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MC-04-0906Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FIL k �~ Phone: (305)795 -2204 Fax: (305)756 -8972 r Inspection Number: INSP - 190320 Permit Number: MC -4 -13 -906 Scheduled Inspection Date: September 23, 2013 Permit Type: Mechanical - Residential Inspector: Perez, JanPierre Inspection Type: Final Owner: , MIAMI PROPERTY SOLUTIONS Work Classification: A/C Replacement Job Address: 1155 NE 103 Street Miami Shores, FL 33138- Phone Number Parcel Number 1122320310080 Project: <NONE> Contractor: MASTER MECHANICAL HVAC CORP Phone: (305)394 -6218 Building Department Comments REPLACE 2 TON AIR CONDITIONING - - - - -- -- ". "' -.'� INSPECTOR COMMENTS False � z313 Passed L101 Inspector Comments Failed Correction Needed ❑ Re- Inspection ❑ Fee No Additional Inspections can be scheduled until re- inspection fee is paid. September 20, 2013 For Inspections please call: (305)762 -4949 Page 2 of 15 ov 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 201 0 Permit Type: MECHANICAL OWNER: Name (Fee,,/ S imple Titlehol Address: I q P /y i� N City: 0 547P P Tenant/Lessee Ny,.Email: e e vin f 1 l 11trjhmr fie APR 30 Z-113 Permit No. -03 ' Master Permit No S0I44- D,"f Phone #: 3��� State: Z- Zip: ����4 JOB ADDRESS: - //.57- 5- /i E7 l0 3 5�11 P e I � City: Miami Shores County: Miami Dade Zip: 331 > .3 i / Folio/Parcel #: Is the Building Historically Designated: Yes Zone: CONTRACTOR: Company Name: tfym %' �C) 11#0 Phone#: ;� 0 S-- —3 ?/ 0 Address: ���'Z% IVCD 33.v AA City: Qualifier Name: zip: 3 IV ?—= Phone#: State Certification or Registration #: t�f14e, / 0%6 4"3 5jL _Certificate of Competency #: Contact Phonek Address: DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ w e //0 Square/Linear Footage of Work: Type of Work: ❑Address DAlteration ONew ",Yl&epair/Replace ODemolition Description of Work: 141 of- 2- ZV /f od2 60,0 0200"--016 9 1 Submittal Fee °� Permit Fee $ Scanning Fee $ Radon Fee $ CCF $ CO /CC $ DBPR $ Bond Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE r`_)y!� Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the ab nce uch posted notice, the inspection will ;4p�� e will be charged. Signature Signature Owner r Agent Contractor s� The foregoing instrument was acknowledged before me this A3 The foregoing iin�strument was acknowledged before me this + 3 day of It 4&Cf* , 20 13, by , day of QQ'�1 , 20 13, by , who is personally known to me or who has produced who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: �, , My Commission Expires: MY COMMISSION A EE 1629 EXPIRES' March 26, 2016 Bonded Tiuu Notary Nft Undem iters APPROVED BY (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) Plans Examiner Structural Review as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Co ExpiresROXANA PEREZ *; MY COMMISSION � DD 857995 '7 P EXPIRES: June 1, 2013 p 4•, Bonded Thru Notary Public Underwriters sk:k�k3s:k ...... �, • geskskag$ssk$s:k Zoning Clerk 1 ♦' f 1 , s 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): 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 ALL SUBMITALS ARI (AHRI) DATA SHEET REQUIRED Change Disconnecting means: YES ❑ NO -ARHI- Sheet- Attache&YYES ❑ NO ❑ ',ZantradA ttaached _YES ❑ 1. Minimum Circuit Ampacity (Wire Size): 2. Maximum Overcurrent Protection (Fus 3. Voltage of Circuit (208/240/480): 4. Size Disconnecting Means: _ Contractor's Company Name/s State Certificai Signature d 0.+aqC-- 3r Size): 6nis g71r 1 6ZZgtf G P Phone: 3,d =3 &d6Z/8 of Competency N. Date: �� UNIT BEING REPLACED DATA NEW UNIT MANUFACTURER AHU or PKG. UNIT MODEL # 196514m n?y,-Ed '— COND. UNIT MODEL # ks c 6 P 5; 8 KIN HEAT k NOM TONS AHU CU PKG 1 M.C.A AHU CU PKG AHU CU PKG 2 MAP AHU CU PKG AHU CU PKG 3 VOLTS AHU CU PKG PKG UNIT / / PKG UNIT / / t'1 EER/SEER / % YES NO REPLACING DUCTS YES YES REPLACING THERMOSTAT YES XQ YES NEW 4 "CONCRETE SLAB YES YES NEW ROOF STAND YES AN9 YES N NEW RETURN PLENUM BOX YES 1. Minimum Circuit Ampacity (Wire Size): 2. Maximum Overcurrent Protection (Fus 3. Voltage of Circuit (208/240/480): 4. Size Disconnecting Means: _ Contractor's Company Name/s State Certificai Signature d 0.+aqC-- 3r Size): 6nis g71r 1 6ZZgtf G P Phone: 3,d =3 &d6Z/8 of Competency N. Date: �� A4COR" CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 3/20/2013 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 pollcy(ies) must be endorsed. If SUBROGATION IS WANED, 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 ADVANTAGE INSURANCE OF AMERICA 4520 NW 7th St Miami. FL 33126 CONTACT PHC E A/C No Ext: (305) 649 -5566 ac No:(305) 649 -5559 ADDRESS:R ackiebatista 749@hotmail.com CUSTOMER ID #: INSLIWAIS) AFFORDING COVERAGE NMC# 06/01/13 INSURED MASTER MECHANICAL H.V.A.0 CORP INSURERA:AMERICAN VEHICLE PREMISES Ea occurrence $ 100,000 INSURER B: CASTLE POINT FLORIDA INSURANCE $ 5,000 4521 NW 33 AVE INSURER C: INSURER D: GENERAL AGGREGATE MIAMI, FL 33142 INSURER E: PRODUCTS - COMP /OP AGG $ 2,000,000 INSURER F: $ COVERAGES CERTIFICATE NUMBER: REVISInN MI]MRFR- 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. ILSSR TYPE OF INSURANCE ADDL NNSR OUSR WVD POLICY NUMBER POLICY E EXP D MM/DD LIMITS GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 1:x1 1 OCCUR GL- 788200 06/01/12 06/01/13 EACH OCCURRENCE $ 1,000,000 PREMISES Ea occurrence $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,00010 0 GENERAL AGGREGATE $ 2,000,00b GEN'L AGGREGATE LIMIT APPLIES PER 7X POLICY PRO- JECT 7 LOC PRODUCTS - COMP /OP AGG $ 2,000,000 $ AUTOMOBILE LIABILnY ANYAUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA UAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DEDUCTIBLE RETENTION $ $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOPWARTNEREXECUTIVE OFFICEWMEMBER EXCLUDED? (Mandatory in NFL If yes, desalbe under DESCRIPTION OF OPERATIONS below NIA 253351 02/06/13 02/06/14 WC STATU- OTH- TORY LIMITS ER E.L EACH ACCIDENT $ 1,000,000 _ E.L. DISEASE -EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 1 7 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) AC INSTALLATION,SERVICE AND REPAIR CERTIFICATE HOLDER CANCELLATION Miami. Shores Village SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Building Department THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 10050 NE 2nd Avenue ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores,FL 33138 AUTHORIZED REPRESENTATIVE 01988- 09 ACORD CORPORATI All rights reserved. ACORD25(2009/09) The ACORD name and logo are registered marks of ACORD �# 4 89 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD SEQ#L12052900681 The CLASS A AIR CONDITIONING CON Named below IS CERTIFIED Under the provisions of Chapter: Expiration dates AUG 31, 2014 RICK SCOTT' GOVERNOR R H.V.A.C. COP FL 33142- DISPLAY AS REQUIRED BY LAW KEN LAWSON SECRETARY FIRST -CLASS U.S. POSTAGE j PAID MI Mt t FL PERMIT NO. 231 THIS IS NOT A 81H — DO NOT PAY 663767 -3 RENEWAL BUSINESS NAME/ LOCATION RECEIPT NO. 690840-5 .MASTER MECHANICAL H V A.0 CORP STATE# CAC1816537 4521 NW 33 AVE 33142 UNIN DADE COUNTY OWNER MASTER MECHANICAL H V A C CORP 'Sec. Type of Business WORKER /S . MfiA C MECHANICAL CONTRACTOR 1 BUSUIE89 TAR F- MM". Ir HOES NOT I'enT THE NOI M m MUTE ANT ZoP LAAWS OF � DO NOT FORWARD =am Os tart. I= DOES rr EXERM TIM cm 90TT ate° AitNO MASTER MECHANICAL H V A C CORP now °1A"{1C" ru RIDER R DE LA NUEZ PRES 4521 NW 33 AVE PA� YMMT MU94MU COUNTYTM MIAMI FL 33142 cou.e= c 08/20/2012 09010131001 Isr��rttl�rrrlJlrf a1ttlC�rlttlttllrrrtlislltrtt�t�trrl +r�ttt�5 000075.00 SEE OTHER SIDE M Master Mechanical H.V.A.C. Corp 4521 NW 33 AVE Miami, FL 33142 Bill To Invoice # �..�1Q.Nrul 1464 Ship To M Invoice Date Invoice # 4/23/2013 1464 P.O. No. Terms Description City Rate Amount l 400(U Total Phone # Fax # web Site Payments /Credits 3053946218 3053595742 www.mastermechanical*.com Balance Due AHRI Certified Reference Number; 5055914 Date: 4/23/2013 Product. Split System: Air -Cooled Condensing Unit, Coil with Blower Outdoor Unit Model Number: MSA4BD024KB Indoor Unit Model Number. BSBMM024K A Manufacturer: MAYTAG Trade/Brend name: MAYTAG MSA480 SERIES Manufacturer responsible for the rating of this system combination Is MAYTAG Rated as follows in accordance with AHRI Standard 2101240 »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): 23000 EER Rating (Cooling): 11.00 SEER Rafting (Cooling): 13.00 • RO&W toito "d by an ask (h (kite a vokmWy rerate of previously pubW*d dale, unless a=mpanted with a WAS, which indicates an tnvoWnWy rerete. 02013 Air- Conditioning, Heating, and Refrigeration Institute CERTIFICATE NO.: 13011