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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 _ �sMa�oottlAca�t�WAMclsaeiM�pl7liMti*;�sti�,'mapotk�i�iani�ebirandae�d. E`�'I'IQtiig�xtJlf�fEG.w tb.tsawaonAtllansraq�it�ifismgra►neaat. Aaatlt1�a1a�M�91IMsfl►tlrs c�gde�eaRuoldnrin�aaelpwm]� _ _ _ R �uCT XME C,AUFLLO Wadd0finsl111AMOA map j Rt-lilt Oft) 2314011 16MIOW97AVOUAM Iuidwi Ld es. FL 3301 ren �►rra �+a,_a�l_i+ rruue+r Phone pal i t 4 t Fax 005} 231.Q7t 1 _ 1 Ay ASSVEENDE COMEW AI.ORWi U" sla - aMeilAlii 6 _ Elrr{iie� Air Inc .— , , - 9725 MIN 109 TEARWE _ _ !lSli#BlF- COYES - - CAT MNJif1BEJi N NUR: .iti1�Sigltb i 14#0F1 Pp9:IC1IrSi?FIII NGELAMDE 0ELtIVIfmvEiiM ISSOEdT011H6 MURERFM"AiN FCNi1WEI ICYPk7711t7D INIl1It71Y1�1 MSTRNGNG ANY Ii wffr TMwm Gt 1t1d71Qb141F ANY Ct]I IiR.+itlGt AR +gi fF1EFC D4G'LMIEMIi Vfi1i'H gpF F 7171AAiiDH 1 I Ns OTFA CERT1Pt 4TE WAY BELqSMOR`MAY PI:RTAW. THE IN90AME AFFt 3 BYTHE UICIES pAM [HE fEF�IS, ExCI#7S NBAl1* CONF311 ONS OFWJR:H PMVJM LMM amm MAY HAVETA —WL 81 1 �Edl1G� itA1Q t�.A�►o�. __ - . -. __ lV�lSJPIa�AI�iANQE Fr14i�rls�eatl€ Lem EiCIMU.MAEMtr - FJ1CNaCCuaia � 7.0[�GI.i1QQAR} ; C + C+sIr16RAF lug rrr T{1 NiE4 l oomox ;�Ixtoa Via► n _ S� Y `p8t4; dBt23121i�5 �air� .s 1 Og4t4t1�00 — - - - ss�uE LtAfP N�➢II,K.;r RFiKin1 .s n ,AWYALFTO i.c a peep ra.rstnlR+rt �,". - F-J runes. n 0 111tputa-"um a J eOCUR F14CH OC _ i n AGMEGA : - - DECt Lma—m LW8ft IiF YIN: Rt211�1l1 D1116 wClDENr► a tOQ,EJDdtiQ_ AW, NOW 71�� bra �,,� s 6t9t?.tMi�tlii4 rn>vx� ff ee��rcws EL; n,arxw,�urtix' a 1i10,�DOC#s�UO oFopilgrar�'�&�ts�pat�6 irre�aenr►15enaiert.n�w Rxwrlos 6dMdt�+4i���P��1 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.: