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MC-13-0256Inspection Worksheet Miami Shores Village �. 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 .3 -� Inspection Number: INSP- 185526 Permit Number: MC -2 -13 -256 Scheduled Inspection Date: September 16, 2013 Permit Type: Mechanical - Commercial Inspector: Perez, JanPierre Owner: INC, PUBLIX SUPERMARKETS, Job Address: 9050 BISCAYNE Boulevard Miami Shores, FL 33138- Project: <NONE> Contractor: A&P AIR CONDITIONING CORP Building Department Comments Inspection Type: Final Work Classification: Addition /Alteration Phone Number (863)688 -747_ Parcel Number 1132060100010 Phone: 305 -556 -7849 FURNISH AND INSTALL NEW AIR CONDITIONING UNIT, Infractlo Passed Comments DUCTWORK, EXHAUST FANS INSPECTOR COMMENTS False V September 13, 2013 For Inspections please call: (305)762 -4949 Page 6 of 38 Inspector Comments Passed Failed Correction Needed ❑ Re- Inspection ❑ Fee No Additional Inspections can be scheduled until re- inspection fee is paid. September 13, 2013 For Inspections please call: (305)762 -4949 Page 6 of 38 .ry I F ,a s >,_ ` � l U;,ga wi IRS VATOq $TOgE 4► .ry I F ,a s >,_ ` � l W 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 Permit Type: MECHANICAL FEB 08 2013 X FBC�20'�t�O Permit No. 1 I l c Master Permit No. U, I Z — 19 7.--, JOB ADDRESS: 9050 Biscayne Blvd City: Miami Shores County: Miami Dade Zip: 33138 Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple Titleholder): ?441ee f.®er 147arAdb Dne- Phone#: t q®- Off - / ® *f Address: r CI 13aX '* VO 7 City: t-,Wt Iowa State: R Zip: 33 tot Tenant/Lessee Name: Email: CONTRACTOR: Company Name: A & P Air Conditioning, Corp. phone#: (305) 556 -7849 Address: 2322 West 78th Street City: Hialeah State: Florida Zip: 33016 Qualifier Name: Adrian F. Gonzalez Phone#: (305) 556 -7849 ext.14 State Certification or Registration #: CAC058427 Certificate of Competency #: Contact Phone#: (305) 556 -7849 Email Address: info @apairconditioning.com DESIGNER: Architect/Engineer: Value of Work for this permit: $ 43,900.00 Square/Linear Footage of Work: Type of Work: DAddress DAlteration ONew ORepair/Replace ❑Demolition Description of Work: Submittal Fee Scanning Fee $ Furnish and install new air conditioning unit, sheetmetal ductwork, and exhaust fans Permit Fee $ I t I CCF $ CO /CC $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ Technology Fee $ TOTAL FEE NOW DUE $ a E - K A� IIII 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 absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature qN -__J Owner or Agent The foregoing instrument was acknowledged before me thi day o , 20 -, by � ' � ° f)CCfl Y rJ �, who i rs ally known% me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sim]( Signature Contractor The foregoing instrument was acknowledged before me this 29th day of January , 20 IL, by Adrian F. Gonzalez , �� y P4eli My Commission Expires:,,),-,5-1,6 .� •. MI L SLOM MY COMM ISSION# EE 056818 �d, Oov EXPIRES: February 5, 2015 0, Bated Tin Budget *tn j;;, n APPROVED BY who is personally own to me or who has produced identificatio4,and who did take an oath. ar r%. / Print: My Commission Plans Examiner Zoning Structural Review Clerk Revised 3 /12/2012)(Revised 07 /10 /07)(Revised 000 /2009)(Revised 3/15/09) Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION FORM ALL CONTRACTORS MUST PROVIDE COPIES OF LICENCES AND INSURANCES EACH TIME A PERMIT IS SUBMITTED OR THE VILLAGE MAY MAINTAIN A FILE WITH YOUR INFORMATION FOR A $30.00 FEE PER YEAR. IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. %/ COPY OF QUALIFIER'S STATE LIC CARD B. vl' COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF LIABILITY INSURANCE (CERTIFICATE HOLDER TO BE MIAMI SHORES VILLAGE BLDG DEPT) D. COPY OF WORKERS COMPENSATION (EITHER CERTIFICATE OR EXEMPTION) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER 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 WORKER 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: A & P Air Conditioning, Corp. BUSINESS ADDRESS: 2322 West 78th Street CITY Hialeah STATE Florida ZIP CODE 33016 BUSINESS PHONE: ( 05 ) 556 -7849 FAX NUMBER f 305) 556 -8186 CELL PHONE ( 786) 255 -0655 QUALIFIER'S NAME: Adrian F. Gonzalez QUALIFIER'S LIC NUMBER: CAC058427 E -MAIL ADDRESS (IF APPLICABLE): info @apairconditioning.com Created on 3119109 BY MLDV I RV 3126109 MLDV 062.51938.. j :. 'DZtiP STATE OF FLQRIDA Z`btENT OF -,-:H *,IIS.INESS AND PROFESSIONAL `AEGVLATION :`GONSTRJCT1ON :2NDt7STRY LICENSING HOARD SEQ# L12080701625 - LICENSE NBR° ' ty pP Elq�� ENVIRONMENTALLY ALLY FRIENDLY INKS City of Hialeah 2012-13 FSC Business Tax Receipt Mayor Carlos Hernandez �`4y BF N1gtF9� City of Hialeah FSC Business Tax Receipt AL EN�n VnM Mayor Carlos Hernandez x: FRIENDLY INKS A C TI F I T F LI I LITY I DATE (MM/DDIYYYI� 6/8/2012 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 °''Y`IQRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. r4'ORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(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 CONTAE: CT Laura Suratt NAM Frank H. Furman, Inc. PHONE (954) 943 -5050 No): (954) 942 -6310 1314 East Atlantic Blvd. E'L ADDRESS: !aura @£urmaninsurance.com P. 0. Box 1927 INSURERS AFFORDING COVERAGE NAIC # Pompano Beach FL 33061 suettoco A .ri -r-c+- Arna*ni n1 f-v True rnTIn hAQ1 A INSURED INSURER B - Travelers Property Casualty Co A & P Air Conditioning Corp INsuRERCAmerican Guarantee & Liability 2322 West 78th Street 1TdQ1[Oro n. Hialeah FL 33016 ( INSURER F • I I COVERAGES CERTIFICATE NI]MRt R-2012 -13 GL /AU /UMB RFVLSIAN NI]MRER! 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 1 R Miami Shores Village POLICY NUMBER POLICY EFF MMIDDIYYYY POLICY EXP MM/ODNM LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE n OCCUR X Per Project AGG $5M Frank Furman, Jr /LS tRG152112 /23/2012 /23/2013 EACH OCCURRENCE $ 1,000,000 PREMISES tEa occurrence) $ 50,000 MED EXP (Any one ) $ EXCLUDED PERSONAL & ADV INJURY $ 1,000,000 X Prior Written Contract GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: 1 POLICY X PRO LOC JECT PRODUCTS - COMP/OP AGG $ 2,000,000 $ 'AUTOMOBILE LIABILITY I] X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON-OWNED FX HIRED AUTOS X BA3953R45A 6/23/2012 /23/2013 Ea acccidennt L 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ $ L-. X UMBRELLA LIAB EXCESS UAS X OCCUR CLAIMS -MADE UC- 5472095 -00 6/23/2012 /23/2013 EACH OCCURRENCE $ 3,000,000 AGGREGATE $ 3,000,000 DED I X RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR /PARTNER /EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ (Mandatory In NH) yes DESCRIPTION under RIPTION OF OPERATIONS below NIA I WC STATU- OTH- TORIMMITS ER E.L. EACH ACCIDENT $ E.L. EDISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT I $ DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) CERTIFICATE HOLDER CANCELLATION ACORD 26 (2010/05) ©1988 -2010 ACORD CORPORATION. All rights reserved. INRn25r7niramni Tho An non name and Inn^ arc rarvl*+crnA marLc of Armin l SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Shores Village ACCORDANCE WITH THE POLICY PROVISIONS. 10050 Northeast 2nd Avenue AUTHORIZED REPRESENTATIVE Miami Shores, FL 33138 Frank Furman, Jr /LS ACORD 26 (2010/05) ©1988 -2010 ACORD CORPORATION. All rights reserved. INRn25r7niramni Tho An non name and Inn^ arc rarvl*+crnA marLc of Armin l A &PAIRC -01 MATERAT ,a►coRVm CERTIFICATE OF LIABILITY INSURANCE `.•�"'F DATE 12 /2 812 0 1 YY) 12/28/2012 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 policy(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 Insurance Office of America, Inc. P.O. Box 162207 Altamonte Springs, FL 32716 -2207 CONTACT NAME: PHONE FAX A/c No 800) 243 -6899 A/C No): (407) 788 -7933 EL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC 4 INSURER A: Insurance Company of the West 27847 PREMISES Ea occurrence INSURED INSURER 6: $ INSURER C: $ A &P Air Conditioning Corp. INSURER D: GENERAL AGGREGATE 2322 W. 78th Street Hialeah, FL 33016 INSURER E: $ 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. ILTR TYPE OF INSURANCE DL yWVO POLICY NUMBER POLICY MID EFF POLICY EXP M/D LIMITS Miami Shores Village 10050 NE 2nd Avenue+ GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 1-1 OCCUR Mlaml Shores FL 33138 EACH OCCURRENCE $ PREMISES Ea occurrence $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEML AGGREGATE LIMIT APPLIES PER: POLICY PRO- LOC PRODUCTS - COMP /OP AGG $ $ AUTOMOBILE LUM31UTY ANY AUTO ALL OWNED SCHEDULED AUTOS NON-OWNED HIRED AUTOS AUTOS COMBINED ISINGLE LIMIT $ BODILY INJURY (Per person) $ BODILY INJURY (Per acddent) $ PROPERTY DAMAGE PER ACCIDENT) $ UMBRELLA LIAB EXCESS LIAR HCLAIMS-MADE OCCUR EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVEYIN OFFICER/MEMBER EXCLUDED? FNI (Mandatory In NH) under DESCRIP�I I N OF OPERATIONS below NIA WFL500093604 1/1/2013 111/2014 X WC STATU- OTH- TORY LIMITS ER- E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) CERTIFICATE HOLDER CANCELLATION ACORD 25 (2010105) ©1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Miami Shores Village 10050 NE 2nd Avenue+ Mlaml Shores FL 33138 ACORD 25 (2010105) ©1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD one- FEB OIL 2013 -- - . 18.0 22.0 40.0 r 8.0 L =15 CL =26.9 2.75 i c 5 =00 PL =15.3 nNSUL 8742 PL =20.7 PL =7.7 PL =27.5 PIPE & CONDUIT BY ANSUL DISTRIBUTOR 80.0 MARK: GH -2 HOOD - SECTION 1 PLAN VIEW 18.1 30.5 31.4 - PL =1.5 F 9 PL =1.5 'dam O Q 1N J 1 FP a a 11FP 11FP 6.0 #-•- -1 12.0 f-- f--26.0 MARK: GH -2 HOOD - SECTION 1 ELEVATION VIEW 3.313 %g 2.0 L =1.5 24.0 a L F� -54.0 �i PROPRIETARY D DRNATM NOTICE, THIS DOCUMENT IS AND CONTAINS CONFIDENTIAL TRADE SECRET WORMATD]N OF THE COMPANY AND REMADyS THE PROPERTY OF THE COMPANY AND IS TO BE RETURNED UPON REBUEST. NEITHER IT NOR THE INFMtt4ATMN IT CONTAINS MAY BE REPRODUCED OR DISCLOSED TO PERSONS NOT HAVING A NEED —TO —KNOW CONSISTENT WITH THE PURPOSE OF LOAN OF THE DOCUMENT WITHOUT WRITTEN PERNISSIER r Rnn rn -C IA MUM, 7E MG, AND CERMF1CAAT= OF SYSTEM 5 -PMMO AND NOISES FROM FACTORY srUeoMTs -MOOT f APPLIANCE DROPS !F SHELVES OR WAMANOM ON ILE SYSM THE APPLIANCE WERFERE WRH NOME DMCHAIME. I PONTS ,SUPPLY RPMO BETWEEN MULTME HOODS. 9 1OORDMAM WITH HOOD MSTALLER FOR PTWPER Sales Order Number. SO# - Urr# I I ZZ1400793 I I I INSTRUCTIONAL I G REENHECK UL 300 FIRE PROTECTION SYSTEM DP27217 ZZ1400793 xx MARK: GH -2 HOOD - SECTION 1 ELEVATION VIEW 3.313 %g 2.0 L =1.5 24.0 a L F� -54.0 �i PROPRIETARY D DRNATM NOTICE, THIS DOCUMENT IS AND CONTAINS CONFIDENTIAL TRADE SECRET WORMATD]N OF THE COMPANY AND REMADyS THE PROPERTY OF THE COMPANY AND IS TO BE RETURNED UPON REBUEST. NEITHER IT NOR THE INFMtt4ATMN IT CONTAINS MAY BE REPRODUCED OR DISCLOSED TO PERSONS NOT HAVING A NEED —TO —KNOW CONSISTENT WITH THE PURPOSE OF LOAN OF THE DOCUMENT WITHOUT WRITTEN PERNISSIER r Rnn rn -C IA MUM, 7E MG, AND CERMF1CAAT= OF SYSTEM 5 -PMMO AND NOISES FROM FACTORY srUeoMTs -MOOT f APPLIANCE DROPS !F SHELVES OR WAMANOM ON ILE SYSM THE APPLIANCE WERFERE WRH NOME DMCHAIME. I PONTS ,SUPPLY RPMO BETWEEN MULTME HOODS. 9 1OORDMAM WITH HOOD MSTALLER FOR PTWPER Sales Order Number. SO# - Urr# I I ZZ1400793 I I I INSTRUCTIONAL I G REENHECK UL 300 FIRE PROTECTION SYSTEM DP27217 ZZ1400793 o s fell$ $aka �� moo rT C Sa $OCR t s as a Y ' fill a9 �� i t b .1 m b o LJ b o b N � �E h b s b o - -- b er L g� � fill E� 9 fill1 CA xx lip ;Olqk. 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V DORDIKATION OF -GAS VALVE HOOKUP TO RELEASE MECHANISM CONTRACTOR `VEISFY OAS VALVE SIZE AND TYPE WITH JOBSiE CONTACT Flow 5 - REMOTE PULL VILA ON HOOKUP RELEASE MECHANISM. -CHARGING, TESTING. A CERTIFICATION OF SYSTEM. ND -PIPING AND NOZZLES FROM FACTORY SRIBOUTS A__ SVST - MODIFY APPLIANCE DROPS IF SHELVES OR SALAMANDERS ON THE APPLIANCE INTERFERE WITH NOZZLE D�HAME. 5 .SUPPLY PIPING BETWEEN MULTIPLE HOODS ODORDINATE WITH HOOD INSTALLER FOR PROPER ORIENTATION OF MULTIPLE HOODS. Job Name: PUBLIX #794, MIAMI SHORES, FL Sales Order Number. SO# - LUIe# I I ZZ1400793 I I I INSTRUCTIONAL I GREENHECK UL 300 FIRE PROTECTION SYSTEM DP27217 ZZ1400793 to �s gig a $ g@ ¢p g y > g N g egg a o x o ire, fill4 0 0� 0 0 0 JOHN 11,210 I O o :mew, = O r =s a 13 �g if is cnzm � �< � n $a INS, S #� � t D. fit � v 'dim .211.1 .9 rar�da a 7 8