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MC-14-1841Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-218360 Permit Number: MC -8-14-1841 Scheduled Inspection Date: September 03, 2014 Permit Type: Mechanical - Residential Inspector: Perez, JanPierre Inspection Type: Final Owner: , Work Classification: A/C Replacement Job Address: 530 NE 91 Street Miami Shores, FL 33138-3153 Phone Number Parcel Number 1132060400010 Project: <NONE> Contractor: DYNAMIC AIRFLOW CORP Isulliamg uepartment comments EXACT CHANGE OUT 4 TON Infractio Passed Comments INSPECTOR COMMENTS False September 02, 2014 For Inspections please call: (305)762-4949 Page 18 of 30 Inspector Comments Passed Ll'z Failed Correction Needed ❑ Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. September 02, 2014 For Inspections please call: (305)762-4949 Page 18 of 30 Miami Shores Village g RECEIVED Building Department AUG 22 2014 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 By Tel: (305) 795-2204 Fax: (305) 756-8972 -- INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC 20 L0 BUILDING Master Permit No. rn�9`�—•1 �'� PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING Ro MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: .`Z�� ® N Q i City: Miami Shores County: Miami Dade Zip: 53 13 Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (fee Simple Titleholder): Phone#: Address: City: Tenanl Email: � A �, State: 4 A— a Zip: % 3 P CONTRACTOR: Company Name: Address: C3c`hS`) S70 g® I 5�" City: �,iG'�%ht ,, rr-- State: L. Zip: c_ 7 Qualifier Name: A�M � KJ 1 Gt�jq) 07- Phone#:r INFO 61'1 a 16 i State Certification or Registration #:i Certificate of Competency #: _ DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ '330 y Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace Description of Work: ❑ Demolition Specify color of color thru tile: Submittal Fee $ ` _Permit Fee. 5j 6D CCF $ CO/CC $ Scanning Fee $ Radon Fee $ Technology'Fee $ Training/Education Fee $ Structural Reviews (Revised02/24/2014) DBPR $ Notary $_ Double Fee $ Bond $ TOTAL FEE NOW DUE $ R 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"R"' The foregoing inWtjument s acknowledged before me this as �"�/-day f 20 � by V"'� ( ��� , who is personally known to me or who has produced identification and who did alb 8 The foregoing instrument was acknowledged before me this day of 20 by s/s� ho is Dersonativ known to me or who has producegas EASANDRAHARRISON identification and who/did take an oath. Notary Public, State of Florida I , NOTARY PUBLIC: Commission # EE 198163 NOTARY PUBLIC: My comm. expires May 14, 2016 Sign: ign: n . Print: Print: Notary Public, tate of Florida Seal: Commission#EE 198163 Sea]: "'pal�v, Re ►" •��a,� VIOlE1A GUERRER0 ate AI:lof lMay14,2016 ?* ,n Commission # FF 62432 nny Commission Expires '�;;;;°a`�•° October APPROVED BY tans Examiner Zoning Structural Review Clerk (Revised02/24/2014) J , 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"R"' The foregoing inWtjument s acknowledged before me this as �"�/-day f 20 � by V"'� ( ��� , who is personally known to me or who has produced identification and who did alb 8 The foregoing instrument was acknowledged before me this day of 20 by s/s� ho is Dersonativ known to me or who has producegas EASANDRAHARRISON identification and who/did take an oath. Notary Public, State of Florida I , NOTARY PUBLIC: Commission # EE 198163 NOTARY PUBLIC: My comm. expires May 14, 2016 Sign: ign: n . Print: Print: Notary Public, tate of Florida Seal: Commission#EE 198163 Sea]: "'pal�v, Re ►" •��a,� VIOlE1A GUERRER0 ate AI:lof lMay14,2016 ?* ,n Commission # FF 62432 nny Commission Expires '�;;;;°a`�•° October APPROVED BY tans Examiner Zoning Structural Review Clerk (Revised02/24/2014) 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 l� PERMIT NUMBER: MC -I� a 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): -� `' A"4 City: Miami Shores Village County: Miami Dade Zip Code: 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 FLKL ARHI Sheet Attached: YES NO ❑ Contract Attached: YES 21 1. Minimum Circuit Ampacity (Wire Size): 'S 2. Maximum Overcurrent Protection (Fuse/Breaker Size): 3. Voltage of Circuit (208/240/480): 4. Size Disconnecting Means: Contractor's Company Name: D fro A,,- %�,�o _C�� Phone: cr State Certificate or Registration. No. rj}G/(�7fr��Certificate of Competency No. Signature Date: e6,14._ 1 it (Qualifier' (Revised02/24/2014) UNIT BEING REPLACED DATA NEW UNIT MANUFACTURER AHU or PKG. UNIT MODEL # COND. UNIT MODEL # KW HEAT 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 . YES NO REPLACING DUCTS YES YES NO REPLACING THERMOSTAT COE NO YES NO NEW 4"CONCRETE SLAB - E NO YES NO NEW ROOF STAND YES (10 YES NO NEW RETURN PLENUM BOX YES NO 1. Minimum Circuit Ampacity (Wire Size): 'S 2. Maximum Overcurrent Protection (Fuse/Breaker Size): 3. Voltage of Circuit (208/240/480): 4. Size Disconnecting Means: Contractor's Company Name: D fro A,,- %�,�o _C�� Phone: cr State Certificate or Registration. No. rj}G/(�7fr��Certificate of Competency No. Signature Date: e6,14._ 1 it (Qualifier' (Revised02/24/2014) DYNAMIC AIRFLOW CORP. 13727 SW 152 ST. #213 Miami, Florida 33177 FL. LIC.# CAC1817782 John Dillon 530 NE 91s` ST Miami, Florida PROPOSAL We hereby submit specifications and estimate for: 4.0 Ton exact replacement system. Connected to existing electrical, plumbing and ductwork. Lennox 16 SEER • New lineset and flush main condensate drain. • Water level safety shut off switch. • New filter drier. • Dehydrate system. • New pre fabricated concrete slab. • Anchor condensing units per high velocity wind zone requirements. • New digital thermostaf. • Reinsulate the return box + Removal and disposal of old system. • Labor.w a • Price installed as �erabae specs, all else excluded: $3,650.00 4 • Permit Estatek3140 ©U (permit'cos will`.be add'ao the price�above) . OTE: We do dot repair wall, telling or painted $ince¢: We will tape the utmost care for �rour property. Dynamic Airflow Corp. or its employees n¢t be responsible for thje repairs" foe, the T? building. If unseen work is required it will be executed uport written proposal. NOTE: Dynamic Airflow is not)resinsible for any lectrical9world Payment Options: SO°fog 'a1 50410 Installed F f All material is g ' r d to' be as specified. All work to be completed in a workman like roamer according to standard practices. Any alteration or deviation from the above specifications involving extra cost, will be executed only upon written orders, and will become an extra charge over the above estimate. This proposal subject to acceptance within 10 days and is void at the option of the undersigned. AUTHORIZED SIGNATURE Arash Khaymedooz, electronic signature.08/19/2014 ACCEPTANCE OF PROPOSAL: The above prices, specifications, and conditions are hereby accepted. You are authorized to do work as specified. Payment will be male upon completion of work or as other wke specified. Failure to make payment will result in Legal action and it is andthat reasonable attorneys fees will be applied to balance owed. ` ACCEPTED: � � DATE: SIGNATURE:G�\� PRINT: —b ; �` b Our installations follow industry standards: Please prote yourself against unlicensed contractors. Visit www.myflorida.corn and use Licensee Database Search. Thank you for allowing my company to service your investment. Arash lQaymedooz Miami shores Village Building Department 10050 N. E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Notice to Owner —Workers' Compensation Insurance Exemption Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05 allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to obtaining a building permit. Pursuant to the Florida Division of Workers' Compensation Employer Facts Brochure: An employer in the construction industry who employs one or more part-time or full-time employees, including the owner, must obtain workers' compensation coverage. Corporate officers or members of a limited liability company (LLC) in the construction industry may elect to be exempt if 1. The officer owns at least 10 percent of the stock of the corporation, or in the case of an LLC, a statement attesting to the minimum 10 percent ownership; 2. The officer is listed as an officer of the corporation in the records of the Florida Department of State, Division of Corporations; and 3. The corporation is registered and listed as active with the Florida Department of State, Division of Corporations. No more than three corporate officers per corporation or limited liability company members are allowed to be exempt. Construction exemptions are valid for a period of two years or until a voluntary revocation is filed or the exemption is revoked by the Division. Your contractor is requesting a permit under this workers' compensation exemption. In these circumstances, Miami Shores Village does not require verification of workers' compensation insurance coverage from the contractor's company. Therefore. you mate personally liable for the worker compensation iniuries of any person allowed to work under this permit Please check with your insurance carrier since most property insurance policies DO NOT cover this type of liability. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Owner Contractor Print Name: k 0 l Print Name: t Signature: Signature: State of Florida) State of Florida ) County of Miami -Dade) �� County of Miami Sworn to)MV subscrib d before me o44d sut day of _,20 CABANDRAHR of VJ9 public, state of Florida By 0"m1won 6 EE t 163 V omm. expires May (SEAL) Type of Identification of Im VIOLETA GUERRERO Commies rt�,FF 62432 t� Expires I tober 13. 2017 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 Ratinas AHRI Certified Reference Number: 3869174 Date: 8/21/2014 Product: Split System: Air -Cooled Condensing Unit, Coil with Blower Outdoor Unit Model Number: 14ACX-047-230* Indoor Unit Model Number: CBX27UH-048-230*+TDR Manufacturer: LENNOX INDUSTRIES, INC. Trade/Brand name: MERIT Series name: 14ACX SERIES Manufacturer responsible for the rating of this system combination Is LENNOX INDUSTRIES, INC. * Ratings followed by an asterisk (*) 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.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.ahrldirectory.org, click on 'Verify Certificate" link we make fife better"' 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 1 'CERTIFICATE NO.: 1305312165241988: