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MC-19-350y S Y Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Issue Date: 03/07/2019 Location Address Parcel Number 1551 NE 105TH ST 210, Miami Shores, FL 33138 1122300530690 :ontacts Permit NO.: MC-02-19-350 Permit Type: Mechanical - Residential: Work Classification: A/C Replacement Permit Status: Approved Expiration: 09/03/2019 INES BELTRAME TRS Owner J M ARCE SERVICE Contractor 13250 KEYSTONE TER, NORTH MIAMI, FL 33181 JOSE M ARCE IBELTRAME@AOL.COM 6030 SW 22 ST, MIAMI , FL 33155 Business: 7864236626 Description: 2 1/2 TON AC REPLACEMENT Valuation: $ 2,800.00 Inspection Requests: 305 7'�2-4 Total Sq Feet: 0.00 Fees Amount Application Fee - Other $50.00 CCF $1.80 DBPR Fee $2.00 DCA Fee $2.00 Education Surcharge $0.60 Permit Fee $50.00 Scanning Fee $3.00 Technology Fee $2.50 Total: $111.90 Payments Date Paid Amt Paid Total Fees $111.90 Cash 02/14/2019 $50.00 Cash 03/07/2019 $61.90 Amount Due: $0.00 Building Department Copy 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, P7the ING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AFFIDA�d' at foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating cons io F hermore, I authorize the above named contractor to do the work stated. / Applicant / Contractor / Agent Date March 07, 2019 Page 2 of 2 .M. A?CF AIR CONDITIONING & REFRIGERATION ,j ,. LES 8�,5'ERVICE INSTALLATION licensed Insured CC Q57All . 24 HRS. EMERGENCY SERVICE .M. WRCE ALR- CONDITIONING, & REFRIGERATION IAA- Felix Luna«f Field Supervisor 786-423-6626 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 BUILDING PERMIT APPLICATION ❑BUILDING ❑ ELECTRIC ❑ ROOFING Master Permit No. m C - ©2 - i o(- 3 sz� Sub Permit No. ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING 2rMECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: l /v S7- City: Miami Shores County: Miami Dade Zip: 3 /3F Folio/Parcel#: V -- 2230 `' 053 — 0690 Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): I CS AaTX H 6 TnS Phone#: 30 S Address: 4 3Z 5'O l��/ � iJ 6 E� City: 0 0 -Y H`'lH4dI State: Tenant/Lessee Name::., Phone#: Email: I bef/ t Qflie e Cz p: 331 j7-( CONTRACTOR: Corn any Name: �}��� - Phone#: �i�6 �� Address:( A03� City: d I �'' YLf,� State: Asa Zip: Qualifier Name: ®jam�� Phone#: State Certification or Registration M "—"J"7 C-- 0 5- 7 9 �7 Certificate of Competency M G 'oe 7 `�� k) DESIGNER: Architect/Engineer: Address: City: State: Value of Work for this Permit: $ 2 Square/Linear Footage of Work: _ Type of Work: ❑ Addition ❑ Alteration ❑ New [Repair/Replace Description of Work: Specify color of color thru tile: Submittal Fee $ • v`Q Permit Fee $ Scanning Fee $ Radon Fee $ Technology Fee $ Training/Education Fee $ Structural Reviews $ (Revised02/24/2014) Zip: ❑ Demolition CCF $ CO/CC $ DBPR $ Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ --Q, i . d 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. 1 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 AG CONTRACTOR The foregoing instrume was cknowledged before me this The foregoing instrume cknowledged before me this day of 20 j by [� day of 20 �1�, by who is personally known to eT _�S �`�C 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 PU NOTARY PUB C: ci��Zes Sign: Sign: Print: I/I.VI F �3 QA%/J/!/r^. Q��/ Print:2� '1/d v pu LUIS o'W pul LUIS FERNANDEZ rot . ec� Seal: W COWAISSION # GG 00161 Seal: ? ° MY COMMISSION # GG 041161 EXPIRES: November T, 2(120 mo` EXPIRES: November 7, 2020 BadedTtruBudget�„y Servi= 'For r�°� Eonded Ttw Budget Notary Servloec sssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssss APPROVED BY \ Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) r harbour-club-villas conclorninfurns 1530 N.E. 1051h Sireel, "WA Shoros, F1odck 3313E ► Phone 893.817E January 22, 2019 Miami Shores Village Building Dept, This Letter is Authorizing unit number 1551 NE 105 St. to install on A/C Unit. If you have any questions, please leave a voicemail at 305-893-8178 and your call will be returned as soon as possible. Sincerely yours, Bruce C Rich, Vice President For the Association. Z:�— C 14 ACCJRif? CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) _. av2sr2a1s THIS CERTIFICATE 1S 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, tho 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 MARINA SANTOS Univista Insurance WCNo. EAU. _ (305) 267-7138 _ —_ . I FAX(305) 267-7143 E-MAIL _ 8476 SW 40th St. Suite 201 msantos@univistainsurance.com ...ADDRESS:.— -- _ _-- Miami Fl, FL 33155 _ INSURERSJAFFORDING COVERAGE NAICS Phone (305) 456-6622 Fax (786) 953-7029 INSURERA:—GRANADA INSURANCE CO — — INSURED _ INSURER B : i J-M ARCE SERVICE INC INSURER c _.... .......... ; f G030 SW 22 ST INSURERo ._____� -�_. ....... N11AMI FL 3315S _ _ _.... _. ____ INSURER F __._ _. _ ....... -. COVERAGES CERTIFICATE NUMBER: REVISION NUMBER --- __ T HIS 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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. tNSR ;ADD SUER POLICY EFF POLICY EXP lTR TYPE OF INSURANCE INSR WVD.. .POLICY NUMBER_______-_ .(MWpDIYYYYj ,IMMlDO/YYYYj LIMITS .... ...... ............. . .......... . .... ......... �/; COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE_ $ 1,000,000.00 CLAIMS -MADE] DAMAGE TO RENTED OCCUR $ 100,000.00 PREMISES (Ea occurrence} MED EXP (Any one person) s—S 000.00 A a185FL111436-0 06/11/2018 06/11/2019 1,000,000.00 - - --- - PERSONAL & ADV INJURY _.. .... .._...... . $ GEN'L AGGREGATE LIMIT APPLIES PER ENERAL AGGREGATE GE G S 2,000,000.00 i ;PRO POLICY JECT �- t OC ____. __m..., PRODUCTS - COMP/OP AGG �. ... $ 2,000,000,00 OTHER $ AUTOMOBILE LIABILITY CO BINE atxade iSINULE UMtT BODILY INJURY (Per person) -- S ANY AUTO I ALL OWNED SCHEDULED BODILY INJURY {Per accident $ AUTOS-_i AUTOS •� i NON-OWNFO PROPERTY pAMAGE $ HIRED AUTOS (_i AUTOS iPar acudoni},,, __ ..... ....... I I S _.. UMBRELLA LIAB :OCCUR I EACH OCCURRENCE $ ,- EXCESS LIAB^_ 4 .,,CLAIMS -MADE..; AGGREGATE _ .. ...... $ ...._ --_ . -._ ..._-... _- + DED RETENTION$ WORKERS COMPENSATION— I l� 1 PER "-} OTH- i—'.. STATUTE-. = " ER AND EMPLOYERS' LIABILITY Y / N j I ' _ - ANY PROPRIET OWPAR TNEwEXi�CUTIVii---- -)FFICFRrMEMBER EXCLUDF_D? N 1 A. � EL EACH ACCIDENT - $ (Mandatory in NH) - { E— L DISEASE ".FMpLOYE4 $ .__....: _.. V yes hescvbe under EL DISEASE -POLICY LIMIT I S DESCRIPTION OF OPFRATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES {Attach ACORD 101, Additional Remarks Schedule, if more apace is rsquiredl AIR CONDITIONING SERVICING AND INSTALLATIONS JOSE M ARCE - CONTRACTOR CAC 057951 .1.1 .... ... ...... CERTIFICATE HOLDER MIAMI SHORES VILLAGE BUILDING DEPARTAMENT 10050 NE 2 AVE MIAMI SHORES, FL 33138 ACORD 25 (2014/01) QF _ _ ,......... _— CANCELLATION ................ - _.._ SHOULD ANY OF THE ABOVE OESCRIB OLICIES t�E CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NO CE WILL B E IVERED IN ACCORDANCE MtH THE POLICY,Q ISIONS. AUTHORIZED REPRESENTA O 198$4O4WC RD CORPORATION. All rights reserved. The ACORD namo and logo are registered marks of ACORD J.M. ARCE SERVICE INC 6030 SW 22"d Street Miami, FL 33155 Date: State of: County of: Before me this day personally appeared deposes and says: 6P.4—c_O That he or she will be the only person working on the project located at : ntractor Signature who, being duly sworn, Sworn to (or affirmed) and subscribed before me this 1L/ day of 22994-, 20 —• By Personally known OR Produced Identification Type of Identification Produced�77 Print, Type or Stamp Name of Notary WIS FERNANDEZ * * MY COMMISSION III GG 041161 opt` EXPIRES: November 7, 2020 OF F� Bonded TIVU Bwlget Notry Smfo" 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. Signature: �2 Owner V State of Florida County of Miami -Dade The fore oing was acknowledge before me this 45 day of 20�. By who is personally known to me or has produced do- as identification. �� . '� KIM£ERIEE MARISSA SHEFFIELD No ` Commission t GG 62179 My Commission Expires SEAL: »w Jenuory 12. 2021 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): IJ6— "(DS tt' St — City: Miami Shores Village County: Miami Dade Zip Code: 3 3 % 2 p ✓ 6 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 d'f§conneetingmeans: YES NO ❑ Ab. RHkSheet-Attached: YES ❑ NO ❑ Col7tmc[Attached: YES ❑ UNIT BEING REPLACED DATA NEW UNIT • y '^� 1 MANUFACTURER A i✓r Tf v r Z)V a6 A 3 AHU or PKG. UNIT MODEL # p P77 Zac 74- 4`1 COND. UNIT MODEL# GS % O KW HEAT J 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 7' AHU CU PKG PKG UNIT / / PKG UNIT EER/SEER YES NO REPLACING DUCTS YES O YES NO REPLACING THERMOSTAT CIE3> NO YES NO NEW 4"CONCRETE SLAB YES YES NO NEW ROOF STAND YES NO YES NO NEW RETURN PLENUM BOX YES O 1. Minimum Circuit Ampacity (Wire Size): 2. Maximum Overcurrent Protection (Fuse/Breaker Size): 3. Voltage of Circuit (208/240/480): '7_ O 0 4. Size Disconnecting Means: O /' Contractor's Company Name: Phone: �,.�j-? -9 - Z 3 - �e� State Certificate or gistr tion Igo � ���✓� Certificate of Competency No. �- Re Signature 4-1 Date: (Qualifiers signatu ) • �- (Revised02/24/2014) GAW&oiLW ts CE�R�TIFIED° www.ahridirectory.org • �I M-6 +;�! t M� AHRI Certified Reference Number: 201298797 Date : 01-29-2019 Model Status : Active Old AHRI Reference Number: 7984193 AHRI Type: RCU-A-CB Series: GSX14 Outdoor Unit Brand Name: ENERGI AIR Outdoor Unit Model Number (Condenser or Single Package) : GSX140301 K* Indoor Unit Model Number (Evaporator and/or Air Handler) : ARUF31 B14A* 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'retiuirement. The manufacturer of this ENERGI AIR product Is responsible for the rating of this system combination. Rated has 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 : 28200 SEER: 14.00 EER (A2)'- Single or High Stage (95F) : 11.60 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 prod uced."Production Stopped" Model Status are those that an AHRI Certification Program Participant is no longer producing BUT is still selling or offering for sale. Ratinas that are accompanied by WAS indicate an involuntary re -rate. The new published rating 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.ahridirectary.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, 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 i.,T,;,ke l;i'e barter, 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. ©2019Air-Conditioning, Heating, and Refrigeration Institute "CERTIFICATE NO.: 1319326093548583713 WYORK" 6030 S. !N. 22 street Heating and Air Contlitiomnq J M . . MCE Miami, Florida 33155 AIR CONDITIONING • REFRIGERATION CONTRACTOR office- (305) 262-3589 SALES • SERVICE • INSTALLATION 90 LICENSED & INSURED State contractor Lic- #CAC 057951 lu rAWE to " PROPOSAL AND SALES AGREEMENT SOLO To: Date: PROJECT: A3 sue' Customer: Telephone: I TX T I I I I I I I . I Sub Total Z� Tara I All orders are C.O.D. (Cash on deWery) bass& unless credit Is already estabrished by on acknowledged credit application. Terms on estabhshed credit accounts, net 30 days. Balances unpoid after 30 days from the date of invoice are subject to service charge of 1.5% Interest per month, maximum olio ved by low. The purchaser also agrees to pay all cost In collecting this account, including reasonable reasonable attorney's fees, court cost. accounting fees, and interest charges accrued. Retumed checks for any reason: $20.00 service charge Received by: Date: 5 0 % R d u a n c e �� I