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MC-15-3104 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL C Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-252039 Permit Number: MC-12-15-3104 Scheduled Inspection Date: February 03,2016 Permit Type: Mechanical - Residential Inspector: Perez,JanPierre Inspection Type: Final Owner: ALEXANDER, DAVID Work Classification: A/C Replacement Job Address: 1640 NE 104 Street Miami Shores, FL Phone Number (646)675-3489 Parcel Number 1122320320430 Project: <NONE> Contractor: MORETT SERVICES AC &SWIMING POOL LLC Phone: (786)378-1050 Building Department Comments REPLACE AC SYSTEM UPSTAIRS 2.5 TONS Infractio Passed Comments INSPECTOR COMMENTS False V Inspector Comments Passed Failed Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid February 02,2016 For Inspections please call: (305)762-4949 Page 29 of 42 P I7 i 24 6-3104 Miami Shores Village E Pe f t1lt yjt ,, t 11 8 ''to )d eiWai 4� 10050 N.E.2nd Avenue NE Work la r#rc t cn:AIC Ri�p1acement Miami Shores,FL 33138-0000 Pe Phone: (305)795 2204 !@/7?lft StBftlS:APPRUVED toxml* x: �/2015FExpiration: /15/2016 Project Address Parcel Number Applicant 1640 NE 104 Street 1122320320430 DAVID ALEXANDER Miami Shores, FL Block: Lot: Owner Information Address Phone Cell DAVID ALEXANDER FL (646)675-3489 Contractor(s) Phone Cell Phone Valuation: $ 2,697.00 MORETT SERVICES AC &SWIMING F (786)378-4050 Total Sq Feet: 0 Tons:2.5 Available Inspections: Additional Info:AC CHANGE OUT Inspection Type: Classification:Residential Final Approved:In Review Review Mechanical Comments: Date Approved::In Review Date Denied: Type of Work: Scanning:2 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $1.80 DBPR Fee Invoice# MC-12-15-58063 $2.00 12/18/2015 Credit Card $69.80 $50.00 DCA Fee $2.00 Education Surcharge $0.60 12/16/2015 Credit Card $50.00 $0.00 Notary Fee; $5.00 Permit Fee $100.00 r Scannin0ee $6.00 Technology Fee $2.40 Total::. ; $119.80 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.th'ereto 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. OWN ERS; FIDAVIT: 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, [uthqrrnore,I authorize the above-named contractor to do the work stated. 1ye" December 18,2015 Authoriz6d Signature:Owner / Applicant / Contractor / Agent Date Building Department Copy December 18,2015 1 Miami Shores Village __e- k BuildingDepartment 10050 N.E.2nd Avue, MiamShores, Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 s FBC 20 Iy BUILDING Master Permit No.MCI S 3 O PERMIT APPLICATION sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING eMECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP / CONTRACTOR DRAWINGS JOB ADDRESS: J�U 10 NC— (04 City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name(Fee Simple Titleholder): Phone#: FAQs `3Pf•/1,40710Addresss:,/4049 /"`` e ; City: /"/�� / o e_S State: Zip: .;3s 3,s Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: ' ��✓f��s �j� Phone#: 7 8 V®f-99 Address: City: ,� State: Zip: �•�®� Qualifier Name: d� � Phone#: State Certification or Registration#: Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: �y City: State: Zip: Value of Work for this Permit:$ 26 9/ry Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New [Repair/Replace ❑ Demolition Description of Work: Ale S X sY-eM s 7W.0s Specify color of color thru tile: Submittal Fee$ Permit Fee$ c CCF$ 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$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. 1 Signature Signature OWNER or AGENT CO TRACTOR The foregoing instrument was acknowledged before me this The foregoing instrumeennt was acknowledged before me this i day of ,1J�'- 20 S by �day of 'binstrument 20 by N&AY.A'1100e— ,who is personally known to WNI(eUr%1. who is personally known to me or who has producedas me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: AAhhG NOTARY PUBLIC: 4GdG Sign: / Sign: Print: — `�`�� ' - Print: _ 03106 Seal: Seal: Seal: CommiSsio 9 `q\ a,�' •.......• ' EE113G5 APPROVED BY ` v `� PI s Examiner Zoning Structural Review Clerk (Revised02/24/2014) Miami Shores Village Building Department £... num" 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305)795.2204 Fax:(305)756.8972 AIR CONDITIONING REPLACEMENT DATA PERMIT NUMBER: MC This form must accompany ALL air conditioning replacement permit applications. Each unit change-out must be on its own data sheet. Multiple units on single sheets are not acceptable. Job Job Address(where the work is being done): /��® 'Ve /,O/ d :6� /V�;4,td 5�0 s City: Miami Shores Village County: Miami Dade Zip Code: .33/,3$ 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[?r ARHI Sheet Attached:YES R"'NO❑ Contract Attached:YES ❑ UNIT BEING REPLACED DATA NEW UNIT 7-IZ41OV61 MANUFACTURER ` ,492,+ V AHU or PKG.UNIT MODEL# 7eA1 VA 04930$31S4 C"C%T ..3DS ,S/ COND.UNIT MODEL# elTT,LY VA30 L/0004 S KW HEAT .5- NOM -NOM TONS 2• S' AHU,30 CU PKG 1)M.C.A AHUSt)CU / PKG AHU 0 CU 90 PKG 2)M.O.P AHU 30CU 9SPKG AHU d CU PKG 3)VOLTS AH U2 UKG PKG UNIT / / PKG UNIT EER/SEER /fl 5- YES NO REPLACING DUCTS YES NO YES NO REPLACING THERMOSTAT YES NO YES NO NEW 4"CONCRETE SLAB YES NO YES NO NEW ROOF STAND YES NO YES NO NEW RETURN PLENUM BOX YES NO 1. Minimum Circuit Ampacity(Wire Size): y'.. 8 / 0 /D 2. Maximum Overcurrent Protection(Fuse/Breaker Size): 3. Voltage of Circuit(208/240/480): 27 4. Size Disconnecting Means: Contractor's Company Name• ® S��ViCL`S /�� iv�iorVo 7�6 • 3 7$r• t�ID�P`® State Certificate or Regi a ior� N Certificate of Competency No. Signature Date:// (Qu ees sign ure) (Revised02/24/2014) 4 4 1 ............ Ccutificate of Product Ratings AHRI Certified Reference Number: 7482002 Date: 12/14/2015 Product:Split System: Air-Cooled Condensing Unit, Coll with Blower Outdoor Unit Model Number. 4TTR4030LI Indoor Unit Model Number:TEM4AOB3OS31+TDR Manufacturer:TRANE Trade/Brand name: TRANE Region: Southeast and North(AL,AP, DC, DE, FL, GA, HI, KY, LA, MD, MS, NC, OK, SC,TN,TX,VA 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: XR14 Manufacturer responsible for the rating of this system combination Is TRANE Rated as follows in accordance with AHRI Standard 2101240-2008 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): 28600 EER Rating(Cooling): 12.00 SEER Rating (Cooling): 14.50 IEER Rating(Cooling): Ratings followed by an asterisk(*)indicate a voluntary rests 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 products} 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 shell 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 usWs Individual, personal and confidential reference. AIR-CONDITIONING,HEATING, CERTIFICATE VERIFICATION &REFRIGERATION INSTITUTE The Information for the model cited an 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 Wed above,and the Certificate No,which Is Wed at bottom right @=4 Air-Conditioning,Heating,and Refrigeration Institute CERTIFICATE NO.: 130946190946300205 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD f qjN CACIBIW44 The CLASS B AIR CONDITIONING CONTRACTOR � Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2016 a� o MORETT, MIGUEL EDUARDO MORETT SERVICES AIR COJ#DlTIONING MMING POOL; LLC 7210 MCKINLEY ST • HOLLYWOOD FL 33024 F: O � ISSUED: 12/23/2014 DISPLAY AS REQUIRED BY LAW SEQ# L1412230000990 C i t y of H LL OD F L O R I D A � OBa'Cbq 2015/2016 LOCAL BUSINESS TAX RECEIPT Business Name:MORETT SVCS AIR CONDITIONING,LLC Account Registration M 89000207-2016 DBA: Expiration Date:9/30/2016 Business Location:7210 MCKINLEY ST Tax Paid:$190.00 Business Category:SERVICE/LICENSED BUSINESS Classification:Contractor/Air Conditioning Tax Basis:1 WORKER(OWNER) A� CERTIFICATE OF LIABILITY INSURANCE � DAM`M" DIYYYY) 12/10/2015 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 OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(les)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 lieu of such endorsement(s). PRODUCER CONTACT— NAME:CTNAME: WE INSURE FLORIDA, INC PHONE FAX o AIC No: 3020 HARTLEY ROAD SUITE 300 ADDRESS: JACKSONVILLE FL 32257 INSU S AFFORDING COVERAGE NAIC g INSURERA: Federated National 10790 INSURED INSURERS: MORETT SERVICES AIR CONDITIONING, LLC 7210 MCKINLEY ST INSURER C: HOLLYWOOD, FL 33024 INSURER O: INSURER E: INSURERF: 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 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. INLTR TYPE OF INSURANCESUB POLICY EFF POUCY EXP POLICY NUMBER D UMn's GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 COMMERCIAL GENERALMABILITYDAMAGE TO RENTE L-ImGL-0000028668-00 06/03/2015 06/03/2016 PREMISES(Ea occurrence) $ 100,000 CLAIMS-MADE rV I OCCUR MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 G 'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 0 00 POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS er acadent $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LINE CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATIONWC STATU- OTH- AND EMPLOYERS'LUU30-ITY Y I N ITORYL ANY PROPRIETORIPARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? ElEJ E.L. ACCIDENT NIA $ (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ Dyes,despite under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1 -1 E I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,K more space Is required) AIR CONDITIONING SERVICING Air Conditioning Contractor License # CAC1818044 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Miami Shores THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 10050 NE 2nd Ave, ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores, FL 33138 AUTHORIZED REPRESENTATIVE O 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD SM 1/2D15 Report Viewer 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 5/11/2015 EXPIRATION DATE: 5/10/2017 PERSON: MORETT MIGUEL E FEIN: 472503490 BUSINESS NAME AND ADDRESS: MORETT SERVICES AIR CONDITIONING LLC 7210 MCKINLEY ST HOLLYWOOD FL 33024 SCOPES OF BUSINESS OR TRADE: HEATING,VENTILATION, AIR-GOND Pursuai to Chaplet 44DJ{6(1'A•F.S,an a�afa arporeMmvAro decle exenPgontran tlds ahq�8er yy��81MH a cer88ca�of ele�m uda 6da s�8on mrt�ayy Inl recarra heae6b or oamperea&m Irder EHa .Puauert to Ct�e 490.06(321•F.S..Certl6caOas atelea8on tobaexenP�-.�qY�Y w10dn Ole scope ot0ie bu5lress a trade listed on Ore roHce arelec6an to ba exenpt.PYes�d�Cher 440.06(3 .F.S.,NoOces ardec0on to ba Bie�p�an�etl on�the��rw�m�0�ieto revocatlmff,stenydme efta 9e18trg ofdrera�cear fha lsal�cadthe e�d6eaie, egiir�nmtla oHHs sec0an Jar isseraa are rar60eate.Tile depap6rlenlal�a0 revoke a DFS-F2 DWC-252 CERTIFICATE OF ELECTION TO HE EXEMPT REVISED 08-13 QUESTIONS?(850)413.1608 tpllappsS.tidfs.can/err ®r/reparM .aspx?data=kdvpgr=9D7Q3gH6TER6ePI MZ%2fSz5l3XKYtBxkrekeESoPVylv4NPOPN42XeirDRGXVW... 1/2 rrn amM Miami shores V Building Department 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 FloridaStatutes. Fla.•Stat. § 440.05 allows corporate officers in the construction industry t obtaining a building permit. Pursuo exempt themselves from this requirement for any construction project prior to ant to the Florida Division of workers'Compensation Employer Facts Brochure: An employer in the construction industry who employs one or more parttime employees,including the owner,must obtain workers' or full-time 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 BELDOU ACKNOWLEDGE THAT YOU CONTENTS. HAVE READ THIS NOTICE ,SND UNDERSTAND ITS Signature: Owner State of Florida County of Miami-Dade The foregoing foregoing was acknowledge before me this �� day of �(LC— 2U (S y //bg '''% who is personally known tome or has produced �$ftientijcation. Notary: = v PUBLIC SEAL: Lam' .EE173059..:'� ,,, OF F1- �� - AIR CONDITIONING - Date: ✓Z/��5 State of County of ✓ � Before me this day personally appeared who,being duly sworn, deposes and says: That he or she will be the only �� /✓� /D = person working on the project at: Savor to r r e bscribed before me this /G day of 20-ZS by Personally know OR Produced Identification Type of Identification Produced Print,Type or Stamp Name of Notary Morett Services Air Conditioning •786-378-4050 • morettservices@gmail.com