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,yNoREs pr` Miami Shores Village Building Department J- 10050 N.E.2nd Avenue y ` Miami Shores, Florida 33138 ro� ORI" 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 shee_ts/are not acceptable. Job Address(where the work is being done): 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 ELEVATION A COPY OF THE CONTRACT IS REQUIRED WITH ALL SUBMITALS AHRI DATA SHEET REQUIRED Change disconnecting means:YES❑ NO® ARHI Sheet Attached:YES NO ❑ Contract Attached:YES UNIT BEING REPLACED DATA NEW UNIT /nom✓ MANUFACTURER eAIWOX 7 AHU or PKG. UNIT MODEL# COh-z7v/1C'03 Zee-40340 COND. UNIT MODEL# KW HEAT 3 7� NOM TONS 3 Jr'D AHU J CU AP PKG 1) M.C.A AHU CU ,3 PKG AHU V CU-SV PKG 2)M.O.P AHU&40 CUED PKG AHU230 CU230 PKG 3)VOLTS AHUZ&,CU<L3tl PKG PKG UNIT / / PKG UNIT /7--00 EER/SEER /:�f OTJ YES NO REPLACING DUCTS YES N YES NO REPLACING THERMOSTAT ryrTV NO YES NO NEW 4"CONCRETE SLAB YES YES NO NEW ROOF STAND YES YES NO NEW RETURN PLENUM BOX YES 1. Minimum Circuit Ampacity(Wire Size): I;ea *Y' ",,"d 2. Maximum Overcurrent Protection (Fuse/Breaker Size): 4 e lCo'C`r- .3 U 3.'- Voltage of Circuit(208/240/480): 71 C/o 4. Size Disconnecting Means: ,A�// � �- 0,0 �J-fi�(> 619 _,n) 1, b��L A�1� e, a. Contractor's Company Name: WR JaW_Ale- yyf All-1W1111C' Phone: 3Y3 ' �.3 /6J?>T- State Certificate or Registration No. 4 ,- }4©210 W0 Certificate of Competency No. Signature _A� Date: /0/� Qualifier's signature) (Revised02/24/2014) Property Search Application - Miami-Dade County Page 1 of 2 OFFICE OF THE PRUV kR01772Y APPRAISER .... Summary Report Generated On: 10/17/2017 Property Information Folio,. 11-2230-053-0530 1513 NE 105 ST UNIT: 1-5 Property Address Miami Shores,FL 33138-2114 Owner LOIS A MAMULA Mailing Address 1513 NE 105 ST#1-5 t ' s t MIAMI, FL 33138-2115 ry Zone 4900 MULTI-FAMILY- r PA Prima CONDOMINUM 0407 RESIDENTIAL-TOTALf Primary Land Use VALUE:CONDOMINIUM- RESIDENTIAL Beds I Baths/Half 2/2/1 ' Floors 0 Living Units 0 Actual Area Sq.Ft Living Area 1,507 Sq.Ft Taxable Value Information Adjusted Area 1,507 Sq.Ft 2017 2016 2015 Lot Size 0 Sq.Ft County Year Built 1970 Exemption Value $50,000 $50,000 $50,000 Taxable Value $46,175 $44,197 $43,543 Assessment information School Board Year 2017 2016 2015 Exemption Value $25,000 $25,000 $25,000 Land Value $0 $0 $0 Taxable Value $71,175 $69,197 $68,543 Building Value $0 $0 $0 City XF Value $0 � Exemption Value _ . .-. _ � . �.$0._-_ $0 $50,000 $50,000 $50,000 Market Value $210,868 $188,275 $150,620 Taxable Value $46,175 $44,197 $43,543 Assessed Value $96,175 $94,197 $93,543 Regional Benefits Information Exemption Value $50,000 $50,000 $50,000 Taxable Value $46,175 $44,197 $43,543 Benefit Type 2017 2016 2015 Save Our Homes Assessment Sales Information Cap Reduction $114,693 $94,078 $57,077 Previous OR Book- , , , Homestead Exemption $25000 $25000 $25000 Sale Price Pae Qualification Description 9 Second Homestead Exemption $25,000 $25,000 $25,000 11/01/1993 $0 16146- Sales which are disqualified as a result of Note:Not all benefits are applicable to all Taxable Values(i.e.County, 3804 examination of the deed School Board,City,Regional). 14823- Sales which are disqualified as a result of 12/01/1990 $0 1858 examination of the deed Short Legal Description 12012- 12/01/1983 $92,500 Sales which are qualified HARBOUR CLUB VILLAS CONDO 6427 TOWNHOUSE 1-5 11/01/1974 $69,000 00000- Sales which are qualified UNDIV 1/79TH INT IN COMMON 00000 ELEMENTS CLERKS FILES 69R143006 &70R100201 The Office of the Property Appraiser is continually editing and updating the tax roll.This website may not reflect the most current information on record.The Property Appraiser and Miami-Dade Countv assumes no liabilitv.see full disclaimer and User Agreement at htto://www.miamidade.aov/info/disclaimer.asD http_//www.miamidade.gov/propertysearch/ 10/17/2017 Ago CCN afl yfloNflf s REFRIGERATION & HEATING INC. October 17, 2017 State of Florida County of Miami Dade Before me this day personally appeared Regis K Kramer Jr who,being duly sworn, deposes and says: That he will be the only person working on the project located at: 1513 NE 105 Street, Miami Shores, FL 33138 Signed: Sworn to (or affirmed) and subscribed before me { this day of 2017 who is personally known to me produced identification Type of identific tion produced OCZ1 Vr�,L. �\\ 4>s'onaq� �.��o�Wd tieloy•.•6�/moi Print,Type or Stamp Name of Noffif 0SLJ* %v.�iA IS S\N�a` i I'��iNatit►►1�N>> 511 Sumter Avenue 9 Davie FL 33325 • Broward (954) 423-9696 • Dade (305) 623-1500 S�ORFs ' gold googol" Miami shores Village Building Department - �LpR{pA 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax:.(305) 756.8972 Notice to Owner — Worker"s' Compensation Insurance Exemption 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-time or full-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 T 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 permit 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' compensatiohrinsurance coverage from the contractor's company for day labor,part-time employees or subcontractors. BY SIGNING'BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENT 7 � Signatu f Owner State of Florida County of Miami-Dade The foregoing was acknowledge b6fore me this day of 04r"IM ,20 /7 . w t By 119915 AIA01 Ufa who is personally known to me or has produced � as identification. Notary: . ) /S k /eh-M SEAL: REGIS K KRAME R MY COMMISSION N FF206274 wiC/�J4ha1'S'{ FkvUNntw• Srr erne r.M i , "NO SWEAT" AIR CONDITIONING, REFRIGERATION & HEATING INC. 954-423-9696 * 305-623-1500 511 Sumter Ave • Davie FL 33325 Serving South Florida since 1983 • CACO26410 State Licensed and Insured Date a �-� r �%' 'i' Home # ;' °' ''` Cell # Customer Name ;; 4C " Address - City, State Legal Description We hereby submit estimate for: -'' � "� ^ f System SEER Rating Condenser Model Air Handler Model # � `'''''`}' i -SC Electric Heater ; KW Model # PRICE INCLUDES: Sales Tax • Installation Labor • Digital Thermostat • Flood Switch • Connect to Existing Copper and Electrical Lines • Liquid Line Filter Drier • Condensing Unit Tie Down Flush Drain Line • Removal of Old Equipment WARRANTIES: ,IV Year Warranty on Entire System with Registration at ' "No Sweat"will provide 1 Year Labor Warranty Cost of System Change Out: $ � ADDITIONAL SERVICES UV Germicidal Light $ Replace Top Of Return Air Plenum With Plywood $ Condensate Pump $ Replace Slab (Size) $ Aluminum Air Handler Stand $ Replace Service Disconnect (Size) $ $ Total Cost of Installation $ Florida Power&Light Rebate Final Cost To Customer $ C, Accepted by Purchaser: �r No Sweat A/C Inc: ,-f' This combination qualifies for a Federal Energy ° Efficiency Tax Credit when placed in service ® 5 between Feb 17, 2009 and Dec 31, 2016. Certificate ®f Product Ratings AHRI Certified Reference Number: 10259480 Date: 10/16/2017 Product: Split System: Air-Cooled Condensing Unit,Coil with Blower Outdoor Unit Model Number:14ACXS036-230A** Indoor Unit Model Number: CBA27UHE-036-230*+TDR Manufacturer: LENNOX INDUSTRIES, INC. Trade/Brand name: LENNOX Region: Southeast and North (AL, AR, DC, DE, FL, GA, HI, KY, LA, MD, MS, NC, OK, SC,TN,TX, VA AK, CO, CT, ID, IL, IA, IN, KS, MA, ME, MI, MN, MO, MT, ND, NE, NH, NJ, NY, OH, OR, PA, RI, SD, UT,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:,MERIT_14ACX-SERIES Manufacturer responsible for the rating of this system combination is LENNOX INDUSTRIES, INC. r Rated as follows in`acco ldancelwit Ah HRI`�Sta I dard 210/240,-2008 for,Unitary;Air-Conditioning and Air-Source Heat Pump Equipment anid subject,to verifiC tion off rkin`g accuracI My by AH lR0 , (sponsored�; �ind�e�pendent,third party testi �'� f U Cooling Capacity(Btuh): 34600&yiyg . fl�� x ` `i, EER Rating (Cooling): 13.00 f SEER Rating(Cooling):"------16:00 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.ahridlrectory.org. TERMS AND CONDITIONS Afim 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.: X31526605848748631