Loading...
MC-14-2223Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-229813 Scheduled Inspection Date: March 11, 2015 Inspector: Perez, JlanPierre Owner: DOMBROWSKY, ALEXANDER Job Address: 1259 NE 97 Street Miami Shores, FL Project: <NONE> Permit Number: MC -10-14-2223 Permit Type: Mechanical - Residential Inspection Type: Final Work Classification: A/C Replacement Phone Number (850)591-3119 Parcel Number 1132050090420 Contractor: FLORIDA COOLING AIR CONDITIONING INC Phone: (305)775-8978 Building Department Comments REPLACE 2 3 TON SPLIT SYSTEMS Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-227617. CREATED AS REINSPECTION FOR INSP-221334. need flood cert not ready Failed Correction ❑ Needed Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. March 10, 2015 For Inspections please call: (305)762-4949 Page 27 of 29 r � r r BUILDING PERMIT APPLICATION BUILDING ❑ ELECTRIC Miami Shores Village. Building DepartmentOCT 06 914 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 L INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC 20 Ld Master Permit No. Sub Permit No. ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING RrMECHANICAL [:]PUBLICWORKS [:]CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 1259 NE 97 Street City: Miami Shores County: Miami Dade Zip: 13 J 1319 Folio/Parcel#: il' 3Q01S' OCA - Is the Building Historically Designated: Yes NO X Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee simple Titleholder): Alexander Dombrowsky/ Marie Blackman Phone#: 850-591-3119 Address: Same as job address City: State: Zip: Tenant/Lessee Name: Phone#: Email: alexdombrowsky@gmail.com CONTRACTOR: Company Name ff �Cj. d �i 949 R Phone#: a®S -4 Address: q ® &Ly' City: Qualifier Name: L_ a oLz&j1,.- State Certification or Registration #: C- Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Zi -p:: �� � d 6 _?> _ -45 - - Address: City: State: Value of Work for this Permit: $ Cl Square/Linear Footage of Work: Zip: Type of Work: ❑ Addition y❑ Alteration l ❑ New C9 -"Rep ❑ Demolition Description of Work: L n {� A t,..Q (3) .3 I/� � Specify color of color thru tile: �.�s Submittal Fee $ rv� Permit Fee $ CCF $ CO/CC $ ,.�1 Scanning Fee $ C:�-j \, Radon Fee $ DBPR $ Notary $ .1 0-0 Technology Fee $ !2, Training/Education Fee $ ` 00 Double Fee $ Structural Reviews $ c -,7j Bond $ 95 TOTAL FEE NOW DUE $ �` L4 (Revised02/24/2014) 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. r Signature Signature C WNER or AGENT CONTRACTOR The foregoing instrument was Acknowledged before me this dayof • °'e. 20 by who is personally known to me or who has produced identification and who did take an oath. NOTARY Print: ' A TPUMUndembrs Seal * MYCON�ulIS47817 S: N, 2015 AE@ft �Bonded Thm as The foregoing instrument was acknowledged before me this C day of 20 by 4I�� r>;y' z, who is personally known to me or who has produced �q � �6 �S iss� identification and who did take an oath. NOTARY PUBLIC: Sign: -O—.-- dotary Publio Spat an my commission FF BOW 0111`1Aj%d *�&N�** APPROVED BY � "Pla s Examiner Zoning Structural Review (Revised02/24/2014) Clerk ' kw. ° r CERTIFICATE OF LIABILITY INSURANCE 1 E10/09/14� —� THIS CERTIFICATE IS ISSUED AS A (NATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS I CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES I BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED j REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the poilcypes) 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 i certificate holder in lieu of such endomement(s). PROBUCER Accurate 8300 West Flagler Suite 114 i Miami, FL 33144 CONTACT Lucia Estrella NAME: �� E � (305)226-8727 AX N,: (305)226-8767 ! � MVL v luciaestreila@beiisouth.net INSURER(S) AFFORDING COVERAGE I NNCd j Phone (305)226-8727 Fax (305)226-8767 I INSURER A: Ascendant Insurance Company j INSURED Florida Cooling Air Conditioning Inc. INSURER B: 1 INSURER C: INSURER D : 140 Olive Dr. iNsuRER E: Ii Hialeah, FL 33010- INSURER F: L._ COVERAGES CERTIFICATE NUMBER: KtV1blUN NUM13tK: 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. 1 INSR --- --- ADDLSUBR POLICY EFF I POLICY EXP - LTR TYPE OF INSURANCE— IUrvS POLICY NUMBER MMID MMIDD LIMITS I GENERAL LIABILITY EACH OCCURRENCE S 1,000,000.00 DAMAGE TO RENTED I COMMERCIAL GENERAL LIABILITY ! I ! PREMISES fEa occurrence I $ 100,000.00 ` ❑ ❑ CLAIMS -MADE © OCCUR y yjGL-431! A. 06 0 ❑ � MED EXP (Any one person) i $ 5,000.00 10/08!2014 10/08/2015 PERSONAL 8 ADV INJURY $ 1,000,000.00 _ 1 � � M ❑ GENERAL AGGREGATE $ 1,000,000.00 IGEN'L AGGREGATE LIMIT APPLIES PER: j PRODUCTS - COMPIOP AGO , $ 1,000,000.00 PRO-❑ LOC ( Sa POLICY ❑ JECT i i $ AUTOMOBILE LIABILITY; j EOMeBiNdEcrDdSINGLE LIMIT $ BODILY INJURY (Per person) I S j ❑ ANY AUTO ALL AUTOS ❑ SCHEDULED ❑ NON -O❑ HIRED AUTOS ❑ AUTOSWNED i❑ ❑ I i j I BODILY INJURY (Per acckbnt) $ PPeOr agent AMAGEI $ is �— ❑ UMBRELLA LIAB ❑ OCCUR i 1I EACH OCCURRENCE $ AGGREGATE Is ❑ EXCESS LIAB ❑CLAIMS MADE I ❑ RETENTION$ S _EDD WORKERS COMPENSATION _ WCSTATU- ❑ OTH-j El 1j1j1j AND EMPLOYERS' LUU3ILITY Y I N ANY PROPRIETORIR/EXECUTNE ERIMEMBER EXCLUDED? —11 � OFFICEXCLUDED? I (Mandatary In NH) �� if yyes describe under DESCRIPTION OF OPERATIONS below N / A i E.L. EACH ACCIDENT $ --'— — E.L. DISEASE - EA EMPLOYEE —� --- E.L. DISEASE -POLICY LIMIT; $ I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) Installers, repalcement, repair of air conditioning units CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESC ED POLICIES BE CANCELLED BEFORE i Miami Shores Village Building Dept THE ACCORDANCE WITH THE THEREOF: 0 ONS` BE DELIVERED IN 10050 NE 2nd Ave Miami Shores, FL 33138 _. i AUTHORED REPRESENTAT I ! 1 305-756-8972 Lucia Estrella ©198 - 0 AC61IMCORPORATION. All rights reserved. ACORD 25 (2010/05) OF The ACORD name and logo are registered marks of ACORD Report Viewer =/I - - 7 Image JEFF ATWATER CHIEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: 9/11/2014 EXPIRATION DATE: 9/10/2016 PERSON: GOMEZ EDDY FEIN: 455377053 BUSINESS NAME AND ADDRESS: FLORIDA COOLING AIR CONDITIONING INC 40 OLIVE DR HIALEAH FL 33010 SCOPES OF BUSINESS OR TRADE: HEATING, VENTILATION, AIR-COND Pursuant to Chapter 440.05(14), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section may not recover benefds or compera ation under this chapter. Pursuant to Chapter 440.05(12), F.S., Certificates of election to be exempL.. apply only within the scope of the business or trade listed on the notice of election to be exempt Pursuant to Chapter 440.05(13), F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the Issuance of the certificate, the pemon named on the notice or certificate no longer meet the requirements of this section for Issuance of a certificate. The department shall revoke a DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 07-12 QUESTIONS? (850)113-1609 Page 1 of 1 file:///C:/Users/felicianoj/AppData/Local/Microsoft/Windows/Temporary%20Internet%20... 9/12/2014 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. In these circumstances, Miami Shores Village does not require verification of workers' compensation insurance coverage from the contractor's company. Therefore, you maybe 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 Print Name: y Signature: - =- State of Florida ) County iami-Dade) Sworn t an ubsc bed bef day of i° t YAV. DEPl1S Afl EE 147917 n A 0 A oc _EXPIRES: November .)q, 2015 of Contractorrr'' -��, Print Name: ehS�­4 L State of Florida ) County of Miami -Dade ) Sworn to-and�subscr�b day of I LIM FF 078$78 3, 2018 Miami Shores Village e� 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): /25'5l X/ C j' PI•TiZ S7 City: Miami Shores Village K County: Miami Dade Zip Code: 32 31 17) 29 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 ® NO ❑ Contract Attached: YES 1. Minimum Circuit Ampacity (Wire Size): 2. Maximum Overcurrent Protection (Fuse/Breaker Size): 3. Voltage of Circuit (208/240/480): Z �d 4. Size Disconnecting Means: //�� I�• Contractor's Company Name: 1-56^1.es, eao �!AP� '4i A- � Phon@: W/y State Certificate or Registratio, 77-1 Certificate of Competency No. Signatur Date: (Revised02/24/2014) UNIT BEING REPLACED DATA NEW UNIT MANUFACTURER AHU or PKG. UNIT MODEL # 6A 'k0 -ti, tp COND. UNIT MODEL # KW HEAT NOM TONS 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 YES NO REPLACING DUCTS YES NO YES NO REPLACING THERMOSTAT YES NO YES NO NEW 4"CONCRETE SLAB YES NO YES NO NEW ROOF STAND YES NO YES NO NEW RETURN PLENUM BOX YES NO 1. Minimum Circuit Ampacity (Wire Size): 2. Maximum Overcurrent Protection (Fuse/Breaker Size): 3. Voltage of Circuit (208/240/480): Z �d 4. Size Disconnecting Means: //�� I�• Contractor's Company Name: 1-56^1.es, eao �!AP� '4i A- � Phon@: W/y State Certificate or Registratio, 77-1 Certificate of Competency No. Signatur Date: (Revised02/24/2014) IF • r This combination qualifies for a Federal Energy ® Efficiency Tax Credit when placed In _service between Feb 17, 2009 and Dec 31, 2013. Certificateof PimAuct EREd-tings AHRI Certified Reference Number: 5874981 Date: 9/2/2014 Product: Split System: Air -Cooled Condensing Unit, Coil with Blower Outdoor Unit Model Number: 4A7A6042H1 Indoor Unit Model Number: GAM5A0B36M31 Manufacturer: AMERICAN STANDARD, INC. Trade/Brand name: AMERICAN STANDARD Gni 'I uA Series name: GOLD XI Manufacturer responsible for the rating of this system combination Is AMERICAN STANDARD, 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: • • 0.6 • • s • �• • 0000 • 000006 •••• 0000 00W:• 69 • • 0000 +6*• 0000 • Cooling Capacity (Btuh): 39500 ' EER Rating (Cooling): 13.00 • • • • 0 00 0000 0.60 SEER Rating (Cooling): 16.00 : • • '± ' • •••0 ••••0p IEER Rating (Cooling): 0 '• • 0000• • .••6 0 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 CONDITIONS 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; 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-CONDMONING, 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. ©2W Air -Conditioning, Heating, and Refrigeration Institute CERTIFICATE NO.: 130541374431790858 FLORIDA COOLING AIR CONDITIONING INC. 40 Olive Dr Hialeah Florida. 33010 (305) 775-8978 - Eddy Gomez Date: 08/25/2014 Number: P-11038 FL State License Number: CAC 1817201 LW OICE Name: Marie Blackman Writer: AFUE/Brand Address: 1259 NE 97 Street System Type: Split system City. Miami Shores Brand Name: America Standard State. FL Refrigerant: America Zip Code: 33138 Tonnage: 3 1/2 Tons Phone: 850-591-3119 Location: System -Install (1) new drainnage Email: 1 alexdombrowsky@gmafl.com .com Ali ent: Standard Equipment list Description Model Number Series AFUE/Brand SEER Width WarranQty Cost -Replace 2 (3 1/2 Ton America Standard Split America 16 10 1 System -Install (1) new drainnage Standard system -Attach Condenser unit to the concrete using tie downs. 0 0 006000 -Install new digital• • • • thermostat 0 • • 0000 -Manufacture Warranty as •*000 follows: 00000 of 10 years on compressor. 5 • •• • • • • 0 years on arts • •"• ' 1 year on labor. •'"• • • -All Labor and Materials 6100 •••• • Included 6 • 040 0 • • • ••• • •• •• 0:060 •• 0•• 6 • • 0 • • ••000• • • • 0 • • • •• • 0 ••0• • •00• 0 -Note: Any alterations or changes in the description of this proposal is subject to price change Sub Total Tax Total Materials Payment as ronow: -60% to begin job, 30% when the job is 50% completed, and 10% due at Final. Total Bid $9,500.00 Nine Thousand Five Hundred US Dollars and Cents Florida Cooling Air Conditioning Inc. highly appreciates the opportunity to provide this proposal. We are lookingforward to hearing from you. if you have any questions please call us at (305) 775-8978 By signing this proposal, I do agree with the terms and conditions stated in the above. Signature Page: 1 of 1 Date D6•• • • • Do00 • D6•• • b0• r•• 0 1••• • • • 0000 • Do*•