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MCC-19-1089Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Permit NO.: MCC-05-19-1089 ^r 1 Permit Type: Mechanical - Commercial J Work Classification: A/C Replacement Permit Status: Approved Issue Date: 06/03/2019 Expiration: 12/02/2019 Location Address Parcel Number 621 NE 92ND ST 1A, Miami Shores, FL 33138 1132060430010 Contacts Elsa Brugues Owner FROZE -ZONE CORP Contractor 621 NE 92 ST 1A LUIS CRUZ 75 SW 116 AVE, MIAMI, FL 33174 Business: 3052997259 Inspection Requests: Description: EXISTING UNIT CHANGE UNIT CONDENSING UNIT Valuation: $ 2,850.00 Inspe ti 4449 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 06/03/2019 $61.90 Credit Card 05/15/2019 $50.00 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. OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulatin%construction and zoning. Futhermore, I authorize the above named contractor to do the work stated. SigFfature: Owner / Applicant / Contractor / Agent Date June 03, 2019 Page 2 of 2 BUILDING PERMIT APPLICATION Miami Shores Village RE[�* EovED Building Department MAY 15 2019 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 0f 1A F B/C'i /201�% Master Permit No. � c&c6 � 1 40 1j Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ZMECHANICAL [_]PUBLICWORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP �1 CONTRACTOR DRAWINGS JOB ADDRESS: �' a �` T qtU I A � City: Miami Shores County: Miami Dade Zip: 33 1 3di Folio/Parcel#: / I - 3 )�6 ! ` 0 0 - O 0 1 0 Is the Building Historically Designated: Yes NO Occupancy Type: Load: ��Co/QJnstrruction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): Y4)1)-' 6 Phone#: Address: 6 D_ I M iE 7 2 S I % Q City: M �.o- • State: I— Tenant/Lessee Name: Email: Zip: 3 3 13 d' Phone#:. b!- 3 o (` 9-7 3 1 CONTRACTOR: Company Name: ry 0 Z t " -L r C ft / Phone#: 301"• a 9 9 -?j. S' 9 Address: /5 S �-✓ / 1 ` AV E City: /'� I A M *1 State: ►� L Zip: 33 1-7 Qualifier Name: 't" " S Q, L✓ � tt \ Phone#: or 1-9 I . -) l ('9 State Certification or Registration #: K A F - 0 � i 4 b! 6 Certificate of Competency #: < < M 6 6 0y 13- DESIGNER: Architect/Engineer: Add Value of Work for this Per Type of Work: ❑ Additio Description of Work: Specify. color of color thru tile: Submittal Fee $5 Permit Fee $ Scanning Fee $ Radon Fee $ Technology Fee $ Structural Reviews $ ❑ New Training/Education Fee $ Phone#: City: State: Zip: /Linear Footage of Work: ❑ Repair/Replace CCF $ DBPR $ ❑ Demolition CO/CC $ Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ (lJ, (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 10 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 ( OWNER or AGENT Tle foregoing instrument was acknowledged before me this Is daffy of •, ,� 20 t, by Gti/R/J�� o is personally known to me or who has produced f "L as identification and who did take an oath. NOTARY PUBLIC: -0 Print: zN ;0'9 Seal: S : •. wen . Q" •' fQ.� A Signature 4 a— ;�� CONTRACTOR The foregoing instrument was acknowledged before me this _ day of 20 �_ by `11A Cx�Z o is personally known to me or who has proas 40801.1 identification 0, dd e'tRittitza, ath. NOTARY PUBLIC.• W • N • �. �` Sign: 00 Print: Seal: "�IrN11111N• *************************** ******* ************************************************************** APPROVED BY loci lans Examiner Zoning Structural Review Clerk (Revised02/24/?014) 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): a 9 A City: Miami Shores Village County: Miami Dade Zip Code: 33 I .3 k 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 12�NO ❑ ARHI Sheet Attached: YES P(NO ❑ Contract Attached: YES ❑ UNIT BEING REPLACED DATA NEW UNIT MANUFACTURER A R E R ; S T'A IL AHU or PKG. UNIT MODEL # P boq A COND. UNIT MODEL # k qAc_L4'D_h D 1 KW HEAT 1<1W NOM TONS -'C o-d 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 i I VVS I .1 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): 30 A M P 2. Maximum Overcurrent Protection (Fuse/Breaker Size): 30 AMP 3. Voltage of Circuit (208/240/480): r-a 4. Size Disconnecting Means: {� c� Contractor's Company Name: I" ✓A� - ^ 3J-A- Phone: 3 D r. a9 9- -7 � S 1 State Certificate or Registration No. 13 n 7 U 6 7 Certificate of Competency No. PA 0 D 0 0 � �- Signature Q Date: (Qualifier's signs re) C 20 (Revised02/24/2014) COMPANY LETTER HEAD Date: E; I 2-e I 01-G (e-) State of County of OILMI (� Before me this day personally appeared .�.�IS {�l$Kb who, being duly sworn, deposes and says: That he or she will be the only person working on the project 1 cated at: Z ( k1Z �'j 2 !7T A77 p� Sworn to (or affirmed) and subscribed before me thiso� day of 20 by IU(s 0"::� ------------------------------------------- Personally know OR Produced Identification Type of Identification Produced ` :c `Dgi �E2- LGEN-k- Print, Type or Stamp Name of Notary ��; •. SINOIA ALVAREZ i� ..."t7;•. MY COMMISSION # GG 238273 EXPIRES: September 3, 2022 ° Bonded jI1tU Noiery pub"t Underv2ere 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: O�vner State of Florida County of Miami -Dade The foregoing was acknowledge before me this By SA � G Notary: 2 G day of 4� — , 2011 . who is personally known to me or has produced as identification. SINDIA ALVAREZ SEAL: MY COMMISSION # GG 238273 o EXPIRES: September 3, 2022 Shores Plaza West Condo P.O. Box 530428 Miami Shores, Fla. 33153-0428 (305) 772-7169 May 30, 2019 Mr. Albert Mora 621 N.E. 92nd Street, Apt. 1A Miami Shores, Florida 33138 Dear Ms. Brugues, This letter serves as permission from the Shores Plaza West Condominium, Inc. and its Board of Directors for you to install an air condition in unit Apt. 1A. The Village of Miami Shores requires the approval of the condominium. This letter can be shared with the Village as to meet their requirements. The Board does require that the installer of an A/C be a licensed contractor and that you and the installing company will obtain the necessary building_ permits. We understand that your contractor is Frozen -Zone Corporation who meets these requirements. In order to make the appearance uniformed, we require that the unit A/C be placed on concrete slab. The work must be done on week days between the hours of 8:00 AM to 6:00 PM. Work of this type cannot be done on weekends. Thank you for your cooperation. Albert Mora, President Shores Plaza West Condominium Association., Inc. Certificate of Product Ratingp-:-: &M. AHRI Certified Reference Number: 201753477 Date: 05-28-2019 AHRI Type: RCU-A-CB Outdoor Unit Brand Name: AMERISTAR Outdoor Unit Model Number (Condenser or Single Package) : M4AC4036D1 Indoor Unit Model Number (Evaporator and/or Air Handler) : M4AH4P36B1 BOOAA Region: All Region Note : 1803 ... *so ' ' Model Status :' • • •••• • •• ••••• • •••••• •• • ••••• •• •• •• • ••••• • •••••• • 00 •••••• 00 • • • ••••• 0000 The manufacturer of this AMERISTAR 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 : 36000 -� _ cEIVML) SEER: 14:50 EER (A2) Single & High Stage.(96F)-_:,12.20._--- _—_. MA [ as id (-. - 1 y �i � L.. A `� / ,► _ • N,tarni SttOt�'S'�/ifl.�g� " i BY DATi~fr _ 9LnG DEPT 'T rn COMP lANCF WITH ALL FEDFRAL I 1 ' i V n(ii FS AND nFGI11 Al I()Ns 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 rating is shown along with the previous (i.e. WAS) ratina. 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, F-MM 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.ahridlrectory.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. ©2019Air-Conditioning, Heating, and Refrigeration Institute I CERTIFICATE NO.: 132035386488975226