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MC-12-1499Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Lt Inspection Number: INSP- 177069 Permit Number: MC -8 -12 -1499 Scheduled Inspection Date: December 05, 2012 Inspector: Perez, JanPierre Owner: HEARN, JOHN Job Address: 1202 NE 93 Street Miami Shores, FL Project: <NONE> Contractor: BIMINI BREEZE HVAC INC Permit Type: Mechanical - Residential Inspection Type: Final Work Classification: A/C Replacement Phone Number (305)751 -6445 Parcel Number 1132050270150 Phone: (305)968 -4205 Building Department Comments AC CHANGE OUT 3 TON Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments 12 December 04, 2012 For Inspections please call: (305)762 -4949 Page 6 of 37 Miami Shores Village TrifECTEIVED Building Department AUG 0 7 nu 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION FBC 20 Permit Type: MECHANICAL OWNER: Name (Fee Simple Titleholder): J0/74Y/9 /v, / '7 Phone #: Address: /P-0 Alr 9 City: !% 9771 ' s fjc C S State: �- Zip: 33/3e Tenant/Lessee Name: Phone#: Email: Permit No. I o_ i li q Master Permit No. JOB ADDRESS: /PO City: Miami Shores County: Miami Dade Zip: 3 '313 ei Folio/Parcel #: Is the Building Historically Designated: Yes NO X Flood Zone: CONTRACTOR: Company Name: {a ?7' Z 4L ,614-Z/- / -2 (C. Phone #: 30 r.-16 g- ciad,S Address: %! N6 ) l )1- S % City: -H4--664w State: Qualifier Name: ■ IA. $7- -1-rr 01'1' % Phone #: State Certification or Registration #: 5/ V4 301 Certificate of Competency #: Contact Phone #: 305 -9 68 -- 990 - Email Address: r , n/l 0"7.41 •/y,C DESIGNER: Architect/Engineer: Phone #: zip: 3 3 o /.S -3 o.s - (,Q - -y /os~ Value of Work for this Permit: $ 3900 0 0 Square/Linear Footage of Work: Type of Work: °Address °Alteration New ARepair/Replace °Demolition Description of Work: 4/C_ C/4n/ 'Oc 0 4-y 3 s o'y --rile-77 * * * * * * * **** ** ******* x *** ** **** * * ** ** Fees **+x *****x ********** * *** ** * **** * * ****,x***** ** Submittal Fee $ Permit Fee $ tQ Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ CCF $ CO /CC $ DBPR $ Bond $ Technology Fee $ TOTAL FEE NOW DUE $ I, , d cc) 9 is W 1 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 conunencement 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 approved and a reinspection fee will be charged. Signature O er or Agent The fo f, going instrument was a ledged efore me this 1 The fore day o " ..A , 20 , by n 1 ,_4A. , day of w o is p- , ally known to me or who has produced wh is Signature identification and who did take an oath. Contractor ment was ackno , 20, by known to me or who has produced NOTAR Sign: Print: My Commission Expires. PUBLIC: entification and who did take an oath. N TARY PUBLIC: Sign: Print: My Com * * * * ******* **** x+ x****** **** ****** ******** * **** ** * * * * ** *axe ** APPROVED BY 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 penult 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): /�� y� �a / City: Miami Shores Village County: Miami Dade Zip Code: 3 3 / C3 S 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 igt ARHI Sheet Attached: YES El. NO ❑ Contract Attached: YES [ UNIT BEING REPLACED DATA NEW UNIT / t�11k/i1/4/MC MANUFACTURER /,3,�)i9 -�%— r 8/ Fe 4// — 3P AHU or PKG. UNIT MODEL # f 1/4/ C4/eCoa.:7- //6/3/Y4036 –/4 /1/4/49. COND. UNIT MODEL # /0 k.k.) KW HEAT / 0 k00 3 NOM TONS .3 AHU 6'0 CU PKG 1) M.C.A AHU 60 CU IriPKG AHU CU PKG 2) M.O.P AHU CU 75 PKG AHUA0 CU p.30 PKG 3) VOLTS AHU —U PKG PKG UNIT / / PKG UNIT / / ,��� EER/SEER / 5) � -j YES NO REPLACING DUCTS YES YES NO REPLACING THERMOSTAT ' • YES NO NEW 4"CONCRETE SLAB N YES NO NEW ROOF STAND S 0 YES NO NEW RETURN PLENUM BOX YES 0 1. Minimum Circuit Ampacity (Wire Size): e 23 5 2. Maximum Overcurrent Protection (Fuse /Breaker Size): V5 4714 e 3. Voltage of Circuit (20 80): ,P VO 4. Size Disconnecting Means: Contractor's Company Name: /3.h'►i tL B. gi=�s= 7' Phone: State Certificate or Registration N. CMC /8/6 3 -? Certificate of Competency N. Date: ./77/ 2- V5 3 o5-- , �- Signature CO CE IFI Ai �■ ahiJd e„etory o "�'g Certificate of Product atings AHRI Certified Reference Number: 3663621 Date: 8/7/2012 Product: Split System: Air - Cooled Condensing Unit, Coil with Blower Outdoor Unit Model Number:116BNA036****A Indoor Unit Model Number: FV4CNFOO2 Manufacturer: BRYANT HEATING AND COOLING SYSTEMS Trade /Brand name: LEGACY RNC 16 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): 33000 EER Rating (Cooling): 12.00 SEER Rating (Cooling): 15.00 *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 responslb0lty for, the product(s) listed on this Certificate. AHRI expressly diselalms 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 ewvw.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 util zed, in any form or manner or by any means, except for the user's individual, personal and confidential reference. CERTIFICATE VERIFICATION The infonnalion for the model cited on this certificate can be verified at www.ahridirectory.org, click on *Verify Certificate" link and enter the AHRI Certify Reference Number and the date on which the certificate was issued, which is listed above, and the Certificate No., which 1s listed below. ©2012 Air - Conditioning, Heating, and Refrigeration Institute CERTIFICATE NO.: 129888153571306207 ` [1i:Dga Air-Conditioning, Heating, ® a.® and Refrigeration Institute CHECK LIST P COSPRESSER tl $ttGqh'i t' • PSI mitt,:; PSI 0 VOLIB . ' AMPS £iingottNitAt. CONNECT1ONS ai CONtl04TS tiOHT 8 LEAN D ! . . s.�#a�coperf ONt 4004•408,8*-108m COND. itgliATT aLtAac.... °.CHARGE FAN :. . : R: . CiTS .. .. AMPS • 'Q CQNNECTIONS 'L1 ;C iNNI CLEAN,'; rat .. ST`$ELT} ITEM OR PART DESCRIPTION PRICE BIMINI BREEZE HVAC INC Commercial • Residential Air Conditioning Services Inc. 7010 NW 169 St Hialeah FL 33015 Ph 305 - 968 -4205 LAST NAME / /./,,tom/ / � ww•PtRN NAVE O 'STREET 3o CITY STAT 0 Manufacturer WerrantY 0 Company Guarantee 0 Somme Agreement 0 Repass 0 Tune . Uu 0 Raa.aenaei 0 Co+— w,,,a, 0 Fe. Duct Roparrs Av Cond.uon•ng 0 RoI'.gerat or 0 Sandaav I Installation SERIAL NUMBER PHONE o : TOTAL PARTS PARTS WARRANTY Ad parts recorded are warranted as per manufacturer specifications LABOR GUARANTY The tabor charge as recorded here relative to the equipment serviced as noted. rs guaranteed for a period of days Wa do not. ecotone. guaranty other parts than Inoae we Install. I1 repairs later become necessary duo to other detective parts. they will be charged separately ENVIRONMENT WRITE OR CODE AMOUNT W REFR MACH USAGE TOTAL OTHER CHARGES LABOR CHARGES TECHNICIAN SIGNATURE MRS CERT. I TOTAL OTHER CHECK LIST ITEM # REPAIR ESTIMATE E F R G E TYPE REFRIO RECOVERED? RECYCLED? RELCAIMED? RETURNED TO THIS SYSTEM? YES NO O El YES NO O � YES NO SYSTEM QTY QTY _ OTT OTT E Q P AA E N T UL s NCQM CHARGED OUT (OR REPLACED)? DIS- MANTLED? 0 l YES NO ® 0 YES NO I HAVE THE AUTHORITY TO ORDER THE ABOVE WORK AND 00 SO ORDER AS OUTLINED ABOVE. IT IS AGREED THAT THE SELLER WILL RETAIN TITLE TO ANY EQUIPMENT OR MATERIAL FURNISHED UNTIL FINAL d COMPLETE PAYMENT IS MADE. AND IF SETTLEMENT 19 NOT MADE AS AGREED. THE SELLER SHALL HAVE THE RIGHT TO REMOVE SAME AND THE SELLER WILL BE HELD HARMLESS FOR ANY DAMAGES RESULTING FROM THE REMOVAL THEREOF. TRIP CHARGE TAX OUR PERSONNEL RECOMMEND: YES ▪ N0 QTY R TIME ARRIVED TIME DEPARTED N C.S. # DISPOSAL NON USABLE DISPOSAL al YES NO QTY _ OWNER'S INITIALS ACCEPTED DECLINED AUTHORIZED SIGNATURE ORDERED *Vatic HAS bete C0YWETED Amp t ACaNOWLEDGE RECErPY et tee CORY X DATE /