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MC-12-1595Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 177758 Permit Number: MC -8 -12 -1595 Scheduled Inspection Date: September 05, 2012 Inspector: Perez, JanPierre Owner: UNIVERSITY, BARRY Job Address: 190 NW 111 Street Miami Shores, FL 33168- Project: <NONE> Contractor: SOUTHEASTERN CHILLER SERVICES Permit Type: Mechanical - Commercial Inspection Type: Final Work Classification: A/C Replacement Phone Number Parcel Number 1121360030480 Phone: (954)796 -8779 Building Department Comments DIRECT REPLACEMENT OF A/C SPLIT SYSTEM Inspector Comments Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. September 04, 2012 For Inspections please call: (305)762 -4949 Page 19 of 33 PERMIT NO. c9 5^ TAX FOLIO NO. 11 2 I SG 403 {!4e8° 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. 1. Legal description of property and street/address: 190 ,V&) / //f/ I%/ "f feerc5 2. Description of improvement j tiL,,.{%_CT G ' 1.4 C. 3. Owner(s) name and address: _ S \CC *� u-v+_t -CS 14•{ tA/cil i¢ ` Interest in property: Name and address of fee simple titleholder: 4. Contractor's name and address! QL c4S I C/'•v CLi' R-p, Sec' U CP 3 ca OU ►J.L..I G art., , c._ 33 a G 5 5. Surety: (Payment bond required by owner from contractor, if any) Name and address: Amount of bond $ 6. Lender's name and address: 7. Persons within the state of Florida designated by Owner upon whom notices or other documents may be served as provided by Section 713.13(1)(a)7:, Florida Statutes, Name and address: S. 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 and address: 9. Expiration date of this Notice of Commencement: (the expiration date is 1 year from the date of recording unless a different date is spec Signature of Owner ,^ - `, // Print Owner's Narne Zeott,/'�c S �7`.�aia -i•-r Sworn to and subscribed before me this 217-1.N4 day of Q{d4Gac-y� , 20 IT! STATE OF FLORIDA, CO i HEREBY CE;;', z at Ns is 74 t f Notary Public Notary's Name My commission expires: 123.01 52 PAGE MY I a $3 COMMISSION 86@29 °� EXPIRES: November 12. 2014 O34 M Notary MOW MOW, Co. (.8W�3- N07ARY ,ev'i.1t.$c i 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 k)) BUIL ING PERMIT APPLICATION 11 AUG�_,Z FBC 20 Permit No. '✓ i ' 515 Master Permit No. Permit Type: MECHANICAL L JOB ADDRESS: / 9 0 �gV /1/ s7 City: Miami Shores County: Miami Dade le! - ( far 2'' Folio/Parcel #: d A A 2134 - U o 3, - 011/0 Is the Building Historically Designated: Yes Flood Zone: OWNER: Name (Fee Simple Titleholder): iCC 1 k.A.NA C Sl Phone#: Address: 1 1100 1 ?it AVG City: M lot ov' .A" re State: fL Zip: 3314/.44&r Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: S du! Ill CAS 1 CJ r. Oki. W' ff /CcS Phone#: g5Li- 1 6 -8779 Address: 36o0 N. Art-, City: CORM— S P R I IG-S state: Zip: 33 ©G Qualifier Name: L A li 12, e:7•4 Ce)".- ) `t (C. p 5 Phone#: 9.5 1/4.1- 9 a 1 "? 1 5-- State Certification or Registration #: C / a O 54 8 '7 ti Certificate of Competency #: Contact Phone #: Email Address: LA(ft.1 S (SCR -e !' S . Cove DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ S j Square/Linear Footage of Work: Type of Work: °Address °Alteration es Description of Work: a,� kr ea g °New ! ' epair/Replace Le_T a ETC MC._ Se I s sfevo,t °Demolition ******** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** gees****** *+ x******** *** ***+x***** ** ******+x******* Submittal Fee $ Permit Fee $ k � % 05-CU $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ Technology Fee $ 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 FT.ECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOTT.F,RS, 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 not be approve ' a reinspection fee will be charged. Signature '4 Signa Owner or Agent ontractor The foregoing instrument was acknowledged before me this arCi The fo egoing instrument was acknowledged before me this 0 day of PAL- cr , 20 by by Re.AA6C VI g-r , day of `r41 , 20 a, by J b, (r (}1 L'lAr4.3 , gyhn inn_ 1y knees► 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. ,Y My e'.1 io 041822 "47ar 'l EXPIRES: November 12, 2014 I.gpp 7ARY PI. Nagy Assoc. Co. + k�k�N�NN��knk�k�k�k +k�k+k�k�N�k�k,k�k+k�k�ksk�k'.; �kN� ,Ia �k sksk APPROVED BY Plans Examiner Structural Review Revised 3 /12/2012)(Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09) NOTARY PUBLIC: Sign: Print: My Co N.AOMMISSION # EE022794 FIRES September 02, 2014 FIotidBN01&y36Nice co fl (407) 398-0153 **************** * * ** **** ** *** ****************** Zoning Clerk aliA IQeiILhi4dIninli isli11(tla4elNe[el tN :U1lligoi ite 1Ne1BMiIt101iplliQ1 :IWN- 1:I:iNI:/e\sai1llmolVil:1a: #. 6205870 STATE OF FLORIDA. UST .'. AND P1 OF.RS IONAL REGULATION TIOINDUSTRY LIC S BOARD SEQ# L12071701381 07/17/2012.; 118214293 CMG056 •The .: MECHANICAL CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapt Expiration date: AUG 31, 2014 MEANS, LAURENCE :;:RICE SOUTHEASTERN' CHILLER 3800 NW 126 AVENUE CORAL SPRINGS RICK ':SCOTT GOVERNOR DISPLAY AS RE.QUIRED`BV LAIN KEN LAWSON SECRETARY BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A -100, Ft. Lauderdale, FL 33301 -1895 — 954 - 831 -4000 VALID OCTOBER 1, 2012 THROUGH. SEPTEMBER 30, 2013 DBA: Business Name: SOUTHEASTERN CHILLER SERVICES -. Owner Name: LAURENCE R MEANS Business Location: 3 800 NW 126 AVE CORAL SPRINGS Business Phone: 954-796-8779 Rooms seats Employees 5 Receipt #:HEAT NG /AIRCONDITION Business Type:(MECHANICAL CONTR) Business Opened:11 /05/1993 State /County /Cert/Reg: cMC o 5 6 8 74 Exemption Code: Machines Professionals For Vending Business Only Number of Machines: Vending Type: CONT Tax Amount Transfer Fee NSF Fee Penalty Prior Years Collection Cost Total Paid 27.00 0.00 0.00 0.00 0.00 0.00 27.00 THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT This tax is levied for the privilege of doing business within Broward County and is non - regulatory in nature. You must meet all County and /or Municipality planning WHEN VALIDATED and zoning requirements. This Business Tax Receipt must be transferred when the business is sold, business name has changed or you have moved the business location. This receipt does not indicate that the business is legal or that it is in compliance with State or local laws and regulations. Mailing Address: LAURENCE R: .MEANS 3800 NW 126 AVE CORAL SPRINGS, FL 33065 2012 - 2013 Receipt #01A -11- 00009607 Paid 08/02/2012 27.00 F=NCTR SOUTCHI -01 JESSICA ACALM? E. +,,, .. --8/20/2012 DATE (MM/DD/YYYY) 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 certificate holder is an ADDITIONAL INSURED, the policy(les) 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 License # NPN 2332080 InSource, Inc. P.O. Box 561567 Miami, FL 33256 -1567 CONTACT PHONE 305 670 -6111 (NC, No, Extt: ) FAX (305) 670 -9699 (Arc, No): ( ) am ADDRESS: INSURERS) AFFORDING COVERAGE NAIC # INSURER A : FCCI Advantage Ins. Co. INSURED Southeastern Chiller Services 3800 NW 126th Avenue Coral Springs, FL 33065 INSURER B : National Trust Insurance Co. 20141 INSURER c : FCCI Commercial Ins. Co. 33472 INSURER D : FCCI Insurance Company 10178 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 POLIC ES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE INSR S W VD POLICY NUMBER POLICY EFF (MM/DDMlYY) POLICY EXP (MMIDD/YYYY) LIMITS A GENERAL X UABIUTY COMMERCIAL GENERAL LIABILITY CPP0014143 5/25/2012 5/25/2013 EACH OCCURRENCE $ 1,000,000 PREAMISES (GE RENTED PREMISES Ea occurrence) 100 100,000 $ , CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE POUCY X UMIT APPLIES Tel: PER: LOC PRODUCTS - COMP /OP AGG $ 2,000,000 $ B AUTOMOBILE X X UABIUTY ANY AUTO ALL OWNED AUTOS HIRED AUTOS X SCHEDULED AUTOS AMEN LINED CA0021122 5/25/2012 5/25/2013 (Ea a derDitSINGLE UMIT $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ (PROPPEERdT nt) AMAGE $ $ C X UMBRELLA UAB EXCESS LU►e X OCCUR CLAIMS -MADE UMB0014388 5/25/2012 5/25/2013 EACH OCCURRENCE $ 4,000,000 AGGREGATE $ 4,000,000 DED X RETENTION $ 10,000 $ D WORKERS COMPENSATION AND EMPLOYERS' UABIUTY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y 1 N N N / A 001WC12A59794 5/25/2012 5/25/2013 X WC STATU- TORY LIMITS OTH- ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) CERTIFICATE HOLDER CANCELLATION Miami Shores Village 10050 NW 2nd Ave. Miami Shores, FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE PROVISO SCE WILL BE DELIVERED IN ACCORDANCE WITH THE OL HEREOF, AUTHORIZED REPRESENTATIVE ACORD 25 (2010/05) © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 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: MCf °R— 15'6 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): 9 90 /.7/ uri City: Miami Shores Village County: Miami Dade Zip Code: Zed M 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: YE NO ❑ Contract Attached: YE64 UNIT BEING REPLACED DATA NEW UNIT MANUFACTURER AHU or PKG. UNIT MODEL # yP� COND. UNIT MODEL # /�f�,o //90 KW HEAT NOM TONS AHU CU PKG 1) M.C.A AHU G UCl is KG AHU CU PKG 2) M.O.P AHUCU PKG AHU CU PKG 3) VOLTS AHU CU PKG PKG UNIT / / PKG UNIT / / EERISEER YES NO REPLACING DUCTS YES #0 YES NO REPLACING THERMOSTAT Y) NO YES NO NEW 4 "CONCRETE SLAB YES NO YES NO NEW ROOF STAND YES O) YES NO NEW RETURN PLENUM BOX YES ((00)) 1. Minimum Circuit Ampacity (Wire Size): 2. Maximum Overcurrent Protection (Fuse/Breaker Size): 3. Voltage of Circuit (208/240/480): ZIA0 arty 4:516 4. Size Disconnecting Means: Contractor's Company Name:80. i ,c1 CIA . s Phone: % %4 '494 47 4) State Certificate or Regis lion N. P,V1A e 654 •7-4 Certificate of Competency N. Date: ?. er's signature only) 1 1 AHRI Certified Reference Number: 3804525 Date: 8/23/2012 Product: Split System: Air - Cooled Condensing Unit, Coil with Blower Outdoor Unit Model Number: 113AN(A,W)036 -E Indoor Unit Model Number: FB4CNF036 Manufacturer: BRYANT HEATING AND COOLING SYSTEMS Trade /Brand name: LEGACY RNC 13 PURON AC Manufacturer responsible for the rating of this system combination is BRYANT HEATING AND COOLING SYSTEMS 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): 32600 EER Rating (Cooling): 11.00 SEER Rating (Cooling): 13.00 * Ratings followed by an asterisk (`) indicate a voluntary rerate of previously published data, unless accompanied with a WAS. which indicates an involuntary rerate. CNN N. 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 (lability 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.attridirectory.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" 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. ©2012 Aft-Conditioning, Heating, and Refrigeration Institute ' 1 Air - Conditioning, Heating, and Refrigeration Institute CERTIFICATE NO.: 129901968815217617 UNIVERSITY 11300 N.E. 2ND AVENUE MIAMI SHORES, fl 33161 -6695 PHONE (305) 899 -4910 V E D 0 R Southeastern Chiller of Miami 3800 NW 126th Ave Coral Springs FL 33065 PURCHASE ORDER No. P0145362 THIS PURCHASE ORDER NUMBER MUST APPEAR ON ALL CORRESPONDENCE, INVOICES, LABELS, PACKAGES, AND SHIPPING PAPERS. SHIP & BILI TO SAME AS PURCHASER UNLESS INDICATED BELOW DELIVER: Barry University 11300 NE 2nd Ave. MARK Miami Shores FL 33161 PKG FOR INVOICE: PURCHASING DEPARTMENT This order Is subject to the Terms and Conditions on the revise side. REQUISITION NO DATE Aug 21, 2012 DATE REQUIRED Sep 13, 2012 SHIPPED VIA FOB TERMS Net 30 Days ITEM NO. QUANTITY AND UNIT STOCK NUMBER DESCRIPTION UNIT PRICE DISC. % EXTENDED PRICE 1 2 1 JB 1 EA To replace 3 ton spin NC system in St. Wash House with new 3 ton split system -190 NW 111 Street to intrude to following: - Remove and store existing refrigerant properly - Disconnect and remove old equipement - Flush and reuse existing line set - Install new Bryant air handler and condensing unit 13SEER - install new T -stat and perform start up - Check and record operation - Repair labor 10 -63401 - 790800 Permit fees Allowance 10- 63401-790800 Myrline AristIl (305) 899 -4843 Work Order # 14232 4,735.0000 500.0000 4,735.00 500.00 TOTAL n� er_rwrAII nt AMOUNT 6,235.00 BY Director of Purchasing TAX main NO.15- 8012620J64C 7