MC-12-85Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 168931 Permit Number: MC- 1 -12 -85
Scheduled Inspection Date: February 29, 2012
Inspector: Perez, JanPierre
Owner: BANICH, ROSEMARIE
Job Address: 521 NE 105 Street
Miami Shores, FL
Project: <NONE>
Contractor: AIR DUCT TECH CORP
Permit Type: Mechanical - Residential
Inspection Type: Final
Work Classification: New A/C System
Phone Number
Parcel Number 1122310140240
Phone: (305)519 -2084
Building Department Comments
NEW INSTALLATYION AIR CONDITIONING CHANGE OUT
& DUCT WORK
Inspector Comments
Passed
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
February 28, 2012
For Inspections please call: (305)762 -4949
Page 13 of 40
NOTICE OF COMMENCEMENT
A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION
PERMIT NO. TAX FOLIO NO. \ �a 31 (7J -r O � 10
STATE OF FLORIDA:
COUNTY OF MIAMI -DADE:
THE UNDERSIGNED hereby gives notice that improvements will be made to certain real
property, and in accordance with Chapter 713, Florida Statutes, the following information
is provided in this Notice of Commencement.
1111111111 1 11111111111111 1 11111111111111111
C Fihl 2.1".) 12ROC)66122.3
OR Bk 27979 Ps 2018; (Ina)
RECORDED 01/31/2012 09:26 :20
HARVEY RUVIN. CLERK OF COURT
MIAMI -LADE COUNTY. FLORIDA
LAST PAGE
Space above reserved for use of recording office
1. Legal description of property and street/address: S 11 }) E . v sk �Tf ee\-- h er"
1 L
2. Description of improvement
,€e, lie Ate ,71-'
Ode `e — »t efwr / #1-0,1,/ r.19
3. Owner(s) name and address: v5E ww G any Lk
Interest in property: S t �.
Name and address of fee simple titleholder. S /
4. Contractor's name, address and phone number:
21933 -md .#2, 9 .„',*re p°
5. Surety: (Payment bond required by owner from contractor, if any)
Name, address and phone number. /vde'- e
Amount of bond $
6. Lender's name and address: �s�r►�
7. Persons within the State of Florida designated by Owner upon who
Section 713.13(1)(a)7., Florida Statutes, /
Name, address and phone number: // �/.it �C/ f e d. "ti/44-0"1/ lei r -Zdi1/
8. In addition to himself, Owners designates the following person(s) to receive a copy of the Lienor's Notice as provided in Section
713.13(1)(b), Florida Statutes.
Name, address and phone number. .moo C� H �21c��✓p /� �-
IdTY OF D
this
ef
ff%1�>(-
��✓
; mor' AiR1111 it Iril!f!�'I.
. , ' Q
9.6e served as
2/973
./Z ,417/e.
/Z , /e.
- plAslrr 6'40A/5�1�-,
7c/z-- .p
9. Expiration date of this Notice of Commencement:
(the expiration date is 1 year from the date of recording unless a different date is specified)
WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED
IMPROPER PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713.13. FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR
IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE
FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK
OR RECORDING YOUR NOTICE OF COMMENCEMENT.
Signature(s) of Owner(s) or Owner(s)' Authorized Officer/Director/Partner /Manager
00Vert-42.
Title/Office Of0 Aolr'ir�
Prepared By
Print Name
Prepared By
Print Name
Title /Office
STATE OF FLORIDA
COUNTY OF MIAMI -DADE -�
The foregoing instrument was acknowledged before me this day of :fl . c2 D1
By J
❑ Individually, or ❑ as
Personally known, or ❑ produced the following type of id
Signature of Notary Public:
Print Name:
(SEAL)
VERIFICATION PURSUANT TO SECTION 92.525. FLORIDA STATUTES
Under penalties of perjury, I declare that I have read the foregoing and
that the facts stated in it are true, to the best of my knowledge and belief.
for
Signatur
By
MARIE LISSETTE GONZALEZ
Notary Public - State of Florida
:= My Comm. Expires Nov 14, 2014
•
. Commission • EE 33222
Bonded Through National Notary Assn
f Owner(s) or Oygier(s)'s Authorized Officer /Director /Partner/Manager who signeTabov
DATA
123.01 -52 PAGE 3 3/10
By
4I/31.7/01.2---(1,w).
BUILDING
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.
PERMIT APPLICATION
FBC 20
Permit Type: MECHANICAL
OWNER: Name (Fee Simple Titleholder): C'_r"nt��', �� oila C V, Phone #: JAS - -)S 1 -Sl S�
� r
JAN 1 9
Master Permit No.
Address: S \ Sz.rt ec?
City: 1 N\ \ a vv, e a State:
Zip: C ��
Tenant/Lessee Name: Phone #:
Email: q, P'(\) 717-C ' )C G Lv L
JOB ADDRESS:
City: Miami Shores County:
Folio/Parcel #: I -S I t] t L I O I O
Miami Dade
Zip: ,3 7/3?
Is the Building Historically Designated: Yes NO
CONTRACTOR: Company Name:
Address:
City:
/
/off- 19u c %
Qualifier Name: /20 eca sve /v
Flood Zone:
7e//
Phone #: f J / 7P Z Oti V
State: Zip:
/i_®fie
��i7 7
Phone #: ,3 d f - .l—/ Z
State Certification or Registration #: C /9 of.1 Certificate of Competency #:
5 b/ f' e7 F e/ Email Address: e4/,2- Vac? %' .&C /fj e4 71-- "i4-1440 • Ceram°
DESIGNER: Architect/Engineer: / zr ...4--9-4/-1 74/ Phone #: 30/ A .r"," 4 ^ 1 Oef:ki
Contact Phone #:
Value of Work for this Permit: $
Type of Work: UAddress
Description of Work:
cfr
Square/Linear Footage of Work: gea
❑Alteration UNew
L1Kepair/Replace UDemolition
".4.- �.°.z.i</ / 'o iii �� r° �i�� C C�
��e1C7` et/,1 ,i/e. C �j Aiv�' e' Cav
*** * ** * * * * * * * * * * * * * * * * * * * * * * * * * * ** mi s** ******** * * * * * * * * * * * * * * * * * * * * * * * * * * * * ***
Submittal Fee $ Permit Fee $ / e CCF $ 1-----00 /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $
e.
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 after the building permit is issued. In the absence of such posted notice, the
inspection will Jt be approved and a reinspection fee will be charged.
Signature
Scr„i.kik
Owner or Agent
Signature
CContractor t
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this t
day of , 20 '7, by f c MA4 Z' , ,t i ay of c , 201 �-; by4Z 0 \ c u t 4
who is personally known to me or who has produced (2C--- 1 O who is personally known to me or who has produced 0
As identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC:
Sign: %(/ ,r /`' Sign: ` . Ex' E >i
Print: = '�/� {' = Print: _ • P/".... � %, �4 �' •
• My Commission Expires: �,'•; ®®,Es /a 6 My Commission Expires: ! , .p'4,'T /�
* * *** * * *** **** * * ** * * ** * * * * ** 4,Y,�� * ** * *. * * */* * * * * * * *, *. * ** * ** ** ** * * * ** * * * *** * * **** * ***** qs *Ri **
APPROVED BY 4� ` l' Plans Examiner Zoning
NOTARY PUBLIC:
Structural Review Clerk
(Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09)
w
6
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): E
City: Miami Shores Village County: Miami Dade
Zip Code: j 3 t
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 LJ NO ❑ ARHI Sheet Attached: YES ❑ NO Er7Contract Attached: YES ❑
UNIT BEING REPLACED
DATA
NEW UNIT
K.;,-'e,0,-41,
MANUFACTURER
...02-/71/14
.4 A7d e, '3
AHU or PKG. UNIT MODEL #
/4'71G L. / -/ ,fo6z
,/y /.¢
COND. UNIT MODEL #
/51,7/ / " Ate
/6'
%- t'
KW HEAT
3'
NOM TONS
Cam' G /Z-�
AHU CU PKG
1) M.C.A
AHU CU PKG
AHU CU PKG
2) M.O.P
AHU CU PKG
AHU CU PKG
3) VOLTS 2 4,/'0
AHU CU PKG
PKG UNIT / /
PKG UNIT / /
/!//
EER/SEER
/ w
YES NO
REPLACING DUCTS
YE ' NO
YES NO
REPLACING THERMOSTAT
ES ) N •
YES NO
NEW 4 "CONCRETE SLAB
YES �0
YES NO
NEW ROOF STAND
YES 4JS
YES NO
NEW RETURN PLENUM BOX
YES v •
1. Minimum Circuit Ampacity (Wire Size):
2. Maximum Overcurrent Protection (Fuse /Breaker Size): pig
3. Voltage of Circuit (208/240/480): Z S%
4.
v
I/
Size Disconnecting Means: ig/Zei- it'
Contractor's Company Name: Ps'L �r�e 71- Phone: i0%1--J
State Certificate or Registration N. C4 /, /icy Certificate of Competency N.
Signature
(Qualifier's signature ortry)��
Date: / - 'GP 2e, /2--
e
1
AIR DUCT TECH., CORP.
AIR CONDITIONING SERVICE
21433 s.w.128TH Place, Miami FL 33177
(305) 519 -2084 - Office, (30S) 278 -2000 Fax State Lkense #CAC 1816043
Servicing Dade, Broward and Palm Beach Counties
ecteltallat wet 85 sew eritetiosed
Proposal submitted to:
Rose Marie Banich
521 NE105th Street
Miami Shores, Florida 33138
September 24, 2011
Ref.: A/C Replacement
(310) 987 -8512 / (305) 751 -5175
Dear Mrs. Banich:
Following please find proposal for the above mentioned reference:
EQUIPMENT SCHEDULE
Quantity
Brand
S.E.E.R.
Condensing
Unit
Air Handler
Strip
Heat
Size
Tons
1
RHEEM
16
14AJM49A01
RHLLHM4817A
10
4
SCOPE OF WORK AND RESPONSABILITIES
Delivery
Installation of equipment
Refrigeration piping
Duct work
Grills
Permit fees
Condensing unit platform
Drain piping
Air handler support
Dryer exhaust
Electrical wiring
Fresh air intake
Chase for Exhaust duct and piping
Thermostat
Air Duct Tech
Other
Not Applicable
10 outlets
10 outlets
Up to $250.00
Flush
Existing
n/a
Existing
n/a
2
GENERAL NOTES /COMMENTS AND RECOMMENDATIONS:
We are not responsible for any plan revision delays or expenses incurred due to any necessary
deviation from approved plans.
If necessary test and balance to be performed by an independent Test and Balance Agency;
therefore cost for this service is excluded in this estimate.
Patching and painting not included
Final connection from washer and dryer appliance to exhaust duct is excluded.
WARRANTY: 1 year from the day of installation, to the original owner. Excluding
weekends and holidays. Warranty will be void if system is service by another contractor.
MANUFACTURER WARRANTY
10 Year - Compressor
10 Years— Condensing coils only
10 Years- On all other components
NOTES
Title to the above merchandise remains with the vendor until paid for in full. In case of any
default in any terms of this Order - Contract, the seller should have the right to take immediate
possession of said merchandise and the full amount of the purchase price then unpaid shall
become immediately due and payable at the Sellers option without notice demand. All monies
paid shall remain with the Vendor as liquidated damages. In the even of default under the
terms of this Contract requiring the services of an attorney to protect the interest of the Seller.
The Purchaser agrees to pay reasonable attorney's fee together with interest thereon at the rate
of 18% per annum, payable monthly, plus all cost incident thereto. The Seller shall not be
liable for delays in delivery or installation resulting from strikes, embargoes, fires, floods, Acts
of God, labor troubles or other causes beyond the control of the Seller. T}iis proposal to the
Purchaser is an offer, and is subject to acceptance by Seller.
If the work covered under this contact is stop for two months, or more other, than by us, the
contract is subject to revision.
That in the event the purchase repudiates this contact after execution and refuses to allow
seller to commence work under contract provisions, then and in that event, the purchase shall
pay to and be responsible to the seller in the sum of 10% of the contact prices and for
liquidated and agreed damages and not as a penalty.
FPL Rebates are payable to the air conditioner contractor, if by any reason not related to
our work we are unable to collect the rebate amount, owner is responsible for the rebate
amount.
3
TOTAL PRICE $ 7,780.00
FPL Rebate $ 780.00
FINAL PRICE (Due to Contractor) $ 7,000.00
* Add additional $ 300.00 for 4.5 tons system.
PAYMENT SCHEDULE:
A 50% down due prior to commencing job, 40 upon delivery of equipment, and 10% upon
completion of job. If paying with major credit card payment must be processed 24 hours prior
to installation for authorization.
Thank you for contacting us, we are looking forward to servicing your air conditioning needs.
Sincerely yours,
i1t,�
10 hulk Nogueira 1 ut • rizedsignature /date
Air Duct Tech., Corp.
Air Conditioning Services
State Licensed Air Conditioning Contractor
Insured
RN /mlg -n
606992 -6
BUSINESS NAME / LOCATION
AIR DUCT TECH CORP.
OPERATING IN DADE
CAL DUSINEES TAX R
)ADE COUNTY K!STATE
EXPIRES SEPT,30, 20
4ISI?LAYE AT Pi,. hCE
COUN 'Y' COD CHAPT;
FIRST - CLASS
U.S. POSTAGE
PAID
MIAMI, FL
PERMIT NO. 231
t'lar '- E' SIC PAY
RENEWAL
EIPT RI
633108-8
E CCAC1
STAT816043
OWNER
AIR DUCT TECH CORP
Sec. of MECHANICAL
THIS is ONLY A LOCAL
BUSINESS TAX RECEIPT. IT
DOES NOT PERMIT THE
HOLDER TO VIOLATE ANY
SFR THE EXISTING LAWS
COUNTY on CITIES., NOR
DOES IT EXEMPT IV THE
HOLDER FROM ANY OTHER
EQY .�TS UIRED BIAWN IS
NOT A CERTIFICATION
OF
THE HOLOER'S OUALIFICA-
t■?TY
PAYMENT RECEIVED
MIAMI -DADS COUNTY TAX
COLLECTOR::'..
07/13/2011
60010000111
000075.00
CONTRACTOR
SEE OTHER SIDE
DO NOT FORWARD
AIR DUCT TECH CORP
ROLANDO NOGUIRA PRES
21433 SW 128 PL
MIAMI FL 33177
1„H,,,II„„III,,,Ii,,,II,,,I,I„ I,,,Ili,i, ►„ II.,,I1„ 31411
UM I bwirI rii r 4=
DATE BATCH NUMBER
08 31 2010
The CLASS S AIR;, CONDITIONING-CONTRA-
Named below. 18 CERTIFIED_
Under .the provisions of Chapter 4'89 FS.
Expiration date: AUG 31, 2012
NOGUUEIRA, ROLANDO
AIR DUCT TECH CORP
21433 SW 128TH PL
MIAMI FL 33177
1.07012516
IiIENSS N$Ii
CAC1816.043
CHARLIE CRIST
• .GOVERNOR
,;:DISPLAY -AS, REQUIRED SY LAW.
ALEX SUSK
* * CENT ATE
CONSTRUCTION INDUSTRY EXEMPTION
This certifies that the individual listed below has elected to be exempt from- Florida Workers' Compensation law.
• EXPIRATION DATE: '011021
ROLANDO
STATE OF FLORIDA
DEPAFITMENT OF FINANCIAL SERVICES
COMPENSATION
@flail LAW �:
o T BE I IF O f.QA MAIM COMPOISATIOR
EFFECTIVE DATE 0910312011"
PERSON: NOGUEIRA
FEIN: 208936820
BUSINESS NAME AND ADS
AIR DUCT T '` CDRP
21433 Sin 128Th PLACE 53177
BSI
FL
SCOPES OF RUS
1- CE TBpx o , AC CONTRACTOR 2- 4• EATINS & An CONDITIONIHN
of �tetHas:t �
mho. elects axed from this- ' by tiling- a- rye -
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scope the enema or trade listed on m w on 3. at any 168* Oto (ice- a a connote 1 any 1 for raiiffie of the Perm
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- -- - -- - -- - --
notNtccta temeats at this section
named � � tcete m meet � tegai _..
1}NC -262 ATE W ELECT TO SE EXEMPT 09 -08
PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE
IMPORTANT
F
"Pursuant 440.8a14L F-.1, et officer of $ --
elects e to from this thallter by Oka a certificate of election
I_ may not fits or _ under this
D-cho of elegy
PursIwnt to chapter 440.�ti3. f.S, C trams teed
exam ate► only std of bi
E the notipe of electi� to be exeft.
R tot 440Ost131, fg Notices of to be exempt
and of election to be ex sal be sub t to revOCatiC*
if, at after the f of tha notice or the _ of the
certificate, tie person nand on the or certificate � me
the r� of Ibis - for issue- of a
shall rev*ke a " at'83ty tip f foliate et the
��, f� an the Certifttafe to requirements of this
secti Q 185W 413 -111
EiTAISOP FLOOD*
orffvutfrearr OF neuttcm. SERVICES
DIVISION oPiNORKERtIrcoMPONSATION
as NOWT FRCSS FLORVA
EFFECTIVE 01/03/2011 EXPIRATIl3I DATE: 01/02/2013
PERSOItt R0113810- ROGUEIRA
FEB% 208938820
BUSINESS NA0lE AND ADDREIW
Ant OUCT TECH CORD
21438 SW 1 8TH PLACE
OAK P1. 33117
SCOPE OF BUSINESS OR TRADE 2- HEATING a eta CONDITIONING
1- � . Ac CONTRACTOR
CUT HERE
* Carry bottom portion on the job, keep upper portion for yotw records. ..
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- filea-2010 /WORD CCIRPORATION. AR rights reseved.
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