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MC-15-996Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-233456 Permit Number: MC -4-15-996 Scheduled Inspection Date: May Y 13 2015 Permit Type: Mechanical -Residential Inspector: Perez, JanPierre yp Inspection Type: Final Owner: PEAKE, FRANCES Work Classification: A/C Replacement Job Address: 9342 NE 9 Avenue Miami Shores, FL Phone Number Parcel Number 1132060020050 Project: <NONE> Contractor: JG CLIMATE CONTROL CORP Phone: (305)318-6479 Building Department Comments REPLACE EXISTING 2 TON SPLIT SYSTEM UNIT Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed Failed Correction ❑ Needed Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. May 12, 2015 For Inspections please call: (305)762-4949 Page 15 of 30 Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Parcel Number Applicant 9342 NE 9 Avenue 1132060020050 FRANCES PEAKE Miami Shores, FL Block: Lot: Owner Information Address Phone Cell FRANCES PEAKE 9342 NE 9 AVE MIAMI SHORES FL 33138-2904 Contractor(s) Phone Cell Phone JG CLIMATE CONTROL CORP (305)318-6479 2 ional Info: REPLACE EXISTING 2 TON SPLIT SYSTEM ;ification: Residential rved: In Review nents: Date Approved:: In Review Denied: Type of Work: nina: 3 Fees Due Amount CCF $1.80 DBPR Fee $2.00 DCA Fee $2.00 Education Surcharge $0.60 Permit Fee $100.00 Scanning Fee $9.00 Technology Fee $2.40 Total: $117.80 Valuation: $ 2,962.00 Total Sq Feet: 0 Pav Date Pav Type Amt Paid Amt Due Invoice # MC4-15-55336 04/27/2015 Credit Card 04/29/2015 Credit Card $ 50.00 $ 67.80 $ 67.80 $ 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. Futhermore, I authorize the above-named contjqctor to do the work stated. April 29, 2015 Authorized Signature: Owner / Applicant / C tr ctor / Agent Building Department Copy April 29, 2015 1 BUILDING PERMIT APPLICATION Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tei: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 ❑ BUILDING ❑ ELECTRIC ❑ ROOFING 7A EcEr APR 2 2015 BY: r. FBC20 10 Master Permit No. IM l __ f Sub Permit No. ❑ REVISION ❑ EXTENSION ❑ RENEWAL []PLUMBING DOMECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 9 3 7 A rC City: Miami Shores r County: Miami Dade Zia• 3313 9 Folio/ParcelR: �� 3 1-0yI ' DO Z - 005'0 Is the Building Historically Designated: Yes NO Occupancy Type: Load: OWNER: Name (Fee Simple Construction Type: Flood Zone: ,Y_1-.- BFE: FFE: City: ) 00,6N 1 SA Oc *5 state: rn, Zip: 1 � Tenant/Lessee Namg:_ 0 //A,---- - Phone#: Email: P, 1-aA w . CONTRACTOR: Company Name: T6 GLIraAle. C.O/V "I- Coe Phone#: 30S 319 6449 Address: l C g 03` NW YC 4W4 City: _w/ow State• re, Zip: 33919 Qualifier Name: !/.S C�?,&%?A-AIVAte,, Phone#: 3 01;3/ft 6S1 State Certification or Registration #: CA f✓ /9®6031 Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City State: Value of Work for this Permit: $ 9,11 4C -1- Square/Unear Footage of Wgrk: 0 Type of Work: ❑ Addition ❑ Alteration ❑ New 91 Repair/Replace ❑ Demolition Desc,riptkm of Work: Tao Ge fAlrAml , . ® Am So i.4 r S,YS lew Uhy/ I Specify color of color thm Submittal Fee $ Permit Fee $ Scanning Fee $ Radon Fee $ Technology Fee $ Training/Education Fee $ Structural Reviews $ (Rev1sed02124/2014) CCF $ Co/CC $ DBPR $ Notary $ Double Fee $ Bond $ //►► TOTAL FE.X 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 co encement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. I th� al�sencT such posted notice, the inspection will not be approved and a reinspection fee will be charged. I I I / ��N fe� Signature n Signature x OWNER or AGENT CO RACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this 2� day of APOA 20 )S , by c9L4_ day of A, L L- , 20 by N who is personally known to �`ESc1S �N , who its personally known to me or who has produced �" �Q-� e. �ICIQ�s me or who has produced �m�i e UCtw as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign Sign: Print: Print: Seak Notary Public State of Florida Seal: P4* Notary Public State of Florida Sindia Alvarez Sittdia Alvarez My Commission FF 156750 �a� My Commission FF 156750 JW Expires 09/03/2018 p' pdp Expires 09/03/2018 **************** 7n= * * **APPROVED BY miner 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 Fan:(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): 93 Vol- Al 7' Ave City: Miami Shores Village County: Miami Dade Zip Code: 39138 ALL CONDENSING UNITS MUST BE ON A 41NCH SOLID CONCRETE SLAB ALL UNITS MUST COMPLY WITH F.E.M.A MINIMUM FLOOD ELWATION A COPY OF THE CONTRACT IS REQUIRED WITH ALL SUBMITALS AHRI DATA SHEET REQUIRED Change disconnecting means: YES ❑ NO)& ARHI Sheet Attached: YES 5d NO ❑ cam Tact Attached: YES UNIT BEING REPLACED DATA NL:W UNIT 'ritike4c o MANUFACTURER TRAM e - /j / of OA i AHU or PKG. UNIT MODEL# TEM 6 A,0 8 2-0 WSA J% Y G 40a A COND_ UNIT MODEL # {/ A kw KW HEAT ht% ,2-0 NOM TONS . Q AHU CU ZS.PKG 1) M.C.A AHU 30 CU / S PKG AHU s' CU 1,6 PKG 2) M.O.F AHU,;S CU PKG AHuj30 CU .294PKG 3) VOLTS AHUZ j WIJ,3 0PKG PKG UNIT / / PKG UNIT APA EER/SEER .-0 YES NO REPLACING DUCTS YES NO YES NO REPLACING THERMOSTAT YES NO YES NO NEW rCONCRETE SLAB YES NO YES NO NEW ROOF STAND YES YES NO NEW RETURN PLENUM BOX YES NO 1. Minimum Circuit Ampacity (Wire Size): / y 2. Maximum Overcurrent Protection (Fuse/Breaker Size): 10 111"^10 3. Voltage of Circuit (208/240/480): 4. Size Disconnecting Means: Contractor's Company Name: Cc, cure. C V VW4, 4040 Phone: 341! 3/0,w)4 State Certificate or Registration No. CA G 1#, GOAL Certificate of Competency No. Signature Date: 0 5//9 5//idl S 1 s denature) (Re&WO2/24/2014) Miami shores Village 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. Ji/ COPY OF LIABILITY INSURANCE* D. '� COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor 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 form and Contractor 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: �� C �-t MA�� (SvoT"7- (fpoLP BUSINESS ADDRESS: "w aV,0 CITY A.�iG,o; STATE aGG ZIP 8' BUSINESS PHONE: FAX NUMBER L R34i CELL PHONE P-0 3 QUALIFIER'S NAME: Je$wl G00d /-e& QUALIFIER'S LIC NUMBER: GQ C- �glL 03l RICK SCOTT; GOVERNOR - KEN LAWSON. SECRETARY S'€10►TE . OF FLQR#iA DEPAIUMENT-OF BUSIES$: to PROFES31ONJ4L, REG JU4TtDW �� CAC1.81iN 39 :.. Tw,`ie:CL�4ISS.B��tRt�rC-pO7NtDi17DRiI Z ...- N � M--ii�R TIRED URt�er .AfOIi§,E ri�l'd 489 F$ ` - i E -P ata .3-17.20 irs_ : GOI Z UWE7JESUS - IN 'gym J}Q��£�/U�M�A�T[eC 3i RQL ■ -� ., , ISSUED. 0&12=4 =PLAYAS REQUHM BY LAW SEQ# L1406120000789 OP ID: LEGO '44� �� CERTIFICATE OF LIABILITY INSURANCE ��„2o° 5' 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 certifit 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 endorsemerBt A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Avante Insurance Agency,NAME 7490 West Flagler StreeInc. Miami, FL 33144 Gabriela F. Dominguez CONTACT FAX PRONE Emil,No E-MBAIL ADDRESS: PRODUCER JGCLI-1 CUSTOMHt ID v: INSURERS) AFFORDING COVERAGE NAIC Il INSURED JG Climate Control Corp 19903 NW 86 Avenue Hialeah, FL 33015 INSURER A:Capac InsuranCe COmPanY INSURER B: Maphe Insurance Co. of FL 34932 INSURER c: Bridgefield Casualty Insurance INSURER D 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 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. LIR TYPE OF INSURANCE Miami Shores, FL 33138 AUTHORS I,iE�?F.R,ESJTATiVE POLICY NUMBER POLICY EFF POLICY EXP LATS GENERAL UABILITY EACH OCCURRENCE $ 1,000, PREMISES IR oocrarense$ 100,00 A X COMMERCIAL GENERAL LIABILITY CLM010093998 01/06/2015 01106=16IRENTED CLAIMS -MADE FX OCCUR MED EXP (any are person) $ 2,50 PERSONAL & ADV INJURY $ 1,000,0 GENERAL AGGREGATE $ 2,000, GEWL AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMMPA}P AGG $ 1,0Now POLICY PRO- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1 'mo, ANY AUTO BODILY INJURY (Per peen) $ B X ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS 4150140009556 01/14/2015 01/14/2016 BODILY INJURY (Per acdderd) $ PROPERTY DAMAGE $ (PER ACCIDENT) $ NON -OWNED AUTOS $ UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000, AGGREGATE $ INCLUDE A X EXCESS LIAB CLAIMS -MADE CXL01006197B 01/0612015 01/0612016 DEDUCTIBLE $ $ RETENTION $ C WORD COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERIEXECUTNEY`N OFFICERIMEMBER EXCLUDED? El (Mandatory in NH) N I A 196-19570 02/24/2015 0212MM6 OTH X WPM TORY LIMITS ER EL EACH ACCIDENT $ 1,000,00 EL DISEASE - EA EMPLO $ 1,=, If yes, describe under DESCRIPTION OF OPERATIONS below EL DISEASE - POLICY LIMIT $ 1,000,000 RIPTI OF OP TIONS LOCATiO ! VEIICLES ACORD 101, Additional Remmis ScheMe, N nmre Is required) A r Con�loning�nstaflation rvice antRepair. CERTIFICATE HOLDER CANCELLATION MIAMISH SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Villas 10050 NE 2 Avenue THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores, FL 33138 AUTHORS I,iE�?F.R,ESJTATiVE ©1986-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD 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 Ratings AHRI Certified Reference Number: 7567553 Date: 4/24/2015 Product: Split System: Air -Cooled Condensing Unit, Coil with Blower Outdoor Unit Model Number. 4TTR6024B1 Indoor Unit Model Number: TEM6AOB24H21+TDR Manufacturer: TRANE Trade/Brand name: TRANE Series name: XR16 Manufacturer responsible for the rating of this system combination is TRANE 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: Cooling Capacity (Btuh): 22000 EER Rating (Cooling): 13.00 SEER Rating (Cooling): 16.00 IEER Rating (Cooling): Ratings followed by an asterisk (') bndicate a voluntary rerate of previously published data, unless accrompanted 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 resporrsibiHry 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 pmduct(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 AHTS. 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 huihridual, 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" Mk 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 Na, which Is fisted at bottom right 130743634841087411 ©2014 Air -Conditioning, Heating, and Refrigeration Institute CERTIFICATE NO.: