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MC - 15- 141Inspection Worksheet Miami Shores Village I 10050 N.E. 2nd Avenue Miami Shores, FIL 1 / Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-226873 Permit Number: MC -1-15-141 Scheduled Inspection Date: February 09, 2015 Permit Type: Mechanical - Residential Inspector: Perez, JanPierre Inspection Type: Final Owner: BROWN, ONEARIES Work Classification: A/C Replacement Job Address: 8955 NE 4 Avenue Road Miami Shores, FL Project: <NONE> Contractor: SUNSHINE AIR INC tsuuamg uepanment comments REPLACE CENTRAL AIR CONDITIONING SYSTEM SAME I Infractio LOCATION INSPECTOR COMMENTS Phone Number Parcel Number 1132060460430 False Phone: (786)488-1200 February 06, 2015 For Inspections please call: (305)762-4949 Page 7 of 26 Inspector Comments Passed Failed Correction Needed ❑ Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. February 06, 2015 For Inspections please call: (305)762-4949 Page 7 of 26 Miami. Shores Village Building Department JAN 212015 i. o050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762A949 BUILDING PERMIT APPLICATION FSC 20 �O Permit Type: MECHANICAL (Fee Simple Titleholder): (Y e CA r C S Y1 P}mne# 'r .,,,- /jA n _ n % OWNER: Permit No. Mager Permit Na � 'S "I L4 mom TenamiL.essee Name: Phone#: Email: `k M-39 JOB ADDRESS: U I J 2 I v -1 MIL City: Miami Shores County: Miami Dade 3 ) Foiiornarcet#: Ila.1b6 6 Ll 6 6 9^5 0 Is the Building Historically Demoted: Yes NO ✓ Flood Zone: ✓ CONTRACTOR: Company Name. 5 h %v1 G f f Y, jL r7 C- Phone#: 986 Y 0 Address: I L1 7 u'7 J w 1 .> > I L 1` City: MCL M; State: � L V, IA G Zip: -3 3/ 5 Qualifier Name: 5h GY &-a n C' L± Phone#: State Certification or Registration #: L iqC / 16 15 A Certificate of Competency #: r� Contact Phone#: / 6 6- 4 8 & I D Q 0 Email Address: .T✓► �0 & Sy n s ti ih L - A �r. w ty DESIGNER: Architect/Engineer•. Phone#: Work for this PermlU $ 3,550 Square/t inear Footage of Work: Type of Work: OAddress CWWration UNew *epair/Repiace ❑Demolition Description of Work: Submittal Fee $ - .��� Permit Fee $ Scanning Fee $ Radon Fee $ KM CCF $ CO/CC $ DBPR $ Bond $ Notary $ TrainingfflAucation Fee $ Technok"u Fee $ Double Fee $ Stractnral Review $ TOTAL FEE NOW DUE $ r .: Bonding Company's Name (if applicable) Bonding Company's Address city state Mortgage Lender's Name (if applicable) Mortgage Lender's Address city Zip State 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, WENS, POOLS, FURNACES, BORERS, 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 > N not be approved and a reinspection fee will be charged Signature Lt-�(.* Signam Owner or Agent Contractor The foregoing instrument was acknowledged before me this day of �4 20 �, by 0Y) t'Q -tI'C'S r pYQ W t't who is personally kno identification and who did take an oath. The foregoing instrument was acknowledged before me thisAo day of 20 15, by SfQ Sy A rI n � ✓I �- } who is known toor who has produced as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUB C: Sign: Sign: Print �r , lJ r Print My Commissi DARIyieLL:"""I U MY Commi RNELL BULLER L�t�iMMISSION # EE0i32242 MY COMMISSI# EE�EXPIRES EXPIRES '' RES April 10, 2015(4-0153 APnl 10,?01' : - ois3 Floridallota;gery####################�R############## #### APPROVED BY 4ans Examiner Zoning Structural Review Clerk (Revised W/iQWXRevised O&I.W2009XRevised 3115!09) WWWWA 16 PRODUCER Edison Insurance Agency, Inc. 3635 Palm Beach Boulevard #A Fort Myers, FL 33916 INSURED uns 10904 SIN 155 Terr Miami, FL 33157 ....... .. . . . . . ........... ............. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOwHAVE S'E'EN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY ;ON T RAG' , OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH. POLICIES. LIMITS SHOVA[N MAY HAVE BEEN REDUC;ED BY PAID CLAIMS. --IINSR MAkin POLICY NUMBER t TYPE Or 45URANCE - POLK Limits MMODrym mmmory GENERAL LIABILITY EACH OCCURRENCE i S 1,1000,1joD 1 —X 1 !MPG2998A A COMMERCIAL GENERAL I-Miu-ry O=W2 DAM - TO RENTED 014 02/2712015 DAM D ........ . CLAIMS�MADE X i OCCUR rPF�tMj �4 DEX 10 0 r PERSONAL ADV INJURY S GENERAL AGGREGATE 2,000,000 GEN:L AGGREGATE LIMIT APPLIES PER: PRODUCTS -C€ MPIGP AGG S 2,66( 000 X LOC 'v'POL; PRO - AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea aoddenI) ANY AUTO �xxxx)( . . .... BODILY IN (Por P—) x ALL OWN -ED AUTOx8 'Ux BODILY INJURY (Per acddmt) 6 xxx" SCHEDULED ALTIOS Xxx)Q( F- :xxxxx PROPERTY DAMAGE I HIRED;AUTOS (PER ACCIDENT) NON -OWNED AUTOS X)(XXX X=)( —T— UMBRELLALIA5 7 --- EXCESS LIAB EACH MCURR 5 xxx" xxxxx CLAWS -MADE 30(xxx AGGREGAFE $ -DEDUCTIBLE $ RETENTION S 1 WORKERS COMPENSATION AND EMPLOYERS'LIABILITY 1VG STATU- 10TH - YIN ANY PROPRIETOR=ARTNEREXECU11VE OFFICERIMEPADER EXCL E,L. EACH ArXIDENT 5xy-X" MWndawy in NH)X)Cx Xx It.2 MSEASE - BA EMPLO z VOW If yes, describe un--ef ------- 1-1 I. DESCRIPTION OF OPERATbbow w C -L, OlSEASE - POLICY LIMIT S X)OM i !xxxxx XX)OCX i xxxxx Vow DESCRIPTION OF OPERATIONS I LOCATIONS I VENCI-15S.(Attach ACORO 101, Additional Rema*s Schedule, it M.f,- a Spai€ r�qu4adj Air conditioning systems or equIpment CERTIFICATE HOLDER CANCELLATION MIA 02 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE VALL BE DELIVERED IN City of Miami Shores Village ACCORDANCE WITH THE POLICY PROVISIONS. Fax # 305-255-7337 10060 2nd Ave. AUTHORIZED REPRESENTATIVE Miami Shores, FL 33138 Cc) 1958-2009 ACO RD CORPORATION. All rights reserved. ACORD 25 (2 09199 The AC ORD name and logo are registered marks of ACORD part ylewer ! ; 100% https://apps8.tldt.com/crreportviewer/reportViewer aspx!data=kdvpg.-. a EF�CHIF Na- OFpK:M STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION " CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS'COMPENSATION ION LAW *' CONSTRUCTION INDUSTRY EXEMPTION This certifies that the IndividUat listed below has elected to be exempt from Florida workers' Compensation law. EFFECTIVE DATE: 3/18/2013 EXPIRATION DATE: 3/18/2015 PERSON: BENNETT STACYANN FEIN: 300528459 BUSINESS NAME AND ADDRESS: SUNSHINE AIR INC PO BOX 972166 MIAMI FL 33197 SCOPES OF BUSINESS OR TRADE: HEATING, VENTILATION, AIR-COND DFS.F2-DWC 252 CERTIFICATE OF ELECTION TO BE E)EmPT RSV*ED 07-12 lofl QUESTIONS? (850)4131609 4/23/2013 4:13 Pio 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. 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 and has acknowledge that he or she will not use day labor, part-time employees or subcontractors for your project. The contractor has provided an affidavit stating dua he or she will be the only person allov*d to work on your project. In these circumstances, Miami Shores Village does not require verification of workers' compensation insurance coverage from the contractor's company for day labor, part-time employees or subcontractors.. Therefore, you may be personally liable for the worker compensation iniuries 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 Signature: State of Florida County of Miami -Dade The foregoing was acknowledge before me this -)C) day of 'Soy " Ooo/ , 20 6 - By ©nC" i wK. Notary=a '- SEAL: t4o�1,',` r MMIS `;ON # SE082242 Contractor Signat e State of Florida County of Miami -Dade The foregoing was acknowledge before me this 2®` day of --�Gkywvy ,20 %S . By c r+4 who ' per" na ly known tom or has produced as i DARNE'LL BULLER Notary: j ''. DIY COMMISSION # EE0822 SEAL: '•,;:. EXPIRES April 10, 2015 SUNSHINIE AIR 01/21/2015 State of Florida County of Miami Dade Before me this day personally appeared Stacyann Bennett who, being duly sworn, deposes and says: I Stacyann Bennett will be the only person working on replacing the central air conditioning system at 8955 NE 4 Ave Road. Swo (or affirmed) and subscribed before this day of �o v,va ry 20 by Personally know V OR Produce Identification Type of Identification Produced DARNELL BULLER My COMMISSION # EE082242 EXPIRES April 10, 2015 Type or Stamp Name of Notary 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. Ly *11 Job Address (where the work is being done):9 �� City: Miami Shores Village County: Miami Dade tip Code: 3 3> 3 8 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 g ARHI Sheet Attached: YES O NO ❑ Contract Attached: YES 1. Minimum Circuit Ampacity (Wire Size): A 2. Maximum Overcurrent Protection (Fuse/Breaker Size): 0?5 3. Voltage of Circuit (208/240/480): A 8 oZ - 0 I r ase ., 60 h Z 4. Size Disconnecting Means: 30 - Contractor's 0Contractor's Company Name: 5,jn -sb i rw, A Y , ::P yl L, Phone: State Certificate orist on N.GAC lei )b l5 ® Certificate of Competency N. Signature Date: / ,3 o / (Qualifier's signature only) UNIT BEING REPLACED DATA NEW UNIT MANUFACTURER CCM AHU or PKG. UNIT MODEL # 19111 7 COND. UNIT MODEL # I 3 M So A in I KW HEAT K W NOM TONS oF1 s 006 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 I ( PKG UNIT I 1 EERISEER YES NO REPLACING DUCTS YES N YES NO REPLACING THERMOSTAT S NO YES NO NEW 4"CONCRETE SLAB M N YES NO NEW ROOF STAND YES YES NO NEW RETURN PLENUM BOX I YES 0 1. Minimum Circuit Ampacity (Wire Size): A 2. Maximum Overcurrent Protection (Fuse/Breaker Size): 0?5 3. Voltage of Circuit (208/240/480): A 8 oZ - 0 I r ase ., 60 h Z 4. Size Disconnecting Means: 30 - Contractor's 0Contractor's Company Name: 5,jn -sb i rw, A Y , ::P yl L, Phone: State Certificate orist on N.GAC lei )b l5 ® Certificate of Competency N. Signature Date: / ,3 o / (Qualifier's signature only) 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: 7426795 Date: 1/20/2015 Product: Split System: Air -Cooled Condensing Unit, Coil with Blower Outdoor Unit Model Number: 14AJM30 Indoor Unit Model Number: RHIT3617STAN 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): 29000 EER Rating (Cooling): 13.00 SEER Rating (Cooling): 16.00 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 responsibility 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.ahridirectory.org. TERMS AND CONDITIONSAll 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 not, in whole or in part, be reproduced; copied; disseminated; ff-Im Im 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 atww 4v !; sdsr aat' r.org, dick on 'Verify Certificate" link we 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 listed at bottom right ©2014 Air -Conditioning, Heating, and Refrigeration Institute CERTIFICATE NO.: 1306626476709862;