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MC-02-22-324Miami 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 ❑PLUMBING ZMECHANICAL ❑PUBLICWORKS JOB ADDRESS: 177- NW qb TH S7 R£CFIVED FEB 0 7 2022 BY: FBC 20 Master Permit No. l C-OZ- Z2 -324 Sub Permit ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS City Miami Shores County: Miami Dade Zip: 33150 Folio/Parcel#: 11- 3 1 O 1— O 2S_ C) 14 0 is the Building Historically Designated: Yes NO ✓ Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): (_�� �( i%� �C%f1/I �/% Phone#: IA�Z Zip: 33 / S—b Tenant/Lessee Name: n Email: �I/% /lt?Ii�/ / .�/ !o CONTRACTOR: Company Name: METgO(Do f—iTWN A/Ct. S.NC• Phone#: 30S-26y-4644 Address: (6917 NW So TH STRe City: M I ri M l State: FL Zip: 3 3i G L Qualifier Name: IlCQC 2 -(`Ya =n \?SL\t'Z- Phone State Certification or Registration #: Certificate of Competency M DESIGNER: Architect/Engineer: t'j 0, Phone Value of Work for this Permit: $ y i 675. 7; Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New R Repair/Replace Description of Work: Specify color of color thru tile: Submittal Fee $_ Permit Fee $ Scanning Fee $ Technology Fee Radon Fee $ Training/Education Fee $ CCF DBPR$ 3 0 5 - 26y- 4646 M ❑ Demolition CO/CC $ \ Notary $ Double Fee $ Structural Reviews $ (Revised02/24/2014) Bond $ TOTAL FEE NOW DUE $ k(TN S. (F) 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 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 The foregoing instrument was acknowledged before me this day of SAN 20 Z-Z by 'DiAi--A I Orv,Ary who is rsonal ow o me or who has produced identification and who did take an oath. NOTARY PUBLIC: as Signature CONTRACTOR The foregoing instrument was acknowledged before me this 3 daly—of t l7 , (( 20 a-� by �Lzc�" 40 who aa is personally known to me or who has produced Oef:S !&YAN•f- as identification and who did take an oath. NOTARY Print: Print: G f ' rry�•.,�ARCENISSILtlE MY COMMISSION#GG950477 «"'"• ILEANARODRIGUEZ Seal: F : Seal: a': A.5 ,4 EXPIRES: March 6,2024 MY COMMISSION#HH 093851 •."'' Bonded Th'u Notary Public Underwriters ;r ipo,- EXPIRES: March 11, 2025 jr}###i#####r}#i#ii#iii#######i#i#iii#iii########## APPROVED BY PI§rfs Exa-miner Zoning Structural Review Clerk (Revised02/24/2014) 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): / 17 7 nup s(o S-' , 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 15 REQUIRED WITH ALL SUBMITALS HRI DATA SHEET REQUIRED i Change disconnecting means: YES[:] NO ARHI Sheet Attached: YES [�(NO ❑ Contract Attached: YES UNIT BEING REPLACED DATA NEW UNIT MANUFACTURER C),C P AHU or PKG. UNIT MODEL # T u S COND. UNIT MODEL# KW HEAT NOM TONS AHU 'f CU 1'6 PKG — 1) M.C.A AHU YS CU I PKG — AHU 5-o CU 3o PKG 2) M.O.P AHU 5-000 q 0 PKG — AHU CU PKG 3) VOLTS l,c) O AHU Cu PKG PKG UNITS-- PKG UNIT—j-'--� EER/SEER / 7, YES ZZ7 REPLACING DUCTS YES NO- REPLACING THERMOSTAT NO YES C90 NEW 4"CONCRETE SLAB YES 0 YES O NEW ROOF STAND YES kbQ YES'(WO)NEW RETURN PLENUM BOX YES <0J 1. Minimum Circuit Ampacity (Wire Size): 2. Maximum Overcurrent Protection (Fuse/Breaker Size): 3. Voltage of Circuit 20 /240/480): $ a 3 D 4. Size Disconnecting Means: Contractor's Company Name: Phone:.�C���04—Y(D`Flo State Certificate or Registration No 00 Certificate of Competency No. Signature Date: O�— 3 (Qualifier's signature) . ... . w •YI.�•.4iY (Revised02/24/2014) Eligible for Federal Tax Credit Certificate of Product Ratings AHRI Certified Reference Number: 8676079 Date: 02-03-2022 Model Status : Active AHRI Type: RCU-A-CB (Split System: Air -Cooled Condensing Unit, Coil with Blower) Series: XR16 Outdoor Unit Brand Name: TRANE Outdoor Unit Model Number (Condenser or Single Package) : 4TTR6036J1 Indoor Unit Model Number (Evaporator and/or Air Handier): TEM4AOC42S41+TDR 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 TRANE product is responsible for the rating of this system combination. Rated as follows in accordance with the latest edition of AHRI 2101240 - 2017 with Addendum 1, 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 : 36400 SEER: 17.00 EER (A2) - Single or High Stage (95F) : 14.00 T°Active' Model Status are those that an AHRI Certification Program Participant is curtenfly producing AND selling or offering for sale; OR new models that are being marketed but are not yet being pmduced'Pmduction Stopped- Model Status are Nose 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 involunlary re-mte. The new published mfino is shown alonq with. the Previous (i.e. DISCLAIMER AHRI does not endome the products) 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 "ED' 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; A..■ `' entered Into a computer database; or otherwise utilized, In any form or manner or by any means, except for the users Individual. personal and confidential reference. AIR-CONOmONING, HEATING, CERTIFICATE VERIFICATION & REFRIGERATION INSTITUTE The Information forthe model cited on this certificate can be verified at www.ahridirectory.org, click on'Verny Certificate' link .ve make We bete, - 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. ©2022Air-Conditioning, Heating, and Refrigeration Institute CERTIFICATE NO.: 132683869826097637 Ron DeSantis, Governor Walsey Qeshears, Secretary JfSSAINl.) P) RaoG���000 G�9G�1L QEG�N ,� CC /1O c�c L8Nl Cr fi�� 1I 'yNJc� u o ! �\ iD M S�IwYT LU(c�G� i��S01�`�9�C B� THE CLASS B d'-'R CONDITIONING CAN B` RD PROVISIONS�C OR HEREIN IS CERTIFIED UNDER iI-IE IMFCg-ICI'9Ef �"99, FLORIDA- 3-f-A•-'M•c.ES La0>(I\�''�� " MCTI>OPOLITApq Alk CONDITIONING, U IONING, INC. 6917 NSW 50VI-I STREET REET MIA MI F& 33166 I- Eilyl�i I�I�JI1/I CI�o C�a �I�L'w91� ILi)fPIRAA'll'I0N1 r))ATE* A UGUS V" 31 Always verify licenses online at MyFl, 022 oridaLicense.corn Donot alter this document ill any form. u his is your license. it is unlaWtLyl for anyone other than the Iicensee to Use e this doca.¢nient. ODIS24 Local Business Tax Receipt Miami —Dade County, State of Florida -THIS IS NOTA BILL -DO NOT PAY 1568519 tL B7T RDSTNESS RAMEA .RATION "BN METROPOLITAN AIR CONDITIONING INC RENEWAL EXPIRES NW SOST MIA SEPTEMBER 30, 2022 MIAMI FL 3316166 1568519 Must he displayed at place of business Pursuant to County Code Chapter BA - Art. 9 & 10 OWNER METROPOLITAN AIR CONDITIONINGINC SEC.TVPEOFRNSWESS 196 SPEC MECHANICAL CONTRACTOR PAYMENTRECENED CAC043919 BTTAX CottEMR Worker(s) ]a $75.00 07/14/2021 CHECK21-21-053496 This Local Business Tax Receipt only confirms payment of the Local BusinassTax. The Receiptis nota license, permit,ovanmental reg oftoo holderndualiftcations,m do business. Roldermust comply With any to icense, or nongovemmamel regulamry laws and requirements which apply s. the business The RECEIPT NO. shove must he displayed on all commercial vehicles- Miami -Dade Code Sec Ba-276. Fermom information,visitMMM,M eMidado....,t,___. _ _. ACORN® CERTIFICATE OF LIABILITY INSURANCE DATE /31/ 22 01/31/2022 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 endorsements . PRODUCER Eckert Insurance Group CONTACT NAME: Dora Bibb PHONE Ed): (305) 685-5671 FAX NoI: (305) 68M529 ADDRESS: dora@eckertins.com 11601 NW 7th Ave INSURERS AFFORDING COVERAGE NAIC # INSURER A : BURLINGTON Miami FL 33168 INSURED INSURER B : INSURER C : Metropolitan Air Conditioning Inc INSURER D : 6917 NW 50TH ST INSURER E INSURER F : MIAMI FL 33166 COVERAGES CERTIFICATE NUMBER: 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. [L SR TYPE OF INSURANCE ADDLTR IM SUER wvp POLICY NUMBER POLICY EFF POLMMfDDAryM ICY EXP LIMITS A COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR Y 215B007129 11/26/2021 11/26/2022 EACH OCCURRENCE $ 1,000,000 PREMISES (Ea occurrence $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L X AGGREGATE LIMIT APPLIES PER: POLICY JECT LOC OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 $ AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ BODILY INJURY (Per aocldent) $ PROPERTY DAMAGE Per accident $ $ UMBRELLA LIAR EXCESS LIAR OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DIED I I RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTiVE YIN OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N ! A ST TUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) License# CAC043919 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Shores Village ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 10050 NE 2nd Ave Miami Shores FL 33138 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD ACCORD® CERTIFICATE OF LIABILITY INSURANCE `� °A03M/2o22 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(ies) 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 CONTACTHENRY BOONE NAME: The Miami Agency PHONE. Ext : (305) 885-2055 FAX No : (305) 885-2005 10 Canal Street ADDRESS: hank@gdhins.com INSURER(S) AFFORDING COVERAGE NAIC 0 #266 INSURERA: SUMMIT CONSULTING MIAMI SPRINGS FL 33166 INSURED INSURER B : INSURER C . Metropolitan Air Conditioning, Inc. INSURER D : 6917 NW 50 Street INSURER E : Miami FL 33166 INSURER F : COVERAGES CERTIFICATE NUMBER: CL2213103372 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. INSR LTR TYPE OF INSURANCE AVUL INSD WISH WVO POLICY NUMBER POLICY EFF MMIDD POLICY EXP MMIDD LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS -MADE 0 OCCUR PREMISES Ea occurrence $ MED EXP Any one person) $ PERSONAL & ADV INJURY $ GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY JEC LOC PRODUCTS -COMPIOPAGG $ $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNERIEXECUTIVE Y / N OFFICERIMEMBER EXCLUDED? ❑ (Mandatory In NH) NIA 0521-09048-000 08/03/2021 08/03/2022 ST STATUTE ER E.L. EACH ACCIDENT $ 100,000 E.L. DISEASE - EA EMPLOYEE $ 100,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, AddMonal Remarks Schedule, may be attached If more space Is required) license number #CAC043919 c:ANt;tLLA I IUN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Shores Village ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE. 2nd. Ave. AUTHORIZED REPRESENTATIVE Miami Shores FL 33138L�y�"""v ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD