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MC-13-170Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 184911 Permit Number: MC -1 -13 -170 Scheduled Inspection Date: February 20, 2013 Inspector: Perez, JanPierre Owner: DOWSON, ALFRED & NANCY Job Address: 252 NE 104 Street Miami Shores, FL 33138 -2016 Project: <NONE> Permit Type: Mechanical - Residential Inspection Type: Final Work Classification: A/C Replacement Contractor: JOSE C YANE AIR CONDITIONING & APPLIANCES SERV INC Phone Number Parcel Number 1121360130330 Building Department Comments AC 3 TON CHANGE OUT 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. February 19, 2013 For Inspections please call: (305)762 -4949 Page 11 of 38 I t 11 131iU a�n. Miami Shores Village Building Department 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 APPLICATION FBC 20 JAN 2 9 2013 Permit No no 5-4-70 Master Permit No. Permit Type: MECHANICAL OWNER: Name (Fee Simple Titleholder ) : ��� /�� ��f�j � adilIiPhone#: /0e6-6�s�"41®/1 Address: 2 0,1' /V £ J s f City: - /2.ecS State: Zip: Tenant/Lessee Name: Phone#: Email: f e JOB ADDRESS: a-C-Z /YE, / V City: Miami Shores County: Miami Dade Zip: /.2 Folio/Parcel#: Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: al' -t= ,� 1"/k aryi phone# Z.T -429 J Address: ®-2 / %-3 City: /V- A /4//if4e i State: �� gip; �� /i %If Phone woe-6 T v� Qualifier Name: State Certification or Registration #: Certificate of Competency #, Contact Phone #: DESIGNER: Architect/Engineer: Email Address c 'MW r. BC t c /%&(L ®l' Phone#: Value of Work for this Permit: $ I 69 0 Square/linear Footage of Work: Type of Work: OAddress DAlteration New °Repair/Replace ODemolition Description of Work: '9 e„. _ TN d/f¢i/ (I. ********** * * * *** ****** * * * * * ** * *** * * * * **F. *** * * * ** ***+ * *w ***** ** ** * *** * * * * * * ** * * * ** Submittal Fee Permit Fee $ Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ CCF $ CO/CC $ DBPR $ Bond $ Technology Fee $ TOTAL FEE NOW DUE $ 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 ELECTRICAL 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 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 appr1 ed • ' a reinspection fee will be charged. Signature The fo day of who is Signature Owner or Agent oing instrument was acknowled ed before me this °. �() The foregoing instrument was acknowledged before me this 20A, by alp Oyu" D94051714, day of 208_, by OS-e , kno to me or who has produced who i : {, - o to me or o has produced Contractor As identification and who SARA MONTERO MY COMMISSION # EE022532 •h EXPIRES September 01, 2014 7) 398-0183 9 FbridallotaryService.com NOTARY PUBLIC: Sign' Print: My Commission Expires: ****** * * * * * * * * * * * * * * * * * * *' * * * * * *,; * ** APPROVED BY as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission E * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Examiner Structural Review (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) S " M1dCrw LIRO %" �ivlfUti.�iSifJAI # F027532 EXPIRES gepterrbor r)1, 2014 398 -0183 FlasiugNn:: rv:;avirn,gtiu ** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Zoning Clerk Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 AIR CONDITIONING REPLACEMENT DATA PERMIT NUMBER: MC J ® V r 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) : "'IS / a y sr- City: Miami Shores Village County: Miami Dade Zip Code: a 3 1 A -I? 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 ARI (AHRI) DATA SHEET REQUIRED Change Disconnecting means: YES Q NO gi ARHI Sheet Attached: YES NO ❑ Contract Attached: YES UNIT BEING REPLACED DATA NEW UNIT /' gt MANUFACTURER ; D t4 X Ai AHU or PKG. UNIT MODEL # Au i=3,1 4 / cF» COND. UNIT MODEL /30,56 KW HEAT 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 V/ — / 3 °° YES NO REPLACING DUCTS YES NO YES NO REPLACING THERMOSTAT YES fr# NO YES NO NEW 4 5CONCRETE SLAB YES / NO _ YES NO NEW ROOF STAND YES NO /V YES - NO NEW RETURN PLENUM BOX YES NO P 1. Minimum Circuit Ampacity (Wire Size): 2. Maximum Overcurrent Protection (Fuse/Breaker Size): V Q 3. Voltage of Circuit (208/240/480): 4. Size Disconnecting Means: Contractor's Company Name: 04-hot. Phone:7 p 6 pa "c7A State Certificate or Registration NE-41-6,--f? «"97 (/ Certificate of Competency N. Signature Date: 77,4 0 /13 ■ 111119101011011 .�.■ Certificate of "rd uct atins AHRI Certified Reference Number: 5360206 Date: 1/29/2013 Product: Split System: Air - Cooled Condensing Unit, Coil with Blower Outdoor Unit Model Number: GSX130361 B* Indoor Unit Model Number: ARUF36C14A* Manufacturer: GOODMAN MANUFACTURING CO., LP. Trade /Brand name: GOODMAN, JANITROL, AMANA DISTINCTIONS, EVERREST, ONE HOUR AIR CONDITIONING AND HEATING, ENERGI AIR Manufacturer responsible for the rating of this system combination is GOODMAN MANUFACTURING CO., LP. Rated as follows in accordance with AHRI Standard 210/240 -2008 for Unitary Air - Conditioning and Air - Source Heat Pump Equipment and subject to verification of rating accuracy by AHRI- sponsored, independent, third party testing: Cooling Capacity (Btuh): 33000 EE.R Rating (Cooling): 11.00 SEER Rating (Cooling): 13.00 * 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 to, and assumes no responsibility for, the products) 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.ahridirectory.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. CERTIFICATE VERIFICATION The information for the model cited on this certificate can be verified at wwwahridirectoryorg, Air - Conditioning, Heating, click on `Verify Certificate" link and enter the AHRI Certified Reference Number and the date on El ®® and Refrigeration Institute which the certificate was issued, which is listed above, and the Certificate No., which is listed below. ©2012 Air- Conditioning, Heating, and Refrigeration Institute CERTIFICATE NO.: 130039589195633045 Jan. 29. 2013 4:24PM TORRES INSURANCE AGENCY No. 2681 P. 3 OR , CERTIFICATE OF LIABILITY INSURANCE ii2 M' d13 PRODUCER (305) 512 -5880 >"AX: (305) 512 -5881 Torres Insurance Agency Inc. 6135 NW 167 STREET # 825 Miami Lakes FL 33015 THIS CERTIFICATE I8 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERALL AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC N INSURED . Jose C Panes Air Conditlori -ng S Appliances 1021 NE 1.32 Street North Miami FL 33161 INSURER A: 10PB'1t3 INSURANCE COMPANY INSURER RERc INSURER 0' INSURER 2: 3.11111 °1'_1`13;: THE REQUIREMENT, THE POLICIES INSURANCE OF INSURANCE USTED BELOW TERM OR CONDITION OF ANY AFFORDED BY THE POL HAVE BEEN ISSUED TO THE INSURED NAMED MOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, CIES DESCRIBED HEREIN i3 SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. A GENERAL fl TYPEOF INSURANCE LIA3IUTY COMMERCIAL GEMINALASILITY POUCT NUMB _R • 323760 POLICY 'FF _ MR AT :X Ar 11/13/2012 POLICY EXPIRATION DA II , + 11/13/2013 LIMITS ;ter. i 1 000, 000 ` , 0"TFD .. $ 100,000 M9M9111 3,000 111111 CLAMS MADE { X I OCCUR IMPRITRIMMIli 1,000,000 ■ _. .x5 -5T s 2,000,000 - .. .. ; -,. • _ r c i 1,000,000 OEMS. AOOFIEGATE LIMIT APPUEB PER: A AUTOMDEILE ■ n X Il 111 LsoIUTT ANY ALTO ALL OWNED AUTOS BCHEGULEDAUTOS HIRED AUTOS NON-OWNED AUTOS • 418o110004s74 7/17/2012 7/17/2013 OWNED SINGLE LIMIT IEReccidunD 3 100,•000 11O0ILYINJURY (Perperems $ BODILY INJURY (Per ecaaenq E PROPERTY DAMAGE (Per =IMO S II GARAGE UABILTIY ANY AUTO u+ i . Y • -- : ; DENT S OTHER THAN EA ACC AUTO ONLY: A EKC .$SIUM$RELLA LIADILITY OCCUR II CLAIMS wax DEDUCT19LF ^q.I.N r.. ` ; ? ` - 5>:Yi 1. WORMS COMPENSATION AND WORMS IMAPLOYNRIF LIABILITY ANY PROPN€TORIPARTNKR/EXECUTVE OPF'ICER/MEMOE'REXCLUDED* Ir yev. describe under 1 LPR. ��: u:,:�• •Lt7 :T gi 0 _ - E.L EACH ACCIDENT - +I.. . - i'' OYE OTHER Deemer:ION OF OPBRATRINW/ LOOATIONMIENICLEWEXCLUBION $ADELE BY ENDORSEMENT PROVISIONS MOSS C. TAM Air Conditioning znatellatioa * Inland amine: Smell Toole $5,000/ 9900 Ded, L0011 Cohn*. EI)Conmeroial Auto: Veh 1: 1999 B'ord/ Eaonoline 3230 via* 1FT?32427111037051S / Veh 2: 2002 Ford/ Tconollne E250 Vini lrtN3242X2EA51198 ***(No Comprehensive t Collision Coverage) * ** CERTIFICATE HOLDER (305)756 -8072 MIAMI SHORES VILLriGE BUILDING DEPARTMENT 10050 N8 2 AVE MIAMI, 8'L 33138 ACORD 26 {2001:091 CANCELLA114N SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE E.1PIRATNJN OAT! THEREOF, THE IBSUIN3 INSURER ALL ENDEAVOR TO MAIL 10 DAYS 1NAITTEN NOTIC$ TO THE CERTIl7CAT@ HOLDER NAMED TO THIS LEI, BUT FAILURE TO 00 BO SHALL WPOSE NO OBLIGATION OR LIABILITY +P ANY KIND UPON THE INSURER,- IT5ALi!MTs OR REPRESENTATIYG$. AUTHORIZED REPRtl$$NTATME ORPORATION 19 TIcal SE QO L12092300708 003+1 The .C1ASS At It 0 Named:: boater 03 CHINT1 Under the' provii�na oirthaPt Napiratiea dates AVG 31, 2014 . : .YANNS AIDSZ..C14324NOTN':,.. 1021 132ND ST '— JOSE itYANES_Art CONDITIONI NOItTEt FL, 33101 euvxcis INC DISPLAY AS REQUIREDSY LAW EN NOON SC1ARY 08 -09 -2012 JEFF ATWATER STATE OF FLORIDA CHIEF FINANCIAL OFFICER 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: 08109/2012 EXPIRATION DATE: 08109/2014 PERSON: VANES JOSE C FEIN: 205350884 BUSINESS NAME AND ADDRESS: JOSE C VANES AIR CONDITIONING & APPLIANCES SERVICES INC 1021 NE 132 ST NORTH MIAMI FL 33161 SCOPES OF BUSINESS OR TRADE: 1- HEATING, VENTILATION, AIR -COND * IMPORTANT: Portaged to Chapter 440 06(14), F.S., se oflicer of a corporation wbo elects exemption from this chapter by filing a certificate of election under this section may sot recover benefits or compensation aaier this cbepter. Parageat to Chapter 440.06{12), F.S., Cortilicetss of election to be exempt... apply ooly witbie the scope of the business or trade listed on the notice of election to a exempt. Pasant to Chapter 440.06(13), F.S.. Notices of election to be exempt and certificates of election to be exempt shall be abject to revocation If, at say time after the thine of the antics or the issuance at the certificate, the person named on the notice or certificate no Wage( meets the requirements of this section for issuance of a certificate. The department shall revoke 1 certificate at any time for failure of the person named ea the certificate to mast the regsiremsats of this sactloa. QUESTIONS? (850) 413-1809 ....... nrn nrn9,r,n�rr ne r:I CPTtflM Tfl no FVFMPT REVISED 01-11 FIRST -CLASS U.S. POSTAGE E PAID MIAMI, FL PERMIT NO. 231 629295-7 THIS IS NOT ABILL - DO NOT PAY RENEWAL 655876 -2 CONDITIONING 8 STATEt15974 APPLIANCES SERVICE INC 1021 HE 132 ST 33161 NORTH MIAMI E C VANE A/C 8 APPL SRV INC CHANICAL CONTRACTOR THIS IS ONLY A LOCAL swoon TAX RECOPY.. IT DOES NOT PERMIT NNE HOLDER TO VIOLATE AM EXISTING REGULATORY OR ZONING LAWS OF THE COWRY OR CITIES. NOR ODES IT EXisWT T!� HOLDER FROM ANY OTNER PERINT REWIRED @ LAW. THIS IS NOT A CERTIFICATION G THE HOLDERS OUALIFEPA- PAYMENT RECMVED MIAMI -DADS COUNTY TAX ' 0U TDRI.0/05/2012 60030000188 000049.50 WORKER /S 1 DO NOT FORWARD JOSE C VANE AIR CONDITIONING 8 APPLIANCES SERVICE INC JOSE C VANES PRES 1021 NE 132 ST N MIAMI FL 33161 I„ II, I, iI,, ,,tl,ll,,,,,li,i„I,,i,I,,,li,i„ 1„1,1,„11A)t JOSE C. YANES AIR CONDITIONING & APPLIANCES SERVICES, INC. 1021 NE 132nd STREET, NORTH MIAMI; FL 33161 LICENSED & INSURED CELL: 786.683.9345 FAX: 305.895.3565 CONTRACT i PROPOSAL p WORK TO BE PERFORMED AT: DATE ,fig NAME ADDRESS ADDRESS .r-- 5 Al . ? i S / CITY, STATE rG / ✓ /il L - lA-'P} CITY,STATE 1 j pAW4119P+11ANS PHONE NO. T' We hereby propose to furnish the materials and perform the labor necessary for the completion of 01/4 r- r All material is guaranteed to be as specified, and the above specifications submitted for above work and completed in a substantial • ('-i.4 -' !>`t /ll work to be performed in accordance workmanlike manner Dollars with the drawings and for the sum of: (` '. a / . i64//VOILOb be follows p4`'l with payments to as c-10/ Any alteration .. O � 1 Respectfully submitted over and above the estimate. AY agreements contingent upon strikes, accidents, ordelay$beyond our contra Note Per - This proposal may be withdrawn by us if not accepted within days. Cp ACCEPTANCE OF PROPOSAL The above prices, specifications and conditions are satisfactory and are hereby be made as outlined above. ` DATE : as -! :.fled. Payments will ACCEPTANCE OF . ONTRACT accepts :''Sfou are : uthorized • e the c- SIG a.!! ��i�....t'�r� SIGNATUR: ..q