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