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MC-14-1345Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 214726 Permit Number: MC -6 -14 -1345 Scheduled Inspection Date: July 02, 2014 Inspector: Perez, Jan Pierre Owner: GOULDEN, LISA Job Address: 162 NW 102 Street Miami Shores, FL 33150- 0 Project <NONE >! Contractor: A KOOL SAVER INC Permit Type: Mechanical - Residential Inspection Type: Final Work Classification: A/C Replacement Phone Number (786)879 -0517 Parcel Number 1131010230120 Phone: (305)403 -8556 Building Department Comments REPLACING EXISTING A/C UNIT 3 TONS Infractio Passed Comments INSPECTOR COMMENTS Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. False L\ pitv Inspector Comments Please call Antonio @ 786 - 543 -0506 before you go. Thank you. July 01, 2014 For Inspections please call: (305)762 -4949 Page 17 of 31 r yn 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 El BUILDING ❑ ELECTRIC ❑ ROOFING PLUMBING JOB ADDRESS: City: MECHANICAL PUBLIC WORKS JUN 242014 FBC 20 Master Permit No. fnC 9 4._ /3 Vs" Sub Permit No. ❑ REVISION ❑ EXTENSION ❑ RENEWAL ❑ CHANGE OF CONTRACTOR 16Z° OV''J toast ❑ CANCELLATION ❑ SHOP DRAWINGS Miami Shores County: Miami Dade Zip: Is the Building Historically Designated: Yes NO Construction Type: Flood Zone: BFE: FFE: Folio /Parcel #: Occupancy Type: Load: 3 31 YO OWNER: Name (Fee Simple Titleholder): Li I' - /k° Address: I% 2 1 (0 2 S t Phone#: "T--Y6 ' Y ¥ o I City: VA 1 A. v01 State: �L Tenant /Lessee Name: A e • Email: Zip: a 3 Phone#: -_ CONTRACTOR: Company Name: ! "1 S A ■1 �Z- Address: Li I , f4 City: \/V A State: r l-- Qualifier Name: L'' 400A ® VV\ e State Certification or Registration #: DESIGNER: Architect /Engineer: VI:\ v Address: City: Value of Work for this Permit: $ e-76-&Z". Square /Linear Footage of Work: 1.3 00 5c1 t Repair /Replace 0 Demolition Phone#: 30gB 03631S-S6 ° Zip: 3 ) .66 Phone #: Certificate of Competency #: Phone#: State: Zip: Type of Work: ❑ Addition ❑ Alteration ❑ New Description of Work: —�� �A Cry; ( s lu j A/c. L.3 $4; i rA ,q Specify color of color :thrua le: Submittal Fee $ Scanning Fee $ Technology Fee $ Structural Reviews $ Permit Fee $ Radon Fee $ Training/Education Fee $ (Revised02 /24/2014) CCF $ CO /CC $ DBPR $ Notary $, Double Fee $ Bond $ TOTAL FEE NOW DUE $ �D RS-Q� 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 Signature OWNER or AGENT , CO. RACTOR The foregoing in ent was acknowledged before me this The foregoing instrume `t was acknowledged before me this Li day of Z- ` 4.-- , 20 ( nn'T ' , by i 9' day of ,3-1...) vk e- , 20 (q ° . by me or who has produced as me or who has produced as , who is personally known to , who is personally known to identification and who did take an oath. NOTARY PUBLIC: identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: * * * * * * * * * * * * * * * * * * * * * * * ** * * * * * * * * * * * **** *fir * ** *************************** ** * ** * **** * ** * *** ** * ** * * ***** ** APPROVED BY Plans Examiner Zoning (Revised02 /24/2014) Structural Review Clerk l 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: Mq 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. 162, N 1 02 5 Job Address (where the work is being done): City: Miami Shores Village County: Miami Dade Zip Code: 32I . 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 AHRI DATA SHEET REQUIRED Change disconnecting means: YES ►1) NO ❑ ARHI Sheet Attached: YES NO ❑ Contract Attached: YES, UNIT BEING REPLAC D DATA NEW UNIT v\ (aAAtt � MANUFACTURER 21-�� - ' ALA r (itkil & (4 AHU or PKG. UNIT MODEL # 1 G ( is-13 it). COND. UNIT MODEL# 12 KW HEAT Ct . NOM TONS AHU CU PKG 1) M.C.A 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 / / EER /SEER 16. YES ►a REPLACING DUCTS YES a _• I YES REPLACING THERMOSTAT YES 1 0 YES ZIP NEW 4 "CONCRETE SLAB YES 60 YES V NEW ROOF STAND YES N YES 0 NEW RETURN PLENUM BOX YES NCI . 1. Minimum Circuit Ampacity (Wire Size): 2. Maximum Overcurrent Protection (Fuse /Breaker Size):. P. 3. Voltage of Circuit (208/240/480): 4. Size Disconnecting Means: fa® Contractor's Company Name: f �Ci 0 L sa eut-- • Phone: 3031101 8536. State Certificate or Registran No. %' / Certificate of Competency No. Date: .6/ Z3 /'l . Signature (Revised02 /24/2014) nature) A KOOL SAVER INC . 4611 NW 74 AVE MIAMI, FL33166 (305) 403 85 56 Fax (786) 401 63 39 Email: info@koolsaver.com License Nu t ber: CMC 1249271 PROPOSAL A/C Date: June 18, 2014 THIS PROPOSAL IS HEREBY SUBMITTED Fc1F Y LOCATION: 162 NW 102 ST MIAMI SHORES, FL 3315Q CUSTOMER LISA, GOULDEN EMAIL: lisagoulde4t@yahoo.com AND AOEPPFAWC> PHOATP: (786) ❖ Install 1 A/C units, brand name Rivera 3, TON, S RHLLfJM3821JA ❖ 1 Supply plenum •3 Condenser and Air handler -xancy floating switch •:+ Alma flex TOTAL: FPLRE1ATE ** Permit cost not included, the **The service of running the WARRANTY 1 year on labor Equipment wairanty by manufact 16.0 Model 14AJMA01 $ 3,187.00 $ 585.00 DRAFT 50% Down payment 50% When is done Qtl�� ato(0 t81 � �i4c.e14- Miami Shores Vijiage Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION ALL CONTRACTORS MUST PROVIDE COPIES OF LICENCES AND INSURANCES EACH TIME A PERMIT IS SUBMITTED. IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. COPY OF QUALIFIER'S STATE LICENCES B. COPY OF LOCAL BUSINESS TAX RECEIPT C. OPY OF LIABILITY INSURANCE* D. COPY OF WORKERS COMPENSATION INSURANCE* 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 STATE REGISTERED CONTRACTOR LICENSE OR MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT. C. COPY OF LIABILITY INSURACE* D. COPY OF WORKERS COMPENSATION INSURANCE* *YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE AS FOLLOW: Certificate Holder: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 Certificate must specify the description of operations or contractor license number. BUSINESS NAME: !\ I(Cc.o L S dcweY - "� x BUSINESS ADDRESS: 6' 11 6'4 (4 A4 CITY W1 l A STATE rL ZIP CODE 33 BUSINESS PHONE: (30S ) ° 3 BM FAX NUMBER (116 ) * (4Q I 6 3 3 d . CELL PHONE ( W' ) S-43 . QUALIFIER'S NAME: ALN "w e vt QUALIFIER'S LIC NUMBER: ( 2-46(.2_1' 9 a • BATCH NUMBER "•.4 ACORO® CERTIFICATE OF LIABILITY INSURANCE �' DATE(MM/DD/YYYY) 06/23/2014 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(Ies) 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 doer; not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Automatic Data Processing Insurance Agency, Inc. 1 Adp Boulevard Roseland, NJ 07068 CONTACT NAME: A/CNNo, Ext): FAX No): ADDRESS: INSURERS) AFFORDING COVERAGE NAIC # INSURER A : Castlepolnt of Florida INSURED A KOOL SAVER INC 4611 Nw 74th Ave MIamI, FL 33166 INSURER B : INSURER C INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 243077 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUB EXCLUSIONS AND CONDITIONS OF SUCH POUCIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. FOR THE POLICY PERIOD ESPECT TO WHICH THIS ECT TO ALL THE TERMS, INSR TR TYPE OF INSURANCE ADDCSUBR INSR WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MMIDDIYYYY) LIMITS GENERALUABILITY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE PREMISES (Ea occurrence) $ MED EXP (Any one perSon) $ CLAIMS-MADE OCCUR PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMP /OP AGG $ GEN'L AGGREGATE POLICY LIMIT APPLIES JEC PER: LOC $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS _ SCHEDULED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ UMBRELLA UAB EXCESS LIAR OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ $ DED RETENTION $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/DECUTIVE Y/ N OFFICER/MEMBER EXCLUDED? Y (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A N WCP761513900 02/07/2014 02/07/2015 X WC STATU- TORY LIMITS 0TH - ER E.L. EACH ACCIDENT, $ 100,000 E.L. DISEASE - EA EMPLOYEE $ 100,000 E.L. DISEASE - POUCY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, AddltIonal Remarks Schedule, H more space Is required) License# CMC1249271 CERTIFICATE HOLDER CANCELLATION Miami Shores Village 10050 Ne 2nd Ave Miami, FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POUCY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2010/05) © 1988-2010 ACORD CORPO - ' TION. All rights reserved. The ACORD name and logo are registered marks of ACORD .ACQ/?L7® kb..........---- ,_,,,.. CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YY) 06/20/14 PRODUCER All Nation 8520 S.W. 40th St Miami, FL 33155 Phone (305) 220 -0900 Fax (305) 220 -3029 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED A KOOL SAVER INC 4611 NW 74TH AVE MIAMI, FL 33166 I INSURER A American Vehicle INSURER B: INSURER C: INSURER D: INSURER E: COVERAGES INSURER F: THE POLICIES OF INSURANCE LISTED 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR ADM_ INSRD TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM/DD/YY) POLICY EXPIRATION DATE (MM/DDIYY) LIMITS A • GENERAL n ❑ . ❑ GEN'L n LIABILITY COMMERCIAL GENERAL LIABILITY ❑ CLAIMS MADE V OCCUR GL 0504009525 -01 08/06/13 08/06/14 EACH OCCURRENCE 1,000,000. DAMAGE TO RENTED PREMISES (Ea occurgnce) 100,000 MED EXP (My one person) 5,000 PERSONAL & ADV INJURY 1,000,000. GENERAL AGGREGATE 2,000,000. PRODUCTS - COMP /QP AGG 2,000,000. AGGREGATE LIMIT APPLIES PER: POLICY 1 PROJECT ❑ LOC ❑ AUTOMOBILE 1 1 • 11 ❑ 1 1 LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) 1 GARAGE LIABILITY • ANY AUTO 1 AUTO ONLY - EA ACCIDENT OTHER THAN EA ACC AUTO ONLY: AGG EXCESS/UMBRELLA LIABILITY 1 OCCUR ❑ CLAIMS MADE • DEDUCTIBLE 1 RETENTION $ EACH OCCURRENCE AGGREGATE WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR / PARTNER / EXECUTIVE OFFICER / MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below TORY LIMITS ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L DISEASE - POLICY LIMIT OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS License Number CMC1249271qualified A Kool Saver CERTIFICATE HOLDER CANCELLATION MIAMI SHORES VILLAGE 10050 NE 2ND AVENUE MIAMI SHORES FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25 (2001/08) QF © ACORD CORPORATION 1988