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MC-15-880Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-232514 Permit Number: MC -4-15-880 Scheduled Inspection Date: May 04, 2015 Permit Type: Mechanical - Residential Inspector: Perez, JanPierre Owner: DOMBROWSKY, ALAN Job Address: 1420 NE 102 Street Miami Shores, FL 33138 - Project: <NONE> Inspection Type: Final Work Classification: A/C Replacement Phone Number 305/756-5690 Parcel Number 1132050240220 Contractor: NO SWEAT A/C CONDITIONING CONTRACTOR Phone: (954)423-9696 Building Department Comments 4 TON A/C CHANGE OUT WITH 10 KW HEAT mrractio vassea comments EQUIPMENT IN SAME LOCATION. INSPECTOR COMMENTS False A 51 OJ �� May 01, 2015 For Inspections please call: (305)762-4949 Page 13 of 41 Inspector Comments Passed Failed Correction Needed ❑ Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. May 01, 2015 For Inspections please call: (305)762-4949 Page 13 of 41 yew° Miami Shores Village CCF 10050 N.E. 2nd Avenue NE DBPR Fee Miami Shores, FL 33138-0000 DCA Fee Phone: (305)795-2204 Project Address Parcel Number Applicant 1420 NE 102 Street 1132050240220 ALAN DOMBROWSKY Miami Shores, FL 33138- Block: Lot: Owner Information Address Phone Cell ALAN DOMBROWSKY 1420 NE 102 Street 305/756-5690 Miami Shores FL 33138 Contractor(s) Phone Cell Phone NO SWEAT A/C CONDITIONING CONI (954)423-9696 (954)557-6179 4 Info: 4 TON A/C CHANGE OUT WITH 10 KW HEA ion: Residential In Review Denied: ning: 3 Fees Due Amount CCF $7.20 DBPR Fee $6.17 DCA Fee $6.17 Education Surcharge $2.40 Permit Fee $411.18 Scanning Fee $9.00 Technology Fee $9.60 Total: $451.72 Date Approved:: In Review Type of Work: Valuation: $ 11,748.00 Total Sq Feet: 0 Pav Date Pav Tvoe Amt Paid Amt Due Invoice # MC -4-15-55202 04/20/2015 Check #: 22449 04/15/2015 Check #: 22445 $ 401.72 $ 50.00 $ 50.00 $ 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 AFFIDA,1(IT: I certify that all the foregoing inform is accurate and that all work will be done in compliance with all applicable laws regulating construction and inq. Futhermore. I authorize the above -famed contractor to do the work stated. April 20, 2015 Owner / Appli*t / / Xontractor') / Agent Building Department Cop's April 20, 2015 1 • . (.4-1115 Miami Shores Village Ulm 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 F-1 BUILDING ❑ ELECTRIC ❑ ROOFING FBC 20(() Master Permit No.—M0s' (�_ RF Sub Permit No. ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING MECHANICAL [-]PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: / q XV Al /®-t. S7" City: Miami Shores County Miami Dade zip: J;:;/3'? Folio/Parcel#: //"'32'e7jr' 6.21/' &9% L9 Is the Building Historically Designated: Yes NO Occupancy Type: 1,5 ' Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): ��`�®�444 Phone#:� 7Jr% ®9��� Address: /�40 /16C� ,�®.'•o -S7 City: 44 ° 4 M/ JW,00 State: _ �� Zip: 3.3 /3 OF, Tenant/Lessee Name: �/� Phone#: Email: CONTRACTOR: Company Name: A1)0 Sfic'6,W �� //yC ' Phone#: Address: City: d$'elre- State: �- zip:333�Jr Qualifier Name: hZ7�7/J /Z. Phone#:9 State Certification or Registration #:� Certificate of Competency #: DESIGNER: Architect gineer: Phone#: _ Address: City: State: Value of Work for this Permit: $---14 117 Square/Linear Footage of Work: Zip: Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace ❑ Demolition Description of Work: 01 ; -sw A 40*V��e- "7 Af XA) Specify color of color thru tile: 4rl Submittal Fee $ Permit Fee $ Scanning Fee $ Radon Fee $ Technology Fee $ Training/Education Fee $ Structural Reviews $ (Rev1sed02/24/2014) 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. Signatur , SignatureAr ' / ' OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this f day of �'414 20 ice' , by day of20 , by Ally°✓ W®m6fi!°`�-'�� ,who is personallyk vn to 1� (�ki�, who is personally known to me or who has produced as me or who has produced Q� identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: r Sign: / Sign: Print: Print: Sealy REri1S K KAAAAER JR Seal E�wo Notary Public State of Florida�COMMI Sindia AlvarBaSSION M FF205274 My Commission FF 156750EXPIRES Mawh 03 20 to Expires t39ro3/20+9 idJt�:t�.��yry Fqw• Sorr«arm APPROVED BY "°g Plans Examiner Zoning Structural Review Clerk IRevised02/24/20141 :m 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):— %GA 0 A t s®'), ,�7 City: Miami Shores Village County: Miami Dade zip Code: .3i1 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 ❑ NOZ ARHI Sheet Attached: YES,R. NO El Contract Attached: YES 1. Minimum Circuit Ampacity (Wire Size): _ A//P °- k Gam Ae'.'® 2. Maximum Overcurrent Protection (Fuse/Breaker Size): 11-1111-60 few 3. Voltage of Circuit (208/240/480): 4. Size Disconnecting Means: SI/- , g� ��dL�,0• Contractor's Company. Name: _ oSll� o' � ®macPh ` � qua- Row/ State Certificate or R istration No. elofedal'0010 Certificate of Competency No. Signature r Al' Date:31-1$ ®J_ (Qualifier's signature) (Revised02/24/2014) UNIT BEING REPLACED DATA NEW UNIT 72- /9 MANUFACTURER G PKG. UNIT MODEL # OND. UNIT MODEL# 4&W 1/ - -® ® KW HEAT f® AHU,VV, CU d PKG AHU60 CU f PKG NOM TONS 1) M.C.A 2) M.O.P o® AHUP CU32, j PKG AHU 68 CU -0 PKG AHU CU PKG 3) VOLTS AHU CU PKG PKG UNIT / / Z EER/SEER PKG UNIT 07 W.-5 -® YES NO REPLACING DUCTS YES YES NO REPLACING THERMOSTAT NO YES NO NEW 4"CONCRETE SLAB YES YES YES NO NO NEW ROOF STAND NEW RETURN PLENUM BOX YES YES 1. Minimum Circuit Ampacity (Wire Size): _ A//P °- k Gam Ae'.'® 2. Maximum Overcurrent Protection (Fuse/Breaker Size): 11-1111-60 few 3. Voltage of Circuit (208/240/480): 4. Size Disconnecting Means: SI/- , g� ��dL�,0• Contractor's Company. Name: _ oSll� o' � ®macPh ` � qua- Row/ State Certificate or R istration No. elofedal'0010 Certificate of Competency No. Signature r Al' Date:31-1$ ®J_ (Qualifier's signature) (Revised02/24/2014) Date: State Of Florida County of Miami -Dade Before me this day personally appeared Regis K Kramer Jr who being duly sworn, deposes and says: That he or she will be the only person working on the project located at: 1420 NE 102 Street Miami Shores, FL 33138. Sworn to (or affirmed) and subscribed before me this 11day of P�? R -t'--- 2015, by :g�lS L k:�QAMlaz �� Personally known OR Produced Identification__ __:� 3l - E G - �4 03 - Type of Identification Produced T:�- _t5p—` �Z u QjFN &1� Print, Type or Stamp Name of NotaryRE State Of Florida ezpn FF 188750 !2018 511 Sumter Avenue 9 Davie FL 33325 9 Broward (954) 423-9696 • Dade (305) 623-1500 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 . f: 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 Al day of I A111- , 20 /y7 By/!�'y tr �%dM�'4��y who is personally known to me or has produced as identification. Notary: /_ `v` • • :b:KRUM K K MSR JR SEAL:MY C ° • M OMMISSI N M FF2052714 •` eM„ EXPIRES MNO 03 2019 This combination qualifies for a Federal Energy Efficiency Tax Credit when placed In service between Feb 17, 2009 and Dec 31, 2014. Certificate of Product Ratinas AHRI Certified Reference Number: 5947379 Date: 4/14/2015 Product: Split System: Air -Cooled Condensing Unit, Coll with Blower Outdoor Unit Model Number: XC254048-230-'* Indoor Unit Model Number: CBX32MV-W+TDR Manufacturer: LENNOX INDUSTRIES, INC. TradelBrand name: DAVE LENNOX SIGNATURE Series name: XC25 SERIES Manufacturer responsible for the rating of this system combination Is LENNOX INDUSTRIES, INC. Rated as follows In accordance with AHRI Standard 2101240-2008 for Unitary Air -Conditioning and Air -Source Heat Pump Equipment and subject to verification of rating accuracy by AHRI-sponsored, Independent, third party testing: SEER Ra,,ng (Cooling): 20.50 LEER Ratjng (Cooling): FootNote 11 - The AHRI i210A240 "ed EER ratings are calculated under the same methodology as the EER ratings at T1 conditions of ISO 51512010 and ISO 13253:2011. • Ratings followed by an asterisk (•) Indicate a voluntary rerate of previously published data, unless acro npanled 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 ties 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.ahrldirectory.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 detabase; 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 a REFRIGERATION INSTITUTE The Information for the model cited on this certificate can be verified at www.ahrid Irectory.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 Rued, which Is listed above, and the Certificate No, which Is listad at bottom right ©2014 Air -Conditioning, Heating, and Refrigeration Institute CERTIFICATE NO.: i30735oos580941' IL �+.■.1 ERTLFIED° www.ahridireciory.or This combination qualifies for a Federal Energy Efficiency Tax Credit when placed In service between Feb 17, 2009 and Dec 31, 2014. Certificate of Product Ratinas AHRI Certified Reference Number: 5947379 Date: 4/14/2015 Product: Split System: Air -Cooled Condensing Unit, Coll with Blower Outdoor Unit Model Number: XC254048-230-'* Indoor Unit Model Number: CBX32MV-W+TDR Manufacturer: LENNOX INDUSTRIES, INC. TradelBrand name: DAVE LENNOX SIGNATURE Series name: XC25 SERIES Manufacturer responsible for the rating of this system combination Is LENNOX INDUSTRIES, INC. Rated as follows In accordance with AHRI Standard 2101240-2008 for Unitary Air -Conditioning and Air -Source Heat Pump Equipment and subject to verification of rating accuracy by AHRI-sponsored, Independent, third party testing: SEER Ra,,ng (Cooling): 20.50 LEER Ratjng (Cooling): FootNote 11 - The AHRI i210A240 "ed EER ratings are calculated under the same methodology as the EER ratings at T1 conditions of ISO 51512010 and ISO 13253:2011. • Ratings followed by an asterisk (•) Indicate a voluntary rerate of previously published data, unless acro npanled 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 ties 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.ahrldirectory.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 detabase; 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 a REFRIGERATION INSTITUTE The Information for the model cited on this certificate can be verified at www.ahrid Irectory.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 Rued, which Is listed above, and the Certificate No, which Is listad at bottom right ©2014 Air -Conditioning, Heating, and Refrigeration Institute CERTIFICATE NO.: i30735oos580941' AIR CONDITIONING, REFRIGERATION & HEATING INC. 954-423-9696 ® 305-623-1500 511 Sumter Ave ® Davie FL 33325 Serving South Florida since 1983 ® CACO26410 State Licensed and Insured 0.5r 1.5`1 G 9 6'14 Date Customer Mame Home# L cart tt Address City, State Zip Legal Description We hereby submit estimate for: System SEER Rating Condenser Model # Air Handler Model # Electric Heater KW Model # PRICE INCLUDES: Sales Tax - Installation Labor - Digital Thermostat - Flood Switch - Connect to Existing Copper and Electrical L,ines - Liquid Line Filter Drier - Condensing Unit Tie Down - Flush Drain Line - Removal of Old Equipment WARRANTIES: Year Warranty on Entire System with Registration at `No Sweat" will provide 1 Year Labor Warranty Cost of System Change Out: WDITI®NAL SERVICES UV Germicidal Light Replace Top Of Return Air Plenum With Plywood Condensate Pump Replace Slab (Size) Aluminum Air Handler Stand Replace Service Disconnect (Size) Total Cost of Installation Florida Power & Light Rebate Final Cost To Customer Accepted by Purchaser: "No Sweat" A/C Inc: F