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MC-14-1221Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-213956 Scheduled Inspection Date: July 23, 2014 Inspector: Perez, JanPierre Owner: , Job Address: 9035 NE 5 Avenue Miami Shores, FL 33138 - Project: <NONE> 0L Permit Number: MC -6-14-1221 Permit Type: Mechanical - Residential Inspection Type: Final Work Classification: A/C Replacement Phone Number (305)219-8267 Parcel Number 1132060400040 Contractor: KINGDOM AIR CONDITIONG INC Phone: (305)553-9946 Building Department Comments REPLACE 5TON CENTRAL AC Infractio Passed Comments INSPECTOR COMMENTS False < -Zl July 22, 2014 For Inspections please call: (305)762-4949 Page 6 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 6 of 24 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fag: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION Permit Type: MECHANICAL JUN 1120% FBC 20 LO Permit No. ry"�C Master Permit No. — d I Z `l JOB ADDRESS: 1? 0915— V 5— City: Miami Shores County: Miami Dade Zip: `tel Folio/Parcel#: Is the Building Historically Designated: Yes NO &/ Flood Zone: OWNER. Name (Fee Simple Titleholder): A -t LI CO' `d .T cl t e S'4 t J Phone#: Address: - JJ t S -L' 6 � eA - 10 f -h `` .C— City: f� 4 te' ek Gg State: C6 Zip: �� C Tenant/Lessee Name: Email: • • • s� WA 0�J",'"V Ill raw "zwk l% Phone#:._?� State Certification or Registration #: (_1 d C ( Y 60 , U Certificate Of�Competency #: Contact Phone# ®� �, Email Addres Q /(4"17!jj4 0 fV air iia Pi 0 �► DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ 33 5_0 - ® 0 Square/Linear Footage of Work: Type of Work: OAddress OAlteration ONew Description of Work: k4.& Submittal Fee $—%`�Permit Fee $ Scanning Fee $ r L Radon Fee $ CCF $ CO/CC $ DBPR $ Bond $_ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ ODemolition 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 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. -J SignatureyZ-- Owner or Agent The foregoing instrument was acknowledged before me this day of 6 20 �,, by An�i�/2_e� i&V�C Y who isrsonally known me or who has produced As identification and who did take an oath. The foregoing instrument was ack4 owledgerd before me this day of �'1%tr ' 666.20 by 7Q I•'�i . who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: NOTARY P C: Sign: D/ �� (�Sign: Print: Print: eV -C �•o` !� M C x,Qp�mtssion # EE 118040 My Commission Exp .�►yi�c p gg,� y y Commission Expires WC8MMWW#EEFM1h July 26, 2018 * * EXPIRES:Ju1g31,2118 �' AF �e�h4e�3e APPROVED BY Plans Examiner zoning Structural Review Clerk Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) aw • Qr • 0 N S,IMIM.9�LOI�DA... 'J.3 ..r1�.�'�S'ti'�"'�P•'`�!� ii7. I' •yw. _ .... r���.�Y��'M�V: -:21� Sr'�R'.:'•-���� •• cl iacatf Q�a 1On� or.,. date: �Ci •. 1 i4 4 IN AGS w' : •'�'i. w?: �� ¢ .9 . 'i' 'P. 5 a t. mo $02i Sid' 15��NA�T1,0 " COURT FL 3x8$ ;• ''�' X ORT ZO/ZO 3E)Vd WOO•IWVIWNIdWOQJNIN 599508'0506 EO"E'l tTOZ/'00/90 08/05/2014 14:21 FAX CRUM Im 001/001 CERTIFICATE OF LIABILITY INSURANCE DATE IMMlDDIWYri 8/5/2014 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 certifloste holder Is an ADDITIONAL INSURED, the policy (i196) must be andomed, If SUBROGATION IS WAIVED, subject to the terms and eondltiorm of the policy, certain policies may require an endorsement A statement on this certificate does not Confer rights to the certificate holder In lieu Of Such an orsa n s . SUER WVD CONTACT PRODUCER �Ae• We as Enit 1-800-277-1020 x4800 lap, Her 7274797.0704 aw- spmll w FRANKCRUM INSURANCE AGENCY, INC. INSURERM) AFFORDING COVERAGE NAICi 100 S MISSOURI AVE INSURER A' FRANK WNSTON CRUM INSURANCE CO. 11600 CLEARWATER FL 33758 INSURED INSURER B. INSURGH C: INSURER D FrankCrum 1-800-277-1820 INSuRCR C 100 5 MISSOURI AVENUE INSURER F. CLEARWAY R FL 33760 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW NAVE 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 13 SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE IMEN REDUCED BY PAID CLAIMS. twAB LTR TYPE Of INSURANCE ADDL LIVER SUER WVD POUCY NUMVIR POLICY EFF (MNUDDMI'rY) POLICY EXP (MMICONV" LIMTS OENERAL LIASUM EAGNOt:GURREM E $ DAWICL t4pfwrFO COMMERCIAL GENERAL UABIUTY PREMISES(Ea o mens. $ MPD EXP m. —M $ CLAIMS MADE =OCCUR PERSONALS APMINJURY $ GENERALAGGREGATE $ OEN'L AGGREGATE LIMIT APPLIES PER' PRODUCTS. COMP/CP AGO $ S roucr rnaacm we COMBINED SING LE LIMIT AUTOMOBILE LIABD.ITY (F,,. $ BODILY INJURY (Pet pNfenl $ ANY AUTO ALLOVVNEC 80WEDULFM AVIOS AUTOD LWU4Y WJUNY (Vor em9evrd) $ NON-0WNED PR ENI Y DA9051.1 FgREO AWTOg AUTOS T $ UM RELLA UAB OCCUR EACH OCCURR NCE $ AG RCCATF $ EXDEES UAE LADd.1•MAOE DED I I RETGNT1QNi $ A VWWNMS CDMP=MArW N AND EMPLOYERII' UASILITY ANY PROPF46TORWAMWER XECUTIVE OPPICERMff7dSER EXCLUDED? NIA WC2044000M 1/1/2014 111/2015 M STATU. CR E L. EACI I ACCIDENT 1 DOD 000 (MmNENON p1 NH) U r.w L%Abt11N Ldt" F1 DISEASE. EA EMPLOYEE 81 0w 000 D@SCRIPTION OF oft" IONS b k. E L DIS E • eQUOY LIMIT 1 O00 O00 IMMMIPtiONCO OOEOATtU NS a LOOAIWNa ! VEHICLES (AUkA ACORD 1D1, AddSlomd Remm1O EtAl 1d, 11 mom spew Is NGWmq EFFECTIVE 07/1212006, COVERAGE IS FOR 100% OF THE EMPLOYEES OF FRANKCRUM LEASED TO ARCON INDUSTRIES, INC. DEA ARCON ROOFING DBA EMANUEL CAZACU ENTERPRISES (CLIENT) FOR WHOM THE CLIENT IS REPORTING HOURS TO FRANKCRUM. COVERAGE IS NOT EXTENDED TO STATUTORY EMPLOYEES. (CLIENT REF' QUALIFIER: LICENSE: CCC057877) 01989-x010 ACORO CORPORATION. Air naRG rmwee. ACORD 25 (20101051 T11e ACORD name and logo aro regixterad merles ofACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES SE CANCELLED BEFORE THE EXPIRAV Nd DATE THEREOF, NOTICE WILL 06 DELIVERED IN MIAMI SHORES VILLAGE ACCORDANCE WITH THE POLICY PROVISIONS. ATTEN; JOANNA 10050 N.E. 2ND AVENUE MIAMI SHORES, FL 33133 AUTHORIZED REPRESENTATIVE 01989-x010 ACORO CORPORATION. Air naRG rmwee. ACORD 25 (20101051 T11e ACORD name and logo aro regixterad merles ofACORD JWF ATWATER STATE OF FLORIDA CN1WFIN4N0IAL0F"C,ER DEPARTM15NT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION CERTIFICATE . Of RKTION TO 89 EXNAPT FROM FLORIDA WORKIIRF COMMSATION LAW CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers'. Compensation law. EFFECTIVE . DATE: 12112/2012 PERSON: p� FEIN: 650701641 BUSINESS NAME AND ADDRESS: KIN&WM AIR COMMUNING M 90651 KV 132 Si # 4 WXALEAH GAMEW FL 33018 Z0/10 39Vd EXPIRATION DATE: 12/12/2014 MICHEL O Woo'IWviwaivwoa0NIi 999908b90E EO:ET tTOZ/b0/90 6/9/2014 3:02 PM FROM: Fax M M FAMILY INS LTD TO: 305 756 8972 PAGE: 001 OF 001 '% r CERTIFICATE OF LIABILITY INSURANCE DATE 06/05/ 6/05//4 14 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(les) 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 does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER M&M Family Insurance, Ltd. 12260 S.W. 8th St. #228 Miarrll, FL 33184 Phone (305) 5545282 Fax (305) 552-8970 CONT_NAMEACT PHONE , (305) 5545282 1 WAX, No : (305) 552-8970 E-MAIL mdhinseprodigy.net INSURERS AFFORDING COVERAGE NAIC INSURERA: ASCENDANT COMMERCIAL INSURANCE INSURED KINGDOM AIR CONDITIONING INC 10651 NW 132 St Bay #4 MIAMI, FL 33018- (305) 986-0424 INSURER B INSURER C: INSURER D: INSURER E: INSURER F : THIS IS TO CERTIFY THAT THE POLICIES OF WSU RANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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 SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDLSUBRPOLICY POLICY NUMBER EFF M/DD/YYYY POLICY EXP M IDD/YYW LIMITS A GENERAL LIABILITY ® COMMERCIAL GENERAL LIABILITY ❑ ❑ CLAIMS -MADE © OCCUR F-1 GL-38120-209/07/2013 09/07/2014 EACH OCCURRENCE $ 1,000,000.00 DAMAGE TO RENTED 1 OO,000.00 PREMISESEa occurrence $ MED EXP (Any one person $ 5,000.00 PERSONAL & ADV INJURY $ 1,000,000.00 ❑ ' GENERAL AGGREGATE $ 2,000,000.00 GEMLAGGREGATE LIMIT APPLES PER: ❑ POLICY ❑ PRO ❑ LOC PRODUCTS-COMP/OPAGG $ 1,000,000.00 $ AUTOMOBILE LIABILITY ❑ ANY AUTO ❑ AUTOS ❑ AUTOS NED SCHEDULED F-1HIRED AUTOS ❑ NON -OWNED ❑ 1:1 AUTOS COMBIN SINGLE LUIT Ea a.dd rd BODILY INJURY (Per person) $ BODILY INJURY (Per accident $ PROPRTY AMAGE $ Pe'..Eiden ❑ UMBRELLA LIAB ❑ OCCUR ❑ EXCESS LIAB ❑ CLAIM&MADE N/A EACH OCCURRENCE $ AGGREGATE $ ❑ DED ❑ RETENTION WORKERS COMPENSATIONY / N AND EMPLOYERS' LIABILITYER ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below $ ❑ WC STATU- ❑ OTH- E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) Description of operations: Air Conditioning Installation and Repairs. Tech: Robert Sarduy (Qualifier) -- License # CAC1816661 CERT( FICATE HOLDER rano-F1 r errnm MIAMI SHORES VILLAGE BUILDING DEPARTMENT 10050 NE 2 AVE MIAMI SHORES FL 33138 ACORD 25 (2010/05) QF SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ®1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD • • ••• • • • •• • • o•• •• •• • •• • • • • • • • • • • • Miami Shores Village . ... . ... . . ........... Building Department ' 10050 N.E.2nd Avenue Miami Shores, Florida 33138 ..:06Tel. (305) 795.2204 . ......... . Fax, (305) 756.8972 AIR CONDITIONING REPMEMENT 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: q60,5- A/ City: Miami Shores Village County: Miami Dade Zip Code: 3 3 / y 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 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 AHG CU PKG PKG UNIT I I PKG UNIT I I EERISEER YES NO -7 REPLACING DUCTS YES NO YES NO REPLACING THERMOSTAT YES NO YES NOX NEW 4"CONCRETE SLAB YES NO YES NO A NEW ROOF STAND YES NO YES NO NEW RETURN PLENUM BOX YES NO 1. Minimum Circuit Ampacity (Wire Size): 2. Maximum Overcurrent Protection (Fuse/Breaker Size): 3. Voltage of Circuit (2081240/480): 4. Size Disconnecting Means: Contractor's Company Name: ®►� �( /1 Pho : ` - 6;T-3 State Certificate or Registration Signature (Qua s sign only) Certificate of Competency Date: A �'•'��Il11aC���rii�•'i i A i I2 C Q ,�T D� I •�' I O•N I N G MAINTENANCEit RE FI % �tP�.ACEMENT 000 10651 N.W. 132 St.: #4 Hialeah Gardens, FL 33018 DATE: ,5 / v/ Ta:OQ5-553;994Q. •• 1834 91K.� --- 1 161,1 - ��mn - JOB CUSTOMER 49 L5 CIM D���� JOB LOCATION EQUIPMENTF28- SYSTEM AND TYPE MATERIALUSED .✓i► _'its:.. `' UNIT. ,r •�;. SUPPLIES: —&9 SEER: Of .,Total v :.► REMARKS: ❑ KITCHEN ❑ DINING ROOM ❑ RETURN ❑ BATHROOM ❑ FLORIDA ROOM ❑ WATER PUMP ❑ LIVING ROOM ❑ BEDROOM ❑ ADDITION ❑ FAMILY ROOM ❑ DEN \ ❑ ❑ ❑ ❑ Purchaser Seller Purchaser Seller Local Permits and Licenses Draw Lines Equipment Foundation Refrigerant Lines Wiring from Building Panel to Unit Cutting Holes Wiring of Control system Bathroom Exhaust New Electrical Service Other Note: — ®� ,�_� iii - /) All equipment, parts, afd/ or materials used will be registered to the properly address and owner stated above for warranty purposes. No other warranty is implied other than the limited warranty stated above. The limited labor warranty does not cover damages caused by natural disaster or an uncontrollable city power surge. If any other company or individual other than a Kingdom Air Conditioning service technician performs any service, repair, troubleshooting, maintenance or system diagnostics test on the Air Conditioning system and/ or part( -s) installed by Kingdom Air Conditioning, the limited time labor warranty provided will be instantly voided. Payments on all work order must be paid in full within 30 days upon work completion and/or final state inspection (if required), no exceptions, Kingdom Air Conditioning reserves the right to reclaim andlor remove any equipment, parts, or materials installed on the property for any unpaid balance stated within the above contract The above work order quotation is only valid for 30 days following the date selected above, or time duration of any manufacturer specials or promotional offers, I agree to the above terms and conditions. INSTALLATION DATE: BUYER APPROVAL: INSTALLER: . . . . . . . . . . %: . . . ... • • . . ..0 't IM(milm Mw I AHRI Certified Reference Number: 45261& ••.D1ie: 594 . ..... %* . Product. Split System: Air -Cooled CondenslA§ UAit• 6110A4 4 Blewer- Outdoor Unit Model Number:13AJN60 Indoor Unit Model Number: RHLL-HM6024+RCSL4H*6024 Manufacturer. RHEEM SALES COMPANY, INC. Trade/Brand name: RHEEM, RUUD, WEATHERKING Series name: Manufacturer responsible for the rating of this system combination is RHEEM SALES COMPANY, INC. Rated as follows in accordance with AHRI Standard 2101240-2008 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): 57500" EER Rating (Cooling): 11.50 SEER Rating (Cooling): 13.50 LEER Rating (Cooling): * Ratings followed by an asterisk (*) Indicate a voluntary rotate of previously Wshed dam, unless accmnparded with a WAS, which Ind tales an involuntary rotate. DISCLAIMER AHRI does not endorse the product(s) listed on this Certificate and makes no representations, warranties or guarantees as to, and assumes no respormibillty for' unauthora�)listed on this Certificate. AHRI expressly alteration of data listed on this Certificatedisclaims all liability for Certified matings are valid damages nly for modelssaan configurations listed in tharising out of the use or e performance the product(s), or the directory at www.ahridlrectory.org. TERMS AND CONDITIONS f This Certificate and its contents are proprietary products of AHRL This Certificate shall only be used for individual, personal and confidential reference puirposes. 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, AIR-CONDITIONING. HEATING, personal and confidential reference. & REFRIGERATION INSTITLII'E CERTIFICATE VERIFICATION The Information for the model Cited on this certificate can be verified at www.a hridirectory.org, dict on `Verify certificate" link we make life 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 CERTIFfCATE NO.1304523568004670 02014 Air -Conditioning, Heating, and Refrigeration Institute I ''