq D s rn a ;1 • COrn 10(0311 n F , )O 'VIO €- P( Zip: 3 i 3 D Phone#: JOB ADDRESS: / 0 (p 3 t{ f 1 ( Qit p (GL e .e. City: Miami Shores County: Miami Dade s 3 1 3 e Folio/Parcel #: I (— Z 2J 2— O 2 D$ 5-0 Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: S I c 1- y-■ Address: --+ t 3( R 4, hcQ C en City: 49( 1 ( 4) O®d < State: c• L- 4-, y Qualifier Name _1— va V) e_ C i((J State Certification or Registration #: G /etc • i 8 l t 2S0 Contact Phone#: 4" &-if q Z 1..0.1-6 Email Address: DESIGNER: Architect/Engineer: /v l i+ . Value of Work for this Permit: $ A *00 rO Type of Work: Address 1 ❑Alteration Description of Work: ,-12 -�G_�i (.0.-02-d• G 5 �.rL m a S yStevvi s Phone #: 4S 4 L{ 2.3 t off' b zip: 3302`x' Phone #: -S'123 1 O. 6• Certificate of Competency #: (l X90lt4as (2. 5 L . Ct➢w, Phone#: Square/Linear F0000ge of Work: ❑New URepair/Replace a-J-r i /' e0 i e tt 6CP:^ ❑Demolition *** * * * * * * * * * * ** * * * * * * * * * * * * * * * * * ** 5 s* ��******* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** 1 Submittal Fee $ Permit Fee $ CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW UE $ v 9 'Zi • Bonding Company's Name (if applicable) n 1 Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip nI� 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 E.T.RCTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S AFFll)AVIT: 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. Owner or Agent The foregoing instrument was acknowledged before me this le-01 day of rn(113 ,20 IL, by 60 Y1C0a n C. LA9 , who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: i�o ""r °OOH CONNIE J. GUNN �� Notary Public -State of Florida 's' —:t�O` es Jan 27, • Iliiiiir , �iiFii " 2149 //a-7/30)a * * * * ** *off * * * ***** **** ** APPROVED BY Signature Contractor ,, , �� The foregoing instrument was acknowledged before me this A day of / in ► �d3 ,20 0 , by G4(1 /24 t'tcn 14 who is personally known to me or who has produced O1.. cation and who did take an oath. NOTARY PUBLIC: /62-4/y3/-2.4-Li -i : C ••,,,,,;;oa,�� ss/on tafe of Bond„ � uss,0 PJres Jan27 ryda lit akdaakd�dkNa+ ksk�kH k, k�k�k�k�k�kiksH�kikikH�s {�sY�iksbsN�, fin, r1, 4 spn lans Examiner Zoning 7/cO (4 Structural Review (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) 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 0 ( 3 4" City: Miami Shores Village County: Miami Dade o Pt . Zip Code: `3 3 1 3 c°a 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 [E( NO ❑ Contract Attached: YES e UNIT BEING REPLACED DATA NEW UNIT " 62oace/A -a4-1 MANUFACTURER g%12.2W) 120. 0 6,0 AHU or PKG. UNIT MODEL # tZ:d-A L L , i-4 (' 1 6024 G t 0 6 0 COND. UNIT MODEL # 11} P( M 5 t0 I<IA / KW HEAT 1D K —' 5" `T" NOM TONS 5 T AHU 50 CU 35- PKG 1) M.C.A AHU CU 3S PKG AHU iS O CU .5-0 PKG 2) M.O.P AHU r®0 CU 50 PKG AHU 2: foCU 2.-f a PKG 3) VOLTS AHU2f0 CU zr PKG PKG UNIT / / PKG UNIT / / EER/SEER t 3 ` / YES NO REPLACING DUCTS YES NO +v. YES NO REPLACING THERMOSTAT YES V NO YES NO NEW 4 °CONCRETE SLAB YES V NO YES NO NEW ROOF STAND YES , t..."' YES NO NEW RETURN PLENUM BOX YES NO 1. Minimum Circuit Ampacity (Wire Size): A- W 1 • 2. Maximum Overcurrent Protection (Fuse /Breaker Size): 0 • P 3. Voltage of Circuit (208/240/480): 2q D J 4. Size Disconnecting Means: 6,0 et 1 ' P" Contractor's Company Name: `1 Ca 0 11 '^ a ?0° State Certificate or Registration N. GA C. /9 4 Z. Certificate of Competency N. Phone: '?S( Lio3 /O SIB ��r�� Signature - Date: ( ualifi s signature only) This combination qualifies for a Federal Energy Efficiency Tax Credit when placed in service between Feb 17, 2009 and Dec 31, 2011. f - uct atin • s AHRI Certified Reference Number: 3799471 Date: 5/19/2011 Product: Split System: Air - Cooled Condensing Unit, Coil with Blower Outdoor Unit Model Number: 14AJM56 Indoor Unit Model Number: RHLL- HM6024 +RCSL -H *6024 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- Conditioning 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 * Ratings followed by an asterisk (1 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(s) 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 listed on this Certificate. Certified ratings are valid only for models and configurations listed in the directory at wwwahridireciory.org. TERMS AND CONDITIONS This Certificate and its contents are proprietary products of AHRL This Certificate shall only be used for individuai, 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.ahridirentory.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 i ®Air- Conditioning, Heating, and Refrigeration Institute CERTIFICATE NO.: 129502548027704600 15- May -11 I & I Cooling Systems Corp 7131 Harding st Hollywood, FI 33024 Office 754 423 1050 email iicooling a(7,gmail.com CAC 1816250 Randall King 10634 NE 10 PI Miami Shore FI 33138 Off email Cell 1 717 385 4953 Proposal- Contract considered Rheem brand unit with friendly Freon R 410A 5t 16 seer 13 eer R 410 A Condenser 14AJM56A01 Air Handled RHLLHM6024JA Heater RXBH24A10J Mat and Labor $4,500.0 - $895.0 FPL rebated Cash Now $3,605.0 (Mat + Labor)- FPL rebate - $300.0 Tax credit 2011 Total $3,305.0 We propose provide material and labor to install a new air conditioning system up to code. 1- Remove old system 2- Install new split System 3- Install Air handled over metal stand 4- Install condenser over new concrete pad and tie down 5- Connect units existent drain line and power supply 6- Install secondary drain pan • 7- Install overflow switch 8- Replaced plenum 9- Replaced all grills 10 -Trash out old unit and generated garbage 11- Factory warranty cover 10 year in compressor and five year in parts if register 12- I & I Cooling Systems cover 1 year labor Note :Plans, Processing Fee and Permit Fee not include 60 % Down payment to star and balance at completion Owner Contractor \`' s Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION FORM ALL CONTRACTORS MUST PROVIDE COPIES OF LICENCES AND INSURANCES EACH TIME A PERMIT IS SUBMITTED OR THE VILLAGE MAY MAINTAIN A FILE WITH YOUR INFORMATION FOR A $30.00 FEE PER YEAR. IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. COPY OF QUALIFIER'S STATE LIC CARD B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF LIABILITY INSURANCE (CERTIFICATE HOLDER TO BE MIAMI SHORES VILLAGE BLDG DEPT) D. COPY OF WORKERS COMPENSATION (EITHER CERTIFICATE OR EXCEMPTION) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER B. COPY OF MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT C. COPY OF LIABILITY INSURACE (CERTIFICATE HOLDER MUST BE MIAMI SHORES VILLAGE BLDG DEPT) D. COPY OF WORKER COMP INSURANCE (EITHER CERTIFICATE OR EXEMPTION) YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE HOLDER AS FOLLOW: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 COMPLETE CONTRACTOR'S INFORMATION BUSINESS NAME: --- c0 (C i' - 6 `l 742- W7 s . c� '"P BUSINESS ADDRESS: C 5 ( tta r 97- CITY 0 /( ,Jooi `r v STATE /- ZIP CODE 33 © 2 T BUSINESS PHONE: (3C-1/ ) 413 1 FAX NUMBER (90 ) ' g 3 B 2 34 CELL PHONE ( 9-SY) 47...-5L00) QUALIFIER'S NAME: C UGt Q.. a' U QUALIFIER'S LIC NUMBER: 6 161-G. 19 .... 0 E -MAIL ADDRESS (IF APPLICABLE): I C COO C t L,La. Q fr l'L C°1.4'-‘ Created on 3119109 BY MLDV 1 RV 3126109 MLDV AC# 400-6 The CLASS Z >QN T ON'I� I Named below I$ CERTIF Under t.e provijsons€ Chapt� Expiration date: AUG 3;1., 2012 CHIDf» 1 & COOLX G SYST S'. 713.1 HA )um :' STRUT HOLLY OOD FL 3302 4-3$27 04 -25 -2011 JEFF ATWATER STATE OF FLORIDA CHIEF FINANCIAL OFFICER DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: PERSON: FEIN: 06/19/2011 EXPIRATION DATE: 06/18/2013 CHIU IVAN R 412188889 BUSINESS NAME AND ADDRESS: I & I COOLING SYSTEMS CORP 7131 HARDING ST HOLLYWOOD FL 33024 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 under 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 if, 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 any time for failure of the person named on the certificate to meet the requirements of this section. QUESTIONS? (850) 413-16 DWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01 -11 BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A -100, Ft. Lauderdale, F L 33301 -1895 — 954 - 831 -4000 VALID OCTOBER 1, 2010 THROUGH SEPTEMBER 30, 2011 DBA: Business Name: I & I COOLING SYSTEMS CORP Owner Name: CHIU IVAN RAMON Business Location: 7131 HARDING ST HOLLYWOOD Business Phone: 754-423-1050 Rooms Seats Employees Receipt #:183-1942 Business Type :HEATING /AIRCONDITION CONTRA (CLASS A AIR CONDITINING CON R) Business Opened:0 6/ 0 8/ 2 0 0 9 State /County /Cert/Reg:cA18162 5 0 Exemption Code:NONEXEMPT Machines Professionals For Vending Business Only Number of Machines: Vending Type: Tax Amount Transfer Fee NSF Fee Penalty Prior Years Collection Cost Total Paid 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 WHEN VALIDATED Mailing Address: CHIU IVAN RAMON 7131 HARDING ST HOLLYWOOD, FL 33024 This tax is levied for the privilege of doing business within Broward County and is non - regulatory in nature. You must meet all County and /or Municipality planning 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. 2010 - 2011 Receipt #05A -09- 00025650 Paid 07/23/2010 27.00 ACORD. CERTIFICATE OF LIABILITY INSURANCE PRODUCER PLACE FOR INSURANCE 1012 S State Rd #7 Hollywood, FL 33023 (954)962 -6000 INSURED ICI Cooling Systems, Corp. 7131 Harding St Hollywood, FL 33024 1 DATE (MMIDD/YYYY) 5/19/2011 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 mum a Merioan Vehicle INSURER Br INSURER C: NAILS INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING MY REQUIREMENT, TERM OR CONDmON 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 AU. THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ma OR Norm Wm TYPE OF INBU POLICY NUMBER LLI1 TEt UNITS A GENERAL X – LIABILITY COMMERCIAL GENERAL LIABILITY [ CLAIMS MADE X OCCUR 3067 -00 10/10/10 10/10/11 EACH OCCURRENCE . $ 500 , 000 yAJR gTD RENTED PREMISES (Ea &murenap,). $ 100 , 000 MEDBXP (Anyone person) $ 5,000 PERSONAL &ADVINJURY $ 500,000 QBNERAL A®GREGATE $ 500,000 GENE i1 AGGREGATE LIMIT APPLIES PER: PRODUCTS • COMP/OP AGG $ 500,000 POLICYF JECT 7 LOC AUTOMOBILE — _" _ LIABILITY ANYAUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON- OWNEDAUTOS COMBINED SINGLE MIT as $ BODILY INJURY (Per pawn) $_ BODILY INJURY (Pwawida it} $ PROPERTY DAMAGE (PeralmIaent) GARAGE — LIABILITY ANYAUTO AUTO ONLY- EAACCIDENT $ OOTTHHEERRTHAN EAACC $ AUTOONI.Y: AGO $ EXCESBIUMBRELLA 7 __ LIABILITY OCCUR ❑ CLAIMS MADE DEDUCTIBLE RETENTION $ EACH OCCURRENCE AGGREGATE S $ ■ • i #,� L..n R $ WORKERSCOMPENSATIONAND EMPLOYERS' ANY SFECiALPROVI� LIABILITY Et EACH ACCIDENT S EJi = awa CUTNE ONS below E.L. DISEASE - EA EMPLOYED $ E.L. DISEASE • POLICY LIMIT i OTHER _. DESCRIPTION OF OPERATIONS / LOCATIONS /VEHiCLEB /EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS CERTIFICATE HOLDER Miami Shores Village Sldg Dept 10050 NE 2nd Ave Miami Shores, FL 33138 t1 TION -� SHOULD ANY OF THE ABOVE DESCRIBED DATE - • HE ISSUING NOTICE TO - CERTIFI ACORD28(2001J08) tid WId9S :60 1102 61 ''EW 17Z98186bS6: '0N Xtid LLED BEFORE THE EXPIRATION ENDEAVOR TO W3 O„ DAYS WRITTEN D TO THELEFT, BUT FAILURE To DO SO SHALL ANY KINDpPON THE INSURER, ITS AGENTS OR OACORQ CORPORATION 191111 90NHZI(1SN I 80A 90bfd : W021d