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MC-11-878
Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 69 NE 98 Street Miami Shores, FL 33138- Owner Information Parcel Number Expiration: 11/13/2011 Applicant Address 1132060131150 Block: Lot: BRUCE PACE Phone Cell BRUCE PACE 69 NE 98 Street MIAMI SHORES FL 33138- 69 NE 98 Street MIAMI SHORES FL 33138- Contractor(s) Phone CHILLS AIR CONDITIONING SERVICE: (305)778 -2665 Cell Phone Valuation: Total Sq Feet: $ 3,756.00 0 Tons: 2.5 Additional Info: NH & COND UNIT Classification: Residential Approved: In Review Comments: Date Denied: Scanning: 1 Date Approved: : In Review Type of Work: MECHANICAL Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Total: Amount $2.40 $2.00 $2.00 $0.80 $131.46 $3.00 $3.20 $144.86 Pay Date Pay Type Invoice # MC -5-11 -40939 05/13/2011 Check #: 2095 $ 50.00 $ 94.86 05/23/2011 Credit Card $ 94.86 $ 0.00 Amt Paid Amt Due Available Inspections: Inspection Type: Final - 1 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 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. May 23, 2011 Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy Date May 23, 2011 1 511 lilt - P,A.rU7ukAA Miami 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 BUILDING PERMIT APPLICATION FBC 20 "" Permit No.IV `C I l Master Permit No. Permit Type: MECHANICAL OWNER: Name (Fee Simple Titleholder): L71>✓ G}1cacG1N■ `� Phone #: q/7 ct"+ - 58ru\ Address: y °l N:'. i 8 sk City: Mt AM: ,\-c re i State: *-t- Zip: 3313 Tenant/Lessee Name: Phone #: Email: JOB ADDRESS: 61, N c, s} City: Miami Shores County: Miami Dade Zip: 3313 23- Folio/Parcel #: Is the Building Historically Designated: Yes NO X Flood Zone: CONTRACTOR: Company Name: 6/1"//r AI- ease:411'04 Phone #: s 77 r -a 6 S Address: 1...2 3 c.c. .5 /c' S S S City: ,./111.441i Qualifier Name: /i%GG/e.r / State: Zip: 33/x'S Phone #: 305- 7e3--S l c 1 State Certification or Registration #: 44� / PI 6 2 V 01 Certificate of Competency #: Contact Phone #: 3 - 6.'3—S \ c.3 \ Email Address: /.I?,' / /s-46 (C/ //oa2 • c c DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ 3/'•s6. Square/Linear Footage of Work: Type of Work: ❑Address ❑Alteration ❑New .Repair/Replace Description of Work: al\ - c...D A-o. V1 A'C'GV.. ' - - VI S 5 ❑Demolition OAWCk;P******** ** * ********* * * ** ** ** ***** * ** *Fe 4, ***************** �xa��x�w ****�x�x�x�x�x ****�x�x *x•*** Submittal Fee $ Permit Fee $ \ r t\ CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ 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 must be posted at the job site for the first inspection hkh occurs seven (7) days after the building permit is issued In the absence of such posted notice, the inspection will not be aprat) d and a reinspection fee will be charged. Signature ( —Owner or Agent Signath Contractor The foregoing instrument was acknowledged before me this / U The foregoing instrument was acknowledged before me this( day of , 20 (/, by (74° `/ / , day of 5- , 20 /, by/%CAPe'/ /��/�'L who is personally known to me or who has produced i dUCtvtwho is personally known to me or who has produced /i-- As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Si My Commission Expir O./ /a Notary Public State of Florida Cory Roth a My Commission DD822787 ‘0,01f Expires 09/14 /2012 0 k0*0 * 000 # ** APPROVED BY / \/e), * *0 * ** (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) Plans Examiner Structural Review Sign: Print: _/1■• f v- -" My Commissio /cIA Notary Public State of Florida Cory Roth My Commission DD822787 F.oires 09/14/2012 ** Zoning Clerk 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): /r9 /ve 97.4r. City: Miami Shores Village County: Miami Dade Zip Code: 33/3 7? 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 RI ARHI Sheet Attached: YESX NO ❑ Contract Attached: YES g UNIT BEING REPLACED DATA NEW UNIT 2b -rte MANUFACTURER ls,se° 4//4 AHU or PKG. UNIT MODEL # (04 44ss9133o./ Ails COND. UNIT MODEL # N /--12. SO 11 KW HEAT S- A 't) _S- T NOM TONS P- S 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,7zu CU noPKG PKG UNIT / / PKG UNIT / / / o Srr/z EERISEER 16 .521-. YES NO REPLACING DUCTS YES .i YES NO REPLACING THERMOSTAT AS' NO YES NO NEW 4 °CONCRETE SLAB reg NO YES NO NEW ROOF STAND YES Afr YES NO NEW RETURN PLENUM BOX YES Ati 1. Minimum Circuit Ampacity (Wire Size): 3c? AV 2. Maximum Overcurrent Protection (Fuse /Breaker Size): L/o 1io/2 3. Voltage of Circuit (208/240/480): 207-23 G 4. Size Disconnecting Means: Contractor's Company Name: 6.4/lT Phone: 3.6T-- 763 -Ski State Certificate or Registration N. GgG /06 .7 Signature (Qualifier's signature only) Certificate of Competency N. Date: 5- -/z - / / Chills Air Conditioning Inc. 12973 SW 112 Street #179 Miami, FI 33186 Licensed & Insured. CAC1816279 Office: 305 - 778 -COOL Cell: 305 -763 -5101 Fax: 305 -479 -2556 Michael ©chillsairconditioning.com Chillsac@yahoo.com Bill To Lyle Churchill 69 Ne 98 St Miami Shores, FI 33138 9177975884 Estimate Estimate No: 61 Date: 12 May 2011 Description Quantity 1.00 Rate $3,506.00 Amount $3,506.00 Chills Air Conditioning service Inc. Proposes the following scope of work. 1) Fumish and install new 2.5 ton Trane 16 seer R 410 split system. Installation includes new digital t -stat, liquid line dryers, water safety switch, condenser hurricane anchors and connection of electric supply. All work will be completed to all state and local code. Unit Model# 4TTR5030A1000A / GAM5AB30M Heater model# 8kw Warranty: 10 year compressor, parts and coil. 5 year labor Notes: *$500.00 FPL rebate included in price. *This system qualifies for $300 federal tax credit. Note: Permits cost not included in price. Permits and expediting 1.00 $250.00 $250.00 Notes: Electrical permit not included in price. Terms 50 °° deposit, 40% upon completion and 10% after final inspection. i 1.00 $0.00 $0.00 This es ate becomes a c pon both party's signatures. Chills a/c o�rneommer • Indicates non - taxable item Subtotal TAX (0.00 %) Total $3,756.00 $0.00 $3,756.00 E RTI I ED;' wwW ahiidirectory orgy 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 ratings AHRI Certified Reference Number: 4150908 Date: 5/12/2011 Product: Split System: Air- Cooled Condensing Unit, Coil with Blower Outdoor Unit Model Number: 4TTR5030E1 Indoor Unit Model Number GAM5A0B30M21 Manufacturer: TRANE Trade/Brand name: XR15 Manufacturer responsible for the rating of this system combination is TRANE 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): 30000 EER Rating (Cooling): 13.50 SEER Rating (Cooling): 16.00 • Ratings followed by an asterisk (') indicate a voluntary rerate of previously published data, unless accompanied with a WAS, which indicates an involuntary rerate. DISCLAIMER AHRI does not endorse the product(s) listed on this Certificate and makes no representations, warranties or guarantees as to, and assumes no responsiblllty for, the product(s) listed on this Certificate. AHRI expressly disclaims as 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 proprietary products of AHRL This Certificate shall only be used for individual, personal and confidential reference purposes. The contents of this Certlticate may not, in whole or In part, be reproduced; copied; disseminated; entered Into a computer database; or otherwlse 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 verified at www.ahridirectory org, click on "Verify Certificate" Zink 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 below. ©2011 Air - Conditioning, Heating, and Refrigeration Institute ILI' Air - Conditioning, Heating, •a a/ and Refrigeration Institute CERTIFICATE NO.: 129496844332993820 r :TAX COLLECTOR 940 W RAILER ST_ 1St FLOOR tAMI, FL 33130 0' 654460 -6 BUSINESS NAME 1 LOCATION CHILLS AIR CONDITIONING SERVICES INC 12300 SW 105 ST 33186 UNIN DADE COUNTY OWNER SC HILLS AIR CONDITIONING SRUS INC 196 SPEC MECHANICAL CONTRACTOR Business ' :• WORKER /S a; ONLY A LOCAL TAX mart IT S NOT Pamir i TO VXRATE ERE NEGULATORY OR NG STY R arm. 1 IT Ewan emE UT a MED BY LAWMIS IS ote 2010 LOCALSUSMESSTAXREC ©PT 2011 MIAM -DADE COUNTY- STATE OF FLORIDA EXPIRES SEPT 30, 2011 MUST BE DNSPI Am, AT PEACE OF BUSINESS PURSUANTA TO COUNTY. CoDE CI4ApTER 9A -ART. 9 & 10 THIS IS NOT A BILL - DO NOT PAY RENEWAL RECEIPT NO. 681518 -8 STATE# CAC1816279 FIRST-CLASS MAIN. FI4 PERAII'C NV 239 LENT RECEVED WADE COUNTY TAX 09/17/2010 02290011001 000075.00 SEE OTHER SIDE OO NOT FORWARD INC ILLS AIR CONDITIONING SERVICES MICHAEL FERNANDEZ PRES 12300 SW 105 ST MIAMI FL 33186 LAh.11 ., ,Iiii.,li,,,,i1.ti,,,,i,hiih in thys26ht BATCH PLUMBER tatgl • r 07 -23 -2010 ALEX SINK STATE OF FLORIDA CHIEF FINANCIAL OFFICER 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 PERSON: FEIN: 07/2312010 EXPIRATION DATE 07/22/2012 FERNANDEZ MICHAEL A 204375633 BUSINESS NAME AND ADDRESS: CHILLS AIR CONDITIONING SERVICES INC 12300 SW 105 STREET MIAMI FL 33186 SCOPES OF BUSINESS OR TRADE 1- SALES 3- INSTALLATION SERVICES 2- CERTIFIED AC CONTRACTOR * IMPORTANT: Pursuant to Chapt section may not recover !wadii scope of the business or trade election to be exempt shell be certificate no longer meets the named on the certificate to me 440. 05(14), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election ander this or compensation ender this chapter. Pursuant to Chapter 440.05(12). F.S., Certificates of election to be exempt.. apply only within the listed on the notice of election to be exempt. Pursuant to Chapter 440.05(13), F.S., Notices of election to be exempt and certificates of subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person 1 the requirements of this section. OWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09 -06 QUESTIONS? (850) 413 -1609 LICERIS CLP zieMEZ ,Scow 106 ST 331s?8 SI:x: M'', O nat81actor vabicki