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MC-16-428 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-253060 Permit Number MC-2-16-428 Scheduled Inspection Date: March 02,2016 Permit Type: Mechanical- Residential Inspector: Perez,JanPierre Inspection Type: Final Owner: SANCHEZ,JOSE LUIS A MARICARMEN Work Classification: A/C Replacement Job Address:10317 NE 2 Avenue Miami Shores, FL 33138-2056 Phone Number (786)717-6690 Parcel Number 1121360130380 Project: <NONE> Contractor. BLUE DIAMOND AIR CONDITION INC Phone: (786)2864294 Building Department Comments EXACT CHANGE OUT 4 TON Infractl° Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed Failed Correction D Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid March 01,2016 For Inspections please call: (305)762-4949 Page 24 of 40 3 yf A�3. ,E 3 i Miami Shores Village P' 10050 N.E.2nd Avenue NE Miami Shores,FL 33138-0000 ' Phone: (305)795-2204 =3lyrltr ` . 12t'i Expiration: 0El2V2016 Project Address Parcel Number Applicant 10317 NE 2 Avenue 1121360130380 Miami Shores, FL 33138-2056 Block: Lot: JOSE LUIS&MARICARMEN SAI Owner Information Address Phone cell JOSE LUIS&MARICARMEN SANCHEZ 10317 NE 2 Avenue (786)717-6690 MIAMI SHORES FL 33138- 10317 NE 2 Avenue MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone Valuation: $ 4,000.00 BLUE DIAMOND AIR CONDITION INC (786)286-1294 Total Sq Feet: 1511 Tons:4 Available Inspections: Additional Info:EXACT CHANGE OUT 4 TON 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 DBPR Fee $210 Invoice# MC-2-16-58709 DCA Fee $210 02/17/2016 Cash $50.00 $109.60 Education Surcharge $0.80 02/23/2016 Credit Card $109.60 $0.00 Permit F� $140.00 Scanninmee $9.00 Technol�gy Fee $3.20 Total: $159.60 P•.7 In consid�rgtion of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertainingMereto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting�fflis permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required f6PELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. `:r OWNERFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating constructi&r and zoning. Futhermore,I authorize the above-named contractor to do the work stated. February 23,2016 A,athorized Signature:Owner / Applicant / Contractor / Agent Date Builcng Department Copy February 23,2016 1 Miami Shores Village PX=BY: ` Building Department 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tei:(305)795-2204 Fac(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 ,FBC 20 BUILDING Master Permit No. I ' ,c 1( — L� PERMIT APPLICATION Sub Permit No. ❑BUILDING n ELECTRIC [] ROOFING (] REVISION EXTENSION ❑RENEWAL ❑PLUMBING ;}MECHANICAL [:]PUBUC WORKS ❑ CHANGE OF ❑CANCELLATION SHOP •� �y CONTRACTOR DRAWINGS JOB ADDRESS: ] o3 -7/ A., ye ' City Miami Shores County Miami Dade Zip: Folio/Parcel#: the BuIlding Historically Deed:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): JOS l,� .• jai 1uG t4F_7. Phoneltj! �,'� Address: A0_3 17 Jif t� 2- Aye— City: Hi,*m i State- 6"dA zip:. Dr�d/I°.r� X31 .G tits- e#0 � '!"-aa 7 Phon Email: IP •J2•MEW, .4 Se9tt W AVZ e9_.Cam CONTRACTOR,Company Name: glue blawnnJ A lid f3jL Phone#: -72Li % 294 :ro Address. fi -I _ l �— 201 - 7708 City: )A lea h Irfor dr4 4 Qualifier Name: _&(6.p-r g©,4Y1ri fly 2. Phone#: State Certification or Registration#: C.4-004. 27f3 3 Certitfcate of competency#: DESIGNER:Architect/Engineer: Phone#: Address- City: State: Zip: Value of Work for this Permit:$ Sua Unear of Wait �/ Footage /- Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace ❑ Demolition Description of Work: s Specify wibf dile: t ,,� Submittal Fee$ Permit Fee$ IND $ CO/CC$" •l-,.._ Scanning Fee$ Radon Fee$ D B P R$4�_.: dotary$ Technology Fee$ Training/E `Fee$ ^Double Fee$ Structural Reviews$ `y Bond$ .LL TOTAL FEE NOW DUE$ (Revbed02/24/2014) Bonding Company's Name of 4ppiicable) Bonding Company's Address qty State Zip Mortgage Lender's Name(if applicable) Mortgage Lender's Address qty State Zi 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 I 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 COM MENCEMENT. 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 C Signature ignature //Z, OWNER or AGENT CONTRA The foregoing instrument was acknowledged before me this The forgoing instrument was acknowledged before m this day of JRA–/ ,20 Ito .by _day of -1,01 .20 /it •by 4 0 S a -+Ui5 _JRnl G 0 who Is personally known to Alth ritl�L_,who is personally known to me or who has produced hn 22:- 3 2 S7- #3aD me or who has roduced s TN-R, =per–" '0 S5 �4 � p id&MUc4tion and who did take an oath. a identification and who did take an oath. t` NOTARY PUBLIC: NOTARY Sign: fin: Print: PriWMWOMW n • r AROW OF637612 Seal: 1' EXPWS:Mmdt 2.2&18 Seal: EXPRES:Mwm;t 6i1P' $04MITt"WAMNMtt+a s itsadp i :'k.ers �, wsssw•ssswssssswswwwwswssswswssssws swssww w s� ww�swssssswwwsswwswswwsssswwwsssssswwswsssswssssssssssssws ' v APPROVED BY lans Examiner Zoning Structural Review Clerk (Revised02/24/2014) 2/3/2016 ,-r",. IM G_5141.JPG RICK$ CT-T GOVERNOR K�lu t.ASC�N.f`tz;�'fi"RNY S"T"ATE Cid FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL_REGULATION CONSTRUCTION INIJUSTRY LICENSING C30ARC+ . � r dA(-04271,13 The u`LASSr 6 AIR Ndarned bel€w!S CERTIFIED Under the PrOvISIOns of Chapter 489 FS Expiration dater AUG 31, 2016 RQDfIGL1EZ_ALBERTQRol BLUE DIAL OINDAIR GOIN t l tx 1 t 132 0 WEST 32 sT HIALEA1i FL,3301-2 h` i fc, r Kn I8st1Et) 06112,2014 f S ?iL Y;AS'jRE VIRE BY LAVV 3E ,# L14061200010I3s Congratulations' With this license you becotner3 � one million Floridians Ilcensed by tfie t?aparOnirit+ � Professional Regulation Cour STATE OF l sl tDA from architects to yacht brokers,from boxers to baiteq aril they keep Flor#da ecomy sYtot 1t �1T Q1I ,I PROFE-;st $ RF Ltd r 4`1G ' Every day we work,to irriprove the way we do busin in larder to,.• �A�IJ42�C33 serve you better, €�r ir;torrriatiett about our servlces,.plesse ott i3 212014 www.myflohdallcense,corn There you can laid m In' abort our divisions and the r�crlat?t� s that'. �� , to department newsjP-jtrurs and learn more a initia(raes. tluri sicn Departments License Efficiently.^Preop W t_ r t ntty stn"e , era-y t;ei c that You >2 4ailvo � cuslorners, Thank you#a: drying business in Ffonda # ;. 1ztt rr,€fae-p o =5€arS er rt.; 4� :end congratulations on yr riea�r ths;r' � i a i„ https:i/mail.google.com/maif/u/0/#inbox/152a8c()fde33dbaa?projector=l Lool Rine ss Tex Reeept Miami-owe Cout"'State of oda M WO A WL -DO WO PAY iY°.aOn*Cgwv no. EXPIRES SEPTEMBER 30, 2016 INC 7432M to as olbouftem t4AUEM,FL 3W2 aero.9tt� IMCNNM BU*OWSOM Ali M tAI sir&x c X27£1°3 pfd fi�teoeoi sG� +ao3,fe�ie�s�s�sl►eincwdSsTo�tAr�o�R�aAn ®r top�amf a 'ts�l� s. 'ris 1l�.�rirea��s ara8li —�iwi.�Mr�r3rs3r� yam_ brseR' silo 0210912016 11:45 TAX) P.0011001 '° ,,, CERTIFICATE OF LIABILITY INSURANCE °ATB(mwwoweme 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: U the aertiHCate Holder to an ADDITIONAL INSWMbr the policy )must be endorsed. It SUISROGAInOWIS WAIVED,subject to the tema and conditions of the policy.certain policies may require an endorsement. A statement on this eertltilode doss not confer rights to the cerdfleate holder in lieu of 9uoh endorsement(e). PROCuorSR T Lucia Estrella Accurate N (305)22&8727 308 226.8767 8300 West Fleglar Suite 114 Iuclaesttelle®bellgotAh rad Miami,FL 33144 INSURBIWAFFORMOCOVSWE MAICO Phone 228.8727 Fax (306)221&5767 INSURER A: Granada insurance O=PsnY INBURP.A INSURim a: Blue Diamond Air Conditioning Inc. INSURak C t 1320 West 32 St MURRR D I Hialeah,FI 33012 INSURER 8: COVERAGES CERTIFICATE NUMBER: INSURER P REVISION NUMBER: THIS 18 TO CERTIFY THAT THE POUCIE J1 OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANYOONTRACT 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 REDUCE=D BY PAID CLAIMS. NRR TYPE OF INSURANCE ADIX SR POLICY ER @ > ' LWZM OlBrBRALLEASK Y EACH OgW REN 1,wV1000.00 ® COMMERCIAL GENERAL LIABILITY01 r ISIAs 100.000.00 ❑ ❑ CLAIMs•A1ADE ® OCCUR 04/28/2015 04/28/2016 A Q 018$FL00088947 tdED ExP aria 8000.00 PERSONAL&AM INJURY 8 1,000,000.00 ❑ GENERAL AGGREGATE i 1,000.000.00 Gtz'PI'L AGGREGATE LIMIT APPLIIM PER: PRODUCTS-COMP/OP AHG 8 9.000,000.00 ®POLICY ❑ Se Q LOC 8 AUTOMOBILE L1AaILITYANY I ANGLE L SAn ❑ Aja AUTO SWILY INJURY(Perper :) 8 ❑ ^`+' W ❑ LED BODILY INJURY(Pru 8 El HIRED AUTOS ❑ A S Wegr2W.RAMAW 8 8 ❑ UM13RBLLA LIAR ❑OCCUR EACH OCCURRENCE $ ❑ ®cow Luule E]cLA1I AGGREGATE s DED El RMWIONS 8 WORKS"COMPENSATION AND NMPLOVNPA UABLnY Y I N STA =CqFMOPECTMUTWE NIA E.L.EACH ACCIDENT >$ waeeut�dete w In NN) e I�E9CRIFTION F ILL DISE°AW-E?AMpL 8 RAINS E.L.DISEASE-POLICY LIMIT 8 DLSa r OF OPERATIONS t LOOAYMM I VLEUCI,EB(A#4*h ACORD 101.AddigunW Remeria Sahaduia.U mare dpaae is requhed) CAC 04.2703 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE Miami Shores VlUage THE tOLPUtATIONAD IBE CANCELLED SSFORE ACCORDANCE WBE DElli/ERtsD iN Building Depsttment 0080 NE 2nd Ave AUTHORMm M ;rRISOLICtFES Miami Shores,FL 33138 306.758.8972 Lucia EtrSIIS ACORD 25(20101053 OF ®1988-2010 ACORD CORPORATION. All rights reserved. The ACORD rams and logo ate registered marks of ACORD 2/3/2016 I M G_5140.J PG 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: 6/2512015 EXPIRATION DATE: 6144/2017 PERSON: RODRIGUEZ ALBERTO FEIN: 272606798 , BUSINESS NAME AND ADDRESS: BLUE DIAMOND AIR CONDITION INC 2940 SW 402 AVENUE MIAMI FL 33165 SCOPES OF BUSINESS OR TRADE: HEATING,VENTILATION, AIR-C°OND Pursuant lc,Chaplet 440.05)14),F.S„an ofncer of a corporation Who elects exeMPd en from oris ChRIDW try Bing a t fixate of elec"hon wmer ilii"section may not recover benents or comwsawn urxlerthis chapter.Pursuant to Chapter 440.0502L FS..COUC8ie9=tif Cko 101ae oxo* apply DIY vvithiri the scope of the business or trade listed on the n,,uce of elsction to be exehV-Pur8uai5t"tri t Itapter 44t3.i =I>S.'..�lt%1�8{sF eieCtlonto be exempt and certificates of electron ttr be exemptstaatl subject is revocation If,3t any time atter tg*ffitng-ofthe t 6Vi� or the issuance of the certificate, the person named on the nota-_or cerlificaie no longer meets the requirements oftill&section fo,issu4me of a cerci`ho�Ae.The departmert shall revoke a Dr-S-F2-D VC-252 CERTIFICATE OF ELECTION TO 8E EXEMPT REVISED 48-13 QUESTIONS?(850}413-1609 Miami shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Oil Tel: (305) 795.2204 Fax: (305)756.8972 Notice to Owner- Workers' Compensation Insurance Exernption 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. f 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: nerState of Florida County of Miami-Dade Theforegoing was acknowledge before me this day of 20 . By., /)O/�F2 who T known to me or has produced le;o 'T Ca&,r) as i PON 4P Notary: SEAL: Blue Diamond Air Condition,Inc. FEBRUARY 9,2016 State of Florida County of Miami-Dade Before me this day personally appeared Abelardo Ramirez who,being duly sworn,deposes and says: That he will be the only person working on the project located at: 1 d 31 a IU 4F „p q lA2. 3s,4-6 8 Sworn to(or affirmed)and subscribed before me this/0 day of 20ff by Personally know OR Produced Identification �1.7 yNn CAM ABS W c ++gsst#FF 000 Type of identification Produced e¢+_y Gen s Bwale nm Nfty P++*Ups J 1� s62 -oo0� 3a- 182- 02 r - �en../� flow" Print,Type or Stamp Name of Notary 1 0377 DiamondBlue • SERVICE INVOICE 1320 w 32 Street C /AC 2 -?0 Hialeah, Fl-33012 Phone: 786-286-1294 SOLD TQANDIOR SERVICED AT: J eaS�' 103/77 Af-E Z'PjA AUIr 141MA4i, R W/Zk Sales Tax Rates: 7.UQ% On Parts INVOICE# INVOICE DATE MAKE OF EQUM9NT MODEL# SERIAL# SERVICE DATE PARTS AND LABOR USED QTY DESCRPTION PRICE AA9OUNT miswe " m mro awv • A- /O d A.- Owe Sx r" 1'.0301.0 � •r.� i ff re. SIE' '.2. INA doe 9&—Ajb- v&l 1 04 Mechanic(s) DATE HOURS PARTS AND • "` • K-2:M LABOR 00 TAX 20.4-0 TOTAL �. ALL LABOR IS GUARANTEED FOR_ YEARS FROM DATE OF INVOICE FOR ALL INSTALLATIONS COMMENTS: d ` 0A4f&VF_ F -rc)0,4&0'40 OF 'jav S/Am MECHANIC SIGNATURE CUSTOM SIGNATU BLUE DIAMOND WARRANTY ON INSTALLED UNITS IS SUBJECT TO THE CUSTOMER PROPERLY MAINTAINING THE UNITS ANNUALLY. MAINTENANCE INCLUDES AN ANNUAL CLEANING OF THE COIL,A PRESSURE CHECK OF ALL THE GASES, AND LUBRICATION OF THE UNIT PARTS. SERVICE OR MAINTENANCE PERFORMED BY AN UNAUTHORIZED MECHANIC I.0 NnT r.1 IARANTFFn RY RI I IF nIAMONn ANIS VOInR THF AROVF MFNTIONFD WARRANTY.BY SIGNING ABOVE.THE Miami Shores Village ttA Building Department 10050 N.E.Znd Avenue Miami Shores,Florida 33138 y Tel:(305)795.2204 r;; Fax:(305)756.8972 AIR CON RE CEMENT DATA - 14 %* PERMIT NUMBER: MC (�^ This fo y it conditioning replacement permit applications.Each unit change-out must o sh M e units on singlee.sheets are not acceptable. e being donej:/wl� res County: Wiiami Dade Zip Code: 133 a' A SING UNITS MUST'BE ON A 4 INCH SOLID CONCRETE SLAB ALL UNITS MUST COMPLY WITH F.LM.A MINIMUM FLOOD ELEVATION / COPY OF THE CONTRACT IS REQUIRED WITH ALL SUBMITALS AHRI DATA SHEET REQUIRED Change disconnbcting means:YES❑ NO❑ ARHI Sheet Attached:YES❑ NO❑ Contract Attached:YES ❑ UNIT BEING RplegR DATA NEW UNIT ,/ t MANUFACTURER rl � AHU or PKG.UNIT MODEL# .- d 4?g. COND.UNIT MODEL#jgg /�jdpg KW HEAT NOM TONS AMU CU PKG 1)M.CA AHU CU PKG AHU CU PKG 2)M•O•P AHU 2j& Z2W AHU CU PKG 3)VOLTS AHU CU PKG PKG UNIT / / PKG UNIT EER/SEER 300 e YES NO REPLACING DUCTS YES NO )e YES NO _ . REPLACING THERMOSTAT YES y NO YES NO NEW 4"CONCRETE SLAB . YES NO YES NO NEW ROOF STAND YES yc NO YES NO NEW RETURN PLENUM BOX YESV NO 1. Minimum Circuit Ampacity Wire Size): ' 2. Maximum Overcurrent Protection(Fuse/BreakerSiize): A d .4,V u b� // 3. Voltage of Circuit 208 240I480) 4. Size Disconnecting Means: Contractor's Company Name: iLt Phone: 8G'�S�-°l`2 9V P Y State Certificate or Registration No. rtificate of Competency No. Signature Date: Q/- 20 M ®( (Q P%—es sign (RevMW2/24/2014) f uer-ti >a uate of Product Rati S AHRI Certified Reference Number: 8629045 Date:2/2/2016 Product:Split System:Air-Cooled Condensing Unit,Coil with Blower Outdoor Unit Model Number:4A7A6048J1 Indoor Unit Model Number:GAM2A0C60S51+TDR Manufacturer:AMERICAN STANDARD Trade/Brand name:AMERICAN STANDARD 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,AMO,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 January1,2015,are ell able to be Installed in all regions until June 30 2016. Beginning Jut 1 2016 central air n igg n r eg eg g y co d do e s can only be installed In regions)for which they meet the regional efficiency requirement. Series name:GOLD 16 Manufacturer responsible for the rating of this system combination Is AMERICAN STANDARD Rated as follows in accordance with AHRI Standard 2101240-2008 for Unitary _ Air-Condtonin and Air-Source e Heat Pum Equipment an subject to verification of rating accuracy b AHRI-sponsored,Independent,third party testing: Cooling Capacity(Btuh): 46500 EER Rating(Cooling): 13.00 SEER Rating(Cooling): 15.50• 1EER Rating(Cooling): Ra&W followed by an asterisk r)bVicate a voluntary relate of previously published data,unle accompanied with a WAS,which indicates an Involuntary relate. DISCLAIMER AHRI does not endorse the products)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 arty kind arising out of the use or performance of the product(s),or the unauthorized alteration of data listed on this Certificate.Cerflfied ratings are valid only for models and configurations listed in the directory at www.ahridirectory.orM 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 users 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.shridirettory.org,click on"Verify Cartificate'link My 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 _�__— 130889014502887957 02014 Air-Conditioning,Heating,and Refrigeration Institute CERTIFICATE NO.: Miami Shores Village �r Ut? � Building Department 10050 N.E.Znd Avenue u x, Miami Shores,Florida 33138 Tel:(305)795.2204 F=(305)756.$972 AIRCONDrTit3NMEN ACBAENT DATA PEPAWNUNMMO Mc This form must accompany mL ak condildonift replaicernmt Arndt applie016ans.Each unit change-out must be on its own data sheet.Multiple units on side-sheets are not acceptable. Job Address(where the wank k l *, ... 4Y-z/ - Z ly _ CiLr NNMW Shores Cauntr. t made Zip Code: ALL CONDENSING UNffS MUST*E ON A 4 ! CIi SOUD CONCRETE SLAB MLuMSMW0MKYWFM F.LMAMINMUM ROOD MWAMON ACwY or-Tw commas mEQmm wrm Pas mwms MW DATA SHEET REQUW charge diconnI cting meam ME] .11100 mu Siteet MW*d:WS Q 1140 D Contract Attached:M D UNITBEING DATA taw Uw RAHUaMANUFACTURER - AHU or PKG.UNIT MODEL# lei CMD.UNrr MODEL KW HEAT NOM TONS'► ) PKG 1)M.CA AHU CU PKG PKG 2)M.o.P MU am 2LAM AHU. CU PKG 3 VOLTS AHU CU PKG PKG UNIT PKG UNIT 1 1 EER/SEER 'Oeq, 13 YES NO REPLAaNG DUCTS 7 YES No YES Iwo REPLAaNG THERM • AT YES NO YES NO NEW 4000NCRETE SLAB_ YES - NO YES NO. NEW ROOF STAND YES NO YES NO NEW RETURN PLENUM BOX No 1. Mlnimurn Ckcult Ampaclty(Wbe Size): 2. Maximum Overcurrent Protection(Fuse/Breaker.S!Z* 0 .4 3. Voltage of Circuit(204/240/480k 4. Size Disconnecting Means f.G conwm:toes com : 81d& ig i Am o rid A, --2w1 c. Pune: -7A-2 -L2 qM. State Certificate or Registration NoX—a-lertificate of Competency No. Signature Date: Q/- 2Q- I (R@rkPd02/26!21)14) "V ' ► f Ceratificate of Product 181011111001 AHRI Certified Reference Number: 8629045 Date:2/212016 Product:Split System:Air-Cooled Condensing Unit,Coil with Blower Outdoor Unit Model Number.4A7A6048J1 indoor Unit Model Number.GAM2AOC60S51+TDR Manufacturer.AMERICAN STANDARD Trade/Brand name:AMERICAN STANDARD Region:All(AK,AL,AR,AZ,CA,CO,CT,DC,OF,FL,GA,HI,ID,IL,W,IN,KS,KY,LA,MA,MD,ME, MI,MN,MO,MS,MT,NC,NO,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 condom 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 most the regional efficiency requirement. Series n A' t gf r> i S �i }'r' t P '.4 _ . .tl e i. ''S `F'Fr � '• -a MID -t 1 Rate& AHRI-,St p 1;` WOO if1�3ource „b b > third Heat � +•1(e> �1' �► � Y�'" i P101111111 " E + WWI IEER Rating(Cooling): • towed by an asterisk 0 its a voluntary terata of previously pubmahed dales r vrlae a VW%whidebwacdes an imol uuiry mate. DISCLAIMER AHRi does not endow the prodwW listed on this Certificate and males no aspresestatiom warnartion or guarantees as to,and asses no responsibility for, the product(s)listed on this Cerdflcate.AHRI expressly disdalms all RabNty for dance of any kind arising art of the on or performance of the product(ay or the unauthorized alteration of deft listed an this CordftM&Certified rathtRs are valid only for mods and configuration meted in the directory at www.abridirectory ori ° TERMS AND CONDITIONS This Certificate and its contents are proprietary products of AHRL This Carttticate shelf only be used for Indhddual,personal and confidential reference purposes.The contents of this Certificate may rot 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-COMMKIN3,HEATWO, CERTIFICATE VERIFICATION &REFRIGERATION iNlSWUM 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 Usted above,and the Certificate No.which is listed at bottom right. ct k ; 02014 Air-Conditioning,Heating,and ReMSeration Institute A NO.: 13Q989t)14S()28$7�'rT