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MC-15-1712 i Inspection Worksheet Miami Shores Village f� j 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-238663 Permit Number: MC-7-15-1712 Scheduled Inspection Date: July 15, 2015 Permit Type: Mechanical - Residential Inspector: Perez,JanPierre Inspection Type: Final Owner: SOUZ,A, HENRIQUE Work Classification: A/C Replacement Job Address:479 NE 102 Street Miami Shores, FL Phone Number (646)320-4171 Parcel Number 1132060170840 Project: <NONE> Contractor: C&T AIR SERVICES INC Phone: 305-888-6560 Building Department Comments CHANGE OUT OF A/C 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. July 14, 2015 For Inspections please call: (305)762-4949 Page 26 of 39 Permit NO. MC-7-15-1712 Miami Shores Village M Permit Type:Mechanical Residential 10050 N.E.2nd Avenue NE PermitWork Classificlation:A/C Replacement Miami Shores,FL 3313&0000 Permit Status:AIPPROVED Phone: (305)795-2204 �toniv►' assue gate:7/14/2015 Expiration: 01/10/2016 Project Address Parcel Number Applicant 479 NE 102 Street 1132060170840 Miami Shores, FL Block: Lot: HENRIQUE SOUZA Owner Information Address Phone Cell HENRIQUE SOUZA 479 NE 102 Street (646)320-4171 MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone Valuation: $ 3,500.00 C&T AIR SERVICES INC 305-888-6560 Total Sq Feet: 0 Tons:4 Available Inspections: Additional Info:CHANGE OUT OF 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-7-15-56280 DBPR Fee $2.00 07/14/2015 Check#: 1109 $91.90 $50.00 DCA Fee $2.00 Education Surcharge $0.80 07/09/2015 Check#: 1103 $50.00 $0.00 Permit Fee $122.50 Scanning Fee $9.00 Technology Fee $3.20 Total: $141.90 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 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. OWNER5Arized AVIT certify that all the oregoing information is accurate and that all work will be done in compliance with all applicable laws regulating constructzon' F ermo , I a ori a the above-n(Ce c ntractor to do the work stated. (`1.f�^ July 14, 2015 Signatu�ment Owner / Applicant / Contractor Agent ate Building Dep a Copy July 14, 2015 1 r _ r . Miami Shores Village 13 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 FBC 20(14 � BUILDING Master Permit No. PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING Eh MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP [� �1 CONTRACTOR DRAWINGS JOB ADDRESS: —) 131 06 106 /�J 57 City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: �� O 0 Tq-Q Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: ( C FFE: / OWNER:Name(Fee Simple Titleholder): l t*4 7 tt, - b e, SyV�'none#: a Address: City: �/ �� d4V State: Zip: 7 i� Tenant/Lessee Name: Phone#: Email: )C2h n 4 if (.1&94 CONTRACTOR:Company Name: Phone#: Address: City: State: Zip: ,3-z2o) `Oct r�^' Qualifier Name: 04 rrrr►► // W Phone#: 2j�� `' State Certification or Registration#. l//'� Iib S(0-n 0� Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: ^� City: State: Zip: Value of Work for this Permit:$ `b� O (D- Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alterations ❑ New ❑ Repair/Replace ❑ Demolition AC, Specify colopt col/rorrt�thru tile: Submittal Fee$ Perm' F $ �� CCF$ CO/CC$ Scanning Fee$ Rad F $ DBPR$ Notary$ Technology Fee$ Tr i ing/Educ Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ (Revised02/24/2014) `Bonding Company's Name(if applicable) Bonding Company's Address — City S to Zip Mortgage Lender's Name(if applicabl Mortgage Lender's Address City St to 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 ys ----C OW or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The fore oing instrument was acknowledged before me this 8 day of J 20 ,:by r day of 20 by Wen(412f, (ISwam0 i ersonally kno to �1� ���"%����e:�' who is personally_�hown to me or who has produced as me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: w7 Nw�� Sign: Sign: Print: LON Q� Print: � , MADELINE CASTELLAN II Seal: ,, Seal: =a ¢=: Notary Public-State of Florida QUIDA JACOBS .•= Commission#FF 234106 MY COMMISSION N FF43955 Istil c' My Comm.Expires May 25,2015 EXPIRES:August 14,2017 ' °i�Y•` ansa.. **************** *********' * * ** APPROVED BY �anS E 'mi r Zoning Structural Review Clerk (Revised02/24/2014) ,5t►oREs L, Miami Shores Village �i Building Department F 10050 N.E.2nd Avenue Miami Shores, Florida 33138 <ORIDA 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. A'n Job Address(where the work is being done): I /J r__1 d 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 E] NO�eARHI Sheet Attached:YES ❑ NO❑ Contract Attached:YES ❑ UNIT BEING REPLACED DATA NEW UNIT MANUFACTURER &000 v i AHU or PKG. UNIT MODEL# {� COND. UNIT MODEL# S; KW HEAT -7 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 N YES NO REPLACING THERMOSTAT YES YES NO NEW 4"CONCRETE SLAB YES YES NO NEW ROOF STAND YES YES NO NEW RETURN PLENUM BOX YES O 1. Minimum Circuit Ampacity(Wire Size): q 2. Maximum Overcurrent Protection (Fuse/Breaker Size): 3. Voltage of Circuit 208/240 80): $/ 1-270 4. Size Disconnecting s: Contractor's Company Name: Phone: ✓� bb �S r State Certificate or Registration No. ` Certificate of Competency o., Signatur -�' "'_�,i Date: s" (Qualifier's signature) (Revised02/24/2014) � ------.-.-_._._---- RICK SCOTT, GOVERNOR KEN LAWSON, SECRETARY STATE OF FLORIDA -DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD CAC056705 The CLASS AAIR CONDITIONING CONTRACTOR a-w°il Named below IS CERTIFIED WE Under the provisions of Chapter 489 FS. ` Expiration date: AUG 31, 2016 CASTELLANOS, TOMAS J€Sv,Ir#S"'" ` r, C &TAIR SERVICE INC" 13910 LEANING pyNI pG '" "< .,» ' ` *' � ,,� pr r MIAMI LAKES - -{t"333014 . `""""_..��„ ��».. ,^•m,:,,� "`.'^�"' mow:,.��•,'y � �hG, ISSUED: 06/17/2014 DISPLAY AS REQUIRED BY LAW SEQ# L1406170000630 003609 Local 8.os ness Tax Receipt miamfl-Daae County, State of FloridaLBT —THIS IS NOTA BILL — DO NOT PAY: 4153433 BUSINESS NAME&OCATION RECEIPT NO. EXPIRES C&T AIR SERVICE INC RENEWAL SEPTEMBER 3O, 2015 40 W 22 ST 4 4337374 Must be displayed at place of business HIALEAH FL 33010 Pursuant to County Code Chapter 8A-'Art.9&10 OWNER SEC.TYPE OF BUSINESS PAYMENT RECEIVED' C&T AIR SERVICE INC 196 SPEC MECHANICAL CONTRACTOR BY TAX COLLECTOR CAC056705 $45.00 07/23/2014 Worker(s) 1 CHECK21-14-032390 This Local Business Tax Receipt only confirms payment of the Local Business Tax.The Receipt is not a license, permit,or a certification of the holder's qualifications,to do business. Holder must comply with any governmental or nongovernmental regulatory laws and requirements which apply to the business. The RECEIPT NO.above must be displayed on all commercial vehicles—Miami-Dade Code Sec Ba-276. For more information,visit w nnr miamidade aovRaxcollector ,4c R CERTIFICATE OF LIABILITY INSURANCE DA-Mw�o` " CSt?IFACATF IS ISSUES AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS THIS CERTIFICATE DSS NOTA 9IRMATWELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED B$THE POLICIES SMOri. THIS,Ci-ONWATE OF INSURANCE DOES NOT ZONSTITTE UA CONTRACT SETWEEN THE ISSUM INSUREW),AUTNORIM REjnMETITATi*l4l,Z PRODUCER,AND THE CERTNICATE EIOLDER. NIrpORTANT: w holder is an ADDITIONAL MURED,the Policy m)must be endorsed. if SUBROGATION is UTAIMM.W*eet bo the Was and ctions of the POW,owtael Polus nuy require an endorsement- A statement on this certificate does not aorlfer rights tD the Qpdkggabe holder in Neu of such NX110MMOIN48) -NAIle- Sthel Grlsutler Casualty systamc (305)551=0590 Fax (3W)551-0857 3331 SFT 107 ?,ve _ __ auaL »Casualtys-ystens.0= AN�oReeNe crac NAX a Mian > FL 33165 A ArCh al- 'USe CO• C E T Air Service Inc. 1 C: 40 West 22 St Bay # 4 D: ,A E gyadea}j FI, 33010 NNsurest F= COVERAGES CEFiCATE NUMBER,=532504069 REVISION N MOVE FR: RTTI THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERI00 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- NORI TYPE OFYNSURAPME Pn y NUMSER pOLILYN}F Llr/rS GENERAL LL489srY � s 51000,000 Op ' f 300,00 % COMMERCIAL GENERAL UABLaY A OLAAG MAW Q OCCUR 023791-00 /25/2015 /2512016 MED S p pap s 5,000 PSMONALaADveNLAM f 5•,000,000 GENERALAGGREqTE f 5,000,000 PRODUCTS-COMPYOPAW f 510001000 (ETLAOC,REGATE uarrA_ ues PE3t f X pouCr PRa Loc e MrraMoaeuAea�IY — qwu ttr,AIRY Mwp—) f ANY AUTO ALLOWNED SCHE ILID HODitYMWR1'(Paa f Alrr06 AUTO f MIRED AUTOS AUTOS f EACH OCCLLCE f IareRai.ALwB occuR s . EXCESSUAS A GATE s DED I I RETENTIONS VNC A OTNi- YIORIQ:RS OO�p@I8p7NON MND WAROYERF UABLM YIN s} E.L EACH A =WrANY S OFRNIA s s s ELL MEASE-EA9AP f ammodffim"to Pal EpESCRIpIjppt�OPERATIONs below EL DISEASE-pOLIC1'LrJR S pESt P7fON OF OPERATIONS I LOGAMONS l V ACLES(A bCh MSORD 101,AddtNcad Rae,Oafs SdhedLdi Ruwe spine NS i'Q'* Mechanical Contractor CAC056705 ate- - - -_ `CANCELLATION n ERNM SHOULD ANY OF TM ABOVE Pouc�s BE CANCELLED B THE EXPIR MM DATE THERgM, NOTICE Vj" BE DELIVERED IN pCCORDM=NTH THE POLICY PROVIS M& City of Miami Shores 10050 NE 2 Ave- AUMOMM mqnVWffATM Miami Shores,Fl 33138 Inas Sernandez/jaAN ACORD 25(2010105) ®tsss-2Dta ACORD CNDRPORATION. AN rWd&rereevea INS095 r�n+rn�m Th.Af'dWn nen 2M ir+,..s�w rc nicM,+orN n+aeNon,+f Af.ARn DATE(MMIOD/YYYY) ,4cORL]`� CERTIFICATE OF LIABILITY INSURANCE 6/10/2015 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 ORPRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT, If the certificate holder is an ADDITIONAL INSURED.the poliay(ies)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 Iiewof such endorsement(s). CO PRODUCER SUNZ Insurance Solutions, LLC. 10: (Ally) M®Iis�_Asr,.... ................................ .. ..:......... NAME: PAX", PHONE......................................... C/o Ally HR, Inc. (�r ,NQxtL....... 904-739-2722 —-------•--- 8018 Philips Hiphway E,9AIL m s a : u sh matrxoneso Jacksonville, FC 32256 a ;;._:......................._...._.._.._�_._.__._._......- L( :cod.........._......._..............._ ................._.................... ........ INSURER(S)AFFORDIN0 COVERAOE MAIC# ...................._.............................._....-.. .._ INSURER A..:..._SUNZ_Insurance,Company....__......_...._........................... ............................... _. INSURCD 2 ..................................IN8URER,B:....A9�"an Re-London B@. st R8tiDq.�A......................................................._.........._........._-........ ......_ Ally HR, Inc. IrrsuRert.c:.._Catlin Syndicate_l ioyds.. Best Rii.! .."A"................._..................'..................................... ...... Philips Hwy __..._ _ Jacksonville FL 322x6 �Nsuaa..:_Brlt Syndiczte..r._}laydg... Begs_Ratinn_:'A......... .................. INbuRERE. ......... ..................................._............................................... ................................... INSURER F COVERAGES CERTIFICATE NUMBER-, 25039481 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. NOTWTHSTANDING 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 DE$MBED HEREIN IS SUBJECT TO ALI, THE. TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. .....__..._..........................._.............. _ _ .......... ............. .__.._......... ... ........_.........._...................._..........._.......................... .... . _ . _ . . _.....__...._.......__............ ..._......._.._.......__. .. Apt5l:.5U'81t - ` P1sL1CY LR`F'""°'POLtcY LIMITS IRO TYPE OF IN8URANGE POLICY NUMBER MMEDDIYYY MPNtVYYYY LTR !i t�AKAACEIGURIYR(ENCEEACH OCC COMMERCIAL GENERAL LIABILITY $5 .... ........ ...................._. pgMl� S ._............................................................... ......._;CLAIM°-MADE ;OCCUR -. MEDIXP(Any one petsbn).._.._. ._.................................................................. _ ............._............._.... .............:................. ....... ........ PF}R:ANApV INJIJRY_..._..................................._............................_.... .........i................ __..................._.........................._.i A00RtV,dATY:: Ew=Ljkirr APP41PeR: ...............- _ ........__.... _._... PRO- -.._.. 'GENE~ PR ~RaL. .... OD!IGT$-COM�'/OP ACiG I•'OLICY L.......... JECT LO" 5 OT'HCO: :a OMBIMEU 5t =LEL g nuY4NI0#ILE L)AI31LITv ..._............................._ iEa eccldenta BODILY INJURY(Pel PO WII) ANY AUTO _.. ._.._........... ...._ g�. ALL OWNEL7 SCHEDULED ILY INJURY(Per accident)r S _...................................................._.... ........... AUTO' AUTOS ^s �CNi t) NUN-QWNEL� ...PROPER ACE DAM ........................_..................Le . .. HIRK)AVI'().y _ ALIT05 UMBRGLLA LIAR 9CClIR ............................. ......._......................................_.. EACH OCCURRENCC AGGREGATE EXCESS LIAO 4lAtMyMADE ....... —' ........._....__......................._......_.......... .._...._�........ ........... .......................:....................._._....._.._....... , U(cD i RETENTION$ 1/1/2015 LATH- A WORKERS COMPENSATION VWCPEOOi)00323 O1 111(2015 1!1!2016gT 1.T... 1w ... AND EMPLOYERS LIABILITY Y/N ANY PROPMETOR/PARTNIER/EY.tt:iJlkVf ._....... ....._......_... E.L.E L.EACH ACCIDENT nFFir;ER/ME•MBER EXC,•Lt)DED^ NIA! .. ........... 1,W0,00 ,. E.L.CII`"EASE_EAEMPLOYF.E_s... .... 1..'QQO.EJOO (Mandatory in NH) e It yyeo,deetnbe under E.L.D EA$E-P"ICY Lima ::s 1.000.000 OtSCRIPTION OF OPERATIONS below This Jr.for informational purpow-;, S Workers Compensation and nothing Shall orO$te any right C Exces4 Coverage udder such reinsurance. D DESCRIPTION C^F CPERATION5/LOCATIONS!V£MICLES (ACORD 101.Atldltlonel Remerke Uh&dUle,n)ey W attached If more space Is reQUIredl Coverage provided for all leased employees bwt not subeOntractor5 of:CT Air oarvice Inc Effective date:111/2015 CERTIFICATE HOLDER CANCELLATION SHOtHBUEXPIRATION DATE VTHEREOF, NOTICE E DESCRIBED I WILL.CANCELLED BE DELIVERED IN City of Miami Shores ACCORDANCE WITH THE POLICY PROVISIONS- 10050 NE 2 Ave. Miami Shores,Fl 33138 AUT?'ORlZkp REPRESENTATIVE Glen J.Distefano 01988-2014 ACORD CORPoRATION, All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD