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MC-11-2062Miami 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 n JOB ADDRESS: 9/i#' D e'/� ,i' City: Miami Shores / . / County: Folio/Parcel #: ! 1 — 32_ 06 -0/ `/ _/ 3d-® Is the Building Historically Designated: Yes NO v R EIy ' D JUN 21 2012 FBC 20 Permit No. rii C t —4-212)412— Master Permit No. C.- c. l 1 -- ZCYP Miami Dade Zip: 33 /21P Flood Zone: p Titleholder): ��e,�.� _ g�� nee, OWNER: Name (Fee Simple : �� �� � � �`/' � j���1 Phone#: �S Address: 6' / %4 /t4 ° 9 d%Q a3 Ole lrJC- City: A4! i i / 3 t1Ye At State: 1:24 Zip:' 3 /V/ Tenant/Lessee Name: Phone#: Email: V ham. 1 cam. Y)Dt. ep 6,1,` Sb k• >k d 4 P✓/+ CONTRACTOR: Company Name: C4 57),(4 ✓7i P 0�s674/S Phone#: Address: i I-'f 19 U Z✓ 6 S / `` City: PRin/J state: `�Zr Zip.: 3D1�9 Qualifier Name: i �r06 4 /3 40 �C'` Phone#: 7 -7es- 9/ State Certificatio�'T Registration #: ale. c. s C7 2_ Certificate of Competency #: Contact Phone#: ?J ' A9cj( Email Address: (J7,41 4)05711444 /)1/2 €S #yJ5, ( V DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ 6P%.5--- 3 247 4911-sce-- Square/Linear Footage of Work: s1i t s r* Type of Work: °Addres °Alteration °New ORepair/Replace °Demoliti n Description of Work: P €Dlill S'7�� J ) /? /G CIA.' / 7— /-i9�,,e L-4ss i214- Gl P'G 4,2 OAS Mb IAA ciAl (a &O /-00f ST,JQS- Nxr6ee,147.9.i /�� „✓� * x�x�x�� . *�xx�x�w�.+x*�xr.wx.+�w**e rw *�r,xw+a.x.*�r+wxG.F w a. a.�xx.x�a.x. wax+ rx�r. x�*+ r�rx.�x *�r *x� *�xwx.,x**r.a� *a.* Submittal Fee $ Permit Fee $ 1� cJ1f ICCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE 4 • tR Bonding Company's Name (if applicable) Bonding Company's Address City State Zip alp 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 T T.ECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDmONERS, 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 COMMENCEMENTS" Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be appyued and a reinspection fee will be charged. Signature Owner or Agent The fore oing instrument was acknowledged before me this day of , 20 �,,. by ■J c 'i '� v� A i� who is personally known to me or who has produced - As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: •;O �,•O� >- oW IQ ******x * *** **** * * **a,** **** * * * *st *44414to .A14****aa�,x�.x�*a�w**** .a�� **************** a�* x��x** ** *a�a�a��n *a.+x,�x.,� *�,****** Plans Examiner Contractor The foregoing instrument was acknowledged before me this /3 day of (e (/1� , 20 1(:, by lSal1/4kt,�e l B ©C. who is personally known to me or who has produced as identification and who did take an oath. NOTARY APPROVED BY Zoning Structural Review Clerk Revised 3 /12/2012)(Revised 07 /10/07)(Revised 06/10/2009)(Revised 3/15/09) , 6 1. 7t1111. Itq,!?* • - d • s 07/02/2012 14:42 95496883W ACORD CERTIFICATE OF API Graup • P.C. Box 934125 BROOME PEEPLES 0A209442 Mare nosi COMM S & R MECHANICAL CORP DEA CUSTOM AIR DESIGNS 1240 S W 6TH ST POMPANO BEACH FL 2SOOS COY GE9 /$"1 armor' • LIABILITY INSURANCE okra ItsscornrAry 07/0213012 THIS CER11F[CATE• 15 N1SUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE !CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT ANEW ETEND OR L ALTER THE COVERAGE AFFORDED BY THE POL BELOW, INSURERS AP'FORDIN4 COVERAGE NA)C f2 IN�RITRL 7 a INTERNATIONAL INSURAPigga. INSURER $: ~-�- INSURER C: M�URER D: POURER S; The FOLIOS OF INSURANCE U5Ta► BELOW HAVE BEEN 1SSJJED To THE IN9DRED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NO1 ft T -IsrANDIR ANY RFAUIREJIENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RISSPECT TO WHICH TNIS CERTIFICATE MAC► P Immo OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES D SGRrseD HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CDNUITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAW, BEIEN REDUCED BY PAID CLADIAB. POLICY mARI RYS 03/1WIZ013 tOR LIEIIT OCC�pU 1. �F39VCj )WPAO CSgftA lea amumcall. s10(000 n®a P9n! aft pWon) si5,000 PERSQNa .RADV[AWRY a 1k010,O00 CIENERA4AOI REGATE 2, nr� 00 PRODUCTS - OP IA00 i;INGLUDED • A U T O ONLY - EA &CC MM OTHER EA A°D $ AUTO ONLT: AAO £0.CE1OQOIRRENCI: mammas ATioNS migooLeatImowldowAosoo TWENI3O rrMOM. PROVISION AIR CONbmoNING CONTRACTOR CERTIFNCATE HoL ER MIAMI DADE cOUI+ITY DEPT OF REGULATORY & ECONOMIC RESOURCES MEOW 28 ST MIAMI FL 331T5 CANCELt -ATIO _ • glom ;wormasovri 1148011o0POLIODSBOCANCELLIMOOONETIMNPIPATION DA78 VIEREOF, Tile Ramp MOM MALL ENDEAVOR TO toNL ' Q_ DATA voo TEI NOTICS THE` CGRY1F ATD HOLDERMAN:0 - IRE LOFT, TaoFAiLLrre Tr! LTD go gHALL IIIKO4401- 5w&14 • LABIUM OP NO UPON THE *AMR, rls AMENS C ATMS. L • • ACORD 25 t2001105) rACO- CCRJ ORATION 192 m CERTIFICATE OF LIABILITY INSURANCE CUSTOM ; OP ID: .1 DATE IMILDDrr rr) 07/02/12 THIS CERTIFICATE 13 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. 1115 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 poIIcy(e) must be endorsed. If SUBROGATION 13 WAIVED. Subject to the terms and conditional of the policy, certain policies may Require an endorsement. A statement on this certifoate does not confer rijlts to the certificate holder in roc of such •ndoreement(s). PROVuc R 407- 889 -0962 ffer SIHLE INSURANCE GROUP, INC. P. O. BOX 160398 ALTAmoNTE SPRINGS. FL 32710 Casey Fcrnandlz INSURED 8 & F Mechariical Corp dba: Custom Air Design 1248 SW 6th St. Pompano Beach, FL 33069 COVERAGES 407-774-008 TiP it Fxp ola ss- certtficatesesihle.com lyi , Not: 4074843580 INSURER/S)AMORE/NS OOIERAGE NAM tt IN$YRERA:Inannance Co.. of the West INSURER e : INSURER C • 278•1 INSURER D : WBURER € : INSURER F • CERTIFICATE NUMBER REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUI=D TO THE INSURI INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBEf EXCLUSIONS AND CONDITIONS OF SUCH POUCIES. UMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS LIR -IDA EL p. TYPE OF INSURANCE Wien Iwvo POUCY NUMBER fMM Y Yt It u1DOitYr1 OEN!RAL UASIUIV ri_ogAMERCIAL OBNF UABIUN l CLAIMS -MADE �^ OCCUR OEM. �IITAP�'PLLIIE�SPER: POLICY 1 ^ I Jpp: I 1 LOC AUTOMOIRLE LUUNLITY ANY AUTO ALL OWNED ?CHL.DULED AUT AUTOS HIReDAUTON N- ED UMBRELLA Lw6 E %LESS UAD OCCUR CLAIMS-MADE I OED s tTENTIQL WORKERS COMPENSATION AND EMPLOYERS' LIABILI'K A ANrPROPRIETOWPARTNEWE)CEcUT1VE OF-FIOEWMEM EXCLUDED? (Mamatmyln N11) Uyes, dgraibe tinder DESCRIPTION OF OPERATIONS below N/A WFL600601801 04/07/12 04107113 1 DESCRIPTION OP OPO AYIONS1 LOCATIONS! VI4ICLES (Mai ACORD 107, AdIMMOnal Remanm $pI$d.Ie tt mwo.paee 16,aq„ira i CERTIFICATE HOLDER Miami Dade county Dept of Regulatory & Economic 11805 SW 26th st Miami, FL 33175 ACORD 25 (2010105) MlADMI1 ED NAMED ABOVE FOR THE DOCUMENT WITH RESPECT ) HEREIN IS SUBJECT TO POLICY PERIOD TO WMICH THIS ALL THE TERMS, Lams EACH OCCURRENCE $ ' Mb0 EXP (Arm one) trot) 0 ', PERSONALS ACV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGO. 5 $ ; BODILY INJURY (Per Ps11son) $ RODILY INJURY (Peracadsnt) 5 : PROPERW (DAMAGE 1;i said $ 5 EACH OCOURRCNOE 5 : AGGREGATE 5 : E.LJACHACCIDENT S . ' 1.000,000 EL DISEASE - EA EMPLOYE = 5 1,000,000 EL DISEASE. POLICY LRIIIT S 1,000,000 } CANCELLATION • SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BEP DELIVERED IN AOCORDANGE WITH THE POLICY PROVISIONS+. • AUTHORIZED REPRESENTATIVE ® 1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD .;a 115 S. Andrews Ave., Rm. A -100, Ft. Lauderdale, FL 33301 -1895 — 954- 831 -4000' VALID OCTOBER 1, 2011 THROUGH SEPTEMBER 30, 2012 DBA: Business Name: CUSTOM AIR DESIGNS Owner Name: SAMUAL A BLOCK Business Location: 1246 SW 6 ST POMPANO BEACH Busing Phone: 954 -565 -8335 Rooms Santa Number of Machines: Receipt #: 3.83 -1668 Business Type: =COND x O CoNTRACTR) Business Opened :l1 /01/2004 State/County /Cert/Reg :CAC03 3 5 62 Exemption Code:NO 4PT Employees 10 -For Vendifa eusIness On)/ Machines Professionals Tax Amount Transfer Fee NSF Fee Penalty r�- Prior Year& Collection Cost Total Paid 27.00 0.00 0.00 0.00 • 0.00 o.00 :29.00 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 Broward Cctun1y and is non - regulatory in nature. You must meet all County nndlor Municipally 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 laws and regulations. • Mailing Address: SAMUAL A BLOCK 1246 SW 6 ST POMPANO BEACH, FL 33069 2011 - 2012 Receipt 4105A -10- 00009896' Paid 08 /08/2011 27.00 • Permit Number: MC -11 -11 -2062 I Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 190438 Inspection Date: May 01, 2013 Inspector: Perez, JanPierre Owner: LLC, DEVINELLA Job Address: 9165 PARK Drive Miami Shores, FL Project: <NONE> Contractor: CUSTOM AIR DESIGNS Permit Type: Mechanical - Commercial Inspection Type: Final Work Classification: A/C Replacement Phone Number (305)785 -8990 Parcel Number 1132060141350 Phone: (954)785 -9128 Building Department Comments 8 NEW UNITS TO REPLACE EXISTING A/C SYSTEM Infractio Passed Comments INSPECTOR COMMENTS True ,A-------*,,Q i .f.) i 1 „„/ Passed Inspector Comments CREATED AS REINSPECTION FOR INSP - 183330. CREATED AS REINSPECTION FOR INSP- 166374. ok for TCO; 1)need to remove smoke detector not req. 2) seal a/c closets. 3) T &B report jppl /28/2012 pending T &B report only el,\ Pt/ -&---- ;lie;, Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled re- inspection fee is paid. until May 01, 2013 For Inspections please call: (305)762 -4949 Page 1 of 1 SMACNA Outlet Test R- 'ort American Standard: AHIJ#I- COND.- 140D #4TTB3060D10006/ A/11 MOD #GAT2A0C60S51 A .320i3 DESIGN VEL or 5P ACTUAL FINAL VEL or SP ACTUAL FINAL C.F.t4. 10 Office 306 NO. DATE: 2/1/2013 TESTED BY: W'ALT R F ADfE55 9165 Park Drive Miami Shor, FI. 331 outlet Tes_t Re rikmerican Standard:MAWS- Cond.-4TT8306013100081 NH- GAT2A0C605515A NO. S12.E FACTOR DESIGN CFM 400 400 DESIGN VEL or SP TEST1 TEST F c.n4 el 42 C14 415 ACTUAL TEST FINAL R3 VEL or CF14 SP ACTUAL FINAL 398 5 8 100 6 409 396 404 93 125 8x8 REMARKS IIIIIIIIIIIIII 111111 1111111111111 11111 1111111111=1111 I.M.--111111MIMUM 1111111111111111111111. foiti so 111111111111111111111111111 11111.1111111111111111111111 111111111111111=111 1900 MI MI NE TOTALS M X)13 NAME: Dr. Keisch Tamp Therapy Office 108 NO. 211/2013 TESTED 81f-: WALTER F ADDRESS: 9165 Park Drive Miami Shores, FL 33138 SMACNA Outlet Test Re ort rAmerican Standard: ANU#2- COND.- MOD#4111330421310008/ MOD#GAT2A 8541SA TEST ACTUAL ACTUAL f FINAL 03 VE FINAL L or CFM C.F.M. P REMARKS 308 NAME: Dr. Keisch Tamp Therapy Office 308 N. DATE: 2/1/2013 ADDRESS: 9165 Park Drive Miami Shores, FL 33138 ...1.7.11 . ... TESTED BY: WALTER F SMACNA Outlet 'rest Re rt American Standar'd :A #7 C:omd.- 4A7B3036E1 A/H-1- GGAFF2A0A36$31SA SIZE REMARKS 11.1.111111. 1111.11111111111111111111 111111111111111111111 11111111111111.1111111111111111111 111111=011 MEI MB ME= 1111111111111 11111MMI NAME: Or. Keisch Temp Therapy Office DATE: 2/112013 TESTED $Y: WALTER F ADDRESS: 9165 Park Drive Miami Shores, FL 3313$ SMACNA American Standard: AHU #3- COND.- MOD#4TT83048D.10006/ A/li MOD #GAT2AOC60 1 SA Outlet Test Re ort NO, SIZE 1 10" 2 10" FACTOR DESIGN OEM 400 400 DESIGN VEL or SP TEST #1 CCM TEST #2 CFM TEST 43 CFN ACTUAL FINAL VEL or SP ACTUAL ANAL C.F.M. 403 410 398 11111111111911%. REMARKS /111111111.1111111111 MUM 0/A 50 1600 JOB NO, DATE: 2/1/3013 TESTED BY: WALTERlF 1607 TOTALS 308 NAME: Dr. Ketsch Temp Therapy Office ADDRESS: 9165 Park Drive Miami Shores, Ft. 33135 05.01 4413 SMACNA .__ 01...A.,........._M...,_ Re rt American Standard: Aliti#4- COND.- MOD#4A783036E1000A/ A/1-1 1 ,.* MOD#3AT2A0B42S31SA NO, SIZE FACTOR DESIGN CFM 200 DESIGN VEL or SP TEST #1 CFM 221 TEST 02 OEM ACTUAL TEST ACTUAL FM,. FINAL OEM #3 VEL or C.F.M. SP 215 128 155 160 320 111 210 208 125 158 164 305 REMARKS 111111111111111111111KIMI NEM 1111.111011111MM11111111111111.111111 MON MIN 111111.111111111MI 1111111•11•11 111111111111111M111.1 EMI MIME 111=1111111111111.111 11111.11111111.111111 111111111111111111 1111111.111111 111111111111111111111=111111111= 1111111111. 11111111111111111 1150 ME 3013 NO. DATE: 2/1/2013 TESTED 8Y: WALTER F 0/A 100 1170 TOTALS JOB NAME: Dr. Keisch Tornp Therapy Office ADDRESS: 9165 Park Drive Miami Shores, FL 33138 SMACNA Outlet Test Re .ort American Standard: AHU#5- COND.- MOD#411133048D10000/ MOD4GAT2A0C60S51SA 2 SIZE FACTOR MIN DESIGN CR4 so DESIGN TEST VEL or *1 Sp CR4 45 TEST *2 CR4 ACTUAL TEST I FINAL #3 VEL or CR4 SP ACTUAL FINAL C.F.M. REMARKS 238 120 175 so 169 SO NM 52 248 125 178 175 52 52 98 300 13 240 247 50 49 15 53 16 6 11111111.11•11111111111111111111111111111111111111111111111 2100 JOB NO DATE: 2/112013 TESTED BY: WALTER F 2108 0/A 145 TOTALS 10B NAME: Dr. Keisch Tomp Therapy Office ADDRESS: 9165 Park Drive Miami Shores, Fl. 33138 k.14,04. '7F