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MC-15-2068 Inspection Worksheet Miami Shores Village 11 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-251078 Permit Number: MC-8-15-2068 Scheduled Inspection Date: January 20,2016 Permit Type: Mechanical - Residential Inspector: Perez,JanPierre Inspection Type: Final Owner: OWENS, MICHAEL Work Classification: A/C Replacement Job Address:9007 NE 4 Avenue Road Miami Shores, FL 33138- Phone Number (305)773-3755 Parcel Number 1132060460040 Project: <NONE> Contractor: JOSE C YANE AIR CONDITIONING&APPLIANCES SERV IN( Building Department Comments AC 3 TON CHANGE OUT 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. January 19,2016 For Inspections please call: (305)762-4949 Page 41 of 56 Permit NO. MC-8-15-2068 Miami Shores Village Permit Type:Mechanical-Residential 10050 N.E.2nd Avenue NE Work Ciassificafion:AIC Replacement Miami Shores,FL 33138-0000 Permolt . Permit Status:APPROVED Phone: (305)795-2204 Issue Date:8/18/2015 Expiration: 02114/2016 Project Address Parcel Number Applicant 9007 NE 4 Avenue Road 1132060460040 MICHAEL OWENS Miami Shores, Fl- 33138- Block: Lot: Owner Information Address Phone Cell MICHAEL OWENS 9007 NE 4 AVE RD#9007 (305)773-3755 MIAMI SHORES FL 33138-3182 Contractor(s) Phone Cell Phone Valuation: $ 2,800.00 JOSE C YANE AIR CONDITIONING&) Total Sq Feet: 0 Tons:3 Available Inspections: Additional Info:AC 3 TON CHANGE OUT 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 $1.80 Invoice# MC-8-15-56730 DBPR Fee $2.00 08/18/2015 Check#:1379 $87.80 $50.00 DCA Fee $2.00 Education Surcharge $0.60 08/14/2015 Check#:1370 $50.00 $0.00 Permit Fee $120.00 Scanning Fee $9.00 Technology Fee $2.40 Total: $137.80 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-nam actor to do the work stated. August 18,2015 Authorized Signature:Owner / Applicant Contractor / Agent Date Building Department Copy August 18,2015 1 vl1� l Miami Shores Village AUGO, 2015 Building Department 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 -q- INSPECTION LINE PHONE NUMBER:(305)762-4949 l t� FBC 20 �� o BUILDING Master Permit No. 5-2c)(09 PERMIT APPLICATION sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING 01111MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 4z c- q,(zee- A City: Miami Shores County: Miami Dade Zip: 33132' Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: gjQ Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name(Fee Simple Titleholder): /tl-IC p4 A-(FL ok,J Eos'S Phone#:'SyS -773 -37 SS Address: cka,3­7 14E 47-W Ay,57 L e 20 AO City: /4(bye( 4 f40 e'Le C State: FI-o k Ia d1 Zip: Tenant/Lessee Name: M(C/4 Al L 0 i`'c AfS Phone#: ��S -? -7 3 - 7?7 SS Email: 1-6:IdSA6 L @ G Ax PL.- Coeuk CONTRACTOR:Company Name:j QX A�_ L fe N/-E_ C Phone#: Address: /a a2 l 0�/� f�:4 T" City: State:�� Zip: Qualifier Name:�,�OSy, e Phone#: State Certification or Registration#:C'^1y�-e i1 � 77 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ *?0 Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration 0 New ❑ Repair/Replace ❑ Demolition Description of Work: �3 !--Z& � Il )� �U Specify color of color thru tile: ter, Submittal Fee$��C7 Permit Fee$ ��• CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ �1 (Revised02/24/2014) r 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 absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. 101 Signatur , A121 Signature OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing Lent was acknowledged before me this —1Y day of VO 'ep20 �'j by day of l�t'C X/d4 20 J , by 9 ,who' ersonally know off ' y " ,who Is ersonally known me or who has produced as �e or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign. "k �?d Sign: —, '1 Prin . .� ► Print: RA a ARA MONTERO ' MY COMMISSION#FF152803 �Lu`o< Seal N„ Seal: 9,f0Fnoa•• EXPIRES September 1,2018 iA Q MY COMMISSION#FF152803 (407)398.0153 FloridallotaryServlce.corn EXPIRES September 1,20Ii; r40713ad•0153 FloridallotaryServlcexorn rkM��&desk4�kdeilr�+krkKr#>krk4�&rk�N�k�P�krk* *rk* rh+Rrk+krk#�b�rhK'&rk�k+kik*skrkrk�N*Nr�Ir�krk+krkw&&rk#ale**rle**rk#4+krk+krk�k�k4uk�R+k+k�*+k**8sk+k*rk�k�k�k�k�ktrrk�krle+h�k�k APPROVED BY /7 Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) I ,5t!oR9r Miami Shores Village Building Department p.,. „,,.l" 10050 N.E.2nd Avenue Miami Shores, Florida 33138 L� `; Tel: (305)795.2204 ORNp 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): 9®®1 NF �� A V 2KtQ 4 City: Miami Shores Village County: Miami Dade Zip Code: 33138' 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❑ ARHI Sheet Attached:YES NO❑ Contract Attached:YES [1� UNIT BEING REPLACED DATA NEW UNIT cy, D MANUFACTURER a am [/" 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 O YES NO REPLACING THERMOSTAT E NO 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)f - 2. Maximum Overcurrent Protection (Fuse/Breaker Size): 3. Voltage of Circuit(208/240/480): 4. Size Disconnecting Means: /� Contractor's Company Name: 3o� C Yes AC Phone: State Certificate or Registration No. C A-C IS 15J°(7L{ Certificate of Competency No. Signature Date: or-IN- /5 cf Qualm si re (Rev1sed02/24/2014) This combination qualifies for a Federal Energy Efficiency Tax Credit when placed In service between Feb 17,2009 and Dec 31,2014. e ate ®f Products AHRI Certified Reference Number: 5756175 Date: 8/14/2015 Product: Split System:Air-Cooled Condensing Unit, Coil with Blower Outdoor Unit Model Number: GSX160361 F* Indoor Unit Model Number:ASPT42D14A* Manufacturer: GOODMAN MANUFACTURING CO., LP. Trade/Brand name:GOODMAN;JANITROL;AMANA DISTINCTIONS; EVERREST; ONE HOUR AIR CONDITIONING AND HEATING; ENERGI AIR Region:All (AK,AL,AR,AZ,CA,CO, CT, DC, DE, FL,GA, HI, ID,IL, IA, IN, KS, KY, LA, MA, MD, ME, MI, MN,MO, MS, MT, NC, ND, NE, NH,NJ, NM, NV, NY,OH,OK,OR, PA, RI,SC,SD,TN,TX, UT,VA,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 reglon(s)for which they meet the regional efficiency requirement. Series name:GSX16 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 Equipment and subject to verification of rating accuracy by AHRI-sponsored, Independent,third party testing: Cooling Capacity(Btuh): 35000 EER Rating(Cooling): 13.00 SEER Rating (Cooling): 16.00 IEER Rating(Cooling): •Ratlnp followed by an asterlsk(*)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.ahrldirectory.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"Verity 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. 130840430354302512 ©2014 Air-Conditioning,Heating,and Refrigeration Institute CERTIFICATE NO.: 1 Work Proposal JOSE C. YANES AIR CONDITIONING & APPLIANCES SERVICES, INC. 1021 NE 132 ST, NORTH MIAMI, FL 33161 LICENSED&INSURED CELL: 786.683.9345 FAX: 305.895.3565 DATE:08/14/15 Name: Michael Owens Address: 9007 NE 4`h Avenue Road City/State: Miami Shores, FL Email: Aleksael@gmail.com WORK PROPOSED TO BE DONE AT: Address: 9007 NE 4h Avenue Road City/State: Miami Shores, FL DESCRIPTION OF WORK PROPOSED: Scope of work: Install a 3 ton 16 Seer Goodman ACS lit System. New Digital Thermostat. 10 years ACS stem Factory Warranty 2 years Contractor Labor Warranty Contractor furnishes labor,materials,ACs stem,license,and insurance. All material is guaranteed to be as specified, and the above work to be performed in accordance with the drawings and specifications submitted above and completed in a substantial workman- like manner for the sum of: Two Thousand Eight Hundred Dollars $(2,800) Payments will be made as follows: 50%Deposit and Remaining Balance after Final Inspection. ❑ACCEPTANCE OF PROPOSAL The above prices,specifications and conditions are satisfactory and are hereby accepted.You are authorized to do the work as specified.Payments will be made as outlined above. Signature Date STATE OF FLORIDA .- DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD "=1815A97491a The CLASS BMR CONDITIONING CONTRACTOR e Named be{aw IS CERTIFIED Under the pwiskm of ChVW 489 FS. Expira8on date: AUCs 31,2016 YANES,.FOSE CLEMENTE JOSE C YANES AIR C4 &APPLIANCES SERVICIM INC 1021 NE 132ND ST NORTH MIAMI' . K33161 tsstlfD. CW4=4 DISPLAY-AS REQUIRED BY lAW SECS Umml4mlw tLBTB �_�It II9..,..:r►ww� '4'eae+a+� ei�' fummlof �lli� �-€ adBOUY� 629r7�s7 _ e� a - � 1W,W329f ovum sac.TV"QP �A1ViNBi1ti1'�6t�V@D CVWMR + .& iOA i lAlU1CALCaNTf ACTS TAY"+of..'rcm fig? t MrL mm CACtst $$5,00 17/2011 €�tC-Gt21•-9 M05!5556 This f,"t$ ?"sas �g �1M�1�f tett 1� �mstei ei.�aedi8 ettlts m �1► 16eeEL'�PT�a►�e�� �� .. C�eseaee�ats. fetartnrI law No. 4865 P. 1 CERTIFICATE OF LIABILITY INSURANCE 7/31`o " 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 DOER NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If rite cortlflcate holder Is an ADDITIONAL INBURRD,the polity(les)must be endorsod. If SUBROGATION IS WANED.subject to the terms and conditions of the policy,oertehl polloles may require an wWorsoment. A statement on this carifflcats doss not confer rights to the cettiftcob holder In bu of such a ulorsaman s PRODecm Josset Jordan Torres Insurance Agmay Xna. {SOS)512-5880 N t3as)sa>:-sesi 6135 NW 167 STREET i 225 j orlon@torreeinsuranac ayoom uI9 I fi trAtc s Miami Lakes LL 33015 A,MAPgRE INSURANC S COMAM INSURED fZ6 Insurance Co Jose C Ranee Aix C*nditioning & ApplianQes Mau"C I 1021 NE 132 Street MSUMDa 1;=Az Ml.Mi S% 33161 SIUMFS COVERAGES CERTIPICATE HUMBER:CL14111422141I REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERM INDICATED. N07VWTHOTANDING ANY RIAQUiRF.MENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT MATH RESPECT TO MICH THIS CERTIFNCATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE APFORDED BY THE POLICIES DESCRIIIED HEREIN 18 SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOV01 MAY HAVE BEEN REDUCED BY PAID CLAIMS. AWL SUN 'tYPfiOFM9tMMCE UMTS e011MALUASILIIY 6KgI 00ciffiRENN 6 1,000,000 OJVAAM TO REN FED X Ctat�arrCU►Ltwu uAearrY e i 100,000 A Ctgpa5 edppg ®O=LIA 9250140016055 I/13/2014 1/13/2015 MED Exp 5,000 PN00M41.QADV BLAIRY a 1,000,000 GEWRALAGGRIaAIR 1 2,000,000 OWLAGGIM"TELWrAPFI. FMt tl -COMMMAW 1,000,000 Xi POUDY TRTL1LOC $ AUTOM091L6 UAB141T11 a ,t lX00,00 BNWAM 800ILYINJURY(PaPw+sa+) 4 �D X fio 150120006143 /27/2015 /17/2016 BppiLYea,R1aY(Pera�tQenq 6 HMOAUT*9 AUTOS 0 0=gr S r'P s 10,000 UMIMELiA UAIt OCCUR EACH OCCUNI1KOE 3 0=60 UA8 CtA9r9 M*= AOMOATE 6 Dw a WQRKM CQMP9KSA=M �, ER AND EMPLOVEW L(A81LIrY -- ANYPROPR1ErORAMtT t�f1�� NIA E.LEACHACCIOENI I C,F[cER ,m,gLp,n,v, ,F (Mm"W"01" t�BEA$H.EA a oteeame OFA Tam w.. EL m9E019-POUCY UW I S vrtacrUPrroN 4I'OP6RAT10NS I rQcATloNeltteH�Lo@ tA�AcmeD�or,Aamtrm,�Ramea�seiteaute,D mere epees re raqunea) . Air Conditioning Installation Blanket Additional. Insured apply to General Liability policy If C8-000323160-3 as required by aontraot- 00' 2033. * Inland Marine: Small Wools $5,000/ 0500 Ded, i00-% Cone. B)Comeraial Auto: Veh 3: 2002 Ford/ laonoliae B250 Vin# 1190, Veh 2: 2005 Chevrolet Silverado Yin#6819, Veh 3: 2006 Chevrolet 8xpress Vin# 22433 0500 Colllision and Comprehensive Dad applicable only on 2005 Chevrolet Silverado Vin # 6819 CERTIFICATE HOLD0 CANCELLATION Miami Shores Village SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERiD IN ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE Zea Ave Miami Shores,FL 3313$ 0 AUTHotts�D aePaessaratas ACORD 26(20106) 01986.2010 ACORD PORATION. All rights reserved. INS025 m anot The ACORD name and Iogo are repletered marlts of ACORD