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MC-15-1727
Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-238773 Permit Number: MC-7-15-1727 Scheduled Inspection Date: July 22, 2015 Permit Type: Mechanical - Residential Inspector: Perez,JanPierre Inspection Type: Final Owner: , Work Classification: A/C Replacement Job Address:9425 NW 2 Court Miami Shores, FL Phone Number Parcel Number 1131010150340 Project: <NONE> Contractor: JA REPAIR SERVICE INC Phone: (786)229-3352 Building Department Comments REPLACE AIR HANDLER Infractio Passed Comments INSPECTOR COMMENTS False V� 1 V Inspector Comments Passed Failed Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. July 21, 2015 For Inspections please call: (305)762-4949 Page 18 of 34 Perritt NGS'MC4,ol `yNOREs yet Miami Shores Village f etmit TyDe.Mechanical- "I"11ti 10050 N.E.2nd Avenue NW n It Wb*C(asstfCah0n:A/C 1r%4 Cert ent Miami Shores,FL 33138-0000 PBt it'Sfatus APOROVEt3 "Fc Phone: (305)795 2204 issue Des:71211201 i Expiration: 01/1712016 Project Address Parcel Number Applicant 9425 NW 2 Court 1131010150340 Miami Shores, FL Block: Lot: ELITE HOME PARTNERS LLC Owner Information Address Phone Cell ELITE HOME PARTNERS LLC 2300 W 84 Street MIAMI LAKES FL 33016- 2300 W 84 Street MIAMI LAKES FL 33016- Contractor(s) Phone Cell Phone $ 3,500.00 JA REPAIR SERVICE INC (786)229-3352 Valuation: _. Total Sq Feet: 00 Tons: Available Inspections: Additional Info: Inspection Type: Classification: Residential Final Approved: In Review Review Mechanical Comments: Date Approved: : In Review Date Denied: Type of Work:REPLACE AIR HANDLER Scanning:3 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $2.40 Invoice# MC-7-15-56295 DBPR Fee $2.00 DCA Fee $2.00 07/10/2015 Credit Card $50.00 $91.90 Education Surcharge $0.80 07/21/2015 Credit Card $91.90 $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. OWNERS AFFIDAVIT: tall th ®ego .ing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and z uther re, a above-named contractor to do the work stated. July 21, 2015 A zed ' ature:Owner / Applicant / Contractor / Agent Date Bui ' g Department Copy July 21, 2015 1 Miami Shores Village L1�0 RD Building Department JUS5 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY: Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 �S 1S FBC 20/1-/ r BUILDING Master Permit No. PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING REVISION ❑ EXTENSION RENEWAL ❑PLUMBING MECHANICAL E]PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP l� CONTRACTOR DRAWINGS JOB ADDRESS: C�1 q�5 I�y� vim-- � 4 t21� City: Miami Shores County: Miami Dade Zip: 33 Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flo jZej: BFE: FFE: ILL U OWNER: Name(Fee Simple Titleholder): M� % 11h Phone#: 3 _ ( l -� Address: 93 U o v„/ S S (1z) City: State: Zip: 0 R Tenant/Lessee Name: Phone#: Email: CONTRACTW:Com any me: �- �`� `r ! / Phone#: Address: T "� G City: Q State: Zip: Qualifier Name:-,J D Phone#: State Certification or Registration#: e / �� 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: ❑ Addition ❑ Alteration ❑ New Repair/ eplace ❑ Demolition Description of Work: .A�"' Specify color of color thru tile: Submittal Fee$ Permit Fee$ 1 -2-2-t5-0CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$��• �� (Revised02/24/2014) Bonding Company's Name(if applicable) 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 bsence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature _ Signature OWNER or AGENT CONT ACTOR The foregoing instrument was acknowledged before m"a this The foregoing instrument was acknowledged before me this day of 20 byhAl � day of 20 � by "f`Q-who is personally known to i who is personally known 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 PUB C NOTARY P LIC: Sign: Sign: f Print: Print: Seal: �air'v Caridad Diaz Seal: �pr'P''••, Caridad Diaz :Commission#FF 160477 ',~ -_Cortmission#FF 160477 "Expires: SEP 16,2018 '<: r. �y ,"Expires: SEP 16,2018 %�EOF p BONDCD THWU •V' Fj@ BGHOCO THRU *************** * *** *� * ******'**I* ***************kx�ifrlk*�1P #MR�URPrG�s?Mlk4************** APPROVED BY 7oa Ian xaminer Zoning Structural Review Clerk (Revised02/24/2014) ,SNoRes Lit Miami Shores Village Building Department k,,,, ,,...M 10050 N.E.2nd Avenue y6 Miami Shores, Florida 33138 ,P Es IDp` 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): 2� 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❑ NO9ARHI Sheet Attached:YES NO ❑ Contract Attached:YES ❑ UNIT BEING REPLACED DATA N UNIT MANUFACTURER r, AHU or PKG. UNIT MODEL# Adt o r—a !3 3 COND. UNIT MODEL# 1� '!5 fE� KW HEAT NOM TONS 3 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 NO YES NO REPLACING THERMOSTAT YES NO YES NO NEW 4"CONCRETE SLAB YES NO YES NO NEW ROOF STAND YES NO YES NO NEW RETURN PLENUM BOX YES NO 1. Minimum Circuit Ampacity(Wire Size): 2. Maximum Overcurrent Protection (Fuse/Breaker Size):: 3. Voltage of Circuit (208/240/480): �- o V 4. Size Disconnecting Means: K_ ( y Contractor's Company Name: `�'��y rZ Phone � Z0 State Certificate or Registration o.C3 � r�j 7 —`-�,� Certificate of Competency No. Signature _ Date: 7 . Qua fier's signature) (Revised02/24/2014) � to Certificate of Product Ratings AHRI Certified Reference Number: 7984177 Date: 7/9/2015 Product: Split System: Air-Cooled Condensing Unit, Coil with Blower Outdoor Unit Model Number: GSX130361E* Indoor Unit Model Number: ARUF37C14A* Manufacturer: GOODMAN MANUFACTURING CO., LP. Trade/Brand name: GOODMAN; JANITROL; AMANA DISTINCTIONS; EVERREST; ONE HOUR AIR CONDITIONING AND HEATING; ENERGI AIR Region: North (AK, CO, CT, ID, IL, IA, IN, KS, MA, ME, MI, MN, MO, MT, ND, NE, NH, NJ, NY, OH, OR, PA, RI, SD, UT,VT,WA,WV,WI, WY, U.S.Territories) 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: GSX13 Manufacturer responsible for the rating of this system combination is GOODMAN MANUFACTURING CO., LP. Rated as follows in accordance with AHRI Standard 210/240-2008 for Unitary Air-Conditioning and Air-Source Heat Pump.Equi ent?n ubb ect to verifi at'QQr� of rating accuracy by AHRI-sponsored, independent,third party testM%Glin�G�apacltyd(Btuh�j: T4bU0 EER Rating (Cooling): 11.00 SEER Rating (Cooling): 13.00 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; PRINZ 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, &REFRIGERATION INSTITUTE CERTIFICATE VERIFICATION The information for the model cited on this certificate can be verified at www.ahridirectory.org,click on"Verify Certificate"link F,:e make lite bertec' 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. 130809257203916984 ©2014 Air-Conditioning, Heating,and Refrigeration Institute CERTIFICATE NO.: RICK SCOTT, GOVERNOR KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD CAC1817206 The CLASS B AIR CONDITIONING CONTRACTOR NaMed below IS CERTIFIED Urider the provisions of Chapter 489 FS. Expiration date. AUG 31,2016 GIL, JULIO_ }r-• 'JA REPAIR SERVICE INC 8711 NW 151 TERR MIAMI.AKES FL 33018 ■ ISSUED: 06/19/2014 DISPLAYAS REQUIRED BY LAW SE]# L1406190000664 002703 -Local Business Tax Receipt Miami—Dade County, State of Florida -THIS IS-NOT A BILL —`DO NOT PAY 7106594 BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES JA REPAIR SERVICE INC RENEWAL SEPTEMBER 301 X015 _ 8711 NW,151 TER 7384318 Must be displayed at place of business �AiAmf LAKE5 FL n018 Pursuant to County Code Chapter 8A-'Art.9&10,; OWNER SEC.TYPE OF BUSINESS PAYMENT RECEIVE JA REPAIR 5ERVICE INC 196 SPEC MECHANICAL CONTRACTOR BY TAX COLLECTOR Worker(s) 1 CAC18W206 $45.00,'07/15/2014 CHECK21-14-018112 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 sqqualifications,to do business.Bolder 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 www miamidade aovhazcolleetar Jul 08 2015 5:OOPM Usl Insurance 3058280770 page 1 ''` ,,." Wt CERTIFICATE OF LIABILITY INSURANCE DATE(haluDayYYy) [REPRESENTATIVE IS CERTIFICATE IS ISSUEIf ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFlCATE HdLD 7108115 THIS ERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES LOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT 13ETYWEEN THE ISSUING INSURER(S),AUTHORIZED OR PRODUCER,AND THE CERTIFICATE HOLDER. PORTANT: If the certificate holder is an ADDITIONAL INSURED,the Poll W)must be endorsed. If SUBROGATION IS NYAI1/ED,subject to the terms and conditions of the Policy,certain Policies may require an sndorsemenL A statelnerd on this certificate does not confer rights to the certificate holder In IIeU of such endorsament(s). PRODUCER CONTACT EVEIYN SANCHEZ US-1 Insurance P101� (305)826-7222 3100 W 761h Street ,MAIL o (305)828-0770 us 7ln aurae 0631 Gaatt.net Hialeah,FL 33018 Phone _.(305)828-7222 Fax (3fHSURE 9 AFFORDINOCOVERAGE r05)82&0770 INSURERA: FEDERATED NATIONAL INSURANCE UJG/ INSURED JA REPAIR SERVICES INC INSURERININRER C 8711 NW 151 Ter INSURER D: MIAMI LAKES, FL 33016 (786)229-3352 INSURER 15: COVERAGESINSURER F 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 POUCY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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 CLAM. ILTK TYPE OF INSURANCE AD UOR M LICY EFF PO CY EXP POLICY NUMBER LIMITS GENERAL LL481UTY EACH OCCURRENCE 1 D00,0D0.00 ® COMMERCIAL GENERAL LIABILITY MEMETORENTED S 1,000,000.00 A ❑ ❑ CLAIMS MADE OCCUR GL-015039-01 MED IEXP M one on 8 5,000.00 ❑ 011162015 01/15/2016 ❑ PERSONAL a ADV INJURY $ 1,0D0,000.00 GENERAL AGGREGATE $ 2,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER POLICY 11 PRO- ❑ LOC PRODUCTS-COMPJOPAGG a 1,000,000.00 ❑ $ AUTOMOBILE LIABAJTY CON!X D SINGLE LIMIT ANY AUTO BODLYINJURY(Perperson) S ❑ AUTALL OS NEO ❑ SCHEDULED NON-OWNED BODILY INJURY(Per aocid S ❑ HIRED AUTOS ❑ AUTOS O $ S ❑ UMBRELLA LL48 ❑OCCUR EACH OCCURRENCE $ ❑ EXCESS LUIB ❑GLAiMS-MADE AGGREGATE $ ❑ DE ❑ RE-rr=NTION$ WORKERS COMPENSATION $ AND EMPLOYERS'LIA61LnY YIN wC STATU- T34 ANY PROPRIETORIPARTNERIEXECUTNE OFFICERTIEMBEREXCLUDED? r—�NIA E.L.EACH ACCIDENT $ (Mandatory In NH) 1 J r y_ d__! under E.L DISEASE-EA EMPLOYER$ OES�RIPTX)N OF OPERATIONS belay E.L DISEASE-POLICY LINT S DESCRIPTION OF OPERATIONS!LOCATIONS!VEHICLES(Atboh ACORD 101,Addltiand Remaft schedule,R mon space is required) AIR CONDITION CO CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE MIAMI SHORES VILLAGE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN 10050 NE 2 AVE ACCORDANCE THE POLICY PROVISIONS. MIAMI,FL 33138 AU RIM SENTATIVE ACORD 25(2010105)QF f 01988-2010 ACORD CORPORATION. All rights reserved. The ACORD narne and logo are registered marks of ACORD r dE JEFF ATWATER CHIEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS'COMPENSATION **CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS'COMPENSATION LAW CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers'Compensation law. EFFECTIVE DATE: 1/21/2015 EXPIRATION DATE: 1/20/2017 PERSON: GIL JULIO J FEIN: 201739543 BUSINESS NAME AND ADDRESS: JA REPAIR SERVICE INC 8711 NW 151 TER MIAMI LAKES FL 33018 SCOPES OF BUSINESS OR TRADE: MACHINERY OR EQUIPMENT ERECTIO Pursuant to Chapter 440.05(14),F.S.,an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section may not recover benefits or compensation under this chapter.Pursuant to Chapter 440.05(12),F.S.,Certificates of election to be exempt...apply only within the scope of the business or trade listed on the notice of election to be exempt.Pursuant to Chapter 440.05(13),F.S.,Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if,at any time after the filing of the notice or the issuance of the certificate,the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate.The department shall revoke a DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS?(850)413-1609 5�!ORES Miami shores Village Building Department ORiDp' 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. 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:4—L-4— "t 0 Owner State of Florida County of Miami-Dade n The foregoing was acknowledge before me this day of I ,20 By P�k b I J( A W. De La Tt who is personally known to me or has produced as identification. Nota SEAL: Caridad Diaz .,Commission#FF160477 Expires: SEP 16,2018 '• 1ST FLORIDA NOTARY,LLC Ja Repair Service Inc 8711 Nw 151 st Terrace Miami Lakes, FL 33018 Date: JWG 20IS State of Ff Ur-I Ga County of Miami -D(01✓ Before me this day personally appeared ` U- IIi 0 C-111 who, being duly sworn, deposes and says: That he or she wi4 be the only person working on the project located at: gH2 Sworn to (or fi m d) and subscribed before me thise day of 2016 , by 0 Personally Know V OR Produced Identification Type of Identification Produced I'm Caridad Diaz ':commission#FF 160477 �j�. .`: �r�:NSEP oPTM16�2018 ,'•`;GF 'IST FLORIDA NOTARY,LLC Print,Type or Stamp Name of Notary