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MC-11-1413Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 LL Inspection Number: INSP - 162835 Scheduled Inspection Date: February 01, 2012 Inspector: Perez, JanPierre Owner: ROSENTHAL, ANNA Job. Address: 1270 NE 94 Street Permit Number: MC -8 -11 -1413 Miami Shores, FL Project: <NONE> Contractor: SERVICE AMERICA ENTERPRISE INC Permit Type: Mechanical - Residential Inspection Type: Final Work Classification: A/C Replacement Phone Number Parcel Number 1132050100160 Phone: (954)979 -1100 Building Department Comments AC CHANGEOUT 4 TON ‹L VL Passed ua Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments 05 - -)6\65 l9 5 zto January 31, 2012 For Inspections please call: (305)762 -4949 Page 2 of 39 3533.3ic 9 CUMULATIVE SUBSTANTIAL IMPROVEMENT VERIFICATION WORK SHEET In accordance with FEMA regulation and Miami Shores Village Flood Damage Prevention Ordinance the costs of all improvements must be monitored. The costs of any improvements in the past 12 months and the costs of any proposed improvements must be shown on the worksheet. The cost of improvements must include demolition, raw and finished materials (include those donated), labor (including volunteer and self - performed), construction supervision and management, and overhead and profit. A list of items the costs of which are to be included as well as those excluded is attached for your reference. (A Copy of the Contract must be attached) PROPERTY OWNER: a ` In+ rd PERMIT # ADDRESS: C vl� 1 — ;cm, .rho s 33)3? FOLIO NUMBER:11 U-- O I 0 FLOOD ZONE: BASE FLOOD ELEVATION: FREEBOARD: EAST OF FL.CCCL: COST OF PAST IMPROVEMENTS (12 MONTHS): COST OF PROPOSED IMPROVEMENTS: (ATTACH COPY OF CONTRACT) TOTAL CUMULATIVE COST OF IMPROVEMENTS (past and proposed): F PRINCIPAL STRUCTURE (attach appraisal): OWNERS SIGNATURE: PLANREVIEWER: PLAN REVIEWER SIGNATURE: 7-\\ DATE: 81 --'7I) 1 Created on June 2009 DATE: 4 SUBSTANTIAL IMPROVEMENT / DAMAGE LIST (NOTE: THIS LIST IS INTENDED FOR GUIDANCE ONLY, AND IS NOT ALL INCLUSIVE) ITEMS TO BE INCLUDED ALL STRUCTUAL ELEMENTS, INCLUDING Foundations including; Spread footing, Continuous footing, isolated footing, piles and pile caps Slabs including; Monolithic, floating, elevated Walls including; Exterior walls, Bearing walls, Shear walls Beams, Tie Beams, Columns and Posts Wood decking, Floor and Roof Sheathing Trusses, Joist Windows /Doors ALL BUILDING ELEMENTS, INCLUDING Interior Partitions, Walls, Columns Drywall, Ceilings, Built in Furniture, Cabinets, Vanities All Fixtures Flooring, Tile, Carpet, Stone, Linoleum, ect. All Finishes including Drywall, Paint, Stucco Plaster, Paneling, Tile, Marble, and Moldings Roofing Material RDWARE ALL UTILITY and SERVICE EQUIPMENT HVAC Electrical System and Equipment Plumbing System and Equipment Security System and Equipment Central Vacuum System Plumbing Fixtures Lighting Fixtures and Ceiling Fans Water Systems including Softeners /Filtration Created on June 2009 ALSO: All Labor and other Costs associated with Demolition, Removing, Replacing, Installing Building or Altering Building Components Construction Management / Supervision Overhead and Profit Equivalent cost for: Donated Materials Volunteer Labor (including owners and friends) Any Improvements Beyond Pre - damaged Condition, including; Utility Upgrades Code Upgrades ITEMS TO BE EXCLUDED Plans and Specifications Survey Costs Elevation Certificate Costs Permit fees Debris Removal Items not considered to be REAL Property Rugs, Furniture, Refrigerator, Appliances not Built -in Outside Improvements, Including; Landscaping Sidewalks Patios Fences Yard lights Sheds Gazebos Irrigation Pool SERVICE . Corporate Office 2755 NW 63rd Court • Ft. Lauderdale, FL 33309 www.serviceamerica.com AIR CONDITIONING we've get you coveted. SALES AGREEMENT 1- 888 - 201 -5759 9rvice o 5 e4 th 1 • Customer Na 5-33 q Account/Contract # Date: r Li _ a Email Address: Home phone: 305- 298' 651-00 S.O. #: Other phone: S.O.# Admin. Fee: 1 270 Vi g y sr Installation Address: Bldg: Apt: l l mui; Slaorej City: l 3313 e:' ZIP: System Type: t U Package 11 Water Source Cifiraight Cool U Heat Pump Condenser Location: Uer-ound D Roof U Crane Needed # of Stories Air Handler Location: U Garage U Attic ID eroset CONTROLS & ELECTRIC µ'.JOB SPECIFICATIONS DRAIN LINE & REFRIGERANT PIPING Thermostat Type: ❑ Digital ❑ Programmable Wiring: ❑ Thermostat ❑ Disconnect Box ❑ Smoke Detector Replace Circuit Breaker: ❑ Air Handler: Size Type Uktondenser: Size ti 0 Type 11111).• ).• VHeater: Size 10 Condensate Drain Hook -up: mary ❑ Secondary ❑ New Condensate Pump U Slab ❑ Auxiliary drain pan ❑ Horizontal drain pan i xilary float safety switch ❑ Refrigerant copper liquid line size: ❑ Refrigerant copper suction line size: U Gas pipe from ❑ Refrigerant line cover VorIOA Flush Installation Information: .2 Sr e, ?'rill" 7'5'5 All work performed in accordance with existing codes. Includes all required permits for work performed by us. Mounting hardware for installation, weather resistant vlbration/isolation pads, hurricane strapping and removal of old equipment. Make C.q r`r+l a P` Tons L% SEER BTU Li 9),500 KWH /4.t' to Model A/H Ft /q ck' F C72t% -00 ModelCond al i oc6l71.lE7)4003 Price G 1119/ Make Tons BTU KWH Model A/H Model Cond Price SEER Make Tons BTU KWH Model A/H Model Cond Price SEER System Investment Install Kit Crane Rebates /Credits Utility F. L. Service America Other Replacement Credit Recommendations: Insulation Duct Cleaning UV Light Other Administrative Fee (non - refundable) Total Investment Down Payment Balance D e 6.y67 ti11:10 .7 760 1294 .17.0e r Lig03 (! °-200 Ce Installation Date: WARRANTIES d t't3fay' IAAE Parts & Labor Warranty A/H Yrs. ii/S/ AE Parts & Labor Warranty Cond. Yrs. c Mfg.'s Warranty on Compressor Yrs. 1: `/Mfg.'s Warranty on Outdoor Coil Yrs. C�Mfg.'s Warranty on Indoor Coil Yrs. (iy5T R JI;?ev h ❑ Mfg.'s Warranty Parts PAYMENT INFORMATION Meth,gd of Payment: ❑ Cash ❑Financing [r,]'Credit Card ❑ Check # CC Type ❑ Visa [iir4fC ❑ Discover Credit Card ReS'ci /6 6584 93!7 176 h Expiration Date. Signature. Financing Company Terms: !accept this Sales Agreement and :he speciftcations and conditions above. You are authorized to perform work as spedfled. It is agreed and understood by the parties that all equipment which is sold pursuant hereto shall not become fixtures or part of the real estate where they are placed until payment in full is received. Buyers right to cancel: You the Buyer may cancel this transaction without penalty or obligation at any time prior to midnight of the third business day after the date of this transaction by proper notification Payment due to installers In full upon completion of installation. My signature acknowledges acceptance of the terms above. I have read and understand all information on the front and back of this Sales Agreement Customer Signature: 'x AL,._* Date: - Comfort Consultant: � Ladder required for inspection: U Yes FiPQo Size: Service America LUCd's CAC014619, Em002822. CFC057126 White Copy - 0 • Yellow Copy - Customer • Pink Copy - Finance • Gold Copy - File Miami Shores village 6)4\ 11(only6 Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 8)9)5Tel: (305) 795.2204 Fax: (305) 756.8972.... )9-01 , INSPECTION'S PHONE NUMBER (305) 7624949 BUILDING Permit No. rn ' ° L113 PERMIT APPLICATION FBC 20 Permit Type: MECHANICAL qp.sc j j l f f OWNER: Name (F ; ;SimpleTitleholder) U�4, m I L (it Phonel / ) -1q Y. tiO Address: i �® 'IV > go t�'I 1 -� } fit, 3 ) City: J `1 i' O(CS State: Zip: Phone#: Master Permit No. Tenant Name: Email: JOB ADDRESS: ) o 13 QL1 t- City: County: Zip: Miami Dade Folio/Parcel#: I)---30-°5---010-.0/(00 Is the Budding Flistorically Did: Yes NO Flood Zone: Phone#' 1 IP -1 Go X I l �0 CONTRACTOR: Co Nam: S-J2JUJ ii IL. Afr r i cc,_ Add�: %�- �ykA),,D k. Q ? C G City: 1/ (4 r State: t° Phone*: Qualifier Name: / it etA s) 5 i' State Certification or Registration #: ' PI .O I U V' ICI Certificate of Competency #: Contact Phone# Email Address: 0 ,PIA fao 39 a --ou c-. ovout6.0, MO 'r1((- DESIGNER Architect/Engineer: Phone#: Value of Work for this Permit: $ �� Ir% • ( Square/Lines-Footage of Work: Type of Work: U OAlteration ONew ►`,"l:pair/Replace Demolition �r ) -t- rn CO/11P Y ) t ,�i20., — I�riptlon of Work: Pr �... Orca,� � /t: F" VL/C.1l/F OS i 0 CM-US Lif ' n® Submittal Fee $ p,DPermit Fee $ Scamdng Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ DBPR $ Bond $ Technology Fee $ Cc/Yva + 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 net the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for Fi ECTRICAL 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 land that all work will be done in compliance with all applicable laws regulating construction and zoning. i "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 l estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and co f +• brochure will be delivered to the person whose property is subject to attachment Also, a certified copy of the recorded n d nt must be posted at the,'ob site days r the building n, In the absence of such posted notice, the for the first inspection which occurs seven (7) day after g pe inspection will not be approved and a r2inspection fee will be charged Signature Owner or Agent The foregoing instrument was acknowledged before me this 4i day of ,4.1 , 2fl ij , by a. r" u c e /a 5�'at Thal , who is personally known to me or who has produced D L� As identification and who did take an oath. NOTARY PUBLIC: °" • TH AtZteliMMANG otary �utile - State of Florida ` LO,' My Comm. Expires Mar 26, 2014 �� q��• Commission # DD 64738 Signature or The fo oing instrument was acknowledged before me day of wh (Revised 07/1 by 71.6,G'`aA.cx known to me who has produced Structural Review 06/10R009XRevised 3/15/09) as tification and who did take an oath. NOTARY PUBLIC: Sign. Print: My Co : DD035088 cxpis -3s 33/21/2 013 Zoning Clerk 3333s Miami Shores village Building Department 10050 IV.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 owr data sheet Multiple units on single sheets are not acceptable. Job Address (where the work is being done): 1 aq ‘C.)' q City: Miand Shores Pillage County: Miami Dade Zip Code: .3 3 d ?)Y) ALL CONDENSING UNITS MUST BE ON A 4 INCH SOLID CONCRETE SLAB ALL UNITS MUST COMPLY WITH F.E.MA MINIMUM FLOOD ELEVATION A COPY OF THE CONTRACT IS REQUIRED WITH ALL SUBMITALS ARI (AHRI) DATA SHEET REQUIRED Change Disconnecting means: YES 0 NO ARHI Sheet Attached: YES IO ❑ Contract Attached: YES UNIT BEING REPLACED DATA j NEW UNIT /. A i- 0 : MANUFACTURER !, +' .��� is ErdiN yi WiliMrLiEn co a; iiiarff AHU or PKG. UNIT MODEL # i�`t1 MI COND. UNIT MODEL # KW HEAT NOM TONS AHU .g s CU . PKG 1 M.C.A ginif11111.1 AHU . , ®CU 'A PKG 2 M.O.P AHU. ^CCUd -j0 PKG AHU CU PKG 3) VOLTS AHU' CU PKG PKG UNIT / / PKG UNIT / / 1 lGa ."5- EER/SEER I . YES /a REPLACING DUCTS YES CW YES ' REPLACING THERMOSTAT YES ` • '�' ^ NEW 4'CONCRETE SLAB `'i NEW ROOF STAND ri3 YES . • NEW RETURN PLENUM BOX YES In 1. Minimum Circuit Ampacity (Wire Size): C 2. Maximum Overcurrent Protection (Fuse/Breaker Size): U -� t:11) SIN_ Ls 1-1' 3. Voltage of Circuit (208/240/480): CAC as) -P. Phone09-1!` 14(1 -1 too le 5c,1 h Date i e•:ct Y Certificate of Product This combination qualifies for a Federal Energy Efficiency Tax Credit when placed in service between Feb 17, 2009 and Dec 31, 2011. atones AHRI Certified Reference Number: 3636982 Date: 8/4/2011 Product: Split System: Air - Cooled Condensing Unit, Coil with Blower Outdoor Unit Model Number: 24ACB748A**30 Indoor Unit Model Number: FV4CN(B,F)005 Manufacturer: CARRIER AIR CONDITIONING Trade /Brand name: COMFORT 17 PURON AC Manufacturer responsible for the rating of this system combination is CARRIER AIR CONDITIONING 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): 48500 EER Rating (Cooling): 13.10 SEER Rating (Cooling): 16.50 *Ratings followed by an asterisk (*) 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 www.ahridirectory.org. TERMS AND CONDITIONS This Certificate and its contents are proprietary products of AHRI. 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" Zink 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 Air-Conditioning, Heating, Er and Refrigeration Institute CERTIFICATE NO.: 129569561069756847 Certificate of Pry This combination qualifies for a Federal Energy Efficiency Tax Credit when placed in service between Feb 17, 2009 and Dec 31, 2011. uct atings AHRI Certified Reference Number: 3636982 Date: 8/4/2011 Product: Split System: Air - Cooled Condensing Unit, Coil with Blower Outdoor Unit Model Number: 24ACB748A**30 Indoor Unit Model Number: FV4CN(B,F)005 Manufacturer: CARRIER AIR CONDITIONING Trade /Brand name: COMFORT 17 PURON AC Manufacturer responsible for the rating of this system combination is CARRIER AIR CONDITIONING 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): 48500 EER Rating (Cooling): 13.10 SEER Rating (Cooling): 16.50 * Ratings followed by an asterisk (') 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 www.ahridirectory.org. TERMS AND CONDITIONS This Certificate and its contents are proprietary products of AHRI. 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 atwww.ahridirectory.org, click on "Verify Certificate" Zink 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 Air- Conditioning, Heating, and Refrigeration Institute CERTIFICATE NO.: 129569561069756847 / SERVICE Corporate Office AMERICA' 2755 NW 63rd Court • Ft. Lauderdale, FL 33309 www.serviceamerica.com AIR CONDITIONING we've get yea *wood. , SALES AGREEMENT 1- 888 - 201 -5759 Customer Name: Rase,% . icc f Account/Contract � a3>& — Li _1I Date: Email Address: Home phone: 34.E ' 796 '- 6 6 4 0 S.O. #: Other phone: S.O.# Admin. Fee: 117e */O` yy Installation Address: sr Bldg: Apt: ma, uMi S 1aore3 City: 5 3 I.3 25 ZIP: System Type: Ul p t ID Package ❑ Water Source LI.•raight Cool ❑ Heat Pump Condenser Location: O tround ❑ Roof ❑ Crane Needed # of Stories Air Handler Location: ❑ Garage ❑ Attic P•C'toset CONTROLS & ELECTRIC Thermostat Type: ❑ Digital ❑ Programmable Wiring: ❑ Thermostat ❑ Disconnect Box ❑ Smoke Detector JOB SPECIFICATIONS DRAIN LINE & REFRIGERANT PIPING Replace Circuit Breaker: ❑ Air Handler: Size Type ltondenser: �.��,�� Size Type 11 Gd'Heater: Size Condensate Drain Hook -up: $'rrmary ❑ Secondary ❑ New Condensate Pump ❑ Slab ❑ Auxiliary drain pan ❑ Horizontal drain pan lxilary float safety switch ❑ Refrigerant copper liquid line size: ❑ Refrigerant copper suction line size: ❑ Gas pipe from ❑ Refrigerant line cover Installation Information: 5" All work performed In accordance with existing codes. Includes all required permits for work performed by us. Mounting hardware for installation, weather resistantvlbration/lsolatian pads, hurricane strapping and removal of old equipment. System 1 4, System 2 .1 System 3r'�'. Make en 1'01ef". Tons SEER /4,6 BTU Cl S,S00 KWH iC. Model A/H CHFC Q<100 Model Cond 21.4 gCg7'/87?003 Price G y 81 Make Tons BTU Model A/H Model Cond Price SEER KWH Make Tons SEER BTU KWH Model A/H Model Cond Price System Investment (.1j 81 Install Kit Crane Rebates/Credits Utility FIN_ Service America Other Replacement Credit Recommen ations: Insulation Duct Cleaning UV Light Other Administrative Fee fnon- refundable) Total Investment Down Payment Balance Due t 700 .� 129 WARRANTIES:'`; i rSAE Parts & Labor Warranty NH @SAE Parts & Labor Warranty Cond. Yrs. li/Mfg.'s Warranty on Compressor Yrs. Mfg.'s Warranty on Outdoor Coil Yrs. fg.'s Warranty on Indoor Coil Yrs. Mfg.'s Warranty Parts i)u5 %mac lc✓ 0 Yrs. 20o - tilod 3 Installation Date: P-,51-11 PAYMENT INFORMATION Mettgd of Payment: ❑ Cash ❑Financing Credit Card ❑ Check # CC Type ❑ Visa 56faC ❑ Discover Credit Card #-Sz1 /8 el68t/ 11317 64 56 Expiration Date. Signature' Financing Company Terms: l accept this Sales Agreement and the specifications and cond'tions above. You are authorized to perform work as specified. his agreed and understood by the parties that all equipment which is sold pursuant hereto shall not become fixtures or part of the real estate where they are placed until payment in full is received. Buyers right to cancel: You the Buyer may cancel this transaction without penalty or obligation at anytime prior to midnight of the third business day after the date of this transaction by proper notification. Payment due to installers In full upon completion of installation. My signature acknowledges acceptance of the terms above. I have read and understand all information on the front and back of this Sales Actreement. Customer Signature: _ i1/4 , - AIL, r_* Date: Comfort Consultant: / � Ladder required for inspection: O Yes �1•PQO Size: Service Amerles Mrs CACO14619 .IA00021122.CFC057126 White Copy -DI • Yellow Copy - Customer • Pink Copy -F13110/CE • Mkt Copy •File Service America