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MC-15-1452Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-236732 Scheduled Inspection Date: June 24, 2015 Inspector: Perez, JanPierre Owner: MURUGAN, JOSEPH Job Address: 8815 NE 4 Avenue Road Miami Shores, FL Project: <NONE> Contractor: PERFECT AC SOLUTIONS Permit Number: MC -6-15-1452 Permit Type: Mechanical - Residential Inspection Type: Final Work Classification: A/C Replacement Phone Number Parcel Number 1132060460520 Phone: (786)512-9165 suiming uepartment comments AC CHANGE OUT 3 TON Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed Failed Correction Needed I� Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. June 23, 2015 For Inspections please call: (305)762-4949 Page 13 of 30 s y®4 Miami Shores Village CCF 10050 N.E. 2nd Avenue NE DBPR Fee Miami Shores, FL 33138-0000 " Phone: (305)795-2204 Project Address Parcel Number Applicant 8815 NE 4 Avenue Road 1132060460520 JOSEPH MURUGAN Miami Shores, FL Block: Lot: Owner Information Address Phone Cell JOSEPH MURUGAN 8815 NE 4 AVE RD MIAMI SHORES FL 33138-3177 Contractor(s) Phone Cell Phone PERFECT AC SOLUTIONS (786)512-9165 Info: AC CHANGE OUT 3 TON on: Residential In Review Denied: ninq: 3 Fees Due Amount CCF $2.40 DBPR Fee $2.00 DCA Fee $2.00 Education Surcharge $0.80 Permit Fee $115.64 Scanning Fee $9.00 Technology Fee $3.20 Total: $135.04 Date Approved:: In Review Type of Work: Valuation: $ 3,304.00 Total Sq Feet: 0 Pav Date Pav Tvoe Amt Paid Amt Due I Invoice # MC -6-15-55961 06/18/2015 Credit Card 06/12/2015 Credit Card $ 85.04 $ 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 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 contractor to do the work stated. June 18, 2015 Authorized Signature: Owner / Applicant / Contractor / Agent Date Building Department Co June 18, 2015 1 BUILDING PERMIT APPLICATION Miami Shores Village Building Department JUN 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 �BYe i INSPECTION LINE PHONE NUMBER: (305) 762-4949 BUILDING ❑ ELECTRIC ❑ ROOFING 2095 AFBC 20 (b Master Permit No. 1' �� ` 1�5 `, Sub Permit No. ❑ REVISION ❑ EXTENSION ❑ RENEWAL ❑PLUMBING MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: ! U �V �y 2-D City: Miami Shores County: Miami Dade Zip: 3 1 3 Folio/Parcel#: 11-3 a OG -04G ` 05 a U Is the Building Historically Designated: Yes NO x Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): S%Q la R V 2v &A M Phone#: 404 - -439 -,34-39 Address: 351 S �A�-: 4 Au V? D City: k",Aun S H0Q::r,- 5 State: Zip: '331 3 Tenant/Lessee Name: J6 Smy\ Phone#: 407 - 736 3 7 8q Email: (' CONTRACTOR: Company Name: ��CL� c:t C- �O`0� 1UV-' 5 Phone#: Address: 46 6 -� SIS � � v Fr City: _P j AULA i State: /- Zip: Qualifier Name: I -A KA�A 2Q:t-rr-rETO S Phone#: --G- �I Z G d GS State Certification or Registration #: C AL I S 19() 2} Certificate of Competency #: DESIGNER: Architect/Engineer: Address: City: State Zip: Value of Work for this Permit: $ Square/Linear Footage of Work: Type of Work: F-1Adddition ❑ Alteration g_❑ New IJ Repair/Replace El Demolition Description of Work: A c cp (A �G-r. C�JA • 3 70 N 1 Specify color of color thru tile: / Submittal Fee $ • 0 Permit Fee $ Ip Scanning Fee $ Radon Fee $ Technology Fee $ Training/Education Fee $ Structural Reviews $ (Revised02/24/2014) CCF $ CO/CC $ DBPR $ Notary $ Double Fee $ Bond $ 95 nu 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 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 OWN or AGENT The foEegoing instrument was acknowledged before me this day of , Mai 20 dJ�. by L who is personally known to me or who has produced � bQ1yk.A'— Lvax identification and who did take an oath. NOTARY PUBLIC: Sign: Print: ... Seal APPROVED BY (Revised02/24/2014) MY COMMISSION # EE841328 EXPIRES r 07.2018 Signature CONTRACTOR The1f regoing instrume t was acknowledged before me this day of k4 ----12015 , by V\ Unelv who is perso ally known to me or who has produced beiiCl/!. as identification and who did take an oath. NOTARY PUBLIC: Print: — Seal: = MY COMMISSION # EE841328 . EXPIRES October 07, 2018 _ P ans Examiner Zoning Structural Review Clerk DISPLAY AS REQUIRED BY LAW SEQ# L1407130000930 �e L i; NFIT CERTIFICATE OF LIABILITY INSURANCE 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(% AUTHORIZED w REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: *'*I*f"*the *****certificate*****—*io—lderls an AQDITIONAL INSURED, the p—ollc**y***(*-*W*-s**)*****must *'b'e, 'endorsed. "If'SU***B'****R**'*O****G**AIIO"N"I"S 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 endomement(a). PRODUCER Gil & Associates Insurance 9485 S.w 72 St Suite A-120 Miami, FL 33173 Phone (305)279-7665 .. . ......... INSURED CIORI INC dba Perfect AC Solutions 4662 SW 74 AVE Miami, FL 33155 - CONTACT "A I�"1 PHONE (A1C,N9,,.xQ. (305)279-7665 (305)279-9705 E-MAIL dgil@gilinsurance.com AQORESS;.... . . . . ..... . ......... ........ — - - ------- Fax (305)279-9705 INSURER A: ACCIDENT INSURANCE COMPANY _1111INSURER 0: ASSOCIATED INDUSTRIES INSURANCE COMPANY .. .......... ... —11 . . . ................... . . INSURER C . . ...... ......... . . ........... . . COVERAGES CERTIFIC THIS IS T66ti;t*Y THAT THE POLICIES OF INS INDICATED. NOTWITHSTANDING ANY REOU(RE CERTIFICATE MAY BE ISSUED OR MAY PERTAIN EXCLUSIONS AND CONDITIONS OF SUCH FOLIC ......... - -------... ........ .. ADDL LTR: TYPE OF INSURANCE .... INSR . .............-- ...... . . ..... ..... GENERAL LIABILITY V: COMMERCIAL GENERAL LIABILITY CLAIMS -MADE At OCCUR A N . ......... . ..... . . .... GEN'L AGGREGATE LIMIT APPLIES PER: PRO- ; LIC jF LOC; POLICY AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIREDAU1OS NON -OWNED AUTOS UMBRELLA LIAR OCCUR EXCESS LIAR CLAIMS-NWE ......... . . .... . .......... ....... DED RETENTION ..... .. .................. WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNERIEXECUTIVE B OFFICEWMEMSER EXCLUDED? N I A (Mandatory In NMI It xes, dmmbe under 9SCRIP.N 0 TIO OPERATIONS kvlow . F (786) 512-9165 INSVAEAE-:� . .............. ..Q11 Rapp ATE U"i4 IAEN' THE ES. L SUBR WV0 NUMBER:REVISION NUMBER: ............. . . . ............... ... ........... . ICE *LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, IMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. . . . . . . .............. . ......... . ..... ... .. ................... POLICY NUMBER POLICY EFF POLICY EXP ........... ...... ............ LIMITS ............. (MMIDDNYYY) (MWDD/YYYY) EACH OCCURRENCE Is 1,0 '000.ou .- i --- ............ ... --- ... ... ...... -- I.- i I . .. ... 11 1 1 -- .. .... ---- ............ . ........ - .. ........... ...... ......... DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Addfilanal Remarks Schedule, It more space to required) STATE MECHANICAL LICENSE NUMBER CAC1515027 AIR CONDITIONING CERTIFICATE A&dko ... .. ......... . ............... ..... ....... .... . ............ -1.1 11-:1-1 ........... ...... I .................................... ........... CANCELLATION' .. .. . ...................... ... . 1.1-1 .......... .. ............. ........ ......... .. . ..................... ............. .... ......... SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE MIAMI SHORES VILLAGE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, 10050 BE 2ND AVE ..... ...... MIAMI SHORES VILLAGE, FL 33138 AUTHORIZED REPRESENTATIVE ....................... .................... .. . . .............. .................. ........ ............ ........... .................. . . ........... . . . . ....... . ©1988-2010 ACORO CORPORATION. All rights reserved. ACORD 25 (2010105) OF The ACORD name and logo are registered marks of ACORD .b ..... ........ ) DAMAGE TO RENTV i 100,000-00 PR MISES a occurrence)_._ i $ ..... ...... . ... ..... .. . ..... ... CPP0005971 02 09/23/2014 09/2312015 (Anynoporson) S MEDEXPo . .. -1111.. 5,000.00 PFRSONAL&ADVINJURY $ 1,000,000-00 GENERALAGGREGATE i $ 1,000,000.00 .. ............ . PRODUCTS- AGG] $ 1.000,000-00 .. .COMP/OP .... ..... .. .................... .. ........ . . .. . ............... .................. COMBINED SINGLE LIMIT (Ea accident) ls ........ ........ . ...... ........ BODILY INJURY (Per person) IS Y (Par amidarrl;. ROMI.Y'INJ . INJURY ........... I 1111.. ..... . ...... ...... is ...... ........... . . ...... ................... ...... ............... ......... .......... .............. ........ EACH OCCURRENCE . ... ......... .................. . ... ------ ... . . ...... li AGGREGATE . .......... .... . ..... is * ** NO 8 A5 i ITO AW* 1 06/05/2015 06/05/2016 F I.: FACH ACCnFNT is 500,000.00 500,000-00 E.L. DISEASE, EA EMPLOYE' S . ..... ... ......... . ... .. . ......... ..... ........... LIMIT I E.L. DISEASE- POLICY $ .. ... .. .. .. .... 500,000.00 ... ............. ..... .- i --- ............ ... --- ... ... ...... -- I.- i I . .. ... 11 1 1 -- .. .... ---- ............ . ........ - .. ........... ...... ......... DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Addfilanal Remarks Schedule, It more space to required) STATE MECHANICAL LICENSE NUMBER CAC1515027 AIR CONDITIONING CERTIFICATE A&dko ... .. ......... . ............... ..... ....... .... . ............ -1.1 11-:1-1 ........... ...... I .................................... ........... CANCELLATION' .. .. . ...................... ... . 1.1-1 .......... .. ............. ........ ......... .. . ..................... ............. .... ......... SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE MIAMI SHORES VILLAGE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, 10050 BE 2ND AVE ..... ...... MIAMI SHORES VILLAGE, FL 33138 AUTHORIZED REPRESENTATIVE ....................... .................... .. . . .............. .................. ........ ............ ........... .................. . . ........... . . . . ....... . ©1988-2010 ACORO CORPORATION. All rights reserved. ACORD 25 (2010105) OF The ACORD name and logo are registered marks of ACORD 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. uJob Address (where the work Is being done): 15 �4 4 Lf— 9— D City: Miami Shores Village County: Miami Dade Zip Code: -53r 3Z 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 0 ARHI Sheet Attached: YES ® NO ❑ Contract Attached: YES N UNIT BEING REPLACED DATA NEW UNIT A2Q i Fc CL MANUFACTURER N Q✓( 404QQ300 AHU or PKG. UNIT MODEL# RH 1 rt S14m 4M(— -o SAZ COND. UNIT MODEL# RA 14 3G AA I pct/ KW HEAT _� 9ai/ 3 T NOM TONS 3"r AHU 0 CU 30 PKG 1) M.C.A AHU qO Cu 30 PKG AHU qp CU 30 PKG 2) M.O.P AHU 40 CU 30 PKG AHU CU PKG 3) VOLTS .2 0 V AHU CU PKG PKG UNIT / / PKG UNIT / / 10 EER/SEER YES NO REPLACING DUCTS YES YES NO REPLACING THERMOSTAT YE NO YES NO NEW 4"CONCRETE SLAB YES 0 YES NO NEW ROOF STAND ES NO YES NO NEW RETURN PLENUM BOX YES NO 1. Minimum Circuit Ampacity (Wire Size): 46 2. Maximum Overcurrent Protection (Fuse/Breaker Size): 40 BQ.RUXIR- 3. Voltage of Circuit (208/240/480): Q 40 4. Size Disconnecting Means: Contractor's Company Name: Phone: 43 (-Si _2 4FG j State Certificate or Registration No. j:? 160 a Certificate of Competency No. Signature Q Date: 6-)a- /5 ( er's si (Revised02/24/2014) aMi AHRI Certified Reference Number: 7491807 Date: 6/9/2015 Product: Split System: Air -Cooled Condensing Unit, Coil with Blower Outdoor Unit Model Number: RA1436AJ1 Indoor Unit Model Number: RH1T3617STAN Manufacturer: RHEEM SALES COMPANY, INC. Trade/Brand name: RHEEM; RUUD Region: Region Note: Central air conditioners manufactured prior to January 1, 2015, are eligible to be installed in all regions until June 30, 2016. Beginning July 1, 2016, central air conditioners can only be installed in region(s) for which they meet the regional efficiency requirement. Series name: IEER Rating (Cooling): ion of ratin 1j', 0 f accuracy by AHRI-sponsored, independent, third t 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.abridirectory.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 'Vett 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 t$ ©2014 Air -Conditioning, Heating, and Refrigeration Institute CERTIFICATE NO.: o7834893168428.