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MC-11-325Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 158268 Scheduled Inspection Date: June 06, 2011 Inspector: Perez, JanPierre Owner: STRAUSS, MICHAEL Permit Number: MC -2 -11 -325 Job Address: 1251 NE 94 Street Miami Shores, FL Project: <NONE> Contractor: EDD HELMS ELECTRIC & A/C INC Permit Type: Mechanical - Residential Inspection Type: Final Work Classification: A/C Replacement Phone Number Parcel Number 1132050100050 Phone: 305 -653 -2520 Building Department Comments REPLACE EXISTING 3 1/2 AND 1 1/2 TON AIR CONDITIONG SYSTEMS (K)-(i“ Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments CREATED AS REINSPECTION FOR INSP - 156418. need to fix dryer duct jpp June 03, 2011 For Inspections please call: (305)762 -4949 Page 11 of 26 l _ /2/ Saus s iami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 Permit No. MC, Master Permit No. agZ1131f WE Fri FEB 2 8 2111 BUILDING PERMIT APPLICATION FBC 20 Permit Type: MECHANICAL Owner's Name (Fee Simple Titleholder) f%/eh4 e / SILr?t.lt 65 Phone # 3as- 419.0- - '/40l32 Owner's Address 42S/ NE 9 6-tree(- City Miami .5JOV &S State %10el e/4 Zip 33/38 Tenant/Lessee Name Phone # Email Job Address (where the work is being done) /a75-1 il/F 9 7 SfYee -/ City Miami Shores Villa a County Miami -Dade FOLIO /PARCEL# 1/- 32es- o/O -OOSU Is Building Historically Designated YES NO Zip 33! 36 Flood Zone Contractor's Company Name Ede/ Helms Ar. and or/ phone # JD 44-.3 -25g 0 Contractor's Address / 785-0 NE- S /4 vtdi , e- City / et en ; State FL Zip 33/6 Z. Qualifier Name g0 bcr Y- ee 4.e ,..--/-s Phone # 30 S-6 S 3 Z S2-0 State Certificate or Registration No. 'A 1 cf / 2 1/90 7g/ Certificate of Competency No. Contact Phone 30c 4,S3 " 2 SZd $ 219 E -mail Architect/Engineer's Name (if applic b � le) i go � Phone # Value of Work For this Permit $ Type of Work: ❑Addition ❑Alteration ❑New epair/Replace ❑ Demolition Describe Work: /?e /ac.e_ e rS"li1 - 3'Z a rp / 12 rl a1 , i, anin S @eddhe /ms ,eeni Square / Linear Footage Of Work: Submittal Fee $ Permit Fee $ 31 ` A D CCF $ CO /CC $ Notary $ Training/Education Fee $ Scanning $ Radon $ DPBR $ Double Fee $ Violation date: Structural Review. $ Technology Fee $ Bond $ Total Fee Now Due $ See Reverse side -- >„ X92 Bonding Company's Name (if applicable) Bonding Company's Address City State Zip 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 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 m st be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. (!iq the abnc s.ost notice, the inspection will not be ap1roved and a reinspection fee will be charged. Signature Signature Owner or Agent Contractor The foregoing instrument was acknowledged before me this Z&4 The foregoing instrument was acknowledged before me this 214" day of , 20 (1 , by , day of Februavy , 20 11 , by ROberf I W19e , wlzo is personally known to me or who has produced who is personally known to me or who has produced as identification and who did take an oath. N AR PUBLIC: OT ;,Y PUBLIC. Sign: 1/f As identification and who did take an oath. My Commission Expires HAC • MY COMMISSION # DD 917400 41 EXPIRES: October 1, 2012 Bolded Thou Nobly Public Underwriters Sign: Print: My Commission Expir y► r :; MARY E. HACKNEY ► ,1 MY COMMISSION 8 DD 817460 �� EXPIRES: October 1, 2012 "4.�iPt<+` r Bonded mru N Uy aub@c Underwriters ***.........*****.*.*****.....*..*.**.*..***..****.........***.*****.******.*..**.*.....******......... 4 APPROVED BY 2/?lb P an"s Examiner Zoning Engineer (Revised 07 /10 /07)(Revised 06/10/2009) Clerk checked 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 S 1 -3 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): /257 /VF 91 City: Miami Shores Village County: Miami Dade Zip Code: 35/3? 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 ARI (AHRI) DATA SHEET REQUIRED Change Disconnecting means: YES ❑ NO 12 ARHI Sheet Attached: YES 12-NO ❑ Contract Attached: YES 0� UNIT BEING REPLACED DATA NEW UNIT -tee MANUFACTURER Rau e4 _ -; AHU or PKG. UNIT MODEL # 13 „ �' O / COND. UNIT MODEL # / /4 'Ao / 5 ER./ KW HEAT ci:s..i NOM TONS /• S AHU CU a PKG 1 M.C.A AHU 3) CU 30 PKG AHU CU PKG 2) M.O.P AHU CU PKG AHU CU PKG 3) VOLTS AHU CU PKG PKG UNIT / / PKG UNIT / / / D EER/SEER I YES ' • REPLACING DUCTS YES NO . �r REPLACING THERMOSTAT NEW 4 "CONCRETE SLAB I►T M re �_� BraMir a NEW ROOF STAND Egal YES 0 NEW RETURN PLENUM BOX YES L NO 1. Minimum Circuit Ampacity (Wire Size): /d 2. Maximum Overcurrent Protection (Fuse /Breaker Size): 30 A-# 3. Voltage of Circuit (208/240/480): 02o �J 3 a 4. Size Disconnecting Means: 30 i`2 1)1S" a «1-- Contractor's Company Name: Edo/ //elms Ai i-Cool cb 740.0 1 n State Certificate Signature Phone: 345--4511 ZSZU Certificate of Competency N. (Qualifier's signature only) Date: i• Z * "1 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 (� 23 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): /o?S/ A/6-" 9'' Sheaf City: Miami Shores Village County: Miami Dade Zip Code: 33/36 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 ARI (AHRI) DATA SHEET REQUIRED Change Disconnecting means: YES ❑ NO la ARHI Sheet Attached: YES E NO ❑ Contract Attached: YES Q' UNIT BEING REPLACED DATA NEW UNIT Rhee s4--► MANUFACTURER 2uGtesG RE/462AJ/ U AHU or PKG. UNIT MODEL # 214/am X22 IJA AWc t72- COND. UNIT MODEL # / tiA JM'OAC) /e /cw KW HEAT NOM TONS _/0�id 3 S AHU46 CU yp PKG 1) M.C.A AHU 4o CU 1/0 PKG AHU CU PKG 2) M.O.P AHU CU PKG AHU CU PKG 3) VOLTS AHU CU PKG ' PKG UNIT / / PKG UNIT / / /0 EER/SEER / (o YES) REPLACING DUCTS YES t0 YES /ISI REPLACING THERMOSTAT YES 1 • YES 1 e, NEW 4 "CONCRETE SLAB YES ( N YES NEW ROOF STAND YES YES k • NEW RETURN PLENUM BOX YES A-0) 1. Minimum Circuit Ampacity (Wire Size): -` 2. Maximum Overcurrent Protection (Fuse /Breaker Size): (. 3. Voltage of Circuit (208/240/480): a O /23 0 4. Size Disconnecting Means: /.)Sco, nee/ Contractor's Company Name: £4'I /Calm's /Jir andi f7or/ >n Phone, - 5 t 5 - 2S 2 6 State Certificate or Registration 1.CM (714 4' Certificate of Competency N. tr Signature (Qualifier's signature only) Date: 2 - 2y - I I CUMULATIVE SUBSTANTIAL IMPROVEMENT VERIFICATION WORK SHEET In accordance with FEMA regulation and Miami Shores Village Flood Damage Prevention Ordinance the costs of all improvements must be monitored. The costs of any improvements in the past 12 months and the costs of any proposed improvements must be shown on the worksheet. The cost of improvements must include demolition, raw and finished materials (include those donated), labor (including volunteer and self - performed), construction supervision and management, and overhead and profit. A list of items the costs of which are to be included as well as those excluded is attached for your reference. (A Copy of the Contract must be attached) PROPERTY OWNER: IA Ono e_ S4ra.1,.5 S < PERMIT # >< ADDRESS: l2S I NF 'T Sire.e,t FOLIO NUMBER: l / " 320,5' D/D - 00So FLOOD ZONE: BASE FLOOD ELEVATION: FREEBOARD: EAST OF FL.CCCL: COST OF PAST IMPROVEMENTS (12 MONTHS): COST OF PROPOSED IMPROVEMENTS: O /Ce• Q d (ATTACH COPY OF CONTRACT) TOTAL CUMULATIVE COST OF IMPROVEMENTS (past and proposed): 5/5.74 � VALUE OF PRINCIPAL STRU TURE (attach appraisal): OWNERS SIGNATURE: DATE: 2'71f —11 PLANREVIEWER: PLAN REVIEWER SIGNATURE: Created on June 2009 DATE: . Edd Helms February 18, 2011 Michael Strauss 1251 NE 94th Street Miami Shores, FL 33138 305 -490 -4602 ass.consutting.cam mstrauss03 @yahoo.com, michaelstrauss@pass.consutting.com Helms Air Conditioning is pleased to provide this proposal to replace the air conditioning in your home. The installation will include the following materials and equipment. 3.5 ton and 1.5 ton Ruud 16 Seer 13 eer systems 1. Removal and disposal of the existing equipment 3. S- 2. New Ruud Condenser 14AJM42A0, Variable Speed Air Handler RI-ILKHM3821JA /• S — 3.- New Ruud14AJMISA01, Variable Speed air Handler RBHP17J06SH1 4. 5kw and 10kw Heater 6. Auxiliary Drain pan and Safety Overflow Switch 6. Inline Float Switch 7. Trapeze to hand new system 8. New Insulated Drain Line 9. New Copper Lines for 1.5 ton, removal of old lines out of attic 10. Two Cases of Filters for Filter Back drips 11. Build New Plenum on 3.5 ton unit and correct duct work to back bedroom 12. Move duct work away from attic entrance and electrical on both systems. 13. Reconnect to the duct work, drain line, copper 14. All Materials and Labor 15. Permit 114'6 5115° Total Terms$ 3 575.00 Down and Balance upon start -up of Rebate ew equipment Warranty: One Year Labor and Five Years Parts. Register system with In 60 days of installation at Werra www.registermyunit.com re Monday and through Friday 8 amdto the 6 pm excluding holidays. all Parts. Warranty hours 14w of Z 11860 N.E. 5th AV3rwe • Miami. Florida 33162 • TeL 305.663.2530 • To8 Free: (800) 3292530. Far (305) 653.7033. Ytavt eddh¢Ime co nl rf . d Hers s Page 2 of 2 1. Edd Helms warrants that all information in the contract is correct. 2. The price in this contract is a fixed price. There are no hidden costs. No additional work has to be performed by 3'1 parties. 3. Edd Helms warrants that the two return air openings in the ceiling for the attic A/C [ 16x20/ hallway) and [12x30 /living room) which transfer into [12x8 /halfway) and [16x8 / lIving room] are correctly sized for the new equipment.. 4. Edd Helms will not crush any R19 insulation. If insulation needs to be removed it will be put back. 5. Edd Helms warrants that the above mentioned sizes of A/C units for the house are correctly sized from a cooling, humidity and mold control perspective assuming replacement of all windows to hurricane Impact proof windows (gas filled double glass). 6. Edd Helms is licensed and insured. 7. Edd Helms is responsible for any damage Included but not limited to newly sanded wood floors. "i '`Z- Ron Thompson Cell 305- 970 -4711 Authorized r -y . - & Date M additional work to be performed shall be paid for at the rate of 394 per regular working -14i advanced written notice from customer. Additional materials used In extra work shalt be paid for at our normal rates. Price Is contingent upon work being performed during normal woddng hours. Payment terms: 5O% on authorization, 5O% on start -up of new equipment. Al payments shall be due in accordance with the terms described above. Customer agrees to pay as court costs and attorneys fees should legal means be necessary for collection 2116112o 1 l feve zoft. 17850 N.E. 81h Avenue • M{amf, Florida 33t$2 . Tel: 305 - 653.2530 . T011 Free: MOM 328-2530 • Fax (3451853 -7933 . www.eddhelm$. pn This combination qualifies for a Federal Energy Efficiency Tax Credit when placed in service between Feb 17, 2009 and Dec 31, 2011. Certificate of Product patinas AHRi Certified Reference Number: 3412579 Date: 2/24/2011 Product: Split System: Air- Cooled Condensing Unit, Coil with Blower Outdoor Unit Model Number: 14AJM18 Indoor Unit Model Number: RBHP -17 +RCHL -24A2 Manufacturer: RUUD AIR CONDITIONING DIVISION Trade /Brand name: RUUD 14AJM SERIES Manufacturer responsible for the rating of thls system combination is RUUD AIR CONDITIONING DIVISION Rated as follows in accordance with AHRI Standard 210/240-2008 for Unitary Air - Conditioning and Air- Source Heat Pump Equipment and subject to verification of rating accuracy by AHRi- sponsored, Independent, third party testing: Cooling Capacity (Btuh): EER Rating (Cooling): SEER Rating (Cooling): • 19200 13.00 16.00 • Ratings followed by an asterisk ( *) indicate a voluntary rerate of previously pubtishad date, unless accompanied with a WAS, which Indicates an involuntaryrerate. DISCLAIMER AHRI does not endorse 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 perfonganco of the product(s), or the unauthorized alteration of data listed an this Certificate. Certified ratings are valid only for models and configurations listed In the directory atwtivw.ahrtdirectory.erg. TERMS AND CONDITIONS This Certificate and its contents are proprietary products of ANN. 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; 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. CERTIFICATE VERIFICATION The information for the model cited on this certificate can be vedfled at www ahrfdirectoryorg, Air-Conditioning, Heading, click on "Verify Certificate link and enter the AHRI Certified Reference Number and the date on �ry� % and Refrigeration institute which the certificate was issued, which is listed aisove, and the Certificate No., which N listed below. ©2010 Air - Conditioning, Heating, and Refrigeration Institute CERTIFICATE NO.: 129430337129165428 Certfficate of Product Ratings AHRI Certified Reference Number: 3849915 Date: 2/24/2011 Product: Split System: Air - Cooled Condensing Unit, Coll with Blower Outdoor Unit Model Number: 14AJM42 Indoor Unit Model Number: RHKL- HM3821 +RCSL- H•3821 Manufacturer: RUUD AIR CONDITIONING DIVISION Trade /Brand name: RUUD 14AJM SERIES Manufacturer responsible for the rating of this system combination is RUUD AIR CONDITIONING DIVISION Rated as follows in accordance with AHRI Standard 210/240 -2008 for Unitary Air- Condltioning and Air - Source Heat Pump Equipment and subject to verification of rating accuracy by AHRI- sponsored, Independent, third party testing: Cooling Capacity (Btuh): 40000 EER Rating (Cooling); .. SEER Rating (Cooling): 13.00 15.50 • Ratings followed by an asterisk (•) indicate a vountary , crate of previously published data unless accompanied with a WAS, which Indicates an involuntary mrato. DISCLAIMER AHRI does not endorse the product(s) listed on this Certificate and makes no representations, warrantee or guarantees as to, and assumes no responsibility for, the product(s) listed on this Cortffkate. 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 etvnvwanddirectary.org. TERMS AND CONDITIONS This Certificate and its contents are proprietary products ofAHRI. 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; 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. CERTIFICATE VERIFICATION The Infomratlon for the model cited on this certificate can be verified etwamehridtrettoryarg, Air- Conditioning, Heating, click on "Veldt/ Certificate link and enter the AHRI Certified Reference Number and the date on IN %ELI and Refrigeration Institute which the certificate was Issued, which Is listed above, and the Coale' ate No., which Is listed below. 02010 Air - Conditioning, Heating, and Refrigeration Institute CERTIFICATE NO.: 129430337743243646 Client#: 53360 EDDHEI ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 7/21/2010 PRODUCER Paul H. DeSilva Bateman, Gordon & Sands, Inc. P.O. Box 1270 Pompano Beach, FL 33061 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POUCIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED Edd Helms Group, Inc.;Edd Helms Electric LLC;Edd Helms Air Conditioning Inc 17850 NE 5th Avenue Miami, FL 33162 -1008 INSURER A: Amerisure Insurance Co. 19488 INSURER B: Amerisure Mutual Insurance Co. 23396 INSURER C: INSURER D: INSURER E: COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR ADD L NSRO TYPE OF INSURANCE POUCY NUMBER POUCY EFFECTIVE DATE (MMIDOIYY) 07/01/10 POUCY EXPIRATION DATE (MM/DD YY) 07/01/11 LIMITS EACH OCCURRENCE $1,000,000 A X GENERAL UABIUTY COMMERCIAL GENERAL LIABILITY GL2011926080010 • $0 Deductible X PREMISES Me occurrence) $50.000 CLAIMS MADE X OCCUR MED EXP (Any one person) $5,000 X XCU /Contractual PERSONAL & ADV INJURY $1,000,000 X Broad Form PD GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIESPER: PRODUCTS - COMP/OP AGG $2,000,000 7 POLICY 1a. 7 LOC ( i I B AUTOMOBILELU181LITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNED AUTOS CA20011460902 07/01/10 07/01/11 COMBINED ; INGLE LIMIT BI $1,000,000 X BODILY INJURY (Per person) $ X BODILY INJURY (Per accident) $ X PROPERTY DAMAGE (Per accident) $ GARAGE UABIUTY ANY AUTO AUTO ONLY - EA ACCIDENT $ R OTHER THAN EA ACC $ AUTO ONLY: AGG $ B EXCESS/UMBRELLALIABILITY CU200114909 07/01/10 07/01/11 EACH OCCURRENCE $5,000,000 OCCUR CLAIMS MADE AGGREGATE $5 000 000 DEDUCTIBLE RETENTION $ 0 $ $ $ A WORIO:RS COMPENSATION AND EMPLOYERS' UABIUTY ANY PROPRIETORIPARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below WC200250110 07/01/10 07/01/11 X I l ORY UMRS I IOER EL. EACH ACCIDENT $500,000 $500,000 $500,000 El. DISEASE - EA EMPLOYEE El. DISEASE - POLICY OMIT OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION Miami Shores Village 10050 NE 2 Avenue Miami Shores, FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO 80 SHALL IMPOSE NO OBUGATION OR UABIUTY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. REPRESENT ACORD 25 (2001/08) 1 of 2 #S315070/M310898 JMR ® ACORD CORPORATION 1988 POWER OF ATTORNEY I, [name] f1' l CH N E to .g [Property owner Address] ' E i Lt 5-I 11. t I -i! ,33i33 U appoint Edd Helms Group. Inc as my Agent (attorney-in-fact) t o a ct for me in any lawful way with respect to the following subjects: EXECUTE ALL PERMIT APPLICATIONS PERTAINING TO PERMIT PROCESSING FOR IMPROVEMENTS TO MY PROPERTY AT THE ADDRESS SHOWN HEREIN. SPECIAL INSTRUCTIONS: ON THE FOLLOWING LINES YOU MAY GIVE SPECIAL INSTRUCTIONS LIMITING OR EXTENDING THE POWERS GRANTED TO YOUR AGENT. L1 r'1 /ja it Th A1i2C1 Ti i7OihJ 1'JG f t.t rf a THIS POWER OF ATTORNEY IS EFFECTIVE IMMEDIATELY AND WILL CONTINUE UNTIL IT IS REVOKED. THIS POWER OF ATTORNEY SHALL BE CONSTRUCTED AS A GENERAL: DURABLE: POWER. OF ATTORNEY AND SHALL CONTINUE TO BE EFFECTIVE EVEN IF I BECOME DISABLED, INCAPACITATED, OR INCOMPETENT. Choice of Law. THIS POWER OF ATTORNEY WILL BE GOVERNED BY THE .LAWS OF THE STATE OF FLORIDA WITHOUT REGARD FOR CONFLICTS OF LAWS PRINCIPLES. IT WAS EXECUTED IN THE. STATE OF FLORIDA I am fully informed as to all the contents of form and understand the full import of this grant of powers to my Agent. Signed this 11 day of . a-a v. ,'20 i [Your Signature - 70 1000 - TZ,. [Your Drivers License Number] [State] STATE OF FLLO� A COUNTY OF Da d e_ This ld�jc ent was acknowledged before me on r, (G t ( S-1-r0.k [Notary Seal, if any]:' .ti ,;sr; .. MARY E. HACKNEY s,= MY COMMISSION # DD 817400 aI EXPIRES: October 1, 2012 •' �Jf .. Bonded flw Notary NM Undanvreera 2- z't r [Date] by [name of principal/. , ture of No a Officer) Public for the to of Florida commission expires: IO -1- j 'L