Loading...
77 NE 95 St (7)Mechanical • .• PERMIT APPLICATION FOR MIAMI SHORES VILLAGE N * y �1 ** * * A * � �/ n y 1 Date'7:2oq L;L Job Address ' /7 p�f . 9541- �S Iy 7 Tax Folio Legal Description Owner / Lessee Tenant 3hfi1,2 / / Master Permit # • Owner's Address 4 i ✓V1 ( , e�1 � Phone 1 46 7 '9 - /BOO Contracting Co. e?v"C',JQh (� /7 " ✓' �1 Address, S N.. I' o+ 1-) S4 red C� rr '' Qualifier ©Y Pre_e.WV GVt — Phone / L-iO State # Municipal # Competency 1(JJCOU0// Ins.Co. Architect /Engineer Address Bonding Company Address Mortgagor Address Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANIC ROOFING PAVING FENCE SIGN I a 1 WORK DESCRIPTION Z v (� I r, (—) 40i S 2u L,t[,i 1 C� ( ; f W 411 i 0 L) 1- lea --e y- a Ind r7 O u-1- Square Ft. ( 0 V LICc tQ j Estimated Cost(value) 44 �. � ' WARNING TO OWNER: YOU MUST I RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO 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). Application is hereby made to obtain a permit to do work and installation as indicated above, and on the attached addendum (if app!licable). I certify that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK. 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. Furthermore, I authorize t ove -named contras or to do the work stated. Signatur of o r and /or Condo '.j ! `dent Sign Date: Da Notary as to Owner and /or. Presi.ent A - My Commission Expires: ..) • r or o x res : Notary as to My Commission FEES: PERMIT / 5 RADON C.C.F. L, I 5 Q NOTARY er- Buil.,der J . . Y TOTAL DUE h 340 Fire Other Zoning � Building Electrical ) Mff i Plumbing Engineering, Date 14- V Job Address "7/E2 N. 6 9.3":11,-; S -re T Tax Folio Legal Description Owner / Tenant / /�. / / Master Permit �� ,�� ©�d` Owner's Address 1 Y vt g �. t Phone 4 4S7 I,_)_00 Contracting Co. 0--oydQ.hie, l E leG-E 1-1'c Qualifier Q V t 1'7 State # Municipal # Architect /Engineer Bonding Company Mortgagor Signatur Date: ** * APPROVED: Zoning PERMIT APPLICATION FOR MIAMI SHORES VILLAGE * er and /or Condo P Notary as to Owner and /or Condo My Commission Expires: * * FEES: PERMIT RADON nt Mechanical * C.C.F. Building Address 5-I(, E-, i 90 -1-G, S Phone / Wo - 077 7 Competency #E100 01 /14QIns.Co. Address Address Address Permit Type(circle one): BUILDIN ELECTRICAL LUMBING MECHANICAL ROOFING PAVING PENCE SIGN WORK DESCRIPTION W; , (--I -Io 1 2 -c..4 Lid l4 /G c rel i4 \6 k\-) 10 1C_� r� 1 � X 5 0 O 0 , Square Ft . Q U /. _ �.__ Also L Estimated Cost (value ) 1 WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO 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). Application is hereby made to obtain a permit to do work and installation as indicated above, and on the attached addendum (if applicable). I certify that all work will be performed to meet the standards of all laws regulating' construction in this jurisdiction. I understand that separate permits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK. 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. Furthermore, I authorize t :.)ve -named contractor to do the work stated. All Signat re ofrractor or Date: otary as to Contractor - or Owner =Bui 14e . y Commission x "es * * NOTARY TOTAL DUE 2 3,6 Fire Other Electrical Plumbing Engineering t.sJ F 64!_1. /0 xf, x / / SO crri // 1 .2 " i o it. / Ito 0 /o x /9 / 0 0 C y ti Zivi /4 '00 el /0x/ox / X00 C Fr 1 sa,o0 /i /0.)c/ox / ,„200 r ,eive i7i7,1Olie Co. /Vs.✓s(9ri Iv41 /ZC )94'Wi// A /j7i . /a. yo sill it , 3 A / / ,Y6 i/uhvzm/t il i/(20/4' %ii S ;c ri o i/ Zi,✓'_c Co.voer vso/1 T Syr ok 9N' O/ / •'•'• • i � • •. •• .41. �' STATE OF FLORIDA : : • • DEPARTMENT OF BEALTA "' • ' • • • :. ONSITE SEWAGE DISPOSAL SYSTEM SITE EVALUATION AVD SYSTEM• SPECIp ONS •• • • • • • APPLICANT: q �� e : 14 •. •• ••• AGENT i LOT: - BLOCK: SUBDIVISION:, PROPERTY ID #: 3 • •• [ ?ectiQn /Township /Range /Parcel No. or Tax ID Number] 1 - -••••• TO BE COMPLETED BY ENGINEER, HEALTH UNIT EMPLOYEE, OR OTHER QUALIFIED PERSON. ENGINEER'S MUST PROVIDE REGISTRATION NUMBER AN) SIGN AND SEAL EACH PAGE OF SUBMITTAL. COMPLETE ALL ITEMS. THE MINIMUM SETBACK WHICH SURFACE WATER: ,„; FT WELLS: PUBLIC: 4i FT BUILDING FOUNDATIONS: PROPERTY SIZE CONFORMS TO SITE PLAN: [; YES TOTAL ESTIMATED SEWAGE FLOW: Li t GALL AUTHORIZED SEWAGE FLOW: I e GALL UNOBSTRUCTED AREA AVAILABLE: :+..O f SQFT BENCHMARK /REFERENCE POINT LOCATION: ELEVATION OF PROPOSED SYSTEM SITE IS SITE SUBJECT TO FREQUENT FLOODING: [ ] YES [NO 10 YEAR FLOODING? [ ] YES [ ] NO 10 YEAR FLOOD ELEVATION FOR SITE: FT MSL /NGVD SITE ELEVATION: /QcC FT MSL /NGVD SOIL PROFILE INFORMATION SITE 1 unsell ar: y :e it • ••• • • • : •• • • CAN BE MAINTAINED FROM THE DITCHES /SWALES: LIMITED USE: 1",.;"4.1 FT I FT PROPERTY LINES: Color Text rM Depth to to to i -- � - to 7'2 . to USDA SOIL SERIES: y° AS , OBSERVED WATER TABLE: CT INCHES [ABOVE / BELOW] EXISTING GRADE. TYPE [PERCHED / APPARENT] ESTIMATED WET SEASON WATER TABLE ELEVATION: INCHES [ ABOVE / kELOW)] EXISTING GRADE. HIGH WATER TABLE VEGETATION: [ ] YES [.[d( N0 MOTTLING: [ ] YES [A NO DEPTH: f t s - ‚ INCHES SOIL TEXTURE /LOADING RATE FOR SYSTEM SIZING: DRAINFIELD CONFIGURATION: [ ] TRENCH [P� REMARKS /ADDITIONAL CRITERIA: � - SITE EVALUATED 13Y: y. "j�*.fv$-� DH 4015, 10/96 (Replaces HRS -H Form 4015 [Page 3] which may be used) (Stock Number: 5744- 003 - 4015 -1) ) BED SOIL PROFILE INFORMATION SITE 2 [ ] OTHER (SPECIFY) PERMIT 21 1 g r) DATE: [ ] NO NET USABLE AREA AVAILABLE: ACRES ONS PER DAY [RESIDENCES -TABLE 1 / 0 HER -TABLE 2) ONS PER DAY [1500 GPD /ACRE OR 2500 GPD /ACRE] UNOBSTRUCTED AREA REQUIRED: '�,Q?I SQFT d [INCHES1(FT]6[ABOVEBE'OW] BENCHMARK /REFERENCE POINT. PROPOSED SYSTEM TO THE FOLLOWING FEATURES: FT NORMALLY WET? [ ] YEp [N0 IVATE: 1411 FT NON-POTABLE:ri r FT FT POTABLE WATER LINES: « FT x Munsell Color Textur Depth 44 f . ' AL-o-1,)( -' to =r"r.sr USDA SOIL SERIES: a. t 0 t om`' to to ty `o to ' t0 DEPTH OF EXCAVATION: 3/ I INCHES Page 3 of 3 • ••• • • _ ••• • • • •• ••• INSTRUCTIONS: • ;• • • • • • • ' • • • • •• • • • • • • • • '• • • • • • • • ••• • • • • • ••• • • • PERMIT NUMBER: Permit tracking number by County Health Department. • • APPLICANT: Property owner's full nam¢,." • • • • ' • • • • • •P • :• • • • • ••• • • • • • • ••• AGENT: Property owner's legally authorize 1 representative. LOT, BLOCK, SUBDIVISION: Lot, block, and subdivision fob lot. ••. •• •'• ; : • • • • • • • • • • • • • •• •• • • • • • • PROPERTY ID NUMBER: 27 character number for propel ,(p 'rti appraiser PD fiumder or section /township /range /parcel number). PROPERTY SIZE: Check if property at site conforms to submitted site plan. Record net usable area available - lot area exclusive of all paved areas and prepared road beds within public rights -of -way or easements and exclusive of streams, lakes, normally wet drainage ditches, marshes, or other such bodies of water. SEWAGE FLOW: UNOBSTRUCTED AREA: MINIMUM SETBACKS: Record the estimated sewage flow for the establishment from Table 1 (residence) or Table 2 (non - residential), Chapter 10D -6, FAC. Record the authorized sewage flow for the lot based on net usable area and water supply (1500 gallons per day per acre for private water supplies and 2500 gpd per acre for public water supplies). If authorized sewage flow does not equal or exceed the estimated sewage flow, the application must be denied. Record the square feet of unobstructed area available and the amount required. Unobstructed area must be at least 2 times as large as the drainfield absorption area and at least 75 percent of the unobstructed area must meet minimum setbacks in Chapter 1OD -6, FAC. The unobstructed area must be contiguous to the drainfield. BENCHMARK INFORMATION: Record the location of the benchmark. If using a surveyor's benchmark record the actual elevation. Record the elevation of the proposed system site in relation (above or below) to the benchmark. Record minimum setbacks which can be meet to all listed features. Actual measurements must be recorded or "NA" for nonapplicable features. Features on site plan or within 75 feet of the applicant lot must be measured. The location of any public drinking well within 200 feet of the applicant's lot must also be verified. FLOOD INFORMATION: Record information on lot's subject to flooding. For lots subject to flooding record 10 year flood elevation for site and actual site elevation. SOIL PROFILE INFORMATION: Two soil profiles within the proposed absorption area to a minimum depth of 6 feet or refusal are required. Soil identification will use USDA Soil Classification methodology (Munsell colors and USDA soil textures). Refusals must be clearly documented. Provide USDA soil series if available, record "UNK" if the series cannot be determined. WATER TABLE: Record the depth of the observed water table at the time of the evaluation. Mark "perched" or "apparent" as appropriate. Record the estimated wet season water table elevation based on site evaluation, USDA soil maps, and historical information. Indicate if there is high water table vegetation present. Indicate if mottling is present and depth. SOIL TEXTURE: Record soil texture or loading rate for system sizing. DEPTH OF EXCAVATION: If applicable record depth of excavation required. Record "NA" if not applicable. DRAINFIELD CONFIGURATION: Check drainfield configuration required. If other, specify type. ADDITIONAL CRITERIA: Record any additional remarks pertinent to site or installation. Ex. dosing required. SITE EVALUATED BY: Signature of evaluator, title, and date of evaluation. Professional engineers must seal all documents submitted. ELEVATION WORKSHEET ELEVATION OF BENCHMARK / REFERENCE POINT IS: BENCHMARK SITE 1 SITE 2 SITE 3 [ + ] SHOT H.I. H.I. H.I. H.I. [ - ] SHOT [ - ] SHOT [ - ] SHOT MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305 -795 -2204 Building Inspection Request Date 01‘6(05 Type Insp'n htdMiY (,.&k PAIA Permit No. KC 5 S Name - jqifftak - Address 11 CampanyTRh t Phone # ? 30511 5 8' 154 5 Inspection Date DI 101165 Approved Correction Re- Insp'n Fee a D 7ypelnspn P er/hit No Na me Ph one # Ins pectio n Date A pproved Correc Re- Insp'n Fee 'Z1 k 1)41 . npany �� lo / 64 4 0 BUILDING ELECTRICAL PLUMBING ROOFING Owner of Building Architect Contractor or Builder Legal Description Address of Building ; , I MIAMI SHORES VILLAGE, FLORIDA 0 ❑ DATE. • ` 195 PERMIT N° _ 615 Contractor's License No. ❑ Work to be performed under this Permit CONTRACTOR OR BUILDER Lot Bl. Subdi- vision Value of Project $ Amount of Permit $ '- This permit is granted to the contractor or builder named above to construc the building or to install the equipment or device described in the application herefor in strict compliance with all ordinances pertaining thereto and with' the understanding that the work will be performed in compliance with any plans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this permit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes r for work done by his agents, servants or employees. Signed. .r 1,,....: 1 L.. BY .) INSPECTOR In consideration of the :Issuance to me of this permit I crate* l 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 ac- cepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee. BY AUTHORITY a MIAMI SHORES VILLAGE B J !WING DEPARTMENT 305-795-2204 Buiklirig Tnspection Request Date Phone # - Ana_ Type inSp'n Permit .No. Name I 1 L—tei Address Company ea \ yy-) r• -7s8 7545. Inspection Date Approved 2-101 4.4' 64,5& Con'ectOn Re-Insp'n Fee 4 . 4 , - - 6 a atersoi ,d . BUILDING PERMIT APPLICATION FBC 2001 Permit Type (circle): Building Electrical Plumbing Owner's Name (Fee Simple Titleholder) JP-vtRe \, Hl /7 ' r/ Phone # Owner's Address 7'7 Ai' Cit /4 / 5J6/1 State i..— Tenant/Lessee Name Job Address (where the work is being done) 7 7 A t ?5 S?—' City Miami Shores Village County Miami -Dade Zip 33 138 Is Building Historically Designated YES NO )L Contractor's Company Name ?4 Li` Y \ ,4//f( Phone # 3 7 $8 <. S Contractor's Address A(3( Ai W / ( Z p A City o 1/4 ' L77c2 State Zip _?id /V Qualifier `(C QL %f 6k Architect/Engineer's Name (if applicable) Phone # $ Value of Work For this Permit Type of Work: ❑Addition Describe Work: Submittal Fee $ Notary $ 5- OU Scanning $ 3,a) Code Enforcement $ Total Fee Now Due $ (I) (Continued on opposite side) III. I D Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 07?ons ['Alteration Permit Fee $ Structural Plan Review. $ Zip Phone # Square Footage Of Work: Permit No. MCZ1S 8 Master Permit No. Roofing 36 .I 9. sA-/8"6 B ❑New 21. Repair/Replace , ❑ Demolition * * * * * * * * * * * * * * * * * * * * * * * * * * ** F ees * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** rY) c.. CCF $ • DO CO/CC Training/Education Fee $ 0.40 Technology Fee $ - ` p - Radon $ Zoning Bond $ Signature day of who is perso Chc 12/15/03 Bonding Company's Name (if applicable) Bonding Company's Address City State Zip A J� e plicable) / { 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 ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and 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. caner r L eed • 11 C z � Theo regoing ins ment was k before me this 20,by (Certificate of Competency Holder) / 4, 474 ,"„ cy _ Signa ( Contractor The foregoing instrument was acknowledged before me this day of , 20 by who is personally kn a to Ime or who has produced as identification • did take an oath. to me or who has produced As identification and who did take an oath. NOT ' P UBLI . �\N . ' I OTARY PUBLIC: / _ Sign: �`�i� . ._o Sign: ■ _ ! � Print: --� Print: • My C mmission Expires: Mr S; My Conuni ion Expires: * * * ** ************************************************** * * * * * ** * * * * * * * * * * * * * * * * * * * * * * ** *fix ** ,W4i` t 1/4 State Certificate or Registration No. CMCd C ?i'S ;, Certificate of Competency No. ********************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** * * * * * * * * * * * * * ** * * * * * * * ** * * * * * * * * * * * * * * * * * * * * * * ** APPLICATION APPROVED BY: � Plans Examiner Engineer Zoning n,8 UNIT . FEE ITEM( SWITCH OUTLETS UNIT FEE ITEM SPACE HEATERS (NIT FEE LIGHT OUTLETS CENTRAL HEATING ZER RECEPTACLES SERVICE TEMPORARY A/C (WIND) C D l wbe A/C (CENTRAL) i1 /y 4/M1,/ SAL :ING FOUNTAIN SERVICE SIZE IN AIMS DUCT WORK CRAIN SERVICE REPAIWETER CHANGE REFRIGERATION ;E TRAP APPLIANCE OUTLETS PROCESS AND PRESS PIPING tCEPTOR RANGE TOP UNDERGROUND TANKS iCRY OVEN ABOVE GROUND TANKS MY TRAY WATER HEATER U.F. PRESSURE VESSELS 1ES WASHER MOTORS 0- 1 FP STEAM BOILERS ER MOTORS OVER 1- 3 If HOT WATER BOILERS POT /3 COMP. MOTORS OVER 3- 5 If MECHANICAL VENTILATION I , RESIDENCE MOTORS OVER 5- 8 If TRANSPORTING ASSEMBLIES , SLOP MOTORS OVER 8- 10 FP ELEVATORS/ESCALATORS , CRARY WATER CLOSET MOTORS OVER 10- 25 FP FIRE SPRINKLER SYSTEMS 'Al MOTORS OVER 25-100 If COOLING TOWERS R CLOSET MOTORS OVER 100 If VIOLATION RECT -WASTES A/CI WINDOW RE I NSPECT I ON R SLPPLY TO: AIR CONDITIONERS 'C UNIT STRIP HEATER IRE SPRINKLER GENERATORS TRANSFCRMEERS 1 :ATER -NEW INST. GENERATORS TRANSFORMERS i :ATER- REPLACE GENERATORS TRANSFCR.MERS Val SPRINKLER -WELL SPECIAL PURPOSE . iIMllhO POOL OUTLETS COMI,iERCIAL ATER SERVICE SIGN TUBES :R CONNECTIONS SIGN TRANSFORMERS .ITY -SEWER SIGN TIME CLOCK .ITY -WATER FIXTLRES SIC TANK ANTENNA kY TELEVISION OUTLETS INFIELD, 4' TILE/RES. VIOLATION & ABANDON SEPTIC TAM( RE I NSPECT I ON , (AGE PIT CU. FT. • >I BASIN CHARGE WELL ESTIC WELL A DRAIN �-- — F INLET 1 ---^ AR WATER HEATER ', E STANDPIPE • L PIPING _ N SPRINKLER SYSTEM 'DICE ER SET (GAS) PIPING ADDENDUM TO ( BUILDING PERMIT APPLICATION APPLICATION FA BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT FAS B. 'AIMED, THE•OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.) PLUMBING ELECTRICAL MECHANICAL Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Printed: 6/24/2005 Applicant: JEFFREY Owner: HILTON JOB ADDRESS: 77 Contractor PALM AIR INC Local Phone: 305 - 758 -7545 Parcel # 1132060130720 Work: Signed: NE 95 REPLACEMENT OF CONDENSING UNIT ONLY! (INSPECTOR) Signed: (Contractor or Builder) Mechanical Permit Permit Number: MC2005 -89 HILTON JEFFREY ST Contractor's Address: 6010 NW 153 STREET Permit Status: APPROVED Permit Expiration: 12/12/2005 Construction Value: $1,900.00 BY: Page 1 of 1 Legal Description: MIAMI SHORES SEC 1 AMD PB 10 -70 E3OFT LOT 21 & LOT 22 BLK 5 LOT SIZE Fees: FEE2005 -8754 FEE2005 -8755 FEE2005 -8756 FEE2005 -8757 FEE2005 -8758 FEE2005 -8759 Description Building Fee CCF Notary Fee Training and Education Fee Technology Fee Scanning Fee Total Fees: Amount $100.00 $1.20 $5.00 $0.40 $2.50 $3.00 $112.10 Total Fees: $112.10 Total Receipts: $0.00 JU 2 8 PAID — JUN 2 PAID 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 responisibility for all work done by either myself, my agent, servants or employes. RE- IbSUAP1 t TOM FI TATE OW FINANCIAL °F RCP ISION WOR CIMP NS cliffAtia�+s o *' RE•ISSUA NCE OF CONSTRUCTION INDUSTRY This certificate exempts the l Officer of the Corporation listed below from the provision of Florida Workers; EFFECTIVE DATE: 01/01/2004 .A EFFECTIVE CORPORATE OFFICER/ ICR080TH �C ER NAME: s FEN 5927763 BUSINESS NAME AND AIR INC ADDRESS: . NE 103RD ST IAMI ROBERT U1- U5-UU4 FIC EXEMPTION er of the Limited LlabWlty Company tion Law for the period indicated below . TION DATE: 08/03/2005 FL 33138 SCOPE Air USI OR TIRADE: HEATING & AIR CONDITIONING IMPORTANT: Pursuant to Chapter 440.05(14) , F .5. an officer of a corporation who elects exenvtion from this chaptet by filing a certificate of a action under this section may not recover benefits or compensation under this chapter OISTIONP18501 41e -2333 CWC.2E3 RE.1SSUAtiCe OF CONSTRUCTION INDUSTRY CERTIFICATE OF EXEMPTKJN REV IM 11 -03