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MC-12-24Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 169302 Scheduled Inspection Date: January 30, 2012 Inspector: Perez, JanPierre Owner: KHAN, BEATRIZ Permit Number: MC- 1 -12 -24 Job Address: 520 NE 92 Street Miami Shores, FL 33138- Project: <NONE> Contractor: COOL BREEZE AIR COND CORP Permit Type: Mechanical - Residential Inspection Type: Final Work Classification: A/C Replacement Phone Number Parcel Number 1132060141190 Phone: 305 - 226 -2665 Building Department Comments EXACT CHANGE OUT OF 3 TON SPLIT SYSTEM riz 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- 168512. NO ONE ANSWER THE DOOR JPP 1/23/12 January 27, 2012 For Inspections please call: (305)762 -4949 Page 30 of 34 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 Titleholder): Address: .6'7-20 .t) C. 9z S'P- City: 772,,9,--7 7 �%,.ai2c -" -- /✓r, ?.9 G`si9./Z JAN 092ii2 IL� 8 Y: _ m Permit No. 1 D 14- Master Permit No. Phone#: (2- 36 •- Q9vv State: /T Zip: 33i��' Tenant/Lessee Name: Phone #: Email: JOB ADDRESS: 6 'c . 90 City: Miami Shores County: Miami Dade Zip: 3-7'Z 66 Folio/Parcel #: /I° 3 Z06 0/ V - // 9c Is the Building Historically Designated: Yes NO %� Flood Zone: CONTRACTOR: Company Name: (i c�L 1�ZCL'� /4d g``- k)eCrev3 Phone#: C��� 2=�` ZGG3 Address: a +ZD "-Z% < ,may t City: "Ma A Qualifier Name: r2 A.N State: 1z . Zip: s ► P c . Phone#: State Certification or Registration #: e_tA co z• Certificate of Competency #: Contact Phone #: Email Address: DESIGNER: Architect/Engineer: Phone #: ry .a Value of Work for this Permit: $ `1 ■ S ®• Square/Linear Footage of Work: Type of Work: DAdOress DAlteration New epair/Replace L]Demolition Description of Work: e x evc r CA-if-9,-56.6.j — D� > 0,- -7 Zed,:.) �`: -Ac-e -"`s 7'6'..-0-. . �ux�******** �x�a* �x�x�x�x +x�xa��x�x+x+xa��x�x�x�u�x*** * * s �x�x�x�x�x+ xa��x�x�x**** �x *�x�xx� *�x****�x�x **** *e��x*** Submittal Fee $ Permit Fee $ t CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ 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 A}tII)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. Signature Owner or Agent The fore oing instrument was acknowledged before me this ri2 , 20 .L, by who • ersonally known to me or who has produced D L day of ( )6 • � As identiation and who did take an oath. NOTARY PUBLIC: y Sign: Print: My Commissio APPROVED BY Ti s. :. Commission # DO 832497 lull 111 Bonded Through National Notary A 0 on c 26 201 • sis Contractor The foregoing instrument was acknowledged before me this day of s , , , 20 AL, by who i ersonally own to me who has produced as identificationnfd who did take an oath. NOTARY PUBLIC:. Sign: Print: My Co 1111i i Commission # DD 832497 Bonded Through National Notary Assn. ************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Plans Examiner Zoning 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): 5 20 10.67° 5'? City: Miami Shores Village County: Miami Dade Zip Code: 33/-vg 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 ARHI Sheet Attached: YES [ NO ❑ Contract Attached: YES ET Change Disconnecting means: YES ❑ NO UNIT BEING REPLACED DATA NEW UNIT Z )-14.::: MANUFACTURER .2'1/6 oZ�?-1 e. - v ea �‘s- AHU or PKG. UNIT MODEL # /9.1.2"."-7,-36. 40 cZ -i\r'-,s `� a' COND. UNIT MODEL # ,Rditc.h/i-,7. e r 1.3-4 cZ�� KW HEAT 3 ferns NOM TONS 3 /c AHU 44-u CU .Dc, PKG 1) M.C.A AHU %o CUyz^ PKG AHU cc, CU tee— PKG 2) M.O.P AHU CU v,Ir PKG AHU asp CU v PKG 3) VOLTS AHU' CU 2s° PKG PKG UNIT / / PKG UNIT / / D EERISEER i 6 - C) YES NO REPLACING DUCTS Y & c ) YES NO REPLACING THERMOSTAT YES) NO NEW 4"CONCRETE SLAB EY S c• YES NO NEW ROOF STAND YES YES.. NO NEW RETURN PLENUM BOX YES NO_ ) 1. Minimum Circuit Ampacity (Wire. Size): At ' co i=t .-& ' 2. Maximum Overcurrent Protection (Fuse /Breaker Size): AA — s� A..-....?. 3. Voltage of Circuit (208/240/480): pci://z34) 4. Size Disconnecting Means: -C D A—? Contractor's Company Name: ecoz s Ad e azrz .i6 Phone: 6.c&3 z-2-‘ ° -161-1- State Certificate or Registration N. CeAs lc -t-'� --," Certificate of Competency N. Signature ualifer's signature on OP ID: EVNA '4i °� i° CERTIFICATE OF LIABILITY INSURANCE DATEEMODNYTY) 12116/11 Alw,THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS RTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES FLOW. 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 305-221-2400 CONTACT Tropical Insurance Agency Inc. 305 - 552 -5360 PH„ E No. INC. No): 8824 Coral Way E-MAIL Miami, FL 33165 ADDRESS: PRODUCER Ct30LB -1 Alfredo Gonzalez &u:13oligRtna . ___...__. ..... _...__._ _. INSURED Cool - Breeze A/C Corp Frank Crawley 13120 SW 130 Terr Miami, FL 33186 INSURERS) AFFORDING COVERAGE NAIC # INSURER A : NATIONWIDE INSURANCE INSURER B : Bridgefield Employers Ins. INSURER C : INSURER D : INSURER E : 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. WAR LTR TYPE OF INSURANCE ADDL INSR BUSK WVD I POLICY NUMBER (POUC OF PMIDwrt F:. POLICY EXIT (IMMJDDtYYYY1 LIMITS A •GENL GENERAL LIABILITY iC1 COMMERCIAL GENERAL LIABILITY ACPGLD05905283046 01/01/12 01/01/13 EACH OCCURRENCE $ 2,000,000 PREN E1DRENTED PREMISES IEe =meow) $ 100,000 6,000 I CLAIMS -MADE r I OCCUR MED EXP {Any one person) $ PERSONAL & ADV INJURY $ _ $ 2,000,000 2,000,000 — —__.. _.. — GENERAL AGGREGATE AGGREGATE LIMIT APPLIES PER 1 POLICY 1 NT 1 — LOC PRODUCTS - COMPIOP AG $ 2,000,000 $ A AUTOMOBILE X ' LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNED AUT OS comp -1000 AC PBAZ5905283046 01101/12 01101/13 COMBINED SINGLE LIMIT (Ea accident) $ $ --- ---- $ $ 1,000,000 • - - -_- -- BODILY INJURY (Per person) --.. • -- - -- —• --- BODILY INJURY (Per accident) X X.1 X PROPERTY DAMAGE (Per accident) I $ X $ A X ._._ UMBREL LA LIAB I X I OCCUR EXCESS UAB 1 CLAIMS -MADE __.._..... Li ACPGLD05905283046 01101/12 01/01/13 EACH OCCURRENCE $ 6,000,000 '1(19-RE-1A-IC--- -$ - - -• -- - - 5,000,000 — DEDUCTIBLE RETENTION $ 10,000 X $ $ WORKERS AND 8 ANY OFFICER/MEMBER (Mandatory ayee DESlRIPTION COMPENSATION EMPLOYERS' UABILITY Y r N N / A 0830 - 334065 04/01/11 04/01112 WCSTATU- OTH- TQm' LOMB_ —E$ E.L. EACH ACCIDENT $ $ 500,000 500,000 PROPRIETOMPEXECUTIVE EXCLUDED? E.L. DISEASE - EA EMPLOYEE In NH) describe under OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 600,000 A Properly i ACPGLD06906283046 01/11/12 01/01/13 busperp ided 85,000 1,000 DESCRIPTION OF OPERATONS t LOCATIONS 1 VEHICLES (Attach ACORD 101, Addltlonal Remarks Schedule, U more space Is required) CERTIFICATE HOLDER CANCELLATION CITYMIS City of Miami Shores Village 10050 NE 2 Ave Miami Shores Village, FL 33138 SHOULD ANY OF THE ABOVE DESCRIB • POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, aTICE WILL BE DEUVERED IN ACCORDANCE WITH THE POLICY PROVI • NS. AUTHORIZED REPRESENTATIVE Alfredo Gonzalez ACORD 25 (2009/09) ©1988 -2009 ACORD C . ORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 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: 3805983 Date: 1/6/2012 Product: Split System: Air - Cooled Condensing Unit, Coil with Blower Outdoor Unit Model Number: 14AJM36 Indoor Unit Model Number: RHLL- HM3821 +RCSL -H *3821 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): 37600 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 responsfirfiity for, the product(s) listed on this Certficate. AHRI expressly disclaims all fiabitity 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.ahridirectoryorg. TERMS AND CONDITIONS This Certificate and its contents are proprietary products ofAHRL 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 at www.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 fisted above, and the Certificate No., which Is fisted below. ©2011 Air - Conditioning, Heating, and Refrigeration Institute A W®' Air - Conditioning, Heating, and Refrigeration Institute CERTIFICATE NO.: 129703541737624666 1LJJV Home Improvement Agreement: HVAC Installation • The Installation Professional named below will furnish, install and service the equipment listed below at the price, terms. and conditions as outlined on this form. Installation Professional /,/V47 Address i.3 /i0 • • W . , �Z. . Phone # Home Depot Information: [Lead# `_ ISO-t %V3k%2 t Installation Professional's License #/Exp. Date rP�� I C#4‘.0 City, State. Zip 7.7494 Proposal P 40/ Ce../..ADO/ Store •3zZ. TTMD Installer # t:ustomer mtormatiun: Name /A eN i',t ��L.3C+tii the Service Address 6.7e) 4, - &. v2 6. .1/. Yes Phone e: ay +2� Z - �+ t yre s3� — 77413 Ciri, State, Zip /�r�� z ffw2�3 j. 3.�, 3e Emal - Pump #1 Model # r : (attach additional list of equipment if necessa Manufacturer: Zat ""`- Permit Required? Yes ❑ No Permit Number City /County Issuing Permit YY1t.r4ervne_ ct(c -g. Scheduled Inspection Date/Time Pump #1 Model # 1* �R %' �./ ❑pCoil Model # It( Condenser/Heat Serial # /Thermostat Model # �r r Re e ❑ Pump #2 Model # ❑ Air Cleaner Model # Condenser/Heat Serial # ❑ HHumidifier Model # Handier #1 Model # Wte.4//�J'P ' frther 'Furnace/Air Serial # Model # /may ❑ Furnace /Air Handler #2 Model # ❑ Other Serial # Model # Provider Extended Service Home Depot ❑ Deductible Program Agreement Only ❑ Manufacturer Length ❑yyy 5 Year %10 Year ❑ 12 Year ❑ Other Type Parts ❑ Labor ❑ Parts & Labor Equipment Covered XComplete System/Kg Unit ❑ Condensing Unit ❑ Fumace/Air Handler ❑ Accessory ❑ Boiler J 4Other / "1:992 ( 1 7cV1 (4e z Check all that apply: ❑ New Amp electric service/disconnect XRemove existing equipment from premises Clean work area to customer's satisfaction Complete system startup 33 point installation audit ❑ Other Prices quoted will be VALID for a period of 10 days from the proposal date of this contract. NOTICE TO OWNER: DO NOT SIGN THIS CONTRACT IF BLANK. YOU ARE ENTITLED TO A COPY OF THIS CONTRACT AT THE TIME YOU SIGN. Total Investment $ Taxes $ Total Amount $ Permit/inspection Information: Permit Required? Yes ❑ No Permit Number City /County Issuing Permit YY1t.r4ervne_ ct(c -g. Scheduled Inspection Date/Time Notice of Cancellation form received: Termination clause reviewed: Initial Definitions: "You" /"Your" means the customer identified above. "Installation" means the installation services specified in this Agreement. "Installation Professional" or "Professional" means an independent contractor authorized by Home Depot (licensed and insured as required by Home Depot and applicable law) and the contractor's employees, agents and subcontractors. "Agreement" means this Special Services/Home Improvement Agreement betweenYou and Home Depot U.S.A., Inc. (interchangeably referred to as "Home Depot"), which includes this page, the General Terns and Conditions following this page, the State Supplement, the Invoice or Specifications and any other documents expressly made a part of this Agreement. Please see this Agreement's GeneralTerms and Conditions for additional definitions. Acceptance and Authorization: By signing below, You authorize Home Depot to (a) arrange for Installation Professional to perform Installation and/or (b) order and arrange for the delivery of special order merchandise, Including special order merchandise that may be custom made, as specified in this Agreement.You understand this Agreement constitutes the entire understanding between You and Home Depot and may only be amended by a Change Order signed by Home Depot (or by Installation Professional or its authorized representative on Home Depot's behalf) andYou.This Agreement expressly supersedes all prior written or verbal agreements or representations made by Home Depot, Installation Professional, You, or anyone else. Except as set forth in this Agreement,You agree there are no oral or written representations or inducements, express or Implied, in any way conditioning this Agreement, and You expressly disclaim their existence. Do not sign if blank or incomplete. (Installation Professional's/permitting information may need to be provided to You later.) By signing,You acknowledge thatYou have read, understand, and accept this Agreement in its entirety.You further acknowledge receiving a complete copy. Keep it to protectYour legal rights. DISTRIBUTION: Whke —Home Depot Copy Yellow— Customer Acceptance & Invoice Copy Pink — installation Professional Copy Gold—Customer Proposal Copy SITE INSPECTION: (explain responses in the Scope of Work section below YES NO ACCA Manual J Load calculation performed ✓ Equipment listed in this proposal will satisfy the Toad requirements determined in load calculation performed for this structure Jv'4.a.t. Z- `UZA 2 ZZe.o.2.q•..3-( AO S. iZiebil 16. _ o seVit. . ....,5`i', LLe.< C'Z,.-. 'C 3(_(.,... , P.:t .. /4(403 41-' R.. ST126" Is the existing ductwork properly sized to meet the requirements of: — — System Airflow (400 cfm/ton) -tt'd. ,sx y pv aczd -€ %/6 ✓ Zz C. t.-.t._• t`a.t . i ( Standard Velocity in branch and main ducts (If any deficiencies in existing ductwork, explain in the. Scope of Work section below) --- — What existing system components will remain a part of this system: (explanation o k section below) Outdoor Condensing Unit i." Refrigerant Lines r. - Furnace Proposed start date / _ Evaporator Coil ,/ Are existing system components compatible with refrigerant type and efficiency of the new equipment listed in the proposal? SCOPE OF WORK: (attach additional description and/or drawings if necessary) S, P4 • .s,z✓k. t,c t-a .3 Lw '&-, � ?Crz- Sysr ry's-�rc. � - t i J4 -r ere- (4)---)D t�c0c,:z te∎ -cr, ,Amy 114. tzsuranos.7t 1. Y1"7-4e. u s k .:.� Jv'4.a.t. Z- `UZA 2 ZZe.o.2.q•..3-( AO S. iZiebil 16. _ o seVit. . ....,5`i', LLe.< C'Z,.-. 'C 3(_(.,... , P.:t .. /4(403 41-' R.. ST126" ) WATG C>lL3t r-• W1/4.,#.10 SPki`L�'7Y Ste J-{ c `,.s�Cy (_Y WZaA70.■ >>A00 *3 C mot. zc�t "TZ1,-r t w,4 CtzPs 42 e_c-4. c--x.r Z-d (cts.TZNC. C�C..(4aC1itx..c, A L t�uC7wchZcL yti, 2.tott"J c.z•vt$ A. 3 7_,..Ls6- Zz- (sesZ.04.JT Lrwc -� . '12L "TYckKe.,f2S1 i - A`7 c -L-Lv9 c S Pta'j s--€5z.1 *-+t. 7 . Zz C. t.-.t._• t`a.t . i ( t ► 1 p:1/4c ;erc_4s 4. ‘-tlS ®. "" )0 as Nit. ,4.11-zs a=� Less t`?c.. c -z cs -mss: 1 Y ,t. E., l eA RA,cz,. 1 . -r &ITAL. 1' 35 5v°' 1 I+ lvixsty,— ,envrAvr. Proposed start date / Expected completion date u omer's gnature: :o- Signer (Map nstallatlon fession S cnature: Date: I'm)._ Date: / /oe Zvi Z this contract is not considered to be binding without the authorized signature of a licensed HVAC Installation Professional. By signing this contract, the licensed HVAC Installation Professional acknowledges the work to be performed will be in accordance with all federal, state, and local codes. DISTRIBUTION: White— Home -Depot Copy Yellow— Customer Acceptance & Invoice Copy Pink — Installation Professional Copy Gold— Customer Proposal Copy 1D -243 (11/18/11)