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MC-14-1972Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-221202 Permit Number: MC -9-14-1972 Scheduled Inspection Date: October 15, 2014 Permit Type: Mechanical - Residential Inspector: Perez, JanPierre Inspection Type: Final Owner: MARTELLY, LESLY Work Classification: A/C Replacement Job Address: 149 NW 99 Street Miami Shores, FL 33138 - Phone Number Parcel Number 1131010230380 Project: <NONE> Contractor: AFFORDABLE AIR & HEAT & ELECTRIC CONTRACTOR Phone: 305-770-4167 Building Department Comments REPLACE 3 TON AC W/H 10 KW Infractio Passed Comments INSPECTOR COMMENTS False q, 9 October 14, 2014 For Inspections please call: (305)762-4949 Page 25 of 40 Inspector Comments Passed �'' CREATED AS REINSPECTION FOR INSP-219315. Failed Correction Needed ❑ Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. October 14, 2014 For Inspections please call: (305)762-4949 Page 25 of 40 Miami Shores Village Building Department Lev"-;� SEP 0 14 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC 20 0 BUILDING Master Permit No.k4Q-- 4- A 97 PERMIT APPLICATION sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING FE -J MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF [-]CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 149 NW 99 St City: Miami Shores County: 2 Miami Dade Zia: Folio/Parcel#:11-3101-023-0380 Is the Building Historically Designated: Yes NO Occupancy Type: S/F Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee simple Titleholder): Lesly & Leandra Martially Phone#: 305-759-3156 Address: 149 NW 99 St city: Miami Shores State: FL zip: 33150 Tenant/Lessee Name: N/A Phone#: Email: N/A CONTRACTOR: Company Name: Affordable Air & Heat Phone#: Address: 515 NE 190 St City. Miamistate FL Z;p; 33179 Qualifier Name: Jon Freeman Phone#: 305-940-0777 State Certification or Registration #: CAC048111 Certificate of Competency #: DESIGNER: Architect/Engineer: N/A Phone#: Address: City: State: Zip: Value of Work for this Permit: $ 1900.00 Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New FEW Repair/Replace ❑ Demolition Description of Work: Replace 3 Ton AC w/h 10 KW Specify color of color thru tile: Ltw Submittal Fee $ Permit Fee $ i CCF $ ° -2-0 Co/cc $ Scanning Fee $ `1 Radon Fee $ DBPR $ Notary $ � Technology Fee $ " ? Training/Education Fee $_ 0 "I -f �_ I Double Fee $ Structural Reviews $ Bond $ TOTAL FEE NOW DUE $ L 102 (Revised02/24/2014) Bonding Company's Name (if applicable) N/A Bonding Company's Address City State Mortgage Lender's Name (if applicable) N/A 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 IWYOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OFCOMMENCEMENT." MENCEMENT." Notice to Applicant: As o-candrtion 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 thea ence of such posted notice, the inspection will n to approved and a reinspection fee will be charged. ER dr AGENT The foregoing instrument was acknowledged before me this 10 day of September 14 by fC— G( -AP—' is personally known to me or who has produced_ "- as identification and wh©`d(d take an oath. NOTARY PUBLIC: - w pf9•,.awdillA VMIIAMS Si Leandra Martellr� s>AuG 12, 2017 Print:.. �Y,w;. 111surimce Seal: CONTRACTOR The foregoing instrument was acknowledged before me this 10 day of September 20 14 by who-(- personally kno n to me or who has produced as identification and who did take an oath."' NOTARY PUBLIC: } Jon Fr ti — CHRISTINA WILD Print: ppg0m" Seal: a EXPIRES: AUG 12, Bonded through let Sista APPROVED BY P ns Examiner Zoning Structural Review Clerk (Revlsed02/24/2014) V 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): 149 NW 99 St City: Miami Shores Village County: Miami Dade Zip Code: 33150 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 M 1. Minimum Circuit Ampacity (Wire Size): 2. Maximum Overcurrent Protection (Fuse/Breaker Size): 3. Voltage of Circuit (208/240/480): S?l � 0 4. Size Disconnecting Mea Contractor's Company m Affordable Air & Heat Phone: 305-940-0777 State Certificate or egistr ion No. CA 48111 Certificate of Competency No. Signature Date• 09/10/2014 (QuaRflee signature) (ReAsed02/24/2014) UNIT BEING REPLACED DATA NPN UNIT MANUFACTURER-%� AHU or PKG. UNIT MODEL # �►� COND. UNIT MODEL # 10 KW HEAT `O NOM TONS AHU CU 20 PKG 1) M.C.A AHU 3 CLI PKG AHYC p CU PKG 2) M.O.P AHU(,,pCU j7® PKG AHLr-;* * PKG 3) VOLTS AHCLIa3rd PKG PKG UNIT / / PKG UNIT . ® EER/SEER YES REPLACING DUCTS YES O NO REPLACING THERMOSTAT NO YES O NEW 4"CONCRETE SLAB YES YES ® NEW ROOF STAND YES YES eTo7p NEW RETURN PLENUM BOX YES (ffg>° - 1. Minimum Circuit Ampacity (Wire Size): 2. Maximum Overcurrent Protection (Fuse/Breaker Size): 3. Voltage of Circuit (208/240/480): S?l � 0 4. Size Disconnecting Mea Contractor's Company m Affordable Air & Heat Phone: 305-940-0777 State Certificate or egistr ion No. CA 48111 Certificate of Competency No. Signature Date• 09/10/2014 (QuaRflee signature) (ReAsed02/24/2014) ie 5 Bim CDNIXTtf N 14G:CON 'f'f�CF �- rt,f &-isrgt�s;r9 FS, - �, Q _ mss. �ws„c `' ° • • N � At .ate .d.��* E -�,� ` ' - • ISSUED: 08/28/2014 DISPLAY AS REQUIRED BY LAW SEQ # L1408280001794 A i=rom: 09/10/2014 09:50 #565 P.002/002 OP ID-- AP ^� ® CERTIFICA`fE OF LIABILITY INSURANCE D091091201 YY) TYPE OF INSURANCELI 09/09/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATNELY 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 endorsements . PRODUCERCONT Rlemer Insurance Group Hallandale Branch PO Box 250 Hallandale, FL 33008-0250 Vita Kagan Gopman ACT NAME: PHONE A/C Noy MWL ADDRESS: c °sDUCEER Dq:AFF0AI1 DISURERIS) AFFORDING COVERAGE _ NAIC # INSURER A: Wesco insurance Co. INSURED Affordable Air & Heal, Inc. 515 PIE 190 Street PPID55018-02 Miami, FL 33179 INSURERS: INSURER C • PDAMAGE TO RENTE - REMISES Ea occurrence) $ 100,00 INSURER D : PERSONAL & ADV INJURY $ 1,000,00 INSURER E INSURER F RGYh71V19 MWIV117LRi 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 REOUIREMENT, 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. LTRR TYPE OF INSURANCELI WvD POLICY NUMBER Y EFF MM/DD POLICY EXP MM/OD LtefnS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE I OCCUR PPID55018-02 03/17/2014 03/17/2015 EACH OCCURRENCE $ 1,000,0 PDAMAGE TO RENTE - REMISES Ea occurrence) $ 100,00 MED EXP (Arty one person) $ 5,00 PERSONAL & ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2„000,00 GEN'L AGGREGATE LIMIT APPLIES PER: X I POLICY PRO- LOC PRODUCTS - COMP/OP AGG $ 2,000,Oft $ AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMB $ (Ea aeeidenq BODILY INJURY (Per person) $ ALL OWNED AUTOS 1 BODILY INJURY (Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE (PER ACCIDENT) HIRED AUTOS NON -OWNED AUTOS $ S UMBRELLA LU1B EXCESS LIAS OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE ww. $ DEDUCTIBLE I RETENTION Is WORKERS COMPENSATION AND EMPLOYERS LIABILITY Y 1 N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in es If ddescribeundander D GIRIPTI N OF OPERATIONS below N f A WC STATU- OTH �r E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ ^V E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS r LOCATIONS /VEHICLES (Attach ACORD 101, AddlUonal Remarks Schedule, If more space is required) Air Conditioning Contractor; Service, Installation S Repair t•_rar'erlrw-ra un1 r,rci City of Miami Shores 10050 NE 2nd Ave Miami Shores, FL 33138 CITYMIA 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 ®1988-2009 ACORD CORPORATION_ All rinlita rnae~v t fit,UKU ZO (ZUU9/UU) The ACORD name and logo are registered marks of ACORD • _ Air Gonditioninc� Electrical Contractors SEP 10 2014 The new �Y pmdin•FAi�3 Tie L?c is or, Coede�,�D Unit cqudcri. �y 1mique. It's Wliv� design i9 un - T -he "Fe4bfly• can be,i t W)ed &s a p 15 Lm scram inst$11tios csr �'a 3116" esbie ' trailstheIbe oml Tie Doom ie t4c irAo y chtyively for Moridi. 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