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MC-15-382Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-228706 Permit Number: MC -2-15-382 Scheduled Inspection Date: March 02, 2015 Permit Type: Mechanical - Residential Inspector: Perez, JanPierre Owner: BENAVIDES, JORGE Job Address: 1700 NE 105 Street 409 Miami Shores, FL 33138 - Project: <NONE> Contractor: MIKE'S AC SERVICE INC comments Inspection Type: Final Work Classification: A/C Replacement Phone Number Parcel Number 1122300500660 Phone: (305)751-5814 REPLACING A 2 TON PACKAGE HEAT PUMP SYSTEM - ----w --' -' INSPECTOR COMMENTS False c� Inspector Comments Passed Failed Correction Needed ❑ Re -Inspection Fee No Additional Inspections can be scheduled until re -inspection fee is paid February 27, 2015 For Inspections please call: (305)7624949 Page 13 of 27 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 BUILDING PERMIT APPLICATION ❑BUILDING ❑ ELECTRIC ❑ ROOFING FBC 20 0 Master Permit No.Y-(G Sub Permit No. ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑ PLUMBING CHANICAL ❑ PUBLIC WORKS ❑ CHANGE OF []CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: Z � � dII / lo 5 4oi!�- City: Miami Shores Countv Miami Dade Zio• Folio/Parcel#:-��'- , �2 ,3 0 - 0.5'0 -- 0 6 6 0 Is the Building Historically Designated: Yes NO A—"� Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): A, _-- _Q%_ -P_hon--�-�3� ���f- -247Z Address: \_)00 it 10�"C State:..Pt. Zip: Tenant/Lessee Neme: Phone#: Email:- ,l� °J�191.U1dLo!S t :M CONTRACTOR: Company Name: Z"' ,eget_ S oO Phone#: S:p_C V �� Address: ®7 1 � W o!� l City: State: Zip: c Qualifier Name: - 12"7< Phone#: State Certification or Registration #: 6 -/Certificate of Competency #: DESIGNER: Architect/Engineer: e: Zip: Value of Work for this Permit: $_ , 3 '7 5 ° Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New /Re lace CKRe air p p ID Demolition Description of Work: 1�2 11 _ —,,7 r ° of d� 6 ; , / = " 0 Specify color of color thru tile: Submittal Fee $ Permit Fee $ Scanning Fee $ Technology Fee $ Structural Reviews $ (Revised02/24/2014) a $ CO/CC $ Radon Fee $ DBPR $ Notary $ _ Training/Education Fee $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ Bonding Company's Name (if applicable) Bonding Company's Address City Mortgage Lender's Name (if applicable) Mortgage Lender's Address City 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. , Signature OWNER or AGENT The foregoing instrumen ,was acknowledged before me this day of 6((01+ .2015 , by tidi S 46�e��]��' ,wo; ids personally known to me or who has produced�U1& C.� &0- U as identification and who did take an oath. NOTARY i Sig Seal: Signature_ t <11 - CONTRACTOR I � The foregoing instrument was acknowledged before me this day of 7o,4,elffl20 -4-r--, by add Q�� a= who is personally known to me or who has producedZ1/0 M4- z.—chs identification and who did take an oath. NOTARY PUBLIC: ®qp + Pyg Notary ruouc -'-- — .._--- Seal: = n Joanna M Feliciano ' e My Commission FF 082753 i�` ®F c1pa Expires 01112/2018 �**�x*•�*�•a�a�•�x�a�**�x�x*�e�s�*n*�x*�x+xw+><*�x�+�a*.x+r<*��•�**�x**�*****a�s�**�xa�**�x*��r**�x*�*����x��x�+��x*ix*��x�**>x•�****�**�***•�x�* APPROVED BY Plans Examiner Zoning Structural Review (Revised02/24/2014) Clerk MARCELAtiOMU Notary Public, Slate of Florida Commission# EE 223036 My comm. expires Aug. 07, 2016 Signature_ t <11 - CONTRACTOR I � The foregoing instrument was acknowledged before me this day of 7o,4,elffl20 -4-r--, by add Q�� a= who is personally known to me or who has producedZ1/0 M4- z.—chs identification and who did take an oath. NOTARY PUBLIC: ®qp + Pyg Notary ruouc -'-- — .._--- Seal: = n Joanna M Feliciano ' e My Commission FF 082753 i�` ®F c1pa Expires 01112/2018 �**�x*•�*�•a�a�•�x�a�**�x�x*�e�s�*n*�x*�x+xw+><*�x�+�a*.x+r<*��•�**�x**�*****a�s�**�xa�**�x*��r**�x*�*����x��x�+��x*ix*��x�**>x•�****�**�***•�x�* APPROVED BY Plans Examiner Zoning Structural Review (Revised02/24/2014) 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):—/ k'�F /0-57 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 0NO ❑ Contract Attached: YES Kk-'o 1. Minimum Circuit Ampacity (Wire Size): 1, 2. Maximum Overcurrent Protection (Fuse/Breaker Size): 3. Voltage of Circuit (208/240/480):��� 4. Size Disconnecting Means: Contractor's Company Name: �� �/ ®e �� 1%'e /6,P Phone:�.Fg2$ e7S 1 State Certificate or Registration No. 4f— 14 Z—f,)31�lel Ce—rtificate of Competency No. Signature Date: 0 _Tb O3_— (Revised02/24/2014) UNIT BEING REPLACED DATA NEW UNIT rf MANUFACTURER d2 0 — % AHU or PKG. UNIT MODEL # COND. UNIT MODEL # KW HEAT NOM TONS AHU CU PKG 1) M.C.A AHU CU PKG / AHU CU PKG 20. 2) M.O.P AHU CU PKG AHU CU PKG . 3) VOLTS AHU CU PK ff PKG UNIT / / PKG UNIT EER/SEER / � e YES NO REPLACING DUCTS YES NO YES NO REPLACING THERMOSTAT E NO YES NO I NEW 4"CONCRETE SLAB YES 0 YES NO NEW ROOF STAND YES O YES NO: NEW RETURN PLENUM BOX YES 1. Minimum Circuit Ampacity (Wire Size): 1, 2. Maximum Overcurrent Protection (Fuse/Breaker Size): 3. Voltage of Circuit (208/240/480):��� 4. Size Disconnecting Means: Contractor's Company Name: �� �/ ®e �� 1%'e /6,P Phone:�.Fg2$ e7S 1 State Certificate or Registration No. 4f— 14 Z—f,)31�lel Ce—rtificate of Competency No. Signature Date: 0 _Tb O3_— (Revised02/24/2014) q a, pts SCRUIC& 10R. k 11: CONDITIONING " N REFRIGERATION PROPOSAL AND SALES AGREEMENT CUSTOMER: Jorge Benavides ADDRESS 1: 1700 NE 105th Street #409 ADDRESS 2: Miami Shores, FL 33138 February 12, 2015 RE: REPLACE 2.0 TON AIR CONDITIONING & HEATING SYSTEM (with new environmentally friendly refrigerant 410A) 1) We will remove the old air conditioning system and we will dispose the old system according to EPA regulations. 2) We will install the new 2 ton hi efficiency HYDROTECH air conditioning & heating system, we will install the new 3/,V inch brass elbows in the unit, we will install new digital thermostat, we will connect the electrical in to existing, we will make new plenum in the air conditioning closet, we will connect the hi pressure hoses in to existing, we will connect the drain line in to existing, we will install new stand in the air conditioning closet and we will install the new float switch in the system. 3) We will start up the new air conditioning system and we will balance the system in the apartment. THE SYSTEMS AND MATERIALS INCLUDED IN THIS PROPOSAL 1 WSVCO24-2LH AIR CONDITIONING & HEATING SYSTEM 13.00 EER 1 DIGITAL HEATING & COOLING THERMOSTAT ALL THE DUCTWORK MATERIALS, FITTINGS, HOSES TO INSTALL THE NEW SYSTEM LABOR WARRANTY: Service will be provided free of charge by us for a period of one year from date of installation, during the regular working days and regular working hours. MANUFACTURER'S WARRANTY: Five years manufacturer's warranty on all parts in the system, and 5 years warranty on compressor from the date of installation. TOTAL SYSTEM COST: We shall furnish equipments, labor & materials only detailed on pages 1 & 2 for $3,395.00 DOLLARS, FPL REBATE: (0) CUSTOMER PAYS $3,385.00 sales tax is included in this proposal. (PLUS THE PERMIT FEE, LOAD CALULATION, & PROCESSING FEES) TERMS: Customer hereby accepts the proposal and agrees to payments as follows, 50% down payment upon acceptance of contract, and 50% final payment when the job is completed. CONTRACTOR: DATE: '� DATE: 'z 1 �r 775 E. 9t STREET MIAMI, t ! PHONE ' 224-2569 49 MAILING ADDRESS * P. 0. BOX 414384 * MIAMI BEACH, FL 33141 AC 039619 SALES [.` ! INSTALLATION SERVICE F... VR n 1974 m n s r1_1401 it � �, +.,y�` ,�*� a � m �'•� A• � �' !� �`,° `' '� '' AHRI Certified Reference Number: 3550705 Date: 2/20/2015 tStatus: Active Product: Water/Brine to Air Heat Pump Packaged Unit Model Number: WSYCO24*-2 Manufacturer: FIRST OPERATIONS LP, DBA FIRST CO. Trade/Brand name: HYDROTECH Rated as follows in accordance with ANSI/AHRUASHRAE/ISO Standard 13256-1 for Water -to Air and Brine ToAir Heat Pumps and subject to verification of rating accuracy by AHRI-sponsored, independent, third party testing: Cooling Air Flow Rate: 680.0/680.0 Heating Air Flow Rate: 680.0/680.0 WLHP (Water -Loop Heat Pumps) Full Load Cooling Capacity(Btuh)) 22500 /22500 Cooling EER Rating(Btuh/watt) 13.00/13.00 Cooling Fluid Flow Rate(gpm) 6.00/6.00 Heating Capacity(Btuh) 28000 /28000 Heating COP(watt/watt) 4.20/4.20 Heating Fluid Flow Rate(gpm) 6.00/6.00 GWHP(Ground-Water Heat Pumps) Cooling Ca c ity(Btuh) Cooling EER Rating(Liwatt) 24900 / 24900 18.00/18.00 the products) fisted on this Certificate AHRI expressly disclaims all liability for damages of any kind arising out of the use or performance of the prwluot(s), of the unauthorized alteration of data listed on this CariMcata. Certified ratings are valid only for models and configuration listed In the Cooling Fluid Flow Rate(gpm) 6.00/6.00 Heating Capacky(Btuh) 21300 /21300 Heating COP(watt/watt) 3.50/3.50 Heating Fluid Flow Rate(gpm) 6.00/6.00 GLHP (Ground -Loop Heat Pumps) Cooling Capad#y(Btuh) Cooling EER Rating(Btuh/watt) Cooling Fluid Flow Rate(gpm) Heating Capacity(Btuh) Heating COP(watt/watt) Heating Fluid Flow Rate(gpm) * Rauh followed by an asterisk (*) indicate a voluntary rerate of previously published data, unless accornpanlecl vitt a WAS, which indicates an involuntary rerate. DISCLAIMER AHRI does not andorse the product(s) Med on this Certificate and makes no representations, warranties or guarantees as to, and assumes no respon ibi ty for, the products) fisted on this Certificate AHRI expressly disclaims all liability for damages of any kind arising out of the use or performance of the prwluot(s), of the unauthorized alteration of data listed on this CariMcata. Certified ratings are valid only for models and configuration listed In the directory at wvew.ahvidlrectory.mrg. TERMS AND CONDITIONS This Certificate and its contents are proprietary products of AHRL This Certificate shaft only be used for Individual, personal and PR confidential reference purposes. The contents of this Certificate may not, In whole or in part, be reproduced; copied; disseminated; 4 fi v,;.UM entered into a computer database; or otrenvise utilized, In any form or th manner or by any means, except for e user's individual. personal and confidential reference. AIR-CONDITIONING, HEATING, CERTIFICATE VERIFICATION & REFRIGERATION INSTITUTE nre Information for the model cked on this certificate can be verified at wwtv.ahrhiireetnry.org, click on 'deify certificate" link Ave uwke life whet, and enter the AHRI Certified Reference Number and the date on which the certificate was issued, which is Med above, and the Certificate No., which is listed at bottom right, 62014 Air-conditioning, Heating, and Refrigeration Institute CERTIFICATE NO.: 13068952M134M Miami shores V Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. COPY OF QUALIFIER'S STATE LICENCES B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF LIABILITY INSURANCE* D. COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER Affidavit) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICATE OF COMPETENCY OF QUALIFIER B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF STATE REGISTERED CONTRACTOR LICENSE OR MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT. D. COPY OF LIABILITY INSURACE* E. COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER Affidavit) *YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE AS FOLLOW: Certificate Holder: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 Certificate must specify the description of operations or contractor license number. BUSINESS NAME: /2 �-4 C, BUSINESS ADDRESS: '7/7 6J -t/-- CITY AP�X/" i STATE ZIP43 1 BUSINESS PHONE:jc -5-FAX NUMBER �) CELL PHONE ( )qAk _& °fie 2— QUALIFIER'S NAME: 21-1® Cz Z'Z, Z"4�� QUALIFIER'S LIC NUMBER: � 4 C 3 e -j RICK SCOTT, GOVERNOR KEN LAWSON, SECRETARY STATE OF FLORIDA • DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD CAC003Nts The CLASS AAIR CONDITIONING CONTRACT© Named below IS CERTIFIED g�p 9 rafo�i'dat AUI'� 14, �Q�S ISSUED: 08/03/2044 DISPLAY AS REQUIRED 9Y LAW SEO # L1408030002M I�ursuBMto +ty C0� pter8A—Art. 9 & 10 880 T"W OF 13USMEM PAYMHl1rf _RECBlVgp 198 SPEC MECHANICAL CONTRA&' W CACM19 ®y tAx oo cTcAl $45.00 *05/2014 CHEW1-14--042 ec�aet�t t of d�►Laaeal BTex. The �'ta aha Ike, ar�d�5 .: to de6asirtees. �tea,�►�r.�,.,,,,,®.��:.� whkb emir to I lel w See es_" . 23/2015 Time: 8:55 AM To: 9305-756-8972 Br n Miami Page: 002 MIKES -2 OP ID: MY CERTIFICATE OF LIABILITY INSURANCE D YY) GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE a OCCUR 02/25 02123/1201201 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 policy, 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 BROWN & BROWN OF FLORIDA INC 14900 NW 79th Court Sulte#200 Miami Lakes, FL 33016-5869 House Accounts NAME AICNE. No IFA' No): E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC $ PERSONAL &ADV INJURY $ 1,000,00 INSURERA:*FCCI Commercial Insurance Co 33472 INSURED Mike's A/C Service, Inc. P.O. Box 414384 INSURER B :*Technology Insurance Co. Inc. 42376 INSURER C: Miami Beach, FL 33141 INSURER D : INSURER E: INSURER F : _ -- - IAV VIVIV I\ 1\Y IVIpGR: 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. LTR TYPEOFINSURANCE ADDLISUBP POLICY EFF POLICY EXP POLICY NUMBER LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE a OCCUR GLOO148483 01/01/2015 01/01/2018 EACH OCCURRENCE $ 1,000,000 PREMISES Ea occurrence $ 100,000 MED EXP (Any One person) $ 5,000 PERSONAL &ADV INJURY $ 1,000,00 GENERALAGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICYF_l PRO -_CT LOC PRODUCTS -COMP/OP AGG $ 2,000,000 $ AUTOMOBILE LIABILITYMBINED ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS OWNED AUTOS E 1 L ELIMIT e accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE- PER ACCIDENT $ $ UMBRELLA LIAR EXCESSLIAB HCLAIMS-MADE OCCUR EACH OCCURRENCE $ AGGREGATE $ DED RETENTION WORKERS COMPENSATION ANDEMPLOYERS' LIABILITY ANY PROPRIETOR/PARTUDED?ECUTNE YIN OFFICER/MEMBEREXCLUDED? ❑ (Mandatory in NH) If yes describe under DE86RIPTION OF OPERATIONS below B NIA 03450308 01/01/2015 01/01/2018 WCSTATU- OTH- X TORY LIMITS X ER EJ..EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE S 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,00 DESCRIPTION OF OPERATIONS t LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) Air Conditioning Contractor CIFRTIFICATF Hn1 neo Miami Shores Village Building Dept. 10050 Ne 2Nd Avenue Miami Shores, FL 33138 ACORD 25 (2010/05) 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 v 1woo-w-IV #kL UKu aUKFUKATIUN. All rights reserved. The ACORD name and logo are registered marks of ACO RD