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MC-13-2331 Inspection Worksheet ] Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-219249 Permit Number: MC-10-13-2331 Scheduled Inspection Date: September 10, 2014 Permit Type: Mechanical - Residential Inspector: Perez,JanPierre Inspection Type: Final Owner: GREEN, MATTHEW&AMANDA Work Classification: A/C Replacement Job Address:930 NE 95 Street Miami Shores, FL Phone Number Parcel Number 1132050070070 Project: <NONE> Contractor: SUPERIOR AIR CONDITIONING CORP Phone: (305)525-7599 Building Department Comments REPLACING OLD WITH NEW HVAC Infractio Passed Comments INSPECTOR COMMENTS False f � Inspector Comments Passed Failed Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. September 09,2014 For Inspections please call: (305)762-4949 Page 38 of 44 • Miami Shores Village F - BuildingDe OCT 11 2013 Department 3Y: 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795.2204 Fax:(305)756.8972 INSPECTION'S PHONE NUMBER:(305)762.4949 BUILDING Permit No.'Li, PERMIT APPLICATION Master Permit No. FBC 20 Permit Type: MECHANICAL Al-bf'4 0A 4--) OWNER:Name(Fee Simple Titleholder):- '/'` yr Phone#: Address: C 0 B C!�-Yk <� City: tjL161-1 :LA State: FLI Zip: TewmtALessee Name. Phone#: Email: JOB ADDRESS: CI -60 Wk City: Miami Shores County: Miami Dade Zip: Folio/Parcel4k !9 "' C07 00 D Is the Building Historically Designated:Yes NO Flood Zone: CONTRACTOR:Company Name: �G�<z@�' AlPhone#:'� �� _ �� Address: 1�® 7S �5 7- City:._1 1-114" —.'State: lam— gip: 33j73 Qualifier Name: v;P IZO X0 SLX;C L Phone#- 5/15-2-3 >74V7 State Certification or kegiWation#: 4=4e-0 fb`.3 4-7,5 Certificate of'Competcncy : Contact Phone#: Email Address: ��- DESIGNI&M Architect/Engineer: Phone#: v Value of Work for this Permit:$ l tatl• �' Square/Linear Footage of Work: Type of Work: ❑Address DAlteration ONew ORepair/Replace ODemolition Deseriplion-of Work: s !k,�!kdN��p**�&+k+k+k�+O+B+�k*�R!�k**:8ti.*kRkd?dk*ditl!9Fk.. I?Ia9?Nik+kik*k8:g�+k�;sdodwk�ppR**YH,k*hN�A!PM!F#+k!i�k4*9�b4*+M Submittal Fee$ �� Permit Fee$_ ` �d C W1CCF$ CO/CC$ Scannlug Fee$ Radon Fee$ DBPR$ Bond$ Notary$ Training/Education Fee$ Technology Fee$ Double Fee$ Structural Review$ TOTAL FEE NOW DUE$ :2 nq •� I� 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 ELECTRICAL WORK,PLUMBING,SIGNS, WELLS,POOLS,FURNACES,BOILERS,HEATERS,TANKS and 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$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lie w brochure will be,delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notic of c mmencernent must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is ' sued. In the absence of uch posted notice, the inspection will not be approved and a reinspection fe ill be charged. Signature Signa Own or Agent Contractor The foregoing instrument was acknowledged before me this e The foregoing instrument was acknowledged before me this day of L.d��,20 93,by e L9,,Hhi rw4ge,�day of + 2013 by"R?dro, ' C.-et 1. who is personally known-to me or who has produced who is personally known to rae or who has produced R As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC; Sign: Sign: �- Print: 1> . °ate Y Print: Kk tL 1,1 a—, ® My Commission Expires: ,Le MARIAN PF.R¢ My Commissio „• :.: MY COMMON EE 127195 v MARIA D PEREZ j EXPIRES:September 7,2D15 + M1'COIN g 12711 iie;t;< g EXPIRES,$eQtember 7,2015 � Bonded Thru Notary Pubs Ur�errAilere � APPROVED BY 'P1�a2Examiner Zoning Structural Review Clerk (Revised 07/10/07)(Revised 0 i/10/2009)(Revised 3/15/09) r Miami. Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 To/ (305) 795.2204 Fax.(305) 756.8972 AIR CONDITIONING REPLACEMENT DATA, PERMIT NUMBER: MC This form must accompany ALL air conditioning replacemen pe applications.Each unit hange-out must be on its own data sheet.Multiple units on single sheets are not acceptable. i Job Address(where the work is being done): ' Ity: i'iami Shores Village County: Miami Dade Zlp Code: s 1 g y 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 ARI(AHRI)DATA SHEET REQUIRED Change Disconnecting means:YES ❑ NO❑ ARHI Sheet Attached:YES❑ NO❑ Contract Attached:YES ❑ UNIT BEING REPLACED DATA NEW UNIT MANUFACTURER 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 1 I PKG UNIT I I EER/SEER YES NO REPLACING DUCTS YES NO YES NO REPLACING THERMOSTAT YES NO YES NO NEW 4°CONCRETE SLAB I YES NO YES NO NEW ROOF STAND I YES NO YES NO NEW RETURN PLENUM BOX I YES NO a 1. Minimum Circuit Ampacity(Wire Size): F-4-�C—iwI 2. Maximum Overcurrent Protection(Fuse/Breaker Size): 3. Voltage of Circuit(208/2401480): 4. Size Disconnecting Means: Contractor's Company Name: Phone:` --7 y State Certificate or Registration N. C�C1-9i0-7. Cerffiicate of Competency N. Signature &ems Date: ' (QualHier's Signature only) p01)Q08 Local Business Tax Receipt Miami-Dade County;'State of Florida THIS IS NOTA BILL-UQ NOT-PAY 2265270 [L t�t,snu��s tW4A7rISlI OC14T[ON SE09nTr NO. EXPIRES SUPERIOR AIR CONDITIONING CORP iRMEINAL SEPTEMBER-30, 2014 7937-NW 64 SF 2382216 Must be dlspiayed at place of business MIAMI FL 33166 Pursuant to County Code- ' Chapter SA-Art.9&70 OWNER BEC.TYPE OP BUBIMMS PAYMENT Rt?CENBD SUPERIOR AIR CONDITIONING CARP 198 SPEC MECHANICAL CONTRACTOR P rax COLLECTORRECD' B Wortcer(s) CAC781b47b $75.00 07/15/20T3 TXHS1-13-026328 This Local Basinass Ten Receipt onlgeendloas�al of the Loess Beslooss Tax.The Receipt is not a 6eense, f18Mif,orscsrtD'rcetioaofthe ldatrquafifi is hastness.Holder mastcomptyw�any gopemmentalor asasaemmenlal regrlatory laws Md requirements which apply to the business. 1110 I MIPT N&above Mast be displayed an aH cosmmrcial vehicles-Miami-Dade Code Sec its 276. For more information,WON �mrRexcrllearar THIS DOC UMENT HASA COLORED BACKGROUND ••- D PAP En ACs# 614473S. STATE.OF,FLORIDA I}EFRTMENT .d1" 813SIN$SS AND PROFESSI0NAL RATION CONSRUION,INDUSTRY LICENSING.•.BQ $EQ#I,]2053000887 r 05'.3 4. .2012''118194175' CA-C18' '47A:. T t it1.:CTrAS5`;F1 Ai CibNbt .IC3NII4G C60ft1iACTQR :Tanned ,be3.pw,..1,5 CERTIFIZ~D Uiader the .�ir6wiSi61% of Chapter .89 FS,: Expiration date: AUG 31, 2014 ROSILY >y*bgo 'SUPERICSR AIR CINDTSONII�C CGRP 9200 SWi *75711"9TREET MIAMI FL ,.3,3173-21,2.11 RimCOTT KEN LAWSON t ORTSRVOR ;` SECRETARY DISPLAY"AS REQUIRED BY'LAW PATee CERTIFICATE OF LIABILITY INSURANCE s3129/2013 c4:15 THIS CERTIFICATE 18 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDEP.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE iSSUB40 INSURER(S),AUTHORR.ED REPRESENTATIVE OR PRODUCER.A E A L IMPORTANT:If the c® *ate holder is an 1 OVAL INSURED,the po cy(les)must be en orsed.if UB N IS W , subject to the terms and conditlons of the po".certain poileles may require an endorsement a statement on this certificate does not confer rights to the Certiffeate holder in Hsu of such endersemerms). PRODUCER mmareute Aighpoint Risk Services LLC (500)718.0823 rww�a�{S72}404�J 5401 LEJ Freeway, suite 1200 , Dallas, TX 79240 INStIRERS AFFORDING COVERAGE NAIL A {N$URERA,ca"wei n v,erme,v aea:awcxcy iewcnnm mer 12157 INSURED: AMS 1/c/f: INSURER 9: SUPERIOR X--R CONDITTONTNG CORP R&URERC, 9200 SW 75TH STREET INSURER D: MIAMI, FL 33173 Phone: 1305) 322-9431 Fax: (305) 59671228 E: { CO ERAGES CERTIFICATE NUMBER: Ac13--16000015-1198559 REVISION NUMBER: N07WITH5TANDIm ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT'TO WHICH THIScERTIF1CATE MAYBE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BYTHE POLICIES DESCRIBED HEREIN IS SURIECTTO ALLTHE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIE&OMITS SHOWN MAY HAVE BEEN REDUCED BY PAiD CLAIMS, pp��y TYPE.OF INSURANCE AU LL Y NUMBER DATE 0 DA LMT3 WVD GENERAL UARIM EACH OOMJFMNCG COMMEROIALOENERALLIAMUTY &MMOETOkli b $ CLAWNADEOCCUR ❑ ❑ MEDMCP{Mymmperebn) $ PERSONAL A ADV INJURY $ GENERALAGGREGATE $ 3AAGGREgAtELUTAPPLIESPOE PRODUCTS-COMPIOP AGO LOD AUTOMOBILE LIABILITY COMBINED SMLE LO {EaBUIdmA) $ ANYAUTO ALL OWNED AUTOS ❑ SCHEDULED AUTOS IAREiY IPS eadr�* S HIREOAUTOS PROPERTY DAMAGE S 1Peta0altlBtil) NON-OWNED AUTOS Sf ilIBRELLAIJAB amd."- ADE EACHOCCURRENGE S EXCESS UAS rl O=RS T S DEDUCTIBLE $ RETBYTION $ NPLOYEfif;LIAx ABILITY ANY PROPFAMORrEXECUntla �Y-�T E.L.EACHACCIDENi >s 1000000 �01TICER.KEMSEREXCLUDED? PYA DVE26272740360 04/01/2013 04/01/2014 EL.oL4Eq •BAQ4IPLOYE@ S 1004000 � H yas, 1 a t�u:der SPEGUIL PROVISION Wgw E.L.DISEASE.POLICYWr S 1000000 Q DESMU'TION OP OPERATIONSILOW—VVEIMLES(A9aahe0 ACOR13107,Addinaiml Rei®rka 6oheaule,I mom spoor Is reM*i3d 1. This certificate remains in effect, provided the client's account is in good standing with ANS. Coverage is not Provided for any employee far which the client is not reporting wages to AMS. Applies to 1Do& of the employees of ALMS leased to SUPERIOR Alli CONDITIONING CORP, effective 04/01/2013 2. INSURED IS AFFORDED us", COVERAGE CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES W,C#40ELi.ED BEFORE TFIE Village Of Miami Shores MWIRATIONDATE THBRuw,r4oTICEWILLSEDELIVERED WAGDDRDANCEWITH 10050 NE 2nd Avenue THE POLICYPAOVISIONS. Miami Shores, Fl 33138 AUMRM089PMEWATM ACORD 2B 2010JOS) 19 21 a ACORD CORPORATIOZ All right reserved. i CERTIFICATE OF LIABILITY INSURANCE DAT 10/08A/YYYY) 14/08/13 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE BOLDER.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),AUTHORLMD REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the palwies)must be eixlorsed. It SUBROGATION 15 WAIVED,subject to the terms and conditions of the policy,certain poflclea may require an endorsement.A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). i PRODUCER — — C!A*M, JULIO JIMENEZ Jimenez 8,Co.,Inc. PHONE E E (30&)264-9900 Fi► No: 305 2645382 8040 Coral Way =Lea: )uliagimenezandcomparry.wro Miami,FL 33155 _ INSURNRtS) ORDOG COVERAGE Nac s- ..,•_ Phone (305)2649900 Fax (305)2845382 INSURER a:~- - CYPRESS PROPERTY$CASUALTY INSURANCE-_ INSURED ENSU ER B ... .. SUPERIOR AIR CONDITIONING CORP 9200 SW 75 ST 04SMR D Mlami,FL 33173 30&525-7599 wsut t E: .....---- —..... -._....---- 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 CONTRACTOR 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 CLAIM , INSR D UBR _ —._...... ...... -POLICY EFF POLICY 5XP TYPE OF INSURANCE -_ POLICY NUMBER DNYM iUNWX)NYMUMTS GENERAL LIABILWY I EACH OCCURRENCE - $ 1,000,000.00 Q COMMERCIAL GENERAL LIABILITY PREDAMS ERFMED a $ 100,000.00 ❑ ElCLAM-MADE W1 OCCUR MED EXP An erre arson S 5.000.00 A ��-I GFL-1019718-02 08/20/2073 09!20/2014 71 .. PERSONAL&ADv INJURY s 1,0()0,000.00 GENERA.AGGREGATE $ 2,000,000.00 GeVL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $_._1,000,000.00 © POLICY ❑ jR •❑ LOC..._. AUTOMOBILE UABILrtY OAABIfd SINGLE LIMIT � ._ J J ANY AUTO BODILY INJURY(Per parser) S �—I ALL OWNED SCHEDULED +_A AUTOS ❑ AUTOS BODILY INJURY(Par awMant) $ ❑ ON-0W HIREDAUTOS A0NED ( eracertGE _ $1 — — L— ❑ _ $ ❑ UMBRELLA RIAS F1 OCCUR - -- -- EACH OCCURRENCE $ ' ❑ EXCESS LIAR ❑CLANG-MADE AGGREGATE $ ❑ DED El RETENTIONs WORKERS COMPENSATION WC QyyATI- OTH- AND EN'PLOYEW LIABILITY YIN ANY PROPRIE-rOR1PARTNERIEXECI.MVE EL.EACH ACCIDENT $ OFFICFRA EMBER EXCLUDED? NIA (Mandatory M NH) I F-L DISEASE-EA EMPLO S If yyaa8s dewAba under -• ---- DE9GIRIPTION OF OPERATKM below — E.L.DISEASE-POLICY LIMIT $ i DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Aitech ACORD"I.Additional Rmnadei ScItwuls,R more space in required) CERTIFICATE HOLDER " . .CANCHI.LATION O OF FRE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE MIAMI SHORES VILLAGE HALL PIRA ON DATE THEREOF,NOTICE WILL BE DELIVERED IN y 100$0 NE 2ND AVE rA 71DAN W THE POLICY PROVISIONS. MIAMI SHORES,FL 3313a TTfhe TAMEACORD 25(2010105)WF - ---- 1988-2010 ACORD CORPORATION. All rights reserved. ACORD name and logo are registered marks of ACORD