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MC-14-811A, Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL (:L L Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 211176 Permit Number: MC- 4- 14-811 Scheduled Inspection Date: April 30, 2014 Permit Type: Mechanical - Residential Inspector: Perez, JanPlerre Owner: AJAMI, KAMRAM Job Address: 171 NE 102 Street Miami Shores, FL 33138- Project: <NONE> Contractor: A TECH SERVICES INC Inspection Type. Final Work Classification: A/C Replacement Phone Number Parcel Number 1132060131840 Building Department Comments ANA �— �� _ � 2 1S HVAC REPLACEMENT 4 TONS INSPECTOR COMMENTS False L, L:-f �. � Q, S i vit- & - v c"*-J FL AroL Inspector Comments Passed s Failed Correction Needed ❑ Re- Inspection ❑ Fee No Additional Inspections can be scheduled until re- inspection fee is paid. April 29, 2014 For Inspections please call: (305)762 -4949 Page 77 of 28 � 8S 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 PERMIT APPLICATION APR 2.2 2014 FBC 20 Permit No. Master Permit No. Permit Type: MECHANICAL JOB ADDRESS: Ed N;F 1 0 Z- <;;T City: Miami Shores County: Miami Dade Zip: 3r3 i 3"y Folio/Parcel #: Is the Building Historically Designated: Yes OWNER: Name (Fee Simple Titleholder):— Address: 3®120 N VJ 4 S0'D S NO Flood Zone: City: Go w rw i CeZe k— State• lr� Zip: 3-3 08 3 Tenant/Lessee Name: Phonek Email: CONTRACTOR: Company Name: A !SeNo C'E�, ANC - Phone#: 5W q1S 37,00 Address: _051 N . 61e 3� o Pr. t. AQ_VeatA1r= 3 _33 0q City: �QQT - -JDE-rM 1E State: FL Zip: Qualifier Name: I UM TD t-A �A i 60r) Phone #• _ State Certification opReaistration #: C-A_C Contact Phone #: DESIGNER: Architect/Engineer. CI Z `7 N/4 -1 Z I Certificate of Competency #: ail Address:. AIUC44 6OLV 9 -ES Value of Work for this Permit: $ A, q-13. D'® Square/Linear Footage k: ototage of Work Type of Work: OAddress OAlteration ONew L` 9Repair/Replace Description of Work: Submittal Fee $ Permit Fee $ Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ ODemolition CCF $ CO /CC $ DBPR $ Bond Technology Fee $ TOTAL FEE NOW DUE $ 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 w Signature Signature Owner Agent Contractor The foregomi instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of 4rl .20 1b by F C"D f—, to U t° day of ��' n , 20 a �I, by l�+r who is personally known to me or who has produced who is personally known tome or who has produced As identification and who did take an oath. tcV4 ir c as identification and who did take an oath. NOTARY PUBLIC: . NOTARY PUBLIC: ERISEBET DR NOLL mm - `2O1pttY At/��+ LETICIA VELAZCUEZ Notary Public -State of Florida `� tA Si `off; My Comm. Expires May 18, 2014 �f MY COMMISSION #FF006483 Si "' EXPIRES April 9.2017 d FlorldallotarySen4m.com Print: L� 6c-- Print My Commission Expires: S— `"� I4 My Commission Expires: Y _ q — ®f APPROVED BY v Plans Examiner Zoning Structural Review Clerk Revised 3 /12/2012XRevised 07 /10 /07XRevised 06 /10/2009XRwAsed 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 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): 1-1 1 W F, Io 2�'1�' 6T 9—TI: E 7- City: Miami Shores Village County: Miami Dade Zip Code: 33 I'5 8 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 X1 NO ❑ Contract Attached: YES Z UNIT BEING REPLACED DATA NEW UNIT MANUFACTURER -T SMPsrA. OL AHU or PKG. UNIT MODEL # FXM4XAS COND. UNIT MODEL # Nx A (A % 64g. A KW HEAT fa NOM TONS AHU CU PKG 1 ) M.C.A AHU CU 24.1 PKG AHU CU PKG 2 M.O.P AHU CU PKG AHU CU PKG 3 VOLTS AHU2_�o CUB PKG PKG UNIT / / PKG UNIT EER/SEER 1 YES NO REPLACING DUCTS YES YES NO REPLACING THERMOSTAT lcng YES NO NEW 4 "CONCRETE SLAB YES NO YES NO NEW ROOF STAND YES 0 YES NO NEW RETURN PLENUM BOX YES 1. Minimum Circuit Ampacity (Wire Size): 2. Maximum Overcurrent Protection (Fuse/Breaker Size): H H u W P. q 3. Voltage of Circuit (208/240/480): 240 4. Size Disconnecting Means: Contractor's Company Name: x)o Y®NA U r) 60n -1 4 State Certificate or Registration N. e f"-- Z 0 Certificate of Competency N. Signature (Qualifier's signature only) Date: 04 1 2014- (S Al A -Tech Services Inc 1451 West Cypress Creek Rd. Suite 300 Fort Lauderdale, FL 33309 561988-3200 Bill To: Kamran Ajami 171 NE 102nd St Miami Shores, FL 33138 1 Invoice No: Date: Terms: Due Date: ............................... ...................... Subtotal $1.973.00 (0.00 %) $0.00 Total $1,973.00 Paid $0.00 Balance Due $1,973.00 A +ham (S Al A -Tech Services Inc 1451 West Cypress Creek Rd. Suite 300 Fort Lauderdale, FL 33309 561988-3200 Bill To: Kamran Ajami 171 NE 102nd St Miami Shores, FL 33138 1 Invoice No: Date: Terms: Due Date: 4 April 14, 2014 NET 30 May 14, 2014 New Mon Tempstar unit 16seer high efficiency system with new 410a refrigerant installed. _ � 1 $2.753.00 v $2.753.00 10years compressor manufacture warranty (100% guarantee labor for 1 year) FPL Rebate 1 - $780.00 $780.00 " indicates non - taxable item ..................................... ............................... ............................... ...................... Subtotal $1.973.00 (0.00 %) $0.00 Total $1,973.00 Paid $0.00 Balance Due $1,973.00 A 4 April 14, 2014 NET 30 May 14, 2014 New Mon Tempstar unit 16seer high efficiency system with new 410a refrigerant installed. _ � 1 $2.753.00 v $2.753.00 10years compressor manufacture warranty (100% guarantee labor for 1 year) FPL Rebate 1 - $780.00 $780.00 " indicates non - taxable item ..................................... ............................... ............................... ...................... Subtotal $1.973.00 (0.00 %) $0.00 Total $1,973.00 Paid $0.00 Balance Due $1,973.00 flit f; AHRI Certified Reference Number: 4054671 Date: 7/10/2013 Product: Split System: Air - Cooker Condensing Unit, Coil with Blower Outdoor Unit Model Number: NXAS48GKW Indoor Unit Model Number: FXM4X48**A* Manufacturer: TEMPSTAR Trade/Brand name: l6 SEER N SERIES R41 DA AC Manufacturer responsible for the rating of this system combination Is TEMPSTAR Rated as follows in accordance with AHRI Standard 210P240 -2008 for Unitary Air- Conditioning and Air- Source P rah► Pump gng Equipment and subject to verification of rating accuracy by AHRI - sponsored, Independent, third Cooling Capacity (Btuh): 46000 EER Rating (Cooling): 13.00 SEER Rating (Cooling): 16.00 • Ratings followed by an asWM V) Indicate a voluntary rests of previously published data, unless accompanied with a WAS, which indicates an involuntary rerate. DISCLAIMER AHRI does not endorse the product(s) iced on this CwUfk fie and mattes no represarft#oM warrantles "guarantees as to, and assumes no responsibility tor, the product(s) untied on this Cwdflcate. AHRI expressly dschdfns an liability for damages of any kind arising out of the use or peribmance of the producks), "the unauthorized alteration of data listed of this Certificate. Certilled rellhngs are valid only for models and conflguratlons listed In the directory at www.alirldirectouy.org. TERMS AND CONDITIONS This Certificate and Its contents are proprietary products of AHRI. This Certificate shall only be used for I ndhrkfuai, personal and corifldentlal reference purposes. The contents of time Certificate may not, In whole or In part, be reproduced; copy; disseminated; entered kdo a computer database; or otherwise utinZed, In any form or manner or by any means, except for the user's individual, personal and confidential reference. CERTIFICATE VERIFICATION l� The Information for the model cited on this certificate can be verified atw o, ,ott .,,rg, J i Air- Conditioning, Heating, click on "Verify cerdficzie" link anti enterthe AM Certified Reference Number and the daft on - IMP 11M and Refrigeration Institute which the certificate was Issued, which Is listed above, and the Certificate No., which Is listed below. 02013 Air- Conditioning, Heating, and Refrigeration Institute CERTIFICATE NO.: 130179596650344065 cc�►RI CERTIFICATE OF LIABILITY INSURANCE �(W21/20PRIM01ft"M 14 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO MON73 UPON THE CERTIFICATE HOLDER. THE CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, E)CMND OR ALTER THE COVERAGE AFFORDED 13Y THE POLICIES. BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A. CONTRACT BETWEEN THE ISSUING INSURER(ft. AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER IMPORTANT, If the certificate holder Is an ADDITIOW INSURED, the policy([* must be endorsed. .It SUBROGATION lS WAS, subject to the term and conditions of the policy, certain policies may require an endorsenumt. A statement on ttds certif els does not confer rlghth to the certificate holder in Neu of such endo s ' PRODUCER Peoples Insurance Samos LLC 4107 N State Rd 7 Lauderdale Lakes FL 38319 cWGT DAWN BRAMWELL PHONe (964)733,8500 mail .net INSURERIS)AFFORDING COVERAGE NAICII WSURERA: LLOYDS OF LONDON INSURED A-TECH SERVICES INC. 1461 WEST CYPRESS CREEK RD SUITE 300 FORT LAUDERDALE FL 33309 INSURERS: 11102!2014 WSUF49RC: $ 1,000,000. RER D : $ 60,000.00 WSUNER E : $. . 6,0W INSIRER F : 8 1,000 t)00 r_nvcoer.FS e_n:QTIFIrATr: urn 11111now REVISION NLIMBEFt 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. INGR L TYPE OF 9=JR/WCE THE M(PEIATiON DATE THEREOF, NOTICE VALL BE DEUVISIVED IN 10050 NE 2nd Avenue PDUC NUMBER Miami Sties FL 33138 LIdBTS A GENERALIJAS11U Y comma ow GENwA umLITY CWMS•MADE ® OCCUR TFM007768 Y 11102120.13 11102!2014 EACH OCCURRENCE $ 1,000,000. : $ 60,000.00 MEDEXP WW onepeman $. . 6,0W PEI NALSADVIN,$NiY 8 1,000 t)00 GENERA-AGOREGATE S 2,000,000 GEM AGGREGAMUMIFAPPUESPM POLICY VAC PRODUCTS- COMPIOPAGG $ 1,000,000 $ AUTOMOB LE Lla®.ITY ANY AUTO �� D M D HIRED AUTO$ AUTOS �• — BODILY INJURY (PapeSM) S B�LY INJURY (Pm: emidard) $ PZM TY $ $ UMBIEIJ.A UAB M ESS LIMB OCCUR EACH REND $ HCLAIMSMADE AGGREGATE $ DWI IRET80=111 WORKERS COr9PEfM'I M AND EMPLOY9RS` UASLrTY ANY PROF" R A� Y� (MwAdery In n OFD N TI betax NIA 19"TTruml. Ica, ELEACHACCIDEN' . $ EA. DISEASE - EA EMPLOYEE S EL DISEASE -POLICY LET $ DESCISPTtOt OF OPERAIXMI LOCATIONS / VEtBCLES ( ACORD 181, AdOlund Remarnm So} " B more space to mqub*M AIR CONUITIONIN REPAIRS AND SERVICE'S CAC057248 n _-a4%=rnATG Rini rMn PAMPM 1 ATrnu ACORD 26 (2010108) is 155WAMu AUUKU UwjwwKA I.RJR. Au rlaum ruaw:Vuw. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DAD POtX= BE CANCELLED BEFORE Miami Shore Viilage Building Department THE M(PEIATiON DATE THEREOF, NOTICE VALL BE DEUVISIVED IN 10050 NE 2nd Avenue ACCORDANCE V.M THE POLICY PROVNKINS. Miami Sties FL 33138 AT Aunco IaE Fax 306.756.8972 ACORD 26 (2010108) is 155WAMu AUUKU UwjwwKA I.RJR. Au rlaum ruaw:Vuw. The ACORD name and logo are registered marks of ACORD 115 S. Andrews Ave., Rm. A -100, Ft. Lauderdale, FL 33301 -1895 — 954 - 831 -4000 VALID OCTOBER 1, 2013 THROUGH SEPTEMBER 30, 2014 Dme: A TECH SERVICES INC Receipt #'REATING/AIRCONDITION Business Name: Business Type: Owner Name: DELROY L TOMLINSON Business Opened:lo /03/2011 Business Location: 1451 W CYPRESS CREEK RD STE 36late/County /CerNRe$:CAC057248 FT LAUDERDALE Exemption Code: Business Phone: 561- 988 -3200 Rooms Seats Employees Machines Professionals 1 For Vending Business only lllWtlher'tff Mar_1linec• Tax Amount TraMdW Fee NSF Fee Penalty Prior Years Collection Cost Toil Paid 27.00 0.00 0;00- 0.00 0.0.0 0.00 27.00 THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT This tax is levied for the privilege of doing business within Browrard County and is non- regulatory in nature. You must meet all County and/or Municipality planning WHEN VALIDATED and zoning requirements. This Business Tax Receipt must be transferred when the business is sold, business name has changed or you have moved the business location. This receipt does not indicate that the business is legal or that it is in compliance with State or local lawns and regulations. Mailing Address: A TECH SERVICES INC 1451 W CYPRESS CREEK RD STE 300 FT LAUDERDALE, FL 33309 STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION CONSTRUCTION INDUSTRY EXEMITION ' tERTUacATEOF ELECTION TLZEXEMPTFFOFFF.OI M FifDFB�RB' CDtiPF]1WATIO TO EFFECTIVE DAM 11nWM3 EXFMRATMN DATE: 11n8m5 Mmm TOWN SON DELROY L � F8@l: 6509! i BUSINESS NAME AND Ate: A lECN SERVICES O C : 1481 W CYPRESS CREEK IS1 FORT W MEWALE R. 59309 SaOPES OF BUMMM OR M OiEATiNG, VENTILATION, AIR -COND Receipt #04A -12- 00014543 Paid 09/20/2013 27.00 2013 -2014 STATE OF FI.OWA AQf pRoMW83 CAS ®��sef�2 *.26003393 F COW v'r'r.` -' COWR p� - r oaasoa�as