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MC-17-251 , 1��;: C V ED Miami Shores Village AN 1 .20» V4OC Building Department 137 10050 N.E.2nd Avenue,Miami Shores, Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 S-I-h F�BC 201 q BUILDING Master Permit No. �" �C PERMIT APPLICATION Sub Permit No. F-IBUILDING F_� ELECTRIC ROOFING REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ® MECHANICAL PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION SHOP CONTRACTOR DRAWINGS JOBADDRESS: 9t5/ N6 (?A1/8 City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: SIJ Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name(Fee Simple Titleholder): V1 P,61 NI A C�Ac _j)t11/!V Phone#: Address: 915 1 N 1 9 Avg City:_///LSA'1i <he2G5 State: _ Ale- Zip: 3 3119 9 Tenant/Lessee Name: Phone#: ' Email: 'D0 M/04CAI,Z,TAVrz-tV- d/er CONTRACTOR:Company Name: TG G C l I"44e— l 0fQ 1 f.O t-- ( _gf Phone#: :30 5 3)RkVe Address: I O fid P3 6 ave- City: / / State: 1211 Zip: 13 Q t f5 Qualifier Name: $ SOA ! Phone#:30 .7-1-6 691 11 State Certification or Registration#:_G c_ f ?1490 3/ Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: ;PTO Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New Uf Repair/Replace ❑ Demolition Description of Work: �f'oG2 /y<Q TON Specify color of,color thru tile: Submittal Fee$ i Permit Fee$ CCF$ Z C 0 CO/CC$ Scanning Fee$ _ Radon Fee$ Z- DBPR$ Notary$ Technology Fee$ Training/Education Fee$ • g Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ �5 (Revised02/24/2014) L V 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_ Signature OWNER or AGENT CO R CTOR The foregoing instrument was acknowledged before me this The foregoing instrument wa cknowledged before me this day of `J�11.0 ULYLq 20 �� by day of -JaA%- CLL L.► 20 (- by y1 CG�l t1 i� 1 UINY1 who is personally known to ,]C�i..1S Ll�l?n?�ilC 2 .who is ersonally known me or who has produced as me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: V Sign: T V Print: Print: f\N Seal: :o JOANIEVELIZ Seal: •� : MY COMMISSION A FF 086981 JOANIE VEL1Z a: EXPIRES:February 28,2018 ' ; MY COMMISSION A FF 086981 Bonded ThruNotary Public underwrders ^; EXPIRES:February 28,2018 Bonded Thr rite Notary Public Underwriters APPROVED BY1 qs Examiner Zoning Structural Review Clerk (Revised02/24/2014) ,5t►qc 193,?ORE,s`,` Miami Shores Village y� Building Department ■■� J •••••� 10050 N.E.2nd Avenue Miami Shores, Florida 33138 iV@N 0oV S8114 Tel: (305) 795.2204 RID 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):_ (?1 1 A16 7 doe City: Miami Shores Village County: Miami Dade Zip Code: -33139 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❑ NOV ARHI Sheet Attached:YES NO ❑ Contract Attached:YES ❑ UNIT BEING REPLACED DATA NEW UNIT L AWWI,-- MANUFACTURER A CD` AHU or PKG. UNIT MODEL# 57A v-r MCGQ-Yr COND. UNIT MODEL# KW HEAT NOM TONS AHU 50 CU PKG 1)M.C.A AHU,5, CU,126 PKG AHU/;0, CU 4S PKG 2) M.O.P AHU CU Y6 PKG AHUAWCU &PKG 3)VOLTS AHU_14,rCUp.yOPKG PKG UNIT / / PKG UNIT EER/SEER / YES REPLACING DUCTS YES NO d72 NO REPLACING THERMOSTAT YES NO YES NO NEW 4"CONCRETE SLAB YES NO YES NEW ROOF STAND YES YES 0-01 NEW RETURN PLENUM BOX YES NO 1. Minimum Circuit Ampacity(Wire Size): E. 2. Maximum Overcurrent Protection (Fuse/Breaker Size): 3. Voltage of Circuit(208/240/480):./ 4. Size Disconnecting Means: /.s Contractor's Company Name: -T6 �? �/le�G �-O�P Phone: 905 .31,q State Certificate or Registration No .Ae /6031 Certificate of Competency No. Signature 4LU Date: tc�ali t1s signature) (Revised02/24/2014) At &AIM r%m Nual CERTIFIED" Certificate of Product Ratings AHRI Certified Reference Number: 7600905 Date: 1/30/2017 Product: Split System: Air-Cooled Condensing Unit, Coil with Blower Outdoor Unit Model Number: RA1448AJ1 Indoor Unit Model Number: RH1P4821STAN 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, TX, 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 region(s)for which they meet the regional efficiency requirement. Series name:,_.__ Manufacturer responsible for the-rating-of this system combination is RHEEM SALES COMPANY, INC. r _ Rated as follows in\accorll( ncelwith AHRI�Standard;210/240-2008 for,,Unitary.Air-Conditioning;and Air- ource Heat'P mp quipment and 0ubject to•verification of rating accuracy by AHRI-sponsor ,d; ind.eVendent,third part� LF Cooling Capacity(Btuh): 45500 ,,, ,r '7 1��� -'`�� •_� ,:> EER Rating (Cooling): 11.70 SEER-Rating(Cooling): 14:00' 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 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.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 AM SUN 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, Fa 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.: 131302831349769091 UIuaiti Local Business Tax Receipt Miami—Dade County, State of Florida —THIS IS NOT ABILL—DO NOT PAY LBT 6331631 BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES J G CLIMATE CONTROL CORP RENEWAL SEPTEMBER 30, 2017 9901 NW 80 AVE#3T 6598297 Must be displayed at place of business VIRGINIA GARDENS FL 33016 Pursuant to County Code Chapter 8A—Art.9&10 OWNER SEC.TYPE OF BUSINESS J G CLIMATE CONTROL CORP 196-SPEC MECHANICAL CONTRACTOR PAYMENT RECEIVED CAC1816031 BY TAX COLLECTOR Workers) 1 845.00 07/18/2016 CHECK21-16-090714 This Local Business Tax Receipt only confirms 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 governmental or nongovernmental regulatory laws and requirements which apply to the business. The RECEIPT N0.above must be displayed on all commercial vehicles—Miami—Dade Code Sec 8a-276. For more information,visit wwyy.miamidade.govAaxcollector RICK SCOTT, GOVERNOR KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION s, CONSTRUCTION INDUSTRY LICENSING BOARD CAC 1816031 "+ The CLASS B AIR CONDITIONING CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2018 , GONZALEZ-NUNEZ, JESUS;`- - A `� � .0 JG CLIMATE CONTROL-CORP ' 19903 NW 86 AVE MIAMI Fr33015" ISSUED: 06/27/2016 DISPLAY AS REQUIRED BYLAW SEQ# L1606270000372 OP ID: LEGO CERTIFICATE OF LIABILITY INSURANCE DATE 01/31/2017(M 112017 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: Avante Insurance Agency,Inc. PHONE FAX 7490 West Flagier Street A/c No Ext• A1C No: Miami,FL 33144 E-MAIL ADDRESS: Gabriela F.Dominguez PRODUCER CUSTOMER ID#:JGCLI-1 INSURERS AFFORDING COVERAGE NAIL# INSURED JG Climate Control Corp INSURERA:United States Liability 19903 NW 86 Avenue INSURER B:Ma fre Insurance Co.of FL 23876 Hialeah,FL 33015 INSURER C:Brid efield Casualty Insurance 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 SUB POLICY EFF POLICY EXP LIMBS LTR POLICY NUMBER MM/DD/YYYY MM/DD/YYYY GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED A X COMMERCIAL GENERAL LIABILITY CL1733502A 01/06/2017 01/06/2018 PREMISES Ea occurrence $ 100,000 CLAIMS-MADE a OCCUR MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ B X SCHEDULED AUTOS 4150140009556 01/14/2017 01/14/2018 PROPERTY DAMAGE HIRED AUTOS (PER ACCIDENT) $ NON-OWNED AUTOS $ UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000 X EXCESS LIAR CLAIMS-MADE AGGREGATE $ 2,000,000 A — XL1574560 09/14/2016 09/14/2017 DEDUCTIBLE $ RETENTION $ WORKERS COMPENSATION X WC STATU- OTH- AND EMPLOYERS'LIABILITY TORY LIMITS ER C ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N 196-19570 02/24/2016 02/24/2017 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additlonal Remarks Schedule,If more space is required) Air Conditioning Installation Service and Repair. CERTIFICATE HOLDER CANCELLATION MIAMISH SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN g ACCORDANCE WITH THE POLICY PROVISIONS. Building Department 10050 NE 2 Avenue AUTHORIZED REPRESENTATIVE Miami Shores,FL 33138 �.�.•j �d ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD Permit IVO. MC-1-17-251 Miami Shores Village M Permit Type.Mechanical-Residential 10050 N.E.2nd Avenue NE PloBt Work Classification:A/C Replacement - Miami Shores,FL 33138-0000 Permit Status:APPROVED Phone: (305)795-2204 �'LORiDA Issue Date:2/6/2017 Expiration: 08/05/2017 Project Address Parcel Number Applicant 9151 NE 9 Avenue 1132060050120 Miami Shores, FL Block: Lot: VIRGINIA DUNN Owner Information Address Phone Cell VIRGINIA DUNN 9151 NE 9 AVE MIAMI SHORES FL 33138-3214 Contractor(s) Phone Cell Phone Valuation: $ 3,780.00 JG CLIMATE CONTROL CORP (305)318-6479 Total Sq Feet: 0 Tons: Available Inspections: Additional Info:REPLACE 4 TON GENERAL AIR CONDITION Inspection Type: Classification:Residential Final Approved:In Review Review Mechanical Comments: Date Approved::In Review Date Denied: Type of Work:REPLACE 4 TON GENERAL AIR CON Scanning: 1 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $2.40 DBPR Fee Invoice# MC-1-17-62781 $2.00 DCA Fee $2.00 02/06/2017 Credit Card $95.70 $50.00 Education Surcharge $0.80 01/31/2017 Credit Card $50.00 $0.00 Permit Fee $132.30 Scanning Fee $3.00 Technology Fee $3.20 Total: $145.70 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 AFFIDAVITMe I the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoninauthorize the above-named contractor to do the work stated. February 06, 2017 Authorizedign tur : n / Applicant / Contractor / Agent Date Building Depaitment Copy February 06, 2017 1