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MC-11-2189
Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 167040 Permit Number: MC -11 -11 -2189 Scheduled Inspection Date: December 21, 2011 Inspector: Perez, JanPierre Owner: CASTRO, MARIA INES Job Address: 515 NE 93 Street Miami Shores, FL 33138- Project: <NONE> Contractor: THE ICE TEAM CORP. Permit Type: Mechanical - Residential Inspection Type: Final Work Classification: A/C Replacement Phone Number Parcel Number 1132060140990 Phone: 305/385 -3880 Building Department Comments REPLACE A/C UNIT AIR HANDLER, 4 TONS ( 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 10 of 35 UI DING 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 No.t l . Master Permit No. 1 +; it NOV 23 .2011 Permit Type: MECHANICAL OWNER: Name (Fee Simple Titleholder): Mei 4- 1lQ Std' Phone 713 (6OP Address: 5,1 5 I �`Z y /4 r B� City: ®&J ' //5& State: 7qE%e ."0 Zip: Tenant/Lessee Name: Phone #: Email: JOB ADDRESS: 6-75- Nt City: Miami Shores County: Miami Dade Zip: Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: % ze Co' Phone: 3 t -3's 03 icrD Address: City: : Qualifier NameTA'4/ C State: Zip: 3 Phone #: O�� -3-TJ 380 State Certification or Registration #: C. /4 C /e/ 3 e$ / Certificate of Competency #: Contact Phone #:3tf"3 I-- 3 SG'( Email Address: 6C lezza.A. e %4-7-77, DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $2 are/Linear Footage of Work: Type of Work ❑Address °Alteration New :,,„ air/Replace °Demolition , }, . Its , (�,i * * * * * * * * * * * * ** * ** * * * * * * * * * * * * * * * *F s************* * * * * * * * * * * * * *** * * * * * * * * * * * * * * ** Submittal Fee $ Permit Fee $ \1)5 t% CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ \\\* 1- T t 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 afier 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 ackn led - d bef re me ,4' " The foreg ing in trument w ackn' ' edged bef e Lis e i • !v day of ,2011 , b '1 �� a / day of 201 , by 111 �ll. l,j' 1 who is personally known to me or who has produced As identification and who did take an oath. NOT ' Y PUBLIC: ' Sign: Print: My Commission Expires: _ !1L �11r1 w I� 1 • is erso * * * * * * * * * * * * * * * * * * * ** * * * * * ** APPROVED BY (Revised 07 /10 /07XRevised 06 /10/2009XRevised 3/15/09) • 11 1 •I, to me or who has produced identification and who did take an oath. OTARY PUBLIC: Sign: Print: al CLAUDIA V. CUSIU.OS My Cornmiss **************************** klLs Examiner Structural Review Notary Pu ' ' F' "��,y MY Comm. Expires Sep 23.2015 • [ l Commission • EE 125510 ••i„Q; 00 Bow dough National NOW/ Assn. Zoning Clerk r . ` i 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 11 "9 ' Ciel 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): ' /5 A/&" 9 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 El NO ] ARHI Sheet Attached: YES NO ❑ Contract Attached: YES UNIT BEING REPLACED DATA NEW UNIT MANUFACTURER a<iei AHU or PKG. UNIT MODEL # /9,W "Yelk2A COND.UNITMODEL# / " V W (L'e / KW HEAT 10 NOM TONS 4 AHU ` CU P- 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 iL9dt YES 10 REPLACING DUCTS YES ES NO REPLACING THERMOSTATS NO YES NO NEW 4 "CONCRETE SLAB YES NO YES NEW ROOF STAND YES CD YES NEW RETURN PLENUM BOX YES (1/b') 1. Minimum Circuit Ampacity (Wire Size): / 2. Maximum Overcurrent Protection (Fuse/Breaker Size): 3. Voltage of Circuit (208/240/480): 2 ®f.- 2-'® 4. Size Disconnecting Means: 111E-- Contractor's Company Name: ;7r1 - 4C�.at-lt 6W�� l Phone: 906' 33'f 37 D State Certificate or Registration N Certificate of Competency N. Signature Ilfler's signature only) Date: FROM :A&D ALL -LINES INS ASSOCIATES FAX NO. :3053872918 Dec. 09 2011 11:50AM P1 ACORD..CERTIFICATE OF LIABILITY INSURANCE i2�9/2o 1 PROM /CFR A&D ALL -LINES INS ASSOC INC 5600 SW 135 Ave Ste 106 Miami, FL 33183 (305) 463 -¢781 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 THE ICE TEAM CORP. 3274 N.W. 38 ST . MIAMI , FL 33142 1305- 385 - 3880 INSURER A: ACCIDENT INSURANCE CO. LIMITS INSURERB: F,U,B,,� C: i IAB)I ITY COMMERCIAL GENERAL LIAE3ILflv rINRURER INSURER 0: 06/25/11 INSURER B: EACH OCCURRENCE COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. FOR THE POLICY TO WHICH ALL THE TERMS, L Y i(F4ZR54 DATE PERIOD INDICATED. NOTWITHSTANDING THIS CERTIFICATE MAY BE ISSUED OR EXCLUSIONS AND CONDITIONS OF SUCH INSw LTRJN Aapti. I%O TYPE OF INSURANCE POLICY NUMBER POLICY EFF IVE DA tAai 1 LIMITS A GENERA). i IAB)I ITY COMMERCIAL GENERAL LIAE3ILflv 090209000004862 06/25/11 06/25/12 EACH OCCURRENCE $ 1.000 , 000 X PREM SES [Ea ocou ence) $ 100 , 000 CLAIMS MADE 0 OCCUR MEDEXP(Anyoneparson) $ 5, 000 PERSONAL &ADVINJURY $ 1.000 , 000 GENERAL AGGREOA1E $ Zs.QQO a 000 $ 2 , 000 , 000 GEN'L AGGREGATE LIMIT APPLIES PER: n P n POLICY LOC PRODUCTS • COMP /OP AGG —I _ AUTOMORILF.I.ASIIJTY — ANY AUTO AIJ OWNEDAUTOS SCHEDULED AUTOS HIRED AUTUS NON- ONEDAUTOS W COMBINED SINGLE LIMIT (Ea =Ideal) $ ,...-- BODILY INJURY (Per person) $ — _ BQDILYINJtIRY (Paracc)dont) $ — PROPERTY DAMAGE (Peraw)dent) S – GARAGE LIABILITY ANYAUTO _ AUTO ONLY- EAACCIDENT $ I1 EA ACC $ ONNL" A Y ACC $ HXCESS/UMBRELLA I.IABILI1 Y OCCUR E CLAIMSMADE DEDUCTIBLE RETENTION $ 04/01/11 04/01/12 EACH OCCURRENCE $ AGGREGATE• $ — $ — $ i( LYORYLAIMrtS I 1EER H- $ B WORKERSCOMPENSATIoNAND ANY PROPNIETCR/PAR XEgUTIVE °yRyaafn ERAdEMBEN EXCLU p' SPECIIAALPR VISON$b Iaw 37648 E.L EACHACCIDENT $ 100 , 00Q EL DISEASE- EAEMPLOYEE$ 100,000 E.LDISEASE- POLICY LIMIT $ ' 5500.000 OTHER DESCRIPTION OF OPERATIONS / LOCATIONS/ VEHICLES! EXCLUSIONS ADDED DYENDDR$I MrNT /SPECIAL PROVISIONS GENERAL CONTRACTOR FICATE HOLDER, CANCELLATION VILLAGE OF MIAMI SHORES BUILDING DEPARTMENT 10050 NE 2 AVENUE MIAMI SHORES, FLORIDA )FAX: 305 -756 -8972 SI IQULP ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION • =• ANY KIND UPON THE INSURER. ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESE AT ACORD 25(2001/08) ORD CORPORATION 1888 0 H iC14 TEAM CORP. \ l Ckad©fi@1 flmj azgye2@for aOect Cleaning m Wz ue 51- oc NU O 3274 NW 38 8t - Miami, Florida. 33142 Ph: (305) 335.3880 - Fax: (305) 971 -6368 (Email: theiceteam@attnet www.theiceteamservice.com Licenced No. CAC 1813831 and Insured 13,4 CA sfrz7 515 N e 93 STreer' Mi t.S v s,FL, 1511 Customer PO # t11f -11 i sf�or�+ Date: 1/ / ,,Z,3 /201/ Reason for call: ❑ No Cool ❑ No Heat ❑ Water Leak ❑ PM ❑ Other: hLee I MS4A�rR'I49AOI '2S4vV44iltJO3 3R Zies l MODE!. R14KL�N1 1,1A Wt i i 1XZ4O WORK PERFORMED: %a,ee ai i Air CenrOditto n t j ,1"" eBaw4,1 1 Ere\ 10 ffliS `. X4-6 0 Sec 1(.o RECORD OF MATERIAL USED QTY Description RD. # PRICE ACCTG. Consufnables 1 Air &Nige -to /1.N rev( N 1 r tAl- M¢ul %lRiN stzona. at.ree til t i 4 yecuys Cdjrrwr o c- 5 ecws Pap is 1 trAir Laho r POio C 1.f CM -1D 4131 ICO STATUS: (Work Completed ❑ Work Incomplete I have authority to order the work, which have been satisfactory performed, as outlined above. It is agreed that the seller will retain title to any equipment or materials that may be furnished until final payment is made, and if settlement is not made as agreed, the seller shall have the right to remove same and The Ice Team Corp. Will be held harmless for any damage resulting from the removal thereof, in case the total charges are collected by suit or upon demand of any attorney, the purchaser hereof agrees to pay reasonable attomey's fees for the making of such collection. Authorked'Signature Date' 1123-11 Please Print Name THANKYOU FORYOUR BUSINESS! WHITE - OFFICE YELLOW - CUSTOMER L Re6Ci fe_ 7g0, Fuel Charge: Welding Charge Recovery .Machint;'& Cylinder Charge ❑ BILLOUT -0 COD ❑ ❑ IAO ❑ PM ❑ CM Refrigerant Usage Report Ref. type 4\ O New ref. added Recovered Reused Contaminated Ibs Reason Used XNew System ❑ Repairs Made ❑ Improper Charge TAX TOTAL Technician Date Haws OT ouLiLs g LABOR TOTAL INVOICE TOTAL STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESS comsTRucrmam INDUSTRY LICENSING BOARD 1940 NORTE DEMOB STREET TALLAHASSEE FL 32399-0783 COLONA r JUAN C THE ICE TEAM CORPORATION 7 986 SW 195TH STREET CUTLER BAY FL 33157 Congratidationst With this license you became one of the nearly one million Risk firms licensed by the Department of Business and Professamal Regulation. Our isofessionals and businesses range from architects to ratit brokers, from boxers to barbeque resteunsits, and they keep Florida's eamatny strong. Every day we wok to improve the way we do Wiriness in wrier to MVO you beam For information about our services, please log onto www.myftoridalicense.com. There you can find more information about our divisions and the regulations that impact you, subscribe to department newsletters and learn more about the Department's irdtiatives. Our mission at the Department is: License Efficiently, Regulate Fairly. We constardly strive to serve you better so that you can save your customers. Thank you for doing business in Florida, and congratulations on your new licens DETACH HERE REGULATION (850) 487-1395 BATCH NUMBER AigliMatMINTAR SEE OTHER SEX DOMMITIOMMMAD ICE TEAM CORPORAIlw THE JUAN C Mg, PRES 7986 SU 195 ST curium BAY FL 33157 IlriSIM nal wri,:vowmpayav wA,v,p4V4*64%t0A, Na7g.:PVRTWOWW ',0tA4 WOW ICE TEAM CORPORATION THE JUAN C COLONA PRES 7986 SW 195 ST CUTLER BAY FL 33157 II 11111111111111111111111141 PARA 11111111g111 Ce 111 :ate of ro tin AHRI Certified Reference Number: 3799428 Date: 12/2/2011 Product: Split System: Air-Cooled Condensing Unit, Coil with Blower Outer Unit Model Nwnber:14AJM49 Indoor Unit Skrdel Number: RHICL-HM4821+RCSL-W41121 Manufacturer. RHEEM MANUFACTURING COMPANY TradeiBrand name: RHEEM 14AJM SERIES Manufacturer responsible for the rating of this system combination i$ RHEEM MANUFACTURING COMPANY Rated as follows In accordance with AHRI Mandan, 2101240- for Air- Conulitionirg and Air -Source Heat Pump Ecpuimund and sabkoct to verification of ratkog accrwacy by raored. independent, third party tesithw wing Ca pack (ma): 46 EER Rating (Coallg) 13.00 SEER Rating (Cool} 16.00 `Ranneletmsedbyat attest* eikidficdaa tiatanttry reads of pr y putdshed data accurtaaefed tab aIfairt an ISCWMER AIM does not embreethe listed anAds Caddicate atd mires no toplasentatimayanuadlas ores ash; and assumes mis tespansbayitac the inathica) Bated an tits CeditkatbAldayeascidras a/ VaitrUyterdznagescisowlandansing aaattbenssev partumance dike area dddsl nd au Ws Ceitikele. Caddied Whop meant anlybroteabantconfiguenthas Asked ln die difechayaty . acta . TERRSAND CONDITIONS Ttb Ceddkate ands contents ant peapatuyanadads arAIWA.'fhb astazde shall a ybessseillar pessanal and continual ideas= muses. The cankeds Wads Contedeenaynat,b whaler/irk put, be wok* edlisdoa complardatahasu ar naked, In any tom Dreamer arbyanr means, except brae ne and =Mafia" ideence, CERTIFICATE VERIFICATION The information batik model cited asttdso e can be waded atwvAN.a a dare -dory r s<.s s r v'z} `t;< Mr-Conditioning, Heating, an °Veayry Certificcate° Ifni and earths A1II Coaled Reference Phoebe, and the date an and Refrigeration Institute which the o teas issued, ankh Is listed above, and the CeatlitCate Na, which brkited haft ©2011 Air- Conditioning, Heating, and Refrigeration institute CERTIFICATE NO.: 173008729958439