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MC-12-656Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 173039 Permit Number: MC -4 -12 -656 Scheduled Inspection Date: May 09, 2012 Inspector: Perez, JanPierre Owner: MINER, ANDREW Job Address: 150 NW 100 Terrace Miami Shores, FL 33138- Project: <NONE> Contractor: UMC MECHANICAL CONTRACTOR Permit Type: Mechanical - Residential Inspection Type: Final Work Classification: A/C Replacement Phone Number Parcel Number 1131010230290 Phone: (786)715 -1447 Building Department Comments AIR HANDLER AND CONDENSING UNITE REPLACEMENT 5/g j 17, 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- 172370. C/O OF 4 TONS SYSTEM NEED HEAT LOAD CALCULATIONS ON FINAL INSPECTION; missing aux drain pan & insulate pvc drain line jpp 14e-a.k 1,0a 6,4cL L6-0- Azt-f-- fL4 IOark Cam` ay\ 3/ tqL-2, May 08, 2012 For Inspections please call: (305)762 -4949 Page 19 of 25 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 BUI D G Permit No PERMIT APPLICATION FBC 20 Permit Type: MECHANICAL ff�� {� n r p 2 OWNER: Name (Fee Simple Titleholder): 1411cLVP,W Mit'hf.V ;Col 6ltt 1" 1y PY Phone #: ')1-"35b ' 55lo j lagMEWLC; it APR 1 3 zoiz BY:— mGi2 (�c2 Master Permit No. Address: 16f) N 100 70-le City: Miami AV's State: F% Zip: 33/5() Tenant/Lessee Name: Phone #: Email: JOB ADDRESS: 150 MN WO TER City: Miami Shores County: Miami Dade Zip: Folio/Parcel #: Is the Building Historically Designated: Yes 'Flood Zone: �Akii►Z Phone#: 7116.714'' /447 FL Zip: 33 l B Phone #: NO CONTRACTOR: Company Name: V t4C.(MJ, 1k'I3%(AL„ Address: 1S4 Z�S sW (?2 ST. • . 1 tO4- City: 1�, caw, State: Qualifier Name: 1 - P A Nti�i1 1 %) t.i t7 State Certification or Registration #:C PLC. 126 OOD�) Certificate of Competency #: Contact Phone #: /8‘.7) (y • 4 4� Email Address: MA qA J AO 2, i1 M G @C Q 1 • d •A DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ q 1 �0 „ Do Square/Linear Footage of Work: of Work: ❑Address ❑Alteration UNew �,c. ..' I' a +lace n of Wore 111 ,.01,1IV OF 191P. * * * * * * * * * * * * * * * * * * * ** * * * * * * * * * * * * ** Submittal Fee $ Permit Fee $ Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ i ** ees************* * ** * **** ** *** ****************** CCF $ CO /CC $ DBPR $ Bond $ Technology Fee $ TOTAL FEE NOW DUE ib ato 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 commenceme ' t must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is ueds, the a sence of such posted notice, the inspection will not lle apprQyed and a reinspection /ee will 11e charged. Signature " V'r -tN" Owner or Agent The foregoing instrument was acknowledged before me this _l3 The for day of Al dY / , 20 ®0? , by day of 3 who is personally known to me or who has produced w o As identification and who did take an oath. NOTARY PUBLIC: Signature Sign: Print: //' �i, ... My Commission Expires: * * * * * * * * * * * * * * * * * * * * * * ** APPROVED BY !LIANA PANEQUE Y.PUq'" MY COMM SSION #00824561 tom` rliE3: SEP 21, 2012 Bone i lSuugii 1®i State Insurance • OTAR Sign: Print: .�-11 o Contractpr, , ent was ackno - I ged b . ore m this N ti / 2Qa,b' / %li.', 4UT O rLg. 1' * -b . p ➢ • e V to me or who has produc entification and who did take an oath. PUBLIC: A:4404 0 .4,/* ' ' CLAUDIA V. CUBILL�_- o rida My Commiss ',..0111'G „ •1„ My Comm.'Ex�ir ° i B @p 23, 2015 =;. o;' Commission # EE 128810 ' %•' ; °pO� Bonded Through National Notary Assn. ************** *+ k+ x+ k**** ** ***** **+ k***m **s: ********************* Plans Examiner Structural Review (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): 1 N IN 1 DO (12. City: Miami Shores Village County: Miami Dade Zip Code: S3/SO 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 ❑ NO ❑ .ARHI Sheet Attached: YES ❑ NO ❑ Contract Attached: YENS)Sil UNIT BEING REPLACED DATA NEW UNIT MANUFACTURER C7 P Ft i viz AHU or PKG. UNIT MODEL # .W D. 2 COND. UNIT MODEL # p4 k {{ . 41. Ott KW HEAT NOM TONS 4 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 13 YES NO REPLACING DUCTS YES NO0 YES NO REPLACING THERMOSTAT YES NO ✓ YES NO NEW 4 "CONCRETE SLAB YES NO of YES NO NEW ROOF STAND YES NO � YES NO NEW RETURN PLENUM BOX YES NO/ 1. Minimum Circuit Ampacity (Wire Size): 2. Maximum Overcurrent Protection (Fuse /Breaker Size): 3. Voltage of Circuit (208/240/480): 4. Size Disconnecting Means: Contractor's Company Name: V Ncirktquotc.t. C bto J%JS C:We Phone: State Certificate or Registr N. Gf4C • rig 0007 Certificate of Competency N. 18TO •,1g - )447 Signature ature only) Date: 04(IN/1 2 ■•a CERTIFIED,. rivemahridIrt•rctury.orlj E Certificate of Prduct Ratin s AHR1 Certified Reference Number: 3585486 Date: 3/15/2012 Product: Split System: Air - Cooled Condensing' nit, Coil with Blower Outdoor Unit Model Number: MAN - 48.410 Indoor Unit Model Number: HD2-48 Manufacturer: EAIR LLC Trade/Brand name: COMFORTSTAR Manufacturer responsible for the rating of this system combination is EAIR LLC 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): • Ratings followed by an 'stem ( -) indicate a voluntary rotate of previously pubb$had data, unless accompanied' with a WAS, which indicates an involuntary rerate. DISCLAIMER AHRI does not endorse the product(a) listed on Oils Certificate and malt o repneserrt+dlons, warranties or guarantees as to, and aasunsrs no responslblfty for, the product(.) listed on this Certificate. mail oxproasiy disclaims all Ica for damages or any kind arising out of the use or performance of the product(a). or the unauthorized aeration 01 data fisted On MIS Certificate. Certified ratings valid only for models and configurations listed in the directory at www.ahr(dlrectory,,org. TERMS AND CONDITIONS This Certificate and Its contents aro proprietary products Of AHRI. Tills 4elrfincate Shan only be need for individual, personal and confidential refersmce purposes. The contents of this Certificate may not. Iii whole or In part, be reproduced; copied; disseminated; entered Into s computer database; or athenwae Wilted, in any form or manner or by any Means, except for the were Individual. pommel and confidential reference. CERTIFICATE VERIFICATION The Information for the model cited en this certificate can be verified at .ahrldtreeteyorg, , Air- Conditioning, Heating, click on " Verity Certificate link and enter the AHRI Certified Reference Nu and the data on , which the Certificate was Issued, which Is listed above, and the Certificate II , which la listed below, and Refrigeration Institute ©2012 Air- Conditioning, Heating, and Refrigeration iflstitute CERTIFICATE NO.: 129762928803507065 T000 /1000 lj Aiddi15 2i'8V 09LVTLt20l: %V3 WVCO:TT ZTOZ /CT /fi0 UMC /MECHANICAL CONTRACTOR CO. 13428 SW 62 ST 1 -104 Miami,FL,33183 Ph: 786- 715 -1447 Fax: 305 -408 -8695 mmunozumc(aol.com TO ANajjv) 1404411- INVOICE NO. [100] DATE ID Cr VNI IZ CUSTOMER ID 1545 "kg 1 oT61K• MiA 3► M■ PAYMENT i Due upon receipt HaIrU'�'�na►cg{�_ K1T :a Z ij PIAc . p 4 '1 AIR rtAhtna D g cT)p v.. 136 O rt Make all checks payable to: UMC /MECHANICAL CONTRACTOR CO. SUBTOTAL SALES TAX TOTAL Al 0411212012 23:47 7865734486 INSURANCE NOW AGENCY PAGE 01/01 A IJ CERTIFICATE OF LIABILITY INSURANCE 1 04;13 _ 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: If the c.ertificate 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 endor.¢mont. A statement on this certificate does not tenter rights to the certificate holder in lieu of such endorsement(s). PRODUCER 786- 573 -4485 786 - 573 -4486 Insurance NOW Agency 12915 SW 132 Street suite 4 -B Miami, FL 33186 aA MSvleeo Blandon P.O. 786-573-4485 IPA. fie): 788-5734486 I,o AoDrcess: c"�CER ,•, . -rc - S A#FORDNGCOVERAGE NAM 8 TN RED UMC Mechanical Contractor Co. 13428 SW 62 Street Miami, FL 33183 INSURER A: Western Heritage Insurance Co. INSURERS : IN$UR$R c : 06/(x8/2011 SISURERD: EACH OCCURRENCE INSURER E : 1( NSURER F : $ 100 000 COVERAC • • THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NoTwITHSTANDINC ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT oR OTHER DOCUMENT W1TH RESPECT TO WHICH THIS CERTIRCATtn 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. p L'FR TYPE OFORIDRANcE : •r , POLICY - -• v ' POLICY IOW A GENERAL LIABILITY C:OMIERCOL GENERAL LIABILITY I71 OCCUR 0608111C 06/(x8/2011 06108/2012 EACH OCCURRENCE $ 1.000.000 1( DAMAGE 1 O RtNTEO PRFilERPS (FR orc/ re1 $ 100 000 1 ckAhms_mAtE MED FXP (fitly cos t1e son1 PERSONAL & ADY INJURY S 5.. Q $ 1 mum s2 000 000 OEENERALAtioseATE GENt AGGREGATE MT 7 n 0 APFU&s PER FRonuCTS - COMP/OP AGO s 1,Q00,QQQ 5 LOC AUroMO91LE LIABILITY ANY AUTO ALL OWNED AUTO? SCHEDULED AUTOS HIRED AUTOS NON -WANED AUTOS COMBINED SINGLE MET (Ea eag9erlt) e _ w_ r ^ BODILY INJURY (Pe person) S BODILY INJURY (Pet mod) $ PROPERTY DAMAGE so (Per =oldest) S S 5 HE BREIA LIAR EXCESS LIAR OCCUR CLAPAGMA08 EACI4 OOCUR7dCE S AGGREGATE 5 DEOUGT1E LE RETENTION S WORKERS COMPENSATION AIM EMPLOYERS' LUIBlLr1Y yin ANT NR OPRIETORIPARTNER+ExEOUnvE ' � EXCLUDED? D In Nit) a yes, d ssbader DESORIPT1oN OF OPERATIONS below N / A STATU- 0111- • RY LIMITS FR E.L. EACH ACCIDENT k_ EL- DISEASE - EA EMPLOYEE $ E.L. DISEASE. POLICY LMT $ DESCRIPTION OF OPERATIONS 1 LOCATIONS / VEHICLES (Attach ACORD 151, Addition4 l'orngrko Suing, V mina space is regldrsd) CANCELLATION Miami Shores Village Building Department 10050 NE 2nd Avenue Miami Shores FL 33138 fax:305 -7 , .972 SHOULD ANY 05 THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION THEREOF. NOTICE WILL BE DELIVERED IN ACCORDANCE (,, �• LICY PROVISIONS, AUTHOiUZE9 REP ACORD 26 (2600/09) Blandon 1 . CO +• CORPORATION. All rights reserved. The ACORD name and logo are registered mar 05 -12 -2011 JEFF ATWATER STATE OF FLORIDA CHIEF FINANCIAL OFFICER DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: PERSON: FEIN: 05/12/2011 EXPIRATION DATE: 05/11/2013 MUNOZ MANUEL SR 264550233 BUSINESS NAME AND ADDRESS: UMC /MECHANICAL CONTRACTOR CO 13428 SW 62 ST I -104 MIAMI FL 33183 SCOPES OF BUSINESS OR TRADE: 1- CERTIFIED MECHANICAL CONTRACTO IMPORTANT: Pursuant to Chapter 440 . 05(14), F.S., an afficer of a corporation who elects exemption from This chapter by 1 fling a carttlicate of election under thls section may not recover benefits or compensation under this chapter. Pursuant to Chapter 440.05(12), F.S., Certificates of election to be exempt... apply only within the scope of the business or trade listed on the notice of election to be exempt. Pursuant to Chapter 440.05(131, F.S., Notices of election to be exempt end certificates of election to be exempt shall be subject to revocation if, at any time after the tiling of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a cerlilicate at any time for failure of the person named on the certificate to meet the requirements of this section. QUESTIONS? (850) 413-11 DWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01 -11 PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DMSION OF WORKERS COMPENSATION CONSTRUCTION INDUSTRY CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW EFFECTIVE 05/12/2011 EXPIRATION DATE: 05/11/2013 PERSON: MANUEL MUNOZ SR FEIN: 264550233 BUSINESS NAME AND ADDRESS: UMC /MECHANICAL CONTRACTOR CO 13428 SW 62 ST I -104 MIAMI, FL 33183 SCOPE OF BUSINESS OR TRADE 1- CERTIFIED MECHANICAL CONTRACTO IMPORTANT F Pursuant to Chapter 440.05(14), F.S., an officer of a corporation who O elects exemption from this chapter by filing a certificate of election L under this section may not recover benefits or compensation under this D chapter. Pursuant to Chapter 440.05(12), F.S., Certificates of election to be H exempt.. apply only within the scope of the business or trade listed on Rthe notice of election to be exempt E Pursuant to Chapter 440.05(13), F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meet the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. QUESTIONS? (850) 413-1609 CUT HERE * Carry bottom portion on the job, keep upper portion for your records. OWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01 -11 MIAMI -DADE COUNTY TAX COLLECTOR 140 W. FLAGLER ST. 1st FLOOR MIAMI, FL 33130 2011 LOCAL BUSINESS TAX RECEIPT 2012 MIAMI -DADE COUNTY - STATE OF FLORIDA EXPIRES SEPT. 30, 2012 MUST BE DISPLAYED AT PLACE OF BUSINE$S. PURSUANT TO COUNTY CODE CHAPTTER 8A - ART. 9 & 10 FIRST -C U.S. POE PAI MIAMI PERMIT I THIS IS NOT A BILL - DO NOT PAY 681015 -5 RENEWAL BUSINESS NAME / LOCATION RECEIPT NO. 708365-2 UMC MECHANICAL CONTRACTOR CO STATE* CMC1250007 13428 SW 62 ST I104 33183 UNIN DADE COUNTY OWNER UMC MECHANICAL CONTRACTOR CO Sec. Type of Business 196 GENERAL MECHANICAL CONTRACTOR THIS IS ONLY A LOCAL BUSINESS TAX RECEIPT. IT DOES NOT PERMIT THE HOLDER TO VIOLATE ANY EXISTING REGULATORY OR ZONING LAWS OF THE COUNTY OR CmES. NOR DOES IT EXEMPT THE HOLDER FROM ANY OTHER PERMIT OR LICENSE REQUIRED BY LAW. THIS IS NOT A CERTIFICATION OF THE HOLDER'S OUAUFICA- TIONS. PAYMENT RECEIVED MIAMI -DADE COUNTY TAX COLLECTOR: 09/29/2011 09010747001 000075.00 SEE OTHER SIDE WORKER /S 1 DO NOT FORWARD UMC MECHANICAL CONTRACTOR CO MANUEL MUNOZ PRES 13428 SW 62 ST 1104 MIAMI FL 33183 1/11111Ii111 1111111111111111 / 11111,,111,11 /111111111111414 l