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MC-16-1240 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756.8972 Inspection Number: INSP-258441 Permit Number: MC-5-16-1240 Scheduled Inspection Date:June 08,2016 Permit Type: Mechanical - Residential Inspector: Perez,JanPierre Inspection Type• Final Owner: BOCKNER, DAVID Work Classification: A/C Replacement Job Address:1199 NE 99 Street Miami Shores,FL Phone Number Parcel Number 1132050180010 Project: <NONE> Contractor: JG CLIMATE CONTROL CORP Phone. (305)318-6479 Building Department Comments REPLACE 4 TON CENTRAL A/C SYSTEM. Infractio Passed Comments INSPECTOR COMMENTS False TO CANCEL PERMIT#MC15-343 Inspector Comments Passed Failed Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid June 07,2016 For Inspections please call: (305)762-4949 Page 12 of 36 s Miami Shores Village 10050 N.E.2nd Avenue NE _ Miami Shores,FL 33138-0000 Phone: (305)795-2204 , R FIla N,-,ZX5rnKe,,W expiration: 11/1312016 Project Address Parcel Number Applicant 1199 NE 99 Street 1132050180010 Miami Shores, FL Block: Lot: DAVID BOCKNER Owner Information Address Phone Cell DAVID BOCKNER 1199 NE 99 Street MIAMI SHORES FL 33138-2677 Contractor(s) Phone Cell Phone Valuation: $4,275.00 JG CLIMATE CONTROL CORP (305)318-6479 �..........._.��, __._.. -� Total Sq Feet: 0 Tons:4 Available Inspections: Additional Info:REPLACE 4 TON CENTRAL A/C SYSTEM. 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 $3.00 Invoice# MC-5-16-59708 DBPR Fee $2'24 05/09/2016 Credit Card $50.00 $121.11 DCA Fee $2.24 Education Surcharge $1.00 05/17/2016 Credit Card $121.11 $0.00 Permit Fee $149.63 Scanning Fee $9.00 Technology Fee $4.00 Total: $171.11 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 cont or to do the work stated. May 17,2016 Authorized Signature:Owner / Applicant A QVnjr / Agent Date Building Department Copy May 17,2016 1 Miami Shores Village Building Department 150 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 BY: Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC20i4 BUILDING Master Permit No. 1214 d PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION RENEWAL F-1 PLUMBING MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: I I iJG Clq ShrC-<-►- City: Miami Shores County Miami Dade zip: -3.3 Gra Folio/Parcel#:_( Olt)'00 IC) Is the Building Historically Designated:Yes NO OccupancyType:' j1d?S1 Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): r�os a baLA-.it1A-r Phone#: Address: 119q Q & Gl 9 �- city: Kickr+ni State: F1 zip:301,�F6 Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: -3(n, C-A W%a , c4parvol Corp. Phone#005)415LO-05-t I Address: P--tt-- City: MC V"6 State: V:1 Zip: 33®i Qualifier Name: pe,-u5 Phone#: -8S911 State Certification or Registration#: °(QAC �s Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ L-A 31�.COQ Square/Unear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New P<Repair/Replace ❑ Demolition Description of Work: V ion Carve►i .41c Specify color of color thru tile: Submittal Fee$ 0" Permit Fee$ 9 CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ � I= I (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. Signature Signature OWNER or AGENT CO TACTOR The foregoing instrument was acknowledged before me this The foregoing instrument acknowledged before me this day of I'A 5 1 .20 1(P ,by of day of V-400-t '20 (L-0 ,by bc"Icd e)OCAc &C .who is personally known ,L.',tto , -1-15 C'1Q(\7-4tL-9-`Z-- ,who i ersonally know o me or who has produced VV me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: , c Sign:. t_ Sign: Print: '��- �'L�Z Print: Z lj�Z JOAPAEVELIZ =`' - Seal: ,,; r,- JOANEVEL¢ Seal: _*. ; MY COWAISSION#FF088�1 =*: ,: hAY COMMISSM#FF 086 1 ., EXPIRES February�,2018 EXPIRES:Febm q 28,2018 Bonded Tlw Notary PuWb Uadwwftm eoftded Tft M Rft U m**ft �*�x��*sx�**see+ray**rsrx�ssssa*�w*��**�*aasasaw�sr�*�asaxa�err**�sxs�wws**e*assw���x*spa*xws�**xasesa�x�*x*x*x� APPROVED BY L® elExaminer Zoning Structural Review Clerk (RevisedO2/24/2014) Miami Shores Village Building Department ..I. n.n 10050 N.E.2nd Avenue `— Miami Shores, Florida 33138 L� � 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): < �Clq 0E0- q,--k Sr City: Miami Shores Village County: Miami Dade Zip Code: 3_�) I36 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 UNIT BEING REPLACED DATA NEW UNIT MANUFACTURER tJE ZO ( Ub AHU or PKG. UNIT MODEL# E /�OD_ / A 6 O(/ff A)®00 d- COND.UNIT MODEL# y '" pA, 0 KW HEAT y NOM TONS 44 AHU 60 CU YQ PKG 1)M.C.A AHU60 CUe/O PKG AHU Q CU &PKG 2)M.O.P AHU GQCU 6PKG AHU CU PKG 3)VOLTS AHU CU PKG PKG UNIT / / PKG UNIT EER/SEER I a YES N REPLACING DUCTS YES NO YES NO REPLACING THERMOSTAT I LyjV NO NO NEW 4"CONCRETE SLAB ES NO YESSk NEW ROOF STAND YES YES CNV I NEW RETURN PLENUM BOX YES (Niol 1. Minimum Circuit Ampacity(Wire Size):R 2. Maximum Overcurrent Protection (Fuse/Breaker Size): 60 3. Voltage of Circuit(208/240/480): 4. Size Disconnecting Means: ii Contractor's Company Name:1(21 C1 iw)nle— QQA_�®( CSP. Phone: (.�) 4,yi4 ) State Certificate or Registration o./IA lel lo�-��I Certificate of Competency No. Signature Date: _51q 1 i (Qu sign re) (Revised02/24/2014) - r Ricks 5 u 3 :=.fy;��`,: � �- �`�xnwht5 sd�s..- `'.,,,' <ys•E moi, ,::,; �,e �� £`w�-`s � .��»,.� x ,�: `� �rr d '�Si r• `� �` ��•`:fir ���''`�an�'�"'w �,,}'`''�S �i 5 ,�`„gr .� �Y Fes• "�^�., a, Ufa �� - � ' f=" M apt � `�; '"a� `�.%�r,�'s�:4 '"�e �<� • a ,Issu�p:. os�i2r2a1a. �=�,�i���C�►S F��Qt��� ,,. , ���' '�.�[������ ' . � f € �f i F. zs5 Yk�# C t EQ ��ppOF P YRA I ads CONTROL C 9.6.S MEC TAX i 8 y 5.00 13/2 mt ECKZ 1 s= Bpi Tax.The "k4wa' Ike �t NO.' wo ae. �f t 2 ® rY This combinationqqualifies for a Falcial Energy Efficiency Tax Crledit when placed In service between Feb 17,2009 and Dec 31,2016. L Aft " 'fireate oa-vff Product AH11 lq.� AHRI Certified Reference Number. 8630139 Date: 502016 Product:Split System:Air-Cooled Condensing Unit,Coil with Blower Outdoor Unit Model Number.4TTR6049J1 Indoor Unit Model Number.TEM6AOD48H41+TDR Manufacturer:TRANE Trade/Brand name:TRANE 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.Territory) 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 requirsement. Series name:XR16 Manufackuw responsible for the rating of this system combinatim is TRANE Rated as,follows In accordance with AHRI Standard 2101240- far Un"Arc Air-Conditioning and Air-Soue Heat Bump Equipment and subject to Verification of rating curacy by ARI-Isl)o mored,Independent,third partying: Cooling Capacity(Btuh): 47000 EER Rating(Cooling): 14.00 SEER Rating(Cooling): 16.50 IEER Rating(Cooling): •rtes followed by an asterisk(q Indicate a vokfffty ren to of previmsty published data,urdess ceded wltih a vws,wtdc h Indicames an kwolun ety rmate. DISCUUNIER MR does riot endorse this produd(s)Fred on Oft Certificate and makes no represortallons,warranties or guarantees as to,and assumes no responsibility for, the product(s)fisted on this Certificate.MRI expremly disdahra all liability for damages of any hind whft out of the we or performance of the produeft or the wrautlrorbed alteration of data listed on this Certificate.Certified rathlgs are vat only for models and conflgurations It I In the directory at www.ahridIrectory.org. TERMS AND CONDITIONS This Certificate and its contents are proprietary products of AHRL This Certificate shall only be used for Individual,personal and confidential reference purposes.The contents of this Certificate may not,in whore or In part,be reproduced; disseminated; entered Into a computer database;or otherwise utilized,in any form or mangy 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 verbied at www.ahridirectory.org,click on`Verify Certificate'link we make life better" and enter the AHRI Certified Reference Number and the date on which the certificate was Issued, Which Is meted above,and the Certificate No.,which Is fisted at bottom tight 02014 Air-Conditioning,Heating,and Refrigeration Institute CERTIFICATE NO.: 939072829 M751530 OP ID:LEGO 14ATE(MMIDONYYY) �R©1 CERTIFICATE OF LIABILITY INSURANCE D0610912016 Ob/09/2018 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 Avante Insurance Agency,Inc. NAME: 7490 West Flagler Street A/c No ac No): Miami,FL 33144 E4LALADDRESS: Gabriela F.Dominguez PRODUCER CUSTOMER ID#:JGCu-1 INSURER(S)AFFORDING COVERAGE NAIC# INSURED JG Climate Control Corp INSURER A:United States Liability 19903 NW 86 Avenue INSURER B:Ma fre Insurance Co.of FL 23876 Hialeah,FL 33015 INSURER C:Br(d afield Casualty Insurance INSURERD: INSURER E: INSURER F 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. IN. POLICY TR TYPE OF INSURANCE POLICY NUMBER � EFF POEXP S Y LLIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY CL1733502 01/06/2016 01106/2017 PREMISES Ea occurrencel $ 100,0014 CLAIMS-MADE D OCCUR MED EXP(Any one person) $ 5,00 PERSONAL&ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,00 POLICY JECT —1 PRO- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,00 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ B X SCHEDULED AUTOS 150140009556 01/14/2016 01/14/2017 PROPERTY DAMAGE HIRED AUTOS (PER ACCIDENT) $ NON-OWNED AUTOS $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION X WC STATU- OTH- AND EMPLOYERS'LIABILITY T RY MITSF C ANY PROPRIETOR/PARTNER/EXECUTIVE YIN 196-19570 02/24/2016 02/24/2017 E.L.EACH ACCIDENT $ 1,000,00 OFFICER/MEMBER EXCLUDED? El N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,00 If yes,describe under DESCRIPTION OF OPERATIONS below I I I i E.L.DISEASE-POLICY LIMIT $ 1,000,00 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space is required) Air Conditioning Installation Service and Repair. CERTIFICATE HOLDER CANCELLATION MIAMISH SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN g ACCORDANCE WITH THE POLICY PROVISIONS. Building Department 10050 NE 2 Avenue AUTHORIZED REPRESENTATIVE Miami Shores,FL 33138 ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 26(2009109) The ACORD name and logo are registered marks of ACORD