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MC-15-1139 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-234693 Permit Number: MC-5-15-1139 Scheduled Inspection Date: June 29, 2015 Permit Type: Mechanical - Residential Inspector: Perez,JanPierre Inspection Type: Final Owner: CAUCHI, PAUL& MAGDALENA Work Classification: A/C Replacement Job Address: 131 NE 96 Street Miami Shores, FL Phone Number Parcel Number 1132060132590 Project: <NONE> Contractor: TSE AIR CONDITIONER CORP Phone: (786)536-8517 Building Department Comments CHANGE OUT OF CENTRAL A/C Infractio Passed Comments INSPECTOR COMMENTS False 15Inspector Comments Passed 6u Failed Correction Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. June 26, 2015 For Inspections please call: (305)762-4949 Page 11 of 28 Permit No Miami Shores Village PeResidential 10050 . .2nd Avenue NE NE2 � Wcrric Clas��«�'i ASC Repla�l�elllt Miami Shores, FL 33138-0000 ,,rerm, ��tus APPROVED FN�p a Phone: (305)795-2204 �'toRtvA � 060 Do6171281 .:.. Expiration: 11/2312015 Project Address Parcel Number Applicant 131 NE 96 Street 1132060132590 Miami Shores, FL Block: Lot: PAUL&MAGDALENA CAUCHI Owner Information AddressPhone Cell ,...-- ... I PAUL&MAGDALENA CAUCHI 131 96 Street I MIAMI SHORES FL 33138- 131 96 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone Valuation: $ 3,700.00 TSE AIR CONDITIONER CORP (786)536-8517 _.. Total Sq Feet: 0 Tons:3 1/2 Available Inspections: Additional Info:CHANGE OUT OF CENTRAL A/C Inspection Type: Classification: Residential Final Approved: In Review Review Mechanical Comments: Date Approved: : In Review Date Denied: Type of Work: Scanning:3 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $2.40 Invoice# MC-5-15-55548 DBPR Fee $2.00 DCA Fee $2.00 05/14/2015 Credit Card $50.00 $98.90 Education Surcharge $0.80 05/27/2015 Credit Card $98.90 $0.00 Permit Fee $129.50 Scanning Fee $9.00 Technology Fee $3.20 Total: $148.90 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 assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELEC I PLUMBING,MECHANICAL,WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AFAouthermore, certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction aI authorize the above-named contractor to do the work stated. May 27, 2015 Authorized Sign ture:Owner / Applicant / Contractor / Agent Date Building Department Copy May 27, 2015 1 Miami Shores Village �F �r Building Department MAY 1 Z015 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 2016 BUILDING Master Permit No. PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING N MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: U t + ' f l[ �J IOGf� City: Miami Shores Countv: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE:: FFE:�p OWNER: Name(Fee Simple Titleholder): dli Phone#: t�5� k� J e�E Addresssy `� ��.V ( � S r City: 1 VI(/U•(A' Jtlyr e-s f /5 State: � Zip: Tenant/Lessee Name: (" Phone#: Email: CONTRACTOR:Company Name: - i %�'�." t(`�n Phone#: � Address: City: 7 State: � Zip: ll 1 Qualifier Name: ��'� 1 � � t�� Phone#:�� t)-3 (/ 4 3 � �SJ 7/ I T State Certification or Registration#: F R ( Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ �� ' Square/Linear Footage of Work: Type of Work: ❑ Ad it'on ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: l� P ��' Z7� Specify color of color thru tile: Submittal Fee$ ';o 10c� Permit Fee$ 1 i CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ Ci (Revised02/24/2014) Ilk Bonding Company's Name(if applicable) t� Bonding Company's Address City State Zip 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 - Signature OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day o "�/�20 /- f by •r�c��p,qday of f 20 15 by 'uho is personally known to i?Q.1%:M ,who is personally known to me or who has produced as me or who has produced" U0JXC(g identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PU IC: Sign: Sign: Print: Seal: , Y Pie Notary Public State of Florida Seal: ,�" Notary Public State of Florida r° 4� Joanna ,A Feliciano : Sindia Alvarez y o My Commission FF 082153 8� My Commission FF 156750 '9,Or'�p4 Expires U,k1,!1^i20�a NOF F\. Expires 09/03/2018 ►,��'1A�'yr'•e,saw ':/�F4e�'�� APPROVED BY �PI ns Examiner Zoning Structural Review Clerk (Revised02/24/2014) A i560 Miami Shores Village Building Department Bull 10050 N.E.2nd Avenue d Miami Shores, Florida 33138 � Rp► 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 acc ptabl Job Address(where the work is being done): 1 tl City: Miami Shores Village County: Miami Dade Zip Code: 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 ❑ UNIT BEING REPLACED DATA NEW UNIT MANUFACTURER T ' 1 < AHU or PKG. UNIT MODEL# 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 0 YES NO REPLACING THERMOSTAT �YE S NO YES NO NEW 4"CONCRETE SLAB NO YES NO NEW ROOF STAND YES NO YES NO NEW RETURN PLENUM BOX YES NO 1. Minimum Circuit Ampacity(Wire Size): a 3, b 2. Maximum Overcurrent Protection (Fuse/Breaker Size): 3. Voltage of Circuit(208/240/480): 4. Size Disconnecting Means: Contractor's Company Name:�-�• `-t"►;� i i�� Phone: State Certificate or ReT ion No. Certificate of Competency,No. Signature Date: z I u Qualifier's signature) (Revised02/24/2014) III This combinationualifies for a Federal Ener 0%0 inal CERTIFIED it"IMF ° Efficiency Tax Credit when placed in service between Feb 17, 2009 and Dec 31, 2014. rrr Certificate of Pla-0'-duct R AHRI Certified Reference Number: 6949629 Date: 5/14/2015 Product: Split System: Air-Cooled Condensing Unit, Coil with Blower Outdoor Unit Model Number: NXA642GKA* Indoor Unit Model Number: FXM4X48**AL Manufacturer: TEMPSTAR Trade/Brand name: TEMPSTAR Region: Series name: 16 SEER R410A AC Manufacturer responsible for the rating of this system combination is TEMPSTAR 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): 42000 EER Rating (Cooling): 13.00 SEER Rating (Cooling): 16.00 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; �,�" 1 entered into a computer database;or otherwise utilized,in any form or manner or by any means,except for the user's individual, AwN" 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 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.: 130760901637510153 STATE OF FLORIDA -= DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION F- f CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 MILIAN-PRIETO, PEDRO TSE AIR CONDITIONER CORP 7 ST 12230 NW 7 ST MIAMI FL 33182 Congratulations! With this license you become one of the nearly one million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range ►« STATE OF FLORIDA from architects to yacht brokers,from boxers to barbeque restaurants, DEPARTMENT OF BUSINESS AND and they keep Florida's economy strong. PROFESSIONAL REGULATION Every day we work to improve the way we do business in order to CAC 1816686 ISSUED: 07/20/2014 serve you better. For information about our services,please log onto www.myfloridalicense.com. There you can find more information CERTIFIED AIR COND'CONTR about our divisions and the regulations that impact you,subscribe MILIAN-PRIETO,PEDRO to department newsletters and learn more about the Department's TSE AIR CONDITIONER CORP initiatives. Our mission at the Department is: License Efficiently, Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, IS CERTIFIED under the provisions of Ch-489 FS_ and congratulations on your new license! Expiration date:AUCs 31,2016 L1407200001197 DETACH HERE RICK SCOTT, GOVERNOR KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION s CONSTRUCTION INDUSTRY LICENSING BOARD & CAC 1816686 The CLASS AAIR CONDITIONING CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2016 0 LEI MILIAN-PRIETO, PEDRO TSE AIR CONDITIONER CORP - 7 ST - 12230 NW 7 ST MIAMI FL 33182 ISSUED: 07/20/2014 DISPLAY AS REQUIRED BY LAW SEQ# L1407200001197 oWs4 Local Buess Tax ReceiRt Miami—Dade 'County, State - of Florida -THIS IS NOTA BILL -DO NOT PAY 6736384 BUSINESS NAME/LOCATION RECEIPT NO_ EXPIRES TSE AIR CONDITIONER CORP 11MVIEWAL SEPTEMBER 30, 2015 12230 NW 7 ST 7009947 Must be displayed at place of business MIAMI FL 33182 Pursuant to County Code Chapter SA-Art.9&10 OWNER SEC* W TYPE OF SUSESS TSE AIR CONDITIONER CORP 196 SPEC MECHANICAL.CONTRACTOR PAYMENT RECEIYEO CAC1816686 BY TAX COLLECTOR wotker(s) T $75.00 08/13/2014 FPPU14-14-007353 This Local Sown=Tax,Nampo*coaNnaspolawatddoLocal 8MMUTnc Thaftweipm Rao Somme. Path or a awdficWoe altlitAWder's gnfifi s,to do hearses.Noldar oust eom-h with am yard or 00agovernmenial reyah"larrs and requiron outs which apply to tM ink The RECErrNa shore wan be dispisyd an an conavancial vehicles-Wumd-Dade Cade Sec ea'-m Foram hdonand e,visit May, 12. 2015 10 : 08AM THE FIRST INS, GROUP CORP No, 0747 P. 1 CERTIFICATE OF LIABILITY INSURANCE F DATE(MMrowYYYY) THIS CERTIFICATE IS ISSUED AS / 12/15 A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT; If the certificate holder Is an ADDITIONAL INSURED,the Policy(ies)must be endorsed. If SUAROGATION IS WAIVED,Subject to the terms and conditrons Of the policy,certain policies may require an endorsement, A statement On this certtficate does not confer rights to the certificate holder in lieu Of such endorsement(s). PRODUCER TACT N MIRIA)vl MESA First Insurance Group PHONE (305)221-7878 10967 SW 40 St nFAc No: (305)554-7090 AIL Miami,FL 33165 SS mlrlammese@aol.com INSURE=RS AFFORDING COVERAGE NAIC# Phone 305)221-7878 Fax (305)554-7090 INSURER A* UNITED SPECIALTY INSURANCE INSURED INSURER B! AMTRUST INSURANCE CO TSE AIR CONDITIONER CORP INSURER C 7 33 NW 108 Ct INSURER b: MIAMI, FL 33172• 305 INSURER E RAGE$ INSURER F: COVE CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUEp TO THF 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 ADD SUBR LTR TYPE OF INSURANCE POLICY NUMBER POLIGY EFF POLICY EXP GENERAL LIABILITY MMIDDIYYYVJ (MMIDDryyyyll LIMITS EACH OCCURRENCE $ 1,000000.00 U COMMERCIAL GENERAL LIABILITY IJAMAGE TO RENTED $ 1,000,000.00 PR MISES 5 occurren A CLAIMS-MADE [I OCCUR CGD0005664 ❑ 01/11/2015 01/1112016 MED EXP(Anyoneperaoo S 5,000,00 ❑ PERSONAL&ADV INJURY $ 1,000,000.00 OEN'L AGGREGATE LIMIT APPLIES PER; GENERAL AGGREGATE $ 2,000,000.00 ❑ POLICY ❑ PRO- ❑ LOC PRODUCTS.COMP/OPAGG s 2,000,000,00 AUTOMOBILE LIABILITY $ MBINED SINGLE LIMIT ❑ ANYAUTO .accident 5 13 ❑ OWNED SCHEDULED BODILY INJURY(Per person) 5 AUTOS ❑ AUTO$ BODILY INJURY Per accident) $ ❑ HIRED AUTOS NON-OWNEO ❑ AUTOS PdiOPERTYDAMAGE $ ❑ or accident ❑ UMBRELLAUAB 5 ❑OCCUR _ ❑ EXCESS LMH ❑CLAIMS-MADE EACH OCCURRENCE 3 DED I RETENTION AGGREGATE S WORKERS COMPENSATION $ AND EMPLOYERS'LIABILITY Y/N 0 WC STATU- ❑OTH. ANY PROPRIETOR/PARTNER/EXECUTIVE AWC1029368TORY IT B OrFICERIM(mandatory In N ER EXCLUDED? N!A E.L.EACH ACCIDENT T 500,000,00 (Mandatory in NH) 01/21/2015 01/21/2016 n es,dasGritl9 Under E.L.DISEASE-EA EMPLOYE $ 500,000.00 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000.00 DESCRIPTION OF OPERATIONS 1 LOCATIONS!VEHICI,E3Attach ACORD Rb 1 ot,Additional Remarks Schoaule,if more spaeo Is raqulrea) GENERAL LIABILITY AIR CONDITIONING INSTALLATION AND REPAIRS. CERTIFICATE HOLDER C o CANCELLATION BUILDING DEPARTMENT OF NIilgMl S�1ftMliaD RD SHE EXPIRATION DAHOULD ANY OF TE THEREOF NOOVE TICE CE WILL 8E E!_aV RED IN CANCELLEDED POLICIES BE BEFORE 10050 NE 2ND AVE. L 33165 ACCORDANCE WITH THE POLICY RO IONS. MIAMI SHORE FLORIDA 305 2217878 AUTHORIZED REPRE5ENTATIVE RALPH N RODRIGUEZ ACORD 26(2010/06)QF �?1888-2010 ACORD R tright5seryed. The ACORD name and I Bred marks of ACORD