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MC-14-2262-W Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-221626 Permit Number: MC -10-14-2262 Scheduled Inspection Date: October 20, 2014 Permit Type: Mechanical - Residential Inspector: Perez, JanPierre Inspection Type: Final Owner: SINGLETON, SCOTT Work Classification: A/C Replacement Job Address: 290 NE 103 Street Miami Shores, FL 33138-2431 Phone Number (404)213-7214 Parcel Number 1132060134850 Project: <NONE> Contractor: MANCO AIR INC. Phone: 305/409-7719 suuaing uepartment comments REMOVE EXISTING A/C Infractio Passed Comments INSPECTOR COMMENTS False October 17, 2014 For Inspections please call: (305)762-4949 Page 20 of 38 Inspector Comments Passed Failed Correction Needed ❑ Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. October 17, 2014 For Inspections please call: (305)762-4949 Page 20 of 38 BUILDING PERMIT APPLICATION Miami Shores Village Building [department 10050 N.E.2nd Avenue, Miami 5hores, Florida 33138 Tei: (3os) 795-2204 Fax: (305) 75b-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC z0 to Master PerrWt No._Ly �- ❑ BUILDING ❑ ELECTRIC ❑ ROOFING Sub Permit No. ❑ REVISION ❑ EXTENSION (]RENEWAL ❑PLUMBING [:P MECHANICAL '❑PUBIJC WORKS ® CHANGE OF ❑ CANCELLATION ❑ 1-101?�iG� CONTRACTOR 100 ADDREW — q ® P-� _, f)21 d � r ZIP Folio/ParceW Is the Building Historlcafly Deslgnated yes NO Occupancy Tyne: LoFd. Construction Type: _ Flood Zone: _ BFE.: _ Fes= _ OWNER: Name (Fee 5irnpteTltleholclefl; Address_ 0 I-V stat?' ctp. ` Tenant/L .ssee Narng: _Rhone#: — CONTRACTOR: Corrtpany Narne: �°' A Address: 1±1 &,,j L(7 4 AvQ '// City.�6 G� G� State: Y gyp' —� 3 ® ,��7 V QuaIIfier Name _ G° - �1 -, -�z/ Pnane ® I State Certlfica,ion or Regislaation #t: S C,ertiflcate of Competency #: grL Miarni Shores Countarni Dade DESIGNER: Arch itect(Engireer: Address: — valueof Work for this Permit,— Type of Work: ❑ Addition ❑ Aheration Description of Work: (( 0 items, & r x " S-* A I'C- Phone#: City: _ State; Tip: Square/Unear Footage of Work: New M Repair jftp�ace A ❑ [}en olitian Specify color of color thru tile: Sulsrnittal Fen S Permit Fee $ U., _40 ,t;% ccF CO/CC $ Radon Fee Notary Scanning fee $ ��°�,� ` � $ T � DBPR $ - T "logy Fre �,-d Tratninig/EdueaticA Fee S Double Fee $ Bond S — Structural Reviews $� — TOTAL FEE NOW DUE 5 e — 49iSvi�Edd,lY4f i;Cl4} ,ti; 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 posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature OWNER or AGENT Signature CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this _ day of C T D E2 20 ��, by q 10 day of t� .20 � , by S(� `rJ: S nl (r�GTO/� ,who is personally known to I i 1 , who is personally known to 2 me or who has produced �1. J'21 V f; I CEiVS� as me or who has produced � a.'A r identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign: Print:"?_- C L �` X Print: Seal: �� r �'�>�eYiC %'A,� ar:L 1 �p P% Seal: �°� 4° Notary Public State of Florid Joanna M Feliciano 082753 j .- u�%:ad_7 ➢. �, i �„ oQ My Commission FF "�-�,o^ Expires 0 1112/2018 i�k+k Aak�6Ile�&yc�[e dcge �k�k �k�lt�k#+k8�k�k�kR�k�k�k�k �k�k �k#�k& �k+k#�k ie �k�k�k�k�kN�k+kS+le �Ie*�k&�k �k�k+k�kak�k oak �k d�ek�k �k#�{oekak Y�rkdak+kb�k Yalak�k�iak#�k �U�k+k�k �k+k+k[e �kakfeBik�B�kek �Rek ak APPROVED BY\YA Plans 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 PERMIT NUMBER: MC � ® 22 -(102 -- This 2 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): 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 ❑ 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): a ?-, C 4. Size Disconnecting Means: Contractor's Company Name: ::30 Phone: State Certificate or Registration -Wo. A -�.e L S 15?0 Certificate of Competency No. Date: Signature r�>' K60fler's signature) (Revised02/24/2014) UNIT BEING REPLACED DATA NIPN UNIT MANUFACTURER AHU or PKG. UNIT MODEL # '3 ,,,a E' COND. UNIT MODEL# V,5,X1.303F,4 KW HEAT NOM TONS AHU CU PKG 1) M.C.A AHU _'j'& CU PKG AHU CU PKG 2) M.O.P AHU 30 CU PKG AHU CU PKG 3) VOLTS AHLA;1,;FpCUdlo PKG PKG UNIT / / PKG UNIT EER/SEER 1 3 YES NO REPLACING DUCTS YES O YES NO REPLACING THERMOSTAT M NO YES NO NEW 4"CONCRETE SLAB Y NO YES NO NEW ROOF STAND YES YES NO NEW RETURN PLENUM BOX YES 1. Minimum Circuit Ampacity (Wire Size): 2. Maximum Overcurrent Protection (Fuse/Breaker Size) 3. Voltage of Circuit (208/240/480): a ?-, C 4. Size Disconnecting Means: Contractor's Company Name: ::30 Phone: State Certificate or Registration -Wo. A -�.e L S 15?0 Certificate of Competency No. Date: Signature r�>' K60fler's signature) (Revised02/24/2014) AHRI Cerflfied Reference Number: 5696656 Date: 10/7/2014 Product: Split System: Air -Cooled Condensing Unit, Coll with Blower Outdoor Unit Madel Number: VSX130361E* Indoor Unit Model Number. ARUF36C14B* Manufacturer: GOODMAN MANUFACTURING CO., LP. TradeBrand name: GOODMAN; JANITROL; AMANA DISTINCTIONS; EVERREST; ONE HOUR AIR CONDITIONING AND HEATING; ENERGI AIR Series name: VSX13 Manufacturer responsible for the rating of this system combination Is GOODMAN MANUFACTURING CO., LP. Rates as follows In accordance with AHRI Standard 210/240-2008 for Unitary Air -Conditioning and Air -Source Heat Pump Equipment and subject to verification of rating accuracy by AHRI-sponsored, independent, third party testing: f:a,e bllovved by an r) Indicate a vow" reran of prevlm* pub@shed dam, unless accornpanled with a WAS, which Indicates an Involuntary imam. DISCLAIMER Antill does not endorse the product(s) listed on this Certificate and makes no warranties or guarantees as to, and assumes no responsibility for. tie product(s) fisted on this Certificate. AHN expressly dlodatins an liability for damages of any kind arising out of the use or performance of the product(s), or the unauthorized atieratonn of data listed an this Certificate Cehttied ratings are mild only for models and configurations Med In the directory at rvV, v✓.a h rid I re cto ry. o vg. TERM AND CONDmoNs This Certificate and its contents are products of AHRL This Certificate shall only be used for Individual, personal amt confidential referernce purposes. The contents of this Certificate may not. In whole or In parr, be reproduced; dissarnkatetk emend Into a computer datatrase: or otherwise utilized. In any form or manner or by any meas, except for the tsar's Individual, personal and confidential referenim AIR-CONDITIONING, HEATING, CERTIFICATE VERIFICATION & REFRIGERATION INSTITUTE The Information forthe model cited on this Certificate can be verified atvvww.ahrid lrectory.org, dick on llerify Certificate" link we make life better" and enter the ANN Certified Reference Number amt the date on which the Certificate was issued, which Is listed abw^ and the Certificate No, which Is lel at bottom runt — 13057163810549M 02M4 Air-conditioning, Heating, and Refrigeration Institute CERTIFICATE NO.: manco air inc. CA CO 58505 197 NW 104 Avenue Coral Springs, FL 33071 Phone 305.409.7719 Service Address 290 N E 103 ST Miami Shores, F Ann: Chip Shepard Comments or Special Instructions: estimate good for 30 days DATE 9/2/2014 Quotation # Customer ID Prepared by: Mike Manno Description AMOUNT Existing 3 ton Split system central a/c: Janitrol, mfg yr. 2000, outside condensing coils are coroded causing system reduced cooling capacity and efficiency. Recommend replacement. New 3 ton Goodman 13 seer hooked up to existing slab, ductwork and electric. 10 yr all parts warranty. WN gsc13036 aruf036 All work up to Miami Shores building codes Estimate 1 2,875.00 TOTAL 1 $ 2,875.00 THANK YOU FOR YOUR BUSINESS! BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895 — 954-831-4000 VALID OCTOBER 1, 2014 THROUGH SEPTEMBER 30, 2015 DBA: FLORIDA SOLAR AC R@C@I 18 Business Name: MANCO AIR INC . pt #'HEATING/AIRCONDITION CONTRACTR Business Type: (AC SALES/SERVICE) Owner Name: MICHAEL MANNO Business Location: 197 NW 104 AVE Business Opened: o2/01/2011 CORAL SPRINGS State/Cou nty/Cert/Reg: CAC 058505 Business Phone: 800-383-9822 Exemption Code: Rooms Seats Employees Machines Professionals 3 Number of Machines: For Vending Business Only Tax Amount Transfer Fee Vending Type: NSF Fee Penalty Prior Years Collection, Cost Total Paid 27.00 0.00 0.00 0.00 0.00 0.00 27.00 THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT This tax is levied for the privilege of doing business within Broward County and is non -regulatory in nature. You must meet all County and/or Municipality planning WHEN VALIDATED and zoning requirements. This Business Tax Receipt must be transferred when the business is sold, business name has changed or you have moved the business location. This receipt does not indicate that the business is legal or that it is in compliance with State or local laws and regulations. Mailing Address: MANCO AIR INC. 197 NW 104 AVE CORAL SPRINGS, FL 33071 2014 -2015 Receipt #30A-13-00013275 Paid 09/26/2014 27.00 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION F CONSTRUCTION INDUSTRY LICENSING BOARD VM1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 MANNO, MICHAEL JOHN MANCO AIR, INC. 197 NW 104 AVENUE CORAL SPRINGS FL 33071 Congratulations! With this license you become one of the nearly 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.myfloridalicense.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 RICK SCOTT, GOVERNOR (850) 487-1395 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND `I— PROFESSIONAL:6tEGULATION CAC058505 ISSUED—.: 09/23/2014 CERTIFIED AIR CORD CONTR" MANNO, MICHAEL. JOHN MANCO AIR, INC, IS CERTIFIED under the provisions of Ch.489 FS. Expiration date : AUG 31, 2016 L1409230004467 KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD LICENSE NUMBER 1 1 The CLASS B AIR CONDITIONING CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2016 MANNO, MICHAEL JOHN MANCO AIR, INC. 197 NW 104 AVENUE CORAL SPRINGS FL 33071 ISSUED: 09/23/2014 DISPLAY AS REQUIRED BY LAW SEQ # L1409230004467 1%/2014 11:09 3526749037 ALLIN ONE INSURANCE PAGE 01/01 Agti>MHDATE(l1MNDDNYY` CERTIFICATE OF LIABILITY INSURANCE ) 10/14/2014 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 certificate holder is an ADDITIONAL INSURED, tho polley(les) must tie endorsed. If SUBROGATION IS WANED, subject to the tennis and conditions of the policy, certain policies may require an endorsement, A statarnant on this carh6cate does not confer rights to the certificate holder in lieu of SUCK andorsemant(s). PRODUCER ALY. IN ONE INSURANCEPH NAME: N (352) 674--901.5 Arc Na,(352) 674-9037 526 NUS gray 441/27 ADDRESS:bsabotkaftellsouth.net Lady Lake, FL 32159 IMURrMM1 AFF>3RDINc COVERAM NAIC# INSURER A: QBE SPECIALTY INSURANCE EACH OCCURRENCE $ 1 000,000 INSURED MANCO AIR, INC INSURER 5: PROGMESSIVE li=nft INS cobomr INSURER C! 4314 NW 120TH AVE INSURER D: CORAL SPRINGS, FL 33065 INSURER E; 561-901-7641 INSURER F: THIS 1S 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 OBSCRISED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLANS. � R TYPE OF INSURANCE MD WVD POLICY NUMBER NAMMODNYMM D LIMITS COMMIRCIAL GAN' ttReAaTY EACH OCCURRENCE $ 1 000,000 CLAIMS MADE ®OCCUR PREMISES Me amarance S 100,000 MED EXP (A cm person) $ 5,000 SCL0002634 10/15/1410/14/15 PERSONAL&ADV INJURY $ 1,000,000 OEN'L AGGREGATE LIMIT APPLIES PER; 7 jEC"T GENERAL AGGREGATE S 2,000,000 PRODUCTS-COMP/OP AGO $ 2,000,000 POLICY LOC OTHER: g AUTOMOBILE LIASILrrY S X ANYAUYO Me 8 BODILY INJURY (Par P9+) S 100,000 B ALL OWNEDX ED SCHEDUL AUTOS AUTOS 08213365-3 08/23/ 4 0@/23/15 BODILY INJURY(Peraccident) S 300 000 HIRED AUTOS AO�NpSWNED ROP DA11MF P r a rt $ 50,000 S . UMBRELLA LIABOCCUR EACH OCCURRENCE S EXCESS LKe -H CIADIiJ54 ADE AGGREGATE $ DED I I RETBNTION P $ WORKERS COMPENSAMC AND EMPLOYERS' LIABILITY YIN STATUTE I ER E.L EACH ACCIDEM S ANY PR0PRIEr0RFARTNER Ma:QU71VE OFFICER EMBER EXCLUDED? � NIA Dlyn USES,dee l NF1) rf ye& deecrlDe under FL DISEASE - EA EMPLOYE $ E,L. DISEASE . POIJCy Uw S DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 1 DI, Additiarml Remarks Sdwadula, may be attached if mve space is required) 2004 DCS SPRINTER 2500 4X2 IgD2PD644745613873 2000 AVEN TRAILER 4T6FB0817YM014134 Air Conditioning Contractor license number CAC058505 rcoTICIrAYe unr nes VILLAGE OF MIAMI SHORES 10050 NE 2ND AVEL'b= MIAMI SHORES FL 33138 FAX!305-756-8972 SHOULD ANY OF THe ABOVI: DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED 4 ^""'%"'40tzv to ,ul) The ACORD name and logo are registered marks of ACORD All riahts rPSPnroPd 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 . f: 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, youmay be personally liable for the worker compensation injuries 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 Print Name: Signature: m ,7 State of Florida) County of Miami -Dade ) Sworn to and subscribed before me this �D day of OC)r�'at�� , 20 F . (SEAL) Type of Identification Pubft State of Florida My Commission FF 158750 Exoires 09/0312018 Contractor Print Name: ,, Signature: State of Florida ) County of Miami -Dade ) Sworn to and subscribed before me this day of � � _ 520 L A . (SEAL) Tvve of Identification Notary Pubft State of Florida My Commission FF 158750 Expires 09=2018