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MC-14-1189Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 213770 Permit Number: MC -6 -14 -1189 Scheduled Inspection Date: June 25, 2014 Inspector: Perez, JanPierre Owner: FISHER, JOCELYNE Job Address: 1270 NE 92 Street Miami Shores, FL Project: <NONE> Contractor: BIMINI BREEZE HVAC INC Permit Type: Mechanical - Residential Inspection Type: Final Work Classification: A/C Replacement Phone Number 305 -757 -1006 Parcel Number 1132050270510 Phone: (305)968 -4205 Building Department Comments AC CHANGE OUT 5 TON Infractio INSPECTOR COMMENTS Passed Comments False Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments June 24, 2014 For Inspections please call: (305)762 -4949 Page 17 of 35 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795 -2204 Fax: (305) 756 -8972 INSPECTION LINE PHONE NUMBER: (305) 762 -4949 BUILDING PERMIT APPLICATION ❑ BUILDING ❑ ELECTRIC ❑ ROOFING —gap JUN 06 2014 FBC 20 L� Master Permit No. Sub Permit No. ` p _ l -- I 1S1 ❑ REVISION ❑ EXTENSION ❑ RENEWAL 9 El PLUMBING MECHANICAL ❑ PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: /-) I C 4 67 21 S71 City: Miami Shores County: Miami Dade Zip: 3 3 i,. E Folio /Parcel #: / / _32- G' ?G! / C Is the Building Historically Designated: Yes NO V' Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): cJG" Address: / 2— '7 C S /7 Si >CI- Phone#: 3C'5;•'' 5Z31/ City: iL/ 4,1, j $ #e ,e c- State: /--7�. Zip: Tenant /Lessee Name: Phone#: Email: CONTRACTOR: Company Name: Address: -7o /0 Ar /6 sr- /( ecc - zL Phone#: 1-30J '"'r 607v"S2-- City: e ���'�!/ ,f State: Zip: 3 39/s— Qualifier Name: 'LtS� `� ,43 State Certification or Registration #: e..4-c. 1 8/6 3 0 9 Certificate of Competency #: DESIGNER: Architect /Engineer: Phone#: Address: City: Phone#: 30 r- 96$-4/74--- State: Zip: c'e Value of Work for this Permit: $ 5-2 -9 4' . Square /Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New Repair- /Replace ❑ Demolition Description of Work: /3/4 - c=/ 7t 7* ii' (` I f ' za I Specify color of color thru tile: Submittal Fee $S-I'". C� Permit Fee $ Scanning Fee $ Radon Fee $ CCF $ CO /CC $ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ TOTAL FEE NOW DUE $ 1.c61 5 (Revised02/24 /2014) • 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 ELECTRIC, PLUMBING, SIGNS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, 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 OWNER or AGENT The foregoing instrument was acknowle ged before me this day of , 20 1 , by who is person ly known to me or who has identification and wh NOTARY PUBLIC: as Signature CONTRACTOR The fore: • ing instrument was acknowledged before me this day of ry ,Z — , 20 1 4 3U3 ` 1 ry I2orn &, who is personally known to me or who has produced FC— a7. Q- Jr'L as p. Sign: Print: Seal: by identification and who did take an oath. NOTARY PUBLIC: Sign: nt: Seal: APPROVED BY (Revised02/24 /2014) 1\ 1 \\\\ \\� 1\ 111 11110 l! / / / / / / /,i 7 ,G ",•. Cy ; . . ... / / / / / / /ii 11111110" \\ \\\`• O ******************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** ans Examiner Zoning Structural Review Clerk • • .: 01P1A+11", 'ITEM OR 1'3ART CESCWI)ON - .- . PRICE BIMINI HVAC Commercial Air Conditioning k•paLt.. BREEZE INc • Residential Services Inc. 169 St FL 33015 tui 01 04ZV ..:.::,:::::........... ..- - PST MM. iiirezer AP PSI :-:,..--;... . ,- AMPS ..,,, . .. t3.• .,,...,y CI Company Guarantee 00 :eel::: twee:rent itittataleAccoNNECTIGNs • tIGHTAO44AN .0.KOMON o CONDENSER COIL titi5dM 9 0 ; tOND • 7010 NW Hialeah - «- • I PIIIIMENFilfg. . a AI Ph 305-968-4205 0 , .. FIRST NAME 0 Tu.s In, 0 Res tUroloO 0 COrrOlOrCOO 0 i 014 Rapoos a Ao Cond;nor,e 0 Re,,lwasor 0 Sano,z,, 0 Installation 1.* ............ OA* • '. 010AW4kcoNfigcnclIc . . .CI*VE . .... ... . EIMINEMLI • STREET , i - (2 liESERFigri ' '''Ellb (4.v..-.)._.9 6 ' MAKE ts1001 1 SER:AL NUMBER triNkititii. • ( # PHONE A IF Met- ,-ti .............. : AR AS 431tiOR .. :1 0 , :0•VERS, .. . . ..: .;;A-• . • -4.YAMI .... .. - • .. , .. . ; .. • . ' ' ... ”0::',M0';:il ti rHEYAX Atti04000* .■ glirc 11111111111111111111111111W ViklinalliEl 19°Y / -"4.11e4wAiwww.-- .......... AP" TO Ai IIIIIIIIIIIIIIIIIIIMIIIIIIIIIIIIIIII iiiiqoYD "1— 52717,40 047,40 A/6.0 7 7 17 PL- ,.:.::.• --::, . - TOTAL PARTS t1.440 ... •6'.- - . .. . . •;,;.'" ; MOTOR i'... ,1,:. -.. , ,,,..,.,, .. ,. '';..,,, ''' " '• ' TIPO'ft.'. PARTS WARRANTY Art parts recorded are war7anted as AV r'Prlaarturer ttineftetiOnS LABOR GUARANTY The tabor charge as worded here re,alive to the equipment serviced as noted. m guaranteed for a period of _. days We do not. oleourse. guaranty other parts than those we ;natal!. II repairs tiler become necessary due to ether defectwe parts. they wit' be charged same* C H tt 2 r R 0 14 E 1 w WR1TF OR CODE AMOUN' .,. POOR MACH USAGE t ABOR CHARGES HRS 5 JHR. 7 0 • t. OTHER CHARGES RIIIIII TECHNICIAN CERT. SIGNATURE ki`Sr- TOTAL OTHER ENVIRONMENT CHECK LIST 13 13 YE$ NO a YES NO - -.. "i i:"MS C,. `,"-'1 HAVE THE AUTHORITY TO ORDER THE ABOVE WORK AND DO SO ORDER AS OUTLINED ABOVE IT IS AGREED THAT THE SELLER WILL RETAIN TITLE TO ANY EQUIPMENT OR MATERIAL FURNISHED UNTIL Faval. a COMPLETE PAYMENT IS MADE. AND IF SETTLEMENT IS NOT MADE AS AGREED, THE SELLER SHALL HAVE THE RIGHT TO REMOVE SAME AND THE SELLER WILL BE HELD HARMLESS FOR ANY DAMAGES RESULTING FROM THE REMOVAL THEREOF. X E p R G E R A 14 T D TYPE REFRIG RECOVERED? SYSTEM OTY OTT E 0 U I P m , c N T CHARGED OUT (OR REPLACED)? MANTLED? C) ITEM# REPAIR ESTIMATE 0 qD ® ® si El YES NO T R I P CHARGE RECYCLED? RELCAIMED? RETURNED Thag DISPOSAL II El ra s NO 11 CI YES NO TO II II SYSTEM/ YES NO QTY OTY OTT TAX OUR PERSONNEL RECOMMEND: ,. TOTAL _.;,10,,,,n• C; VMS ARRNED TIME DEPARTED AUTHORIZED SIGNATURE . EMI , • NON USABLE MI RI EITY YES NO DISPOSAL OWNER'S INITIALS MOW Olealtee0 WPM HAS WM Ate , • TED AM ■ •• ■ • . ,, ■ y cops DATE f /11///ir 1 Ali i ' - ■■ .440r / / ACCEPTED DECLINED C.S. # VP r This combination qualifies for a Federal Energy Efficiency Tax Credit when placed in service between Feb 17, 2009 and Dec 31, 2013. Certifii. ate of Pro.uct Rafings AHRI Certified Reference Number 3664607 Date: 6/2/2014 Product: Split System: Air - Cooled Condensing Unit, Coil with Blower Outdoor Unit Model Number: 116BNA060**'*"A indoor Unit Model Number FX4DN(B,F)061 Manufacturer BRYANT HEATING AND COOLING SYSTEMS Trade/Brand name: LEGACY RNC 16 PURON AC Series name: Manufacturer responsible for the rating of this system combination is BRYANT HEATING AND COOLING SYSTEMS Rated as follows in accordance with AHRI Standard 210/240 -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): 54500* EER Rating (Cooling): 13.50* SEER Rating (Cooling): 16.00* lEER Rating (Cooling): * Ratings followed by an asterisk C) indicate a voluntary rerate of previously published data, unless accompanied with a WAS, which indicates an Involuntary rerate. DISCLAIMER AHRI does not endorse the product(s) listed on this Certificate and makes no representations, warranties or guarantees as to, and assumes no responsibility for, the product(s) listed on this Certificate. AHRI expressly disclaims all liability for damages of any kind arising out of the use or performance of the product(s), or the unauthorized alteration of data listed on this Certificate. Certified ratings are valid only for models and configurations listed In the directory at www.ahrldlreptory.org. TERMS AND CONDmONS This Certificate and its contents are proprietary products of AHRL This Certificate shall only be used for individual, personal and confidential reference purposes. The contents of this Certificate may not, In whole or In part, be reproduced; copied; disseminated; entered Into a computer database; or otherwise utilized, in any form or manner or by any means, except for the user's Individual, personal and confidential reference. CERTIFICATE VERIFICATION The information for the model cited on this certificate can be verified at www.ahridlrectory.org, click on *Verify Certificate" link and enter the AHRI Certified Reference Number and the date on which the certificate was issued, which is listed above, and the Certificate No., which is listed at bottom right ©2014 Air-Conditiofing, Heating, and Refrigeration Institute F CERTIFICATE NO.: • AIR-CONDITIONING, HEATING, & REFRIGERATION INSTITUTE we make life better'° 130461571108058243 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): /9--79 City: Miami Shores Village County: Miami Dade Zip Code: 3 3 / e 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 ❑ NO4A ARHI Sheet Attached: YES', NO ❑ Contract Attached: YES UNIT BEING REPLACED DATA NEW UNIT MANUFACTURER ,3 4,q1- • 094 AHU or PKG. UNIT MODEL # f511 DNfob/ %o° •60 W-10 COND. UNIT MODEL # /(6 %ii/1/4/406o 0 0 KW HEAT S. NOM TONS <S AHU 4OCPKG 1) M.C.A AHU OCU `/PKG AHU • CU .'} KG 2) M.O.P AHU OCUN.FP KG AHU •' U >hxpKG 3) VOLTS AHU 236La3tPKG PKG UNIT / I PKG UNIT I I 10 EER/SEER ` -t YES 60 REPLACING DUCTS YES 10 NO REPLACING THERMOSTAT NO YES NEW 4 "CONCRETE SLAB YES YESt/ " i jj,— of ( .p0 NEW ROOF STAND YES as YES Is) NEW RETURN PLENUM BOX YES 6) 1. Minimum Circuit Ampacity (Wire Size): 2. Maximum Overcurrent Protection (Fuse/Breaker Size): 3. Voltage of Circuit (208/240/480): 4. Size Disconnecting Means: eit 6'0 471. 610 / 406 ,( cPO Contractor's Company) Name: 8.-1/175: L- (/ °'�G Phone: ' AS' f6g (favor- State Certificate or Registration N. CA--c-/k/639--9 Certificate of Competency N. Signature (Qualifier's si - re only) Date: ‘,/cY/Y.