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MC-14-1508Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-215891 Permit Number: MC -7-14-1508 Scheduled Inspection Date: August 27, 2014 Permit Type: Mechanical - Residential Inspector: Perez, JanPierre Inspection Type: Final Owner: PERRY, WILLIAM Work Classification: A/C Replacement Job Address: 340 NE 94 Street Miami Shores, FL Phone Number Parcel Number 1132060136160 Project: <NONE> Contractor: COOL AIR USA INC Phone: (954)915-1155 Building Department Comments AC CHANGE OUT GOODMAN 5 TON 16 SEER Infractio Passed Comments INSPECTOR COMMENTS False 0 August 26, 2014 For Inspections please call: (305)762-4949 Page 4 of 14 Inspector Comments Passed Failed Correction Needed Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. August 26, 2014 For Inspections please call: (305)762-4949 Page 4 of 14 Z -t A- [ � ?)6 1 �'l 0) P- Miami Shores Village CEIVE� Building Department JUL 16 014 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 [Y:�.._ Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC 20 10 BUILDING Master Permit No.mc,)�-1 " I sow PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC M ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING [DMECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 340 NE 94 STREET City Miami Shores County Miami Dade Zip; 33138 Folio/Parcel#: 11-3206-013-61601 is the Building Historically Designated: Yes NO XXX Occupancy Type: SF Load: Construction Type: CBS Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): WILLIAM PERRY Phone#: 786-290-9810 Address: 340 NE 94 STREET City; MIAMI SHORES State: FL Zip; 33138 Tenant/Lessee Name: N/A Phone#: N/A Email: N/A CONTRACTOR: Company Name: COOL AIR USA Phone#: 954-915-1155 Address: 4151 SW 47 AVE SUITE 2B City; DAVIE State: FL Zip; 33314 Qualifier Name: LIOR POYASTRO Phone#: 954-915-1155 State Certification or Registration #: CACI 815656 Certificate of Competency #: DESIGNER: Architect/Engineer: N/A Phone#: Address: N/A City: State Zip: Value of Work for this Permit: $ 3600.00 Square/Linear Footage of Work: 4,051 SF Type of Work: ❑ Addition ❑ Alteration ❑ New IN Repair/Replace ❑ Demolition Description of Work: A/C CHANGE OUT GOODMAN 5 TON 16 SEER Specify color of color thru tile: Submittal Fee $ Permit Fee $ C) CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ a- 0191— TOTAL FEE NOW DUE $ (Revisedo2/24/2014) � 11� 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 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 oke —.1 OWNER or AGENT The foregoing instrument was acknowledged before me this 11 day of JULY . 20 14 , by WILLIAM PERRY , who is personally known to me or who has produced DIL as identification and who did take an oath. NOTARY PUBLIC: Sign:_ Print.• RO Seal: cs� APPROVED BY (Revised02/24/2014) MY COMMISSION # EE183283 EXPIRES March 26 2018 Signature ' -4 CONTRACTOR The foregoing instrument was acknowledged before me this 11 day of JULY , 20 14 , by LIOR POYASTRO , who is personally known to me or who has produced identification and who did take an oath. NOTARY PUBLIC: Sign: ::� Print: ROBERT C V Seat: 9 ; "ROBERY J CARVAL.HO •"c MY COMMISSION # EE183283 EXPIRES March 26 2016 as Plans Examiner Zoning Structural Review Clerk Client#- 1046843 COOLAIR2 ACOR& CERTIFICATE OF LIABILITY INSURANCE7/15/2014 DATE(Mm=ft-j l THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFiRMATNELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE 001:5 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 INSUREO, the policy(ies) must 'endorsed. If SUBROGATION IS WANED, subfW_ to the terms and conditions of the policy, Certain policies may require an endorsement, A statement on this Certifroate does not Confer rights to the certificate holder In 11eu of such endorsement(s). PRODUCBR 17 7;LAUSI Insurance Services. LLCICL P.O. BOX 141918 305 889.6000 Nu: Coral Gables, FL 331141916305 689-6000 INsua AfFgRDING.COVERAGE NAICINSURED American Safety Indemnity Compa 25433 Cool Air USA Inc INSURER B: Associated Industries Ins. Co., 23140 4151 SW 47 AVG Ste 28 INSURIMQ, Ft Lauderdale, FL 33314-4054 INSURER D : CERTIFICATE NUMBER: REVISION NUM$ER: THIS IS TO CERTIFY T}jAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REOUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT *NTH RESPECT TO WFIIChI 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 gHOWN MAY HAVE 82EN REpUQEQ BY PAID CLAIMS. iR TYPE OF INSURANCE nDa ua POLICY NUMOORmP Inv EFF ow v LIMITS A oENER" IJABIIJTY ESL100234913 8/19/2013 08/19/201 EACH OCCURRENCE 51.000,000 X coMMERcwLGF-NERALuAbluTr �A �yT ,�,�„�, s50000 CUMM"ADE � OCCUR MEOW An ono Daraonl 30 X BI/PD Ded:S 000 LIMIT APPLIES PER: AUTOMOBILE UAML:TY ANY AUTO 2""05 NED a AUTOS LBO HIRED AUTOS AALMO-0S�� UMBRELLA LIAR OCCUR MOUS 1A8 B wax-R*COMPPMATiON AWC1026565 ANP EMPLOYERS• LIABILITY YIN OFFICERAA BER � WEr;0? yGX6CuTTVE N I A (MandatOry In On DESCRIPTION OF OPERATION51 LOCATIONS I VEHICLES (Attach ACORD 101, A44MOnal PAMArks Schadai0, N 111070 apao .a raQairad) RE: CAC 01815656 S BODILY INJURY (Per pamn) 12 BODILY INJURY(Paracammp I a =01'."I - ROP. DGS S Miami Shores Villages SHOULD ANY OF THE ABOVE DESCRIBED POLICIES $a CANCELLED BEFORE 10050 N8 Z Ave TWE E)�IRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Miami, FL 33138.2304 Al SENTATIVE ®1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) 1 pf 1 The ACORD name and logo are registered marks of ACORD #S12925943/1411448722 LPPEV l 'd tl9L'0N }aqui saaanW — o0 pta!}ya}!1 WvZI Ol tiIOZ Sl'�nr 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): 340 N E 94 STREET City: Miami Shores Village County: Miami Dade Zip Code: 33138 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 ❑ NO 0 ARHI Sheet Attached: YES 0 NO ❑ Contract Attached: YES no 1. Minimum Circuit Ampacity (Wire Size): 45 2. Maximum Overcurrent Protection (Fuse/Breaker Size): 50 3. Voltage of Circuit (208/240/480): 4. Size Disconnecting Means: Contractor's Company Name: COOL AIR USA Phone: 954-915-1155 State Certificate orrRRe 'ation No. CAC1815656 Certificate of Competency No. Si gnature -J7Date: f1mL 1mses signature) (Revised02/24/2014) UNIT BEING REPLACED DATA NEW UNIT MANUFACTURER GOODMAN TOO OLD TO IDENTIFY OR READ AHU or PKG. UNIT MODEL # ASPT60D14A COND. UNIT MODEL # GSX16061F KW HEAT 10 NOM TONS 5 AHU CU PKG 1) M.C.A 45 AHU CU PKG AHU CU PKG 2) M.O.P 5o AHU CU PKG AHU CU PKG 3)VOLTS AHU CU PKG PKG UNIT / / PKG UNIT EER/SEER 13/16 YES NO REPLACING DUCTS YES NO NO YES NO REPLACING THERMOSTAT YES NO YES YES NO NEW 4"CONCRETE SLAB YES NO NO YES NO NEW ROOF STAND YES NO NO YES NO NEW RETURN PLENUM BOX YES NO No 1. Minimum Circuit Ampacity (Wire Size): 45 2. Maximum Overcurrent Protection (Fuse/Breaker Size): 50 3. Voltage of Circuit (208/240/480): 4. Size Disconnecting Means: Contractor's Company Name: COOL AIR USA Phone: 954-915-1155 State Certificate orrRRe 'ation No. CAC1815656 Certificate of Competency No. Si gnature -J7Date: f1mL 1mses signature) (Revised02/24/2014) This combination qualifies for a Federal Energy Efficiency Tax Credit when placed in service between Feb 17, 2009 and Dec 31, 2013. Certificate of Product Ratings AHRI Certified Reference Number: 5756178 Date: 7/12/2014 Product: Split System: Air -Cooled Condensing Unit, Coil with Blower Outdoor Unit Model Number: GSX160601F* Indoor Unit Model Number: ASPT60D14A* Manufacturer: GOODMAN MANUFACTURING CO., LP. TradeBrand name: GOODMAN, JANITROL, AMANA DISTINCTIONS, EVERREST, ONE HOUR AIR CONDITIONING AND HEATING, ENERGI AIR Series name: GSX16 Manufacturer responsible for the rating of this system combination is GOODMAN MANUFACTURING CO., LP. 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): 54000 EER Rating (Cooling): 13.00 SEER Rating (Cooling): 16.00 IEER Rating (Cooling): ' Ratings followed by an asterisk (') Indicate a voluntary rerate of previously published data, unless accompanied with a WAS, which indicates an involuntary rarate. 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.ahridirectory.org. TERMS AND CONDITIONS This Certificate and Its contents are proprietary products of AHRI. 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. AIR-CONDITIONING, HEATING, CERTIFICATE VERIFICATION &REFRIGERATION INSTITUTE The Information for the model cited on this certificate can be verified at www.ahrldlrectory.org, click on "Verify Certificate' link we make.life letter - 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 -Conditioning, Heating, and Refrigeration Institute CERTIFICATE NO.: 130496602242005561 Date Y Tech- Name w�EiA11L�glYL Ip`@+a Address, [�y(L• l l'r�'I Apt. q — UC* Coc tatsasa City, / /4vt1U !&-+7 ' G , St p 1 �i 7J COOL AIR U.S.Q. / '� _ I A1C Service & Air Duct Cleaning Tei �Y.ell 4151 SW 471h Ave - Suite 2B - Davie FL 333I4 Toll Frcc 1-877-895-1155 WWW.COOLAIRUSA.COt,A Email/Fax: i tus t-roposw Is to give you an esumare Tor turnlarnng, installing ane guarantee all PROPOSAL l 66' NTRA-CT— Refrig Type DR -22 D Rd laza JOB rt _ _ f ! �•• ! L ULR3I UNItHMLAi1 HtUlbIt_N UNII UF4UNt:FUNMANUI-AU IUMWAHHAN I 1 Pressure HI • r �. "-�tallatien is to the e��Et 2liaik1[ifie u -Closet -Garage -Other Cl Fused Disc-Ahu-CN /"'Aconnect Existing Ductwork 0 Filter ornoN #1 Brand Seer f j L U-AtdC-Garage-Other Cl Whip and Wire D Additional Ductwork 0 Extended Warranty OPTION 92;E Brand Seer (fes EXISTING EQUIPMENT BRAND 0 Size of Attic Open X Reconnect to bxisdng Eiec 0 Filter Back Grill fl Mach Permit • L11 # L11 AUL AHU # �� lt� Cr CM -Ground -Roof -Other 4 Smoke Detector l7 Transfer Grills Q Crane cru Yf HS f;-- cru 6UX 1t q & 0 t J ft. Ground -Roo! -Other Cl Other Elee items!' nnect to Existing Drain 0 Vibration Pads Heat Kw 5 8 (10)7.5 HP Fum• AIR HANDLER BRAND Model Serial t Switch E3 W Light 17 Cond. Pump. 115 240 ❑ Mise. items Total Price FPL Rebate Kestat _ 1 ,Mater Rack 0 Secondary Pan Net Price ' �� Net Price -�9;2 1Service Contract Mr -H Rebates C� �' MFR Rebates 1 Q 1 Year Q 2 Years J 3 Years Net Price Net Price �" Q 4 Years D 5 Years MFR. Wa rranty .. MFR, Warranty _Year Parts —Year Compressor Parts —Year Parts —Year Compressor Parts Service Call Year Labors . —Outdoor Coil _ Year labors _ Outdoor Coil , K I hereby authodze COOL AIR USA Air Conditioning Service to charge the listed credit card for the amount of $ vara by, D Finance D Cash Q Check # 0 Visa D MC R AMEX D Discovery CW # Fx. Date.CC 4 Authorization # Di # , Permi costs and Financing Application Fees are not refundable: Initials i/t f je D Signing this section indicates the receipt of the estimate, but does not obligate me to Its perforinancer Signature I(��� 1 Date ! D ay $*" t,ea.+; an Ww &.forces perm Nm of ak above ssnke and am•'eea to me lame a conddrmc eeumm m me reverse ane or ma wreerrbnt wm rawd m Vww w+w'& y mammw.ark4,iowwd by cm me wm re" /erVtCE! are peftmac CmOww mo arm la pay k run ale d"ea relermvd above, kXkd tp 0 AMNO re tue; W90wlr w ft war cnarot tw aWtow wv caa 11V twooud. we aro not reapwoble Im arty para t i s i al,mt reQiaan amrennvee by Cuammer at ffte tna �rvicee am Signature Date VERIFIED THAT THE AC UNIT IS IN WORKING CONOMON AND THE WORK HAS BEEN COMPLETED TO MY SATISFACTION, Customer Date 1 Pressure HI • r �. "-�tallatien is to the e��Et 2liaik1[ifie ornoN #1 Brand Seer f j L OPTION 92;E Brand Seer (fes EXISTING EQUIPMENT BRAND t L11 # L11 AUL AHU # �� lt� CONDENSER BRAND Model • Serial. cru Yf HS f;-- cru 6UX 1t q & 0 t Heat Kw 5 B 7,5 HP Fum Heat Kw 5 8 (10)7.5 HP Fum• AIR HANDLER BRAND Model Serial Total Price Total Price FPL Rebate FPL Rebate C2 r! t>f .' Net Price ' �� Net Price -�9;2 1Service Contract Mr -H Rebates C� �' MFR Rebates 1 Q 1 Year Q 2 Years J 3 Years Net Price Net Price �" Q 4 Years D 5 Years MFR. Wa rranty .. MFR, Warranty _Year Parts —Year Compressor Parts —Year Parts —Year Compressor Parts Service Call Year Labors . —Outdoor Coil _ Year labors _ Outdoor Coil , K I hereby authodze COOL AIR USA Air Conditioning Service to charge the listed credit card for the amount of $ vara by, D Finance D Cash Q Check # 0 Visa D MC R AMEX D Discovery CW # Fx. Date.CC 4 Authorization # Di # , Permi costs and Financing Application Fees are not refundable: Initials i/t f je D Signing this section indicates the receipt of the estimate, but does not obligate me to Its perforinancer Signature I(��� 1 Date ! D ay $*" t,ea.+; an Ww &.forces perm Nm of ak above ssnke and am•'eea to me lame a conddrmc eeumm m me reverse ane or ma wreerrbnt wm rawd m Vww w+w'& y mammw.ark4,iowwd by cm me wm re" /erVtCE! are peftmac CmOww mo arm la pay k run ale d"ea relermvd above, kXkd tp 0 AMNO re tue; W90wlr w ft war cnarot tw aWtow wv caa 11V twooud. we aro not reapwoble Im arty para t i s i al,mt reQiaan amrennvee by Cuammer at ffte tna �rvicee am Signature Date VERIFIED THAT THE AC UNIT IS IN WORKING CONOMON AND THE WORK HAS BEEN COMPLETED TO MY SATISFACTION, Customer Date