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MC-16-2234 (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-264993 Permit Number: MC-8-16-2234 Scheduled Inspection Date: August 22,2016 Permit Type: Mechanical - Residential Inspector: Perez,JanPierre Inspection Type: Final Owner: SCOTT JR, GEORGE M Work Classification: A/C Replacement Job Address:480 NE 103 Street Miami Shores, FL 33138- Phone Number (813)362-9468 Parcel Number 1132060170710 Project: <NONE> Contractor: AMERICA'S ECONOMIC AIR CONDITIONING CORP Phone: (305)378-6168 Building Department Comments EXACT AC REPLACEMENT 4 TON Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed , Failed Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. August 19,2016 For Inspections please call: (305)762-4949 Page 24 of 42 NWTII—�L,� Miami Shores Village tyres 10050 N.E.2nd Avenue NE £ t)I]t6 Miami Shores,FL 33138-0000Per � P10, � mit8� , hie Phone: (305)795-2204 g_ FLORID .� _ Expiration: 11f201 Project Address Parcel Number I Applicant 480 NE 103 Street 1132060170710 Miami Shores, FL 33138- Block: Lot: GEORGE M SCOTT JR Owner Information Address Phone Cell GEORGE M SCOTT JR 480 NE 103 Street (813)362-9468 MIAMI SHORES FL 33138-2457 480 NE 103 Street MIAMI SHORES FL 33138-2457 Contractor(s) Phone Cell Phone Valuation: $ 3,000.00 AMERICA'S ECONOMIC AIR CONDITI( (305)378-6168 Total Sq Feet: p Tons:4 Available Inspections: Additional Info:EXACT AC REPLACEMENT 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 $1.80 Invoice# MC-8-16-60921 DBPR Fee $2.00 DCA Fee $2.00 08/11/2016 Credit Card $77.80 $50.00 Education Surcharge $0.60 08/08/2016 Credit Card $50.00 $0.00 Notary Fee $5.00 Permit Fee $105.00 Scanning Fee $9.00 Technology Fee $2.40 Total: $127.80 In consideration of the issuance to me of this permit, I agree toerform the work covered hereunder in com lianlce with all ordinances and regulations P P 9 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. understand that separate permits are required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS AFF I A T: I certify that all the foregoing il�orma'on is accurate and that all work will be done in compliance with all applicable laws regulating construction andI 2 Un .'F he ,I e the atfove-na d contractor to do the work stated. August 11, 2016 Authorized Signature:Owner / Applicant / Contractor / Agent Date Building Department Copy August 11,2016 1 W'o Miami Shores - es Village Building Department AUG n8 ?m 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20y�� BUILDING Master Permit No. eI PERMIT APPLICATION sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING & MECHANICAL [::]PUBLICWORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP r� CONTRACTOR DRAWINGS yl JOB ADDRESS: fl r L a� {z 0 � City: Miami Shores County Miami Dade zip: ?2:3� f 3�� Folio/Parcel#: r Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): Phone#: Address: 9 4?yNNC-- l® 3 e N City:_ A `^4 `, S State: C�. Zip: 3 Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: RAA e. 0%l C.A% a C.y N C K I C A ) e- Phone#: Address: / f f 22 A/W Y $ Aye- City: F L Zip: 3 3 r r ,�, ( �}I& t State:�.S O Qualifier Name: 1 C 0-'0A, A- eSA AW C\vA 2 Phone#:3 0 r 3 State Certification or Registration#: ` A C 0 �-171 9 T- Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ ®®a. QOM Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New N Repair/Replace ❑ Demolition Description of Work: �C/`G� �l C !CA^15 l° 0 ut- � -To—N Specify color of color thru tile: �p Submittal Fee$ .� Permit Fee$ CCF$ CO/CC$ Scanning Fee$ !!�-j • n� Radon Fee$- O DBPR$ Notary$ � ` ' Technology Fee$ C ' `I o Training/Education Fee$ 0 ® Double Fee$ _ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ � t:-) (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 SignatureLO J OWMER or AGENT CONTRACTOR The f,�,rpgoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this _day of V 5 -4— 20 by le� _day of ®� 20 by C�r �LG who is personally known to �J_S ht. r�'�hooiissppersonally known to me or who has produced j7r,(,Jto S UC�S�- as me or who has produced ft IOU as identification and who did take an oath. identification and who did take an oath. 111l11111//� NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign: Print: �� Print: _�': "• Seal: a i Seal: %*�•s'�d/dX3 N��S����a� NATALIE ZAGURY !oi ' ••••••••••6�>�>• MY COMMISSION#FF984799 411111M APPROVED APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) ,yNoRFs G� Miami Shores Village t Building Department �ine 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Rp, 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): f 0 N L 10 ?> S T City: Miami Shores Village County: Miami Dade Zip Code: 3 313 -2 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 K ARHI Sheet Attached:YES Dj NO ❑ Contract Attached:YES ❑ UNIT BEING REPLACED DATA NEW UNIT MANUFACTURER AHU or PKG. UNIT MODEL# COND. UNIT MODEL#PAAJ KW HEAT 10 NOM TONS AHU CU PKG 1)M.C.A AHU CU PKG AHU CU PKG 2) M.O.P AHU CU PKG AHU CU PKG 3)VOLTS AHU CU PKG PKG UNIT / / PKG UNIT EER/SEER YES NO REPLACING DUCTS YES NO YES NO REPLACING THERMOSTAT NO YES NO NEW 4"CONCRETE SLAB YES O YES NO NEW ROOF STAND YES YES NO NEW RETURN PLENUM BOX YES O 1. Minimum Circuit Ampacity(Wire Size): Y� 2. Maximum Overcurrent Protection (Fuse/Breaker Size): & o 3. Voltage of Circuit(208/240/480): .2 Ya 4. Size Disconnecting Means: Contractor's Company Name: l a M.e nl'_0 S G Qd N d M `C- ! e- Phone: .3 o T 3 G j G 27 State Certificate o Registration No. C IDS / Certificate of Competency No. Signature Date: (Qualifier's signature) (Revised02/24/2014) ♦ ORE's s� Miami shores Village Building Department ORDe, 10050 N.E.2nd Avenue Ip' 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. Signa O r State of Florida County of Miami-Dade The foregoing was acknowledge before me this day of 9 y GU S► ,20 By tjy Al l (- SQ)D� who is personally known to me or has produced as identification. Notary: SEAL: Pie �iarary?i:;,iic State of Florida m,• o`` P;ry Gummias�or.FF 15675Q -gar"tcr`.,J°ef" rN�.'�'4r1°'�r4;,.4r�•�fi*�"ci'�_ ` STATE OF FLORIDA DEPARTMENT OF BUSINESS AND ^-4 PROFESSIONAL REGULATION CAC057797 4SSUED: 07/24/2016 CERTIFIED AIR COND CONTR SANCHEZ,VICENTE AMERICA'S ECONOMIC AiR CQND CORP IS CERTIFIED under the provisions of Ch.489 FS. EcpvaWn date:AUG 31,2018 L16072400015M Local Business Tax Receipt Miami—DadCounty,OT A BILL—otateNOT PAoIf Florida 4032322 BUSINESS NpMElLOCATtON RECEIPT NO. EXPIRES SEPTEMBER 30, 2017 AMERICAS ECONOMIC AIR CONDITIONING CORP RENEWAL 18822 NW 48 AVE 4208377 Must be displayed at place of business Pursuant to County Code MIAMI FL 33055 Chapter 8A-Art.9&10 SEC.TYPE OF BUSINESS PAYMENT RECEIVED OWNER RAL MECHANICAL CONTRACTOR BY TAX COLLECTOR AMERICAN ECONOMIC AIR GOND CORP 196 GENE CAC057797 $75.00 07/10/2016 Worker(s) 1 CREDITCARD-16-037823 This Local Business Tax Receipt only cold'irms payment of the Local Business Tax The Receipt is not a license, permit.or a certification of the holders qualifications.to do business.Holder must comply with any gaverumantel or nongovernmental regulamry laws and regmremsmi;which apply to the business. The RECEIPT N0.above must be displayed on all commercial vehicles-Miami-Dade Code Sac So-276. For more information.visit wwwmilainidadambbINDAMPRE 141� ;;,I DATE(MIVUDDNY) p im;-0 11,0110'..i MEMS N41. 08/11/2016 VT "MITT, 5­­­­­­_­­,_­____, AC PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE NESPRAL INSURANCE,INC. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 2600 SW 107 AVENUE SUITE 38 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. MIAMI,FLORIDA 33185 COMPANIES AFFORDING COVERAGE TEL; 306-227-6417 COMPANY A ASCENDANT COMMERCIAL INSURANCE,INC, INSURED AMERICKS ECONOMIC AIR CONDITIONING CORP COMPANY 18822 NW 48 AVE - a MIAMI GARDENS FL 33055 COMPANY C COMPANY Rr W-V D WE IS.�RIIS#sis3u?•sfls .s 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 8 Y THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED 13Y PAID CLAIMS. CO POLICY EFFECTIVE POLICY EXPIRATION LTR TYPE OF INSURANCE POLICY NUMBER 'DATE(MWDDfYY) DATE(MMIDUM) LIMITS GENERAL LIABILITY GENERAL AGGREGATE 5 1,000,000 A X COMMERCIAL GENERAL LIABILITY OL-37639-6 06/2912016 06/29/2017 PROC.UcTs-COMPIOP AGG 6 1,000,000 CLAIMS MADE OCCUR PERSONAL&ADV INJURY 5 1.000l000 OWNERS&CONTRACTOR'S PROT EACH OCCURRENCE 6 1,000,000 FIR E (Anw gnu fird) 0 10010 MED EXP (Any aria person) $ 5,004 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Pur Praoil) ....... HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per 4Wdtmt) PROPERTY DAMAGE GARAGE LIABILITY AUTO ONLY,F_AAcaoEwr ANY AUTO 0 1 TH9R'rHAN AUTO ONLY: ZACACCIDENT_ 6 AGGREGATE $ EXCESS LIABILITY EACH OCCURRENCL! $ UMBRELLA FORM AGGREGATE cYrHER 114AN UMBRELLA FORM 10TH- WORKER'S COMPENSATION AND T I.ItdlTa -R EMPLOYERS`LIABILITY EL EACH ACCIDENT THE PROPRIETOWINCL EL DISEASE-POLICY LIMIT $ PAKNEAS/ExECUTIVE OFFICERS A145: EXCL EL DISEASE-EA EMPLOYEE S OTHER CAC057797 NAM. _001MYNN, .11111.1a , IT SHOULD ANY OF THE ABOVE A RIBED POLICIES BE CANCELLED BEFORE THE MIAMI SHORES VILLAGE BUILDING DEPARTMENT EXPIRATION DATE THEREOF HE ISSUING COMPANY WILL. ENDEAVOR TO MAIL 30 E WRITTEN 10 T 10050 NE 2ND AVENUE _ DAYS WRITTEN ICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, B h IL L SUCH Wo ;�E SKALL IMPOSE NO OBLIGATION OR LIABILITY MIAMI FL 33138 B I L SUCH NO PONTHE , ON T149 cOMPANY, ITS AGENTS OR REPRESENLA-TIVES, AU REP ESENTATIVe ;?t',, ll R 4�.Vm OR,mmill MoR., . ........... ................. TO 39Vd 30NvdnSNI­lVNdS3N 0096lv9zzz506 L6:0T 9TOZ/Tl/80 WRIM IMOR WORPAlfi W gn U-1 N'. x I 214Vv' w mm'. R,V ;M-7 ME . g ON �,�z xv Way", v NO 'q� Up mi z I ffl'l a ;IMM"ni ��m ............ 'R4 .................... .............. NAZISM R f �v gg'WE, W-M��g'�rg M M. 'g -M�ORR OWN RM.; g Fm "HE glg ROBINS ENR go, Plljrlilm\.'� T11Z 1, Na I,W .' IN p,M 10 17111171111 Ell ww"m .MINE I MINE ME= M IN— .......... .N N N N N N N N N N N� pT 11111"E" M RAIRM fNI . N I'll "All URN .......... ......... 14 -Ull EPA, HE"FaEll.-El"I'l —M,! �'�--Z""2,E., N w IR Wz RMIN F�O ogg ffig -RYMOAMAM-m, nymp, I,\- M, R" Rol ima"' "W� ATIF a ME 'N 10 SERUM, �l ON SO g g! I'M to This combination qualifies for a Federal Energy Efficiency Tax Credit when placed In service between Feb 17,2009 and Dec 31,2016. Certificate of Product Ratings AHRI Certified Reference Number:7943714 Date:4/17/2016 Product:Split System:Air-Cooled Condensing Unit,Coll with Blower Outdoor Unit Model Number:RA1660AJ1 Indoor Unit Model Number:RH1T6024STAN Manufacturer:RHEEM SALES COMPANY,INC. Trade/Brand name: RHEEM;RUUD 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,TY, UT,VA,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 reglon(s)for which they meet the regional efficiency requirement. Series name: i i Manufacturer responsible for the rating of this system combination Is RHEEM SMILES COMPANY,INC. Rated as follows In accordance with AHRI Standard 210/240-2008 for Unitary Ai;-Conditioning and Air-Source Heat P Equipment and subject to verification of rating accuracy by AHRI-sp�onson�,Independent,third party t ng: Cooling Capacity(Btuh): , 58000 EER Rating(Cooling): 13.00 SEER Rating(Cooling): 16.00 1 IEER Rating(Cooling): `Ratings followed by an asterisk(`)indicate a voluntary rerate 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 o,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 r 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.ahridirectory.org. TERMS AND CONDITIONS This Certificate and its contents are proprietary products of AHRI.This Certificate shall only be used for Individual,personal pnd confidential reference purposes.The contents of this Certificate may not,in whole or In part,be reproduced;copled;disseminated; entered Into a computer database;or otherwise utilized,in any form or manner or by any means,except for the user's individual, Aim" personal and confidential reference. AIR-CONDITIONING,HEATING, CERTIFICATE VERIFICATION &REFRIGERATION INSTIME The information for the model cited on this certificate can be verified at www.ahrldlrectory.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 listed above,and the Certificate No.,which is listed at bottom right. 13105365262M=n ©2014 Air-Conditioning,Heating,and Refrigeration Institute [CERTIFICATiNO.: AMERICAS ECONOMIC AIR COND CORP 18822 NW 48 AVE MIAMI GARDENS FL 33055 3053786168 Date: State of FL oe4 f34- County of 14-x i l —DA4N - ` r I Before me this day personally appeared V 1 'e A-�'G�e 2 whooping sworn, deposes and says: That he or she will be only person working on the project locate Y8 0 A16;r /d.5 ST Sworn to (or affirmed and subscribed before me of 20�-by Personally know Or Produced Identification 1��ldrll� Type of Identification Produced P1�77° • � Print , type or stamp Name 6f•oNotaryl, 1.0 S\VAIN,