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MC-13-1134Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 191962 Permit Number: MC -5 -13 -1134 Scheduled Inspection Date: June 17, 2013 Inspector: Perez, JanPierre Owner: DIAZ, MARIA Job Address: 8827 NE 4 Avenue Road Miami Shores, FL Project: <NONE> Contractor: CORALAIRE SERVICE INC Permit Type: Mechanical - Residential Inspection Type: Final Work Classification: A/C Replacement Phone Number Parcel Number 1132060460580 Phone: (954)979 -9707 Building Department Comments NC CHANGE OUT Infractio Passed Comments INSPECTOR COMMENTS False Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments June 14, 2013 For Inspections please call: (305)762 -4949 Page 14 of 34 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 BUILDING PERMIT APPLICATION FBC 20 MAY 2 2 2013 BY: Permit No. MC) ) 6 4 Master Permit No. Permit Type: MECHANICAL OWNER: Name (Fee Simple Titleholder):' i Leo 11/43 Address: a City: A/V:c Mt ho Tenant/Lessee N Email: JOB ADDRESS: 10? 3v? CJs City: Miami Shores County: Folio/Parcel #: m c O -- % .0 80 Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: l 1411 1•-(N1 . 5 GQa.ActS Pho,.e#: Phone#: qS. - sia • 05 �►a ,a pit iii: t Zip: " ! 3 Phone Miami Dade Zip: '8 Address: -10i 1,5 10 AP, ES'% City: l State: Qualifier Name: (le.) ot■,e, A P (-rim QL 9 °q.q'i9110i 0135 35063 Zip: Phone#: State Certification or Registration #: Pi c S1.3 A.? Certificate of Competency #: Contact Phone#: S K ° Email Address: C..0 rt c, 1' e.e. Qo k • c Pit DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ Type of Work: °Address °Alteration Description of Work: A t: CAAPAYAE (ware/ w (ware/A4w Ft age of Wo z ��, , > .1sk flit %LP `tip,.. tOc. . °Demolition ***************************************Fees*** , x+�,��x * ** ** * ** ** * *a * * * ** **** * * * * ** * ** Submittal Fee $ Permit Fee $ Wv 6 0 0 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 S ` ' 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 f 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 th person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absen o such pos otice, the inspection will not be appr.,_ rein ection fee will be charged. Signature ../-41' � l z Signature Owner or Agen Contractor 0 The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of I t t6,/ , 20 13, by .. (7Ct beflf) ()Leal , day of , 20 )3 , by Lo i hint P-T b L , wh• ''person `I ly known to m= who has produced sho is nersonally knoyalame or who has produced as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLI Sign: Print: As identification and who did take an oath. a r r 67•• KELLY FRANQUI • t Notary Public - State of Florlda t• My Comm. Expires May 4, 2016 %Iflk� �C1c: ►i. My Co ion Expires: 514/201 Sign: /, - Print: My Commission Expires: owe_ efamn SIC •STATE OF FLORIDA ,)..'.1°,o R. Ketcham C9rmLui 11 # DD898453 Expires: JULY 14, 2013 111111 1 ATLANTIC aO1YDIN000,111C *************************** * * * * * * * **** * * **** ** *** ** * *** * ** aim* r** a, *, a**** s**s ********* * t ,* * *,x,x***** *** * * * * * *** *** APPROVED BY .4 l v v/ j Plans Examiner Zoning C� tl Structural Review Clerk (Revised 07/10/07)(Revised 06 /10/2009)(Revised 3/15/09) Miami Shores village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 MR 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): x`2.1 9 PA ■rti . CIO . City: Miami Shores Village County: Miami Dade Zip Code: 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 Al' SUBMITALS ARI (AHRI) DATA SHEET REQUIRED Change Disconnecting means: YES 0 NO ❑ ARHI Sheet Attached: YES Igf NO ❑ Contract Attached: YES ❑ tt/Legl Cah- UNIT BEING REPLACED DATA NEW UNIT bran 0...NAMO1/4 MANUFACTURER jl AHU or PKG. UNIT MODEL # �r� COND. UNIT MODEL# r icSKS'N'Vepa L/4,1, KW HEAT NOM TONS AHU CU PKG 1) M.C.A AHU PKG AHU CU PKG 2) M.O.P AHU PKG AHU CU PKG 3) VOLTS AHU C PKG _ PKG UNIT / 1 PKG UNI / / EERISEER 1I IA YES NO REPLACING DUCTS YES 0 YES NO REPLACING THERMOSTAT YES 0 YES NO NEW 4 °CONCRETE SLAB YES 0 YES NO NEW ROOF STAND ` YES YES NO NEW RETURN PLENUM BOX YES 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: Phone: 95-v-979-9707 State Certificate or Registrations CI? g A, Certificate of Competency N. Sie ✓t cis Signature (Quali iees signature only) Date: John D. Buerosse, P.E. 750 E. Sample Road, Bldg. 3, Suite 220 Pompano Beach, FL 33064 954- 633 -4692 07 May 2013 Miami Shores Building & Zoning 10050 N.E. 2nd Ave. Miami Shores, Fl 33138 Subject: Minimum Energy Efficiency 8827 N.E. 4th Ave. Road Miami Shores, FL Gentlemen: I have reviewed the replacement Rheem 13AJA36A condenser and the existing York F3RPO36H air handler for the subject project and have made the following findings. All components are designed to operate using R -22 refrigerant. Both the condenser and the air handler are fitted for 3/4" gas and 3/8" liquid lines. These similarities demonstrate both are intended to operate with a similar volume of refrigerant flow and that the compressor and expansion valve are well matched. In my opinion, the energy efficiency of this combination will not be less than that of the originally installed components. Thank you, MIS( [y' 2013 o D. Buerosse Florida P.E. #0050867 EngLt13O27 John D. Buerosse, P.E. 750 E. Sample Road, Bldg. 3, Suite 220 Pompano Beach, FL 33064 954- 633 -4692 07 May 2013 Miami Shores Building & Zoning 10050 N.E. 2nd Ave. Miami Shores, Fl 33138 Subject: Minimum Energy Efficiency 8827 N.E. 4th Ave. Road Miami Shores, FL Gentlemen: I have reviewed the replacement Rheem 13AJA36A condenser and the existing York F3RPO36H air handler for the subject project and have made the following findings. All components are designed to operate using R -22 refrigerant. Both the condenser and the air handler are fitted for 3/4" gas and 3/8" liquid lines. These similarities demonstrate both are intended to operate with a similar volume of refrigerant flow and that the compressor and expansion valve are well matched. In my opinion, the energy efficiency of this combination will not be less than that of the originally installed components. Thank you, 7 2013 4 (!1• Joh D. Buerosse Florida P.E. #0050867 EngLt13O27 CHECK LIST DESCRIPTION OF WORK D COMPRESSOR D SUCTION PSI 0 HEAD P81 D VOLTS AMPS • • ELECTRICAL CONNECTIONS D CONTACTS TIGHT & CLEAN D OIL LEVEL & CONDIi1ON D CONDENSER 0011:. fl CLEAN COIL & CHECK PIN COND. el ENT _'P 4VC4' T A REFR IGE R ANT 0 0 .FLEAN'AN0 D O MCW R O L3 E.LESTRPAL :CONNEC IONS f1' C?0N TA01'8 *NKr & CLEAN O *Atm, um_ some* & MOTOR RA'L OIL 0 CLEAN COIL $ CHEFC EFN CENT DB T P; O$NT Mt8r. F LVG DB I 0* > 1 0 a1 o N COIGINAL �� �0 COMPLAINT ` la \ Salk ayAn C,hooittiot. - ' JJL 1Urt, € (L TIME ARRIVED TIME DEPARTED TRAVEL TIME �I %��j�j�� I�/�� N9 15798 /�.'IVf�W#f�W�IGeiei/WY ' TE DATE ORDERED DATE SCHEDULED NAME, M !i;s y ,, ::v- STATE Z P o AIR CONDITIONING • HEATING MECHANICAL CONTRACTING 1611 Banks Road Margate, Florida 33063 (954) 979 -9707 4014 is kl \t &;A '1 E IAL NUMBER PHONE LOCOCATION K PHONE ❑ WARRANTY 0 CONTRACT ❑ SERVICE CONTRACT 0 NORMAL RES. ❑ COMMERCIAL t ITEM OR PART. DESC IPTIOP4 P NT ENDING START TOTAL MILES • /HR.= x CHARGE $ /MI.= TECH #1 H f8.O REGULAR IHR. Y HRS. 0 OVERTIME /HR.. TECH #2 TECHNICIAN REGULAR Isms. 0 1 HRS. OVERTIME e 0 • /HR. CERT.. TOTAL OTHER TERMS: DUE UPON COMPLETION 1 HAVE THE AUTH a RITY TO ORDER THE ABOVE WORK AND DO SO ORDER AS ABOVE. ITS AGREED THAT THE SELLER WILL RETAIN TITLE ea, ANY EQUIPMENT OR MATERIAL FURNISHED UNTIL FINAL AMPLETE PAYMENT IS MADE AND IF SETTLEMENT IS NOT MADE AGREED, THE SELLER SHALL HAVE THE RIGHT TO REMOVE AE AND THE S LLER WILL BE HELD HARMLESS FOR ANY DAMAGES RESULTING FROM THE REMOVAL THEREOF. A 1.5 PERCENT PER MONTH INTEREST WILL BE CHARGED FOR ANY BALANCE OVER 30 DAYS OLD. SUB- TOTAL TRIP CHARGE TAX TOTAL A110UI41 DUE Miami Shores Vitiage Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION FORM ALL CONTRACTORS MUST PROVIDE COPIES OF LICENCES AND INSURANCES EACH TIME A PERMIT IS SUBMITTED OR THE VILLAGE MAY MAINTAIN A FILE WITH YOUR INFORMATION FOR A $30.00 FEE PER YEAR. IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. `� COPY OF QUALIFIER'S STATE LIC CARD B. s" COPY OF LOCAL BUSINESS TAX RECEIPT C. ✓ COPY OF LIABILITY INSURANCE (CERTIFICATE HOLDER TO BE MIAMI SHORES VILLAGE BLDG DEPT) D. B/ COPY OF WORKERS COMPENSATION (EITHER CERTIFICATE OR EXCEMPTION) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER B. COPY OF MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT C. COPY OF LIABILITY INSURACE (CERTIFICATE HOLDER MUST BE MIAMI SHORES VILLAGE BLDG DEPT) D. COPY OF WORKER COMP INSURANCE (EITHER CERTIFICATE OR EXEMPTION) YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE HOLDER AS FOLLOW: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33438 COMPLETE CONTRACTOR'S INFORMATION BUSINESS NAME: C A (AR L(1S` _ SEIM eia BUSINESS ADDRESS: *I'll wb.) R-S,t CITY Pi L6P$ t STATE Fr.A < ZIP CODE 83o BUSINESS PHONE: (9 54 ) 91 q 0 7 fl FAX NUMBER (i Sy ) c agv 7 (y CELL PHONE ( ) QUALIFIER'S NAME: Wit-AAA VI I$ L., QUALIFIER'S LIC NUMBER: Ce- IziGo53gT 7 N),1,. iV T 19493 55'0 gsv E -MAIL ADDRESS (IF APPLICABLE): Camkovire @ c, o(, C.sOT\ Created on 3119109 BY MLDV 1 RV 3126109 MLDV 05101207.3 15:37 9549560555 ACORD,. CERTIFICATE PRODUCER COVER ALL INSURANCE 5800W ATLANTIC BLVD MARGATE, FL. 33063 PH: 954959,0408 FX: 954- 956 -0555 INURED CORALAIRE SERVICES INC. 7915 MN 20TH STREET MARGATE, FL 33083 COVER ALL INSURANCE OF LIABILITY INSURANCE THIS CERTIFICATE IS ISSUED AS A ONLY AND CONFERS NO RIGHTS HOLDER. THIS CERTIFICATE DOES ALTER THE COVERAGE AFFORDED PAGE 61/01 DATE (MMIDDI>YTT) 0511012013 MATTER OF INFORMATION UPON THE CERTIFICATE NOT AMEND, EXTEND OR BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIL # INSURER A; FEDERATED NATIONAL {NS ~�- INSURER 8: INSURER CG; INSURER 0 INSURER S. COVERAGES THE ANY POLICIES UIREMENT, TEINSURANCE R OR map BELOW HAvE ONNDRION QF ANY BEEN 1 OR OTHER NDOCUMENNTMWITTH RESPECT TO WHICH PERIOD �ISSUEEDD OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS i3UBJEGT TO ALL THE TERMS. EXCLUSIONS AND G©NDITIONS OF SUGH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. -N POLiGY� ',r' iN9RaDist, - POLICY NU I1 f.: , tt , r� • ••i GENERAL LIAIMUTY X COMMERCIAL GENERALLlA@IU1Y CLAIMS MADE Ei OCCUR GL•0544008951 -01 GENT. AGGREGATE LIMIT WOES PER; POLICY In .IFCT L29 AUTOMOBILE HAEILI1Y ANY AUTO ALL OWNED AUTOE SCHEDULED AUTOS HIRED AUTOS NONd1WNED AUTO GARAGE LIABILITY ANY AUTO EXCESS/UMBRELLA UARIUTY El CLAIMS MADE DEDUCTIBLE RETENTION $ WORKERS COMPENSATION AND EMPLOYS LtAOR11Y ANY PRO�RRPEI EXCLUDED'? g es dssrE e under %Xis OTHER 3-31-2013 341.2014 UMUS EACH URRENGE __ s 1 690 000 ij 4AG�ET tzEnniy - s 140,000 MEDEXP(Attueno,pVsO1 3500 PERSONAL & A0V U4't Y $ 1,500,000�� GENERAL AGGREGATE E 2.000000 PRODUCTS - COMPi0P AGO $ 2 004,O00 C MEI SINGLE LIMIT (Par • LperOatl) B DY (POerrAccideent)RY 3 3 pRopER tPP rr den°AMA°E $ 3 _AU 0THE1 0ONLY- EAACCIDEf T $ 1 TWAN !+ "C 3 AUio ONLY: AQS $ EACH GOCURREN'CE 3 AGOREGATE� - S REBOOT= OF OPRRATIONS 1 LOCATIONS l VEHICLES I EsCi.utdONS ADDED ST ENDORSEMENT 1 SPECIAL PROVISIONS AIR CONOTIIONING CONTRACTOR CERTIFICATE HOLDER CITY OF MUM SHORES BUILDING DEPARTMENT 10050 NE 2 AVENUE MIAMI SHORES, FL 33138 FX 954-968 -7142 ACORA 29 (2001108) VARY �ATit- UTH- ESL. EACH ACCIDENT 3 - E.L DISEASE -Ea EMPLOYEE $ LI- DISEASE - PrN ICY IT 5 CANCELLATION glOULDANY°PTHE ABOVE DET IEEDPOLICIES 131 ?CANCELLED DEPOSETNEEXP1RAiION DATE THEREOF, THE ISSUING BISURER WILL ENDEAVOR TO MAIL 14 DAYS WRITTEN NOTICE TOTE CERTIFICATE HOLDER MIRED= THE LIB, BUT FAILURE TO DO SO SHALL I!JPOSE NO OBLIGATION OR LIABILITY OF ND UPON THE I .- AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE 06 -27 -2012 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: 07128/20/2 EXPIRATION DATE: 07/28/2014 TAIBL WILLIAM P 592626377 BUSINESS NAME AND ADDRESS: CORALAIRE SERVICES INC 7915 NW 20 ST POMPANO BEACH FL 33063 SCOPES OF BUSINESS OR TRADE: 1- CERTIFIES? AC CONTRACTOR IMPORTANT: Pursuant to Chapter 440 . Q5114), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section may not recover benefits or compensation under this chapter. Pursuant to Chapter 440.06(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, 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 meets 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 OWC -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 DIVISIONOF WORKERS' COMPENSATION CONSTRUCTION INDUSTRY CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW EFFECTIVE 07/28/2012 EXPIRATION DATE: PERSON: WILLIAM P TAIBL FEIN: 592625377 BUSINESS NAME AND ADDRESS: CORALAIRE SERVICES INC 7916 NW 20 ST POMPANO BEACH, FL 33063 SCOPE OF BUSINESS OR TRADE 1- CERTIFIED AC CONTRACTOR 07/28/2014 IMPORTANT rt Pursuant to Chapter 440.05(14), F.S., an officer of a corporation who 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 E the notice of election to be exempt R 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 meets 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. DWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01 -11 BATCH NUMBER to Mr 111, 115 S. Andrews Ave., Rm. A -100, Ft. Lauderdale, FL 33301 -1895 — 954 - 831 -4000 VALID OCTOBER 1, 2012 THROUGH SEPTEMBER 30, 2013 DBA:CORALAIRE SERVICES INC Business Name: Owner Name: w P TAIBL Business Location: 7915 NW 20 ST MARGATE Business Phone: 954- 979 -9707 Rooms Seats, Receipt #NEAT NG /AIRCONDITION co Business Type: (AIR CONDITIONING CONTRA Business Opened:05/08/1986 State /County /Cert/Reg:CACO 5 8 3 2 8 Exemption Code: EMpleyees Machines Professionals 1 For Vending Business Only Vending Type: Tax Amount Transfer Fee NSF Fee Penalty Prior Years Collection Cost Total Paid 27.00 0 00 0 :00 i x �, �0 `s 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: W P TAIBL 7915 NW 20 STREET MARGATE, FL 33063 2012 - 2013 Receipt #01A -11- 00010398 Paid 08/27/2012 27.00 ACTR OR)