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MC-20-388Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Location Address 126 NE 108TH ST, Miami Shores, FL 33161 rnntnrtc �°rlZl�';1111)�'u Issue Date: 02/28/2020 Parcel Number 1121360090060 Permit NO.: MC-02-20-388 Permit Type: Mechanical - Residential Work Classification: A/C Replacement Permit Status: Approved Expiration: 08/24/2020 ROBERTO LIERA Owner ADVANCE AIR TECH CORP Contractor 126 NE 108 ST, MIAMI SHORES, FL 33161 IZMERT LABRADA Business: 3057953414 Inspection Description: EXACT A/C CHANGE OUT Valuation: $ 2,500.00 Requests: 4949 Total Sq Feet: 0.00 Fees Application Fee - Other CCF DBPR Fee DCA Fee Education SurchargePermitFee ]Am Scanning Fee Technology Fee Total: Payments Date Paid Amt Paid Total Fees $117.90 Credit Card 02/24/2020 $50.00 Credit Card 02/28/2020 $67.90 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, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I ce that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zo ng. Futhermore, I authorize the above named contractor to do the work stated. Authorized Signature: Owner / Applicant / Contractor / Agent Date February 28, 2020 Page 2 of 2 ADV 4C::1E AI]Z T1E4C:H Air Conditioning Contractor 6010 SW 19t" St Miami, FL 33155 Phone(305) 794 3414 Email:advanceairt@gmail.com Date:12/18/19 State of r L County 240Qe Before me this day personally appeared ►- - Lo, who,being duly sworn, deposes and says: That or she will be the only person working on the project located at 1240 0 C- (U 6 � i iA1--f1 C)t\ofLE5, �L 33(4oI Sworn to (or affirmed) and subscribed before me this t y day of i�7 < 6 .20 2c, ;by Personally know Or produce Identification Type of Identification 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 r• k.1 r L!0i0 �_4 -�.. State of Florida County of Miami -Dade The foregoing was acknowledge before me this day of 1� 20_:;�IrQ By � ak>j who is personally known to me or has produced 'X—tt \_)as identification. Notary: EIRA ' ary f lic - State of Florida SEAL: +'= Commission # FF 983292 My Comm. Expires Apr 18, 2020 Bonded through National Notary Assn. Miami shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. COPY OF QUALIFIER'S STATE LICENCES B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF LIABILITY INSURANCE* D. COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICATE OF COMPETENCY OF QUALIFIER B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF STATE REGISTERED CONTRACTOR LICENSE OR MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT. D. COPY OF LIABILITY INSURACE* E. COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) *YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE AS FOLLOW: Certificate Holder: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 Certificate must specify the description of operations or contractor license number. BUSINESS NAME: �'f C4'vA ,✓ ' �� L, ��� C BUSINESS ADDRESS: (�0 6 (0 SL<-) 01 'S_ CITY WALA-t i STATE FL ZIP 3� ( � BUSINESS PHONE:( Y'7 V? 0 "f FAX NUMBER ( �) CELL PHONE( G ) ? `� 3 `�� QUALIFIER'S NAME: A. QUALIFIER'S LIC NUMBER: 0 ( & � 6d 2 G BUILDING PERMIT APPLICATION ❑ BUILDING ❑ ELECTRIC ❑ PLUMBING E ECHANICAL 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 RECEIVZD fE 242Q�J BY: FBC 20 I a Master Permit No. MCA - (j ;I-- Ga- -:?--, W Sub Permit No. ❑ ROOFING ❑ REVISION ❑ EXTENSION MRENEWAL PUBLIC WORKS CHANGE OF CANCELLATION M SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 0-0 06 (06 5 City: Miami Shores County: Miami Dade zip: 3 3 ((o ( Folio/Parcel#: f ( - 7-i 3 j�, - OOCI - U U (o o Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): (41b E ti � O Phone#: 1$ �, Ti 3 (f`L r Addre1ss0 12So eV C c 0 E S"i City: M A u , ��`�� C- 5 State: zip: 33 ((v Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: V V4 ti GG 4-fit- /e7c-(, , L; Phone#: 3 G 7 7 -7 S -70 Y Address: (oU / S w ( 61 - 7- City: Sate: zip: 3 3 Qualifier Name: 1 2 -C t La' --A State Certification or Registration #: e 4 Cc DESIGNER: Architect/Engineer: Address: Value of Work for this Type of Work: ❑ Ad Description of Work: $ '-5 OU • vo Z ❑ Alteration Ld New Specify color of color thru tile: Submittal Fee $ v6E a Phone#: '3 -0 - ` 1 c7 of Competency #: rl `F& 7--`2--(o (o e#: City: State: Zip: r Footage of Work: t ZQO Repair/Replace ❑ Demolition Permit Fee $ 1 CCF $ CO/CC $ Scanning Fee $ Radon Fee $ Technology Fee $ Structural Reviews $ Training/Education Fee $ DBPR $ Notary $ Double Fee $ Bond $ 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. /n the absence of such posted notice, the inspection will not be app ed and a reinspection fee will be charged. Signature Signature - - OWNER or AGENT CONTRACTOR The foregoing instrume,"as-a'cknowledged before me this 2 2- day of _kJ2 VCt Y` 20 -20 by QQ1Q r+0 ULO r , who is personally known to me or who has produced 17L L- &0Q -720 -f.1b-LY/-Qs identification and who did take an oath. NOTARY PUBLIC: Sign: Print: 02014 Seal: "» • `- Commission # FF 983292 ,�� My Comm. Expires Apr 18, 2020 Bonded through National Notary Assri. The foregoing instrument was acknowledged before me this 7-0 day of I-G bV,0 k4 . 20 7 A by y ta�✓-� 11: �m49yho is sonaIIy kn n to me or who has produced identification and who did take an oath. NOTARY PUBLIC: Print: Seal *************s*s*****ss*ss*s*****ss** **ss*s* * * s ss** APPROVED BY lans Examiner T6 -( ,�;is�PU, ,o1MARIANELATEIXEIRA 'r Notary Public -State of Florida + Commission # FF 983292 Yn Comm. Expires Apr 18, 2020 as s****sss** Zoning Structural Review (Revised02/24/2014) Clerk 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): 1 -2- Jo A-) & 0 7- 4 N(t 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 E3"'ARHI Sheet Attached: YES E3e`NO ❑ Contract Attached: YES [� UNIT BEING REPLACED DATA NEW UNIT aC, - MANUFACTURER f ✓ != AHU or PKG. UNIT MODEL # a-tf C.l 3 COND. UNIT MODEL# 4T( v w KW HEAT -7 iz- NOM TONS 3 AHU! itCU y( PKG 1) M.C.A AHU 30 U 2 r PKG AHU` Q,1(CU; PKG 2) M.O.P AH U '3: PKG AHU CU c PKG 3) VOLTS AHUtc U KG PKG U / / PKG U IT / / l EER/SEER YES NO REPLACING DUCTS YES NO YES NO 7W0q REPLACING THERMOSTAT YES NO YES ✓ NO NEW 4"CONCRETE SLAB YES NO YES N0 ;,/ NEW ROOF STAND YES NO YES 'NO NEW RETURN PLENUM BOX YES NO 1. Minimum Circuit Ampacity (Wire Size): to 2. Maximum Overcurrent Protection (Fuse/Breaker Size): `I/0 3. Voltage of Circuit (208/240/480): 'pO9 4. Size Disconnecting Means: 7 O Contractor's Company Name: Phone: '?UT- 7 YF 7 C^7 0 State Certificate or Registration No. Certificate of Competency No. % V Signature Date: 0 21-2-( (Qualifier's signature) (Revised02/24/2014) Cerfificate Of Product Ratings AHRI Certified Reference Number: 201285991 Date: 02-21-2020 Model Status: Active Old AHRI Reference Number: 7942207 AHRI Type: RCU-A-CB Outdoor Unit Brand Name: RHEEM Outdoor Unit Model Number (Condenser or Single Package) : RA1636AJ1 Indoor Unit Model Number (Evaporator and/or Air Handier): RH1T3617STAN Region : All (AK, AL, AR, AZ, CA, CO, CT, DC, DE, FL, GA, HI, ID, IL, IA, IN, KS, KY, LA, MA, MD, ME, MI, MN, MO, MS, MT, NC, ND, NE, NH, NJ, NM, NV, NY, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VA, 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 RHEEM product is responsible for the rating of this system combination. Rated as follows in accordance with the latest edition of AHRI 210/240 with Addendum 1, 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 : 35400 SEER: 16.00 EER (A2) - Single or High Stage (95F) : 13.00 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. t ar W tan inv lun n MOW tin i. 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 urauthortmd alteration of data listed on this certificate. Certified ratings are valid only for models and configurations listed in the directory at wv .:r.ahKe"'.reclo r,.org. TERMS AND CONDITIONS r- --- - " This Certificate and its contents are proprietary products of AHRI. This Certificate shall only be used for individual, personal and 6i 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, 000 lit tt u personal and confidential reference. Alii-r,UNIiMONING, HEATING, CERTIFICATE VERIFICATION The information for the model cited on this certificate can be verified at www -1hr10irerfory,or„ 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. -- ------ - ----- 132267937113281tiS3 t ©2020AIr-Conditioning, Heating, and Refrigeration Institute CERTIFICATE NO.: i # of -A4k- ADVANCE AIR TECH Air Conditioning Contractor I. I ;1111:i f REY. I� cFR71i��° Certified Contractor 7255 NW 68 Street Unit 15 Miami, Florida 33166 Ph: 305-747-5704 E-mail: Advanceairt@gmail.com Lic.& Insured CAC 1818026 Proposal Submitted To: a Date: 2 Address: City: State: Zip: 33( Phone: E-mail: We hereby submit specifications and estimates for: h' 5 16 Option 1 Option 2 Option 3 BrandL�E Efficiency Condenser Model A Air Handler Model !' r? 514 14 Package Unit Model IIAdditiional Parts eo Heater {r" % kl— _ Years Parts Warranty Digital Thermostat Years Labor Warranty Metal Stand Extras: Tie Downs Flow Switch f/ Filter Rack Disposable Filter Concrete Slab Condensate Pump UV Light Permit Fees We propose hereby to furnish material and labor - complete in accordance with the above specifications: Total Cost $ ;�_ 111:�_U 01 U 0 Finance by: No Interest Financing: Any alteration or deviation from above specifications involving costs will be executed only upon written order, and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents or de- lays beyond our control. Respectfully c11hmif m Dollars Note - this proposal may be withdrawn by us if not accepted within days. Zkmt llix UL Vmo" The above prices, specifications and conditions are satisfactory and are Signature hereby accepted. You are authorized to do the work as specified. Payments will be made as outlined above. Date of Acceptance Signature