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MC-14-1607Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-216571 Permit Number: MC -7-14-1607 Scheduled Inspection Date: September 15, 2014 Permit Type: Mechanical - Residential Inspector: Perez, JanPierre Inspection Type: Final Owner: MELTZ, JONATHAN Work Classification: A/C Replacement Job Address: 157 NE 104 Street MIAMI SHORES, FL 33138-2028 Phone Number Parcel Number Project: <NONE> Contractor: AIR AT YOUR DOOR, INC sunaing Department comments A/C UNIT REPLACEMENT INSPECTOR COMMENTS False 1121360130750 Phone: (305)885-7771 <q, q I 'I )� September 12, 2014 For Inspections please call: (305)762.4949 Page 8 of 26 Inspector Comments Passed Failed Correction Needed ❑ Re -Inspection ❑ Fee No Additional Inspections can be scheduled until reinspection fee is paid. September 12, 2014 For Inspections please call: (305)762.4949 Page 8 of 26 BUILDING PERMIT APPLICATION Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 ❑BUILDING ❑ ELECTRIC ❑ ROOFING �FBC 20 pw Master Permit No. l� u _, � L� ` \ � Sub Permit No. ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 157 NE 104 Street City: Miami Shores County: Miami Dade Zip: 33138 Folio/Parcel#: Is the Building Historically Designated: Yes NO - Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): Jonathan Maltz phone#: (786) 269-5630 Address: 157 NE 104 Street City: Miami Shores State: FL Zip: 33138 Tenant/Lessee Name: Phone#: Email: Jmeltz@bellsouth.net CONTRACTOR: Company Name: Air at Your Door, Inc. Phone#: (305) 885-7771 Address: 14262 SW 140 Street, Unit 103 City: Miami Qualifier Name: State Certification or Registration #: FL Zip: 33186 Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: Type of Work: ❑ Addition Description of Work: 0 City: State: Square/Linear Foo a of Work: kr Repair/Replace Zip: ❑ Demolition Specify color of color thru tile: Submittal Fee $ - (3 Permit Fee $ 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 $ G a V 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 ed notice, the inspection will not be approved and a reinspection fee will be charged i e Signature Signature OWNER orAGEN CONTRA The fore ping instrument was ackn ledged before me this d of 20, who is per onally known t me or who has produced as identification and who did take an o:�/%4 o NOTARY PUBLIC: ,e% Sign:_ Print: The foregoinginst I day of Mme or who has produced before me this 20 ,by who is personally known to as identification and who did make an oath. NOTARY PUBLIC: V I ' Print: vie -A (yy VC.ldi` L' eetttbjy . Seal: a°��v?�°� a Carlos A. NIeI�' Seal: �,ti,�,y :COMMISSIONREIMM Notary Pubes SM of Florida X(9RES: APR, 03 2D36 Henrry Valdivia , ++au nee My Cwlgr1lai011 EE 843234 x�a�**+swwwx��xx�x�w�x�+x+sw� **�x�a�*�•�xwr***�a�*�x�xx��w�+��*ww�x** � �ss3�$6i��*a�aw� *�� APPROVED BY � �Pla s Examiner Zoning 4A Structural Review Clerk (Revised02/24/2014) AIRAT-1 OP ID: SD ,,..- CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 07/22/14 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 certiflcate 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 Kahn -Carlin S Company, Inc. 305-046-2271 3350 S. Dixie Highway 305-448-3127 Miami, FL 33133-9984 CONTACT PHONE FAx SA No Ext : 305-446-2271 (Alk No : 305-448-3127 AD RESS: processing@kahn-carlin.com INSURER(S) AFFORDING COVERAGE NAIC S INSURER A: FCCI Advantage Insurance Co 12842 INSURED Air At Your Door Inc. 14262 SW 140 St, #103 Miami, FL 33186 INSURER s: National Trust Insurance Co 20141 INSURER C: INSURER 0: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE 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 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 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shore Village g POLICY NUMBER POLICY EFF MMIDD POLICY EXP MMIDD LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR CPP001754501 10/22/13 10/22/14 EACH OCCURRENCE $ 1,000,00 PREMISES Ea occurrence $ 100,00 MED EXP (Any one person) $ 5,00 PERSONAL &ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRO LOC POLICYFX-JFC PRODUCTS - COMP/OP AGG $ 2,000,00l( $ B AUTOMOBILE LIABILITY X ANY AUTO ALL OWNED SCHEDULED AUTOS NUTOS ON -OWNED HIRED AUTOS AUTOS CA0026519-01 10/22/13 10/2204 EBMBjINSINGLE UMfi $ 1,000,00 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY AMAGE $ Per. dent UMBRELLA LIAB EXCESS LIAR HCLAIMS-MADE OCCUR EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN OFFICER/MEMBER EXCLUDED? N (Mandatory In NH) If describe under under DESG�RIPTION OF OPERATIONS below N / A 001 WC13A69365 10/22113 1012204 WC STATU- OTH- X TORY UMllf ER E.L. EACH ACCIDENT $ 500,00 E.L. DISEASE - EA EMPLOYEE $ 500,00 E.L. DISEASE - POLICY LIMIT $ 500,00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, H more space is n,q nKQ Re: State of Florida License CAC1817285 ACDTIClf%ATF UnI ncD nAlkI _FI I AT1111M MIAM121 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shore Village g THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NW 2nd Avenue Miami Shores, FL 33138 AUTHORIZED REPRESENTATIVE U 1888-ZUIU AWKU GUKI-UKAI IUN. All rlgnis reServeO. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0763 MARTIN CARLOS A AIRATI�OUR DOOR, INC. 14262 SW 140 ST UNIT 103 MIAMI FL 33186 Congratulations! With this license you become one of the neatly one million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range from architects to yacht brokers, from boxers to barbeque restaurants, and they keep Florida's economy strong. Every day we work to improve the way we do business in order to serve you better. For information about our services, please log onto www.myfloridalleense.com. There you can find more information about our divisions and the regulations that impact you, subscribe to department newsletters and learn more about the Department's initiatives. Our mission at the Department is: License Efficiently, Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, and congratulations on your new license! DETACH HERE r JZ`1# Miami Shores Village pBuilding Department 10050 N.E.2nd Avenue BYMiami Shores, Florida 33138 Tel: (305) 795.2204 Fax:(305) 756.8972 AIR CONDITIONING REPLACEMENT DATA PERMIT NUMBER: MC _ —B 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): 151 N E 1 6) ibl City: Miami Shores Village County: Miami Dade Zip Code: 3 3 OF 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 ❑ ARHI Sheet Attached: YES ❑ NO ❑ Contract Attached: YES ❑ 1. Minimum Circuit Ampacity (Wire Size): 2. Maximum Overcurrent Protection (Fuse/Breaker Size): 3. Voltage of Circuit (208/240/480): 4. Size Disconnecting Means: Contractor's Company State Certificate or Res Signature (Revised02/24/2014) t T-nc Phone: C-3 F � Certificate of CompetencyN . Date: I � 1 ure) 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 NO YES NO REPLACING THERMOSTAT YES NO YES NO NEW 4"CONCRETE SLAB YES NO YES NO 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 (208/240/480): 4. Size Disconnecting Means: Contractor's Company State Certificate or Res Signature (Revised02/24/2014) t T-nc Phone: C-3 F � Certificate of CompetencyN . Date: I � 1 ure)