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MC-11-1404Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 166819 Scheduled Inspection Date: January 18, 2012 Inspector: Perez, JanPierre Owner: STEELE, ELIZABETH Job Address: 301 NE 98 Street Miami Shores, FL 33138- Permit Number: MC -8 -11 -1404 Project: <NONE> Contractor: MIKE'S AC SERVICE INC Permit Type: Mechanical - Residential Inspection Type: Final Work Classification: A/C Replacement Phone Number Parcel Number 1132060135610 Phone: (305)751 -5814 Building Department Comments REPLACE 3 TON AC AND HEATING 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- 163885. CREATED AS REINSPECTION FOR INSP- 162778. seal a/c piemun, seal closet jpp LIZ STEELE 305.502.6266 January 17, 2012 For Inspections please call: (305)762 -4949 Page 17 of 49 Miami Shores Village Building Department 15( 1 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 r —d0(100-- INSPECTION'S (305) 795.2204 Fax: (305) 756.8972 l INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING Permit No. f C11.14"— 109 PERMIT APPLICATION Master Permit No. FBC 20 RECEIVED AUG 0 4 2011 BY: Permit Type: MECHANICAL OWNER: Name (Fee Simple Titlehol . r): I Z Q, >'�"-" "� Phone#: le r P ) Addres: City: Tenant/Lessee Nam ( Email: V11i t ?I7 I2 • JOB ADDRESS: State: Zip: a 4- ee. Co(K Phone#: 3-0 5--- 75 I City: '3 Miami Shores r County: Folio/Parcel #: 1! 2- 0 G 0 1 3 5 (A 10 Miami Dade zip: 3 31 3 9 Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: D i f 14(2.,;.0 f4 G - S E //e' e Phon#: JCS 7s! , ,E8 /4 - Address: l< N c 7 Cf .S 77 - S rte! AA City: AP)--7 s'27 f • State: (e/- y Zip: ,� ? l - S Qualifier Name: /'V? 1 / V Eli il /4 44- State Certification or Registration #: 6 / 9 Certificate of Competency #: Contact Phone#: 3Qr 757-6-8 if 4- Email Address: "k2/11 k e S CS � Pi 3 • coff. DESIGNER: Architect/Engineer: o Phone#: Value of Work for this Permit: $ ®7 ® Square/Linear Foo a of Work: Type of Work: ❑Address DAlterwso, Description of Work: C New epair/Replace ODemolition .� - . 14 'r ,4'4 9 /-, ..9 77;r, * * * * * * * * * ** �N* *** ******+ k******M* ***** *sk *+ k*** ************ ********************* Submittal Fee $ ••' Permit Fee $ Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ CCF $ CO /CC $ DBPR $ Bond $ 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 FLRCTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDmONERS, 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 Signature Owner or Agent Contractor The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of S, 20 I , by j7 A(Jf�- il- J -kc(e_ , day of 20 t , by who is personally known to me or who has produced As identification and who did take an oath. as identification and who did take an NOTARY PUBLIC: who is personally known to a or who has produced NOTARY PUB IC: `I Sign: Print: frh My Commission Expires: MIRTA LINO Comillibbknat Expires Weber 15, 2014 Bonded Thru Troy Fain Insurance g 7 II' •I w �► ►� ►a�AUUU /, Sign• // r �. <%Yr -sib Prin // ��? ** + k*B ****ek**********+ N******** ***N*********4, h***I' �k�ksk�k�k \ ///��iIIIIIIIII►►►►\\ Mans Examiner Zoning Structural Review Clerk (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) , t. c RiJ CERTIFICATE OF LIABILITY INSURANCE OP ID JV DATE (MM/DDIYYYY) 01/05/11 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(ies) 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 BROWN & BROWN -HBA DIVISION 2500 NW 79TH AVE, SUITE 101 MIAMI FL 33122 6V N I Al. NAME: (Eac o, No, Ext): FAX No): ADDRESS: CUSTOMER ID #: MIKES -2 INSURER(S) AFFORDING COVERAGE NAIC # INSURED Mike's A/C Service Inc. R.A. Box 4384 Miami Beach FL 33141 .- INSURER A : *Technology Insurance Co, Inc 4237 6 1NSURER B: *FOCI Commercial Insurance Co 33472 INSURER C : 01/12/12 PERSONAL INSURER D : $ 1 , 000 , 000 INSURER E : PREM AISES (Eaboccurrence) 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 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 AUUL INSR SUUF WVD POLICY NUMBER (MM/DD/YYYY) Y EXP (MM/DD/YYYY) LIMITS B GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY OCCUR GL0005097 01/12/11 01/12/12 PERSONAL EACH OCCURRENCE $ 1 , 000 , 000 X PREM AISES (Eaboccurrence) $ 100,000 CLAIMS -MADE X MED EXP (Any one person) $ 5 , 000 &ADVINJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMB APPLIES PER: PRODUCTS - COMP /OP AGG $ 2 , 000 , 00 0 I POLICY JEC° LOC $ AUTOMOBILE UABIUTY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ $ UMBRELLA UAB EXCESS UAB CLAIMS -MADE EACH OCCURRENCE $ _OCCUR AGGREGATE $ DEDUCTIBLE RETENTION $ $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUT OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS Y / N N / A TWC3263026 01 /01 /11 01/01/12 , X WCSTATU- OTH- TORY LIMITS ER E.L. EACH ACCIDENT $ 100 0 0 0 0 E.L. DISEASE - EA EMPLOYEE $ 1000000 below E.L. DISEASE - POLICY LIMIT $ 1000000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) CERTIFICATE HOLDER CANCELLATION Miami Shores Village 10050 Ne 2Nd Avenue Miami Shores FL 33138 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 ACORD 25 (2009/09) CORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD BATCH NUMBER MIAMI -DADE COUNTY 2010 LOCAL BUSINESS TAX RECEIPT r . e s FIRST-CLASS TAX COFCTOR MIAMI -DADE COUNTY - STATE OF FLORID U.S. POSTAGE 140 W. FLAQ R ST. EXPIRES SEPT. 30, 2011 PAID $ MIAMI, FL 33130 MUST BE DISPLAYED AT PLACE OF BUSINESS MIAMI, FL PURSUANT TO COUNTY CODE CHAPTER 0A • ART. 9 & 10 PERMIT NO. 231 THIS IS NOT A BILL — DO NOT PAY 166337 -7 BUSINESS NAME / LOCATION MIKES A C SERVICE INC 775 NE 79 ST 33138 MIAMI R MIKES A C SERVICE INC Sec. Type of Business WORKER /S Tres H: r6A C MECHANICAL CONTRACTOR 10 BUSINESS -TAX RECEIPT. DOES NOT PERMIT THE HOLDER TO VIOLATE ANY EXISTING REGULATORY OR ZONING LAWS OF THE COUNTY OR CITIES. NOR DOES IT EXEMPT THE HOLDER FROM ANY mist PERMIT OR LICENSE REQUIRED BY LAW. THIS IS NOT A CERTIFICATION OF TTHO R E HHOLDE S QUALIFICA- 1 RENEWAL RECEIPT NO 166337 -7 STATE# CAC039619 PAYMENT RECEIVED COUNTY TAX COLLEGTOit 09/07/2010 60010000191 000045.00 SEE OTHER SIDE DO NOT FORWARD MIKES A C SERVICE INC MIGUEL MAYTA PRES PO BOX 4384 MIAMI BEACH FL 33141 ,11111,,, 11111111, 111111111111, *1111111$11111111111111111P1 0 111 AHRI Certified Reference Number 3412409 Date: 8/2/2011 Product: Split System: Air - Cooled Condensing Unit, Coil with Blower Outdoor Unit Model Number: 14AJM36 Indoor Unit Model Number: RHLL- HM3617 +RCSL- H*3617 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 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): 36200 EER Rating (Cooling): 13.00 SEER Rating (Cooling): 15.50 Ratite Mowed by an asterisk (*) hdcate a voluntary relate of ply published data, amass accompardadwah a WA,S, which indicates an Involuntary mate. DISCLAIMER AHRI does not endorse the product(s) listed on this Cede and makers no representations, vernandes or guarantees as to, aril assumes no responsliMhy for, the product(s) l i s t e d on t h i s Certificate.AHRI expresslydiscialms at habilltyfor dam of any!dhd aching out of the usea perfomahce of the unauthorized alteration of data listed on this Gems. CertPled ratings are valid onyforunder and hated In the orate directory at wuvw.ahridirectoryorg. TERMS AND CONDITIONS TI; Cert cafe and Its contents are proprietary products ofARRI. This Certifkate shall any be used for Individual, personal and confidential reference purposes. The contents of tide Certificate may not, in inhabit or in part, be reproduced; coplerb dhseur entered hdo a commder database; or otherwise utilized, to any form or manner or by any means, except for the user's Individual, personal and confiderdbd hence. CERTIFICATE VERIFICATION The bdanratah for the model cited on this certificate can be trollied atwww.ahridlrector org, click on "Verify Certificate" Mk and enter the AHRJ Ceti led Reference Number and Medan %filch the certificate was Issued, which is listed above, and the Certificate No,wlddthwedbekw. ©2011 Air- Conditioning, Heating, and Refrigeration institute ag Air - Conditioning, Healing, and Refrigeration Institute CERTIFICATE NO.: 129567759088918750 } 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): 3D1 Ale q cs 7 Zip Code: 3 3 13 City: Miami Shores Village County: Miami Dade 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 VNO ❑ ARHI Sheet Attached: YES 0110 ❑ Contract Attached: YES IEK UNIT BEING REPLACED DATA NEW UNIT /� j- /[�'�/ MANUFACTURER R J� ee1)/ AHU or PKG. UNIT MODEL # COND. UNIT MODEL # /d¢ A 7 /r/ 3I ,4Tj l /0 /c. / KW HEAT / a /c NOM TONS AH CU PKG 1) M.C.A U CUL 3 PKG — AHU CU PKG -_ 2) M.O.P AHU CU36 PKG AHU CU PKG 3) VOLTS AHUG743DCU.Z7CPKG PKG UNIT / / PKG UNIT / / EER/SEER /%57.---c- YES NO REPLACING DUCTS YES iiIr'- YES NO REPLACING THERMOSTAT tEP NC) YES NO NEW 4 °CONCRETE SLAB YES �10 YES NO NEW ROOF STAND YES 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: I Contractor's Company Name: / (2,� � rV(Ee Phone: 3 s 7$ (--ra / C.f. State Certificate or Registration N. f 4 C 03 Td, j Certificate of Competency N. Signatur v�- (QuaU ier's slgn : re only) Date: 0 E2JI.0 prin Liliou cJi• AIR CONDITIONING & REFRIGERATION PROPOSAL AND SALES AGREEMENT CUSTOMER: Ms. Elizabeth Steele ADDRESS: 301 NE 98th Street ADDRESS: Miami Shores, FL 33138 -2409 July 28, 2011 RE: Replace 3.0 ton air conditioning and heating system (with new environmentally friendly refrigerant 410A) DESCRIPTION OF SERVICES: INSTALL 3.0 TON RHEEM AIR CONDITIONING & HEATING SYSTEM 1) We will recover the refrigerant 22 from the old system, we will remove the old air handler unit from the attic, we will remove the condensing unit, and we will dispose the old airconfdioning system according to EPA regulations. 2) We will install new 3.0 ton HI EFFICIENCY RHEEM air conditioning & heating system, the air conditioning system has efficiency rating of 15.50 SEER, all installations will be done according to South Florida BLDG codes. 3) We will ink the new condensing unl in the same place, we will install the new air handler unit in the same place in the closet, we will install the new float switch in the air handier unit, we will reconnect the electrical in to existing, we will gleaned out the existing refrigerant lines with RI1 flush out, we will reconnect the reconnect the refrigerant lines in to existing, and we w l reconnect the ductwork into exisfing. 4) We will eremite the system, we wffi charge the system v h new refrigerant R1OA and we will the syshen in the h the house. EQUMNENT: AIR CONDITIONING & HEATING SYSTEM SEER IS 15.50 1 14JM38A01 CONDENSING UNIT 1 RHLLHM3617JA AIR HANDLER UNIT 1 DIGITAL HEATING & COOLING THERMOSTAT 1 RXBH1724C07.1 DATER 1 AIR HANDLER UNIT STAND 1 ALL THE MATERIALS TO INSTALL THE NEW AIR CONDITIONING & HEATING SYSTEM SERVICE W : wires* be provided free of charge by us fora period alone year from date of i regular worms dam Munday tlsu Friday & regubr wodrirag hours 8:00 AM to 5:0? PM. ..'.E, the parts in The system for pearl e Miffed of fen years, the condenser col for period often years and the compressor for period forten years-from The dale of installation. TOTAL SYSTEM COST: We shall furnish labor, materials & equipment Mailed on pages 1 & 2 for $3,7.. tax is included in this REBATE TOTAL CUSTOMER PAYS SUMO i FEE & PROCESSING TERMS: Customer /Imlay accepts this proposal and agrees 10 payments as f. 50% down parted with Smolder ate final payment when the job is CONTRACTOR: City DATE: ' "to,/aqerr DATE: D S' J b Z 1 775 N. E. 79th STREET SUITE H MIAMI, FL 33138 * PHONE (305) 751 -5814 * FAX (305) 861 -4190 MAILING ADDRESS * P. 0. BOX 414384 * MIAMI BEACH, FL 33141 CAC 039619 SALES * INSTALLATION * SERVICE SINCE 1974 h 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 No. i/ 1G O"") C"- gO4 Master Permit No. Permit Type: Electrical OWNER: Name (Fee Side Titleholder): )-- ((2 �i_ (-_) c � LPhonet i 5 -(02-6 6 Address: 0 1 Cr - `1 Cts' + City: I"1, ct,-b . < J �- + grace = I gyp: 3 3 fS Tenant/Lessee Name: - PIS JOB ADDRESS: tl r-vm Z �.: City: Miami Shares County: Miami Dade - Tip. ) 3 Email Folio/Parcel#: i , �, � _ .. �� C Is the Building : Yes CONTRACTOR: Co y Name: 0:4".C1) NO Flood Zone: Ph01 $C 476.. a 4 S1) ( 4 7 / L 4 _ . ; City: l' �� Stater' Qualifier Name: d • 4 . /14/7% ' State Certification or Registration 8: COQ at:3 cemfirate of Cot cy #r t # 7 . .tef, c dk Ate --% Tap: 4.10Zej- — Contact Phone#: 7806-410? b Email Address: DESIGNER: Architect/Engineer: nowt Value of Work for this Permit: $ (6)"4`9 Sq utr: I1. ;.. of Work: Type of Work: OAddress • OAlteration ONew oft of Work: & A . • LAgire yelo taqn,11-7 16-e‘\*Aek.... ELIA. CAN lace Submittal Fee $ Scanning Fee $ Radon Fee $ Notary $ Trainingfalucadon Fee $ Double Fee $ Structural Review $ Fees*" Permit Fee $ ®� id 6' CCF $ CO/CC $ DBPR $ Bond $ Technology Fee$ TOTAL FEE NOW DUE $ Bonding Company's Name (if applicable Bonding Company's Address City Mortgage Lender's Name (if Mortgage Lender's Address City State Zip 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 BLECI RICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC..... OWNER'S AFFIDAVIT: I certify that all the forming 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 t© the issuance of a building permit with an estimated value exceedi4 $ the applicant Est ar good frith dart a copy of the notice of costanencerneat and conarttaion lien kw bn'hwe will be idivered tom person whose property is subject m attachment Ate, a certified copy of the recorded notice of raw be posted at the job site for the inspection winch s seven (7) � � p - - In the absence of such posted nab the inspection will not be approved ;; a reinspect& ma fee will be charged. The day of Owner or Agent 2O r by 4.:itff to me arm has produced As identification and who did take an oath. NOTARY LIC: Si Print .411/111. ' -IA ` Commission #DD932071 - # N0o 29, 2013 My Commission APPROVED B <' 1. Plans Examiner who is k::171 Y. hi" .. Contractor was acknowledged brie this f l by 04-6 to me ort has i31 e.;�li :r:t as identiIcation and who did take an oath. NOTARY Pat My Commission LIC: u� 0 _JAM114-1 a 11.411) "'IN Melissa C. Wolin Commission #DD932071 Expires: NOV. 29, 2023 BONDED THRII ATLANTIC BONDING CQ,INA frvi Structural Review ( 07n0/07)(Rev set 06!11V2009 )(Revised 3115/09) Zoning Clerk