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MC-11-1655Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 C f� Inspection Number: INSP - 164269 Permit Number: MC -9 -11 -1655 Scheduled Inspection Date: February 27, 2012 Inspector: Perez, JanPierre Owner: MOEGERLE, ELIZABETH Job Address: 10 NE 102 Street Miami Shores, FL Project: <NONE> Contractor: AMERICAN RESIDENTIAL SERVICES Permit Type: Mechanical - Residential Inspection Type: Final Work Classification: A/C Replacement Phone Number Parcel Number 1132060131490 Phone: 9541973 -0900 Building Department Comments A/C REPLACEMENT Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments February 24, 2012 For Inspections please call: (305)762 -4949 Page 5 of 43 Miami Shores Village �ZII�I3j1 Building Department � C� CEP 0 3 2011 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 qt ' y ' la — i INSPECTION'S PHONE NUMBER: (305) 762.4949 Permit No. )1 KIM B ILDING PERMIT APPLICATION FBC 20 Master Permit No. Permit Type: MECHANICAL OWNER: Name (Fee Simple Titleholder): Phone#: Address: 0 C� i o, City: m ,11 I (��Q State: Zip: 31 Tenant/Lessee Name: Phone#: Email: JOB ADDRESS: b 1 1 1 11S"' City: Miami Shores County: Folio/Parcel #: 1 1 r 57P0 Is the Building Historically Designated: Yes NO Miami Dade Zip: 351'S Flood Zone: CONTRACTOR: Company Name: ILIA: • &I 1 4 call lb one#: Address: 4 ov-il, Co , • City: 11 ats State: Zip: 33) _ Qualifier Name: r Pica, Phone# c 9t' State Certification or Registration #: CA___ _' 1_Q Certificate of Competency #: Contact Phone #: L�r..: Email Address: DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ �J, (a(5 Square/Linear Footage of Work: Type of Work: Address DAlteration DNew RRepair/Replace Description of Work: 0,10- (VOCerne04— ❑Demolition ** * ** * * * * * * * * * * * * * * * * * * * * * * ** * * ** * * Fees�x* �x�x: x�xx�x��x�xx�x�x��x�x�x�x ****�x�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, BOIT.FRS, HEATERS, TANKS and MR 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 cons >.. tion lien brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recor tice of c 'ncement must be posted at the job site for the first inspection which occurs seven (7) days after the building p - .wit is issued. n the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature The for day of e Owner or Agent oing instrument was acknowledged before me this ,20.1 `,b;\ ‘O Signature The fore day of Contractor nt was acknow edged bgpre me 's E5 201 i , by , who is personally known to me or who has produced 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 oath. NOTARY PUBLIC: Sign: Print: My Commission Expir * * * * * * * * * * * * * * * * ** APPROVED BY k BRENDA COWIZO MY COMMISSION # DD 780137 1 EXPIRES: Apr1128, 2012 Els WA* MON4143511* V V\ Plans Examiner Structural Review NOT UBLIC: Sign Print: My Commissio Ifto Ly; rte • • %iFr, *' Bonded Trot Notary Public underxmters BRENDA COLLAZO MY COMMISSION # DD 780137 EXPIRES: April 28, 2012 ************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) * ** Zoning 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): t D OE, \ S L31� City: Miami Shores Village County: Miami Dade Zip Code:3 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 ❑ NQ1 ARHI Sheet Attached: YES 0140 ❑ Contract Attached: YE UNIT BEING REPLACED DATA MANUFACTURER AHU or PKG. UNIT MODEL # NEW UNIT COND. UNIT MODEL # KW HEAT 1 NOM TONS 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 AHU CU PKG PKG UNIT / / PKG UNIT / / EER/SEER 9 t YES --175, REPLACING DUCTS YES ►fiW CY€S ' NO REPLACING THERMOSTATS) NO YES NO NEW 4 "CONCRETE SLAB YES NO YES NO NEW ROOF STAND YES YES NO NEW RETURN PLENUM BOX YES 4 NO) 1. Minimum Circuit Ampacity (Wire Size): 2. Maximum Overcurrent Protection (Fuse/Breaker Size): V 0 J #4 P 3. Voltage of Circuit (208/240/480): 4. Size Disconnecting Means: Contractor's C. any N , e: State Certificat ;- strat I Sill �h 'Lc %`ia: 4 • Signature Ir, Certificate of Competency N. QuaIHier's =' ature only) Date: d 1I Home Improvement Agreement: p g ment: 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 Permit Required? ‘, ` ^ ^ , I ^ i t j Service Address (� ` t p/� Ci y, State, Zip \" V4t fc Install r !! :' � i fAi �1 ' 4 Address Is—m• V ` s I®�3 w k � , ,IIp . 4 ° ❑ Fumace/Air Handler #2 Model # l� • S 1 S7 d ❑ Other Serial # . Phone # 3os 23 5 - . Lr "� 7 Jcaram �l Home Depot Information: Lead # Store # OAS,. 1 . THD Installer # Name p t � Permit Required? ‘, ` ^ ^ , I ^ i t j Service Address (� ` t p/� Ci y, State, Zip \" V4t fc ` \ r`='C/ • 102- s vii S 7 j . 33 13 s Phone #'s: Day Email > �( Bing 2' i� ❑ Humidifier Model # Fumace/Air Handler #1 Model # ❑ Other Equipment Information: (attach additional list of equipment if necessary) Manufacturer: av,:'e/"\ Permit Required? es NO 1-19110 Condenser/Heat Pump #1 Model # 1 I.) (�lt Qf(J' ❑ Coll Model # 1 Serial # ❑ Thermostat Model # ❑ Condenser/Heat Pump #2 Model # ❑ Air Cleaner Model # Serial # ❑ Humidifier Model # Fumace/Air Handler #1 Model # ❑ Other Serial # Model # ❑ Fumace/Air Handler #2 Model # ❑ Other Serial # Model # Provider Extended Service ❑ Home Depot Agreement Only ❑ Manufacturer Length Type ❑ 5 Year ❑ Parts ❑ 10 Year ❑ Labor ❑ 12 Year ❑ Parts & Labor ❑ Other Equipment Covered ❑ Complete System/Pkg Unit ❑ Accessory ❑ Condensing Unit ❑ Boiler ❑ Furnace/Air Handler ❑ Other Check all that apply: ❑ New Amp electric service/disconnect lean work area to customer's satisfaction Complete system startup &,T'- Remove existing. equipment from premises 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. r Total Investment $ Taxes $ Total Amount $ 5( 6(0; Permit/inspection Informa n: . Permit Required? es NO Permit Number City /County Issuing Permit /'� . , c j f-x r / y� ' Scheduled Inspection Date/Time Notice of Cancellation form received: '1/' G , ,mx Initial Termination clause reviewed: frf 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 Terms 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 General Terns and Conditions for additional definitions. Acceotance end 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 toYou 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 protect Your legal rights. DISTRIBUTION: White —Home Depot Copy Yellow—Customer Acceptance & Invoice Copy Pink — Installation Professional Copy Gold -- Customer Proposal Copy HD -243 (6/14/11) below YES NO ACCA Manual J Load calculation performed Equipment listed in this proposal will satisfy the load requirements determined in load calculation performed for this structure Is the existing ductwork properly sized to meet the requirements of: System Airflow (400 cfm/ton) Standard Velocity in branch and main ducts (If any deficiencies in existing ductwork, explain in the Scope of Work section below) (explanation What existing system components will remain a part of this system: f Work section beilow)e Outdoor Condensing Unit ...--- Refrigerant Lines L./ Furnace -,-- 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) —a:1QC) 11 4ATO Proposed start date Expected completion date X 4e r Custom rs Signtture: X Co-Signe X Installed 11 al Signature: 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 Plnk— Installation Professional Copy Gold— Customer Proposal Copy HD-243 (6/14/11) Date: Date: r i AM Bin GERTIFIE TM% w hrvtlirectoryorg 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: 3799429 Date: 9/7/2011 Product: Split System: Air - Cooled Condensing Unit, Coil with Blower Outdoor Unit Model Number: 14AJM49 Indoor Unit Model Number: RHLL- HM4821 +RCSL -H *4821 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): EER Rating (Cooling) SEER Rating (Cooling): 46000 13,00 16.00 " 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.ahridirectoryorg. TERMS AND CONDITIONS This Certificate and its contents are proprietary products of AHRL 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 listed above, and the Certificate No., which is listed below. ©2011 Air - Conditioning, Heating, and Refrigeration Institute $ LI l Air - Conditioning, Heating, AM i� 1/ and Refrigeration Institute CERTIFICATE NO.: 129598903429232936 • 145#;.11,/. ESS;NAME,/ LOcATIO ERICAN R SID FLORIDA IN 720 . 5W ,... _3157 UNI R:RESID Rof Busine Cn?r#_.ECT 1 E . .utolaTe:; TORY OR THE: DO NOT FORWARD tHE ANY OTHER �E ' AMERICAN RESIDENTIAL SERVICES UR OF FLORIDA INC JOSE MANUEL PERAL MANAGER 18720 SW 108 AVE MIAMI FL 33157 • 0/20 O0002:7 ,; {O00075i. 0�.?. SEE OTHER SIDE itt lilt dill 1111111111M 11111111 1 /l3'tlIli$11i111il11111l 1 11 SEE OTHER SIDE DO NOT FORWARD AMERICAN RESIDENTIAL SERVICES OF FLORIDA INC JOSE MANUEL PERAL MANAGER 18720 SW 108 AVE MIAMI FL 33157 h ills, lltttlil/ lllli ”A41.111111111111111tltilltuh t! ...e, ;.1;1P!;PrZ Q11 o ;:Ci,\,„::„.„/_sY,r ■)K.447W-,` o ,:cz,\,,,,,,,_,TiN Fo ----y -- ..y, -rap 4 _ 0 .0 OA .01? 071.-4 Vra .A`� °� CERTIFICATE OF LIABILITY INSURANCE lon/2011 �'9/8r2011 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: It the certificate holder Is an ADDITIONAL INSURED, the pollcY(les) must be endorsed It 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 corder rights to the certificate holder In Ileu of such endorsement(s). PRODUCER Lockton Companies,LLC NE 1185 Avenue of the Americas, Suite 2010 New York 10036 646-572-7300 �p NMLACT rave, F,tr 1 a roI; E-MAIL ADDRESS: INSURER J AFFORDING COVERAGE NAICe INSURER A : Liberty Mutual Fire Insurance Company 23035 INSURED AMERICAN RESIDENTIAL SERVICES LLC 1073055 860 RIDGE LAKE BLVD MEMPHIS TN 38120 INSURER B: Liberty Insurance Corporation 42404 INSURER C: Navigators Insurance Company 42307 INSURER D: CLAIMS -MADE X INSURER E : INSURER F • PERSONAL &ADV INJURY COVERAGES AMERE02 RB CERTIFICATE NUMBER: REVISION NUMBER: XXXXXXx 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. LT'RR TYPE OF INSURANCE ti)? N VIN, N POLICY NUMBER TB2- 631 - 508631 -020 (M 10/1/2010 IMMp71M 10/1/2011 LiMiT$ EACH OCCURRENCE s 2,000,000 A GENERAL LIABILrTV COMMERCIAL GENERAL LIABQ.rTY OCCUR X PREM13E3W allo EiDrenco $ 1,000,000 $ 10,000 CLAIMS -MADE X MED DIP (Anyone person) PERSONAL &ADV INJURY $ 2,000,000 GENERAL AGGREGATE $ 4,000,000 GEM_ AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 4,000,000 7 POUCYI 1 JEL LOC $ A AUTOMOBILE LI sILIrY ANY AUTO A(�1T0$ ED HIRED AUTOS _ g���D AUTO NONOjWNED A UT N N AS2-631- 508631 -030 10/1/2010 10/1/2011 COr� dk�DtSINGLE LIMIT (BODILY $ 2,000,000 X INJURY (Per person) $ QX _ BODILY INJURY (Per accident $ XXXXXxx _ _ PROPERTY DAMAGE (Per accident) $ _ $ XXXXXXX C X UMBRELLA LiAS EXCESS LIAB X OCCUR CLAIMS-MADE N N NY1OUMR7150881V 10/1/2010 10/1/2011 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 DED 1 !RETENTION $ $ XXXXXXX B AND ANY (Mmloe2ory DESORIPTION EMpwYER$' Lwsn.mr r/ N NIA N WC7- 631 - 508631 -010 10/1/2010 10/1/2011 X Iggra $I 'W- PRO RJETOR P ATEE In NH) OFBOPERATONS below N E.L EACH ACCIDENT $ 1,000,000 $ 1,000,000 $ 1,000,000 E.L DISEASE- EA EMPLOYEE E.L DISEASE- POLICY LAST DESCRIPTION OF OPERATIONS / LOCATION$ / VEHICLES /(Attach ACORD 101, Additional Remarks Schedule, H more apace h required) THE GENERAL LIABILITY POLICY'S GENERAL AGGREGATE LIMIT APPLIES PER LOCATION AND IS SUBJECT TO A $20,000,000 GENERAL AGGREGATE POLICY LIMIT. DER CANCELLATION 11415986 CITY OF MIAMI SHORES ATTN: PERMIT DEPARTMENT 10050 NE 2ND AVENUE MIAMI SHORES FL33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DEL MELTED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORED REPRESENTATIVE ACORD 26 (2010/06) 61958 -2010 ACORD CORPORATION. All rights reserved The ACORD name and logo are registered marks of ACORD