MC-14-2028Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL y�
Phone: (305)795-2204 Fax: (305)756-897"
Inspection Number: INSP-219849 Permit Number: MC -9-14-2028
Scheduled Inspection Date: November 12, 2014
Inspector: Perez, JanPierre
Owner: IZQUIERDO, NICOLAS
Job Address: 78 NE 101 Street
Miami Shores, FL
Project: <NONE>
Contractor: EMPIRE AIR INC
tsunatng uepartment comments
VENTILATION WORK DUCT WORK AND CHANGE OUT
Permit Type: Mechanical - Residential
Inspection Type: Final
Work Classification: Addition/Alteration
Phone Number (786)231-5339
Parcel Number 1132060131330
INSPECTOR COMMENTS False
V�
Phone: (786)236-9043
November 10, 2014 For Inspections please call: (305)762-4949 Page 19 of 49
Inspector Comments
Passed
Failed
Correction
Needed ❑
Re -Inspection ❑
Fee
No Additional Inspections can be scheduled until
re -inspection fee is paid.
November 10, 2014 For Inspections please call: (305)762-4949 Page 19 of 49
�s;�
. of wO O.
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 UNE PHONE NUMBER: (305) 762-4949
❑BUILDING ❑ ELECTRIC ❑ ROOFING
FBC 2010
Master Permit No. 9� O y -...zn� F
Sub Permit No. — A `
❑ REVISION ❑ EXTENSION [:]RENEWAL
PLUMBING 0 MECHANICAL E] PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS:
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: 1 132,._0W 31330 Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: / FFE: �'�G
OWNER: Name (Fee Simple Titleholder): a Phone#: 32G- z!S 1 lQ
Address: 12SW r-,,,_CI�+__� CAA:, IN 1
City: ) a C1 'rA ` State: �(� Zip:
Tenant/Lessee Name:
Email:
CONTF
Addre!
City: t •
dState• Zip: 0/19
Qualifier Name:. n7 -nCeol fir% Phone#:
O
State Certification or Registratio f Certificate of Competency #:
DESIGNER: Architect/Engineer: �� Phone#: ? ^�
Address City: J) State: �—_ L Zip:
Value of Work for this Permit: $ ��� Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration New Repair/Replac ❑ Demolition
Description of Work:
Specify color of colYYorrt�thru tile:
Submittal Fee $ W Permit FeeCCF $ 14. CO/CC $
Senning Fee $ Radon Fee "-G DBPR $ __ Notary $
Technology Fee $ Training/Education Fee $ ` Double Fee $
Structural Reviews $ Bond $ ' 0
TOTAL FEE NOW DUE $ 2
(Revisedo2/2a/2014) tq
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. 1 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 Signature
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this
day of S , 20 by
�X-Ok-0-5 1241Q�A itb0 who 'rrsonally kr ow o
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
_
®o �Q,
Seal:
�' •
00
r 'lnU1"0
APPROVED BY
(Revised02/24/2014)
The foregoing instrument was acknowledged before me this
[ice day of .20 . , by
o i erson� ally known t
me r who has produced as
identification and who did take an oath.
NOTARY PUBLIC.
Sign:
Pring 1
Seal: ��'' * MycMISSION01"IM
*ug EXPIRES: M®y 28,2018
Plans Examiner
Structural Review
koning
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): 78 NE 101 STREET, MIAMI SHORES FL
City: Miami shores village County: Miami Dade zip Code: 33138
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 M 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): 240
4. Size Disconnecting Means:
C.U'. 45, AHU 60 amps.
so C
AIAO
Contractor's Company Name: Empire Air Inc. FPhone: 305-829-2493
State Certificate or Re ' r ion No. C C 1816524 Certificate of Competency No.
Signature Date: 9/12/2014
(QualMmes signature)
(Revised02/24/2014)
UNIT BEING REPLACED
DATA
NEW UNIT
MANUFACTURER
RHEEM
AHU or PKG. UNIT MODEL #
RHSL4&
COND. UNIT MODEL #
13AJN99 e(,
KW HEAT
7
NOM TONS
4
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
13
YES
NO
REPLACING DUCTS
YE
NO
YES
NO
REPLACING THERMOSTAT
NO
YES
NO
NEW 4"CONCRETE SLAB
RYES
NO
YES
NO
NEW ROOF STAND
YES
NO
NEW RETURN PLENUM BOX
NO
1. Minimum Circuit Ampacity (Wire Size):
2. Maximum Overcurrent Protection (Fuse/Breaker Size):
3. Voltage of Circuit (208/240/480): 240
4. Size Disconnecting Means:
C.U'. 45, AHU 60 amps.
so C
AIAO
Contractor's Company Name: Empire Air Inc. FPhone: 305-829-2493
State Certificate or Re ' r ion No. C C 1816524 Certificate of Competency No.
Signature Date: 9/12/2014
(QualMmes signature)
(Revised02/24/2014)
EMPIRE AIR, INC. LIC#: CAC 1816524
8649 N.W. 188 TERRACE UNIT# 3405 MIAMI, FL 33015
TLF: 786 236 90434, FAX: 305 829 2493
PROPOSAL # 10876 DATE: 09/11/14
ADDRESS: 78 NE 101 STREET. MIAMI SHORES, FL 33138
SCOPE OF WORK DESCRIPTION:
1. REPLACE DAMAGE DUCTS.
2. INSTALLATION OF NEW A/C EQUIPMENT, INCLUDING AIR HANDLER AND
CONDENSATION UNIT. MFGR: RHEEM.
3. REPLACE VENTILATION IN BOTH BATHROOMS.
EXCLUDE:
PERMITS, TEST AND BALANCE, FURNISHING MATERIALS, fiberglass plenums for linear
diffusers, plenum for linear diffusers by others(we will Install), -AC EQUIPMENT, CRANE
SERVICES, REFRIGERANT LINES, UNDERGROUND WORK, CONDENSATE DRAIN PIPE,
LOW VOLTAGE WIRING, START UP, AHU STANDS, FIRE STOPPING, DUCTWORK
INSULATION AND DELIVERING MATERIALS TO THE JOB SITE
EMPIRE AIR, INC:
DATE: o/-((
PRICE: $ 7,000.00
OCORPORATION
DATE: 7/1, 111f
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
CONTRACTORS' REGISTRATION FORM
ALL CONTRACTORS MUST PROVIDE COPIES OF LICENCES AND INSURANCES EACH TIME A PERMIT IS
SUBMITTED OR THE VILLAGE MAY MAINTAIN A FILE WITH YOUR INFORMATION FOR A $30.00 FEE PER YEAR.
IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR:
A. COPY OF QUALIFIER'S STATE LIC CARD
B. COPY OF LOCAL BUSINESS TAX RECEIPT
C. COPY OF LIABILITY INSURANCE (CERTIFICATE HOLDER TO BE MIAMI SHORES VILLAGE BLDG DEPT)
D. COPY OF WORKERS COMPENSATION (EITHER CERTIFICATE OR EXEMPTION)
IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY:
A. COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER
B. COPY OF MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT
C. COPY OF LIABILITY INSURACE (CERTIFICATE HOLDER MUST BE MIAMI SHORES VILLAGE BLDG DEPT)
D. COPY OF WORKER COMP INSURANCE (EITHER CERTIFICATE OR EXEMPTION)
YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE HOLDER AS FOLLOW:
MIAMI SHORES VILLAGE BLDG DEPT
10050 NE 2ND AVE
MIAMI SHORES, FL 33138
COMPLETE CONTRACTOR'S INFORMATION
BUSINESS NAME:
BUSINESS ADDRESS: %s � '57 /mac l�� r��'f'°
CITY �aqA_711
STATE t- ZIP CODE--; 3 ® l B
BUSINESS PHONE: -9 515 1 FAX NUMBER 07^7 02 f 123
CELL PHONE(, 2.3 Ce 50 ?QUALIFIER'S NAME:
QUALIFIER'S LIC NUMBER: CA
E-MAIL ADDRESS OF APPLICABLE): kvO'e'-7 ce-s 0 r) -
Created on 311910.9 BY MWV I RV 31209 MLDV
S STATE OF FLO A
DEPARTMENT F BUSINESS AND
PROFESSlO AL REGULATION
CAC1816524 SSUED:. 09/03/2014
CERTIFIED Alii=w CONTR
PROENZA, OSA+ILNY
EMPIRE AIR INC,
IS CERT D under t pro Ch.489 FS.
ExPkB vial : AUG 31, 2016 L1408030001920
STATE oF
OFB'ARTKF�
�ncDNISIM WORKERS' ATI�CONSTRCINM
MMY
CL= UMMATE OF E.ECT[ON TO 13E EXeWIr FRCW FLORIDA
WORKERS' COMPENBATM LAW
ACTIVE 12/31/2012 EXPIRATION DATE: 12/31/2014
PERSON OSKW pROENU
FEIRt: 2051086M
BUSHIESS NAME AND ADDRESS: -
ENPBW A82 INC
8725 NW 189 TEM
HIALEAK FL 33018
SCOPE OF BUSINESS OR TRADE
1- HEATU VM"TroN, AR-CONS
CERTIFICATE OF LIABILITY INSURANCE OWIS114
Tires$ C-OMIF=IMIX IS 9 WjW A&,A WATtER OF, , ONOY AND COWSM NO NdWt UPN'JLI —*I cvn*lcm-' i' owi i�*9
CEMPICATE AOS NOT JIFIFIFSAXWELY OR W4ATAI LY A'MM, OMP On ALWA THE =MPAGE AFFORDO ITY VM POUCES
. 7t1IS ATE OF Ia+8WNICE DMI MW COS:#'EIJTE A CONiIUM BE77FYEEL THEWOWWWWWS),AUTHOMM
@:ATM OR PIIaBdUMV Aft! INE CMPICdATE i MPP
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Phone pal i t 4 t Fax 005} 231.Q7t 1 _ 1 Ay ASSVEENDE COMEW AI.ORWi U"
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ExCI#7S NBAl1* CONF311 ONS OFWJR:H PMVJM LMM amm MAY HAVETA —WL 81 1 �Edl1G� itA1Q t�.A�►o�. __ - . -.
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Miami shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
Compensations'
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. 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 map be
ersonall liable for the worker compensation in'uries of an on 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:
i�
State of Florida )
County of Miami -Dade)
Sworn to and subscribed before me thisj�,
day of ` 20 ``\ 807 //".
(SEAL)
Type of Identification Produced
State of Florida )
County of Miami -Dade)
Sworn to and suscribedbefbre ;
day of � (f , 20
of Identification
this .1b _
Notary Puft state bf FloWa
Commission EE128705
cRO oMirtol5
cot%r�rr
DBA/BUSINESS NAME:
EMPIRE AIR INC
BUSINESS LOCATION:
8725 NW 189 TERR
MIAMI, FL 33018
OWNER/CORP.
EMPIRE AIR INC
PHONE # 786-236-9043
8725 NW 189 TERR
MIAMI, FL 33018
NAICS CODE: 238990
MIAMI-DADE COUNTY - STATE OF FLORIDA N/A October 10, 2014
LOCAL BUSINESS TAX RENEWAL
2014 -2016 APPLICATION RECEIPT. 6114862
STATE # CAC1816524
BUS. COMMENCEMENT DATE: 10/01/2006
SEC TYPE OF BUSINESS
MECHS SPEC MECHANICAL CONTRACTOR
1
If no longer In business, please notify us In writing.
Review and correct the information shown on this application.
A 25% penalty will be assessed to anyone found operating
without a paid local business tax, in addition to any other
penalty provided by law or ordinance (Sec 8A-176(2)).
A Certificate of Use and/or City Business Tax
Receipt may also be required.
FEE
AMOUNT
Receipt Fee
30.00
UMSA Fee
30.00
Beacon Council Fee
15.00
Bingo Permit Fee
0.00
Nightclub Permit Fee
0.00
Multi -Municipal Contractor Fee
0.00
Restricted Contractor Fee
0.00
Library Fee
0.00
Transfer Fee
0.00
Doing Business without a License Penalty
0.00
Late Penalty
7.50
Collection Cost
0.00
NSF Fee
0.00
Prior Years Due
0.00
Amount Recently Paid
To pay online go to www.miamidade.gov/taxcollector
To pay by mail, make check payable to:
Miami -Dade County Tax Collector
Business Tax
200 NW 2nd Avenue
Miami FL 33128
To pay in person go to:
200 NW 2nd Avenue
(305) 270-4949, fax (305) 372-6368
A service fee of not less than $25.00 up to a minimum of 5%
will be charged for all returned checks.
t RETAIN FOR YOUR RECORDS t
82.50
.................................................................................................................................................................................................................................................................................................................
MIAMI-DADE COUNTY -
i DETACH HERE AND RETURN THIS PORTION WITH YOUR PAYMENT 1 N/A October 10, 2014
STATE OF FLORIDA
LOCAL BUSINESS TAX
RENEWAL
2014 - 2015 APPLICATION
pll
III
I
II ��I
I
I
I I
STATE #CAC18 6524
6716444
BUSINESS LOCATION:
8725 NW 189 TERR
MIAMI, FL 33018
BUS. COMMENCEMENT DATE: 10/01/2006
SEC TYPE OF BUSINESS
OWNER/CORP.
MECHS SPEC MECHANICAL CONTRACTOR
EMPIRE AIR INC
1
APPLICATION IS HEREBY MADE FOR A LOCAL BUSINESS TAX RECEIPT OR PERMIT FOR THE BUSINESS PROFESSION
OR OCCUPATION DESCRIBED HEREON. I HAVE BEEN INFORMED OF ALL ZONING RESTRICTIONS IMPOSED ON THIS RECEIPT.
I SWEAR THAT THE INFORMATION IS TRUE AND CORRECT.
EMPIRE AIR INC
OSMANY PROENZA PRES
8725 NW 189 TERR
MIAMI, FL 33018
SIGNATURE REQUIRED SEE INSTRUCTIONS ABOVE
Please pay only one amount. The amounts due after Sept 30th Include penalties
per FS 205.053.
if Paid By Oct 31, 2014 Nov 30, 2014 Dec 31, 2014 Jan 31, 2015
Please Pay $0.00 $0.00 $0.00 $0.00
7000000000000000000000006114862201500000007500000000000005
t
AHRI Certified Reference Number: 4526116 Date: 9/17/2014
Product: Split System: Air -Cooled Condensing Unit, Coil with Blower
Outdoor Unit Model Number: 13AJN48
Indoor Unit Model Number: RHSL-HM4821+RCSL-H*4821
Manufacturer: RHEEM SALES COMPANY, INC.
Trade/Brand name: RHEEM; RUUD; WEATHERKING
Series name:
Manufacturer responsible for the rating of this system combination is RHEEM SALES COMPANY, INC.
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:
Cooling Capacity (Btuh): 46000
EER Rating (Cooling): 10.50
SEER Rating (Cooling): 13.00
IEER Rating (Cooling):
Ratings followed by an asterisk (*) indicate a voluntary rerate 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 responsiblllty for,
the product(s) listed on this Certificate. AHRI expressly disclaims all liability for damages of any kind arising out of the use or performance of the product(s), or the
unauthorized alteration of data listed on this Certificate. Certified ratings are valid only for models and configurations listed In the
directory at www.ahridiroctory.org.
TERMS AND CONDITIONS
This Certificate and Its contents are proprietary products of AHRI. This Certificate shall only be used for individual, personal and "�*f111R
confidential reference purposes. The contents of this Certificate may not, 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-CONDITIONING, HEATING.
CERTIFICATE VERIFICATION & REFRIGERATION INSTITUTE
The Information for the model cited on this certificate can be verified at www.ahridirectory.org, click on "Verify Certificate* link we make life becter"-
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 listed at bottom right. — – — V --` 5
130554491680126785
02014 Air -Conditioning, Heating, and Refrigeration Institute CERTIFICATE NO.: