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MC-15-612Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-230639 Permit Number: MC -3-15-612 Scheduled Inspection Date: April 13, 2015 Permit Type: Mechanical - Residential Inspector: Perez, JanPierre Owner: , Job Address: 141 NE 104 Street Miami Shores, FL 33138 - Project: <NONE> Contractor: ELEPHANT AIR CONDITIONING CORP Building Department Comments Inspection Type. Final Work Classification: A/C Replacement Phone Number Parcel Number 1121360130730 Phone: (305)397-7339 REPLACE 5 TON AC UNIT intractio Nassea comments INSPECTOR COMMENTS False April 10, 2015 For Inspections please call: (305)762-4949 Page 10 of 26 Inspector Comments Passed Failed Correction Needed ❑ Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. April 10, 2015 For Inspections please call: (305)762-4949 Page 10 of 26 BUILDING PERMIT APPLICATION Miami Shores Village Building Department MAR 19 X015 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 .By INSPECTION LINE PHONE NUMBER: (305) 762-4949 ?fZNjDi Nie Xr-r— 10 A -v17 FBC 201ci Master Permit No. _ � c 15—(40 � BUILDING ❑ ELECTRIC ❑ ROOFING ❑PLUMBING �Q MECHANICAL [:]PUBLICWORKS Sub Permit No. ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS:. � ° Aj VIE: S—F City: Miami Shores County: Miami Dade Zi : 1-3 Folio/Parcel#: r �' OIS— Q-1� Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: OWNER: Name (Fee Simple Titleholder): {✓(015� Address:-��(o CCA City: rnen L Go4is State: Tenant Email Flood Zone: BFE: FFE: CONTRACTOR: Company Name:'—/; Address: ��.-3 JAW IIA4-, City: Qualifier Name: U` F7— Zip q 3 e#: State Certification or Registration #: (2j(U Zi- j (4 CYj f' Certificate of Competency #: _ DESIGNER: Architect/Engineer: � Phone#: _ Address: ID, City: State: Value of Work for this-Pem9V$ 2,7 ® Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration / ❑ New Repair/Replace Description of Work:QIQOQ� Specify eo.,lor of color thru tile: Submittal Fee $ Permit Fee $ W U t,[ Scanning Fee $ Radon Fee $ Technology Fee $_ Training/Education Fee $ Structural Reviews $ _ (Revised02/24/2014) Zip: ❑ Demolition CCF $ CO/CC $ DBPR $ Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ 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. Signature mm Signature OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this t � day of , 20 �5 , by &_nd "� :FOCEL� , who is personally known to me or who has produced F L. :,�riq-cm LAC_Qvia_ as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: APPROVED BY (Revised02/24/2014) ,w NVII,01 n : #EE 222975 The foregoing instrument was acknowledged before me this I 1 day of �_� , 20 kEJ , by rQ PvoA who is personally known to me or who has produced br i-,., as identification and who did take an oath. NOTARY PU Print: Seal: � �I ns Exami Structural Review 'S •�'�0S6IOI6�cI� �. %�% st6,2py�gN.� #EE 222975 0Q Q 101—'.. s,LIC, Zoning Clerk To whom this may concern, this letter is to inform the Miami Shores Village Building Department that I, Jorge Aguilar (Elephant Air Conditioning Corp.) will be the only person working on this HVAC project on 141 NE St. Miami Shores, FL 33138. Name: Signature: MY COMMISSION f FF 2080 EXPIRES: July 11, 2018 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. t + pp(( Job Address (where the work is being done): I City: Miami Shores Village County: Miami Dade Zip Code: '31-51,38 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 ❑ N& ARHI Sheet Attached: YES;'" NO ❑ Contract Attached: YE _- 1. Minimum Circuit Ampacity (Wire Size): 2. Maximum Overcurrent Protection (Fuse/Breaker Size): 3. Voltage of Circuit (208/240/480): 4. Size Disconnecting Means: Contractor's Company Name: p—. A / 6t) �' e: 30S 39 State Certificate or Registration N e C a Q Certificate of Co petency No. Signature Date: ®310115 (Qua r signature) (Revised02/24/2014) UNIT BEING REPLACED DATA NEW UNIT MANUFACTURER AHU or PKG. UNIT MODEL # COND. UNIT MODEL # KW HEAT I e, NOM TONS AHU CU P 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 0 YES NO REPLACING THERMOSTAT ES NO YES NO NEW 4"CONCRETE SLAB ES 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): 4. Size Disconnecting Means: Contractor's Company Name: p—. A / 6t) �' e: 30S 39 State Certificate or Registration N e C a Q Certificate of Co petency No. Signature Date: ®310115 (Qua r signature) (Revised02/24/2014) Notice to Owner — Workers' Com Miami shores V Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 sation Insurance Exemotion 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 that he or she will be the only person allowed 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. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature: Owner State of Florida County of Miami -Dade The foregoing was acknowledge before me this__ tkO day of ��% , 20A. By `F' \ � C—I"(,�Ll�' who is personally known to me or has produced Notary:;� moi+ SEAL: e' @q,�5t6,R,97 90 e. 0. #EE 222975 ,a dpp e113: nCIV LMVVOVIV, OCIiRCI/AM I STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD _ICENSE NUMBER .tI The CLASS B AIR CONDITIONING CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2016 AGUILAR, JORGE ANDY ELEPHANT AIR CONDITIONING CORP 5823 SW 149TH AVE MIAMI FL 33193 ISSUED: 08/12/2014 DISPLAY AS REQUIRED BY LAW SEQ # L1408120001682 Y® LCERTIFICATE OF LIABILITY INSURANCE DAT/Y)A` 10/23/2014 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 Temax Insurance CONTACT NAME: Xamet Barreras aCN o Ext): (786) 539-5989 AI No: (305) 356-1235 E-MAILADDRESS• xamet@temaxinsuranre.com 7990 SW 117 ave #113 INSURER(S) AFFORDING COVERAGE NAIC # INSURERA: ACCIDENT INSURANCE COMPANY 11573 Miami FL 33183 INSURED INSURERS: INSURER C: Elephant Air Conditioning Corp INSURER D : 5823 SW 149 ave INSURER E: INSURER F: Miami FL 33193 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 LTR TYPE OF INSURANCE ADDL INSR S BR MM POLICY NUMBER POLICY EFF M/DDIMMIDOIYYYY) POLICY EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ 100,000 CLAIMS -MADE X OCCUR MED FRCP (Any one person) $ 5,000 PERSONAL 8 ADV INJURY $ 1,000,000 A CPP00016503-00 10/05/2014 10/05/2015 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 $ X POLICY PRO LOC AUTOMOBILE LIABILITY CEO e.6d nits NGLE LIMIT $ BODILY INJURY (Per person) $ ANY AUTO BODILY INJURY (Per accident) $ ALL OWNED SCHEDULED AUTOS UTOS H RED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE $ Per accident UMBRELLA UAB H OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED I RETENTION $ $ WORKERS COMPENSATIONTRSTATTU- AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN OFFICER/MEUIBEREXCLUDED? [—NIA (Mandatory In NH) OTH- I ER E. L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT $ If yes, describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, K more apace is required) # Lic : CAC 1816007 ltl a:4112l f -I R: Vi 1111] =1 WITIA •1 • ' SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Building Department ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2 Ave AUTHORED REPRESENTATIVE Miami Shores FL 33138 ACORD 25 (2010/05) ©1988-2010 AGURD COKFURA 1 IUN. All ngnrs reserves. The ACORD name and logo are registered marks of ACORD r s a 8/1212014 Report Viewer JEFF AaWKER �� aro ,�• CHIEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * * CERnFICATE 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 10/19/2014 EXPIRATION DATE 10/18/2016 PERSON: AGUILAR JORGE B FEIN: 263151321 BUSINESS NAME AND ADDRESS: ELEPHANT AIR CONDITIONING CORP 5823 SW 149 AVE MIAMI FL 33193 SCOPES OF BUSINESS ORTRADE HEATING, VENTILATION, AIR -GOND a a or DFS-F2-DWC-252 CERTIFICATE OF ELEC110N TO BE E)EWT REVISED 07-12 QUESTIONS7 (850)413-1609 hrttpsJ/apps8.fidts.corWcrreport%imw/reportVi.aspXldata=k4Vinc8D7Q3gH6TER6ePlKMZ%2PSz5bXKYfi3>kdeESoP Vylv4NPOPN42XeirDRGXVWbH... 1/2 Elephant Air Conditioning Corp 5823 SW 149th Avenue Miami, FL 33193 Office 305.397-7339 CAC1816007 October 19, 2014 Proposal/Agreement for: Andres Fortuny Address:141 NE 104t" St. Miami Shore SCOPE OF WORK: Change out of existing a/c handler unit. To a new 5 Ton SEER central air condition HVAC unit. ARUFI8B-CCw2 Price includes all materials, equipment and labor. 3 year manufacture warranty included. Permit fee is not included. General Provisions: All work shall be completed in a workmanship like manner and in compliance with all building codes and other applicable laws. To the extent required by law all work shall be performed by individuals duly licensed and authorized by law to perform said work. Price $2800.00 Two Thousand Eight Hundred Dollars and 00/100 Cents Payment to be as follows: 30% deposit at time of contract. Owner: �r Jorge B. Aguilar Tech:Boza Elephant Air Conditioning Corp AHRI Certified Reference Number: 5717433 Date: 11/18/2014 Product: Split System: Air -Cooled Condensing Unit, Coil with Blower Outdoor Unit Model Number: VSX130611A* Indoor Unit Model Number: ARUF60D14A* Manufacturer: GOODMAN MANUFACTURING CO., LP. Trade/Brand name: GOODMAN; JANITROL; AMANA DISTINCTIONS; EVERREST; ONE HOUR AIR CONDITIONING AND HEATING; ENERGI AIR Series name: VSX13 Manufacturer responsible for the rating of this system combination Is GOODMAN MANUFACTURING CO., LP. 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): 55000 EER Rating (Cooling): 11.00 SEER Rating (Cooling): 13.00 IEER Rating (Cooling): * Ratings followed by an asterisk (*) indicate a voluntary rerate of previously published data, unless accompanied with a WAS, which indicates an involuntary rerate. DISCLAIMER AHRI does not endorse the product(s) listed on this Certificate and makes no representations, warranties or guarantees as to, and assumes no 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-CONDITIONING, HEATING, CERTIFICATE VERIFICATION & REFRIGERATION INSTITUTE The Information for the model cited on this certificate can be verified at www.ahridirectory.org, click on `Verify Certificate" link we make life 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.: 130600 79663051488!1 a� Miami Shores Village fi 10050 N.E. 2nd Avenue NE DBPR Fee Miami Shores, FL 33138-0000 F Phone: (305)795 2204 Project Address Parcel Number Applicant 141 NE 104 Street 1121360130730 MADISON BRADLEY HOLDINGS Miami Shores, FL 33138- Block: Lot: Owner Information Address Phone Cell MADISON BRADLEY HOLDINGS LLC 141 NE 104 Street MIAMI SHORES FL 33138- 141 NE 104 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone ELEPHANT AIR CONDITIONING CORF (305)397-7339 Tons: 5 Additional Info: REPLACE 5 TON AC UNIT Classification: Residential Approved: In Review Comments: Date Approved:: In Review Date Denied: Type of Work: Scanning: 1 Fees Due Amount CCF $1.20 DBPR Fee $2.00 DCA Fee $2.00 Education Surcharge $0.40 Permit Fee $100.00 Scanning Fee $3.00 Technology Fee $1.60 Total: $110.20 Valuation: $ 2,000.00 Total Sq Feet: 0 Pay Date Pay Type Amt Paid Amt Due Invoice # MC -3-15-54859 03/19/2015 Credit Card $ 50.00 $ 60.20 04/01/2015 Credit Card $ 60.20 $ 0.00 Available Inspections: Inspection Type: Final Review Mechanical In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS 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. =Fe thorize the above-named contractor to do the work stated. April 01, 2015 Authorized ltr.06ner / Applicant / Contractor / Agent Building Department Copy April 01, 2015