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MC-13-1368Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 195999 Scheduled Inspection Date: July 31, 2013 Inspector: Perez, JanPierre Owner: POWELL, SHANNON Job Address: 78 NW 95 Street Miami Shores, FL 33138- Project: <NONE> Contractor: AIR COOLING INC CL".-- Permit Number: MC -6 -13 -1368 Permit Type: Mechanical - Residential Inspection Type: Final Work Classification: A/C Replacement Phone Number (786)597 -3705 Parcel Number 1131010340080 Isunamg uepanment comments REPLACE EXISTING 3 TONS UNIT Infractio Passed Comments INSPECTOR COMMENTS False d E ` July 30, 2013 For Inspections please call: (305)762-4949 page 14 of 31 Inspector Comments Passed CREATED AS REINSPECTION FOR INSP- 193814. Failed Correction Needed ❑ Re- Inspection ❑ Fee No Additional Inspections can be scheduled until re- inspection fee is paid. July 30, 2013 For Inspections please call: (305)762-4949 page 14 of 31 Miami Shores Village Building Department 10050 NEInd Avenue, Miand Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762-4949 BUILDING PERMIT APPLICATION FBC 2010 Permit No. Muter Permit No. 71 JUN 1 013 Permit Type: MECHANICAL OWNER: Name (Fee Simple Titleholder). S _Fhortel.�-1 -4 - 3-+o S Address: :As 0 %Ili 9 C5 C-_T ?_eeT_ City: )KLQWi S�n(!!eS ktk eta e_ State: _&L (2 1( 1 C\ In' Zip Tenantfieks6e Nanw. Phonet Email: JOB ADDRESS: S � V3 CL 45 City: Miami Shores County: Miami Dade —Zip:. 3 t 3'8 Folio/Parcelt. � L -� 101 — 0 3 —DO&O Is the Building Historically Designated: Yes NO —Flood Zone: CONTRACTOR: Company Name: A% R cool % N rr T;n c- 4&A2 3 & 3 414 1 Address: :ARUIy WC__S_V :10 Lay-e- City: "A State: 0 k Qualifier Name: '> o C3"q,,vo —Phone#: 3 k( Y 0 State Certification or Registration #- CAC 1-9 t 51r-2- C:A_CertifjcgLte of Competency " #: Contact Phone .) S-14 ;) q 4 o Email Address: � Kc. eo WA DESIGNIM: Architect/Engineer: % a --- — or- 4, dy..; ;k Phone#-. Value of Work for this Permit: $Van a 02 Square/Linear Footage of Work: Type of Work: UAddress UAlteration QNew )dRepair/Replace ' ElDemolition Description of Work: 'R P- P LACt aY t 5-n 4 Gr Pr i C Lj N L'r 3 -M t42 -Z-:6 14 exi C-C&I t D m j; - o r N 4 - I A - - J_S (o . 5 *, 5 -.9f -t L-­ - sp Submittal Fee$ Permit Fee $ - I ; Z- CCF CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ — Technology Fee $ Double Fee $ Strac tur-al 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 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, ETG..... 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 ^ A Signature Signature Owner or Agent Contractor 1g- The foregoing instrument was ac)m7wledged b70a-14--11 re me this g The foregoing instrument was ackn- owwlledged before me this day of � , 20/ 3 by� ��'� °� , day of _ l 2013 by who is personally known to me or who has produced who is personally known to me or who has prodtced� As identification and who did take an oath. NOTARY Sign: v U LCJ Print: .N MGEUCA M SUENO My Commissio 0 Nary Pow - state of Ronda • Wry Comm. Exphn Nov 18, 2018 Cowdoslon #t EE 127828 , , • as : SNI Z - 1 /,RI FAW . Structural Review (Revised 07 /10/07)(Revised 06 /10/2009)(Revised 3/15109) as identification and who did take an oath. NOTARY PUBLIC: Sign: (..� Print: My Commission Expires: O W AU Zoning Clerk FOIST-CLASS U.S. POS'T'AGE } PAID MWA FL PERMIT NO. 231 THIS tS NO3i'AY.BILi DO'NOT PAY RENEWAL 618707 -4 BustraESS I,E t locarfofs RECrdtrr No. 6 5155- 3 AIR COOLING INC STATE *: °CAC1815729 :7966 W 30 LA AH 33018 HIAL OWNER AIR COOLING INC sm'lyp of Bush"" 196 SPEC 14ECHANICA-L CONTRACT01t .MM IS 04LV LOCAL 4 TAAx RECEIM IT WORKER /S I DO NOT FORWARD I LANW•Tmis AIR COOLING INC OF ,, tM 0 CERTUMATWH JOSE L BUENO PRES MON.% 7966 W 30 LA rA,r sTAEC»aEO HIALEAH FL 33618 �uA� -oaoe colsrrr�Ax COLLECTOW* 07/24/2012 .j tt fl tt ttt t tl f ! �t tt fl tt t I t 60010000232 ss rrr r rrurr a ru r sr sss r sus sss r� .e r+' 000045.00 37 SEE OTHER SIDE AC#..6.1 3,9 290 DHPA STATE OF FLORIDA. -XK SEQ#LI2052400964 GOVERNOR KEN LkwsoN NSOLAYAS REQUIREli: BYLAW SECRETARY AC90RDr ' CERTIFICATE OF LIABILITY INSURANCE °A'E05, 6,1°x"' 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: N the certificate holder Is an ADDITIONAL INSURED, the pollcy(les) must be endorsed. If SUBROGATION IS WAIVED, 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 CONTACT NAME: Ana CamafeIG3 Just Insurance Brokers 1200 NW 78 Ave Suite 105 PHONE (305)418-4701 F' � No): (305) 418 -4706 0 L ADDRESS: anac@justirisurancebrokers.com INSURER(S) AFFORDING COVERAGE NAIC # Miami, FL 33126 INSURER A: Granada Ins. Co. DAMAGE TO RENTED PREEM SES JE, 0= 11=11 Pion (305) 4184701 Fax (305) 41&4706 INSURED INSURER B : PERSONAL & ADV INJURY INSURER C : ❑ AIR COOLING, INC. INSURER D : GEHL AGGREGATE LIMIT APPLIES PER: ❑ POLICY 11 PR0. ❑ LOC 7966 W 30 LN INSURER E: HIALEAH, FL 33019 (786) 23 &3"1 AUTOMOBILE LIABILITY ❑ ANY AUTO ❑ AUTO ED ❑ AUTOS D NON-OWNED ❑ HIREDAUTOS ❑ AUTOS ❑ INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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. INSR LTR TYPE OF INSURANCE ADD IN UBR D POLICY NUMBER POLICY EFF MMIDD POLICY EXP M LIMITS A GENERAL LIABILITY Q COMMERCIAL GENERAL LIABILITY Y ❑ ❑ CLAIMS -MADE 0 OCCUR ❑ 0185FL00039378 09/23/2012 09/23/2013 EACH OCCURRENCE $ 1,000,000.00 DAMAGE TO RENTED PREEM SES JE, 0= 11=11 $ 100,000.00 MED EXP (Any one person $ 5,000.00 PERSONAL & ADV INJURY $ 1,000,000.00 ❑ GENERAL AGGREGATE $ 1,000,000.00 GEHL AGGREGATE LIMIT APPLIES PER: ❑ POLICY 11 PR0. ❑ LOC PRODUCTS - COMPIOPAGG $ 1,000,000.00 $ AUTOMOBILE LIABILITY ❑ ANY AUTO ❑ AUTO ED ❑ AUTOS D NON-OWNED ❑ HIREDAUTOS ❑ AUTOS ❑ COMBINED SINGLE LIMIT Ea accident BODILY INJURY (Per Person) $ BODILY INJURY (Per accdent) $ (Par., $ 1 $ ❑ UMBRELLA LIAB ❑ OCCUR ❑ EXCESS LIAR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ ❑ DED ❑ RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNERIEXECUT{VE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) El If yyes describe under DESG�Onc N OF OPERATIONS glow N I A ❑ WC STATU ❑ OTH- ER E.L. EACH ACCmENT $ E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, N more space is required) AIR CONDITIONING (INSTALLATION, REPAIR, SERVICE) CERTIFICATE HOLDER CANCELLATION ©1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) QF The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE MIAMI SHORES VILLAGE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. BUILDING DEPARTMENT 10050 NE 2ND AVE MIAMI SHORE, FL 33138 AUTHORU ED REPRESENTATIVE ©1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) QF The ACORD name and logo are registered marks of ACORD ( I r.i f !'U Ri'�, , 'y G.<< i (i n. ": !��• rii fAW. Pram aR CkwW 440 . 05114 F.S.. s &facer of a "M aids aass " km das > by fWas a cwdftm of dedws whr Gds secom my ad mmm bonft w comPONOW ssdor 05 CkNDW Prssstt to CkmpW 448.O5W F-SL, CadBcfts s1 decom hr be ems.- ON* G aDOE s 00 move d tie I or hsda nowd an do mom of *INS= to be eseMpt. Pram !s OmPter 44LOSM F.S., Nofta of obcdo to be eft ad ceaantams of sh"m to be a>mpt duo be mtb m m ocOn IL at asy ffm NOW go Uft ad 00 sow or dm fumm" a1 dw fbe Pmm nmsd m tbe- settee a COMM w tesger seeds am FoRoftmom of aft seeBat for Imem of a we dmu masks a ewdroaft r my tbm 1w hdbt o df an 1m d a do erg is am dw movemat d to allESTOW M 413 -1609 a=-Z2 COMMAIrE OF Eft M TO BE MOrF Dili M -11 This cortifies drat the Wd'WuW listed below has elected to be enmpt fmo Roddy Vftifws� COMWAWM levv .,mss,. � •'" ;�,i !�_� r- Ri Mi . ,4: 4� �" kT AIR COOLING INC Air Conditioning & Refrigeration Certified State Contractor 7966 West 30" Lane Hialeah Fl 33018 (786) 236 3440 (786) 236 3441 Fax (305) 8271042 Date : May 8, 2013 PROPOSAL- CONTRACT2013 -019 , Submitted to: Shannon Powell & Dasha Medvedyeva 78 NW 95 Street Miami Shores FI 33138 We hereby submit specifications and Estimates for: Replace existing central air conditioning remove old existing unit, evacuate refrigerant system, out copper lines, disconnect electricity and low volts, disconnect main duct supply existing to — remain, installed new condenser unit outside, new slab concrete if required unit upper concrete slab secured with tie down unit to base, solder copper lines with silver re connect electricity and low volts existing, air handler unit installed inside into closet designed for a1c, new metal stand air handler unit upper stand hook up main duct fiberglass supply air sealed with tape foil and mastic, new float switch protection to prevent water leaf new thermostat digital non programmable, solder copper lines with silver, re connect electricity and low volts, PVC drain line discharge water condensation, flush copper lines with dry nitrogen pressure to eliminate— humidity, evacuate nitrogen, make vacuum system, charge with new refrigerant R410A New equipment RHEEM, 16 SEED 3 Tons, condenser model 14AJM36A, air handler unit model RHLL HM3821JA 10 years warranty compressor and parts from manufacturer after registration I Year Labor warranty by installer Air Cooling Inc from defective parts. Cost for this installation is $3780.00 Less FPL Rebate Program - 585.00 Amount Due $ 3195.00 Plus Estimate Cost of Permit Process 200.00 Total Amount for complete job is $3395.00 Any alteration or deviation from the above speci6cations, involving additional costs, materials and or labor, will be executed only with approval by Owner, with written order and if there any charge for such alteration or deviation, additional charges shall be added to the price of this Proposal.All materials are guaranteed to be as specified All work to be completed in a workmanlike manner according to standard practices. This Proposal subject to acceptance within 30 days and it is void thereafter at the option of the undersigned Payments: P initial deposit in the sum of $ 2 395.00 to process permit, order equipment, and coordinate for commencement work 2"d payment final in the sum of $1000.00 in time of completion of thejob You agree that approval of work for installation and/or services that you have read in this Proposal, understand it, and agree by its terms and conditions specified in this document: Original Contract with all specifications and terms of payments will be issued after approval of this Proposal This price will be in effect for 30 days from date issued and is void thereafter. We are honor and thank you for the opportunity to offer this Proposal - Contract Accepted by 6 toe, 1 Signature Print Name II CFhi 2013RO417498 OR Sk 28648 Psis 0654 - 655; (2p9s) RECORDED 05/28/2013 09:59128 DEED DOC TAX 11416.00 HARVEY RUVIWt CLERK. OF COURT MIAMI-QADE COUNTYt FLORIDA Prepared By. Joseph A. Vecchio, Jr., P.A. Fl. Bar 158848 4613 N. University Dr. - # 588 Coral Springs, FL. 33067 PH: 954 510 7484 Record & Return To: Property folio number. 11 -3101- 034 -0080 Warranty Deed tin p� This Indenture, Made this 1� t0�� 1 , 2013 between MAR.IAY, LLC, a Florida Limited Liability Company, 1615 S. Ranison Street, Hollywood, Florida 33020, grantor*, and Shannon Powell and Darya Medvedyeva, Husband and Wife, whose address is: 78 NW 95s'. Street, Miami Shores, Miami -Dade County, Florida 33150, grantee *, "gnmtor" and "grantee" are used for singular or plural, as context requires WITNESSETH: That said grantor, for and in consideration of the sum of TEN ANY) No/100 Dou ARs ($10.00) and other valuable considerations to said grantor in hand paid by said grantee, the receipt whereof is hereby acknowledged, has granted, bargained and sold, to the said grantee, and grantee's hews and assigns forever, the following described land, situate, lying and being in MIAMI -DADS COUNTY, FLORIDA, wit: Lot 12 and the East One Half (1/2) of Lot 13, Block 167, PLAT OF SECTION NO. 6-A, according to the map or plat thereof as recorded In Plat Book 12, Page 54, Public Records of Miami -Dade County, Florida A/K/A 78 NW 95". Street, Miami Shores, Miami, Florida 33150 SUBJECT TO RESTRICTIONS, RESERVATIONS AND LIMITATION OF RECORD, IF ANY, AND TAXES FOR THE YEAR 2013 AND SUBSEQUENT YEARS. and said grantor does hereby fully warrant the title to said land, and will defend the same against the lawful claims of all persons whomsoever. Page One of Two Pages Book28648 /Page654 CFN #20130417498 Page 1 of 2 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): :4 $ f4 W c S S T 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 Attached: YES Z] NO ❑ Contract Attached: YES UNIT BEING REPLACED DATA NEW UNIT n ew MANUFACTURER EEM AHU or PKG. UNIT MODEL #<LL AIM 3x2.1 UNIT MODEL # TM 34+ �r5 KW W H K HEAT NOM TONS CA Ay 3 .rowgT AHU.f& CU yv PKG 1 M.C.A U -05 CLI30 PKG -� AHU Lo CU PKG 2 MAP AHU4o CU PKG -- AHU 0 CU 23q PKG 3 VOLTS AHU7.30CU OPKG .- PKG UNIT I l PKG UNIT -- EER/SEER L t iN YES NO REPLACING DUCTS YES 0 YES NO REPLACING THERMOSTAT p,( N0 NO YES NO NEW 4 °CONCRETE SLAB YES NO NEW ROOF STAND f,; YES NO NEW RETURN PLENUM BOX YES 1, Minimum Circuit Ampacity (Wire Size): �2 2. Maximum Overcurrent Protection (Fuse/Breaker Size): 15-6 3. Voltage of Circuit (2081240/480): tog 12Lfo 4. Size Disconnecting Means: 1 150 Contractor's Company Name: A'% t COOL t IQ Cr c . Phone• State Certificate or Registration N. CA-, C 1 cA I �-LPk Certificate of Competency N. • --- Signature (&a� (ou s s e only) Date: r Miami shores Village Building Department CONTRACTORS' REGISTRATION 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 ALL CONTRACTORS MUST PROVIDE COPIES OF LICENCES AND INSURANCES EACH TIME A PERMIT IS SUBMITTED. IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. V" COPY OF QUALIFIER'S STATE LICENCES B. y-' COPY OF LOCAL BUSINESS TAX RECEIPT C. V-' COPY OF LIABILITY INSURANCE (CERTIFICATE HOLDER TO BE MIAMI SHORES VILLAGE BLDG DEPT) D. V' COPY OF WORKERS COMPENSATION JE1THER CERTIFICATE OR EXCEMPTION) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER B. COPY OF LOCAL BUSINESS TAX RECEIPT 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 WORKERS 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 33138 COMPLETE CONTRACTOR'S INFORMATION BUSINESS NAME: elo d /, .17 IG e- BUSINESS ADDRESS: -7 g G & (iii 3 D CITY f« 4 STATE -q5Z ZIP CODE '33 0! S BUSINESS PHONE: () 2�SrS�� FAX NUMBER( o-�) CELL PHONE ) ?-3(- 3 S/,V O QUALIFIER'S NAME: Ja Sc 1 • A`le H o QUALIFIER'S LIC NUMBER: Cie API/5-F29 E -MAIL ADDRESS (IF AP ►IJSC'�GGIS QG/Gdl� `l !2 It f > Created on 3119109 BY MLDV 1 RV 3126109 MLDV I RV 6127111 AS This combination qualifies for a Federal Energy Efficiency Tax Credit when placed in service between Feb 17, 2009 and Dec 31, 2013. AHRI Certified Reference Number: 3805983 Date: 5/2212013 Product: Split System: Air -Cooled Condensing Unit, Coil with Blower Outdoor Unit Model Number:14AJM36 Indoor Unit Model Number: RHLL- HM3821 +RCSL- H*3821 Manufacturer: RHEEM MANUFACTURING COMPANY Trade /Brand name: RHEEM 14AJM SERIES Manufacturer responsible for the rating of this system combination Is RHEEM MANUFACTURING COMPANY 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): 37600 EER Rating (Cooling): 13.00 SEER Rating (Cooling): 16.00 * Ratings followed by an asterisk ( *) Indicate a voluntary rerate of previously published data, unless accompanied with a WAS, which Indicates an involuntary rerate. 02013 Air- Conditioning, Heating, and Refrigeration Institute CERTIFICATE NO.: 130137337619891110