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MC-16-1205 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores,FL Phone: (305)795-2204 Fax: (305)756.8972 Inspection Number: INSP-258164 PermitNumber: MC-5-16-1205 Scheduled Inspection Date: May 18,2016 Permit Type: Mechanical - Commercial Inspector. Perez,JanPlerre Inspection Type: Final Owner. ,SHORES SQUARE INVESTMENTS Work Classification: A/C Replacement Job Address:9045 Biscayne Boulevard Miami Shores,FL 33138- Phone Number Parcel Number 1132060110051 Project: <NONE> Contractor: CMS MECHANICAL SERVICES LLC Phone: (321)473-0275 Building Department Comments REPLACE LIKE TO LIKE Infractlo Passed Comments 10 TON UNIT INSPECTOR COMMENTS False Inspector Comments Passed Failed Correction Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-Inspection fee is paid. May 17,2016 For Inspections please call: (305)762-4949 Page 25 of 44 Miami Shores Village n R 10050 N.E.2nd Avenue " Miami Shores,FL 33138-0000 Phone: (305)795-2204 ! 13 Expiration: 11/0712016 3 'tu' 71 Project Address Parcel Number Applicant 9045 Biscayne Boulevard 1132060110051 SHORES SQUARE INVESTMENT Miami Shores, FL 33138- Block: Lot: Owner Information Address Phone coil SHORES SQUARE INVESTMENTS 3850 BIRD Road MIAMI FL 33146- Contractor(s) Phone Cell Phone $ 12,318.51 Valuation: CMS MECHANICAL SERVICES LLC (321)473-0275 Total Sq Feet: 0 Tons:10 Available inspections: Additional Info: 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 $7.80 Invoice# MC-6-16.69645 DBPR Fee $5.54 05/04/2016 Credit Card $50.00 $360.44 DCA Fee $5.54 Education Surcharge $2.60 05/112016 Credit Card $360.44 $0.00 Permit Fee $369.56 Scanning Fee $9.00 Technology Fee $10.40 Total: $410.44 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, OOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing informatio 's a and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore,I authorize the above-n co or tck do the work stated. May 11,2016 Authorized Signature:Owner / Applicant on r or / gent Date Building Department Cop May 11,2016 1 I - i Miami Shores Village Q Building Department MAY 0 4 2016 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 BY.- Tel: Y;Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 T-V� FBC 20 N BUILDING Master Permit No.r1 c1 — 12, PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION [RENEWAL []PLUMBING 0 MECHANICAL []PUBLIC WORKS [:] CHANGE OF ❑CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 9045 BISCAYNE BLVD City Miami Shores County Miami Dade Zip: Folio/Parcel#;11-3206-011-0051 Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder):SHORE SQUARE PROPERTIES LLC Phone#: Address:696 NE 125 CT City. MIAMI State: FLORIDA Zlp: 33161 Tenant/Lessee Name: FAMILY DOLLAR 2415 Phone#: Email: DANIELFLOHR@CMSMECHANICAL.COM CONTRACTOR:Company Name: CMS MECHANICAL Phone#: 3214730275 Address: 445 WEST DRIVE City: MELBOURNE State: FLORIDA Zip; 32904 Qualifier Name: ROBERT BULL Phone#: 3214730275 State Certification or Registration M CMC057101 Certificate of Competency M DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$12,318.51 Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New FN Repair/Replace ❑ Demolition Description of Work: R-EP A"E-HK -rC WE et2Na V6� lib Specify color of color thru tile: Submittal Fee$-%5D�;Ki C—)_Permit Fee$ gjCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ 3(90-44 (Revised02/24/2014) 4 � A ® HI Certi icate of Product ngs .11, n� AHRI Certified Reference Number:5581744 Date: 5/3/2016 tStatus:Active Product:Single-Package Air-Conditioner,Air-Cooled Model Number:50TC*(D,E)12***(5,6,1)A**"(A,C,D,F)* Manufacturer:CARRIER CORPORATION Trade/Brand name:CARRIER CORPORATION Series name:CARRIER WEATHERMAKER Rated as follows In accordance with AHRI Standard 340/360-2007,Commercial and Industry Unitary Air-Conditioning and Heat Pump Equipment and subject to verification of rating accuracy by AHRI-sponsored, Independent,third party testing: Refrigerant Used: R-410A Hertz: 60 Cooling Capacity(Btuh): 114000/114000 EER Rdting(Coaling): 11:30/11.30 -IE ER: 11.8/11.8 Heating Capacity. 47F(Btuh): COP at 47F: Heating CapaciEy,at 1.7F;(Btuh): COP at 17F: Full LoadIndoor Coil Air Quantity `3000 The AHRI 340A60 certified EER ratings in Bid hff are calculated under the same methodology as the EER ratings at T1 conditions of ISO 5151:2010 and ISO 132532011. `Ratings followed by an asterisk(*)indicate a voluntary rands,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#ability 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.abridirectory.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; AM 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.CONOfnOMPle,HEATINS, CERTIFICATE VERIFICATION &REFRIGERATION INSMUTE The information for the model cited on this certificate can be verified at www.abridirectory.org.dick on'Verify Certificate"fink 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 fisted at bottom right ©2014 Air-Conditioning,Heating,and Refrigeration Institute CERTIFICATE NO.: 1317503182798354 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 ILIrisdiction. 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. Signature t Signature OWrAGENT' CONTRACTOR The foregoing instruficnt w acknowledged before me this The foregoing instrument was acknowledged before me this 44114 day ofRY .20 16 ,by day of Y 20 \ lv ,by �OLAJ�t ,who i ersonall/kno to au1 v t73who is ersonally 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 PUBLIC: NOTARY PUBLIC: Sign: Sign: Print: "' JQRGE A.DE LA ROA Print: yy Notary Public.State of Floridaa •.y Seal: Commission#F FF 948619 Seal: _�' Notary Pubic.State of Florida My Comm.Expires Apr 23.2020 _ Commission#►it 240314 '�%'� �`(',,• Bonded through National Notary Assn. =;?9,F oP � My Comm.Expires Jun 14,20 BaWed through National Notary n APPROVED BY la miner Zoning Structural Review Clerk (Revised02/24/2014) w s 5N0> r Miami Shores Village Building Department ..,. .....te 10050 N.Ed 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 Address(where the work is being done): ��S $C,__2 IF V City: Miami Shores Village County: Miami Dade Zip Code: 3 ALL CONDENSING UNITS MUST BE ON A 4 INCH SOLID CONCRETE SLAB ALL UNITS MUST COMPLY WITH F.E.M.A MINIMUM FLOOD ELEVATION A COPY OF THE CONTRACT IS REQUIRED WITH ALL SUBMITALS AHRI DATA SHEET REQUIRED Change disconnecting means:YES[] �NOARHI Sheet Attached:YES NO F-1ContractAttached:YES La UNIT BEING REPLACED DATA NEW UNIT CA Q,PL1C-(2 . MANUFACTURER 67L_ D 0/2V$�/ AHU or PKG.UNIT MODEL# —O COND.UNIT MODEL# hC P­MN� KW HEAT p NOM TONS In AHU CU PKG ® 1)M.C.A AHU CU PKG ,S® AHU CU PKG 2)M.O.P AHU CU PKG 60 AHU CU PKG 2'jo 3K 3)VOLTS AHU CU PKG PKG UNIT / / PKG UNIT /0 EER/SEER s YES 0 REPLACING DUCTS YES YES REPLACING THERMOSTAT YES YES N NEW 4"CONCRETE SLAB YES YES 9QNEW ROOF STAND YES YES (NV NEW RETURN PLENUM BOX I YES Top 1. Minimum Circd)t Ampacity(Wire Size): �f(p 2. Maximum Overcurrent Protection (Fuse/Breaker Size): 3. Voltage of Circuit(208/240/480): Z09/2,30 3 4. Size Disconnecting Means: (00 n 2 Contractor's Company Name: 0 t�n l ,7 I'l 6"►7�j� Phone: 2� �/ 0270 State Certificate or g' tra 'on No. rn AA C 51 101 Certificate of Competency No. Signature Date: 061-2211(a (Q aiffiees signature) (Revised02/24/2014) STATE OF FLORIDA „ DEPARTMENT OF BUSINESS AND PROFESSIONAL. REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 1.940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 BULL, ROBERTALLEN JR CMS MECHANICAL SERVICES LLC 445 WEST DRIVE SUITE#101 MELBOURNE FL 32904 Congratulations! With this license you become one of the nearly one million Floridians licensed by the Department of Business and STATE OF FLORIDA Professional Regulation. Our professionals and businesses raneeDEPARTMENT from architects to yacht brokers,from boxers to barbeque restaurants, PROFE, WI[O RI�,GUILAT ON N and they keep Florida's economy strong. .� p5t2gJ20 t4 'Ssun:; Every day we work to improve the way we do business in order to CMC057"101 , serve you better. For information about our services,please log onto CERTIFIED MEG• NIAKCQ. jpR www.myfloridalleense.com. There you can find more inforrriatron BULL RpBER.Tr ':...z about our-divisions and the regulations that impact you,subscribe ,. •• to department newsletters and team more about the Department's CMS'MECHANI.G.,A 58'E t 19;&F L•'I�G: initiatives. yr==N r Our mission at the Department is: License Efficiently,Regulate Fairly. Ig;CERTIFIED under the provisions of Ch.aaa FS. We Constants strive to serve you better so that you can serve your L,a.489 FS. customers. Thank you for doing business in Florida, P,�,,,,aa,e ;nue s,,zo,s and congratulations on your new llcensel DETACH HERE KEN LAWSON,SECRETARY RICK SCOTT, GOVERNOR STATE OF FLORIDA DEPARTMENT OFBUSINES'SAND PROFESSIONp+L•REOULATION CONSTRUCTIOWW USTRY LICENSING BOARD d: 7CMMC7065711 ~' '`' "'p'r•tnl�w"�Yv hM; The MECHANICAL CONTRACTOR Named below IS.CERTIFIED F: Under the provislons.of C.2a0pter 489 FS: Expiration date: AUG 31, .}. , pyo..,• � BULL, RO5ERTALLEN•JRw ` yam. CMS-MECHA:NI,CAL SERYIG S .4445 WEST DRI.VI=•, a:;: ;� ,.. .. � .a:,...•` . , SUITE#101 FL32904 � n$ ➢2 55 Q MELBOURNE Y_ ,'" ', • ;z•: a�� :. ,�. ..:,��»'k.:.».�,. 290002475 ISSUED: 05/29/2014 DISPLAY AS REQUIRED BY LAW SEQ# L1405 ACORD® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 4� 10/1/2016 5/4/2016 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 pol)cy(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 LOCKTON COMPANIES CONTACT NAME: 444 W.47TH STREET,SUITE 900 PHONE I FAX KANSAS CITY MO 64112-1906 -MAIL AIC"O (816)960-9000ADDRESS: INSURER 8 AFFORDING COVERAGE NAIL# INSURER A:Zurich American Insurance Company 16535 INSURED CMS MECHANICAL SERVICES,LLC INSURER B:Great American Insurance CoMpy 16691 1402353 445 W.DRIVE INSURER C:American Zurich Insurance Company 40142 SUITE 101 INSURER D: MELBOURNE FL 32904 INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER: 14039888 REVISION NUMBER: XXXXXXX 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. INSR TYPE OF INSURANCE ADDL SUER POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MMIDD MMIDD A X COMMERCIAL GENERAL LIABILITY N N GLO 0136624 10/1/2015 10/1/2016 EACH OCCURRENCE $ 1,000,000 DGE ToCLAIMS-MADE D OCCUR PRAEM SES Ea occurrence) $ 500RENTED 000 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GENT-AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY�JEST F—]LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ A AUTOMOBILE LIABILITY N N BAP 0136625 10/1/2015 10/1/2016 CEOaMaBBIINdEeDt INGLE LIMIT $ 1,000,000 X ANY AUTO BODILY INJURY(Per person) $ XXXXXXX ALL OWNED SCHEDAUTOS BODILY INJURY(Per accident) $ XXXXXXX X HIRED AUTOS NON SWNED PROPERTY DAMAGE $ XXXXXXX Per acadent $ XXXXXXX B X UMBRELLA LIAB X OCCUR N N TUU4085566 10/1/2015 10/1/2016 EACH OCCURRENCE $ 5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000 DED I X I RETENTION$ 10,000 $ XXX'XXxx C WORKERS COMPENSATION N X PER EOR EMPLOYERS'LIABILITY YIN WC 0136627-01 10/1/2015 10/1/2016 STATUTE ER ANY PROPRIETORIPARTNERIEXECUTIVEE.L.EACH ACCIDENT $ 1,000,000 OFFICERIMEMBER EXCLUDED? FN--1 N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 A LEASED/RENTED EQUIP N N CPP0184621 10/1/2015 10/1/2016 ANY ONE ITEM/PER OCC: $500,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached H more space is required) Contractor License CMC057101 CERTIFICATE HOLDER CANCELLATION 14039888 Miami Shores Village,FL SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 10050 NE 2 Avenue THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Shores FL 33138 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTA 0 1988014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD BREVARD COUNTY BUSINESS TAX RECEIPT ACCOUNT NO. 2015 - 2016 SUBJECT TO COUNTY ZONING RESTRICTIONS 200051418 TAX RECEIPT SHOULD BE DISPLAYED ON PREMISES THE PERSON(S),OR ENTITY BELOW: BUSINESS PERIOD: October 01,2015 - September 30,2096 CMS MECHANICAL SERVICES, LLC EXPIRES: SEPTEMBER 30,2016 445 WEST OR ISSUED PURSUANTAND SUBJECT TO FLORIDA STATUTES AND BREVARD COUNTY CODE ISSUANCE SUITE 101 DOES NOT CERTIFY COMPLIANCE WITH ZONING OR OTHER LAWS.. MELBOURNE, FL 32904 BUSINESS TAX RECEIPT IS SUBJECT TO REVOCATION FOR ZONING VIOLATIONS,AND i OR FAILURE TO MAINTAIN REGULATORY PRE-REQUISITES AS REQUIRED FOR BUSINESS CLASSIFICATION(S),OR SUBSEQUENT ACTIVITIES.NOTIFY TAX COLLECTOR UPON CLOSING OF BUSINESS. A PERMIT IS REQUIRED TO ADVERTISE(Including with signage)"GOING OUT OF BUSINESS'. LISA CULLEN,CFC,Brevard County Tax Collector LOCATION: P 0 Box 2500,Titusville,Florida 32781-2500 445 WEST DR (321)264-6910 or(321)633-2199 ext.46910 SUITE 101 CITY OF MELBOURNE,FL 32904 y ,•,> ;r•. ..:,ti::fc:��F' ::1;rii''. !Q =.. OWNED BY. CMS MECHANICAL SERVICES, LLC BUSINESS CLASSIFICATIONS,DISCLAIMERS,AND RELATED FEES: EXEMPTIONS: 0.00 600 CITY RESTRICTIONS APPLY 300425 MECHANICAL CONTRACTOR 590501 HAZ WASTE GEN.SURCHARGE 820005 RECEIPT AMT Receipt Fee 37.00 Hazardous Waste Fee 50.00 Zoning Application Fee 0.00 Building Occupancy Review Fee 0.00 Fire Prevention Fee 0.00 Late Penalty 0.00 NSF Fee 0.00 Transfer Fee 0.00 Paid 000-15-00081403 07/07/2015 87.00 MAIN OFFICE: 400 South St.,6th Floor,Titusville,FL 32780 BRANCH OFFICES: Merritt Island Office,1605 N.Courtenay Pkwy Melbourne Office, 1515 Sarno Road Palm Bay Office,450 Cogan Dr.SE Titusville Office,800 Park Ave. Indian Harbour Beach Office,240 E.Eau Gailie Blvd.