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MC-14-2386Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-222549 Permit Number: MC -10-14-2386 Scheduled Inspection Date: December 03, 2014 Inspector: Perez, JanPierre Owner: TRAAD, MONIQUE Job Address: 50 NE 104 Street Project: Contractor: Miami Shores, FL 33138-2027 <NONE> Permit Type: Mechanical - Residential Inspection Type: Final Work Classification: A/C Replacement JOSE C YANE AIR CONDITIONING & APPLIANCES SERV INC tlunamg ueparltment comments Phone Number Parcel Number 1121360130890 AC 4TON SPLIT SYSTEM Infractio Passed comments REPLACE EXISTING FLEX DUCT WORK NEW INSPECTOR COMMENTS False CONCRETE AC PAD <L � -L-) -�) I 1t- T Inspector Comments Passed W � Failed vpP /Y Correction ❑ Needed Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. December 02, 2014 For Inspections please call: (305)762-4949 Page 9 of 28 Miami Shores Village Building Department 7907cT 29 2014 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 1;Q�_ Tel: (305) 795-2204 Fax: (305) 756-8972 15 L INSPECTION LINE PHONE NUMBER: (305) 762-4949 r FBC 20 l� BUILDING Master Permit No. i c,ILI'Zs PERMIT APPLICATION Sub Permit No. r --]BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ffmECHANICAL ❑PUBLIC WORKS c,❑ CHANGE OF ❑ CANCELLATION ❑ SHOP A-12 11/v CONTRACTOR DRAWINGS JOB ADDRESS: � City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: ��jjF OWNER: Name (Fee Simple Titleholder):( % j (u�� zeAi Phone#: rV&9z / d C�v/ Address: S-`;' /y IE- la �` -C Z, j �^ City: �5 ® &--E / (2 V State: �` „� — Zip: Tenant/Lessee. Name: Phone#: Email: CONTRACTOR: Company Name: � V q W -'E r j r�_� Phone#: Address: /0 r-;tC 'y'e z' 32_S'i City: 41 /111011 ew / State: /5�;� Zip: it Qualifier Name: State Certification or Registration #: of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $L -5','F a 19 Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: 151 L0 �!�`i� � �--� r! ��� a`� _ P,41�1Com' A X IAC (L_ Specify color of color thru tile: Submittal Fee $ Permit Fee $ Scanning Fee $ Technology Fee Structural Reviews $ (Revised02/24/2014) Radon Fee $ Training/Education Fee $ CCF $ CO/CC $ DBPR $ Notary $ Double Fee $ Bond $ 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 9 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 /len 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 0 ER or AGENT The foregoing instrument was acknowledged before me this day of 20 :L4 , by ®n tQc„LQ —Ty -m o-�--A , who i personal known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: All Sign: _rf.Ct� Print: l� Seal =o�'"A`8�:- SARA MONTERO MY COMMISSION #FF152803 `•"�' �` s� tember 1, 2018 EXPIRES • p reo�i 398 0153 Fiodd,NotarysFNac"•com APPROVED BY (Revised02/24/2014) Signature L �`�ONTRACTOR The foregoing instrument was apknowledged before me this �+t s day of 20 1�lf by c who is erso ly'known to e or who as produced as identification and who did take an oath. NOTARY PUBLIC: Sign:. Print: Seal: • } MY COMMISSION #FF152803 �;' oF�op.= EXPIRES September 1, 2018 f407) 398.0153 Floridallotary5eryice.com ns Examiner Structural Review Zoning Clerk This combination qualifies for a Federal Energy Efficiency Tax Credit when placed in service between Feb 17, 2009 and Dec 31, 2013. AHRI Certified Reference Number: 5756177 Date: 10/27/2014 Product: Split System: Air -Cooled Condensing Unit, Coil with Blower Outdoor Unit Model Number: GSX160481F* Indoor Unit Model Number: ASPT48D14A* Manufacturer. GOODMAN MANUFACTURING CO., I.P. Trade/Brand name: GOODMAN; JANITROL; AMANA DISTINCTIONS; EVERREST; ONE HOUR AIR CONDITIONING AND HEATING; ENERGI AIR Series name: GSX16 Manufacturer responsible for the rating of this system combination is GOODMAN MANUFACTURING CO., LP. Rated 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; , ' Ratings followed by an asterisk (') indicate a voluntary ramie of previously published data, unless accompanied with a WAS, which Indicates an involuntary rerate. DISCLAIMER AHRi does not endorse the product(s) listed on this Certificate and makes no representations, warranties or guarantees as to, and assumes no responsibility for, the product(s) listed on this Certificate. AHRI expressly disdains all liability for damages of any kind arising out of the use or performance of the product(s), of the unauthorized afGeratton of data fisted on this Certificate. Codified ratings are valid only for models and configurations Bated in the directory at www.ahridirectory.org. TERMS AND CONDITIONS This Certificate and its contents are proprietary products of AHRI. This Certificate shall only be used for individual, personal and confidential reference purposes. The contents of this Certificate may trot, 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, personal and confidential reference. AIR -CONDI f ONING, HEATING, CERTIFICATE VERIFICATION & REFRIGERATION INSTITUTE The Information for the model died on this certificate can be verified at www.ahrldirectory.org, click on "Verify Certificate" link wv 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 Bated at bottom right ©2014 Air -Conditioning, Heating, and Refrigeration Institute I'CERTIFICATE NO.: 130589088817 ' Miami shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION IF CONT TOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. ROPY OF QUALIFIER'S STATE LICENCES B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF LIABILITY INSURANCE* D. COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER Affidavit) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF STATE REGISTERED CONTRACTOR LICENSE OR MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT. D. COPY OF LIABILITY INSURACE* E. COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER Affidavit) *YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE AS FOLLOW: Certificate Holder: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 Certificate must specify the description of operations or contractor license number. BUSINESS NAME: NAC'c Av to 6'nc:rt BUSINESS ADDRESS: /n .i 00>?—,, CITY M i & rr� r STATE �7L ZIP 3 3)401 BUSINESS PHONE: ( ) (�� 3 ' �/ 3Lt S FAX NUMBER (as- CELL ®SCELL PHONE QUALIFIER'S NAME: QUALIFIER'S LIC NUMBER: C,A C )'9 10 7 q j 4c Named bekr 1S CERTWW Under do prrn%%i���i��si+of Cho 489 FS. E� dela. AUG X 1 � 2 6 YANES, JOSiE CLEMENTE:; .�E C YANES Aft COQ Nt3 & APPLIANCES SERVP 1021 JOE 132ND ST .. :.t NORTH MIAMI 'V 61 ISSIM 088412014 µ DISPLAY AS REQUIRED BY LAW' DEQ# L140040001384 Oct.20. 2014 2:27PM TORRES INSURANCE AGENCY No.2867 P. 1/1 AeGR& CERTIFICATE OF LIABILITY INSURANCE DATE(M]<UDD 10/20/2014/2o/�014o1a 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. uirr'Vn1Ari I : IT me t:ertmcm nower is an ADDITIONAL INSURED, the 11000y(ies) must be Endorsed. If SUBROGATION 18 WAIVED, subject to the terms and Conditions of the policy, Certain policies may require an endorsement. A statement on this oertifioata does not confer rights to the certlticats holder In lieu of such endorsement 9 . PRODUCER CO ACT Jorge. Rivera 2orrea Insurance Agency Inc. PN NE (305) 512-5980 , (3osis12-sect 61.35 NW 167 STREET # E23 ADoliEss:jrivex,3@torre$inauraaceagelacy.e� Prs�U Ell Ellrn„00004949 INSURED LINSU=R Jose C Yanes Air Conditioning & Appliances$eL`1tlC@8 IAC.1021 NE 132 stmtNorth Miami FL • 33162 INWRER F: "' THIS IS 1'0 CERTIFY THAT THE POLICIES OF ' INSURANCE """•'�"^•" '�""""+ ` r Av , LISTED BELOW HAVE BEEN ISSUED TO REVISION NUMBER: INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY THE INSURED CONTRACT OR NAMED ABOVE FOR THE POLICY PERIOD CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED OTHER DOCUMENT WITH RESPECT TO WHICH THIS EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. BY LIMITS SHOWN MAY HAVE BEEN THE POLICIES DESCRIBED REDUCED BY PAID HEREIN IS SUBJECT TO ALL THE TERMS, I TR TYPE OF INSURANCE ADDL BR POLICYNUMBER CLAIMS. EFF POP EXp MMU U MfDD LIMBS GENERAL UAINUTY X COMMERCIAL. GENERAL uABILnY EACH OOCURRENC6 Is 1,000,000 DAMAGEPRWISEEe C bw $ 100,000 A _ CLAWS -MADE X OCCUR -000323760-3 1/13/2013 1/13/2014 MED EXP one reon $ 5,000 PERSONAL &ADV INJURY S 11000,000 GENERAL AGGREGATE S 2, 000, 000 GENL AGGREGATE LIMIT APPLIES PER X7 POLICYPRQDUCT$ LOO • COMPIOP AGG $ 1,000,000 $ AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT (Es WddM) $ 100,000 A ALL OWNED AUTOS 150120006143 7/17/2014 7/17/2011 BODILY INJURY (Per pe:aal) $ X SCHEDULED AUTOS BODILY INJURY (Per sowdant) s HIRED AUTOS _ PROPERTY DAMAGE S (Per acddero NON OWNED AUTO$ Pip amid S 10 , 000 —•- X Pip $10,0001$0 DED UMBRELLA UAB OCCUR KXCI188 UAB CLA4dS•M1AABE EACH OCCURRENCE c AGGREGATE g DEDUCTIBLE •— RETENTION B $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN WO STA - OTH- ANY PROPRIETORMARTNEROMCUTIVE OFFICER/MEMBER EXCLUDED? � N/A LL EACHACCf0s $ 100,000 (Myyaeenssd ryInNH) Dif96AIPTION OF OPERATIONS below CC0043268 0/31/2013 0/31/2014 E.L. DISEASE-EAEMPL0 $ 100,00 EJ- DI8EASE - POUCY LIMIT & S00,000 DESCRIPTION OF OPERATIONS / LOCATIONS 1 VEHICL.EB (A=vh ACORD 101, Add mW Ramarks Schedule, If uum &Mae Is rogwrad) Air Conditioning ineota].1rrtioA Bl-*-vt Addition-]. tasured apply to ftMV07. Liability policy # C8-000323760-3 ae re • Tas"nd required by contract- 2033. Ce l="G: 8-011 TOOLS $5,000/ $SOO Dad, 100& Colne, $)COmmoreiva Autos Veh 1: 2002 Ford/ Xconoline X250 vis# 1F=242X21;A51198 ***(No Comprehenaive & Collision CERTIFICATE HOLDER .....__.. _ �_ _ _ (305)756-8972 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami. Shore village ACCORDANCE WITH THE POLICY PROVISIONS. Building Department 10050 NE 2nd Ave AUTHORIZED REPRESENTATIVE Miami Shores, VL 333.319 ACORD 28 (2009/09) 1NS0251.988-2009 ACORD CORPORATION. All rights reserve, lZOC9091 The e�.eQn .,�r„e .-A r_.._ --.-._-- a ...- •-ate �•� •�=fA cw urarrW Vr MVVF%V Oct.23.2014 11:49 AM JEFF ATWATER CHIEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION x' CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW °' CONSTRUCTION INDUSTRY EXEMPTION This certifies that the Individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: 10/23/2014 EXPIRATION DATE: 10/22/2016 PERSON: YANES JOSE C FEIN: 205350884 BUSINESS NAME AND ADDRESS: JOSE C YANES AIR CONDITIONING & APPLIANCES SERVICES INC 1021 NE 132ND ST NORTH MIAMI FL 33961 SCOPES OF BUSINESS OR TRADE: HEATING, VENTILATION, AIR-COND Pureuent to Chapter 440.05(14), F.S., an officer of a eorporatlon who atom exemption front this Chapter by firing a certificate of eleCdan under this $Mon 9VW not racowr benuffla or compensation under this chapter, Pursuant to Chapter 440.05(12), F.S., Certificates of election to be exempt... sp* c* within nw swo of the busihess or trade Ilated on the notice of election to be exempt. Pursuant to Chapter 440.06(13). F.S.. Notices of election to be exempt and cer11ficato8 or Wdlon to be exempt shall be subject to revocation N. at any ume after the tilng of the notice or the Isausnoa or the csrUficale, the person namhd on the police or caMcale no longer meets the requirements of this sectkm for issuance of a certificate. The depanma d d*1 rovoko a PAGE. 2/ 2I DFS-F2-DWC-282 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 07-12 QUBS flow (850)413-1609 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 she�etsj are not acceptable. Job Address (where the work is being done) -_,.\,L2 ay G7 /oLf 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 6] NO ❑ ARHI Sheet Attached: YES NO ❑ Contract Attached: YES ❑ 1. Minimum Circuit Ampacity (Wire Size): 2. Maximum Overcurrent Protection (Fuse/Breaker Size): Y® 3. Voltage of Circuit (208/240/480): 4. Size Disconnecting Means: Contractor's Company Name: State Certificate or Signature (Rev1sed02/24/2014) Phone -2&L-4 9?`q.3 ST Certificate of Competency No. Date: 10`aq UNIT BEING REPLACED DATA NEW UNIT MANUFACTURER 117 AHU or PKG. UNIT MODEL # COND. UNIT MODEL # Z I 4A # Imo' 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 ES NO YES NO REPLACING THERMOSTAT 7M NO YES NO NEW 4"CONCRETE SLAB E NO YES NO NEW ROOF STAND YES 0 YES NO, NEW RETURN PLENUM BOX YES 1. Minimum Circuit Ampacity (Wire Size): 2. Maximum Overcurrent Protection (Fuse/Breaker Size): Y® 3. Voltage of Circuit (208/240/480): 4. Size Disconnecting Means: Contractor's Company Name: State Certificate or Signature (Rev1sed02/24/2014) Phone -2&L-4 9?`q.3 ST Certificate of Competency No. Date: 10`aq Work Contract JOSE C. YANES AIR CONDITIONING & APPLIANCES SERVICES, INC. 1021 NE 132 ST, NORTH MIAMI, FL 33161 LICENSED & INSURED CELL: 786.683.9345 FAX: 305.895.3565 Monique Traad October 15&12014 WORK PROPOSED TO BE DONE AT: DESCRIPTION OF WORK PROPOSED: Installation of 4 Ton 16 Seer A/C Split System Installation of New Di 'tal Thermostat Installation of New Air Handler Stand, Concrete Slab for outside Condensing Unit All New Duct Work with 9 Vents Installed Electrical Work for A/C System will be completed 10 Year Factory Warranty for A/C System 2 Year Contractor Labor Warranty Contractor will furnish Labor, Materials, A/C System, License, Insurance, Permit and Materials All material is guaranteed to be as specified, and the above work to be performed in accordance with the drawings and specifications submitted above and completed in a substantial workman- like manner for the sum of Six Thousand Nine Hundred Eighty and 00/100 dollars $6,980.00 Payments will be made as follows: 50% ($3,490.00) deposit required before work commencement, balance will be due upon work completion ACCEPTANCE OF PROPOSAL Signature The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payments will be made as outlined above. Date