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MC-18-675Permit NO. MC-3-18-675 yew!V o�{ Miami Shores Village Permit Type: Mechanical - Residential 10050 N.E. 2nd Avenue NE Work Classification: Addition/Alteration Miami Shores, FL 33138-0000 Pen t Permit Status: APPROVED Phone: (305)795-2204 tORiDp' Issue Date: 4/2612018 Expiration: 10/23/2018 Project Address Parcel Number Applicant 126 NE 107 Street 1121360070220 ILEANA ESTHER FAJARDO Miami Shores, FL 33161-7032 Block: Lot: Owner Information Address Phone Cell ILEANA ESTHER FAJARDO 126 NE 107 Street MIAMI SHORES FL 33161- 126 NE 107 Street MIAMI SHORES FL 33161- Contractors) Phone Cell Phone HERZTECH CORP. (786)348-8023 Info: CHANGE OUT AND RELOCATION OF CENTRA on: Residential In Review omments: ate Denied canning: 1 Fees Due Amount CCF $2.40 DBPR Fee $2.05 DCA Fee $2.00 Education Surcharge $0.80 Notary Fee $5.00 Permit Fee $136.50 Scanning Fee $3.00 Technology Fee $3.20 Total: $154.95 Valuation: $ 3,900.00 Total Sq Feet: 0 Date Approved:: In Review Type of Work: CHANGE OUT AND RELOCATION OF Pay Date Pay Type Amt Paid Amt Due Invoice # MC-3-18-66802 04/26/2018 Check #: 697 $ 154.95 $ 0.00 AvanaDle Ins Inspection Type: Final Rough Duct N 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 construction and zoning. Futhermore, I authorize the above -named c&tractor to do the work stated. Authorized Signature: Owner / / Agent April 26, 2018 Building Department Copy 26, 2018 1 Miami Shores Village F-CI Building Department MAR 14 7018 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 CD ((''��FBC 201•�- BUILDING Master Permit No.y_ C- 16 llJ PERMIT APPLICATION Sub Permit No.MC t - F-�BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION RENEWAL ❑ PLUMBING R4,MECHANICAL [:]PUBLIC WORKS [:]CHANGE OF CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: /Lgez 6 ! _14 Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load OWNER: Name (Fee Simple Titleholde Address: Z22? City:(WAP r Tenant/Lessee Construction Type: Flood Zone: N State: BFE: FFE: 6 Phone#: Zip:�� b Phone#: Email: IICAiar 0 t4/1Gi f1�! (9 Q�'t^(ii(. C-P/{'� CONTRACTOR: Company Name://P�C� CD�►� Phone#: Address: ) 2 25D 50 Lt'D `�L City: Ar-(l State: /`'t/_ Zip: p,,, a Qualifier Name: 1�� / 2 /A-)OAs\X � Phone#: I ft — : y b - 0 a J State Certification or Registration #: 69(,W64416 Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ 3i q O0. O 'D Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration 0 New EO'Repl:air//Rleplacee❑ Demolition Description of Work: i�,V,G L Q()� &A S L1tA4 C .�C,14Ai-A 'A Z44551W CtI diAIAi --. Specify color ofic-olo♦rthrux;tile. Fp�,'4iy Submittal Fee $ x . a . ,» a a ` +> Permit Scanning Fee,$ �•- Radt7tt�Fee�$"_ Technology Fee $_ Structural Reviews $ Training/Education Fee $ CCF $ CO/CC $ _ DBPR $ Notary $ Double Fee $ _ Bond $ 5 TOTAL FEE NOW DUE $ (� (Revised02/24/2014) Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip 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. AGENT The foregoinglinstrument wa a cnowledged before me this J2 day of 20 . by ol'�nn personally known to me or who has produced l l iac" as identification and who did take an oath. The foregoing inst , i day of me or who has p CONTRACTOR acknowledged before me this 20 / q , by , who is personally known to Las identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: rs Seal: RACHEL LEMUS ='r •': MY COMMISSIONS FFOOSS33 NY�I:#!M-u5,� r�•■►.rwrs �wvnr.can APPROVED BY 17 lans Examiner Zoning Structural Review Clerk (Revised02/24/2014) 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' being done):_l a (2 N �, 10l4l" St, 4 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 V ARHI Sheet Attached: YES dNO ❑ Contract Attached: YES [ UNIT BEING REPLACED DATA NEW UNIT MANUFACTURER j>% AHU or PKG. UNIT MODEL # FX Z>Al r0 D1403 SO COND. UNIT MODEL#1dA1&1VAQ*3-A /9 K W KW HEAT XVV V 2 -rook' NOM TONS TONS AHU , CU PKG 1) M.C.A A U5eZCU PKG AHL60 C PKG 2) M.O.P AHU(VOCU PKG AHU` CU PKG 3) VOLTS AHU12daU' KG PKG UNIT / / PKG UNIT EER/SEER YES NOL REPLACING DUCTS YES NO YES NO REPLACING THERMOSTAT YESIt NO YES" NO NEW 4"CONCRETE SLAB YES V NO YES NO NEW ROOF STAND YES NO YES NOVNEW RETURN PLENUM BOX YES NO 1. Minimum Circuit Ampacity (Wire Size): 2. Maximum Overcurrent Protection (Fuse/Breaker Size): 3. Voltage of Circuit (20 24 480): A- �' 01_7 ; 4. Size Disconnecting Means: Contractor's Company Name: State Certificate or.Re Signature ifier's signature) (Revised02/24/2014) Phone: Certificate of Competency No. Date: /`` ERZTECH C0RP0RAT 10 ROBERTO HERNANDEZ 1 ------------------------------------------------------------------------------ AGREEMENT FOR SERVICES Date: March 2, 2018 Attn: Ileana Fajardo 126 NE 107fh St Miami, FL. Tel: 305-609-319A Email: fajardo.ileana1 1 @gmail.com Re: The following services: ■ Replacement and installation of central air-conditioning unit RHEEM/CARRIER - A tons - 16 Seer - R-Al 0. Includes the following: • Air handler unit and heat • Condenser unit • Washable filter • Non -programmable digital thermostat • Concrete slab for condenser unit • Aluminum stand (2A") • Relocate refrigerant pipes (lines 7/8 & 3/8) • Relocate drain line *TOTAL FOR PARTS & LABOR: **$ 3,900.06 * *50% Deposit is due at the start of job *Warranty: 10 years on the compressor; 10 years on parts; 1 year of labor Robert Hnandez Herztech Corp. Ilea Fajardo Clien This combination qualifies for a Federal Energy Efficiency tax Credit when placed in service between Feb 17,2009 and Dec 31, 2016. Certificate of Product Ratings AHRI Certified Reference Number : 9200321 Date: 03-08-2018 Model Status :Active Old AHRI Reference Number : AHRI Type: RCU-A-CB Series : 16 SEER AC Outdoor Unit Brand Name : CARRIER Outdoor Unit Model Number (Condenser or Single Package) : CA16NA048'0"A• Indoor Unit Brand Name : Indoor Unit Model Number (Evaporator and/or Air Handler) : FX4DN(B,F)049L Furnace Model Number : 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. - - The manufacturer of this CARRIER product is responsible for the rating of this system combination. Rated as follows in accordance with the latest edition of ANSI/AHRI 210/240 with Addenda 1 and 2, Performance Rating of Unitary Air -Conditioning & Air -Source Heat Pump. Equipment- and subject to rating accuracy by AHRI-sponsored, independent, third party,testing:. Cooling Capacity (A2) - Single or High Stage (95F), btuh 46500 SEER'. 16.00 I EER (A2) - Single or High Stage (95F) : 13.50 IEER : t"Active" Model Status are those that an AHRI Certification Program Participant is currently producing 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 that an AHRI Certification Program Participant is no longer producing BUT is still selling or offering for sale. Retinas that are accompanied by WAS indicate an involuntary re -rate. The new published ratingg is shown along with the previous (i.e. WAS) rating. 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 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, MR1 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 an which the certificate was issued, which Is listed above, and the Certificate No., which Is listed at bottom right. ©2018Air-Conditioning, Heating, and Refrigeration Institute 1 CERTIFICATE NO.: 131648417134666438 Miami shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Notice to Owner - Workers' 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 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' compensation insurance 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 CONTENTS. Signat6ie 4-_____ Ow r State of Florida County of Miami -Dade The foregoing was acknowledge before me this �� day of MQ i'� , 201 1. By 1-f-an0i ZC �01 alma who is personally known to me or has produced T)6W(,.V,CRYIISt as identification. Notary: SEAL: YANADY PRIErO MY COMMISSION # FF 214031 EXPIRES: March 25, 2019 Bonded Thru Notary Public Under Neva ERZTECH CORPORAT 10 ROBERTO HERNANDEZ, 305-205-413�— Date: 03�0<9 lc6 State of —F-7c' County of / AA-(t - .Z>Ayt Before me this day personally appeared F1LAJ4-,oVe� who, being duly sworn deposes and says: That he or she will be the only person working on the project located at: rac r S nature Swor o (or a irme ) n subscribed before me this _�_ day of 1./4A 20 , by Personally know Or Produced Identification Type of Identification Produced RACHEL IEMUS MY COMMISSION x FF965633 EXPIRES Feh,Uwy 29. 2020 Print, Type or Stamp Name of Notary