MC-16-660 (2) Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
inspection Number: INSP-258940 Permit Number: MC-3-16-660
Inspection Date: May 16,2016 Permit Type: Mechanical- Residential
Inspector: Perez,JanPierre Inspection Type: Final
Owner: , Work Classification: Addition/Alteration
Job Address:280 NE 91 Street
Miami Shores, FL 33138- Phone Number
Parcel Number 1132060190410
Project: <NONE>
Contractor: AIR COOLING INC
Building Department Comments
REPLACING DUCT WORK REPLACING 2 COMPLETED Infractio Passed Comments
A/C UNITS LINT#13 TON RHEEP 14 SEEN UNIT#2 2 INSPECTOR COMMENTS False
TON RHEEP 14 SEEN
c � l
Inspector Comments
Passed Nk CREATED AS REINSPECTION FOR INSP-254619. pending revise plans&
need dryer vent
Failed El
Correction
Needed
Re-Inspection
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid
For Inspections please call: (305)762-4949
May 16,2016 Page 1 of 1
9
Miami Shores Village
10050 N.E.2nd Avenue NE � c
Miami Shores,FL 33136=0
Phone: (305)795-2204
B - Expiration: 0 !19/2016
Project Address Parcel Plumber Applicant
280 NE 91 Street 1132060190410
Miami Shores, FL 33138- Block: Lot: NATIONAL CAPITAL ENTERPRI:
Owner Information Address Phone Cell
ETO
NAL CAPITAL ENTERPRISES 9500 N MIAMI Avenue
MIAMI SHORES FL 33138-
9500 N MIAMI Avenue
MIAMI SHORES FL 33138-
Contractor(s) Phone Cell Phone Valuation: $ 7,000.00
AIR COOLING INC
Total Sq Feet: 2500
Tons:3&2 Available Inspections:
Additional Info: Inspection Type:
Classification:Residential Final
Approved:In Review Rough Duct
Comments: Date Approved::In Review Review Mechanical
Date Denied: Type of Work: Review Mechanical
Scanning:1 Underground
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $4,20
DBPR Fee Invoice# MC-3-16-59001
$3.68 03/14/2016 Credit Card $50.00 $216.56
DCA Fee $3,68
Education Surcharge $1.40 03/23/2016 Credit Card $216.56 $0.00
Permit Fee $245.00
Scanning Fee $3.00
Technology Fee $5.60
Total: $266.56
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: I certify that all the foregoing informatio is accu and that all work will be done in compliance with all applicable laws regulating
construction and zoning. Futhermore,I authorize the above-na cont r to do the work stated.
March 23,2016
Authorized Signature:Owner / Applicant / dor / Agent Date
Building Department Copy
March 23,2016 1
Miami Shores Village MAR 14 2016
Building Department BY.
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795.2204 Fax:(305)756.8972
INSPECTION'S PHONE NUMBER:(305)762.4949
BUILDING Permit No.J&Id-
PERMIT
d PERMIT APPLICATION Master Permit No.e-,f T_
FBC 20
Permit Type:MECHANICAL
Simple 17�t dAp1'A-L �llC A5f14 3531
OWNER:Name(Fee S' le Titleholder): Phone#:
Address: 2 A O NF t SV
Ci R Ifs(kN SWALNAL •
City: N� state:
Tenant bsee Name: Phone#:
Email• f`�1 �L 'To i-t fl •C,p
JOB ADDRESS:
City: Miami Shores County: Miami Dade Zip:_33/
Folio/Parcel#:
Is the Budding Historically Designated:Yes NO Flood Zone:
CONTRACTOR:Company Name: N\N1, C.-"�Z l-l6••1 S �1-s C„ Phone#
Address: � °%�o to �,.s 3 4 L ire,
city: State: Zip:33 O 1)?
Qualifier Name: M-w- L 2L-,At-o Phone#:
State Certification or Registration#: C•A G.t e ti S I X- t Certificate of competency#:
Contact Phone#:_11(n k ZL6-'34 qO Email Address:-" 1h PWZ ca0 UN5 i N C• cz ,
DESIGNER:Architect/Engineer: %roai-r *& X4',J Phone#: fi3D
Value of Work for this Permit:$ SquarelLinear Footage of Work•
Type of Work: DAddress DAlteration Phew ODemolition
Description of work:
u GC3�
l' _rurwhet�
00
Uv i i 2
Submittal Fee$ .Z 2- 04—Permit Fee$ e® CCF$L�. � _ CO/CC$
Scanning Fee$ :3, . CIO Radon Fee$ . t DBPR$ 8 Bond$--0..
Notary$ T taininsWacation Fee$ Technology Fee$ L=;
Double Fee$ Structural Review$
TOTAL FEE NOW DUE$ I
Bonding Conpx6yPs Name(if applicable) N
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 instal ation 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 ELBC TRXCAI.WORK,PLUMBING,SIGNS,
WELLS,POOLS,FURNACES,BOILERS,HEATERS,TANKS and 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 NOT IICE 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 sof 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 &C&lz Signature
(11 Owner or Agent Contractor
The foregoing instrument was acknowledged before me this J_a, The foregomi instrument was acknowledged before TOP this J�
day of F ,20�.,by �i°l:c sr.wvl �ord\00 day of U� ,20 by L
who is perso�own to me or who has produced who is personally or who has prodocod
As identification and who did take an oath. — — �s� 'on and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC• e
ELgNA SOLER
COMMISSION 0 FF1075P
XPIRES:Ap7 04,2018
Sig — EMILY ODAK ign:
PWft-State of Florida
Print 7946
MY
My Commission Expires: COM.ENWU Apt18.2019 y Commission Expires: a ®/
BotdsO L�loinlN9HryA1�ea.
APPROVED BY �" "J Plans Examiner Zoning
NX
Structural Review Clerk
(Revised 07n0/07)(Reviwd 0rdtoa009)(Rr4sed 3/15)09)
4
Miami Shores village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel:(305) 795 2204
AIR CONDITIONING REPLACEMENT DATA Fix:(305) 756.8972
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 ameptable.
Job Address(where the work is being done): n.9 S V� S
City: Miami Shores Village County: Miami Dade Zip Code: _
ALL CONDENSING UNITS MUST BE ON A 4 INCH SOLID CONCRETE SLAB
ALL UNITS MUST COMPLY WITH F-EMA MINIMUM FLOOD ELEVATION
A COPY OF THE CONTRACT IS REQUIRED WITH ALL SUBMITALS
ARI(AHRI)DATA SHEET REQUIRED
Change Disconnecting means:YES ❑ NO` I ARHI Sheet Attached:YES❑ NO❑ Contract Attached:YES[
UNIT BEING REPLACED DATA NEW UNIT
v t <IU / A,gjjCTURER CT
Arllt (01 S A- KG.UNIT MODEL# ,
M l NIT MODEL#
2, G ju 4 v HEAT
NOM TONS
AHU CU PKG 1 M.CA AHU CU PKG
AHU CU PKG 2 M.O.P AHU CU PKG
AHU CU PKG 3 VOLTS 'Zc),q 1,LZ4 3=r AHU CU PKG
PKG UNIT I I PKG UNIT I 1
EERISEER
YES NO REPLACING DUCTS NO
YES NO REPLACING THERMOSTAT NO
YES NO NEW 4000NCRETE SLAB NO
YES NO NEW ROOF STAND YES
YES NO NEW RETURN PLENUM BOX YES
1. Minimum Circuit Ampacity(Imre Size): Ai/
2. Maximum Overcurrent Protection(Fuse/Breaker Size): v
- 7
3. Voltage of Circuit(20040/480):
4, Size Disconnecting Means:
Contractor's Company Name: CIZ-0 V J r Phone; `o
State Certificate or Registration N. zi Certificate of Competency N.
Signature p ,
RICK SCOTT,GOVERNOR _ W - KEN LAWSON,SECRETARY
STATE OP FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATIONg ,h
CONSTRUCTION INDUSTRY LICENSING BOARD
CAC1815M06
The CLASS B AIR CONDITIONING CONTRACTOR
Named below IS CERTIFIED {uy
Under the provisions of Chapter 489.17S.Expiration date: AUG 31,2016
BUENO,JOSE LUIS -
0
AIR COOLING INC . . .0
7966 WEST 30T",,I.MF:
■
HIALEAH FLj33618-3830
■
ISSUED: 06108=4 DISPLAYAS REQUIRED BY LAW WQa L14 100e
• d
a -
. ,
awls
_Local Business Tax Receipt
Miami—Dade County, State of Florida
TNS 13 NOTA BILL — DONC'TFAY
6187074 N k. Tj' . 1LB
WARMEMNATA&SOCAMON Mme*No• EXPIRES
AIR COOLING INC RENEWAL SEPTEMBER 30, 2015
7965 W 30 IA 64641363 Must be displayed at place of business
HIALEAH R.33018 Pursuant to County Code
Chaps 8A—ArL 9&10
0wmak SEC.TYPE Cw 61M PAVWIL 11T
AM COOLING INC 19B SPEC SIM CONTRACTOR SY TAX COLLEM"k
Wad=($) 7 CACISISM SUM 07/13/2015
CHECK21-15-489319
itbtstasd> easTa�Aecafpto� A e[ffisi»cal Tax 1ha toneeaaes�a.
�reaaattfaaa s applyftdmb ��1r aa118
noBECBPfdIB.*Awmast6edlorlaYalanall +ad —WwmI4WeCadeSen8s-;178
Fora -vkkvrAmmmb
L'd Zt O L LZ8 900 0u1 15u11000.ny
''°' W& CERTIFICATE OF LIABILITY INSURANCEVA-M
0304I2D16
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFOFMATION ONLY AND CONFERS NO THE CERTIFICATE HOLDER.TRIS
CERTIRcATE DOE$NOT AFmRL rvr=LY OR NEQATIVELY AMEND,EXTE11D OR ALTER THE COVERAGE AFFORDED BY TME POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTkIORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
QRPORTANTt H the care loato holder 1s—ADDITIONAL INSUA the pdky(l*MUM be endorsed. IMSUBROGATION M WANED,avb)eet to
the amo snd oorl Mrd od 1he VWWV,amtdn poltoles 1eaY Mgtdre ae andolsantML AstownWd onuds cwgkmb does not corder tights to the
eerofta a holder in time of such endorsement(o).
PRODUCIMCm MARY URREOO
0-mor insurance x . (305 257-4541Mel: X7•-4543
8200 W 33 Ave 117 flUoletl�grlMu111sturtstxe 00m
H ateahFL 33038 wsuRatelat nRF�aho cOrenAse 1rA�
Phone (S05)267-4541 Fax r.400 267-4543 ;
1nBURED UNITED SPECIALTY INS-COUP
AIA COOLING iN RER 8 INC - —
3866 W 30 LN
HIALEAH FL 33018 ERE•
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF IN9l1 MCE E TED BELOW HAVE BEEN BSUED TO THE INSURED"AIMED 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 AF<MW BY THE POLO ES DESCRIBED HEREIN 19 SUSJECT TO ALL 114E TERMS.
EXCLUSIONS AND CONDrTKM OF St)CH POLICIES-LIMITS SHCWN MAY HAVE BEEN REDUCED SY PAID CLAIMS.
TYPEorIMUMME La
COMMiMCIALGENBRgL UI MUTY R Lam
F-1
❑ MAMMMWE ® OOCUA T R 1 1000000.00
I c 9 50.000.00
: A I❑ N N CoCoo-3746 IQW2015 1=812DIS lam cne a 5,000.0a
PERS NAL a Acv INjIm 9 1000.000.00
01OWLAGGRE43ATEUMITAPPUISPER: OENH4ALA(itIRLeCiATE t 2.000ACM1.00
®PoucY ❑ El Loc
OTHI33 PRO1>OCi's-. P AOG $ 1000.000.00
`AUMM013ILELLOJM 7Y CiWGLEUMITMY AUTO S
I !!aALL OWNED HEpi ED
Et�iLY1NURY(PerPeroon) e
i ❑ AUTOS ❑ SC
AVTOB ( l130
ILYW3URY(Peradetea _._.
❑ NM
MEDA008 ❑ AII•aS
s
tlta3ltlsLl.A L1ns C3 ocix>R
emomeLtAe i EACH OCCURRENCE
em aeMA� j AGGREGAW 4
YYOFs M8 C01IPEt9XTM
s --
AND Ett1+LOVL9tS t.tp>e1LrtY YIN
OCEk� E�EWEI NIA
�N EL9ACFAGgOENT
9E.L.01 EA
S
EMPLOY
OE9CRIPT'm OF OPBRATIONs below EL.OSA -POLOY LIMIT L
N OF OPERAtONSI LOCATIONS!VEHIOLBe(J�seb AODRD 10l.Adsel R 9otmeh9a.I!more ataoe b rsquleedl
AIR CONDITIONER CONTRUMR LICENCE Ai CACI815728.
COI IS LISTED AS AN ADDITIONAL INSURED.
CERT0qCATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED PoUCIES BE CANCELLED BEF0142
MIAMI SHORES VILLAGE THE WMATION DATETHF.REOF,NOTICE 1AflLLBE DEWERED IN
SUL.DING DEPARMENT ACCORDANCE WITH THE POLICY PROVISIONS.
10050 NE 2ND AVE AtrrttoRlmSD el;u+RtrrA
MIAMI FL 33138
L MARY URREGO
0114 D CORP TION. All rights rassrved.
ACORD 25(2014101)OF The ACORD natne logo erg f0W& wW marks Of ACORD
Z-d Zti0 L LZ8 g0£ out Bullooc)liy
Q
JEFF ATYVATM
t:tMEF F&MUML OFFIM STATE OF FLORIDA
D�PARTIS=I+1T OF FINANCIAL SERVICES
DIVISION OF TION
•'
CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORA WORKERS'COMPENSATION LAW••
INDUSTRY EXEMPTION
Ttus cwWm that itm ffKbkksid Ilded beer has elected to be saw"tram Rmde Workers'CmVwoabm law
EFFECTIVE DATE: U2=16 EXPIRATION DATE: U2112Q18
PERSON: BUENO JOEL
FEIN: 208400758
BUSINESS NAME AND ADDRESS:
AIR COOLING INC
7331 NW 201 TERR
MIAMI FL 33015
SCOPES OF BUSINESS OR TRADE:
HEATING,veNTII.AnoN.
AIR-corp
P tat r44Q�(14AF.S.!na®oarUfa aoapma6, vft aom�isdmp6r a of anumdwd s
ooto3omamtmr sora anueIrOb PaoojLffl
�(1 ,FS, ddledioetobee any
liresoaFoafUred orhedlesudando Hoaaf a to 40AR131,FftKofiSdele Ihcleii obna►6mimdaeoraas � `afddo6ar �ao 1akaBa
OFS+Z-OA VC-M CERTMATE OF ELECTMN TO BEEXBdPT OB-13 Q1 5T10fV.S?�D 13-1t
AIR COOLING INC
AIR CONDITIONING&REFRIGERATION
Certified State Contractor Licensed&Insured
7966 West 30 Lane Hialeah Florida 33018
Ph 786 236 3440&786 236 3441 Fax 305 8271042
Email:ioseluis@aircoolinginc.com ioel@aiorcoolinginc.com
Date:March 14,2016
County of Dade
Before me this day personally appeared'-../Owho being duly sworn, deposes and
says: /�
Joy /-4" <<
"dp Oro C7 r 14 7 13 W& I VA J40 r.,/ v&0769 -f-/0..
That he or she will be the only person working on the project located at: a Aje �!S
Sworn to(or affirmed)and subscribed before me this day of M�r3r% .201 by
Personally know
Or Produced Identification
Type of Identification Produced
iqf
Nota Pim
MY ora BxpiPrint,Type or Stamp ta
Miami Shores Village
"" Building Department
rim 10050 N.E.2nd Avenue
lOR1Dp' 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 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.
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:
Owner
State of Florida C
County of Miami-Dade
The foregoing was acknowledge before me this 2 day of 104'rz C y ,20 / C.
By /7lGl w el —raol l,y who is ersonally kno to me or has produced
as identification.
No r
SEAL: M, ON#FF 4M
r EXPIRES:Norm r 18,2019
ft drnNftyPh olJafr
' ® Product Ra
ngs
Uenl 1
MM Certified Reference Number. 7480963 Date:3/23/2016
Product:Split System:Air-Cooled Condensing Unit,Coll with Blower
Outdoor Unit Model Number. RA1424AJI
Indoor Unit Model Number.RHI P2417STAN
Manufacturer:RHEEM SALES COMPANY,INC.
Trade/Brand name:RHEEM; RUUD
Region:Southeast and North(AL,AR,DC,DE,F1,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,W1,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:
Manuf darer responsible for the rating of this system combination Is RHI_EM SALES COMPANY,INC.
Rated as follows in accordance with AHRI Standard 210/240:2008 for Unitary
Air-Conditioning and Air-Source
Heat Equipment and subject to verification of rating accuracy by AH reored,Independent,third
Party
Cooling Capacity(Btuh): 24000
EER Rating(Cling); 11.50
SEER Rating(Cooling 14.00
IEER Rating(Coaling):
•R fdkwmd by an as c o a vdw ty.erste of p wAousgr puWW"door,worts acoo d wb a V&S wilds bei as bavokmWy rte.
DISCLAIMER
AM does net endom the product(s)listed on this Carttflrnto and makes no representations,warrantees or guarantees as to,and assumes no responsibl y for,
the prodacKs)fisted an this Certificate.AHRI expiessgr dirxlehrs all liability for dam of any kind arbng out of tie use or performance of On prodrrogs�or the
u sufforked aseratlmn of data listed on this Certificate.Certified ndIR ya are vat only for aTadea and configurations listed In the
directory at www.ahridirectory.org. _
TERMS AND CONDITIONS
This Certificate and its contents are proprietary products of AHRL This Certificate shag only be used for individual,personal and
confidential reference purposes.The Contents of this Certificate may not,In wools or In Part,be reproduced;copes disseminates
entered Into a Computer database:or otherwise uta,In any form or manner at by any means,except for the user's Individual,
pew and wnildeM181 reference AIR-CONDITIONING,HEATING,
CERTIFICATE VERIFICATION &REFRIGERATION INSTITUTE
The afOmetiOn for the model cited on this certificate can be verlihid at inm.ahrid Irectory.org,click on`Verify Certificate*adc vm make life better
and enter the AHRI Certified Reference Number and the tate on which the certificate ryas Issued,
rrhtcth Is listed above,and the Certificate No.,wild is gated at bottom righty.
02014 Air-Conditioning,Heating,and Refrigeration Institute CERTIFICATE NO.: 13103.2178351025285