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MC-16-1007Project Address 5 NW 106 Street Miami Shores, FL 33150 - Miami Shores Village 10050 N.E. 2nd Avenue NW Miami Shores, FL 33138-0000 Phone: (305)795-2204 Permit Permit NO. MC -4-16-1007 Permit Type: Mechanical - Residential Work Classification: Addition/Alteration Permit Status: APPROVED Issue Date: 4/27/2016 Expiration: 10/24/2016 Parcel Number 1121360060240 Block: Lot: Applicant ESTEBAN MATIAS STAVILE Owner Information Address Phone Cell ESTEBAN MATIAS STAVILE 2723 NE 6 Lane WILTON MANORS FL 33334- Contractor(s) COOLING FX INC Phone (954)916-6640 Cell Phone Valuation: Total Sq Feet: $ 3,500.00 0 Tons: 3 Additional Info: AC FOR ADDITION EXSITNG SYSTEM RELO Classification: Residential Approved: In Review Comments: Date Denied: Scanning: 1 Date Approved: : In Review Type of Work: ADDITION Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Total: Amount $2.40 $2.00 $2.00 $0.80 $122.50 $3.00 $3.20 $135.90 Pay Date Pay Type Invoice # MC -4-16-59415 04/27/2016 Credit Card 04/14/2016 Check #: 527 Amt Paid Amt Due $ 85.90 $ 50.00 $ 50.00 $ 0.00 Available Inspections: Inspection Type: Final Rough Duct Review Mechanical Review Mechanical Underground 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 accurate and that all work will be done in compliance with all applicable laws regulating construc ' : an • oni ig. Futhermore, I authorize the above-named contractor to do the work stated. 411.7111111. Authorized Signature: Owner / Applicant / Building Department Copy Contractor / Agent April 27, 2016 Date April 27, 2016 1 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 — 5 5 Inspection Number: INSP-256947 Permit Number: MC -4-16-1007 Scheduled Inspection Date: August 16, 2017 Inspector: Perez, JanPierre Owner: STAVILE, ESTEBAN MATIAS Job Address: 5 NW 106 Street Miami Shores, FL 33150 - Project: <NONE> Contractor: ARTIC CIRCLE AIR CONDITION SERVICE CORP Permit Type: Mechanical - Residential Inspection Type: Final Work Classification: Addition/Alteration Phone Number (786)447-6812 Parcel Number 1121360060240 Building Department Comments AC FOR ADDITION EXSITNG SYSTEM RELOCATED FROM INSIDE TO OUTSIDE 3 TON Infractio Passed Comments INSPECTOR COMMENTS False ./v//7 Inspector Comments Passed Failed Correction Needed Re -Inspection Fee No Additional Inspections can be scheduled until re -inspection fee is paid. August 15, 2017 For Inspections please call: (305)762-4949 Page 1 of 17 cd1R \I\J) BUILDING PERMIT APPLICATION ❑BUILDING ❑ ELECTRIC Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 ❑ ROOFING ❑PLUMBING [ECHANICAL ❑ PUBLIC WORKS RECEIVED APR 18.2017 FBC 201`1 Master Permit No. %e. C. Sub Permit No. MC \ b - 1001 ❑ REVISION ❑ EXTENSION ❑ RENEWAL ANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS .�" ,c�cv / D 6 ,51 /1/ P‘ ei sb PC ,/4J-033�s'c� NO JOB ADDRESS: City: Miami Shores Folio/Parcel#: County: Miami Dade Zip: Occupancy Type: Load: OWNER: Name (Fee Simple Titleholder): Address: wJ 00 1 Jb LLr� Zip: ✓ /✓ C/ Construction Type: Is the Building Historically Designated: Yes Flood Zone: BFE: FFE: fj 474one#:6YWM/Z City:,/ Tenant/Lessee Name: Phone#: U "� 16‘77 —16g/a, Email: State: CONTRACTOR: Compan N.me: Address: `T City: ,� 1 11"L State: .Phone#: Qualifier Name: 940-2A7z- Zip:: T l [ L Phone#r./�i' J gO7-2V7- State Certification or Registration #: C/'4 Iv 4?93 Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: Value of Work for this Permit: $ 00 Square/Linear Footage of Work: City: Type of Work: d ition ❑ Alteration Description of Work: 641, 4: 0 New ) State: Zip: ❑ Repair/Replace Demolition E hAt) Specify color of color thriu tile: Permit Fee $ Submittal Fee $ Scanning Fee $ Technology Fee $ SSG: Radon Fee $ Training/Education Fee $ +$ CO/CC $ DBPR $ Notary $ Double Fee $ Structural Reviews $ Bond $ TOTAL FEE NOW DUE $--1JS• e0..\g (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 The foregoing instrument was ackn ledged before me this 44 / V{�day of // 20 1 , by gr 7 4A_) {�#NRT4'ISpersonally town to me or who has produced identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Signatur‘.,,, KA, I CONTRACTOR The foregoing instrument was acknowledged before me this day of :u. ( _ , 20 I ' , by 0110 LIW, aho is personal known to me or who has produced sbnal ti ek_d L I eas identification and who did take an oath. NOTARY PUBLIC: •,.� , Ili e 'we Seal: * ia COMMISSIONI Seal: 3 COMMISSION#FF156830 - s # FF156630 = %; ""-407 r EXPIRES: Sept 3, 2018 ,p EXPIRES: Sept 3, 2018 - ' ""i `�� •,�����a�A� • WWW.AARONNOTARY.COM •nQ;��a``� WWW.AARONNOTARY.COM ************************************************************************************************************ APPROVED BY (Revised02/24/2014) gliAVet Plans Examiner Structural Review Zoning Clerk Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CHANGE OF CONTRACTOR / ARCHITECT Permit N. 1 �p ^ ©D Owner's Name (Fee Simple Title Holder): t- 0/1 S -10i 1); ) e. Owner's Address: S ►J i O 6 S 1 City: M j r c/3 Phone#: �%'W-{4 • '712 State : - Ot Job Address (Of where work is being done): ' w l 000 S 4— Zip Code:33'1: City: Miami Shores )( State: Florida Contractor's Company Name: epCt Address: S LF -fix .enc . 1012 Zip Code: 3 . LS O Phone#: QS"I 1(4-(06(60 City: _ Qualifier's Name :� SS State: -c l Zip Code: 3 G¢..9/) Lic. Number: Architect/ Engineer of Record Name: Phone #: Address: City: State: Zip Code: 1 Describe Work: \((,qi U c,� �i o„ — � Z �S km S LAo oie cc 'In�; Q i 3 I hereby certify that the work has been abandoned and/or the contractor/architect is unable or unwilling to complete the contract. I hold the Building Official and the Miami Shores harmless of all legal involvement. Signature ner The fore oing instrument was aknowled_ed .ef this 10 day of Arbil., L ,20 Pity Signature Contractor or Architect %) The foregoing instrument was aknowledged before me Wiethis /7" day of Arra 1 , 20 by Jesse. %u who is personally known to me or who has produced as indentification. Who is all to me or p y ho has produced R,i4.i 1t`i ! 1' indentification. Notary Public Sign: Seal: 1414 Jacqueline Rivero COMMISSION ! FF156630 EXPIRES: Sept. 3, 2018 WWW.AARONNOTARY.COM Notary Public: Sign: Se: KYLE C HAMBRIICK •': MY COMMISSION ale GG060511 EXPIRES January 26.2021 RICK`SCOTT, GOVERNOR __ 111 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD MATILDE MILLER, INTERIM SECRETARY LICENSE NUMBER CACI 817983 The CLASS B AIR CONDITIONING CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2018 QUIJADA, KEVIN "F ARCTIC CIRCLE AIR CONDITION SERVICES CORP 13991 SW 144 AVE SUITE301 MIAMI FL 33,186, ' L ISSUED: 02/15/2017 DISPLAY AS REQUIRED BY LAW SEQ # L1702150000595 Local Busi ness Tax Fbcei pt Miami -Dade County, State of Florida -THIS IS NOT A BILL - DO NOT PAY 7177239 BUSINESS NAM EILOCATION ARCTIC C IRCLE AIR CONDITION SERVICES CORP 13991 SW 144 AVE 301 MIAMI, FL 33186 OWNER ARCTIC C 112CLE AIR CONDITION SVCS CORP C../!1 KFVIN 1 N ILIA IIA VV:F Worlcer(s) 2 RECEIPT NO RENEWAL 7457240 EXPIRES SEPTEMBER 30, 2017 Must be displayed at place of business Pursuant to County Code Chapter BA Art. 9 8 10 SEC TYPE OF EUSLNESS 196 SPEC MECHANICAL CONTRACTOR CAC 1817983 PA YM ENT RECEIVED BY TAX COLLECTOR 82.50 12/28/2016 0202-17-001481 This Local Business Tax Receipt only con"rrrs payrrcnt of the Local Business Tax. The Receipt is not a License, pernit, or a certi "cation of the holder's quali ^cations, to do business. Rider mat comply with any governmental ornongouerrcrental;-niatory laws are requirements which apply to the Ixsines& The RBD6 PTNO above mast bo cfi splayed on all commercial vehicles - Miam -Dade Cade Sec as -27E „,!�► Far more irdorrnation, visit A`� CERTIFICATE OF LIABILITY INSURANCE DA�"OQ1"; Y) 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 POUCIES 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. N 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 Ileu of such endorsement(s). PRODUCER Ample Insurance Company PO Box 929 Oakland FL 34760 Noun: Flar Molina �fA/CONA o. : 305-264.9900 (ac. No): EMAIL g. Fmolina@amplelns.com INSURER(S) AFFORDING COVERAGE MAIC INSURER A : ARCH SPECIALTY INSURANCE COMPANY COMMERCIAL GENERAL UABIUTY INSURED ARCTIC CIRCLE AIR CONDITION SERVICE CORP 13991 SW 144 Ave Unit 301 Miami FL 33186 INSURER a : COMMERCE & INDUSTRY INS.COMPANY AGL0040567 INSURER c : NORMANDY INSURANCE COMPANY 08/15/2017 INSURER 0 : S 1,000,000 INSURER E : INSURER F: DAMACLAJMS•MADE PREMISESO/Ea occuurrencel COVERAGES CERTIFICATE NUMBER: ION 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 AU. THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POUCIES. UMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS INSR LTR TYPE TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF RAMODNYYYI POLICY EXP IMMAXINNYYI LIMITS A X COMMERCIAL GENERAL UABIUTY Y AGL0040567 08/15/2016 08/15/2017 EACH OCCURRENCE S 1,000,000 X OCCUR DAMACLAJMS•MADE PREMISESO/Ea occuurrencel S 100.000 MED EXP (Any ens person) S 5,000 PERSONAL & ADV INJuRY $ 1,000,000 GENL AGGREGATE POUCY OTHER: X UNIT APPUESPER: LOC GENERAL AGGREGATE 5 2,000,000 PRODUCTS • COMP/OP AGO S 2,000,000 $ AUTOMOBILE — LIABILITY ANY AUTO ALL LOOS N� HIRED AUTOS _ _ AUTOS AUTONON D MB USINGLE LIMIT- Walden (BEODILYINJURY(Perperson) $ $ BODILY INJURY (Per =Adam) $ PROPERTY IPer dent)DAMAOE $ $ B X UMBRELLA UAB EXCESS UAB X OCCUR CLAIMS -MADE EBU 067946875 08/15/2016 08/15/2017 EACH OCCURRENCE $ 2,000,000 AGGREGATE s 2,000,000 DEo IX RETENTIONS 0 PRODUCTS $ 2,000.000 C WORKERS COMPENSAT oxPER AND EMPLOYERS' LIABILITY Y! N N/A X NHFL0031392016 12/18/2016 12/18/2017 DTH• I STATUTE I ER E.L EACH ACCIDENT S 500,000 ANY PROPRIETOR/PARTNER/p(E )TIVE OFTICERIMEMBEREXCUIDED'1 (MyaeMandatory in NH) describe under DESCRIPTION OF OPERATIONS below Y Et DISEASE - EA EMPLOYEE S 500,000 E.L DISEASE • POUCY UMIT $ 500,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached B mora apace Is required) " Air conditioning, installation service & repairs Workers Compensation employees list: Antonio Ouijada Exempt Officer Kevin OuiJada Exempt Officer, Pedro Wares, Jose A Martinez, Rose Mary Rosales CERTIFICATE HOLDER CANCELLATION Village of Miami Shores 10050 NE 2nd Ave Miami Shores, Fl 33138 I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POUCY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2014/01) ®1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD BUILDING PERMIT APPLICATION Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 Master Permit No. Sub Permit No. F BC 2014 IS -Ss �Y1 GRo -- o(+ - El BUILDING ELECTRIC ROOFING D REVISION EXTENSION D RENEWAL PLUMBING JOB JOB ADDRESS: art: MECHANICAL PUBLIC WORKS 'S N.w. g0 ❑ CHANGE OF ❑ CANCELLATION SHOP CONTRACTOR DRAWINGS City: Miami ShoreslCounty: Folio/Parcel#: 11 2t 3�o-�cO ^--cp_1{0 Occupancy Type: Load: OWNER: Name (Fee Simple Titleholder): Address: 5 ' f".`.' • 16,6 51". City: Sk r , Construction Type: E sl,e ,v. Miami Dade Zip: 3 3150 Is the Building Historically Designated: Yes NO DC Flood Zone: BFE: FFE: AkJic.S S A-0,uhbite#: ` M ki GS I State: Pk- Zip: 3150 Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: 6001;15 F 14„..c.. Phone#: &%'() q16.- (o (0 Address: 3i 2( 3-.4, 41 R.JL V- (DlZ City: rw`. L State: Fk ' Zip: 3 \3 3 I Phone#: G1-4) al—C60 /b Z State Certification or Registration #: k\ tq 0 1 Lq T- Certificate of Competency #: M0000 Ie DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Qualifier Name: `J -5Sc G%PI )19--- Value 19.. Value of Work for this Permit: $'55 coo, ob Square/Linear Footage of Work: Type of Work: Fe' Addition Ekt Alteration ❑ New Description of Work: iDl R (L Aur a d � . cv� �v► s4 tr.G S'-'S4t/l1 rLaIota ir c� -�rvN J 1A%(,)e c1/44A--s — -V- ori ❑ Repair/Replace ❑ Demolition Specify color of color thru tile: Submittal Fee $ Permit Fee $ Scanning Fee $•(J.J Radon Fee $ Technology Fee $5'. .7,-(3 Training/Education Fee $ Structural Reviews $ (Revised02/24/2014) us a. `0 co/as DBPR $ Notary $ f . Double Fee $ Bond $ �j TOTAL FEE NOW DUE $ 5 ` ( O 5L� 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 apprg'ed and a reinspection fee will be charged. Signature OWNER or AGENT Signature The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this 1..51 day of fi orch , 20 R, , by \Li any of (kcilk , 20 KS), , by esk�Gn Mal, 165 SOU►Ierwho is personally known to J�Q.,\' C ('N{i , who is personally known to me or who has produced as me or who has produced as identification and who did takean oatl NOTARY PUBLIC: ?' a, s +398.0153 Sign 4 KYLE C HAMBRICK id ntification and who did take an oath. MY COMMISSION # EEB670511 TARYPU EXPIRES January 22, 2017 FiondallotaryServIo cam Print:, /4 leNNb✓l,c.L. Seal: APPROVED BY (Revised02/24/2014) * * *** * \./1, ****** ******** * * ** * * * * * * **** ** ************ **** ** ****** * Print C_ �- Seal: ROBERT C. SMiTli m� is • State of Florida My Comm' Expires Jul 14, 2017 •, # FF 035935 y,f ans Examiner Structural Review Zoning Clerk ACORa CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDOlYYYY) 03/15/2016 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(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 endorsements(s)- PRODUCER Iron Fidelity Insurance Services, LLC 2004 LaPrada Pkwy Mesquite, TX 75150 CONTACT NAME: PHONE (A/C, No. Ext): FAX (A/C. No): E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC# INSURER A. XL Specialty Insurance Company 37885 INSURED Payroll Management Inc 348 Miracle Strip Pkwy Suite 39 Building H Fort Walton Beach, FL 32548 INSURER B. INSURER C. 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 NAME ABOVE FOR THE POLICY PERIOD INDICATED. NOT1MTHSTANDING 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 LTR TYPE OF INSURANCE AMYL INSRD SUBR wVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/OD/YYYYI LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY Not Applicable EACH OCCURRENCE $ XXXXXX DAMAGE TO RENTED PREMISES (Ea occurrence) $ XXXXXX MED EXP (Any one person) 5 XXXXXX CLAIMS MADE OCCUR PERSONAL & ADV INJURY s XXXXXX GENERAL AGGREGATE $ XXXXXX PRODUCTS-COMP/OP AGG S XXXXXX GEN'L AGGREGATE LIMIT APPLIES PER- POLICY n PRO- f JECT I ILOC $ XXXXXX AUTOMOBILE _ `— LIABIUTY ANY AUTO ALLOWNED AUTOS HIRED AUTOS — SCHEDULED NUTOS ON -OWNED AUTOS Not Applicable COMBINED SINGLE LIMIT {Ea accident) s XXXXXX BODILY INJURY (Per person) $ XXXXXX BODILY INJURY (Por accident) $ XXXXXX PROPERTY DAMAGE (Per accident) $ XXXXXX $ $ UMBRELLA LIAR EXCESS LIAB OCCUR CLAIMS MADE Not Applicable EACH OCURRENCE $ XXXXXX AGGREGATE $ XXXXXX $ XXXXXX -- DED `— RETENTION S $ XXXXXX $ XXXXXX A WORKERS COMPENSATION AND EMPLOYERS' LIABIUTTY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER dE ER EXCLUDED Y� (Mandatory Dry In NH) If yes. describe under DESCRIPTION OF OPERATIONS below N/A RWE943545301 05/01/2015 05/01/2016 X WV/C STATU- TORY LIMITS OTH- ER E L. EACH ACCIDENT $ 1,000000 .00 E L DISEASE•EA EMPLOYEE $ 1.600 000 00 E.L. DISEASE -POLICY LIMIT $ 1,000,003.00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES Attach ACORD 101, Additional Remarks. THIS CERTIFICATE CONFERS NO ADDITIONAL INSURED RIGHTS UPON subcontractors of COOLING FX, INC DBA COOLING FX // COVERAGE ONLY THAT ARE LEASED TO THE FOLLOWING "CLIENT COMPANY" COOLING FX, PAYROLL MANAGEMENT INC. & SUBSIDIARIES ACTIVE EMPLOYEE(S) WHILE APPLY TO STATUTORY EMPLOYEE(S) OR INDEPENDENT CONTRACTOR(S) COVER USL&H. EMAIL PAYROLL(o(PM(PEO.COM FOR ACTIVE EMPLOYE Schedule, If more space is required) THE CERTIFICATE HOLDER. // Only the co -employees bu not APPLIES TO ACTIVE EMPLOYEE(S) OF PAYROLL MANAGEMENT INC., INC. "COVERAGE ONLY APPLIES TO INJURIES INCURRED BY WORKING IN THE STATE OF FLORIDA.'COVERAGE DOES NOT OF THE CLIENT COMPANY OR ANY OTHER ENTITY.'DOES NOT LIST CERTIFICATE HOLDER 1668 CANCELLATION MIAMI SHORES VILLAGE BUILDING DEPARTMENT 10050 NE 2ND AVENUE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores, FL 33138 /�Jf� AUTHORIZED REPRESENTATI i[`ir���,��+ Adam Goldberg e�L n,naa_?non ACOPn r.nRPORATION- All riahts reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD AWRif CERTIFICATE OF LIABILITY INSURANCE `.•-- DATE(MM/DO/YYYY) 03/29/2016 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 POUCIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: N the certificate holder is an ADDITIONAL INSURED, the policyQes) must be endorsed. If SUBROGATION IS WANED, 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 A & H Insurance ServicesN,, 3320 Griffin Road Fort Lauderdale, FL 33312 Phone (954) 239-8773 Fax (954) 251-1423 CONTACT DARLENE LAUZURIQUE NAME: Exu: (954) 239-8773 FAX (, No); (954) 251-1423 dadene@autohomeins.net INSURERS) AFFORDING COVERAGE NAIC 8 INSURER A : Starr Idemnity & Liability Company In COMMERCIAL GENERAL LIABILITY INSURED COOLING FX INC 2906 SW 79 TERR DAVIE FL 33328 INSURER B : 1000370199161 INSURER C : 03,'24/2017 INSURER D : $ 4,000,000.00 INSURER E : $ 100,000.00 INSURER F : MED EXP (Any one person) 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 LTR TYPE OF INSURANCE ADDLSUBR INSR WVD POLICY NUMBER POLICY EFF (MDD/YYYY) POLICY EXP (MMIDDIYYYY) UMIT9 A In COMMERCIAL GENERAL LIABILITY 1000370199161 03/24/2016 03,'24/2017 EACH OCCURRENCE $ 4,000,000.00 G❑ NTED PREM SES TOR occurrence) $ 100,000.00 CLAIMS -MADE M OCCUR MED EXP (Any one person) $ 5,000.00 PERSONAL & ADV INJURY $ 2,000,000.00 GEN'L AGGREGATE UMIT APPUES PER: ❑ POLICY ❑ Eo- ❑ LOC ❑ OTHER GENERAL AGGREGATE $ 4,000,000.00 PRODUCTS - COMP/OP AGG S 4,000,000.00 $ AUTOMOBILE UABILITY ❑ ANY AUTO ❑ AALL UTOS OWNED ❑ SCHEDULED NON-OWNED(P ❑ HIRED AUTOS ❑ ❑ COMBINED tSINGLE LIMIT ) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ $ EACH OCCURRENCE $ II UMBRELLA UAB ❑ OCCUR ❑ EXCESS UAB ❑ CLAIMS -MADE AGGREGATE $ ❑ DED ❑ RETENTIONS $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PAR TNERIEXECUTNt�— OFFICER/MEMBER EXCLUDED? I N / A ❑ PER ATUTE ❑ ER E.L. EACH ACCIDENT $ E.L DISEASE - EA EMPLOYE $ ( If yes, desa5e under DESCRIPTION OF OPERATIONS below EL DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS 1 LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) HVAC COMPANY State License# RM14016982 County License: 13M000016 CANCELLATION I MIAMI SHORES VILLAGE BUILDING DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED ACORD 25 (2014/01) QF ©1988-2014 ACORD CORPORATION. AN rights reseryed. The ACORD name and logo are registered marks of ACORD 701 Z.Y Srni11•16 AVG 4r 4141.6M 2-50•...i CERiFIED' Certificate of Product Ratings ARM .M.•AR.•M..NN••rMRM1 o..e1-1. • ••••••••••••••••.[•••••••••••••••00,..0.•••• 0•00••••••••••••=••• MIC1.113.10+- 6.1tem 1.1.1•4•1W Tw••••••• •••• PLICATIENTS MN maw ••••••••• br.,••••••••••1•POOm ...ppm 121•CM•Mt••••18,4 I••••• l• sears •1•••••• 14•010.1••• NA.A........m.amININANANANYANAMANYAANIE •••• 11••••• Coi••• C•• .,.•••..a.•FD...••••00 ..0— C•••N.. P. PN..N SEM Papag" LIN MPS NR CON motaN0 Nous DUCIMDD SHALL SS 1-111 TEM 3 POUNCE PER CUBIC FOOT DENSITY FIIDML.E EMR VAPOR BARRIERS. UNLESS 01101* 5PECNMD. DUCTWORK MULL RE FABRICATED AM MTALIED IN ACOMANCE EON NAIMACTUREM EPEOEICATONS a ACOIDMO TO -MIME. S YNACRA• STANDAMI. DUCT ORE NAME AM IN MOMS AM CORRESPOND TO ENKE OMEN 101* MOTH E IE010. DUCT swum SHALL COALY MRM MRN' STD N0. MA ARDOR EEE. DUCTWORK AND COMMENTS SHELL EE CLASS I MATERIALS M ACCOMANCEMTM 221 IM TESTI. 2. COORDINATE LGCATIOM STIES AM MOINES MRN OMR TRAMS ON THE JOE. AIC CONTRACTOR SHALL IMAM M COMMIS DOT STATEN WITH T I MMM VAMP AT ALL ELBOWS. STATEN AM MOMS AS REWIRED. ALL FMN MTS. %MINIONS. COM 151000, ETC. SMALL E IMAM. AA REWIRED TO OPERATE E MTLI SO THAT M OSECTDNAS2 000D MNL BE REND M TRE IMNRAYE SPACES DE TO AA VELOCRY, ROTOR MDL VERATON OR NECIMICAL NOVEINT. R,0 SYSTEM MALL HAVE OIPOSAML AM RTES LOCATED AS REDOEEO FOR MY ACEMIMV. A. AG STSTENN •MALL E CONTROLLED BY A TNERNOSTAT NOUHJTED S'A• MOVE FOMRM FLOCS UREA OTHMMME NOTED. P. ALL MELEE a CIF* MMM TO E ALUMINUM CUTMCTpI& DBFIMIDM MALL HAVE MOEN OPPOSED MAGE DANPE RS. PROVIDE BASKETS ON ALL GRILLES S ON0MER3. 'TINS• OR •ANEOIpE• MIMEO COLOR BY ARCHITECT. UPPERCUT DOORS 1• All. AS INDICATED. ALL REPRMUAMT PPM MALL E COPPER MAID DRAM TYPE L. ACR TYPE, DIEWORAT0D l SEXED. ALL MTINSS 0041 BE WROUGHT COPPER ALL ADMIT SMALL E WADE MRM MGM IMPERATDE DRAMA ALLOY OF NOT LESS THAN AA SRVML PEED MUTATION NOT LESS MAN E. THICN GMLFLER•. 1100117 i SUCTION LIB MULL E SEED ACCORDING TO MENEM MDWACDSEM BECOME MATONM FOR EWMALEINT LENGTH OF . PINED auN FOR CMMI® TONNME. ALL PMMO ACCESSORIES SHALL E CONSTRUCTED AS SUMMED BY EDWEUR NASUFACTUER. ALL PIPING SMALL E EVACUATED PEN GOOD PSM PEACTCE BEFORE START UP. PROVIDE FLIER/DRYER AM MIR CLAN ON LOW LRE CONDENSING UMTS SIMIM A MNERE DMTANCE OF: TURA FHT FROM NELOAE MASERS. TEN RET FROM Ll. TAMILS FEN RET POSE CLOTHES OMEN H WUMT COMDMM LEM1 LOCATION DULL E AS PEI MAIMFKTIIER'S ECDNEHDE0 ININM CLEARANCE TO MMOTUES. 0 .01 Pang • Do„IND. AMNN.D.M MGN.MR L_ Mr.1110 YON DAM PLOW •tr•intac �• NNW. NmM CONDENSING UNIT MOUNTING DETAIL NTA EXHAUST ROOF CAP DETAIL BATHROOM, HDTDIEN HOOD a 4ORM OR'END01LUST FAH +M ilannWQMENAIUSI 6.1•00.1k MIAMI 00if aima..wn. .�s`�0'e1..rF�•er (41 fit+twi1T (ax Newt 41t 04 rucT 11ec(Tf WALL UNIT SCHEDULE UNIT NUMBER VIII MATCHING CONDENSING UNIT cu UNIT LOCATION bedroom 3 UNIT TYPE WALL UNIT ENTERING AIR TEMP. (db/wb) 80' / 67' MANUFACTURER CARRIER MODEL NUMBER OUTSIDE RAS-09LAV-UL MODEL NUMBER INSIDE RAS-09LKV-UL EVAPORATOR CFM 244 COOLING CAPACITY (BTH/HT) 9,000 AVAILBLE VOLTAGE 240/120-1-60 TOTAL HEATING CAP (BTU/HR) 5,100 SEER/EER 20.0/13.0 FILTER TYPE REMOVABLE W040E1 SV [cnf Or, tor. p.p. IAII (6f-wRD a'wowy fGx UI CN.V.9f u+ 0 O Q Q WW1. VCM TW NW E-- 8' Fni MECHANICAL PLAN 1 C441 ART f1110L 710EST, P. I11QW: IWg1M11D (3•0151>D• 91.001.11116.201.1 mMWRAM FL Min .00•061 PO. SOX ROHM PUPIL ROAD. DM a'41441,10N t fs001flaW 05,.ltTy fyM our or far e41 -t> w H/i11#4 yrAmi-t 41110 IN '911•01; 80.1 *WO, ft. 9W.01 j.1.1 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 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): 'ga1J" ' 106 City: Miami Shores Village County: Miami Dade Zip Code: 3360 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] ARHI Sheet Attached: YES a NO 0 Contract Attached: YES [i UNIT BEING REPLACED DATA NEW UNIT MANUFACTURER AHU or PKG. UNIT MODEL # COND. UNIT MODEL # 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 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): 2. Maximum Overcurrent Protection (Fuse/Breaker Size): 3. Voltage of Circuit (208/240/480): 4. Size Disconnecting Means: Contractor's Company Name: Cc <K,3 \-7X Phone: ct Lo -( o State Certificate br Registr'on No. l\-kal.ec, k- Certificate of Competency No. `3 •CSM 1u2, `,t Signature (Revised02/24/2014) ifier's signature) Date: °3,iLI—(c Q