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MC-18-1488 ' 1 1 { Permit NO. MC-5-18-1488 `5µones Lei ? Miami Shores Village Permit Type:Mechanical-Commercial 10050 N.E.2nd Avenue NE Work Classification:A/C Replacement �- Miami Shores,FL 33138-0000 Per "I tPermit Status:APPROVED Phone: (305)795-2204 FtORtDA Issue Date:6!112018 Expiration: 1112812018 r { Project Address Parcel Number Applicant ' 716 NE 92 Street Number: 2-M 1132060440520 E Miami Shores, FL Block: Lot: EDUARDO ARAOZ I Owner Information Address Phone Cell EDUARDO ARAOZ 1026 NE LITTLE RIVER Driveway EL PORTAL FL 33138- 1026 NE LITTLE RIVER Driveway a EL PORTAL FL 33138- - � Contractor(s) Phone Cell Phone =2,000.00 Valuation:COOL WAVE AIR CONDITIONING 786/236-3441 Total Sq Fee Tons: Available Inspections: I Additional Info:A/C REPLACEMENT 2 1/2 TONSE Classification:Commercial Inspection Type: Final I Approved: In Review Review Mechanical Comments: Date Approved:: In Review Date Denied: Type of Work:A/C REPLACEMENT 2 1/2 TONS Scanning:3 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $1.20 PR Fee $2.00 Invoice# MC-5-18-67757 DB DCA Fee $2.00 06/01/2018 Check#:3764 $66.20 $50.00 I Education Surcharge $0.40 05/31/2018 Check#:3762 $50.00 $0.00 Permit Fee $100.00 Scanning Fee $9.00 I Technology Fee $1.60 Total: $116.20 I 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 j 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 construction and z e ermore,I authorize the above-named contractor to do the work stated. June 01, 2018 ` Authorized e:Owner / Applicant / Contractor / Agent Date i Building Department Copy June 01,2018 1 i i Inspection Worksheet Miami Shores Village f 10050 N.E. 2nd Avenue Miami Shores, FL L� ' Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-305460 Permit Number: MC-5-18-1488 Scheduled Inspection Date: June 05, 2018 Permit Type: Mechanical - Commercial Inspector: Perez,JanPierre Inspection Type: Final Owner: ARAOZ, EDUARDO Work Classification: A/C Replacement , Job Address:716 NE 92 Street 2-M Miami Shores, FL Phone Number Parcel Number 1132060440520 Project: <NONE> f Contractor: COOL WAVE AIR CONDITIONING Phone: 786/236-3441 ► , Building Department Comments A/C REPLACEMENT 2 1/2 TONS Infractio Passed Comments INSPECTOR COMMENT False f v , I In Comments Passed { Failed J Correction Needed . i Re-Inspection ❑ Fee I � No Additional Inspections can be scheduled until + re-inspection fee is paid. i a i a E A June 04,2018 For Inspections please call: (305)762-4949 Page 34 of 50 Aco CERTIFICATE OF LIABILITY INSURANCE °" (111111111001"M�/ 05/18/2016 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(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 lieu of such endorsement(s). CONCT PRODUCER NAME Susan CamachO Just`Insurance Brokers PNONE . (305)418-4701 Nej: (305)418-4706 1200 NW 78 Ave Suite 105 EADM% • scamadm@jibfl.net INSURER(S) AFFORDING COVERAGE NAIL 0 Miami FL 33126 INSURERA: Catlin Specialty Insurance Compare INSURED INSURER B: Cool Wave Air Conditioning Corp.C/O Luis Blanco INSURER C: 6605 SW 164 Ave INSURER D: INSURER E: Miami FL 33193 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. LTR TYPE OF INSURANCE POLICY NUMBER LILY EFF POLILY EXP M VMS GENERAL LIABILITY EACH OCCURRENCE $ 1,000.000.00 X COMMERCIAL GENERAL LIABILITY PREMISES Ea 00man ce $ 100,000•00 CLAIMS-MADE a OCCUR MED EXP(Arty oneperson $ 5,000.00 A 0900017180 09/23/2017 0923/2018 PERSONAL 8 ADV INJURY $ 1,000,000.00 GENERAL AGGREGATE $ 2,000,000.00 �GEEML AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,0000 ,0 .00 POLICY PRO-JECTLoc S AUTOMOBILE W&LITY EaMBINEaccideMSINGLE LIMIT ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS S UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE AGGREGATE $ DED RETENTIONSS WORIMRS COMPENSATION WC STATU 0Tw AND EMPLOYERS'LIABILITY I ER ANY PROPRIETOR/PARTNER/EXECUTIVE YD NIA E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ryyywWalory in NH) E.L.DISEASE-EA EMPLOYE S DESCR�O O�OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ DESCRIPTIWI OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,AddlMonal Remarks Schedule,H mon space Is required) 'Lic#CACI 813460 'CERTIFICATE HOLDER CANCELLATION 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 Village Building Department AUTHORIZED REPRESENTATIVE 10050 N.E.2nd Ave, Miami Shores, FL 33138 I!� `ACORD 25(2010/05) ®1988-2010 ACORD CORPORATION.All rights reserved. The ACORD name and logo are registered marks of ACORD t ��j Miami Shores Village c ` Y �� , 4�` Building Department M Y 31 2018 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 ` V� Tel:(305)795-2204 Fax:(305)756-8972 BY: INSPECTION LINE PHONE NUMBER:(305)762-4949 17 tik>h FBC 20 BUILDING Master Permit No.�c t v -148S PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC ROOFING ❑ REVISION ❑ EXTENSION RENEWAL ❑PLUMBING (MECHANICAL ❑PUBLICWORKS [:] CHANGE OF CANCELLATION SHOP / .w CONTRACTOR DRAWINGS JOB ADDRESS: -7/& /VE� G!9- -57- IJi II-- -' 2A4 City: Miami Shores County: Miami Dade Zip: 316 Folio/Parcel#:_ Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): A0 Phone#: 2&—fP2�-803 Address: 1,42((00 AIE Lrr�L�2 2t✓ee D?— City: L--,4x l YD2v4g-/— State: —EL Zip: 33�3U Tenant/Lessee Name: Phone#: Email: //jj' "' CONTRACTOR:Company Name: 4giy C- �tJ.c ��G Phone#: 0S-- 3 8'�� SZ 3,6 Address: 660 ,mac ' /'6 V A ye-. City: /1.deyl State: 'f�io _ Zip: --3-3/ 5". Qualifier Name: z%S' , ivea Phone#: J® off 072 State Certification or Registration#: CA G /.9/j),"0 0 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: + City: State: Zip: Value of Work for this Permit:$ O O 0 Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New N Repair/Replace ❑ Demolition Description of Work: a tt Specify color of color thru tile: Submittal Fee$ 1 Permit Fee$ 11V CCF$ CO/CC$ i Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$_ Structural Reviews$ Bond$_ TOTAL FEE NOW DUE$ f (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---< �. _ �1 la Signature OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this —Z day of /l ?4 V 20 !a by _ d'daffy of /f�i4�/ 120 a by j�/d)20d 'z 0who is personally known to i—u� N S, IANC c7 who is personally known to 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: 4JSign: Sign: V if Print: Print: or Not Public Stele of Ronda _+• Notary Public State of Florida Seal: MARINELY GARCIA Seal: �' A MAR'mm GARCIA • ' M Commission GG 170475 My Commimm GG 170475 Y op Expires 12125/2021 4j��o° Expires 12/2512021 ******************************* ****** ******************************************************************** i APPROVED BY �Cxaminer Zoning Structural Review Clerk (Revised02/24/2014) certificate ®f Product Ratings AHRI Certified Reference Number:201168350 Date:05-28-2018 Model Status: ctive Old AHRI Reference Number:7491225 AHRI Type:RCU-A-CB Tly Outdoor Unit Brand Name:RHEEM Outdoor Unit Model Number (Condenser or Single Package):RA1430AJ1 Indoor Unit Model Number(Evaporator and/or Air Handier):RH1 P3017STAN Region: Southeast and North(AL,AR,DC,DE,FL,GA,HI,KY,LA,MD,MS,NC,OK,SC,TN,TX,VA,AK,`t;0, 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 000000 until June 30,2016.Beginning July 1,2016 central air conditioners can only be installed in regions)for •••• ••••• • which they meet the regional efficiency requirement. • • •• : : • 960.90 •• 6 0.0000 6.9:9• • • - The manufacturer of this RHEEM product is responsible for the rating of this system combination. • �� •••• n • • • • 0 rj(ff � 9999 06 •• •0•06 t — E • - Rated as follows in accordance with the latest edition of ANSI/AHRI 210/240 with Addenda 1 and 2,Performanee 3atiag of Urjt@pr.;• ""' Air-Conditioning&Air-Source Heat Pump Equipment and subject to rating accuracy by'AHRi-spolnsored;Inde pI:nder t�t bird p arty testing: - vii • • e 1 • ..•••- Cooling Capacity )=Single or High Stage(95F),btuh:28600 l" •.09:. I - 6 • 6 SEER 14.00 _ pt?�'..e,' EER(A2)-Single or Hi c�fig #: _�Miami•Shires Villa e""'"�""�`--- � �w �i % APPROVED BY DATE a Y 3 201 l ZONING DEPT 1 BLDG DEPT BZ'' - - - Al" SUBJECT 1'0 CGNIP11PNCE WI FH ALL.FEDERAL STATE ANL)C( I jN,'f rlbLcS AND.REG(JLA'f t"Active"Model Status are lose that-ari-AHRI EertificabonRrograrlLP-g c, ant+s&PeQ1Arodu ng AND selling or offering for sale;OR new models that are being marketed but are not yet being produced'Production Stopped"Model Status are those a an I Certification Program Participant is no longer producing BUT is still sellin or offering for sale. new ublished ratin is how Ion with the revious i.e.WAS rati k. Ratings that are accompanied by WAS indicate an involuntary re rate. The D 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. 0 TERMS AND CONDITIONS AHRI.This Certificate shall only be used for individual,personal and This Certificate and its contents are proprietary products of confidential reference purposes.entered Into a computer database;or otherwise utilizede contents of this ,In any form ocate may rmanneror by le or iany means,except for n part,be �the user's Individual, r AIR-CONDITIONING,HEATING, personal and confidential reference. &REFRIGERATION INSTITUTE CERTIFICATE VERIFICATION The information for the model cited on this certificate can be verified at www.ahridirectory.org,click on"Verity 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 CERTIFICATE NO.: 131720138826439853 ©2018Air-Conditioning,Heating,and Refrigeration Institute I } CHECK LIST I , . _ .pp�� •� •�• ��1 I 1 i� 6605 S.W. 164 Ave. woo ij MIAMI FL. 33193 ❑ COMPRESSOR • • • ... . . : — Dade: (305)388-5236 + 0 SUCTION ....... ...... ..PSI • • • • • • • •j?-,d W4w 1' -6m4m cArg www.coolwaveairconditioning.com • • .• • • • • .. 0 HEAD ........ ... .... ..PSI CUSTOMER P.O.. O VOLTS .. .............. ELECT O CONTACTS TIGHT &CONNECTIONS 24 Hours Emergency N O 1621 DATE ❑CONTACTS TIGHT&CLEAN fg cY Services U OIL LEVEL&CONDITION 000 :0• OLeensed&Insured CAC1813460Te >~ _ ❑ CONDENSER OIL �e1 Q • • • • • BI 0 i . DA DERE _ •0 CLEAN COIL&CHECK FIN COND. • • • • 0 ENT °F LGV °F G JOB LOCATION: DATE SCHEDULED 0 REFRIGERANT 0 LEAK 0 CHARGEAICADDRESS: PHONE ❑ FAN AND MOTOR • . DESCRIPTION OF COWILAINT ❑VOLTS AMPS • • • • •• • • ❑ WARRANTY 0 ELECTRICAL CONNECTIONS • • • • ❑ CONTRACT ❑CONTACTS TIGHT&CLEAN ❑ SERVICE CONTRACT E3 FAN PULLEYS(ADJUST BELT) 0 CHECK.LUB BEARING AND MOTOR DESCRIPTION OF WORK PERFORMED ❑ NORMAL 'RES. El COMM. ❑ EVAPORATOR COIL ❑ TIME&MATERIAL 0 CLEAN COIL&CHECK FIN 0 ENT DB °F LGV_*F 0 ENT WB_°F LGV -F CONDENSATE AREAS ❑INSPECT&CLEAN GRAIN PAN ❑INSPECT&CLEAN DRAIN r El AIR FILTER ❑CLEANED 0 REPLACED ❑ HEATING ASSY. ❑BURNER&HEAT EXCHANGER 0 FUEL SUPPLY&PRESSURE ❑PILOTASEMBLY ❑FLAME ADJUSTMENT L��, IV 0 PRIMARY RELAY&FLUE 0 FAN&LIMIT SWITCH OPER ,- y- OBLOWERASSEMBLY 0 RV VALVE TOTAL PARTS 0 STRIP HEAT WRITE OR CODE AMOUNT ❑DEFROST CYCLE PARTS WAARAM N I O ELECTRICAL COMP'TS AI pert M HIe.lded a.enBUBed Y pw eIMBdBCOBa E 0 RELAYS ❑CONTACTORS a TECHNCIAN DATE TRAVEL FASKILAR O.T.HRB. COST" i ❑OVERLOAD Ll PRESS.SWITCH LABOR G 1ARAY . HOURS HOURS ❑ THERMOSTAT DIE bbwdnBye..I.eofdedhere h 11Mto0M.gap• U O.K. ❑REPLACE mod IRwrk.dumli ,legawaft dlarepMlodol I ' ❑RELOCATED 30dg/. UNIT DESCRIPTION we40rA%d wirw'vim"COW pouIRft" w YMLII tl npeirt Ula Oeooer Rx e.My due to dlw UNIT MANUFACTURER ddill-p.ftOMTrN0.IAerpeds*wdWy, o TOTAL TECHNICIAN L°• CERT. TOTA -,I W OTHER CHARGES S SIGNATURE (,/ LAIlOR J j ENVIR NMENT_ HE K LIST_ - •. . . SAL UNIT MODEL NO. OIRG TYPE SYSTEM E CHANGED 1 HAVE THE AUTHORITY TO ORDER THE ABOVE WORK AND DO SO AS OUTLINED PARTS CODE REFRIG. OTY. El ABOVE.IT IS AGREED THAT THE SELLER WILL RETAIN TITLE To AMY EOUVP fT OR TOTAL i R V REPLACED a NO MATERIAL FURNISHED UNTIL FINAL A Co.rLETE PAYMENT IS MADE.ALIO IF SETTLE• DyMOMRM E Q RECOVERED? ❑ ❑ Q,.,,. P MENT IS NOT MADE AB AGREED.THE SEVER SHALL HAVE THE RGHT To REMOVE iUNIT SERIAL NO. F YES NO M DISMANTLED ❑ ❑ SAME AND THE SELLER WILL BE HELD HARMLESS FOR ANY DAMAGES RESULTING TRS E YES NO FROM THE REMOVAL THEREOF. CHARGE I FEDERAL E/RMONMEIRAL REGULATIONS PROHIBIT THE UNAUTHORIZED REMOVAL R 0 RECYCLED? CITY N REFRIGERANT DISPOSAL AND DISPOSAL OF HAZARDOUS MATERIALS SUCH AS ASBESTOS,CONTAMINATED TAX TYPE OF EOUIP. YES NO T OLS AND REFRGERAMTS.COST OF SUCH REMOVAL AND DISPOSAL IS REOWED BY SSPLIT PKG.YST ❑ UNIT [3 ' ® RECLAIMED?G YES NO F-1 F1oTY MILEAGE COC ONA11p®VTC j}E NCI�TptlEp Fpq SERVICES. DICIDENTAL TO THIS PIPIOPOSAL A FEE 1IYILL`BE B START ODOMETERWALL B ERETURNED TO IF] F-1 CHILLER ❑ UNIT ❑ R DO SYSTEM YES NO OTY._ ENDING ODOMETER AUTO SIDIIATURE ® DISPOSAL ABOVE ORDERED WORK HAS MEN COMPLETED AM 1 ACKNOWLEDGE RECEIPT OF MY COPY. REFR. ❑ HEATER ❑ A NON USEABLE El El TOTAL MILES R WATER N YES NO OTY.� x FCOOIlP ❑ COOLED CQ T ® DISPOSAL C IHARGE DATE AM*J FEV Vtl Aw.a RV 442 L CRESy Miami Shores Village Building Department B.o, ,.,,,M 10050 N.E.2nd Avenue �.. Miami Shores, Florida 33138 Ln pNT ,y6 . Tel: (305)795.2204 ORIDp 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): :�Z&/l/f= 122 t5�T - 21 City: Miami Shores Village County: Miami Dade Zip Code: O�3/ 38 ALL CONDENSING UNITS MUST BE ON A 4 INCH SOLID CONCRETE SLAB ALL UNITS MUST COMPLY WITH F.E.M.A MINIMUM FLOOD ELEVATION 0000 A COPY OF THE CONTRACT IS REQUIRED WITH ALL SUBMITALS •„�•• ••• AHRI DATA SHEET REQUIRED ' Change disconnecting means:YES❑ NO ARHI Sheet Attached:YES NO ElCb11tfgCt Attached:YES ,.••; 0000 0000. UNIT BEING REPLACED DATA •••; UNI •��••• MANUFACTURER �.Lf��M...... ...... AHU or PKG. UNIT MODEL# COND.UNIT MODEL# /QAo44^ 3,, 0 "”"' KW HEAT ��"� ' �- !ti � t-•�� > 00006. 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): "L--30P•g 2. Maximum Overcurrent Protection (Fuse/Breaker Size):` —Vo,�ttyP 3. Voltage of Circuit(208/240/480): 4. Size Disconnecting Means: ,wry x'S _ Contractor's Company Name: <:�&n L_ (a)A".0 Phone: State Certificate or Registration No. �, %8'j ?V G L-7 Certificate of Competency No. Signature Date: (Qualifier's signature) i (Revised02/24/2014) 745 North East 91 st Street Miami Shores,FL 33138 305-759-9069/ ' - _ - E-MAIL•spel23@att.net May 29, 2018 Miami Shores Village Building Dept. 10050 NE 2nd Avenue Miami Shores, FL 33138 Dear Sir/Madam: This letter will serve as your confirmation that "Cool Wave Air Conditioning Corp" has been contracted by the owner of Apt. 2M at 716 NE 92 Street, Miami Shores, FL 33138 and is fully authorized by the Shores Plaza East Condominium Association, to replace the central air conditioning unit at said apt. Should you have any questions regarding the enclosed, please feel free to contact our office at your earliest convenience. Sincerely yours, �/reasurer Oscar oza Say / cc: file Mi*ami shores Village !a1 Q numm W-- Building Department 10050 N.E.2nd Avenue oRiMiami Shores, Florida 33138 Tet: (305) 795.2204 Fax: (305) 756.8972 Notice to Owner - Workers' Compensation lnsurance Exemption Fiorida Law requins'Workcrs' Compensation insurance coverage under Chapter 440 of-the l=lnrida`Statutes: Fid. Stat. %,440.05 allow corporate officers in'dte construction industry to exempt themselves from this rcquircment for any construction project prior to obtaininc a huilding permit: Pursuant to the Florida Division of Workers'Compensation Employer Facts 11mchurc:, An employer in the cnnstruetion industry who employs_one or more part-time or,full-time employees. including the owner.must obtain workers'compensation coverage. Corporate officers or meiiibers of a limited liability company (1:L(;)+in the construction industry may elect to be exempt if: L The vfGc&owns at least 10 percent of the stock of the corporation;or in the case of an GLC,a statement attesting to the minimum 10 percent ownership; The officer is listed as an-offecer,of the corporation in the records of the Florida Department of State,Division of Corporations:and 3- The corporation As roistered and listed as active with the`Florida Department of State.Division of Corporations. No more than three corporate officers per corporation or litnited liability company members are alloWed to-he'exempt. Construction Exemptions are valid for a period of two years or until.a; voluntavy 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 h.-or she will hot use. day,labor,part-time employees or subcontractors for your project-The contractor has provided an affidavit slating that he or the will be,the only'person allowed to work on your project.In these circurnstanecs,kiiami Shores Village does'notrcquire vu riGcatiott of workers'compensation insurance cnveragefrom the contractor's company kir day labor,part-tirru employees or subcontractors. BY SIGNING BELO�V YOU ACKNOWLEDGE THAT YbU HAVE .READ TMS NUTIC;G :4\I,) llAi)F Rti'1'iX11) i'C$ CO NITE NTS. Signatures„ &15- 0►i•ncr State of V16-ride County of N-fiami-Dade The"tbregoin-.qas ackh6wledge`before ine this_3 p,,,,,day of _ .20-&—. ,d/Mp-L 'who is personally known to me or has produced /I G.20 —20l- -9!) ' - 0 as identification. Notary~ SEAL: GRETHEL SILVA Notary Public-State of Florida o01U :. •: men %h + My_Comm.Expires.Nov 7, 2020' ,.t•��' Sondedth44gh National Notary Agsn. ettatZia" 4e Date: 5-29-2018 I State of Florida County of Miami Dade E Before me this day personally appeared ... ii S 1 A1. 'c Who being duly sworn, deposes and says: That he or she will be the only person working on the project located at: ........................-.7r.4.......?u.......` , .. ............................................................... Contractor signature Sworn to (or affirmed)and subscribed before me this.....3'.0......day of.....X"y.....20.1,�. Personally know.............................. Or produce identification..�✓'.5'.5..�:sSL.. `f-�� Type of identification produced...�f�/�!✓ n..Lic�,t µ GRETHEL SILVA .......... ��' ..NotsP.ublic:.Sfalspl.FJncula . Commission#GG 010744 Print,Type or �ekb-ft0j%11pires Nov 7,2020 SWedthrough National Notary Assn, 6605 S.W. 164th Ave- Miami, Florida 33193/Tel: (305)388-5236/Email: Lablanco@coolwaveairconditioning.com w . JIMMY PATRONIS CHIEF FINANICAL 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: 4/27/2018 EXPIRATION DATE: 4/26/2020 i PERSON: BLANCO LUIS A FEIN: 650712187 BUSINESS NAME AND ADDRESS: COOL WAVE AIR CONDITIONING CORP 6605 SW 164TH AVE , MIAMI FL 33193 SCOPE OF BUSINESS OR TRADE: I j { RICK SCOTT, GOVERNOR KEN LAWSON, SECRETARY STATE OF FLORIDA I DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD ` CAC 181346D The CLASS AAIR CONDITIONING CONTRACTOR—` f Named below IS CERTIFIED '` Under the provisions of Chapter.489 Expiration date: AUG 31, 2018 +� * w BLANCO,LUIS A 'COOL WAVE AIR CONDIT O tNG CORP_ 6605 SW 164"AVE-r-.�.. � �. _ sNV .�� R MIAMI +,171`°33193 _ _ a y� P f 4 c ISSUED: 07/28/2016 DISPLAY AS REQUIRED BY LAW SEQ# L1607280001195 001239 Local Business Tax Receipt Miami—Dade County, State of Florida THIS IS NOT A BILL-DO NOT PAY _ LBT i - -3608925 __._,BUSINESS NAME/LOCATION """" - - __� - j =RECEIPT NO:- EXPIRES COOL WAVE AIR CONDITIONING CORP RENEWAL SEPTEMBER 30, 2018 6605 SW 164 AVE 3770881 Must be displayed at place of business MIAMI FL 33193 Pursuant to County Code Chapter BA-Art.9&10 OWNER SEC.TYPE OF BUSINESS PAYMENT RECEIVED COOL WAVE AIR CONDITIONING CORP 196 SPEC MECHANICAL CONTRACTOR BY TAX COLLECTOR C/O LUIS BLANCO PRIES CAC1813460 Workers) 1' 875.00,08/20/2017 CREDITCARD-17-054881': -- This Local Business Tex 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 governments[ 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 www.miamidade.gov/taxcollector t i ��Q CERTIFICATE OF LIABILITY INSURANCE DATE(MWDD/YYYI() `.� 05/18/2018 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 CONTNAME:: Susan Camacho Just Insurance Brokers PHONE . (305)418-4701 FA No): (305)418-4706 1200 NW 78 Ave Suite 105 ADDRIESS: scamacho@jibfl.net INSURER(S) AFFORDING COVERAGE NAIC# Miami FL 33126 INSURERA: Catlin Specialty Insurance Company INSURED INSURER B: Cool Wave Air Conditioning Corp.C/O Luis Blanco INSURER C: 6605 SW 164 Ave INSURER D: INSURER E: Miami FL 33193 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. rA TYPE OF INSURANCE POLICY NUMBER MAODLSUBR PM/DOI EFF MPMLIDCY EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000.000.00 DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ 100,000.00 CLAIMS-MADE OCCUR MED EXP(Any one person) $ 5,000.00 0900017160 09/23/2017 09/23/2018 PERSONAL&ADV INJURY $ 1,000,000.00 GENERAL AGGREGATE $ 2,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP'AGG $ 2,000,000.00 X POLICY PRO LOC $ COMBINED SINE LIMIT cci AUTOMOBILE LIABILITY Ea adent $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIREDAUTOS r AUTOS Per accident UMBRELLA UAB HOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION TOR STY LIOTH- R AND EMPLOYERS'UABYIN IUTY MIT MIT ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ N/A E.L.EACH ACCIDENT $ .. OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYE $ (Mandatory In NH) If yes,describe under, E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS below 1 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,H more space Is required) �:-•1��,� �� Jf I � f y I CERTIFICATE HOLDER CANCELLATION 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 Village Building Department AUTHORIZED REPRESENTATIVE 10050 N.E.2nd Ave, Miami Shores, FL 33138 ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION.All rights reserved. The ACORD name and logo are registered marks of ACORD «