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MC-10-20-2499Permit NO,: MC�0-24 Miami Shores Village " g „• ter Type: Mechanical - Residers 10050 NE 2 Ave Miami Shores FL 33138 Work Classification: A/C Replacemi 305-795-2204 0— f c+-+—. 8atnrnr Expiration: 07/06/2021 Location Address Parcel Number 645 NE 92ND ST 151), Miami Shores, FL 33138 1132060430080 .ontacts ANNA LIU Owner POLO HEATING & AIR CONDITIONING Contractor 645 92 ST 15-d, MIAMI SHORES, FL 331382953 INC JOSE M POLO MARICHAL 3106 RED KITE PONTE, ORLANDO, FL 32829 Inspection Requests: Description: REPLACE AIR HAMDLER AND CONDENSER ? Valuation: $ 5,300.00 o 05 75 449 �v .j Total Sq Feet: 0.00 Fees Amount Application Fee - Other $50.00 CCF $3.60 DBPR Fee $2.78 DCA Fee $2.00 Education Surcharge $1.20 Permit Fee $135.50 Scanning Fee $9.00 Technology Fee $4.64 Total: $208.72 Payments Date Paid Amt Paid Total Fees $208.72 Credit Card 10/29/2020 $50.00 Credit Card 01/04/2021 $158.72 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 AFFIDA a the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construe i a oni Futher ore, I authorize the above named contractor to do the work stated. /--2a�1 Owner (_—Applicant / Contractor / Agent Date January 04, 2021 Page 2 of 2 Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Location Address Parcel Number 645 NE 92ND ST 15D, Miami Shores, FL 33138 1132060430080 Contacts Permit NO.: MC-10-20-2499 Permit Type: Mechanical - Residential Expiration: 07/06/ 2021 ANNA LIU Owner POLO HEATING & AIR CONDITIONING Contractor 645 92 ST 15-d, MIAMI SHORES, FL 331382953 INC JOSE M POLO MARICHAL 3106 RED KITE PONTE, ORLANDO, FL 32829 _..._._........_. _ _......._.........__.._ ................_.._........._------ ......_._......_............... .........._.__................. __................_........_._.._._........_..__.._ Ins ection Requests: Description: REPLACE AIR HAMDLER AND CONDENSER Valuation: $ 5,300.00 , 305 7 Total Sq Feet: 0.00 Fees Amount Application Fee - Other $50.00 CCF $3.60 DBPR Fee $2.78 DCA Fee $2.00 Education Surcharge $1.20 Permit Fee $135.50 Scanning Fee $9.00 Technology Fee $4.64 Tota I : $208.72 Payments Date Paid Amt Paid Total Fees $208.72 Credit Card 10/29/2020 $50.00 Credit Card 01/04/2021 $158.72 Amount Due: $0.00 Applicant Copy For Inspections, Call (305) 762-4949 or Log on at https://bidg.miamishoresvillage.com/cap/. Requests must be received by 3pm for following day inspections. NOTICE: In addition to the requirements of this permit, there may be AND THERE MAY BE ADDITIONAL PERMITS REQUIRED FROM OTHER additional restrictions applicable to this property that maybe found in the GOVERNMENTAL ENTITIES SUCH AS WATER MANAGEMENT DISTRICTS, public records of this county. STATE AGENCIES, OR FEDERAL AGENCIES. January 04, 2021 Page 1 of 2 Il(3o�7A___)'20 4- MP. (I -- BUILDING PERMIT APPLICATION Miami Shores VillagecIVE� Building Department 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 201 Master Permit No._mo ` lo— LU -24 Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: Cp 4 ✓ "i �) 2 niA 54y?, I J5- D City: Miami Shores County: Miami Dade Zip: 3 3 13,9 Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): .4x,,Nq L i iA Phone#: 5 07 — �_Zg _.3 b3 Address: f2 ti `1 C1 PO N T 6,ft Dr, -f 5 O `t' City: State: FL Zip: 33 l ! , q Tenant/Lessee Name: C fR I C VA5Q utZ Phone#: 3 c'5 3 4 Email CONTRACTOR: Company Name: FV C_ 0 Q �� Address: 3 10 b Z o(I /1 /l ,e r City: LA V d G1 State: Zip: Z Qualifier Name: 1?a L & ti Phone#: State Certification or Registration #: Certificate of Competency #: Y g DESIGNER: Architect/Engineer: ��Phone#: Address: City: State: Zip: Value of Work for this Permit: $ 55 3 Q 0% Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New pair/Replace ❑ Demolition �' 4' A/ 2 W,41V d L a r '4 'tom p� D ��J S Description of Work: ✓ r% � C( C �% Cr / � T Specify colors of color thru tile: Submittal Fee $ s 0�3' Permit Fee $ CCF $ Scanning Fee $ Technology Fee $ Structural Reviews $ Radon Fee $ Training/Education Fee $ DBPR $ CO/CC $ Notary $ 21-1 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 WE 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. 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 (/ Signature _ �w CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument �waas c/k�n]owllerdged before me this day of tv� �� 20 �2 , by 7 day of 6167Vy,! � , 20 � o , by uJ\;fi L,) i,,( who is personally known to "" 5 P f 0, , who is personally known to me or who has produced as me or who has produced identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PU CIC: Rixpires Notary Public State of Florida 4OEA�22odw� Sign: Susana Avila 1/�� ign: 7 " K/� OW21no21 —'� Print: tint: Seal: Seal: MY COMMISSION # GG 214633 P ` EXPIRES: May 6, 2022 J of F�°• Bonded ihru Notary Pubk Underwriters as APPROVED BY Plans Examiner _ Zoning 141 SIP Structural Review Clerk (Revised02/24/2014) Property Search Application - Miami -Dade County Page 1 of 1 OFFICE OF THE PROPERTY APPRAISER Summary Report Property Information Folio: 111-3206-043-0080 Property Address: 645 NE 92 ST UNIT: 15D Miami Shores, FL 33138-2956 Owner ANNA LIU Mailing Address 2999 POINT EAST DR APT C304 AVENTURA, FL 33160-5052 PA Primary Zone 3000 MULTI -FAMILY - GENERAL Primary Land Use 0407 RESIDENTIAL - TOTAL VALUE: CONDOMINIUM - RESIDENTIAL Beds / Baths / Half 2 / 1 / 0 Floors 0 Living Units 0 Actual Area Sq.Ft Living Area 814 Sq.Ft Adjusted Area 814 Sq.Ft Lot Size 0 Sq. Ft Year Built 1949 Assessment Information Year 2020 20191 2018 3 Land Value $0, $0i $0 Building Value $0. $0 $0 XF Value Market Value $0 $120,831 $Oi $112,9261 $0 $106,034 Assessed Value $120,831 1 112,926 $106,034 Benefits Information Benefit Type 2020i 2019 2018 Note: Not all benefits are applicable to all Taxable Values (i.e. County, School Board, City, Regional). Short Legal Description SHORES PLAZA WEST CONDO UNIT 15D 2ND FLOOR BLDG 1 UNDIV .03690% INT IN COMMON ELEMENTS CLERKS FILE 73R-213196 Generated On : 10/29/ Taxable Value Information 2020 2019 2 County Exemption Value $0 $0 Taxable Value $120,831 $112,926 $106. School Board Exemption Value $0 $0 Taxable Value $120,831 $112,926 $106. City Exemption Value $0 $0 Taxable Value $120,831 $112,926 $106 Regional Exemption Value $0 $0 Taxable Value $120,831 $112,926 $106 Sales Information Previous OR Book Price Qualification Description Sale Page 27735 06/16/2011 $60,000 Qual by exam of deed 0040 25696- Sales which are disqualified as a resu 05/01/2007 $0 0163 examination of the deed 19687 05/01/2001 $40,000 Sales which are qualified 4107 02/01/2000 $42,500 19014-451 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 Appra and Miami -Dade County assumes no liability, see full disclaimer and User Agreement at http://www.miamidade.gov/info/disclaimer.asp https://www.miamidade.gov/Apps./PA/propertysearch/ 10/29/2020 Detail by Entity Name Page 1 of 3 Florida Department of State Departmenl of Stele / Division of Corporal.ions / Search Records / Search Dy Ent€Iv Name / Detail by Entity Name Florida Not For Profit Corporation SHORES PLAZA WEST CONDOMINIUM, INC. Filing Information Document Number 726431 FEI/EIN Number 59-1570223 Date Filed 05/17/1973 State FL Status ACTIVE Last Event REINSTATEMENT Event Date Filed 02/14/2011 Principal Address 637 N.E. 92ND ST 9C MIAMI SHORES, FL 33138 Changed: 03/02/2016 Mailing Address 637 N.E. 92ND ST 9C MIAMI SHORES, FL 33138 Changed: 03/02/2016 Registered Agent Name & Address Gomez, Marco A 637 NE 92nd St 9C Miami, FL 33138 Name Changed: 03/20/2018 Address Changed: 03/20/2018 Officer/Director Detail Name & Address Title Treasurer GOMEZ, MARCO DIVISION OF CORPORATIONS http: //search. sunbiz. org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=Entit... 10/29/2020 Detail by Entity Name Page 2 of 3 637 N.E. 92nd St. Apt. 9C MIAMI SHORES, FL 33138 Title D VELEZ, CRISTINA 2121 BAYSHORE DR. 1413 MIAMI, FL 33137 Title President Mora, Albert 645 NE 92nd St 14D Miami Shores, FL 33138 Title VP Salmon, Colin 637 NE 92nd St 11C miami. FL 33138 Title Secretary Giusti, Mariella 689 N.E 92nd St. 12G, FL 33138 Title D Kilpatrick, Todd 621 ne 92nd st 4 miami shores, FL 33138 Title D John, Kilpatrick 621 ne 92nd st 3 miami shores, FL 33138 Annual Reports Report Year Filed Date 2018 03/20/2018 2019 03/02/2019 2020 03/17/2020 Document Images W! s T20120 -- ANNUAL R Ef ORT View image m P>DF tormat http://search. sunbiz.org/Inquiry/CorporationSearchISearchResultDetail?inquirytype=Entit... 10/29/2020 Detail by Entity Name Page 3 of 3 03;0212019 -- ANNUAL REPORT View image in PDF forma# t;3120i2018 -- A.NNUAL 11EPOi3'T' .................................................................................................. View image in PDF fc rniai. 02 01 i2017 --ANNUAL REPORT View image in PDF format 03102?2016v- ANNUAL REPORT' View image in PDF forrnat 02/11/2015 -- ANNUAL REPORT: View image in PDF #ormat 01131/2014 -- ANNUAL. REPORTIView image in PDF forma# 129L013:ANNUALREP ,.__�lT DF frnal 04/1212012 --ANNUAL REPORT View image in PDF format 02?14/2011 -- REINSTATEMENT View image in PDF format 0110912009 -- ANNUAL REPORT' View image in PQF format 03i14/2005 ... ANNUAL REPORT View image in PDF t'ormat 03 121'2007 -- ANNUAL_REPOR:T'. View image in PDF formal 01/ 17/2006 -- ANNUAL REPORT View image in PDF format 01? j4!26G5 ::-ANNUA,L,_F2EPCIRT View imago in F'DF forrnat 02102/2004 -- ANNUAL REPORT" View image in PDF format 01113?2003 -- ANNUAL. REPORT View image in PDF forma# )113i2002_,..-ANtvUgL-itEfQ2T;, View image in PDF(,.anna#. 01/11/2001 --ANNUAL REPORT View image in PDF format 0'L?Otr/2000 .... ANNUAt. REPC'1R'i View image in F'D# forrnat 02?24/1999 -- ANNUAL REPORT" I View image in PDF format 01/16? 1996 -- ANNILIA1.. REPORT JView image in PDF fiorma# 1 2=ai3-J(a;j..;-_AN ?U�L_I. .E F'.v.R.T;, View image in PDF formal. 04/04/1996 -- ANNUAL. REPORT View image in PDP format 05101/1995 .,_ANNUA;L_RE_f ORT View image in PDt forrnat 1I -.eI http://search. sunbiz.org/Inquiry/CorporationSearchISearchResultDetail?inquirytype=Entit... 10/29/2020 Local Business Tax Receipt Miami —Dade County, State of Florida -THIS IS NOTA BILL -DO NOT PAY 7259714 BUSINESS NAME/LOCATION POLO HEATING AIR CONDITIONING INC 270 E 4TH ST UNIT 4 HIALEAH, FL 33010 OWNER POLO HEATING AIR CONDITIONING INC ('.Ir) .tl152F M Pr)[ n MARIr.WAI WnrkPr(c) 1 RECEIPT NO. RENEWAL 7546371 LBT EXPIRES SEPTEMBER 30, 2021 Must be displayed at place of business Pursuant to County Code Chapter SA - Art. 9 & 10 IN, SEC. TYPE OF BUSINESS 196 SPEC MECHANICAL CONTRACTOR CACIS19469 PAYMENT RECEIVED BY TAX COLLECTOR 45.00 09/02/2020 (`QC (11T!' p C n_7/11177nno ONQUe JIMMY PATRONIS CHIEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS` COMPENSATION LAW * * CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers` Compensation law. EFFECTIVE DATE: 6/2512020 PERSON: JOSE M POLO MARICHAL FEIN: 830556317 BUSINESS NAME AND ADDRESS: POLO HEATING & AIR CONDITIONING INC 3106 RED KITE PT ORLANDO, FL 32829 SCOPE OF BUSINESS OR TRADE: Heating, Vengation, Air - Conditioning and PA ftem ion Systems trstWbiim Service and Re*r, Shop. Yard & Drivers EXPIRATION DATE: 6/25/2022 EMAIL: INFO@ FLORIDALICENSESANDCORPORATIONS.0 OM IMPORTANT: Pursuant to subsection 440.05(14), F.S., an officer of a corporation who elects exemption ftom this Chapter by filing a cedficate of election under Us section may not recover benefds or compensation under aids clutter. Pursuant to subsection 440.05(12), F.S., Certify of election to be exempt issued under subsection (3) shall apply only to the corporate offrcerr named on tihe notice of election to be exempt and apply only within the scope of the business or trade listed on the notice of election to be exempt. Pursuant to subsection 440.05(13), F.S., nob s of election to be exempt and des of election to be exempt shall be subject to revocation ff, at any time after the fling of the notice orthe issuance of the certifxete, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shalt revoke a cerdficare at any time for failure of the person named on the certfla a to meet the requirements of this section. DFS-F2-0WC-252 CERTIFICATE OF ELECTION TO 8E EXBAPT REVISED OS-13 E01181087 QUESTIONS? (SM) 413-1609 Local Business Tax Receipt Miami —Dade County, State of Florida -THIS IS NOTA BILL -DO NOT PAY 7259714 BUSINESS NAME/LOCATION POLO HEATING AIR CONDITIONING INC 270 E 4TH ST UNIT 4 HIALEAH, FL 33010 RECEIPT NO. RENEWAL 7546371 EXPIRES SEPTEMBER 30, 2021 Must be displayed at place of business Pursuant to County Cade Chapter SA - Art. 9 & 10 OWNER SEC. TYPE OF BUSINESS PAYMENT RECEIVED POLO HEATING AIR CONDITIONING 196 SPEC MECHANICAL BY TAX COLLECTOR INC CONTRACTOR 45.00 09/02/2020 r.1r3 .Ir1CF M Pr)l n MARIr.WAI Wnrkorlcl 1 CAC1819469 rccniri^een_�nn�onno COMPANY LETTER HEAD Date: 16 /Z G2o State Cofuntyof: m I '�- W1 % 1'�Q --e 6 o /V Before me this day personally appeared -lpt,R M fda deposes and says: That he or she will be the only person working on the project located at: 1 Contract ignature Who, being duly sworn, Sworn to (or affirmed) and subscribed before me thisd5 Day of .20ZP By Personally know OR Produced identification Type of identification produced fZ<' v'e2 Lf' i . Print, Type or stamp. Name of Notary JESSIADEIANEGREIRAMENEI40: MY COMMISSION # GG 214f,^•': =�� e EXPIRES: May 6, 2022 BonMThruNWryPublicftierwrftcts �/ Gam! f2 2 r�'or c L? LIU Notice to Owner — Workers' Com Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 nsation 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:'L ..._ ..-•--� Owner State of Florida County of Miami -Dade The foregoing was acknowledge before me this I day of 20 By i j,v-C� who is personally known to me or has produced A Q' qua as identification. Notary:_ ��J 1 I{f`t'"`;;.I�ELANEGREIRAMENENDEZ MY COMMISSION#GG214633 SEAL�� .�fP��RM o".7' EXPIRES; May6,2022 ,l k, bolded Thru NWary p n POLO HEATING & AIR CONDITIONING, INC. CAC 1819469 Contractors Invoice N2 0137, 004 English (407) 486-5406 Espanol 407 486-5272 WORK PERFORMED AT: TO: I (� 2.. � 12 r/rA;F3L*- DATE �� r- ✓ " -ZO YOUR WORK ORDER NO. / f OUR BID NO. DESCRIPTION OF WORK PERFORMED V /0 r- G All Material is guaranteed to be as specified, and the above work was performed in accordance with the drawings and specifications provided for the above work and was completed in a substantial workmanlike manner for the agreed sum of Dollars ($� �' �� )• ��/ C/.l /�� //j�% �/ l 5 C/ This is a �artial ❑ Full invoice due and payable by: `6 2y ZZ) moft in accordance with our. El Agreemenj QProposal No. ) (I - Dated N Day Ypr Customer Sig.' \ Authorized Sig. This combination qualifies for a Federal Energy Efficiency Tax Credit when placed in service between 1/1/2015 and 12/31/2020. Certificate of PMEOWroduq� -ct Ratings:-MMR, AHRI Certified Reference Number: 202033784 Date : 10-13-2020 Model Status : Active AHRI Type: RCU-A-CB (Split System: Air -Cooled Condensing Unit, Coil with Blower) Series: 16 SEER AC Outdoor Unit Brand Name: PAYNE HEATING AND COOLING Outdoor Unit Model Number (Condenser or Single Package) : PA16NA037*0**B* Indoor Unit Model Number (Evaporator and/or Air Handler) : PF4MNB037L Region : Southeast and North (AL, AR, DC, DE, FL, GA, HI, KY, LA, MD, MS, INC, 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 PAYNE HEATING AND COOLING 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 parry testing: Cooling Capacity (A2) - Single or High Stage (95F), btuh : 35200 SEER: 16.00 EER (A2) - Single or High Stage (95F) : 13.50 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. Ratings that are accompanied by WAS indicate an involuntary re -rate. The new Dublished 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 vrww.ahrldirectory.org. TERMS AND CONDITIONS This Certificate and its contents are proprietary products of AHRI. This Certificate shall only be used for individual, personal and A 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-,ww.ahridirectory.org, click on "Verify Certlficate" 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. ©2020Air-Conditioning, Heating, and Refrigeration Institute CERTIFICATE NO.: 132470697863145934 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 ysheets are not acceptable. T Job Address (where the work is being done): City: Miami Shores Village County: Miami Dade Zip Code: 3 3( 3� 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 ❑ NOSg ARHI Sheet Attached: YESZ NO ❑ Contract Attached: YES12— UNIT BEING REPLACED DATA NEW UNIT MANUFACTURER AHU or PKG. UNIT MODEL # COND. UNIT MODEL # j4 KW HEAT 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 EER/SEER 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): / _ 2. Maximum Overcurrent Protection (Fuse/Breaker Size): 3. Voltage of Circuit (208/240/480): -Lo� 4. Size Disconnecting Means: 160 hr M/? / Contractor's Company Name: Po L0 G t gal I +j S i AJ Q y)�� I (ffhon�: �() } �S 4 v G State Certific Signature ate or RegistrL (✓ Certificate of Competency No. Date: d� alif' signature (Revised02/24/2014)