MC-14-1054h
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-212897 Permit Number: MC -5-14-1054
Scheduled Inspection Date: November 24, 2014
Inspector: Perez, JanPierre
Owner: SEGAL, ILAN
Job Address: 500 NE 96 Street
Miami Shores, FL 33138
Project: <NONE>
Contractor: AIR COOLING INC
tsunaing uepanment comments
NEW INSTALL 2 SPLIT SYSTEM CENTRAL AND MINI
SPLIT VENTILATION BATH
Permit Type: Mechanical - Residential
Inspection Type: Final
Work Classification: Addition/Alteration
Phone Number
Parcel Number 1132060140700
INSPECTOR COMMENTS False
ffl �t 1 -7"
Passed
Inspector Comments
Failed
Correction
Needed ❑
Re -Inspection
Fee
No Additional Inspections can be scheduled until
re -inspection fee is paid.
November 21, 2014 For Inspections please call: (305)762-4949 Page 7 of 44
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
EiVE
DC12014M
FBC 20 /,0
Master Permit No. _T 14
Sub Permit No. MCA LA — 0511
❑BUILDING
❑ ELECTRIC
❑ ROOFING
❑ REVISION
❑ EXTENSION
❑RENEWAL
❑PLUMBING
ECFIA At,.
❑PUBLICWORKS
[:]CHANGE
CONTRACTOR
❑ CANCELLATION
❑ SHOP
DRAWINGS
JOB ADDRESS: ®® N_.5 r-,
City: Miami Shores County: Miami Dade Zip:
X1113 li!7
Folio/Parcel#: wr,-- - V Q4 e ® F®® Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: V- t!;,• Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): TIS e__tF-IG64— Phone#: ® ;50?- -S b
Address:®® .1 Ow 57"�
City: k4Stater Zip: IV;? 6�
Tenant/Lessee Name: Phone#:
Email: 6 &'_
CONTRACTOR: Company Name: Atlz cook t u G Ty, C Phone#: -Is 6 23 4
Address: '�? 16 C W Q s i 3 z, Lac E.
City: . �5, State: "SF( O'n Ar, Zip: 330104
QualifierName:SOSe � •3U-e.CO Phone#:RX&' zua SOY1
State Certification or Registration #:(' k C L $ 15 -4Zcl Certificate of Competency #:
DESIGNER: Architect/Engineer: Phonel
Address: City: State:
Value of Work for this Permit: $ ft rz, ®®®e 00 Square/Linear Footage of Work: _
Type of Work: ❑ Addition ❑ Alteration 54 New ❑ Repair/Replace
Zip:
❑ Demolition
Description of Work: oW `k�'�, �(b « '1;�G �r( 5_ a_IuIrgT1 g�
\'A t u� 5` c'f_ A r3f 1 J e c oc'� a o n 'D A7S _ e
color thru tile:
Submittal Fee $��' 0 Permit Fee $
Scanning Fee $ Radon Fee $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
CCF $ CO/CC $
DBPR $ Bond
Technology Fee $
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,
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 feill be charged.
Owner k'AgeHt
The foregoing instrument was acknowledged before me thi
day of�rv=AAbywho is to or who has produced
As identification and who did take an oath.
o [ei l_A:i 1111 1-31
Sign:
Print:/Aryl 00-1
My Commission Expires: Fy; APEREZ
# ; CMdaft # FF 069164
itor�edniuTMMWh F�7,201gW.
5aote
Signature
Contractor
The foregoing instrument was acknowledged before me this
day of 20 4by 5055— 6QCA 0
who is personally known to me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign: YJ/
Print: d
YAJAIRAtSUIV
WCOMMSSION;FF00W
1 EXPIRES: December 21, 2017
5C
My Commission
e:6tiYP`' Bonded Thru Notary Pubitc Undertw fors
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APPROVED BY Y Plans Examiner Zoning
Structural Review
Revised02/24/2014)(Revised 5/2/2012)(Revised 3/12/2012) )(Revised 06/10/2009)(Revised 3/15/09)(Revised 7/10/2007)
Clerk
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): 00® v� Il,& -T --
City: Miami Shores Village County: Miami Dade Zip Code: V y 1 �, `90 °
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 0 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
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 Nire Size): to &t-tP
2. Maximum Overcurrent Protection (Fuse/Breaker Size): 4,0 a"
3. Voltage of Circuit (208/240/480): . '
4. Size Disconnecting Means: 40.0 -N-A P •
Contractor's Company Name: A L O—C,-,a I r N(; -Xw c Phone: :19 4, 23 G 3 YY I
State Certificate or Registration N. CA C l f 5 1 L!4_Certificate of Competency N.
Signature 4Date: e*- /&- 14
(�iMiees signature only)
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, you may 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.
Print Nam(
Signature:
State of FI(
County of Miami -Dade )
Sworn to and subscribed before me this
day of 1•' 6,`{ , 20 .
DIV", 7 M.
By X LA4_-'-> y
(SEAL)
Contractor
Print Nam �.
Signature:
%0-0 SM4C
ti
•,Q�G 26, 20� ,•
#EE860800 _ Q
STAB
State of Florida)
County of Miami -Dade )
Sworn to and subscribed before me this le
day of "gn , 20 LL%�__.
of
Notary Public Stab W Florida
AIR COOLING INC.
Air Conditioning State Contractor
Licensed and Insured
7966 West 30 Lane Hialeah Florida 33018
Phone (786) 236 3440 (786) 236 3441 Fax (305) 8271042
Emaii.joseluis@aircoaiinginc.com joel@aircoolinginc.com
Date: April 24, 2014
Submitted to:
Vision Miami/ lion Segal
401 Washington Ave Suite # 202
Miami Beach Florida 33139
We hereby submit specifications for:
CONTRACT # 14-025 Revised
Job Place:
Segal Residence
500 NE 96 street
Miami Shores Florida 33138
First Floor.
New installation central air conditioning 5 tons RHEEM, 5 tons, new rigid fiberglass duct main, new flexible round ducts, new —
boots, fabrication and installation special boots for all lineal diffuser specified in plans, 2 exhaust fan bathroom quiet, run new —
set copper lines from inside air handler to outside condenser unit, new PVC lines discharge water condensation, new air handler
stand metal, auxiliary pan to prevent water leaking, new thermostat digital programmable standard, support ducts with hanger
metal strap, new Lineal diffuser Air Guide manufacturer, standard supply air grilles specified in plans, and return air, solder all —
copper lines with silver 15% flush lines with dry nitrogen pressure, make vacuum, charge system with R410A, start up system.
Second Floor:
New installation rigid duct work fiberglass R6,1 X", hanger with metal strap, new supply air outlets, return air, air handler stand
metal, new auxiliary pan to protect for water leaking, new float switch to prevent water leaking with interrupt 24 volts, new—
digital thermostat programmable standard, new equipment RHEEM, 2 Tons, run new set copper fines from second floor thru —
garage how indicated In plans, condenser unit secured with tie down to concrete slab, solder all copper lines with silver 15% —
flush lines with dry nitrogen pressure, make vacuum, charge with R410A.
First Floor Back:
New installation equipment mini split Mitsubishi with 3 zones, run new set copper lines from condenser to every zone, total of 3 -
sets lines, new communication cable from each zone to condenser, new concrete slab for condenser unit, new line discharge —
water condensation from each zone to outside, open valves, charge with R410A.
Notes:
Concrete slabs for condenser unit will be done by General contractor, Electricity and Low volts lines required from a/c units --
will be done by Electrical contractor, Permits costs are not Included in this price shown above, if any charge by City will be In -
additional charges.
Total Amount for work speclfled above Including materials, eauioment, and labor Is $15000.00
In the event Owner or General Contractor shall fail to pay any periodic installment payment due ---------
hereunder, Air Cooling Inc., may cease work without beach pending payment or the resolution of any -----
dispute.
If payments is not made when due Air Cooling Inc. may suspend work in the job until such time as all
payments due have been made. A failure to make payment for period in excess of 10 days from due date -
of the payment shall be deemed material breach of this contract
Any alteration or deviation from the above specifications, involving additional costs, materials, delivery —
and or labor, will be executed only with approval by Owner, Architect or General Contractor, with written
orders, and if there any charge for such alteration or deviation, additional charge shall be added to the —
price of this Contract.
Air Cooling Inc., shall not be liable for any delay due to circumstances beyond our control including -----
strikes, casualty or general unavailability of materials or equipment, This work required to be ---
coordinated before begin the job, without the coordination the Air Cooling Inc. are not responsibilityfor—
feature conditions or technical conditions.
Contract Price:
The Owner or General Contractor shall pay to Air15 000.00Cooling Inc. for the equipment, materials and
labor to —be performed under this contract for the sum of $ subject to additions and deductions pursuant
to authorized change order.
Terms of Payments:
1st initial payment in the sum of $ 7 500.00 in time of signing contract to order materials and begin job.
2nd Partial payment in the sum of $ 6 000.00 in time of begin to install equipment
3rd Final payment in the sum of $ $ 1500.00 0.00 in time of completion of the job
Terms:
If by reason of custom default in any of customer obligations under this agreement, including but not ----
limited to the payment of any sum owing to Air Cooling Inc., under term and conditions specified in this --
Contract, and Air Cooling Inc., employs an attorney to enforce this agreement or to collect any ---------
delinquent payments, customer agree to pay all costs and reasonable attorney fees incurred or expended
by Air Cooling Inc. including appeals.
All materials are guaranteed to be as specified. All work to be completed in a workmanlike manner -----
according to standard practices. This Contract subject to acceptance within 30 days and it is void —
thereafter at the option of the undersigned.
Price of this Contract will be in effect for 90 days from date issued and is void thereafter.
ACCEPTANCE OF CONTRACT.
The above prices, specifications and conditions are hereby accepted. You are authorized to do the work
as specified. Payments shall be made as outlined above.
Signed _Z_,<-- day of 201
By:
Print Name
Signature
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