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MC-16-2882 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-269585 PermitNumber: MC-10-16-2882 Scheduled Inspection Date: October 31,2016 Permit Type: Mechanical - Residential Inspector: Perez,JanPierre Inspection Type: Final Owner: PEEL, CATHY&JEFFREY Work Classification: A/C Replacement Job Address:487 NE 100 Street Miami Shores, FL 33138- Phone Number Parcel Number 1132060170540 Project: <NONE> Contractor: AFFORDABLE AIR& HEAT&ELECTRIC CONTRACTOR Phone: 305-770-4167 Building Department Comments REPLACE EXISTING MINI SPLIT SYSTEM Infractio Passed Comments INSPECTOR COMMENTS False U'13 Inspector Comments Passed Failed Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. October 28,2016 For Inspections please call: (305)762-4949 Page 22 of 31 i Perot Ala,M '4 '� + (.. vtoaFs Miami Shores Village ' Pennit' yt#' :'Mk � i�= f(d t1t) 1•i 10050 N.E.2nd Avenue NE W ct^ �1 ARe pla+cement Miami Shores,FL 33138-0000 Ali"MAM APPROVED Phone: (305)795-2204 �YORl4P issue Date:1{1127t2Q16 Expiration: 04/25/2017 Project Address Parcel Number Applicant 487 NE 100 Street 1132060170540 CATHY&JEFFREY PEEL Miami Shores, FL 33138- Block: Lot: Owner Information Address Phone Cell CATHY&JEFFREY PEEL 487 NE 100 Street MIAMI SHORES FL 33138-2446 Contractor(s) Phone Cell Phone Valuation: $ 2,950.00 AFFORDABLE AIR&HEAT&ELECTR 305-770-4167 ..... .. Total Sq Feet: 0 Tons: Available Inspections: Additional Info:REPLACE EXISTING MINI SPLIT SYSTEM Inspection Type: Classification:Residential Final Approved:In Review Review Mechanical Comments: Date Approved::In Review Date Denied: Type of Work:REPLACE EXISTING MINI SPLIT SYS Scanning:3 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $1.80 DBPR Fee $2.00 Ir1VOICe# MC-10-16-61757 DCA Fee $2.00 10/27/2016 Check#:3566 $71.05 $50.00 Education Surcharge $0.60 10/24/2016 Check*3539 $50.00 $0.00 Permit Fee $103.25 Scanning Fee $9.00 Technology Fee $2.40 Total: $121.05 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 AFF AVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating constructio zoning. Futhermore,I authorize the abov ed ntr or o th work stated. October 27, 2016 Authorized Signature:Owner / Applicant / Contractor / Agent Date Building Department Copy October 27,2016 1 Miami Shores Village Building Department bo Ulu i 10050 N.E.2nd Avenue,Miami Shores, Florida 33138 BBY: _ Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 2014 D BUILDING Master Permit No. C. k®^ PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ® MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP 11 ii`` CONTRACTOR DRAWINGS JOB ADDRESS: N�)q �� 1 cE5F ` City: Miami Shores /� County: Miami Dade Zip: ✓"o' Folio/Parcel#:t -�5xo - 0111 - �(C Is the Building Historically Designated:Yes NO Occupancy Type: _Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name(Fee Simple Titleholder): ��� r �- Phone#:��JC) Address-`kc) "-.,�1 ear M,1 City: KM( (Dea_n State' Zip:3 Tenant/Lessee Name: Phone#: Email: .�/� (� CONTRACTOR:Company Name:FFs�Dk+DL± . � -'� � Phone#: 6 l.d 0'n 1, /n 9 Address: � /► f Ro City:1Y/`I�p'C1y L t-- �yS��A State: Zip: ✓'✓+ ) Qualifier Name: �+ T I�-L�'y;,.lA� j� Phone#: �qW® Q;: State Certification or Registration#: (,An,00 � I ` I Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ _ Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New T Repair/Replace 1-1 Demolition Description of Work: I�LA0i��J-Wi n(QI 16 P.-IT 1,aj b Specify color of color thru tile: Submittal Fee$ �50 PPt -Permit Fee$ t CCF$ CO/CC$ " Scanning Fee$ Radon Fee$ 2- ' DBPR$ Z •®o Notary$ Technology Fee$ 2 Training/Education Fee$ . (00 Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ I (Revised02/24/2014) A � 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 rqyst be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. 1 e absen of such posted notice, the inspection will not be approved nd a reinspection fee will be charged. Signature Signature OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of C4-0 jplQ ,20 by ZQ day of 0C-k:�10,U ,20 E: .by who is personally known to JQI"J L�14,0—( ,who is personally known to me or who has produced IDL- as me or who has produced as identification and who did take an oath. identification and whoi a c r RI�FIAN 4 s CHRISTINA NOTARY PUBLIC ��� B^ � NOTARY PUBLIC 4 MY COMM f0fulDFS1359 z MY XPIRiMISSION( UG 2F 2017 61 Bond WIRES through iUt Stat�ll�lsa a e Inra a Sign Sign: Print: Print Seal: �✓"�1`l L—L Seal: APPROVED BY P ns Examiner Zoning Structural Review Clerk (Revised02/24/2014) s OP ID:AP ATE CERTIFICATE OF LIABILITY INSURANCE D10/27/22712/Y016 106 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 NAME: Amanda Pas ualini Riemer Insurance GroupPHONE FAX Hallandale Branch A/c No Ext:754-202-0883 A/C N.J:954-454-9552 PO Box 250 A DRESS:apasaqualini@riemerinsurance.com Hallandale,FL 33008-0250 PRODUCER AFFOAI1 Vita Kagan Gopman CUSTOMER ID#: INSURERS AFFORDING COVERAGE NAIC# INSURED Affordable Air&Heat,Inc. INSURERA:WeSCO Insurance Co. 515 NE 190 Street Miami,FL 33179 INSURER B: INSURERC: INSURER D: 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. INSR TYPE OF INSURANCE ADDL UB POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MM/DD/YYYY MM/DD GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY X WPP1055018-04 03/17/2016 03/17/2017 DAMAGE TO RENTED 100 000 PREMISES Ea occurrence $ , CLAIMS-MADE Fx_1 OCCUR MED EXP(Any one person) $ 5,00 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY PRO- JECT RO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE HIREDAUTOS (PERACCIDENT) $ NON-OWNED AUTOS $ UMBRELLA LIAB HOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N TORY LIMITS I i ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? F7N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Addlfional Remarks Schedule,If more space la required) Air Conditioning Contractor; Service, Installation & Repair// Miami. Shores Village is named as additional insured. CERTIFICATE HOLDER CANCELLATION Miami Shores Village MIAMSH1 g SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Building Department THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 10050 N.E.2nd Avenue ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores Village,FL 33138 AUTHORIZED REPRESENTATIVE ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD ACORO® DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 10/27/2016 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 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 Greta Nielsen NAME: Corporate Insurance Advisors PHON o . (954)315-5000 FAAX No:(954)315-5050 M.1401 E Broward Blvd ADORIEss:service@ciafl.net Suite 103 INSURER(S)AFFORDING COVERAGE NAIC# Ft. Lauderdale FL 33301 INSURERAAssociated Industries Ins Co 23140 INSURED INSURER B Affordable Air b Heat, Inc. INSURER C: 515 NE 190TH ST INSURER D: INSURER E: MIAMI FL 33179 INSURER F COVERAGES CERTIFICATE NUMBER:CL168518078 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. I�7R TYPE OF INSURANCE ADDL SU POLICY NUMBER MM/DD EFF POLICY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE FIOCCUR DAMAGE ( RENTED PREMISES Ea occurrence) $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY❑PRO- JECT ❑ LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident UMBRELLA LIABOCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X I PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY OFFICER/MEIMBEREXCLUDD�ECUTIVE � N/A E.L.EACH ACCIDENT $ 500,000 A (Mandatory In NH) ANC1067925 8/8/2016 8/8/2017 E.L.DISEASE-EA EMPLOYE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) RE: License #CAC048111 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Building Department ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2 Ave Miami Shores, FL 33138 AUTHORIZED REPRESENTATIVE Mark Schwartz/NICOLE "� �' ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025 t7nunrn ,yes Miami Shores Village Building Department ..,. ,n„M 10050 N.E.2nd Avenue b Miami Shores, Florida 33138 Tel: (305)795.2204 Fax:(305)756.8972 FZIF,C AIR CONDITIONING REPLACEMENT DATA OCT 4 2016 PERMIT NUMBER: MC rm 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):LjEo KE to 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.E.M.A MINIMUM FLOOD ELEV.ATIQN 0 6•.6.6 A COPY OF THE CONTRACT IS REQUIRED WITH ALL SUBMITA&•6 Goes •• AHRI DATA SHEET REQUIRED 066.60 0.00•• Change disconnecting means:YES❑ NO 14 ARHI Sheet Attached:YES NJ NO❑ ra Att0HQti:•YES�... ...... .... ..... UNIT BEING REPLACED DATA 06 MEW UNIT". •60.:0 �l_IlTbu MANUFACTURER • • • AHU or PKG.UNIT MODEL# Lbl�j 6"'0 •..... CON D.UNIT MODEL# LWI �/•••• • • KW HEAT ftip •• NOM TONS ®l- AHqa CU /® PKG 1)M.C.A AHU20 CU/0 PKG AHU 15 CU 15 PKG 2)M.O.P AHU $' CU-/ PKG AHU /S CU /S PKG 3)VOLTS AHU//1 CU X PKG PKG UNIT / / PKG UNIT EER/SEER / YES NO REPLACING DUCTS YES NO YES NO REPLACING THERMOSTAT YES NO YES NO NEW 4"CONCRETE SLAB YES NO YES NO NEW ROOF STAND YES NO YES NO NEW RETURN PLENUM ��BOX �� YES NO 1. Minimum Circuit Ampacity(Wire Size): --W1 2 T+h4ly 2. Maximum Overcurrent Protection (Fuse/Breaker Size): A192 3. Voltage of Circuit(208/240/480): 1Q-0 V 4. Size Disconnecting Means: jo Contractor's Compa5gistrat* ' Phone: 30rQL4D� n State Certificate or R No. Certificate of Competency No. Signature Date: 10•� ° (Qualiflees gnature) (Revised02/24/2014) 0000.. 0000.. . . • 0000 .. • . . 00000 . 0000 0000.. . 0000.. ..... ... .0000 . . 0000. .. . 0000 0000. ...... 0000.. 0000 00*000 • 0000.. .0000. . . 0 . 0000.. 00.00. . . . . . .000 . .. >Sisps 62420 ,. II��'III� —Where Quality(Service is Affordable— 515 N.E.190th t•Miami,FL•33179 CPr;04g11 Dade(305) 9-0 •Broward(954)987.9943 PRIMARY,*'-,, } s3i 4E17U y : NAME J0'`8t CiyJt � � STiEEtYy 487 rte0f $ `` .r x -- -- --- + EQUIPMENT SCHEDULE PE11,MIK f"1111%P80,100 94101awftlol DESCRIPTION OF SERVICES PFFUF011�11 tRtwTtoNt i 1tsh.fidll i� i,r_ - iamb,fin,fig tfAtn , ;; _.. ,. ' 4>+_, 0000•• rrt • • 4s"s� ' -- •ii••• '-• •• 0000•• •��•i a i� • • • • •• 0000• 01 a eve mere dice r sins with Affordable Air and Heat.Inc. • • 111i�DISTRIBUTION: cella n - fault in any termodil lnR Eontract,the 0••• 00000 Ductwork will be designed,fabricated and Install in ac dance wflh aelier sh a to mediate possessio ofs lherchand" and full amou o rice then unpaid she �� i • •••••• accepted engineering TI Become immediately • p g g practices end In compliance iitlt aR1<flding cad &Palny a a s4"'on without notice or dar•am4k6*monies paid • •forte nn above date. ahwnted damages.In thefwentlhe a9rvices of an •QUCT W altoa requi terest of the sellerothe purcttaser shall% � •••••• System of flax/flber and/or r1/8 dUClWO requpay as anomey'Aces together wilih interest and all costs • • theret N artan`y' +rvice shall be peed on accoantgwNh all outstanding 000000 outlets and rV a returns.Subject t nw cation aeeor total b arrAnty excl des,existing ,ctwork,existRVifeiectfIcal syste 3 •• • • or other requirements- r v maint e rant airs. �' • • •11 • ),�QR WARRANTY: �� In th nt the rchaser refuses to a w seller to commence work after Service will be provided free by usffor period of A Ort@ B n ct face executed haler s be responsible to the seller for 2 r he to pric led and d damages.Seller shall not be year(s)from date of Indanatlon during r pular working days& urr resp for ext building or el code violations. M&NVF_A f WARRANTY' ' .q tAll terial gu an to be at spec .All work to be completed In a �-.� o a ner acc d� to sta rd Parts Warranty � practices. Any alteration or (Yrs) A flV@ a comract spbcificatio olving extra costs I be executed Compressor Warranty(Yrs.) A S@ ars and will be$b as v nd abo is estimate. �tQELIQED WARRANTY: '� �1` �j Provided through ...yea.(i� � i 1 Initial H AFFnr,DABLE AIR&HEAT,INC.WILL PAOVIf YES NO OE YE El �N CpNC SLABt ' YES NO EXISTING INSTALLATION OF EQUIPMENT REFRIGERATION LINES( )OR FLUSH i�x �, �/ THERM l7 n GRILLES( )RETURNS( ) ,` 8 BALAN / B PERMIT FEE(S)&PLANS,IF REQUIRED ❑ ❑ REMOVAL.* 0 1EtQ Q D DRAIN PIPING( )OR FLUSH(X ) " Q ELECTRI WIRING(P0 CQ OL) 11 11 Q AIR HANDLER SUPPORTS d CONNECT EXLSRVICIVPANELS Q CONDENSATION PUMP OAR rJ a ❑- EMERGENCY FLOAT SWITCH a THEir— / a HURRICANE TIE-DOWNS O 2SOU, sq Q i/'Yv`�.1`:�'U,�,,Id'�' 'y> U '. ytttfnt to,.b�ftlIb as,ft�fi�I Wit "x' d Aie�ios)t ;b�'1(�Ttgel�oLr��s�atR�+ r� �► ir c� �1dau a »is rr p�sa�l{-s'00to x d i� ►o ('#a xf3 t t sx'aat tom,(!0-0100 W 1 o�?ASts�IFaTtf�LIIDEdfi�!EJ�� ` tirt ...... ...... .... ...... 0 es ..... .. . .... ..... .... ...... ...... .... .. .. ...... . . . . CERTIFIED 1 ry.1 Cer0iiifficate of Product Ratings AHRI Certified Reference Number: 7065150 Date: 10/24/2016 Product:Variable Speed Mini-Split Heat Pump,with Remote Outdoor Unit Air-Source, Free Delivery Outdoor Unit Model Number: LSU120HXV Indoor Unit Model Number: LSN120HXV Manufacturer: LG ELECTRONICS, INC. Trade/Brand name: LG Series name: Manufacturer responsible for the rating of this system combination is LG ELECTRONICS, INC. Rated as follows in accordance with AHRI Standard 210/240-2008 for Unitary Air-Conditioning WMIr-Somme, • Heat Pump Equipment and subject to verification of rating accuracy by AHRI-sponseped,•Independent,third 0 party testing: 000000 0000 0000.. 000000 0000.. 000000 0000 . .. . Cooling Capacity(Btuh): 12000 000000 00.• 0000.. 0000 EER Rating (Cooling): 10.50 0000.. . 0 000000 SEER Rating (Cooling): 17.00 000000 r- : 0 0000 Heating Capacity(Btuh)@ 47 F: 13000 1 �� •••0 • Miami ShcresVilla ge •• Region IV HSPF Rating (Heating): 9.00 Heating Capacity(Btuh)@ 17 F: 8000 APPROVED BY DATE rN ZINING DEPT i_Dr DEPT J_�JLCT i'O CCNIP114 NCE W1 TIi ALL FEDERAL ",-c ANL)C( IiN I f Hl,LES AND RF70ULATIONS CERTIFIED RATINGS FOR VARIABLE-SPEED,MINI-AND MULTI-SPLIT SYSTEMS ARE VALID FOR ALL COMBINATIONS OF INDOOR UNITS (BASED ON COMBINATION TYPES)WITH THE SPECIFIC OUTDOOR UNIT LISTED ABOVE AND IN THE AHRI DIRECTORY OF CERTIFIED EQUIPMENT.VISIT WWW.AHRIDIRECTORY.ORG TO VERIFY THAT THIS COMBINATION IS AN ACTIVE LISTING AND THE DATA LISTED ON TMS CERTIFICATE IS ACCT RATE.SEARCH ON THE F HRI R% CE#TO QUICKLY LWCVF$THI,C9MBINA.TION IN THE DIRECTORY. atmgs fo lowed by an asterisk( indicate a voluntary rerate of pre ously pu lis ata,unless accompanied a A ,whic in icates 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 liability 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.ahridlrectory.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; 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-CONDITIONING,HEATING, CERTIFICATE VERIFICATION &REFRIGERATION INSTITUTE The Information for the model cited on this certificate can be verified 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 listed above,and the Certificate No.,which Is listed at bottom right. ©2014 Air-Conditioning, Heating,and Refrigeration Institute [CERTIFICATE NO.: 131217939033588969 r IA71'• 1M IAMT-DADF COUNTY a,7l PRODUCT CONTROL,SECTION 11805 SW 26 Street,Room 208 D'F,—, A RTMENT OF REGULATORY AND ECONOMIC RESOURCES(RER) Miami,Florida 33175-2474 BOA 71)AND CODE ADMTNISTRATION DIVISION T(786)315.2590 F(7A)315-2599 N07ffCE OF ACCEPTANCE (NOA) www.mlarnldnde.¢ov1eeonomy Rh­n Sales Company,Inc. 56110 TNd Greenwood Rd. Fort Smith,AR 72917 So7or'F: This NOA is being issued under the applicable rules and regulations governing the use of constniction materials. The documentation submitted has been reviewed and accepted by Miami-Dade Count,RER-Product Control Section to be used in Miami Dade County and other areas where allowed by the Authority Having Jurisdiction(AHJ). This NOA shall not be valid after the expiration date stated below. The Miami-Dade County Product Control Section (In Miami Dade County) and/or the AHJ(in areas other than Miami Dade County) reserve the right to ha»e this product or material tested for quality assurance purposes. If this product or material fails to perform in the accepted manner, the manufacturer will incur the expense of such testing and the AHJ may immediately revoke, modify, or suspend the use of such product or material within their juris atiba. RER reserves the right to revoke this acceptance, if it is determined by Miami-Dad; County PAdu c t ControT• • Section that this product or material fails to meet the requirements of the applicable tole jdlrg cod*„••• ••••;• This product is approved as described herein,and has been designed to comply witll,tW Worida Budding Codi.. including the High Velocity Hurricane Zone. sees .. :0060: . . e DR,1):RIPTION: Mechanical Unit Steel and Aluminum Tie-Down Clips for GrAd;'nd Rooft00u• 00:0 ApplicotionA00 0 00 00 se sees 000000 Ar7OVAL DOCUMENT:Drawing No. 15-2543GA,titled"Wind Load Certifigatippf Mechanical Unit •0 Cahinctry and Steel/Aluminum Tie-Down Clips:At Grade and Roof Mounted AppIrcatiorfs", sh@ets L e 0060:9 through 7 of 7,dated 05/14/2015,revised on 11/20/2015,prepared by Engineering 1;xpre'sx,signed and scaled.e e e by Prank L. Bennardo,P.E., bearing the Miami-Dade County Product Control approval stamp wit�tiut:Notice of A cr,�ptance number and approval date by the Miami-Dade County Product Control Section. Mr'9c7LE IMPACT RATING: None EA'1171 LING:.Each unit shall bear a permanent label with the manufacturer's name or logo, city, state, model/series, and following statement: "Miami-Dade County Product Control Approved", unless otherwise noted 1--:rein. RENEWAL of this NOA shall be considered after a renewal application has been filed and there has been no change in the applicable building code negatively affecting the performance of this product. T1K'RW7NATI0N of this NOA will occur after the expiration date or if there has been a revision or change in the matcriat4, use,and/or manufacture of the product or process.Misuse of this NOA as an endorsement of any product,for sales, advertising or any other purposes shall automatically terminate this NOA.Failure to comply with any section of this NOA shall be cause for termination and removal of NOA. ,ADVERTISEMENT: The NOA number preceded by the words Miami-Dade County, Florida, and followed by the expiration date may be displayed in advertising literature. If any portion of the NOA is displayed, then it shall be done in its nr"irety. IN8T"ECTION: A copy of this entire NOA shall be provided to the user by the manufacturer or its distributors and shall h available for inspection at the job site at the request of the Building Official. This NOA consists of this page I and evidence page E-1,as well as approval document mentioned above. The submitted documentation was reviewed by Carlos M. Utrern,P.E. ��DE NOA No. 15-0903.08 Expiration Date:February 25,2021 Approval Date:February 25,2016 Pagel 0000.. •0000• . • 0 0000 . .• • . • 0000•0 0000 0000.• • oee 0000•• • • . •• 0000 • . . • 0000. .. . 0000 0000. 0000 0000.• • 0000.• 0000 000000 • . . •••••• 0.0000 • 0 0 • 0000•• • . . • • 00000. . . • • t E1aTTM., Sales Com-Any,Inc NOTICE OF ACCEPTANCE: EVIDENCE SUBMITTED A. ,DRAWINGS 1• Drawing No. 15-2543GA, titled "Wind Load Certification of Mechanical Unit Cabinetry and Steel/Aluminum Tie-Down Clips: At Grade and Roof Mounted Applications", sheets 1 through 7 of 7, dated 05/14/2015,revised on 11/20/2015, prepared by Engineering Express,signed and sealed by Frank L. Bennardo, P.E. B. TESTS 1• Test report on Uniform Static Air Pressure Test per FBC, TAS 202-94 along with marked-up drawings and installation diagram of Rheem RA Series Mechanical Units, prepared by American Test Lab of South Florida, Test Report No. 0323.01-15, dated 05/18/2015, signed and sealed by Stephen W. Warter, P.E. :-0-:- .. . ---- 0 0 0000.. 0000 0000.. C. 'CALCULATIONS 0 0 0.0 0 0 • :0000: 1• Anchorage calculations prepared by Engineering Express, dated 1 J 0 U/20150.,Isi g hed 0000o and sealed by Frank L. Bennardo, P.E. 000000 0000 00:000 .. .. ---- 0000:0 0000.. . 0 . . . . 0000. I). QUALITY ASSURANCE 0.0 0 .. R• Miami-Dade Department of Regulatory and Economic Resources(AAR) -0 0- :0 0 0 0 0.. . E. `14ATERIAL CERTIFICATIONS None. F. STATEMENT Statement letter of code conformance to the 51h edition(2014) FBC issued by Engineering Express, dated 08/24/2015,signed and sealed by Frank L. Bennardo, P.E. 2. Statement letter of no financial interest issued by Engineering Express, dated 11/20/2015, signed and sealed by Frank L. Bennardo, P.E. 3. Distributor agreement dated 11/12/2015. 4�02 Carlos M.Utrera,P.E. Product Control Examiner MOA Mo. 15-0903.08 Expirntion Date:February 25,2021 Approval Date:February 25,2016 E-1 0000•• 0000•• • • • • •••• • •• 0000•• 0000 0000•• • • • • 0000•• 0000•• • • • •• 0000 0000• •• • 0000 0000• 0000 0000•• • • • ••w••• 0000 •• •• • • • •••••• 0000•• • • • • 0000•• 0000•• • • • • • 0000 • •• u 2 ^ ,� awN; wO�� rOpZZa yt3� yLL°Z�j Q�" 3t�YWw Z�`w' w�Caz,,, ,.m � rogo08 mwNt� ��� ea J�§� R0 O�t.1u $�va �o�omay ►+y v W .aZ h J h J ® rn �wKhEZ VNfZ-Q 7oZth _ �W. W �O OCa'N gOm W h.N.a W h ag Oxg cn , W3 w NN oz Q N aCmx2 ka�r�� Jzu ,t"- aOQz g SrZUZ J.r-�v� ° r/tw O ph0 UN yz F-i. ,u x N`��. t7 c7 ao w 'ae.z�i`J� ►- r waC aocz WJZ F. 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