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MC-15-90of Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FIL 1 Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-226553 Permit Number: MC -1-15-90 Scheduled Inspection Date: February 09, 2015 Permit Type: Mechanical - Residential Inspector: Perez, JanPierre Inspection Type: Final Owner: SANCHEZ, ISRAEL Work Classification: A/C Replacement Job Address: 375 GRAND CONCOURSE Miami Shores, FL Phone Number Project: <NONE> Contractor: AFFORDABLE AIR & HEAT INC Building Department Comments Parcel Number 1132060135940 Phone: (305)940-0777 REPLACEMENT OF 5 TON UNIT Infractio Passed Comments INSPECTOR COMMENTS False i e February 06, 2015 For Inspections please call: (305)762-4949 Page 6 of 26 Inspector Comments Passed 786-253-6004 ISRAEL 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 6 of 26 BUILDING PERMIT APPLICATION ❑BUILDING ❑ ELECTRIC Miami Shores Village Building Department JAN 15 2015 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC 20 P Master Permit No. M C 15—�o ❑ ROOFING ❑PLUMBING MECHANICAL ❑PUBLIC WORKS Sub Permit No. ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: -")nP5 GgAkID C0QW(Jg2E rite- Miami Shnrac rnnnty Miami Marla lin• ✓J1�� Folio/Parcel#: it- 32ao -015 - �7q4G is the Building Historically Designated: Yes NO _ Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): IL-- ��'� Phone#: �1�sc� - 253 c�oo<f Address:.'3rWj- GiR-A+-0 0,CW0(2cjj (,, City: Mt c( State: �e Zip: �L� ~ ��4�Y Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: A FFol12�13Lf- A-112'3 11EA r Phone#: " CWDcrm - Address: 5 (1j t4-G-� )c::�?O (fD�. " City: State: Zip: 01 Qualifier Name: L Phone#: State Certification or Registration #: CAG 04k) I I I Certificate of Competency #: DESIGNER: Architect/Engineer:)Phone#: Address: City: State: Zip: Value of Work for this Permit: Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New 54 Repair/Replace ❑ Demolition Description of Work: 0E.PLAozme NT- U%�: 15 ION UN i T- . Specify color of color thru tile: Submittal Fee $ Permit Fee $__ CCF $ CO/CC $ Scanning Fee $ Technology. Fee $_ Structural Reviews $ (Revised02/24/2014) Radon Fee $ Training/Education Fee $ DBPR $ Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ L. 80. 10 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 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. 'I'll / Sign ure 4rge-­,�000r:!�O �e2e�,­rvp Z—,, OWNEor dNT The foregoing instrument was acknowledged be o e this e^0 day�o+f� � �V "� , 201 by J.�', who is personally known to me or who has produced fL nLO cS5`L2 - q Uq - 72 ^ as identification and who did take an oath. NOTARY PUBLIC: Sign: 4 Print: ��•zo e� - "IL bA A THOMPSON Seal: • Notary Public - State otfWids My Comm. Expires Feb 28, 2017 '•.,;�qFfl;`' Comm ss eri # EE 870422 APPROVED BY (Revised02/24/2014) The foregoing instrument w s acknowledged before me this /— day of ht 20 . by who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Seal: Emil' tiExaminer Zoning Structural Review 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): 2) u� &AkK D 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 ❑ NO ❑ ARHI Sheet Attached: YES,g NO ❑ Contract Attached: YES ❑ 1. Minimum Circuit Ampacity (Wire Size): G� 2. Maximum Overcurrent Protection (Fuse/Breaker Size): 3. Voltage of Circuit (208/240/480): 4. Size Disconnecting Means: Contractor's Com ny me: A(12_4 A+F—AT Phone: ®-m State Certificate o RetnNZ Certificate of Competency No. _ Signature Date: w`^' (Qualifier's signature) i (Revised02/24/2014) T BEING REPLACED DATA NEW UNIT i 11-00 '1.. MANUFACTURER AHU or PKG. UNIT MODEL #kj✓( Pj b n 14 -r/ I COND. UNIT MODEL # 11 (p0 16 KW HEAT 10 NOM TONS AHU C U JrZ PKG 1) M.C.A AHU CU PKG AHU40 CU,6rb PKG 2)M.O.P AHU CU PKG AHUA O CU VO PKG 3) VOLTS AHU CU PKG PKG UNIT / / PKG UNIT EER/SEER YES REPLACING DUCTS YES <30> YES YES REPLACING THERMOSTAT NEW 4"CONCRETE SLAB YES YES YES NEW ROOF STAND YES YES Ar=? NEW RETURN PLENUM BOX YES 1. Minimum Circuit Ampacity (Wire Size): G� 2. Maximum Overcurrent Protection (Fuse/Breaker Size): 3. Voltage of Circuit (208/240/480): 4. Size Disconnecting Means: Contractor's Com ny me: A(12_4 A+F—AT Phone: ®-m State Certificate o RetnNZ Certificate of Competency No. _ Signature Date: w`^' (Qualifier's signature) i (Revised02/24/2014) This combination qualifies for a Federal Energy Efficiency Tax Credit when placed in service between Feb 17, 2009 and Dec 31, 2013. Certificate of Product Ratings AHRI Certified Reference Number: 7513304 Date: 1/13/2015 Product: Split System: Air -Cooled Condensing Unit, Coil with Blower Outdoor Unit Model Number: 4TTB6061B1 Indoor Unit Model Number: *AM7BOC6OH51 Manufacturer: TRANE Trade/Brand name: TRANE Series name: XB16 Manufacturer responsible for the rating of this system combination is TRANE 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): 57500' 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.ahvidiroetory.org. TERMS AND CONDITIONS This Certificate and its contents are proprietary products of AHRI. This Certificate shall only be used for individual, personal and A 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, wmma personal and confidential reference. AIR-CONDITIONiNC. 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 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. F- ©2014 Air -Conditioning, Heating, and Refrigeration Institute CERTIFICATE NO.: 130656308030495790 Afforda'ble Air&Inc. WHERE QUALITY IS AFFORDABLE 515 N.E. 190th Street • Miami, FL 33179 CAC048111 Dade (305) 940-0777 Broward (954) 987-9943 EC0001140 HOME # CELL # WORK # OTHER #: NAME,- JOB NAME: STREETS STREET.' CITY: ST 3 zIR " . CITY. STATE 3S3 DESCRIPTION OF SERVICES PERFORMED Title to the above merchandise remains with Affordable Air and Heat, Inc. AIR DISTRIBUTION: Ductwork will be designed, fabricated and installed"in accol. accepted engineering practices and In compliance wit a(ild (seller) until paid for in full. In case of default in any terns of this contract, the self�i s �thave the right to take immediate possession of said merchandise a f ,afpoagtcf the purchase price then unpaid shall become immediately inforoeonabovedate. ;�� dnS}ayabaasellefsgptionwithoutnoticeordemand.Ail monies paid aha117agng vyR11,(e self as liquidated damages. In the event the services of DUCTWORK: System of flexifiber and/or .5u ductwk with x anattomeYarerregrtbenforcetheinterestoftheseller,thepurchasershall be required to peY>ht reasonable attorney's tees together with interest and all costs thereto. NWwarranty service shall be performed on accounts with an outlets and _�_ returns. Subject to modif cation)-oCcording to structural outstanding balance. Labor warranty excludes, existing ductwork, existing or other requirementC-- electrical systems, and maintenance related repairs. LABOR WARRANTY:t In the evert : ea urchaser r$fuses to'allow seller to commence work after P Service will be provided free by us foraperiod of 4 _ C_ the' con"otha` n executed po chaser'shaR be responsible to the seller for 25% 01e>tota) puce as Iiquidafe{f and agreed damages. Seller shall not be year(s) from date of installation during regular workin ours. responsible fotanyoxisting building" welectricalcodeviolations. MANUFACTURER WARRANTY: ' 'All'geteriagi� guaranteed to 40.as specified. All work to be completed in a Parts Warranty (Yrs.) A /0 B _C anlike rgontyer accordi standard practices. An alteration or 00 ip t Davt ie contract spegi�d ns invotying ex be executed Compressor Warranty (Yrs.) A-%92 B, G µ upon wiiltenorders and will besubject tocharges ov n e is estimate. EXTENDED WARRANTY: > Provided through - foryear($). ial AFFORDABLE AIR & HEAT, INC. WILL PROVIDE: YE NO ' EXISTING / YES NO EXISTING INSTALLATION OF EQUIPMENT ❑ ❑°/ THOMPUAT T` ❑ ❑ REFRIGERATION LINES ( ) ORF USH:(• ), ❑ . ` ❑ GRILLES RETURNS CAEPE�RY ❑ ❑ ( ) (-O F e x ❑ [ 6 AkANCE,A*FkQW ❑ ❑ PERMIT FEE(S) S PLANS, IF REQUIRED'} Q,"; Q` RF�OVAL OFJ08'SITE DEBRIS 1:1 El �] DRAIN PIPING ( ) OR FLUSH ( ) �L.- fl, -k EEECTitIClEL'WIRING (POWER CQNTROL) ❑ �J AIR HANDLER SUPPORTS ❑ ,A CQ,4NEC1 TO �TIN0,,SERVICEIPANELS ❑ ❑ J CONDENSATION PUMP / / S •r -S ❑ ."F Q" iKt'$EASE ELEt3-RICAl SERVICE _ AMP 'K ❑ J EMERGENCY FLOAT SWITCHQ�ER; �" 02 ® ❑ EJ HURRICANE TIE -DOWNS ❑ "0. 0 ER,a 142 ❑ CONCRETE SLAB ❑ ❑' 54 . OTHERE El COST ."AEBATESICREDITS TOT- A'C,OOSTAd / A G� C 6F.INANCING AVAILABLE -- Payment to be made as folio ,�"'—r..■�-. deposits balancupoEr sttt up. Authorized Company Signature = . y+ Date This proposal subject to acceptanc within _J0 day& and is void there atter• at the• option of a seller.: TNE ABOVE PRICES, SPECIFICATIONS AN CONORIONS ARE , OIrJUIE THE WORK AS SPECM. PAYMENT 11111111 ABOVE. Option Chosen_Signat re Dater OP ID: AP CERTIFICATE OF LIABILITY INSURANCE F DATEiMM- nomofln4 YY)�n�d THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER., THIS "-RTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES OW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements). PRODUCER Riemer Insurance Group Hallandale Branch PO BOX 250 Hallandale, FL 33008-0250 Vita Kagan Gopman CONTACT PHONE FAX A/C No): A/C No Ext):(AIC' ADDRESS: cusT°MERID#:AFFOAII INSURERS AFFORDING COVERAGE NAIC # LIMITS INSURED Affordable Air & Heat, Inc. INSURER A: WeSCO Insurance Co. 515 NE 190 Street Miami, FL 33179 INSURER B : EACH OCCURRENCE $ 1,000,000. A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE F—v OCCUR INSURER C: INSURER D: PP1055018-02 INSURER E: 03/17/2015 INSURER F: MED EXP (Any one person) $ 5,00 COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT 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 SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY MM/D P LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000. A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE F—v OCCUR PP1055018-02 03/17/2014 03/17/2015 DAMAGE TO RENTEIT_ PREMISES Ea occurrence $ 100,00 MED EXP (Any one person) $ 5,00 PERSONAL & ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 PRODUCTS - COMP/OP AGG $ 2,000,00 ,EN'L AGGREGATE LIMIT APPLIES PER: X POLICY PRO LOC $ AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT (Ea accident) $ - BODILY INJURY (Per person) $ ALL OWNED AUTOS BODILY INJURY (Per accident) $ SCHEDULED AUTOS HIRED AUTOS PROPERTYDAMAGE $ (PER ACCIDENT) $ NON -OWNED AUTOS $ UMBRELLA UAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DEDUCTIBLE $ $ RETENTION $ WORKERS COMPENSATION WC STATU- OTH- EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVEE.L. OFFICER/MEMBER EXCLUDED? ❑ N / A MRY ITER EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ (Mandatory in NH) H s, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ T 77 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) Air Conditioning Contractor; Service, Installation & Repair City of Miami Shores 10050 NE 2nd Ave Miami Shores, FL 33138 CITYMIA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE © 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 26 (2009/09) The ACORD name and logo are registered marks of ACORD � CERTIFICATE C LIABILITY INSURANCE C r001"57Y) 5a�c 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. IMPORTANT, If the certificate holder is an ADDITIONAL INSURED, the policy(les) must `be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the poitcy certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). 'PRODUCER Corporate Insurance Advisors 1401 E Broward Blvd Suite 103 Ft. Lauderdale rL 33301 AONE lienee Bowman PHONE (954)315-5000 (954)315-3050 E-MAIL :rbowman@ciefrl.net INSUREM) AFFORDING COVERAGE _ ..._ waC # INSURERAASSOciated Industries ins Co 23140.._. INSURED w Affordable Air & Heat, Inc. 515 NE 190th Street: Miami FL 33179 INSURER 8: ... INSURERC: INSURER D: INSURER E. INSURERs AClilfCr!'�A:TC i1/918CtCCS.TJn�rri Lt!'+T:A....'1 F "Full9f"M 1N1IMKI-...K!. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAX 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 SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. .LTR TYPE OF INSURANCE. . SUORPOL POLICY NUMBER : MADM DtYY YI LIMITS.. GENERAL LIABILITYEACH COMMERCIAL GENERAL LIABILITY CLAIMS -MADE Q OCCUR OCCURRENCE $ P ISS a occurrence $ MED EXP (Any om person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE S GEN'L AGGREGATE LIMIT APPLIES PER PRO- El LOC 17 POLICY L PRODUCTS- COMPIOP'AGG $ AUTOMOBILE LIABILITY ANY AUTO ALL OS OVOIEDSCHEDULED AUTOS HIRED AUTOS AUTO ELS, O i SINGLE I.IMIT BODILY INJURY (Per person) $ BODILY INJURY IPeraccdent) S PROPERTY OAMRGE g UMBRELLA LIAR EXCESS LIAR OCCUR CLAIMS -MADE ' EACH OCCURRENCE $ AGGREGATE DED I IRE TENTIONN $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABiI.tTY ANY FROPRIETORIPARTNEMCU TIVE YIN W OFFICERIMEMBER EXCLUDED? F� (Mandatory In MR) ifyas; describe under RIPTION OF OPERATIONS Eeknti DESC' NIA' WC1035459 /812019 /8/2019 E.L, EACH ACCIDENT $ 500. 000 E.L DISEASE -ER EMPLOYE S 500,000 � E.L. DISEASE-POLICYLIMrr S 1500 000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, N rn ore space is required) Except 10 Dai* Notice of Cancellation for Non Payment of Premium -Air conditioning contractor; Service; Installation; and 'Repair. Iii K I IP ILA I t rI V LUr—K L.A Pf %' cLLA l IVIS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Village of Miami Shores ACCORDANCE WITH THE POLICY PROVISIONS. Building Department 10050 NE 2 Ave AUTHORIZED REPRESENTATIVE Miami. Shores, F"I, 33138 Mark Schwartz/BOWMAN t14 ACORD 25 (2010105) (D 1988-2010 ACORD CORPORATION. All rights reserved. iNSQ251�mrm{Int Thu A( nPM names axrrl Inn^ ora raniafarar) mnrrra of ar?nan t AFFORDABLE AIR & HEAT, INC. AFFORDABLE ELECTRICAL CONTRACTORS, INC. WHERE QUALITY IS AFFORDABLE 515 N.E. 190`h STREET MIAMI, FL 33179 DADE (305) 940-0777 - BROWARD (954) 987-9943 Building Official, In order to obtain the necessary permits for the installation of a central air conditioning system, and/or required electrical work, please be advised that an employee of Affordable Air & Heat, Inc. and/or Affordable Electrical Contractors, Inc., will be signing on behalf of the homeowner. l Homeowner's S' ture Date Homeowner's Printed Name �� , This document was signed before me on this � day of 20 .•O r4 Notary Publib , 1�� L„ , tat, State of Florida y Comm.ExDNOs Feb 2�, 2017 ;;; ;; Commission # EE 870422 A/C UNIT HOUSING AND MOUNTING CERTIFICATION -CERTIFIES BOTH UNIT INTEGRITY AND ANCHORAGE TO HOST STRUCTURE FOR WIND RESISTANCE (FOR AT -GRADE USE ONLY) r B;•CKUP .I AJD'LSt4SAT CLIP "\. 'I" �'4' n �•' .' _`C I•• "-`.'-� 3ACKUP (3)CORNERS FOR REINF. l'. ,�',` ) CLIP \� 1" GONGBASE TAB 1`- HOUSING (j .,,;•`F' .'. `" SCREW PER CLIP -�.-#' -"- .-REINED , HOUSING ..:.' WKETS i '<+.-.�SACKUP tCLEAT TYP.LIP CED H N •°" .... BASE TABR OUST G._ 3ACKUP CUP PLUS (2) #14 SMS AT (3) CORNERS INTO 0.026' HOUSING HOUSING 1 f SCALE; N.T.S. CLIPV'C„ 6^' l �V, ONii ay'i '' NO SMS REQ'D UHIS �" "'� C'OR CORNER ONLY) "-' _-- f 3" TVP. BASE BRACKETS PER CORNERBASE TAB (SEE DETAIL): TYPE A - BRACKETS .1 TYPE B - 2 TYPE C-4 0.400" 00.250" o a C g { 0.045"0.045" 0.00 - 80.100" (60.250" @0.250"-1.380" / 075- BACKUP CLIP MATERIAL:RO 060 (2Xy R0.250"- .0.250" 1050 STEEL 0.030THK 0.187" R0.2S0" 0;0002 INK ZINC PLATE WITH CRON" SURFACE CONVERSION. 1.50 4:][BEND RAD. 0.06 UNLESS OTHERWISE SPECIFIED. 4° 0.200" -- 0.325 -�-0.032" _... RICHARD BROTHERS ,p T T \ i ENGAGEMENT HOLE ice } I R0.060" (2X) FOR #12-18 SHEET c (- 0.880 - METAL SCREW (0..1860) BASE TAB BRACKET 0.120"TYR. i TABLE DIRECTIONS: 1. SELECT DESIRED UNIT SIZE. 2' SELECT DESIRED HOUSING, 'STANDARD" HOUSING IS THE TYPICAL HOUSING AS SHIPPED HY.FANUFACTURER, "CLIPPED" H"XJSI : 'S THE TYPICAL HOUSING WITH THE ADDITION OF BACKUP CLIPS AS SHOWN, .No "REINFORCED" HOUSING IS THE TYPICAL HOUSING WITH THF ADDITION OF BACKUP CLIPS AS WELL AS (2),= INTO (3) CORNERS OF THE BASEPAN AS SHOWN. 3. SELECT DESIRED CLIP CONFIGURATION: A,B, OR C. EITHER OF THE (2) BASE CLIPS MAY BE USED WITH THIS DOCUMENT. 4. SELECT HOST STRUCTURE UNDER CONSIDERATION AS VERIFIED BY OTHERS. '. 5. MATCH UNIT SIZE; HOUSWG, AND CUP CONFIGURATION WITH THE INTENDED HOST STRUCTURE TO DETERMINE MAXIMUM ALLOWABLE WIND PRESSURE FDR THE SYSTEM. STTE-SPECFIC REQUIRED WIND PRESSURES PER SEPARATE CERTIFICATION OR BY DINERS. r3v" 1, 06' 0 a -- -- 0.296" X 1" F MATERIAL: PREPAINTED GALVANIZED LL TYP CLEAT ` STEEL ES3101203, PER 3' `{ 80 L1 T- y 060 TH .060 7HK '.060 INSIDE RADA UNLESS 01800" F I R0.120" TTP.. OTHERWISE SPECIFIED :�363tiP01 2.56 2.s2�6.93 333 3>e _1.9g_I 153086P62 2'0 1.91 2A' E 43 3 35I..39 3 BASE TAB BRACKETS_ 1 SCALE: N.T.S. ^- UNIT HOUSING 0.026' 0.178" -- -- 0.296" X 1" F LONG NIPPLE CLEAT 0 030" -0.296" 3 BASEPAN- -- y E A/C HOUSING E5 CLEAT SCALE: N.T.S. SECTION UNIT MODELS -T- -(' --T 030 THICK _ f41� 0" 0.0.025" 1 -0,045" 0,139.030" 0.0450.100"0.500" 0." RO.O60-(2X)� 0:31V 4 BACKUP CLIP 0.380"- 1 SCALE: N.T.S. -- TYPE "XOD % V I - - (1) #12-14 SELF - .,,4,.. DRILLING METAL .--.r SCREW PER CUP ,... ---' SEE TYPICAL ANCHOR SCHEDULE BELOW 1 BASEPAN CONNECTION SCALE: N.T.S. 6 CONNECTION TYPES 1 SCALE: N.T.S. PLAN VIEW L3r-Mr-K wL" IVU 1 CZ) 1... THE SYSTEM DESCRIBED HEREIN WAS BEEN DESIGNED !Ik ACCORDANCE WITH THE STRUCTURAL PROVISIONS OF 2010'\ FLORIDA BUILDING CODE FOR WIND RESISTANCE, FOR USE - WITHIN AND OUTSIL;, THE HIGH VELOCITY HU,RICAME _ ZONE, FOR GROUND -MOUNTED APPLICATIONS ONLY. 2. NO 33-1/3% INCREASE IN ALLOWABLE STRESS HAS BEEN USED IN THE DESIGN OF THIS SYSTEM. WIND LOAD DURATION FACTOR Cd -1.6 HAS BEEN USED FOR WOOD ANCHOR DESIGN, 3. POSITIVE AND NEGATIVE DESIGN PRESSURES CALCULATED FOR USE WITH THIS SYSTEM SHALL BE DETERMINED BY OTHERS. ON A 306 -SPECIFIC BASIS IN ACCORDANCE WITH THE GOVERNING CODE. 4. DESIGN OF THIS SYSTEM IS BASED ON PROPRIETARY INTERNAL DOCUMENTS FOR THE CLIENT LISTED AND SOME DETAILS HAVE BEEN OMITTED FOR CLARITY. REFERENCE TRANE/AMERICAN STANDARD INSTALLATION KITS BAYECMT023 OR SAYECMT004 FOR MORE INFORMATION. S. THE SYSTEM DETAILED HEREIN IS GENERIC AND DOES NOT PROVIDE INFORMATION FOR A SPECIFIC SITE, FOR SITE CONDMONS DIFFERENT FROM THE CONDITIONS DETAILED HEREIN A LICENSED ENGINEER OR REGISTERED ARCHIMCT SHALL PREPARE. SITE SPECIFIC DOCUMENTS FOR USE IN CONJUNCTION WITH THIS DOCUMENT. 6. THE ADEQUACY OF ANY EXISTING STRUCTURE TO WITHSTAND SUPERIMPOSED LOAOS SHALL BE VERIFIED BY THE ONSITE DESIGN PROFESSIONAL AND IS NOT INCLUDED IN THIS CERTIFICATION. 7. ALL BASE TAB BRACKETS SHALL BE GRADE 50 GALVANIZED G90 STEEL W/ FY - 50 KSI AND SHALL CONFORM TO ASTM A653. S. ALL BOLTS B. WASHERS SHALL BE ZINC COATED STEEL, GALVANIZED STEEL, OR STAINLESS STEEL WITH A MINIMUM TENSILE YIELD STRENGTH OF 60 KSI. 9. BASEPAN MATERIAL CHOPPED FIBER LAMINATE W/ Fy-1S KST. PLASTIC COMPONENTS USED WITHIN THE HVHZ MUST MEET ALL APPLICABLE FIRF/SMOKE(UV PERFORMANCE REQUIREMENTS AS SET FORTH IN THE ABOVE -NOTED BUILDING CODE. 10. ALL STEEL IN CONTACT WITH ALUMINUM SHALL BE PAINTED OR PLATED AS PRESCRIBED IN THE ABOVE -NOTED BUILDING CODE. ANCHOR NOTES: 1. SEE ISOMETRIC BASE LAYOUT FOR ANCHOR LOCATIONS AND/OR SPACING 2. ANCHORS SHALL BE INSTALLED IN ACCORDANCE WITH MANUFACTURERS RECOMMENDATIONS. 3. TAPCONS SPECIFIED HEREIN REFER 10 ITW CARBON STEEL TAPCONS OR EQUIVALENT W/ 1-3/4.MIN EMBED, 2-1/2' MIN EDGE DISTANCE AND 3' MIN SPACING (UNLESS NOTED OTHERWISE), FASTENED TO MINIMUM 3,000 PSI EXISTING CONCRETE AS VERIFIED BY OTHERS. 4. LAG SCREWS AS SPECIFIED HEREIN SHALL BE MINIMUM ASTM A307 W/ MINIMUM FTE. 70 KSI (BENDING YIELD STRENGTH), 1-1/2" THREAD PENETRATION AND )'; EDGE DISTANCE INTO #2 SOUTHERN YELLOW PINE WOOD W/ SPECIFIC GRAVITY G-0.55 MIN. 5. SHEET METAL SCREWS (SMS) AS SPECIFIED HEREIN SHALL BE MINIMUM SAE GRADE 5 UNC COARSE THREAD W/ MIN (5) PINCHES PAST THREAD PLANE, &I' EDGE DISTANCE INTO MINIMUM'/ s' THICK A36 STEEL OR 6063-T6 ALUMINUM. 6. MINIMUM EMBEDMENT SHALL BE AS NOTED. MINIMUM EMBEDMENT AND EDGE DISTANCE EXCLUDES STUCCO, FOAM, INSULATION, AND OTHER FINISHES. 7. WHERE EXISTING STRUCTURE IS WOOD FRAMING, EXISTING CONDITIONS MAY VARY. FIELD VERIFY THAT FASTENERS ARE INTO ADEQUATE WOOD FRAMING MEMBERS, NOT INTO PLYWOOD. ALLOWABLE WIND PRESSURES FOR _ "..` `.,"'.• T==--' "."""`.""" "" ::" _ "..'" . `""" '.-..' -, MULTIPLE BASE BRACKET AND UNIT CONN TYPE A OR a SEE COLUMN CONN TYPE„ CONN T/PEA OR B SEE COLUMN ICOM'' TYPE', CONN TYPE A OR B SEE COWNN CDNN TYPE'. HOUSING CONFIGURATIONS C ONLY C ONLY C ONLY DESIGNATION ''.. UNITUNITUNIT STANDARD j CLIPPED REINF, RDNF STANDARD CLIPPEDREINF. j ROW, STANDAPD CLIPPED REINf RE[NF. WIDTH DEPTH HEIGHT HOUSING ;HOSING !MOUSING ! HOUSING HOUSING I HOUSING , HOUSING HOUSING HOUSING HOUSING HOUSING HOUSING 116 PSF I l5 P5F U6 FSP :.'S PSF 26 PSF 26 PSF 26 PSF - RR PSF �9 10 -ISR -0002 o: A'III YRTPTION:. TRANS A/C UNIT HOUSING AND MOUNTING CERTIFICATION TABLEDIRECTi(aNs: GENERAL NOTES " 1.. THE SYSTEM DESCRIBED HEREIN HAS BEEN DESIGNED 'CERTIFIES BOTH UNIT INTEGRITY AND ANCHORAGE TO HOST STRUCT3RE FOR WIND RESISTANCE (FOR AT -GRADE USE ONLY) 1. SELECT DESIRED UNIT SIZE. ACCORDANCE WITH THE STRUCTURAL PROVISIONS OF 2010 2. SELECT DESIRED H.I.G,'STANDARD" HOUSING IS THE TYPICAL HOUSING FLORIDA BUILDING CODE FOR WIND RESISTANCE, FOR USE' 4S. SHIPPFD BY MAN IFACTURER, 'COPPED' HOISINC. 1 5 THF TYPICAL HOUSING BACKUP _ADO`L SMSAT- J 4 Cup ) -,. DO'L SMS .,.F"'.t' -`"..BACKUP WITH THEIS THE ON OF BAOUSI CLIPS H SHOWN, ANO "REiNFDRCEED" WITHIN ANO OUTSIDE THE HIGH. YC1OCiTY HURRICANE \ - CUP MOUSING IS THE "KCAL HOUSING WITH THE ADDITION OF 0A COPS AS ZONE, PO0. GROUND -MOUNTED APPLICATIONS ONLY. FOR REINF. i''' , ...: , , •- WELL AS (2) SMS INTO (3) CORNERS OF THE SASEPAN AS SHOWN, 2. NO 33-1/3% INCREASE IN ALLOWABLE STRESS HAS BEEN tt > 1"LONG BASE TAB . e ,j 3. SELECT DESIRED COP CONFIGURATION: A; R, OR C. EITHER OF THE (2) OUSE USED IN THE DESIGN Of THIS SYSTEM. WIND LOAD CLIPPED HOtlS NG (1) • " .HOUSING tv HOUSFNG _- CKETS °., C BACKUP . CUPS MAY BE USED WITH THIS DOCUMENT. DURATION FACTOR Cd -1.6 HAS-BEEN USED FOR WOOD ' #12-145H METAL' ',y '� ., SCREW PER CLIP' - iA CLEAT TVP. CLIP - - 4. SELECT MOST STRUCTURE UNDER CONSIDERATION AS VERIFIED BY OTHERS. ANCHOR DESIGN. - 1 5. MATCH UNIT SIZE, HOUSING, AND CUP CONFIGURATION WITH TME INTENDED 3. POSITIVE AND NEGATIVE DESIGN PRESSURES REINFORCED HOUSING, «' s BASE TAB _ L i HOST STRUCTURE TO DETERMINE MAXIMUM ALLOWABLE WIND PRESSURE FOR CALCULATED FOR USE WITH THIS SYSTEM SHALL BE (1) #12-34 SMS AND s>-( y1 BRACKETS (E THE SYSTEM. SITE-SPECIFIC REQUIRED WIND PRESSURES PER SEPARATE = T DETERMINED BY OTHERS ON A 138 -SPECIFIC BASIS IN BACKUP \ CERTIFICATION BY. OTHERS. BACKUP CLEF PLUS (2) �"7 , �e J q" ACCORDANCE WITH THE GOVERNING CODE. r 024 SMS AT (3) 4-- CLIP \� o: .. 4. DESIGN OF THIS SYSTEM IS BASED ON PROPRIETARY CORNERS INTO 0.026" - ti"•(•RQ - INTERNAL DOCUMENTS FOR THE CLIENT LISTED AND SOME HOUSING Zp 'II'RQ ✓"`- DETAILS HAVE BEEN OWTTD FOR CLARITY. REFERENCE .. 3 TRANE/AMERICAN STANDARD INSTALLATION KITS HOUSING NO SMS REQ'D HIS \ 't \ I SAYECIRTO23 OR BAYECMT004 FOR P40RE INFORMATION. I 5. THE SYSTEM DETAILED HEREIN IS GENERIC AND DOES L'1 T r CORNER ONLY) _ 3" TYP. 2 REI NFO RC EM ENT E; NOT PROVIDE INFORMATION FOR A SPECIFIC SITE. FOR SITE BAIL BRACKETS PER CORNER �" : CONDITI(NLS. DIFFERENT FROM THE CONDITIONS DETAILED SCALE: N.T.S. [SOAR. (SEE DETAIL)• BASE TAB - ---1 HEREIN, A LICENSED ENGINEER OR REGISTERED ARCHITECT 1 BRACKETS - z SHALL PREPARE SITE SPECIFIC DOCUMENTS FOR USE IN TYPE A - I € TYPE B- 2 Y ".f _ CONIUNCTION WITH THIS DOCUMENT. TYPE G - 4 �•' 6. THE ADEQUACY OF ANY EXISTING STRUCTURE TO (1) 012-14 SELF WITHSTAND SUPERIMPOSED LOADS SHALL BE VERIFIED BY 4. DRILLING METAL THE ONSITE DESIGN PROFESSIONAL AND IS NOT INCLUDED 0.400' SCREW PER CLIP IN THIS CERTIFICATION. 7. ALL BASE TAB BRACKETT$ SHALL BE GRADE SO .410.2`'0' o a •'+ C c u GALVANIZED G90 STEEL W/ FV =' 50 KSI AND SHALL $ 0 0 M A653. o j I ( ��-�, SSCH DULE BELOW R S. ALL BOLTS CONFORM TO i WAASHEIS SHALL BE ZINC COATED STEEL, ti 0.00 -� I R0:100" 0045"0045 GALVANIZED STEEL, OR STAINLESS STEEL WITH A MINIMUM RENGTH OF 60 KSt. 60.250" 60,25D" --1380 1 BASEPAN CONNECTION 9 NS�PIDE ttAR@ MATERIAL CHOPPED FIBER UM[NATEWIFY•36 R0.060"(2Xi- RO 250" 0.75- BACKUP CLIP MATERIAL: KSI. PLASTIC COMPONENTS USED WITHIN THE HVHZ MUST .250' SCALE: N.T.S. 0.187" RO.ZSO" .` • 1050 STEEL 0.030 THK. 1 MEET ALL APPLICABLE FIREJSMOKE/W PERFORMANCE 0.0002 THK. ZINC PLATE WITH CR(NdAK SURFACE CONVERSION. REQUIREMENTS AS SET FORTH IN THE ABOVE NOTED 4-11 0.200* 1.50 BEND RAD, 0.06 UNLESS OTHERWISE SPECIFIED. BUILDING CODE. 10. ALL STEEL IN CONTACT WITH ALUMINUM SHALL BE 0.032" �. RICHARD BROTHERS / PAINTED OR PLATED AS PRESCRIBED IN THE ABOVE -NOTED I -'T \8 SHEET _ % ENGAGEMENT HOLE C (C� BUILDING CODE. J /� o I� �} {{c 8}0.0-60° f2Y}\/ETALFOR ISCIREW (0.1860) a f' BASE TAB BRACKET 0.120" TYP. }- 0.880 -�-} A . - - ANCHOR NOTES• r3v..M 0.06, TYP. 3 ( .TERIAL: 1i PRE -PAINTED GALVANIZED '` STEEL ES3101203, PER I BSOMN260 L ` 0.t80'r 0.074"+ ' .060 THK. 0.800.--}---� 80.320' TYP. `.060 INSIDE OTHERWISE SPECIIFIEDLESS BASE TAB BRACKETS 1 SCALE: N.T.S. UNIT HOUSING 0.026" 0.176^ - -0.246" X 1" LONG NIPPLE CLEAT 0.03011,' -0.296" BASEPAN-- A/C HOUSING S CLEAT SCALE: N.T.S. SECTION UNIT MODELS -}- - 1030 THICK -.,0.330" gg m 0.t80'r 0.074"+ .-RO.425" Q .045" 0.139' 80.030" 0.100' R0.0 " y 0.500" 0.190" RO.060"(2X) 0.310" 4 BACKUP CLIP 0360" 1 SCALE: N.T,S. TYPE"XB XR" ALLOWABLE WIND PRESSURES FOR MULTIPLE BASE BRACKET AND UNIT HOUSING CONFIGURATIONS DESIGNATION UNIT UNIT UNIT WIDTH DEPTH HEIGHT 6CONNECTION TYPES 1 SCALE N.T.S. PLAN VIEW 1. SEE ISOMETRIC BASE LAYOUT FOR ANCHOR LOCATIONS AND/OR SPACING. 2. ANCHORS SHALL, BE INSTALLED IN ACCORDANCE WITH MANUFACTURERS' RECOMMENDATIONS. 3. TAPCONS SPECIFIED HEREIN REFER TO ITW CARBON STEEL TAPCONS OR EQUIVALENT W/ 1.3/4" MIN EMBED, 2.1/2' MIN EDGE DISTANCE AND 3" MIN SPACING (UNLESS NOTED OTHERWISE), FASTENED TO MINIMUM 3,000 PSI EXISTING CONCRETE AS VERIFIED BY OTHERS. 4. LAG SCREWS AS SPECIFIED HEREIN SHALL BE MINIMUM ASTM A307 W( MINIMUM Plb- 70 KSI (SENDING YIELD STRENGTH), 1-1/2" THREAD PENETRATION AND 4'i' EDGE DISTANCE INTO #2 SOUTHERN YELLOW PINE WOOD W/ SPECIFIC GRAVITY G.0.55 MIN,. S. SHEET METAL SCREWS (SMS) AS SPECIFIED HEREIN SMALL BE MINIMUM SAE GRADE 5 UNC COARSE THREAD W/ MIN (5) PINCHES PAST THREAD PLANE, Y." EDGE DISTANCE INTO MINIMUM Vj" THICK A36 STEEL OR 6063-T6 ALUMINUM. 6. MINIMUM EMBEDMENT SHALL BE AS NOTED. MINIMUM EMBEDMENT AND EDGE DISTANCE EXCLUDES STUCCO, FOAM, INSULATION, AND OTHER FINISHES. 7. WHERE EXISTING STRUCTURE IS WOOD FRAMING, EXISTING CONDITIONS MAY VARY. FIELD VERIFY THAT FASTENERS ARE INTO ADEQUATE WOOD FRAMING MEMBERS, NOT INTO PLYWOOD. CONN TYPE CONN TYPE CONN TYPE CONN TYPE A OR B SEE COLUMN CONN TIPS A OR B SEE COLUMN I CONN TYPE A OR B SEE COLUMN C ONLY C ONIV C ONLY IANDARD COPPED REINF REINFSTANDARD CLIPPED REINF REINF STANDARD CLIPPED REINF REINF. DUSING ' HOUSING HOUSING HOUSING HOVSIYG HOVSING HOUSING HOUSING HOUSING HOUSING HOUSING HOUSING 66 P56 66 PSF 66 PSF I lS PSf 61 PSF 61 PSF 61 PSF I7S PSF 49 PSF 49 PSF - 49 PSF 169 PSF Pe PSF M PSF ! 94 PSF IT3 PCFI SA oCF AA PCF AA PSF 175 PSF 6> PSF 6> PSF 67 PSF 17S PSF 2 W 6 O �o a OT J n V1 zn (now Ong Lu jf¢ QS LD .02. Z 2 H O � E z O n QU 10 -ISR -0002 TRANE 0 HC - Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-227663 Permit Number: EL -1-15-135 Scheduled Inspection Date: February 05, 2015 Permit Type: Electrical - Residential Inspector: Devaney, Michael Inspection Type: Final Owner: SANCHEZ, ISRAEL Work Classification: Alteration Job Address: 375 GRAND CONCOURSE Miami Shores, FL Phone Number Parcel Number 1132060135940 Project: <NONE> Contractor: APL ELECTRICAL CONTRACTOR INC. Phone: 305-331-9876 tiuuai comments RELOCATE AND REPLACE AC UNIT AND RELOVATE ------ ONE -----ONE WATER HEATER INSPECTOR COMMENTS False Inspector Comments PassedFt�l' Failed Correction Needed Re -Inspection Fee No Additional Inspections can be scheduled until re -inspection fee is paid. February 04, 2015 For Inspections please call: (305)762-4949 Page 30 of 39 OWNER: Name (fee Simple Titleholder): Israel I. Sanchez Phone#: 786-253-6004 Address: 375 Grand Concourse City: Miami Shores State: FL Zip: 33138 Tenant/Lessee Name: Phone#: Email: iisanchez@hotmail.com CONTRACTOR: Company Name: LZ ae t C cg2 Phone#;30 5 62D 70 Address: WL22 A—)L& City: State Zip3�'b Qualifier Name: IvaSC V GL Phone#:,g0 !6 ZD 70,7e State Certification or Registration #: Certificate of Competency #: g E -'9Z0 e? I Z Z DESIGNER: Architect/Engineer: Phone#: Address City: State: Zip: Value of Work for this Permit: $ Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace ❑ Demolition scription of Work: r GL e_. C.2_ C- U Specify color of color thru tile: `� Submittal fee $ (:)'uo Permit Fee $ Scanning Fee $ Radon Fee $ Technology Fee $ Trainng/Education Fee $ Structural Reviews $ (Revised02/24/2014) K4¢i}S tS illdi. d9ictpt� ,$`t'4*:'}� Y� a r`• � #Pfott 1i 'k ftweienfP01 CCF $ DBPR $ Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ Co_ Miami Shores Village JAN 2 12015 Building Department 10050 N.E.2ndAvenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC 201 BUILDING Master Permit No.M PERMIT APPLICATION Sub Permit No. ❑BUILDING WELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICALPUBLIC WORKS F-1 CHANGE OF 0 CANCELLATION [:]SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 375 Grand Concourse 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: OWNER: Name (fee Simple Titleholder): Israel I. Sanchez Phone#: 786-253-6004 Address: 375 Grand Concourse City: Miami Shores State: FL Zip: 33138 Tenant/Lessee Name: Phone#: Email: iisanchez@hotmail.com CONTRACTOR: Company Name: LZ ae t C cg2 Phone#;30 5 62D 70 Address: WL22 A—)L& City: State Zip3�'b Qualifier Name: IvaSC V GL Phone#:,g0 !6 ZD 70,7e State Certification or Registration #: Certificate of Competency #: g E -'9Z0 e? I Z Z DESIGNER: Architect/Engineer: Phone#: Address City: State: Zip: Value of Work for this Permit: $ Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace ❑ Demolition scription of Work: r GL e_. C.2_ C- U Specify color of color thru tile: `� Submittal fee $ (:)'uo Permit Fee $ Scanning Fee $ Radon Fee $ Technology Fee $ Trainng/Education Fee $ Structural Reviews $ (Revised02/24/2014) K4¢i}S tS illdi. d9ictpt� ,$`t'4*:'}� Y� a r`• � #Pfott 1i 'k ftweienfP01 CCF $ DBPR $ Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ Co_ 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 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. Sign OT The foregoing instrumentrua 13th day of January Israel I. Sanchez ENT acknowledged before me this . 20 15 by who is personally known to me af, Signature CONTRACTOR The foregoing instrument was acknowledged before me this day of 20 IS by who is personally known to me or who has produced WC -4—, t f as h. identification and who did take an oath.\0"1 1 1 111 NOTARY PUBLIC: NOTARY PUBLIC: r/ Si Sign: Sign: O`n�'/� : CD Print: N,u,,,, Print Seal , + f Wy Pvbk • U t of s• My Coma. E*m Joe 21, 20116 Seal `% Fr°° ••..... \, ` Co neat" # EE 210196 puna• WWI Through NOW N01sfy Atm. APPROVED BY .%f�_/i Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) A DATE{MMIDDIYYYY) — ..- CERTIFICATE OF LIABILITY INSURANCE I _ _ 01/15/15 THIS CERTIFICATE IS ISSUE- 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. WPORTANT: if the certificate holder is an ADDITIONAL INSURED, the pollcy(es) must be endorsed, If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the cerd lease holder in lieu of such endorsement(s). PRODUCER N�AMEACT — ' Annette Willis Insurance PHONE DANIEL WILLIS AIG. No Ext1 (305) 625 8131 F�� 345 625-3894 4759 N.W. 183rd St.•MAIL - — (- At3OM3__ DANIEL.IMLLIS(,tNNETTEWILLISINSURANCE.COM -- -- -- - Miami, FL 33455 INsuRE s AFFORDING COVERAGE Phone(305 625-8131 Fax (305) 625-3694 tNsuRER A : GRANADA INSURED INSURER B: _ APL ELECTRICAL CONTRACTOR, INC INSURER C.' — 4850 NW 170 ST INSURER 0: Miami, FL 33055 (305) 620-2098 INSURER E: { —.._ ..—. .—_ INSURER F. COVERAGES CERTIFICATE NUMBER: _ - _ _ REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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 SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. R DD5T AU8—..-- —__-- — J TR TYPE OF lN9URANCE D POLICY NUM BER _ — aPOLIm EFF POLDDy�, yyy� LIMITS GENERAL LIABILITY - - DmY- —.. _ EACH OCCURRENCE 1,004,000.00 r� COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED' L 1 I CLAIMS -MADE n OCCUR PREfj41SES.(EaUrrpnce) $ '100,000.00 7 A - 0185FLOOD27876MEP EXP {An- S, wee person) g 5,000.00 —..._ ❑ — 48106!2014 08/06/2415 PERSONAL & ADV INJURY $ 1,000,000.00 ❑ - GENERAL AGGREGATE S 2,000,000.00 GEN'LAGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG $ 2,000,004.00 ❑ POLICY LJ -ML El —,.—_ - -- — I—I LOC S. AUTOMOBIEE LIABILITY COMBINE031NGEE LIMfr ❑ ANY AUro BODILY INJURY (Perperaon) $ ALL ❑ AUTOSNED ❑ ALITOSULED BODILY INJURY (Per accidenl S ❑ HIREOAUTOS NON-OMJNED -- _._--„- ❑ AUTOS t ?OPERYDMA AGE $ — —._ L_.—_.—i.--- DESCRIPTION OF OPERATIONS / LOCATK)NS/ V£HtCLES (AHach ACORD 101, Addillonal Remarks Schedule, It more apace Is regUired) ELECTRICAL CONTRACTOR I ELECTRICAL WORK CERTIFICATE HOLDER CANCELLATION_ _ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Village of Miami Shores — THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Building Depatment � AC ORD NCE WITH THE POLICY PROVISIONS. 10050 NE 2 AVE AUTHORIZED REP SENiAn MIAMI SHORES, FI 33138 ACORD 26 (2010105 OF 0 88-2010 CR D CORPORATION. Al Ights reserved. Ths,A� ORD name and logo are registered tlrks of ACORD - _ __.- ..--- -- ..._._.._ EACH OCCURRENCE AGGREGATE WC L_TORY.L.MRS I EOTH -- — S — $ ❑ UMBRELLA LIAR ❑ OCCUR EXCESS LIAR ❑ CLAIMS -MADE NIA ❑ DED ❑ RETENTION$- WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANYPROPRIETORiPARTNEWEXECUTIVE OFFICER/MEMBEREXCLUDED? (Mandatory In NH) Ir as, desanbe under DESCRIPTION Oelow F OPERATIONS p .— $ E, L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYE$ E.L. DISEASE -POLICY LIMIT 5 — —._ L_.—_.—i.--- DESCRIPTION OF OPERATIONS / LOCATK)NS/ V£HtCLES (AHach ACORD 101, Addillonal Remarks Schedule, It more apace Is regUired) ELECTRICAL CONTRACTOR I ELECTRICAL WORK CERTIFICATE HOLDER CANCELLATION_ _ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Village of Miami Shores — THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Building Depatment � AC ORD NCE WITH THE POLICY PROVISIONS. 10050 NE 2 AVE AUTHORIZED REP SENiAn MIAMI SHORES, FI 33138 ACORD 26 (2010105 OF 0 88-2010 CR D CORPORATION. Al Ights reserved. Ths,A� ORD name and logo are registered tlrks of ACORD STATE OF FLORIDA DEPARTNIE BUSINESS AND '2 PROF, GULATION ER0014903 `` : ' 07/2912014 REG ELECT _ PASCUAL, APL ELEC TRI O (INDIVIDUAL M L LICENSING RE(tdi OR x TO CONTRACTIN . HAS REGISTERED under the ProvisionS of Ch.489 FS. E date : AUG 31. 2016 L1407290001932 PLEASE CUT OUT CARD BELOW AND RETAIN FOR FUTURE REFERENCE STATE OF FLORIDAIMPORTANT - DEPARTMENT OF FINANCIAL SERVICES Pursuant to Chapter 440.05(14), F.S., an officer of a corporation who elects DIVISION OF WORKERS' COMPENSATION0)o exemption from this chapter by fitirtg a certificate of elegy under this section may not recover benefits CONSTRUCTION INDUSTRY EXEMPTION p or compensation under this chapter. a CMF'CATE OF ELECTON TO BE EXERT FROM FLORIDA WORKERV COhPeMTM LAW j L Pufsttant to Chapter 440.05(12), F.S., Certificates Of election to EFFECTNE DATE: 3WO13 EXPIRATIOAI DATE: 3/SM15 : D ; be exempt... apply only withinthe scope of the business or trade listed on the notice Of election to be exempt PERSON: PASCHAL WILSET FEIN: i ' H 850901660 E Pursuant to Chapter 440.05(13), F.S., Notices of election to be exempt BUSINESS NAME AND ADDRESS: R and certificates of election to be exempt shall be subject to revocation it, a t time APL ELECTRICAL CONTRACTOR INC any after the filing of the notice 41350 NW tta ST I E or the issuance of the cei tfieate, the person named on the notice or certificate no homer meets the requirements of this NMAMt FL 33055 section far issuance of a certificate. the department shah revoke SCOPES OF BUSINESS OR TRADE: ' a certificate at any time for failure of the person named On the certificate to meet the requirements of this section. r--rr!kA^.A.t IAJJOIAI,, PLEASE CUT OUT CARD BELOW AND RETAIN FOR FUTURE REFERENCE ----------- ------- TATE OF FLORIDA i IMPORTANT -------------- DEPARTMENT OF FINANCIAL SERVICES Pursuant to Chapter 440.05(14), F.S.. an officer of a corporation DIVISION OF WORKERS' COMPENSATION who elects exemption from this chapter by filing a certificate of F election under this section may not recover benefits or CONSTRUCTION INDUSTRY EXEMPTION K compensation, under this chapter. STE ON LAW LAW FROM FLORIDA EFFECTNE DATE: WSW13 EXPIRATION DATE: 3/5/2015 PERSON- PASCUAL RAFAEL FEIN: 65f1901860 Sr NNESS NAME AND ADDRESS: APT. ELECTRICAL CONTRACTOR INC 4350 NW 170 ST iiIMAN FL 33055 SCOPES OF BUSINESS OR TRADE: 1ECTRICAL WIRING L Pursuant to Chapter 440.05(12), F.S.: Certificates of election to D be exempt.._ apply only within the scope of the business 0, trade listed on the notice Of election t0 be exempt. H Pursuant to Chapter 440.05(13), F.S., Notices of election to be E exempt a m cerwcates of election to be exempt shah be R subject to revocation if, at any time atter the filing of the notice E I ire Issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a cartftae. The dent shalt revoke a certificate at any time for failure of the person named on the certificate to meet the requirements Of this section. DFS-F2-DWC_252 CERTIFICATE OF ELECTION TO RF FXFIUDT omAocn — -- 5 R, ..,.�, Miami shores Village Building Department IORiDA 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 I . 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. Owner Contractor Print Name: Israel 1. ez Print Nam Z�; I W S C -Ci C( Signature: � � ` Signature: t g � State of Florida) State of Florida County of Miami -Dade) County of Miami -Dade) Sworn to and subscribed before me this 13th Sworn to and subscribed before me this ?I day of4snuery , 2015 day of 7y k _J 20 L p , 6:1 4F /� VMAN GUN ITAIrAf lip (SEAL(SEAL) cr> p Type oT e of Identifi roduceC'ORIIl)�:=1011 Zi41� ' 1 "" "too I%,�