MC-14-1374Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-214892
Scheduled Inspection Date: July 23, 2014
Inspector: Perez, JanPierre
Owner: MICHELS, SAMUEL
Job Address: 1070 NE 92 Street
Miami Shores, FL
Project: <NONE>
C L -
Permit Number: MC -6-14-1374
Permit Type: Mechanical - Residential
Inspection Type: Final
Work Classification: A/C Replacement
Phone Number
Parcel Number
1132050130040
Contractor: C&R AIR CONDITIONING CO Phone: 305-685-6394
lsunaing uepanment comments
EXACT CHANGE OUT OF EXISTING 2 1/2 TON UNIT
SPLIT SYSTEM
INSPECTOR COMMENTS False
July 22, 2014 For Inspections please call: (305)762-4949 Page 8 of 24
Inspector Comments
Passed
Failed
Correction
Needed ❑
Re -Inspection ❑
Fee
No Additional Inspections can be scheduled until
re -inspection fee is paid.
July 22, 2014 For Inspections please call: (305)762-4949 Page 8 of 24
r ' Miami 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
FBC 20
u�► 8 2014
Master Permit No.&'/�_— 2-41
Permit Type: MECHANICAL k
OWNER: Name (Fee Simple Titleholder): ltt'm LPhone#: ODSWI - 4,r9 1 p
Address: 107 0 ,/l C'q d 4r
' ko(1�s
City: � f q v'h .� SState: 1 Zip: �31 1 2
Tenant/Lessee Name: Phone#:
Email:
JOB ADDRESS: 10 7 0 N E 9 a s T
City: Miami Shores County: Miami Dade Zip: ;3:3
Folio/Parcel#:
Is the Building Historically Designated: Yes
NO z Flood Zone:
CONTRACTOR: Company Name: c `�• R V � % yr ` e ®+` � • � 0 • Phone#: 3o ,T 6 916 3 14
�
Address: 013 3 1 y Q 0 to � 7 47 C. - L4 �^ p�
City: A I' State:
State: f Zip:
is -
Qualifier Name: Q 6 b e f' J C k P,r t T _ Phone#:
State Certification or Registration #: c A C 02 6 Ll l t( Certo'
Certificate of Competency #: ® 4' t 0 a '-)
Contact Phone#: Email Address: C q nj R 9 C co'n a®n l@ A 0 a. c d M
DESIGNER: Architect/Engineer: Phone#:
Value of Work for this Permit: $ 13 19 1 Square/Linear Footage of Work:
Type of Work: OAddress _ OAlteration ONew _ Wooepair/Replace
Description of Work:
k
ODemolition
Submittal Fee $ Permit Fee $ CCF $ CO/CC $
Scanning Fee $
Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
Technology Fee $
TOTAL FEE NOW DUE $
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 ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and 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 insp tion which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will be approved and a reinspection fee will be charged.
Si nature I� f/a SignaturUWe.
g
Owner or Agent Contractor
The foregoing instrument was aXT
ed be�foof a me t is The foregoing instrument was acknowledged before me this 2
day of n , 20 L( , by / �! day of 3 Cit n e , 20 H, by e 6 ee P r a
who i personally known' me or who has produced who ' personally kno o me or who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
Sign:'°
Print: oVert Z. C Nt a J t
My Commission Expires:
APPROVED BY
ROBERT J. CHRYST
Cnsv%is on # FF 088047
Ex -1+:a .,Aay 24, 2018
i dod tt" Imy Fen kwxw e801- 7
(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)
4a 'ner
Structural Review
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My
'commission # EE 091937
Expires May 9, 2015
ft" n mRoyFdnna m=00.,W7M
Zoning
Clerk
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): 167 0 N Ir I a sT
City: Miami Shores Village County: Miami Dade Zip Code: �� 1
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 ❑ NO ❑ ARHI Sheet Attached: YES ❑ NO ❑ Contract Attached: YES ❑
UNIT BEING REPLACED
DATA
N W UNIT
r Q
MANUFACTURER
U
F IF
3
AHU or PKG. UNIT MODEL #
a.-t'TD
14
COND. UNIT MODEL #
14 AfT /V►
KW HEAT
NOM TONS
2;5-
,1AHU
AHUCU
PKG
1 M.C.A
AHU CU Ig PKG
AHU CU
PKG
2 MAP
AHU CUA 0 PKG
AHU CU
PKG
3 VOLTS
AHU CU PKG
PKG UNIT
I
l
PKG UNIT / I
EERISEER
I t .
YES
NO
REPLACING DUCTS
YES ONO
YES
NO
REPLACING THERMOSTAT
VW NO
YES
NO
NEW 4"CONCRETE SLAB
YES NO
YES
NO
NEW ROOF STAND
I YES
YES
NO
NEW RETURN PLENUM BOX
I YES
1. Minimum Circuit Ampacity (Wire Size): 18 '1110
2. Maximum Overcurrent Protection (Fuse/Breaker Size): 30
3. Voltage of Circuit (208/240/480): �- 4 0
4. Size Disconnecting Means: :3 0
Contractor's Company Name: A " r Co r%J . C O . Phone:
State Certificate o RegistratioKWeessfgnature
C02 G 41 Lf Certificate of Competency N. 0 ti 8 ir® a�
Signature Date: 4-26' y
only)
C&R C&R Air Conditioning Co. C&R
6073 NW 167h Street Suite C-4 Miami Gardens, FL 33015-4330 < >
DAT]R- x1715-AR'll RR(1WART71• oSd-ARA-AAQA
CUSTOMER
Sam Michels Residence
si$
PHONE NUMBERS
CELL 1 6-25-14
ADDRESS 305-757-5599 305-613-6122
1070 NE 92"� Street ❑UNDER CONSTRUCTION
CITY ZIP Email:
Miami Shores 33138 ® EXISTING STRUCTURE
We hereby propose to: Furnish, install and service the equipment and materials listed below with the conditions and specifications detailed below during our
regular working hours of Monday through Friday 8:30 – 4:30.
NEW EQUIPMENT System # 1 $ 4489.00 System #2 $ System #3 $
FPL Rebate (instant)
Your Investment
Manufacturer
Condensing Unit Model #
Air Handler Model #
Refrigerant
Heating KW
Btuh
S.E.E.R.
Warranties *IF REGISTERED
Condensing Unit Stand
® Concrete Slab
❑ Other
❑ Package Unit Change -out
500.00
3989.00
RUUD
14AJM30
RHBLFR36
R410
28.800
16.0
Parts 10 Yr. Compressor 10 Yr.
1 Year Labor
® Air Handler Stand
® Thermostat D
® Reconnect to Existing System
1-01
A qualified air conditioning expert will start
Parts _ Yr. Compressor —Yr. Parts _ Yr. Compressor _ Yr.
I Year Labor 1 Year Labor
® Float Switch
® Auxiliary Drain Pan
® Existing Reconnection
❑ New Electric
El
item and explain its operatic
❑ Ref. Line cover
❑ UV Light
❑ Condensate Line
❑ Fire Dampers
® Existing Reconnection
❑ Ref lines ft.
® Flush Lines
for a two week period from date of proposal and at
mal time is suoleca to review. i me to the system snail remain in us until all sums due us have been fully paid. In the event the purchaser fails to comply with any
of the requirements of this contract and such default results in litigation, the Purchaser agrees to pay reasonable attorney's foes and all court costs and expenses
incident to such litigation. Delinquent payments shall bear 1.5% per month interest from due date until paid. All work is to be performed during our regular work
hours unless otherwise specified. This contract contains all agreements. Neither party shall be bound by any representation, warranties nor agreements, oral nor
written not herein contained. This proposal shall become a contract when accepted by you and approved in writing by our duly authorized corporate officer.
We agree to furnish and install the above described labor and materials on the terms indicated below for System # 1
TOTAL INVESTMENT $ 4489.00
FPL/DEALER
REBATE $ - 500.00 FPL Account#
YOUUER
ENT $ 3989.00
PERT INCLU D
PURCHA �r DATE ,
VALID
JOB NOTES
0;�04PRESENTATIVE
u _;
50% DEPOSIT $ 1995.00
50% DUE WHEN
READY TO OPERATE $ 1994.00