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MC-16-2776 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores,FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-271119 Permit Number: MC-10-16-2776 Scheduled Inspection Date: November 16,2016 Permit Type: Mechanical - Residential Inspector: Perez,JanPierre Inspection Type: Final Owner: TADDEO, FRANK Work Classification: A/C Replacement Job Address:341 NE 92 Street Miami Shores, FL 33138- Phone Number (305)758-7493 Project: <NONE> Parcel Number 1132060136380 Contractor: ANACHRIS A/C& REFRIGERATION INC Phone: 305-899-1187 Building Department Comments CHANGE OUT A 2 TON AND 4 TON, SPLIT AIR Infractlo Passed Comments CONDITIONING SYSTEM. INSPECTOR COMMENTS False Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-268868. need to make 1st floor air handler accessible for service Failed Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid November 15,2016 For Inspections please call: (305)762-4949 Page 24 of 34 � s r, Miami Shores Village ,a3ii �� nt� 10050 N.E.2nd Avenue NE UVfl�'�O Miami Shores,FL 33138-0000 Phone: (305)795-2204 � � Expiration: 04/19/2017 Project Address Parcel Number Applicant 341 NE 92 Street 1132060136380 FRANK TADDEO Miami Shores, FL 33138- Block: Lot: Owner Information Address Phone Cell FRANK TADDEO 341 NE 92 Street (305)758-7493 MIAMI SHORES Fl-33138-3133 Contractor(s) Phone Cell Phone Valuation: $ 9,465.00 ANACHRIS A/C 8,REFRIGERATION IN 305-899-1187 Total Sq Feet: 0 Tons:6 Available Inspections: Additional Info:CHANGE OUT A 2 TON AND 4 TON,SPLIT 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 $6.00 Invoice# MC-10-16-61635 DBPR Fee $4.97 10/21/2016 Credit Card $321.21 $50.00 DCA Fee $4.97 Education Surcharge $2.00 10/13/2016 Credit Card $50.00 $0.00 Notary Fee $5.00 Permit Fee $331.27 Scanning Fee $9.00 Technology Fee $8.00 Total: $371.21 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 accur d that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore,I authorize the above-named contr o dlo the work stated. October 21,2016 Authorized Signature:Owner / Applicant / C ntr ctor A ent Date Building Department Copy October 21,2016 1 �� • Miami Shores Village RECEIVED Building Department cT 3 1016 g p n 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 r— T4 FBC 2®N BUILDING Master Permit No. MC PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL r-1 PLUMBING ® MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 3S�1 • �r�Nd S/ City: Miami Shores County Miami Dade Zip: 3Z'5� Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder):_ _� A) �41� C Phone#: Address: 3 `/l A��, - / City: o�;y, /i State: Zip: Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: �ti « r /� Phone#: ��S g�7 —11T7 . Address:�j City: /�5 iSC''f/©�/ � E'K Stater �`_� Zip: Qualifier Name: :f5 z leC51- � �: l�� � Phone#: State Certification or Registration#: Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: _ City: State Zip: Ci G% Value of Work for this Permit:$ "7 . Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace ❑ Demolition Description of Work: %/ci Specify color of color thru tile: Submittal Fee$ Permit Fee$ d���� CCF$ ^� CO/CC$ Scanning Fee$ Radon Fee$ U DBPR$ •Cl Notary$ 0 Technology Fee$ .� ining/Education Fee$ 2 Double Fee$ Structural Reviews$ Bond$ ® g TOTAL FEE NOW DUE$ 1 B 1 (Revised02/24/2014) i ti 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: 1 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 occ (7) days after the building permit is issued. In the absence of such posted notice, the inspection will of be approve nd a insp ction fee will be charged. nature Signature O R or AGENT CO RACTO �J The foregoing ins ment a acknowledged before me this The foregoing instrument was ackn edged before me this day of �� v 20 16 by 13 day of OMOOF--- 20 I by )—tv {w CC T vi-ho is personally known to who is personally known to me or who has produced as me or who has producedT identification and who did take an oath. identification and ho did take an oath. NOTARY PUBLIC: - NOTARY PUBLIC: Sign. Sign: Print '•. H TO MnRwn Print Q MMY pf:"• nCOMMI EXPIRE SS :SMIOaNy I2F1F2002011750 Boddr oPobLcUndervtlrs Seal: 'PpY R No�ry Public State of Florida ° Sindia Alvarez �, My Commis sio2018156750 ****************** ******************************************************* **k **FF `* 21 * APPROVED BY W 1 Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) AC R® 100/111111/201166 CERTIFICATE OF LIABILITY INSURANCE DATDJ 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(ies) 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 NAME: GEICO Insurance Auency,Inc. GEICO Insurance Agency,Inc. �c N Ext): 877-515-2191 FAC No): PO Box 5316 E-MAIL Binghamton,NY 13902 ADDRESS: commercialserv' omesite com INSURER($)AFFORDING COVERAGE NAIC# INSURER A: Midvale Indemnity Company 27138 INSURED INSURER B: ANACHRIS AIR CONDITIONING S REFRIGERATION,INC. INSURER C: 821 NE 109TH STREET INSURER D: MIAMI FL 33161INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:013858100095421013 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 W ADD'SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSR WVD MMlDD1YY DryYYYI GENERAL LIABILITY EACH OCCURRENCE $1,004,000 A X COMMERCIAL GENERAL LIABILITY Y N GLP1001038 06/03/2016 06/03/2017 PREMISES DAMAGE ToEa ocamerx a $100,000 CLAIMSMADE Xl OCCUR MED EXP(Arty one person) $10,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,444,004 GEN'LAGGREGATE LIMIT APPLIES PEFt PRODUCTS-COMP/OPAGG $2,400,044 X POLICY JPER LOC CT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ANY AUTO BODILY INJURY(Per person) ALL OWNEDSCHEDULED BODILYINJURY AUTOS AUTOS Per acc HIREDAUTOS NON-OWNED PROPERTY DAMAGE AUTOS (Peraccident) IDERELLA LIAR UR EACH OCCURRENCE$ ESS LIAB IMS-MADE AGGREGATE D I I RETENTION$ MARKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N TORY LIMBS I ER ANY PROPRIETOWPARTNEWEXECU -TIVE OFFICERIMEMBER EXCLUDED N/A E.L.EACH ACCIDENT (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE If yes,describe under DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT PROFESSIONAL LIABILITY OCCURRENCE AGGREGATE DESCRIPTION OF OPERATIONS!LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,N more space Is required) Heating,Venting and Air Conditioning Services CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED MIAMI SHORES VILLAGE BUILDING DEPT BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2nd AVE AUTHORIZED REPRESENTATIVE MIAMI SHORES FL 33138 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marcs of ACORD BID 013 20130603 Page 1 of 1 JEFF ATWATER CHIEF FINANCIAL OFFICER STATE Of FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS'COMPENSATION **CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS'COMPENSATION LAW CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers'Compensation law. EFFECTIVE DATE: 10/12/2015 EXPIRATION DATE: 10/112017 PERSON: NUNEZ SERGIO R FEIN: 650403009 BUSINESS NAME AND ADDRESS: ANACHRIS AIR CONDITIONING$REFRIGERATION INC 821 NE 109 ST MIAMI FL 33161 SCOPES OF BUSINESS OR TRADE: HEATING,VENTILATION, AIR-GOND Puasramt to Chapter 440.05(14).F.S.,an officer of a corporation who ekxft exemption from this chapter by fil ft a certificate of election under this section may not recover benefits or cornpersation under this chapter-Pursuant to Chapter 440.05(12),F.S..Certificates of election te be exempt..apply only w6tih the scope of the business or trade feted on the rine of election to be exempt Pu rsuard to Chapter 440.05(13),F.S..Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if,at any time atter the filft of the notice or the issuance or the certificate, the person named on the notice or cerlificete no longer meets the requirements of this section for issuance of a certificate.The department shall revoke a DFS+243VW-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS7(830)413-1609 1) Ana ThRIS Air Conditioning and Refrigeration Inc. 821 N.E. 109 Street • Miami, FL. 33161 •Tel.: (305) 899-1187 • Fax: (305) 899-1187 Date: rid 11326(� State of Florida County of Miami-Dade Before me this day personally appeared SERGIO NUNEZ who,being duly sworn,deposes and says: That he or she will be the only person worldng on the project located at 341 NE 92nd Street. Sworn to (or affirmed) and subscribed before me this day of()Q�EC 2016, byGtO N UNC Personally know OR Produced Identification Type of Identification Produced (2.(VEV- J'1CR45F' Dog.°P&e< Notary Public State of Florida ' Sindia Alvarez p `aQ My Commission FF 156750 mop Expires 09/03/2018 Print,Type or Stamp Name of Notary own Miami shores Village yid Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305)795.2204 Fax: (305)756.8972 Notice to Owner-- Workers' Com nsation Insurance Exemption NO _ ,e• 3 -� a-' '' .�z <.', q, a"q- xI 10i a,t 4r`�.�`yi., ky"'"r<'z -c^z .a� 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-fame or foil 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 pepnit 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 f1roT940 contractor's company for day labor,part-time employees or subcontractors. BY SIGNING BELOW YOU ACKNO GE YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature: ner State of Florida County of Miami-Dade The foregoing was acknowledge before me this J(Y day of By. -Trt Jdf o who is personally knownto me r has produced as identification. r�� H Notary. MY C0MM1SS10N#FF 02�AUBERTOMORENp01 SEAL: HUMB EX oN#� ISD ��U bot P°bge Undenrr�rg L �--` 15' ALLEY (per- plat) SITE LOCATION a A5 h�l�a±��( -- _�._. - - 1,"�,, n!rs l od o0 50.0' 50.0' � It. 30.n'n.s c�3 • �\0 v 0� Lt` 6La 1 o Lv �OS [ Z a' J} c1 1f1 LLI 'r zQ j N CD �1 o �/ ��c C-A / tJ 0 m m Br;r-k woil 11.2' Br�c4 teals c U) r '' 3 N cS 1L� -c o OO ° 50.0' 50.0' N , 2vo.a _ - I OD.OQ' 1 1 Ln '. N.E. 92nd STREET 75' Right-of-Way 1$ A5 p ha_Jb NOT VAUD WITHOUT SHEET /OF 2 ATTACHED �n It NnARY SURVEY DATE REY/S/ONS DATE 06108104 �"�` OW YER . y �5t!O Rmss p Miami Shores Village Building Department Ross n... 10050 N.E.2nd Avenue Miami Shores, Florida 33138 iigjARt©p; Tel: (305)795.2204 Fax:(305)756.8972 AIR CONDITIONING REPLACEMENT DATA PERMIT NUMBER: MC A 6'2- 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): -3'-I'r A)-&f- -� 5 77 City: Miami Shores Village County: Miami Dade Zip Code: '�33 MR 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 Z ARHI Sheet Attached:YES ❑ NO ❑ Contract Attached:YES ❑ UNIT BEING REPLACED DATA NEW UNIT MANUFACTURER AHU or PKG.UNIT MODEL# &P m A®A 19/4I I I COND. UNIT MODEL# 4A71A ® z A KW HEAT NOM TONS 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 N OLS ts) . EER/SEER I b .5 `L YES NO REPLACING DUCTS YES O YES NO REPLACING THERMOSTAT E NO YES NO NEW 4"CONCRETE SLAB ES NO YES NO NEW ROOF STAND Y-K NO YES NO NEW RETURN PLENUM BOX YES O 1. Minimum Circuit Ampacity(Wire Size): A l& '4(yp . 2. Maximum Overcurrent Protection (Fuse/Breaker Size): 3. Voltage of Circuit(20 /240 480): 4. Size Disconnecting Means: Contractor's Company Name: /J,4 IS' Phone: -3 State Certificate or Registration No. 2 `� g' ! Certificate of Competency No. e Signature �— Date: 11� feZ (Qu flee' signatur (Rev1sed02/24/2014) REs L� Miami Shores Village Building Department •••• MIN 10050 N.E.2nd Avenue Miami Shores, Florida 33138 yjrR �e 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): 7L City: Miami Shores Village County: Miami Dade Zip Code: �1�S' 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 to ARHI Sheet Attached:YES ❑ NO ❑ Contract Attached:YES ❑ UNIT BEING REPLACED DATA NEW UNIT MANUFACTURER /t, P i AJ -;;77 AHU or PKG. UNIT MODEL# (9-A&l X71' 0=10(i M.3 f g COND. UNIT MODEL# qr9 Z4 &0 17XI 0 oo (,lJ KW HEAT _S_AG 14-2 . NOM TONS q%®,4J 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 U 6PKG PKG UNIT / / PKG UNIT L)tj "0 Gc, j EER/SEER /(o YES O REPLACING DUCTS YES O YES O REPLACING THERMOSTAT ES NO YES NO NEW 4"CONCRETE SLAB YES NO YES NO NEW ROOF STAND YES NO ' YES N NEW RETURN PLENUM BOX YES NO 1. Minimum Circuit Ampacity(Wire Size): 2. Maximum Overcurrent Protectionuse Breaker Size): 3. Voltage of Circuit(208 40 480): 4. Size Disconnecting Means: ��'✓�'!�� J1 'S Contractor's Company Name: C-L Phone- Q Z96 _/906)_/906)State Certificate or Registration No. a A 5-9k Certificate of Competency No. Signature _ Date: 6 (Qualifl s sig)ture Cj (Revised02/24/2014) f .r• Ana a- /hiz]'S Air Conditioning and Refrigeration Inc. 821 N.E. 109 Street • Miami, FL. 33161 • Tel.: (305) 899-1187 • Fax: (305) 899-1187 Name/Address Estimate Frank J.Taddeo 341 NE 92 Street Miami Shores,FL Date Estimate# 8/31/2016 140 Description Total We respectfully propose to supply and install two American Standard split air conditioning systems, in replacement of existing,as follows: Downstairs: 5,280.00 16-SEER,4-ton American Standard condensing unit model #4A7A6049J1000A,air handler model#GAM5BOC42M31 SB Upstairs: 4,185.00 16.5-SEER,2-ton American Standard condensing unit model #4A7A6024J1000A and air handler model#GAM5AOA18M11SA Both units will be connected to existing ductwork, electrical and condensate piping. Existing refrigerant lines will be flushed to accept the new 41 Oa refrigerant and drain overflow switches will be installed on both units. Concrete slabs will be replaced on each outdoor condensing unit. New digital thermostats will be installed to control each unit. Each system comes with a 10-year parts and compressor warranty and a one-year labor warranty. Permit fees are not included. 60%due on acceptance; balance due upon completion. Total $9,465.00 Signature