MC-13-1597Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
inspection Number: INSP- 207503 Permit Number: MC -7 -13 -1597
Inspection Date: February 19, 2014 Permit Type: Mechanical - Residential
Inspector: Perez, JanPlerre Inspection Type: Final
Owner: MASSASSO, LUCA
Job Address: 34 NE 101 Street
Miami Shores, FL 33138-
Project: <NONE>
Work Classification: A/C Replacement
Phone Number
Parcel Number 1132060131370
Contractor: JIREH COOLER CO Phone: (954)254 -5910
Buildina Department Comments
CHANGE OUT A 5 TON NEW COOPER LINE A/C SYSTEM
Infractio Passed
Comments
INSPECTOR COMMENTS True
Passed
KE
Inspector Comments
Failed El
Correction
Needed
Re- Inspection ❑
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid
For Inspections please call: (305)762 -4949
February 20, 2014 Page 1 of 1
Miami Shores Village ;FES
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
Permit Type: MECHANICAL
FBC 20
Permit No.
4 Z0
Master Permit No � (L 1- a 9
JOB ADDRESS: 3 4 06 10 I .S T_
City: Miami Shores County: Miami Dade Zip: 93-1
Folio/Parcel #:
Is the Building Historically Designated: Yes
NO 2<- Flood Zone:
OWNER: Name (Fee Simple Titleholder): L QCA NASAhone #:
Address: 34 ij c 101 S` t
City: , I A Nl t S if0 nRT State: L_
Tenantlessee��Naeeme: Phone#:
Email: L. t�
CONTRACTOR: Company Name: "F'iTLfl-( eADDle-rL. cQk-a Phone #: 11 rM d Pf g_%%
Address: �� L•!r h-� /t€.V,�
City: bO CA RA t O V State: L zip: 4
Qualifier Name: oyS e'.S ® ✓CY2X- Phone#•
State Certification or Registration #: G Ac- l 11 S' :� Y i Certificate of Competency #:
Contact Phone #: 015V_-1 Sy 99 Email Address: 4,00& � !3er.(,SMRk f
DESIGNER: Architect/Engineer. Phone #:
Value of Work for this Permit: $ yr 6CU. 0o Square/Linear rRe ge of Work:
Type of Work: ❑Address_ QAlteration ONew air/ Repiace ODemolition
Descriptiiiri of Work: ,.sue w S Ttoov., AC- C114AI c? OU'
Submittal Fee $ Permit Fee $ CCF $ CO /CC $
Scanning Fee $
Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
Technology Fee $
TOTAL FEE NOW DUE $
Bonding Coagfty',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 lo 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 absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature
r Owner or Agent
The foregoing instrument was acknowledged before me this
day of , 20 by -W e9&SSQ'l.S'� ,
who is personally known to me or who has produced,,_
As identification and who did take an oath.
NOTARY PUBLIC:
Sign:
P
Ody Commission Exp
� de ar 3e dnkx, R dr �Y aY 4nh k aF ar aY a4 �Y,
APPROVED BY C
"1—'r rulxtc Star@ Of Flon?de
Joanna M Feiic,
Comm on FF owm ano
EX PI 01/12/2018
m/�,�
Signature w`°"'
Contractor
The foregoing instrument was acknowledged before me this
day of G/ 20, by 4Q61�e S J%
who is personally known to me or who has produced.
41 )6s� -' as identification and who did take an oath.
Plans Examiner
Structural Review
(Revised 3 /12/2012)(Revised 07 /10 /07XRevised 06 /10/2009XRevised 3/15/09)
NOTARY PUBLIC:
Sign:
0nna M FeUdAno
Xin
`
7 �NAytommW9ion FF 082783
Expl= 01/1201018
Zoning
Clerk
nil
Miami Shores Village
Building Department
10050 N2.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
BUILDING
PERMIT APPLICATION
FBC ZO
Permit Type: MECHANICAL
, u t/ c�
7 263
Permit NoM& J ��9
F]
r✓
Master Permit No
OWNER: Name (Fee Simple Titleholder): At� k Good o' Phone#: 305 S Y
Address: fit-( 0.1 t= 1® ( S i
City: M %AVM i S 4o IZ.LF-& State: PL gip; '3313 5
TenantUssee Name: Phone#:
Email:
JOB ADDRESS: 3 Li N t ®1 S t
City: Miami Shores County: Miami Dade Zip: 3.313
Folio/Parcel#:
Is the Building Historically Designated: Yes NO Flood Zone:
CONTRACTOR: Company Name: °�aR �C3flC� -n- C10" Phone#:
Address: 16'8f-9 %mod L &AZJ'&
City: 7J®CA- 1V'1-0 ---State: PC- Zip: 3 3 Ll
Qualifier Name: 0 b X A C-S ®t-" V f ;fU Phone#:
State Certification or Registration #: LA- C- 114 I S `J J Certificate of Competency #:
Contact Phone #. `S� ' 1 Email Address:
DESIGNER: ArchitectBngineer: Phone#:
t��
aloe of Work_f_or this Permit: a Square/I.inear Footage of Work:
Type of Work: OAddress OAlteration
Submittal Fee $ Permit Fee $
Scanning Fee $
ONew ORepair/Replace ODemolition
S` % ®e✓ e✓ew- eo,-Pp&2, lY its G�-
03TOW 3823L
ros .FS Aso e9a,gx7 . r,11a 4"
CCF $ COJCC $
Radon Fee $ DBPR $ Bond $
Notary $ Thdriing/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $
+-2, q?
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Tap
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 time 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 and a reinspection fee will be charged
Signature Signa
Own +r Agent Contractor
The foregoing instrument was acknowledged before me this The foregoin instrument was acknowledged before me this
day o , 20 t , by day of 20 L by
who is perso ally known to me or who has produced who is personally known to me or who has produced_,_
L)l C • As identification and who did take an oath.
NOTARY PUB
Sign:
Print:�.,�, :..._
My Commission Expires:
JESSE W1lLIM
Merry► Pubk - State of nor"
Nry Cemmtm. EWM Sep 23.2011
Concession # EE 89792'1
APPROVED BY Z I 7'Z I Plans Examiner
Structural Review
(Revised 07 /10/07)(Revised 06/10=09)(Revised 3/15/09)
as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
w
Print: w : Co =
My Commission Expires: 0�
Zoning
Clerk
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel. (305) 795 2204
: (305) 756.8972
AIR CONDITIONING REPLACEMENT DATA Fax
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). 3 Lf m cf;' 101 'ST-
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 0 THE CONTRACT IS REQUIRED WITH ALL SUBMITALS
ARI (AHRI) DATA SHEET REQUIRED
Change Disconnecting means: YES NO ❑ ARHI Sheet Attached: YES NO ❑ Contract Attached: YES
<,_,
1. Minimum Circuit Ampacfty (1Mre Size): 6
2. Maximum Overcurrent Protection (Fuse/Breaker Size): to
3. Voltage of Circuit (2081240/480): 2 `'I
4. Size Disconnecting Means: Shp' 90 A A"P S
Contractor's Company Name: j t A f- M ez;p L611- C�O = Phone:
State Certire R gistration N. ���- 9 l S °f t Certificate of Competency N.
Signatu Date:
muenees 61pd ne onio
UNIT BEING REPLACED
DATA
NEW UNIT
MANUFACTURER
e
AHU or PKG. UNIT MODEL #
R /+ rK
COND. UNIT MODEL #
/
KW HEAT
! K w
NOM TONS
3'
AHU
CU
PKG
1 M.C.A
AHU 41FCU 0 PKG
AHU
CU
PKG
2 M.O.P
AHU SD CU KG
AHU
CU
PKG
3 VOLTS
AHU CU PKG
PKG UNIT I
I
PKG UNIT I I
EER/SEER
YES
NO
REPLACING DUCTS
YES
YES
NO
REPLACING THERMOSTAT
NO
YES
NO
NEW 4 °CONCRETE SLAB
NO
YES
NO
NEW ROOF STAND
YES
YES
NO
NEW RETURN PLENUM BOX
YES
<,_,
1. Minimum Circuit Ampacfty (1Mre Size): 6
2. Maximum Overcurrent Protection (Fuse/Breaker Size): to
3. Voltage of Circuit (2081240/480): 2 `'I
4. Size Disconnecting Means: Shp' 90 A A"P S
Contractor's Company Name: j t A f- M ez;p L611- C�O = Phone:
State Certire R gistration N. ���- 9 l S °f t Certificate of Competency N.
Signatu Date:
muenees 61pd ne onio
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
r
CONSTRUCTION INDUSTRY LICENSING BOARD
1940 NORTH MONROE STREET
TALLAHASSEE FL 32399 -0783
OLIVEIRA, MOYSBS
JIREH COOLER, CO
18869 CLOUD LAKE
BOCA RATON
CIRCLE
FL 33496
(850) 487 -1395
Congratutkxrsl With this tic ense ' �;
STATE of FLOWA A� 619 9 4 19
la
you become one of the nearly one mi�on ;.
Florkfians licensed by the Deparbnent of Business and Professional Regulation ; DEPARTNI Olt BUSINESS AND
PROEES$iONAL REGULATION
Our p and businesses map from architects to yacht brokers, from
boxers to barbeque restaurants, and they keep Florida s economy strong. f
CAC1815741 07j12/12 120026019
Every day we work to improve the way we do business In order to serve you better!,:.
For information about our services, please log onto www.rnyftddaIIcens&qorrL ! CERTIFIEb AIR COND G"C1NTR ti ''
There you can find more Information about our divisions am the regulations that GOl7TVSIRA,
impact you, subscribe to department newsletters and team more about the ES ! JIBLBR CO
Department's bnitlatives. <:
Our mission at the Depadment im License Efficiently, Regulate Fairly. We
constantly strive to serve you better so that you can serve your customers. ss -�xn s cam.
Thank you for doing business in Florida, and congratulations on your new license!" i f ��9
}� dates A 3 2
DETACH HERE
AC# 6199419 STATE OF FLORIDA
DR PAR �e SINES�,.,,. � PROFESSIONAL EGULATION
IONIRF LICENSING
BOARD
s
SEW
.M267-12006-74
F
07/12j/20121120026019
The CLASS B AIR CONDIT NTRACTOR
Named below IS CERTIFI
Under the provisions of' r 489 FS.
Expiration dates AUG 31, 2014;;
f4
i
OLIVEIRA, MOYSBS L�
JIRTH COOLER CO
18869 CLOUD LAKE CI1E2
BOCA RATON
A.
t l �-.�i�
�
• a
LANSON !
COOK '* r.:. ,.:, �_ "
SECRETARY i
_':D1SP(:±Q►Y AS REQUIREp EY 4A1At .
* * 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: 03115/2012
PERSON: OLIVEIRA
FEIN 650927836
BUSINESS NAME AND ADDRESS:
JIREH COOLER CO
18868 CLOUD LAKE CIR
BOCA RATON FL 33496 -2130
SCOPES OF BUSINESS OR TRADE:
1- AIR CONDITIONING
EXPIRATION DATE: 03/15/2014
MOYSES
2- INSTALLATION SERVICES
IMPORTANT., Pursuant to Chapter 440 . 0504), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election adder this
section may not recover benefits or compensation under this chapter. Pursuant to Chapter 440.0602), 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 440.05113], 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
DIVISION OF WORKERS' COMPENSATION
CONSTRUCTION INDUSTRY
CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA
WORKERS' COMPENSATION LAW 9
EFFECTIVE 03/15/2012 EXPIRATION DATE: 03/15/2014
PERSON: NOYSES OLIVEIRA
FEIN: 650927836
BUSINESS NAME AND ADDRESS:
JIREH COOLER CO
18869 CLOUD LAKE CIR
BOCA RATON, FL 33496 -2130
SCOPE OF BUSINESS OR TRADE
1- AIR CONDITIONING 2- INSTALLATION SERVICES
IMPORTANT
OPursuant 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 440.051171, F.S., Certificates of election to be
H exempt - apply only within the scope of the business or trade listed on
Rthe notice of election to be exempt
E Pursuant to Chapter 440.05(13), F.S., Notices of election to be exempt
and certificates of election to be exempt shell 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.
CUT HERE
4UESTIONS? (850) 413 -1609
* Carry bottom portion on the job, keep upper portion for your records.
OWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01 -11
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Now die p l a y i n g records 1- 1 or I total
HQ= Contact Us [Terms and Popaftm I License AHRI Direc-WQI D ata Help Wfth this 5ile
Copyright 0 2013 Air-Candidoft Healing, and Refte►atIon Institute. All lights reserved.
1/1
AREH COOLER CO.
Air Conditioning
270 S. Military Trail
Deerfield Beach, FL 33442
(954) 254 -5910
BILL TO
A?1 A &00 \I CA,
STREET
3Li N �c
CITyyY�� p �((,,�r� y1 ,,...{
1 , A W cS40n.0 -3
IT
TECHNICIAN
M S�
WORK TO BE IIERFORMED
DA7E CONDENSING UNIT
o r S/ �3
PROMISED ❑ RECOVERED
SCHED. ❑ A.M 0 RECYCLED
TIME ❑ P.M.
❑ RECLAIMED
❑ RETURNED
❑ DISPOSAL
HVAC SERVICE ORDER
INVOICE
1492
}'r'',_
JTAL,GHECK LIST
WORK PERFORMED
OTY.
TYPEDISPOSMON
CONDENSING UNIT
FURNACEIELEC.HTR
RPLCD UNIT
RPLCD UNIT
OILED MOTOR
CHNGD COMPRESSOR
DESCRIPTION OF WORK PERFORMED
RPLCD GAS VALVE
CHNGD MOTOR
RPLCD FUSE
THERMOCOUPLE
LIT PILOT
.t, J / �{�
fu Cluj r O^I 1� J'T e6► M If (. ( � ew 1 A' �" t "CAL.(• • 0S 7A -r
CHKD CHARGE
CLNO BURNERS
.7 ju, 'D f f
's
ADDFREON
CHNGD MOTOR
'
CLING COILS
RPLCD CONTACTOR
CLND BLOWER
U DISMANTLED
❑ CHANGED OUT/REPLACED
TOTAL $
REPAIRED LEAK
RPLCD LIMIT
OILED MOTOR
RPRD WIRING
DESCRIPTION OF WORK PERFORMED
RPLCD FUSE
LIT PILOT
.t, J / �{�
fu Cluj r O^I 1� J'T e6► M If (. ( � ew 1 A' �" t "CAL.(• • 0S 7A -r
INSTALL DISCONNECT
RPLCD TRANSFORMER
.7 ju, 'D f f
's
New 5/� Phi s+�u; f cf/ �'uJ cO��(2�� 9 �f3 Nc =-�-J ��
RPRD WIRING
NEW HEAT KIT
RPLCD CONTACTOR
ADJUSTMENT
L/1 JV �!' �I 6 t 3 / $ GV ew eL,/erL IV le
RPLCD CAPACITOR
GO TEST
RPLCD RELAY
OILED MOTOR
ADJUSTMENT
REFRIGERATION
NEW FILTER /DRIER
RPLCD LIMIT DISK
RPRD WIRING
HARD-START KIT
--
EVAPORATOR COIL
CHNGD COMPRESSOR
QTY
MATERIALS & SERVICES
UNIT PRICE
AMOUNT
HRS
LABOR
RAVE
AMOUNT
RPLCD. UNIT
RPLCD THERMOSTAT
REFRIGERANT R- LBS.
RPRD LEAK
RPLCD DEFROST
TIMER
SEAL
RPRD LEAK
FILTERS X X
RPLCD. EXP DEVICE
ADD FREON
CLND COIL
CLND /DEFR COIL
TOTAL LABOR
CLND DRAIN
ADJUSTMENT
RPLCD PAN
RPLCD HTRS.
RECOMMENDATIONS
RPLCD PVC
WINDOW UNIT
DUCT
RPLCD UNIT
ADJUSTED
CLEANED
--
INSTALLED
ADD FREON
TOTAL MATERIALS
THERMOSTAT
RPLCD STAT/SWITCH
TERMS
ADJUSTED
CHNGD COMPRESSOR
REPLACED
CHNGD FAN MOTOR
`
FILTERS
❑ CLEANED ❑ REPLACED
I have authority to order the work outlined above which has been satisfactorily
TOTAL SUMMARY
completetl. I agree that Seller retains title to equipmentimaterials furnished until final
'i payment is made. If payment is nor made as agreed. Seller can remove said
-.. egwpment,matermis at Seller's expense and for impose a 2% liquidation tee on the entire
LIMITED WARRANTY: All materials, arts and equipment are
P
by the
TOTAL
MATERIALS
/ 4
f �� ®�
! amount co tained in the Seiler /Buyer transaction. Any damage resulting from said
removals l not ba me responsi ility of Seller.
Warranted manufacturers' Or suppliers' Written warranty
only. All labor performed by the above named company is war-
V
' ru 0 ' 1
r0
ranted for 30 days or as otherwise indicated in writing. The above
TOTAL LABOR
J
named company makes no other warranties, express or implied,
O'ER SIGNATURE IIIATE I
and its agents or technicians are not authorized to make any
TRAVEL CHARGE
such warranties on behalf of above named company.
OD OF PAYMENT
❑ REGULAR ❑ WARRANTY
TAX
❑ CASH ❑ CHECK
IV UQ NO
❑ SERVICE CONTRACT
n
r (7 L l��
^^
16 95,1 (Z
CREDIT CARD O MC ISA 0 AMEX EXP. DAT
CC NO
� nn
CJ
TOTAL
Q
Designmar Load Calculation
Pas,ts are irftfWW fbr use with he ,g and wing system