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MC-13-2838Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 204807 Permit Number: MC -12 -13 -2838 Scheduled Inspection Date: February 10, 2014 Inspector: Perez, JanPierre Owner: MYERS, KEITH Job Address: 9022 NE 8 Avenue 3N Miami Shores, FL Project: <NONE> Contractor: STAR AIR CONDITIONING CORP Permit Type: Mechanical - Residential Inspection Type: Final Work Classification: A/C Replacement Phone Number Parcel Number 1132060420540 Phone: (305)969 -1090 guuamg vepartment comments EXACT REPLACEMENT OF 2 TON UNIT Infractio Passed Comments INSPECTOR COMMENTS False February 07, 2014 For Inspections please call: (305)762 -4949 Page 11 of 44 Inspector Comments Passed Failed Correction Needed ❑ Re- Inspection ❑ Fee No Additional Inspections can be scheduled until re- inspection fee is paid. February 07, 2014 For Inspections please call: (305)762 -4949 Page 11 of 44 I 1 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fag: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION FBC 20 bo Permit No. G Master Permit No. �`✓i 3 ` f—O Permit Type: WC. HA�N�ICAL. (1 L JOB ADDRESS: 0 ,F— S � J� g City: Miami Shores County: Miami Dade Zip: �� 3 Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple Titlehol er): L Ip Address: �� \v � t \)Q, City: M I —OA ,1 ��kz—s State: U Zip: TenanVl,essee Name: Phone#: Email: CONTRACTOR. Company Name: Ak N b V aq Phone#: q pQ (6 q o Address: I.`V SW �9 City: \ ���� ttate: Zi 1 Qualifier N. Q- 6Z Phone#:3 n r�-nD State Certification Registration # m c� Certificate of Competency_ #: Contact Phone #: -3 - i5 Email Address: DESIGNER Architect/Engineer: N A Phone#: Value of Work for this Permit: $ 3 00 ` (" Square/Linear Footage of Work: Type of Work: UAddr((e��ss !]Alteration ONew .gRepair/Replace a ODemolition Description of Work: It2 A, CQ— Gf" C a to t o N \ VS N \ o� `sic c-NA T Submittal Fee $ Permit Fee $ 6 v� Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ CCF $ CO /CC $ DBPR $ Bond $ _ Technology Fee $ TOTAL FEE NOW DUE $ R� 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 EMPROVEMENTS 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 e Signature Signature Owner or Agent The foregoing instrument was acknowledged before me this day of DQC ,20L�_,by Y\-Q- t 1 �\ o is nally known to me r who has produced As identification and who did take an oath. NOTARY PUBLIC: Contractor The foregoing instrument was acknowledged before me this day of 1-9— C , 20-P, by L who is personally known me or who has pro aced as identification and who did take an oath. NOTARY PUBLIC: Sign: Sign:` HA ft2va Print: Print: P My Commission Ex� EXPIRES: July 19, 2014 My Commissi * * EXPIRES: Jury 19, 2014 r�t,00° ftdWTlsuSud�NoieyS s ~ OF FU ltormra too N" SWAM APPROVED BY !/ ® Plans Examiner Zoning Structural Review Revised 3/11J MXRmised 07 /10/07XRevised 06110/2009XRvAsed 3/15/09) Clerk V 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. y� I Job Address (where the work is being done): City: Miami Shores Village County: Miami Dade Zip Code: 3 g 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 mans: YES ❑ NO R] ARHI Sheet Attached: YES ❑ NO Pfl Contract Attached: YES ❑ UNIT BEING REPLACED DATA NEW UNIT MANUFACTURER V AHU or PKG. UNIT MODEL # Ev 1A InIg-1-1 COND. UNIT MODEL # KW HEAT NOM TONS Z.vo AHU CU PKG 1 M.CA AHU CU PKG AHU CU PKG 2 M.O.P AHU CU PKG AHU CU PKG 3 VOLTS AHU CU PKG PKG UNIT / / PKG UNIT 1 / EER/SEER YES NO REPLACING DUCTS YES NO YES NO REPLACING THERMOSTAT YES NO YES NO NEW 4 °CONCRETE SLAB YES NO YES NO NEW ROOF STAND YES NO YES NO NEW RETURN PLENUM BOX YES NO 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: s� N N �\ C C-a k P Phone: State Certificate or Registration NCJ S I`i\6d0 i 22 Certificate of Competency N. Signature Date: _ (Quamees signature only) 0 \ e CLASS AAIR CON I.TIQMN C0NTRA'%0F'5`� 'med below HAS RE G STEREDy `�� °.'� 4 ■ ❑ . der the provisions of hapter 489 ES — piration date /AU1G. , -2r, w '.• � F'Ni4^t^d ��� F PLASENCIA,:B B-10 ` STAR iAIR -ON—D UTG� 12045.SV T w ��" ` `` ,``w`-' J .. MIAMIy fr VIVA ROR10A500. s . RICK SCOTT ISSUED- Q ; / Q�� ,S� f a3Q7� !}OODQBG =,� A� ; E KEN LAWSG?N x< GOVERNOR bISPLAYAS;REQIJIRED:B SECRETARY n,�. 3rf:'f �.+�ESC. ? .€ A ,a' =d S' •:�',ef� Fr t .r �'RK '� f t i bh r' ° n r e s *, x t'� Olt- a¢1.Ft F '•c. m7S^^ a r �yq,dyh `mc � � w �,� i � s. � "x ,p 4.z �,• a .�`. � loo 1 'Ii sYr i ? ` ku r iN -k ' a ft. n i CERTIFICATE OF LIABILITY INSURANCE 121171 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: Mthe certificate holder Is an ADDITIONAL INSURED, the poficy(les) must be endorsed. H 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 Hsu of such endorsement(s). PRODUCER Eguino & Associates 7229 Coral Way Miami, FL 33155 Phone (305) 266-1700 Fax (305) 267 -1197 CONTACT MARITdA INCLAN 305) 266 -1700 No l. 305) 267 -1197 ADDRESS@ Mindan@egWno.com INSURER(S)AFFORDING COVERAGE NAIC S INSUNR A : CYPRESS PROPERTY & CASUALTY Y INSURED Star Air Conditioning, Corporhldlon 12045 SW 185 Terr Miami, FL 33177- (305) 9691090 INSURER 13: BUSINESSFIRST INSURANCE CO. 09112!2013 INSURER C : EACH OCCURRENCE INSURER O' DAMAGE O RENTED PREMI E5 occunence INSURER E: MED EXP (Any one person INSURER F -PERSONAL &ADVINJURY 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. MR TYPE OF INSURANCE ADD BR POLICY NUMBER LICY �F POLICY EXP LlMIT8 A SAL LIABI I Y Q COMMERCIAL GENERAL LIABILITY ❑ ❑ CLAIMS -MADE 0 OCCUR ❑ Y GFL10026990281 09112!2013 09!1212014 EACH OCCURRENCE $ 1,000,000.00 DAMAGE O RENTED PREMI E5 occunence $ 100,000•00 MED EXP (Any one person $ 5,000.00 -PERSONAL &ADVINJURY $ 1,000,000,00 ❑ GENERAL AGGREGATE $ 1,000,000.00 GENL AGGREGATE LIMIT APPLIES PER: 0 POLICY ❑ PRO- ❑ LOC PRODUCTS - COMPIOP AGG $ 1,000,000.00 $ AUTOMOBILE LIA131U7Y ❑ ANY AUTO ❑ �OOWNED ❑ SCHEDULED ❑ WREDAUTOS ❑ NON-OWNED AT ❑ ❑ e eBIN� INGLE LIMIT $ BODILY INJURY (Per person) $ BODILY INJURY (Per acdderM $ PROPERTY DAMAGE Peen $ $ ❑ UMBRELLA LIAB ❑ OCCUR ❑ EXCESS LIAO ❑ CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ ❑ DEO RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? (Menddwy In NH) fl desalt under DESCRIPTION OF OPERATIONS below NIA 0521 -07540-0 08!30/2013 08!30/2014 WC STATU OTH 1:1 ER E.L. EACH ACCIDENT $ 100,000.00 E.L. DISEASE - EA EMPLOYE $ 100,000,00 E.L. DISEASE - POLICY LIMIT $ 5 ,000.00 N DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES lAtte h ACORD 101, AddMonal Remarks Schedule, If more apace Is required) AC INSTALL SERVICING & REPAIR CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE MIAMI SHORES VILLAGE BUILDING DEPARTMENT THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 10050 NE 2ND AVE ACCORDANCE WITH THE POLICY PROVISIONS. MIAMI SHORES, FL 33138 1 AUTHORUD REPRESENTATIVE FAX-305-756-8972 ACORD 26 (2010/06) OF Id'0;11Ah1 ;j:1V#d ©1988-2010 ACORD CORPORATION. AU rights reserved. The ACORD name and logo are registered marks of ACORD 10M, T a wa• JEFF ATwATER STATE OF FLORIDA CHIEF FINANCIAL OFFICER.., DEPARTMENT OF FINANCIAL. SERVICES.'. . M'9 OE'. ti CCU P NSAYION w d- cr f `,. n +. •f}i rsxti 5 L t.k n8t g q EitS'?OMPEIVSATIOIy W *'.., *'CERTIFICAT•E OF KEC1' I� C _ 7, , 4<, ,,r,,. t,. ,r f ,•; CONSTRUCTION INDUSTRY EXEMPTION - This certifies that the individual listed below has elected to ba exempt from :Florida Workers' Compensation law EFFECTIVE DATE: 8/3/2013 EXPIRATION' DATE:. .0/2016 PERSON: 'PLASENCiA gELGRABE FEIN: 262820009, BUSINESS NAME AND ADDRESS* STAR AIR. CONDITIONING -CORD 12045 SW 185 TERR MIAMI FL 33177 SCOPES OF BUSINESS OR TRADE': HEATING, VENTILATION, Alfa -COND •. r'4 � N o fitifi a certificate of election under this section may Pursuant to Chapter 440 05(14) F S an officer of a corpoiatto ' 8 exemption fiont p : Ujl !I rdfl note bus ness efits or Listed on the notice ofielectlon to be exempt Pursuant o Chept ri. 0 (e1 , FtS$ Notices ofeledtion to,bpa exempt and certificates cates scope of th election ccaato no longer meets the requirements is of. thus section for time issuance r a filing of o a certlfl� nf e• :Ths epartment shell revoke a certificate at any time for failure of the ce e certificate 9 section. person named on the certificate to meet the requirements of this QUESTIONS? 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