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MC-19-678Permit No.: MC -03-19-679 Miami Shores Village Permit Type: Mechanical - Residendal 10050 NE 2 Ave Miami Shores FL 33138 Work Classification: A/ Replacement 305-795-2204 nom. .i..„•. A --.--A Issue Date: 04/03/2019 1 Expiration: 09/25/2019 Location Address Parcel Number 102 NW 94TH ST, Miami Shores, FL 33150 1131010330740 Contacts JOHN ROIG Owner SERVICE EXPERTS HEATING & AIR Contractor 102 NW 94 ST, MIAMI, FL 331502240 CONDITIONING CAREY ZARM 1209 POTOMAC, MERRITT ISLAND, FL 32952 Business: 3052642020 Description: EXACT CHANGEOUT 4 TON A/C PACKAGE UNIT Valuation: $ 15,500.00 Inspection Requests: 4949 WITH 9 KW HEATER Total Sq Feet: 0.00 Fees Amount Application Fee - Other $50.00 CCF $9.60 DBPR Fee $8.14 DCA Fee $5.43 Education Surcharge $3.20 Permit Fee $492.50 Scanning Fee $9.00 Technology Fee $13.56 Total: $591.43 Payments Date Paid Amt Paid Total Fees $591.43 Credit Card 03/29/2019 $50.00 Credit Card 04/03/2019 $541.43 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, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNEAS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regula4rlg cgrstruction avid zoning. Futhermore, I authorize the above named contractor to do the work stated. re: Owner / Applicant / Contractor / Agent Date April 03, 2019 Page 2 of 2 Miami Shores Village RECF:jVF'D Building Department M 2 9 2019 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY. Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 / FBC 20 BUILDING Master Permit No. PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING EdMECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP I 0 � NW L� 'CONTRACTOR � ���., DRAWINGS JOB ADDRESS: 1 ` City: Miami Shores : Miami Dade Zip: Folio/Parcel#: I 1 10 1 ' Q y�nCoun ' b (40 Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: I' ,^, C zz OWNER: Name (Fee Simple Titleholder): '-Ta Vl �( Phone#: 6"5 ' T�? ' W 1n q Address: �l o Z MW /64 City: 1 �6 t a&-4iStater Zip: " r /b Tenant/Lessee Name: Phone#: Emai I CW DS SaU fh, tje' CONTRACTOR:•CQmpany Name:' Address: G IN -1 IyW City: D MS �C/I VI C:QJ • ,Phone# �`•���' �n Qualifier Name: 1 11 - E��/++fza" n / Phone#: State Certification or Registration U. C, `/ J 91 ! I �� Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for.this Permit: $ ' J00� Square/Linear:Footage'of Work: Type of Work: ❑ Addition 'A"I yp ❑ Alteration New r Repair/Replace Demolition T Description of Work: c►' Ci UJK( -f - W J !q Kw r Specify color of color thru tile: Submittal Fee $S�)' oz� Permit Fee $ Scanning Fee $ Radon Fee $ Technology Fee $ Training/Education Fee $ Structural Reviews $ (Revised02/24/2014) CCF $_ DBPR $ CO/CC $ Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ 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. E Signature -P, - -R ' OWNER or AGENT The fore oing instrument was ack owI dged before me this �da i q4 20 by who is personally known to me or who has produced as identification and who did take an oath. A{LY P& JESSICA ACOSTA NOT?PUC:'����Commission#GG096T44 Expires May 13,2021petde80dedThmou NotarySe"b" Sign: PrintSSS I'-OS1 Seal: Signature— CONTRACTOR ignatureCONTRACTOR The foregoing instr4iment was acknowledged before me this day of 2 by L. w(o is personally know to me or who US produced as V*�� JESSICAACOSTA identification and wa aOD946lon#GG 098744 3.2021 NOTAf)UBLIC• 1,gt1'OUmdedpTl uBudgetlNotaryseeMces Sign:_ "I Print: Seal: VIns APPROVED BY Examiner Zoning Structural Review Clerk (Revised02/24/2014) 3/29/2019 Property Search Application - Miami -Dade County 0 0 F.FICE F THE PROOP"'ERTY APPRAISER .. . Summary Report Property Information Folio: 11-3101-033-0740 Property Address: 102 NW 94 ST Miami Shores, FL 33150-2240 Owner JOHN R ROIG &W LEESA Mailing Address 102 NW 94 ST MIAMI, FL 33150-2240 PA Primary Zone 0800 SGL FAMILY - 1701-1900 SQ Primary Land Use 0101 RESIDENTIAL - SINGLE FAMILY: 1 UNIT Beds / Baths / Half 2 / 1 / 0 Floors 1 Living Units 1 Actual Area 1,757 Sq. Ft Living Area 1,379 Sq. Ft Adjusted Area 1,631 Sq.Ft Lot Size 10,017.12 Sq.Ft Year Built 1938 Assessment Information Year 2018 2017 2016 Land Value $220,646 $220,646 $220,646 Building Value $122,325 $113,518 $113,518 XF Value $1,628 $1,646 $1,664 Market Value 1 $344,599 $335,810 $335,828 Assessed Value 1 $105,700 $103,526 $101,397 Benefits Information Benefit Type 2018 2017 2016 Save Our Homes Cap Assessment Reduction $238,899 $232,284 $234,431 Homestead Exemption $25,000 $25,000 $25,000 Second Homestead Exemption $25,0001 $25,000 $25,000 Note: Not all benefits are applicable to all Taxable Values (i.e. County, School Board, City, Regional). Short Legal Description MIAMI SHORES SEC 6 PB 10-39 LOT 1 & E1/2 LOT 2 BLK 133 LOT SIZE 81.440 X 123 OR 9324 481 Generated On : 3/29/2019 Taxable Value Information 2018 2017 2016 County Exemption Value $50,000 $50,000 $50,000 Taxable Value 1 $55,700 $53,526 $51,397 School Board Exemption Value $25,000 $25,000 $25,000 Taxable Value $80,700 $78,526 $76,397 City Exemption Value $50,000 $50,000 $50,000 Taxable Value $55,700 $53,526 $51,397 Regional Exemption Value $50,000 $50,000 $50,000 Taxable Value $55,700 $53,526 $51,397 Sales Information Previous Sale Price OR Book -Page Qualification Description 04/01/1976 1 $37,500 00000-00000 1 Sales which are qualified 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 County assumes no liability, see full disclaimer and User Agreement at http://www.miamidade.gov/info/disclaimer.asp Version A �® CERTIFICATE OF LIABILITY INSURANCE DA��019W� 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 have ADDITIONAL INSURED provisions or 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 Aon Risk Services southwest, Inc. Dallas TX Office CONTACT NAME' P�, E,): (866) 283-7122 FAR No.: (800) 363-0105 EMAIL ADDRESS: CityPlace Center East 2711 North Haskell Avenue suite 800 Dallas TX 75204 USA INSURER(S) AFFORDING COVERAGE NAIL # INSURED MSURERA: Westchester Fire Insurance Company 10030 Service Experts Heatinq & Air Conditioning LLC 3820 American Drive, #200 INSURER B: ACE American Insurance Company 22667 INSURER C: INSURER D: Plano TX 75075 USA INSURER E: INSURER F: MED EXP (Any amperson) Excluded COVERAGES CERTIFICATE NUMBER: 570075386805 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. Limits shown are as requested INSR LTR TYPE OF INSURANCE AUDI IINSDWVD POLICY NUMBER LIMITS X COMMERCUILGENERALLvaLrrY XSLG A EACH OCCURRENCE $500,000 CLAMSMADE ❑X OCCUR SIR applies per policy to & conditions $500,000 PREMISES Ea ocarmnee MED EXP (Any amperson) Excluded X Includes CaMracUtal Liability PERSONAL& ADV INJURY $500,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $10,000,000 POIJCY � JECT ❑Lac PRODUCTS - COMPIOPAGG $2,000,000 OTHER: SIR $5U0, 000 B AUTOMOBILE LIABILITY Y Y ISA H25276139 03/22/2019 06/30/2020 COMBINED SINGLE LOAMfEa accident) $2,000,000 BODILY INJURY ( Per person) X ANY AUTO BODILY INJURY (Per aoriderW OWNED SCHEDULED AUTOS ONLY AUTOS HIRED AUTOS NON -OWNED PROPERTY DAMAGE ONLY AUTOS ONLY A UMBRELLA LIAB XJ OCCUR Y Y 646614094003 03 22 2019 06/30/2020 EACH OCCURRENCE S4,000,000 X EXCESS LIAB CLAIMS -MADE AGGREGATE $4,000,000 DED I RETENTION B B WORKERS COMPENSATION AND EMPLOYERS' LY1BILnY EMPLOYERS ANY PROPRIETOR / PARTNER / EXECUTIVE Y I N OFFICERIMEMBEREXCLUDED? (Mandatory in NH) NIA Y WLRC65893022 AOS WLRC65896357 AOS 01/22/2019 03/22/2020 5372-272020 06/30/2020 TH- X I SSTA7IJTE 10TH_ ER E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE -EA EMPLOYEE $1,000,000 D es, IPTIOe OF er DESCRIPTION OF OPERATIONS below O E.L. DISEASEPOLICY LOU $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks SdmduK may be attached B more spa,, b: req dr m License #CAC1817129 RE: A/C installation. Certificate Holder is included as Additional Insured in accordance with the policy provisions of the General Liability, Automobile Liability and Excess Liability policies. General Liability and Automobile Liability policies evidenced herein are Primary and Non -Contributory to other insurance available to an Additional insured, but only in accordance with the policies provisions. A waiver of subrogation is granted in favor of Certificate Holder in accordance with the policy provisions of the General Liability, Automobile Liability, Excess Liability and workers' Compensation policies. see attached notice of cancellation endorsements. CERTIFICATE HOLDER CANCELLATION Miami Shores village Building Department 10050 NE 2 Avenue Miami shore FL 33138 USA SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED N ACCORDANCE WITH THE POLICY PROVISIONS 01988-2015 ACORD CORPORATION. All rights reserved. 0 m ern C, P.- N ulft Drive 4 Service Experts b 110 Pak 1 HEATING &'AIR CONDITIONING Jupiter, FL93458 Customer Name:�`— Street Address: IbZ City: f_ti M i t r(r? e State: ,L Zip: Emall: PrimaryPhone: 7 'cN LQ 77- Secondary Phone: Service Address: L142 O Annual rgmlr and rnsintenerm camps O M bcffi end federal pemrs and code compl once O Hundreds of dollars in average repair 9who O Fully bonded, focused NO Insured ` O No deductible O Mdm* Acrxedlted A+ BBB Rathg -O T019-*M:L2 Yearfs)- - - — -- - - — --- - -- -- - - - ---- - Equipment Model/ADW Desc i0on Part Warranty O Outdoor z R.QLAI (' d 4 O Outdoor ILI,C41W yaarts} O Indoor I t o . ) O Indoor�reer(s) O 1AQ i O IAQ Yofff O Insulation O MIN ■0749 West Palm Beach: 661.88 M41 Boca Raton: 581.285A949 Steart 712.286.1699 .hipper: 561.744.2790 1An WI IE EtS GRA O Heconned mODI; duct work OAdd SM* O Add Realm O Insuft dud work O Seel dud work O fiance air flow -O RecOmw wising wking. - O Clan NeScer O Power dre dt oconudwft O Celrng sawn Idt w/auto mbff O Gas PVM O Rue PON O Ike Ural' O o*simd re N@rsnd *fng O Ardrifacbaal p ft cover O condensate piping/pump O Oondenser balstion pad o VfbratiorlbIft bomiors O con oft sir O Gaon Wales' Her O Replaced compmmras disposal 0 older O Dmp dWAoor saver pmtecffon O canplete cemlup A vacuundng O Certflted mft% rand hwang 0 kMW ducts fa size and leakage O t.cad micuistion rx www o vertly Proper rebigeralrt dlerpe Date of Sale w/ I i/ I I I I I Delivery Date i I Dealer Number I I I I I I I I. r I I I I I I I I O CASH O VISA O WC O AMD( O DISC O Check O Load $ Amount Financed . I r r I I I• r I I Loan Type BY SIGNING BELOW, I AGREE TO THE TERMS OF THIS SERVICE ORDER, THE ATTACHED GENERAL TERMS AND CONDITIONS, AND WHERE APPLICABLE, THE THIRD PARTY SERVICE NET WARRANTY, UL TERMS AND CONDITIONS. I ALSO AGREE THAT I HAVE BEEN NOTIFIED VERBALLY OF MY RIGHT TO CANCEL, THAT I HAVE RECIXD TWO COPIES OF THE NOTICE OF RIGHT TO CANCEL AND WHERE APPLICABLE, ANYADDENDUDESC IBING�MjY RIGHTS UNDER STATE LAW. Print CustDmhr Name o f a Qualifying - credH 'IIs6ales and Ited9e ate atrbjxt b appleelb ttterrlFa�ar Eetlla dMl codrjbtla You, the buyer, may catoel this transaction at any time prior Customer Stgn mala to mWrilTflt of the third business day ager the date of this transacbt. See the notice of cancellation form for an Custom gneture Date molar ldorl of ft right I _4 Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 h 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 •••Y be on its own data sheet. Multiple units on single sheets are not acceptable. • 0000 0000.. Job Address (where the work is being done): 02- NLJ q+iJ `, • 0000.. City: Miami Shores Village County: Miami Dade Zip Colo f r% (9 ; • •..: 0000 YY . • • •••• • •• ••••• ALL CONDENSING UNITS MUST BE ON A 4 INCH SOLID CONCRETE:j4�S••�••' ALL UNITS MUST COMPLY WITH F.E.M.A MINIMUM FLOOD ELEVA�fli3�l. 00•• 0.00•• 0000• .' A COPY OF THE CONTRACT IS REQUIRED WITH ALL SUBMITAL$ ' : 0 0 0 * 0•:0 AHRI DATA SHEET REQUIRED • 0.0 .0 to -00 Change disconnecting means: YES M NO ❑ ARHI Sheet Attached: YES �NO El Contract Attach-d:YES 1. Minimum Circuit Ampacity (Wire Size): l>� 2. Maximum Overcurrent Protection (Fuse/Breaker Size): fl::� O 3. Voltage of Circuit (208/240/480): 2, T 0 4. Size Disconnecting Mea Contractor's Company Name: v (CZ., Phone: 305. 501+ 15; 3 0 State Certificate or Certificate of Competency No. Signature Date: 3 26 l ualifier's signature) (Revised02/24/2014) UNIT BEING REPLACED DATA NEW UNIT ra Ne_ MANUFA URER jj y1 Ci O 2 I Ob AHU oPKG. UNIT MODEL # COND.bmf MODEL # KW HEAT cl K uJ 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 Eq/SEER YES NO R,EMDTTlTG DUCTS YES NO YES NO REPLACING THERMOSTAT YE NO YES NO NEW 4"CONCRETE SLAB S NO YES NO NEW ROOF STAND YES 0 YES NO NEW RETURN PLENUM BOX 77S NO 1. Minimum Circuit Ampacity (Wire Size): l>� 2. Maximum Overcurrent Protection (Fuse/Breaker Size): fl::� O 3. Voltage of Circuit (208/240/480): 2, T 0 4. Size Disconnecting Mea Contractor's Company Name: v (CZ., Phone: 305. 501+ 15; 3 0 State Certificate or Certificate of Competency No. Signature Date: 3 26 l ualifier's signature) (Revised02/24/2014) v This combination qualifies for a Federal Energy Efficiency tax Credit when ANs CERTIFIED - placed in service between Feb 17,2009 and Dec 31, 2016. S,13 Certificate of Product Ratings AHRI Certified Reference Number: 9989614 Date: 11-02-2018 Model Status : Active AHRI Type: HSP -A • • • • • • •••• • ••• Outdoor Unit Brand Name: LENNOX • • • • Outdoor Unit Model Number (Condenser or Single Package) : LRP16HP48P • • • • • • • • • • so 00* • The manufacturer of this LENNOX product is responsible for the rating of this system combinaWn.• • • • • • • • • Rated as follows In accordance with the latest edition of ANSIIAHR12101240 with Addenda 1 and 2. Performance fta iVJ Lnitery ;, • • • • Air-ColMltlaMrg & Mr -Source Heat Pump Equipment and subject to rating accuracy by AHRI-sponsored, hldependark uloid party testing:• • Cooling Capacity (A2) - Single or High Stage (95F), btuh : 47000 : : • • SEER :16.00 ; •' • EER (A2) - Single or High Stage (95F) :12.00 Heating Capadty (H12)- Slagle or High Stage (47F):46000 HSPF -•Active• Model status are loft that an AHRI CerlEAcatian Program Padldpait is coffer y producing AND sailing or offartg for sale; OR now models that aro being marketed but aro not yet being produced. Productibn Stopped' Model Status are those that an ANN CerYM1talion Program PartldpaM Is no knger producing BUr Is still left or oftering for sale.. -- DISCLAIMER AHRI does not endorse the products) listed an this Certificate and makes no representations, warrentles or guarenteas as to, and assumes no responsibllity far, the product(s) Isted on this Cerdi vt& AHRI owessiy disciaims all IfabtiMy for damat)ea of any kind arising out of the use or perfomcance of the product(4 or the uneudumbad •llerstion of data listed on this Certificate. Certirtel ratings we veld only for models and configurations listed In the directory at www ahrhNreetory.org. TERMS AND CONDITIONS This Certificate and Its contents are proprietary products of AHRI. Thls CarWIcals shall only be used for indhidual, personal and conAderoft reference purposes The contents of this Cerdli ate may not, in whole or lin past be reprod m4 coplad; di sendki i k entered into a computer database; or otherwise utilaed, In any form or moaner or by any means, emept for the user's Individual, personal and oonfidentlel reWs=4 1HRRaAMM OMM HEATING, CERTIFICATE VERIFICATION StREWtleI 1101IN'TITM The Information for the model cited on this certiPoats can be vadfied at www.shrhdreatory or{, qkk an %%ft Cortitieato• Ink vie made IEe boast" and enter the AHRI Certified Reference Number and the date on vfikh the ceftilcate was Issued, which Is listed above, and the Certificate No, which Is listed at bottom d& ®20180 -Conditioning, Heating, and Refrigemdon Institute �i�.: 1�1,f • •• :if••: