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MC-09-23-2204Permit NO.: MC-09-23-2204 Miami Shores Village Permit Type: Mechanical - Residential 10050 NE 2 Ave Miami Shores FL 33138 Work Classification: A/C Replacement 305-795-2204 Permit Status: Approved Issue Date: 09/13/2023 Expiration: 03/13/2024 Location Address Parcel Number 1150 NE 102ND ST, Miami Shores, FL 33138 1132050190170 Contacts SARA SEIDLER Owner Mike's AC Service Contractor 1150 NE 102 ST, MIAMI SHORES, FL 33138 MIGUEL MAYTA Home: 3057546084 saraseidler@gmail.com 775 79th Street H, Miami, FL 33138 Business: 3059860702 mikesacs@msn.com Description: REPLACE 5 TON AIR CONDITIONING SYSTEM Valuation: $ 8,850.00 Inspection Requests: (EXACT CHANGE OUT) Total Sq Feet: 0.00,,wy,_ Fees Amount Application Fee - Other $50.00 CCF $5.40 DBPR Fee $4.65 DCA Fee $3.10 Education Surcharge $2.70 Permit Fee $259.75 Scanning Fee $9.00 Technology Fee 530.913 Total: $36S.58 Payments Date Paid Amt Paid Total Fees $365.58 Credit Card 09/07/2023 $50.00 Credit Card 09/13/2023 $315.58 Amount Due: $0.00 Building Department Copy In consideration of the issuance to me of this permit, 1 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 regulating construction and zoning. Futhermore, I authorize the above named contractor to do the work stated. Authorized Signature: Owner Applicant / Contractor I Agent date September 13, 2023 Page 2 of 2 R 7-i,CEIVED Miami Shores Village SEP 0 7 2023 Building Department BY:—e> LK 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC 202O 0 14I, BUILDING Master Permit No. N1C'o9'z3'2201-1 PERMIT APPLICATION sub Permit ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING 0 MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 1150 NE 102 ST City Miami Shores County Miami Dade Zip: Folio/Parcel#:11 3205 019 0170 Is the Building Historically Designated: Yes NO Occupancy Type: SF Load: Construction Type: Flood Zone: OWNER: Name (Fee Simple Titleholder): SARA SEIDLER Address:1150 NE 102 ST City: Miami Shores State: Florida BFE: FIFE: Tenant/Lessee Name: Phone#: Email: SAeASefJ1e4V— 0161 1Arl LOW 305 754-6084 33138 CONTRACTOR: Company Name: Mike's AC Service Phone#: 305 751-5814 Address: 775 NE 79th Street Suite H City: Miami State: FL Zip: 33138 Qualifier Name: Miguel Mayta Phone#: 305 751-5814 State Certification or Registration #: CAC 039619 of Competency M DESIGNER: Architect/Engineer: N/A Phone#: Zip: Value of Work for this Permit: $L� 5 U' 0 r Square/Linear Footage of Work: Type of Work: ❑ Addition i__I Alteration ❑ New ❑■ Repair/Replace ❑ Demolition Description of work: REPLACE 5 TON AIR CONDITIONING SYSTEM (EXACT CHANGE OUT) Specify color of color thru Submittal Fee $ Permit Fee $ Scanning Fee $ Technology Fee Structural Reviews $ Radon Fee $ Training/Education Fee $ CCF DBPR $ Co/cc $ Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ _ (Revised02/24/2014) Bonding Company's Name (if applicable) N/A Bonding Company's Address City State Mo age..ender's Name (if applicable) Mortgage Lends►Address City State N/A 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 certffed 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 Signature OWNER or AGENT The foregoing instrument was acknowledged before me this day of . 20 . by , who is personally known to me or who has produced Identification and who did take an oath. NOTARY PUSUC: Sign: Print: CONTRACTOR The foregoing instrument was acknowledged before me this day of .20 . by as me or who has produced , who is personally known to identification and who did take an oath. NOTARY PUSUC: Sign: Print: Seal: Seal: as *sssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssss APPROVED BY Plans Examiner Zoning (Revised02/24/2014) Structural Review Clerk Bonding Company's Name (if applicable) N/A Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State N/A 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. 1 understand that a separate permit must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, AIR CONDITIONERS, ETC..... OWNER'S AFFIDAVIT: 1 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. OWNER or AGENT The foregoing instrument was acknowledged before me this _ 7 day of J 2-�-4- 20 z3 by SQYZ fie' who is personally known to me or who has produced "" y C- L as identification and who did take an oath. NOTARY PUBLIC: Print: V kV e h re - Vivienne Yao Seal: : t�PY• "UA'o 'cis Comm.:HH222410 ExpiresAan.31,2026 ` NntaaPublic - State of Florida APPROVED BY Signature ..� ✓'� C��G•�� CONTRACTOR The foregoing instrument was acknowledged before me this day of 20 Z3 by who is personally known to me or who has produced ri - (� i r _ as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: 1 Vr I �V�y E yCL� Seal: ;.?Y?i%�8�� Vivienne Yao `� Corn m.:HH222410 �. A. 1 Expires: Jan. 31, 2026 Notary Public -State of Florida sxsssssesrsrrsss>VYY4`isssss srsssssssssssssssssrresrrrr Examiner Zoning (Reviwd02/24/2014) Structural Review Clerk Summary Report PROPERTY INFORMATION Folio 11-3205-019-0170 Property Address 1150 NE 102 ST MIAMI SHORES, FL 33138-2616 Owner SARASEIDLER Mailing Address 1150 NE 102 ST MIAMI SHORES, FL 33138-2616 Primary Zone 1100 SGL FAMILY- 2301-2500 SQ Primary Land Use 0101 RESIDENTIAL- SINGLE FAMILY: I UNIT Beds / Baths /Half 3/2/1 Floors 1 Living Units 1 Actual Area 3,508 Sq. Ft Living Area 2,236 Sq.Ft Adjusted Area 2,959 Sq.Ft Lot Size 15,070 Sq.Ft Year Built 1955 Year 2023 2022 2021 Land Value $1,133,235 $730,307 $475,958 Building Value $310,695 $310,695 $221,925 Extra Feature Value $3,533 $3.579 $3,624 Market Value $1,447.463 $1,044,581 $701,507 Assessed Value $378,601 $367,574 $356,868 Benefit Type 2023 2022 2021 Save Our Homes Assessment $1,068,862 $677,007 $344,639 Cap Reduction Homestead Exemption $25,000 $25,000 $25,000 Second Exemption $25,000 $25,D00 $25,000 Homestead Widow Exemption $5.000 $500 $500 Note: Not all benefits are applicable to all Taxable Values (i.e. County, School Board, City. Regional). MIAMI SHORES SEC 8 REV PB 43-67 LOT 7 LESS PORT LYG IN RIW & PORT OF LOT 8 DESC BEG SWLY COR OF LOT 7 TH SWLY27.41 FT 2 1 1 Generated On: 09/04/2023 Year 2023 2022 2021 COUNTY Exemption Value $55,000 $50,500 $50,500 Taxable Value $323,601 $317,074 $306,368 SCHOOLBOARD Exemption Value $30,000 $25,500 $25,500 Taxable Value $348,601 $342.074 $331,368 CITY Exemption Value $55,000 $50,500 $50,500 Taxable Value $323,601 $317,074 $306,368 REGIONAL Exemption Value $55,000 $50,500 $50,500 Taxable Value $323,601 $317,074 $306,368 Previous Sale Price OR Book- Qualification Page Description 01/01/1996 $230,000 17079-0268 Sales which are qualified 06!0111992 $146,500 15595-0703 Sales which are qualified 03/01/1991 $129,000 14959-2750 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.miamidad e.gov/info/disclaimer.asp CITY COPY 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 q " Z3 22 PERMIT NUMBER: MC 0 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 City. Miami Shores VRiage 1150 NE 102 ST County: Miami Dade zip tee: 33138 ALL CONDENSING UNITS MUST BE ON A 41NCH SOLID CONCRETE SLAB ALL UNITS MUST COMPLY WITH F.LMA MINIMUM FLOOD ELEVATION A COPY OF THE CONTRACT IS REQUIRED WITH ALL SUBMITALS AHRI DATA SHEET REQUIRED Change disconnecting means: YES ❑ NO 0 Aim sheet Attached: YES N NO ❑ Contract Attached: YES ❑ UNIT BEING REPLACED DATA NEW UNIT TRANS MANUFACTURER AMERICAN STANDARD rI AHU or PKG. UNIT MODEL # TEM660C60H51SA '7-1 1901apG COND. UNIT MODEL# 4A7A4060N1000B KW HEAT 10 KW NOM TONS 5 TON AHU CU PKG 1) M.C.A AHU CU PKG 34 AHU CU PKG 2) M.O.P AHU CU PKG 60 AHU CU PKG 3)VOLTS AHU CU PKG208230 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 YES NO NO NEW ROOF STAND NEW RETURN PLENUM BOX YES YES NO NO 1. Minimum Circuit Ampacity (Wire Size): 40 2_ Maximum Overcurrent Protection (Fuse/Breaker Size): 50 3. Voltage of Circuit (208/240/480): 208/240 4. Size Disconnecting Means: 60 Conttactor'sCompanyName: MIKE'S AC SERVICE 305 751-5814 State Certificate or Registration No. CAC 039619 Phone: Certificate of Competency No. Signature 14ualmerss�wwre/ Date: VED (RWsed0Zn4/2014) SEP 0 7 2023 BY .--Ld� Certificate of Product Ratings AHRI Certified Reference Number! 208156655 Date : 09-04-2023 Model Status: Active AHRI Type: RCU-A-CB (Split System: Air -Cooled Condensing Unit, Coil with Blower) Outdoor Unit Brand Name: AMERICAN STANDARD Outdoor Unit Model Number (Condenser or Single Package) : 4A7A406ON1 Indoor Unit Model Number (Evaporator and/or Air Handler): TEIVISBOC60V51+TDR Region: Ali (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, NH, NJ, NM, NV, NY, OH, Ole, OR, PA, RI, SC, SD, TN, TX UT, VA, VT, WA, WV, WI, WY, U.S. Territories) Region Note: On January 1, 2023, efficiency standards increased for Central air conditioners. Beginning January 1, 2023, central air conditioners can only be installed in region(s) for which they meet the new regional efficiency requirements. The manufacturer of this AMERICAN STANDARD product is responsible for the rating of this system combination. Rated as follows In accordance with the latest edition of AHRI 210/240 — 2023, Performance Rating of Unitary Alr-Conditlaning & Alr-Source Heat Pump Equipment and subject to rating accuracy by AHRI-sponsored, independent, third party testing: Cooling Capacity (AFull) — Single or High Stage (95F), btuh : 56000 SEER2 : 14.80 EER2 (AFun— Single or High Stage (95F) : 12.00 1"Active' Model Status are those that an AHRI Certification Program Participant is carrermy producing AND selling or offering for sale; OR new models that are being marketed but are not yet being produced.'Produdion Stoppecl' Model Status are those that an AHRI Certification Program Participant is no longer producing BUT is still selling or offering for sale. Ratings that am accompanied by WAS Indicate an involuntary re -rate. The new published rating is shown along with the previous (i.e. WAS) rating. The Department of Energy has published updated energy efficiency metrics for central air conditioners and heat pumps. This publication reflects both the 1987 metric (SEER) and the 2023 metric (SEER2). Efficiency requirements ere published at 10 C.F.R. 430.32(c). Please refer to ww,vAHRlnaLorg for more information about updated energy efficiency mabes. 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 CertMcate. 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 pmpdetary products of AHRL 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; copled; disseminated; entered Into a computer database; or otherwise utilized, In any form or manner or by any means, except for the user's Individual, Pin personal and confidential reference. AIR-CONDmONINQ NMn", CERTIFICATE VERIFICATION & REFRIGERATION INSTITUTE The Information for the model cited on this certificate can be verified at www.ahridirectory.org, click on *Verify Certificate' link make life bate, - and enter the AHRI Certified Reference Number and the date on which the certificate was Issued, which is listed above, and the Certlllcate No., which is listed at bottom right. ©2023Air-Conditioning, Heating, and Refrigeration Institute I CERTIFICATE NO.: 13338295s owfiws1 Ron DeSantis, Governor Melanie S. Griffin, Secretary STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD LICENSE NUMBER: CAC039619 EXPIRATION DATE: AUGUST 31, 2024 THE CLASS A AIR CONDITIONING CONTRACTOR HEREIN IS CERTIFIED UNDER THE PROVISIONS OF CHAPTER 489, FLORIDA STATUTES MAYTA, MIGUEL Q. r MIKE'S A C SERVICE INC P O BOX 414384 MIAMI BEACH FL 33141 �s M Jr • ISSUED: 08/LW022 Sys verify licenses online at MyFloridaLicense.com Do not alter this document in any form. This is your license. it is unlawful for anyone other than the licensee to use this document 000120 Local Business Tax'Receipt Miami -Dade County, State of Florida THiSIS NOTA BILL -DO NOT PAY 1663377 MIKES A C SERVICE INC 775 NE 79TItST # 1 MIAMI FL 33138-4743 LE11r RENEWAL SEPTEMBER 30, 2024 1 MM77 Must be displayed at place of business Pursuant to County Code Chapter SA - Art. 9 & 10 -0 owum SELTMOFtttISH M PArt#FKTS£I M IWKESA C SOMCE INC 196 SPEC MECHANICAL CONTRACTOR ByTsxtftLWas CAC039619 $45.00 08/08/2023 Worker(s) 10 FPPU21-23--000497 This Local Business Tax Receipt only confirms payment of the Local Busiae=TwL The Receipt is not a Itcer m pormkoracardfleadenefdwboldw'spdificadamtodobudnn& Holder most comply with any goveraaee ml cr a—gan man ay taws and rsquiramcats which apply to the basin . The RECEIPT NO. above avid be displayed an all commercial vehicles - Miami-Qade Code Sec Ba-"& Far more Information, visit rAC-Z3 - e-2 ,04 ACORN® CERTIFICATE OF LIABILITY INSURANCE 0110&2= 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 certificats holder Is an ADDITIONAL INSURED, the policy(les) must have ADDITIONAL. INSURED provisions or be endorsed. If SUBROGATION 13 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 ceri flcate holder in lieu of such endorsement(s). PRODUCER Brawn & Brown of Florida, Inc. 8826 NW 21stTerrace Doral FL 33172 CONTAW NAME: Heather Ctaw-Cass PHONE (954) 820-T894 No (305) 714-4401 ADOREas: heather.chase-coss@bbrown.com aFFOROM COVERAeE NAIL s INSURER A: FCCI Commendal insurance Company 33472 INSURED Mike's AC Service, Inc. P.O. Box 414384 Miami FL 33141-0384 INSURER S : Technology Insurance Company, Inc. 42376 0=RER c : INSURER D : R=RErt E INSURER F : COVERAGES CERTIFICATE NUMBER: 23-24 REVISION NUMBER: THIS ISTO 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. TYPE OF INSURANCE POLICY NUMBER LMM NYMMERILAL GENERAL L ABILFTY EACH OCCURRENCE a 1,000.000 CLAIMS.MADE ® OCCUR PREMISES $ 100,000 MED EXP one $ 5,000 A GLI0003421305 01101/2023 01101=4 PERSONAL d.ADVINJURY $ 1,000,000 GENLAGGREGATE LIMIT APPLIES PER: POLICY � PRO- F�LOC GENERALAGGREGATE $ 2,000,000 PRODUCTS - COMPIOP AGG S 2,000,000 s OTHER: AUTOMOBILE LIABILITY ED SINGLE LIMrr me seckwa s ANY AUTO BODILY N.EIJRY (Per person) $ OWNED SCHEDULED ONLY AUTOS BODILY INJURY (Per acciderd) $ POWPEMY DAMAGE $ HIRED NWNEO AUTOS ONLY AUTOS ONLY a UMBRELA LIAB OCCUR EACH OCCURRENCE $ HCLAIMS-MADE AGGREGATE $ EXCESS LIAR DED RETENTION S S B WORKERS CORWENSATION AND EMIPLOYERS' LIABILITY ANY PROPRIETORIPARINEWEXECUTNE Y / N DY OFFICERIMEMBEREXCLUDED? (Mu,drdory In NIII NIA TWC4188100 01/01/2023 01/01/2024 PM � ELL EACH ACCIDENT S 1,0OO,OQO E.L. DISEASE - EA EMPLOYEE $ 1,000.000 ayes. describe under DESCRIPTION OF OPERATIONS' E.L. DISEASE - POLICY LIMIT' $ 11000,000 DESCRWTWN OF OPERAT)ONS I LOCATIONS 1 VEM CM (ACORD 101, AddMonel Remarks Schedule, reap► be attached if more spars bz required) " Workers Comp Inbrrnatieon "Proprietors/ParMers/Executive OffscersJMembers Excluded as per form #WC 00 03 08: Gerardo Mayta Miguel Mayta Heating. Air Conditioning Contractor - No liquid gas Air Conditioning Contractor -License #CAC039619 Miami Shores Village Building Dept. 10060 No 2Nd Avenue Miami Shores FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPtRA11ON DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 01988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD