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MC-11-1623Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 165245 Permit Number: MC -9 -11 -1623 Scheduled Inspection Date: October 11, 2011 Inspector: Perez, JanPierre Owner: COMBE, DORIS Job Address: 1500 NE 105 Street C -12 Miami Shores, FL Project: <NONE> Contractor: EMERGENCY AC SERVICES INC Permit Type: Mechanical - Residential Inspection Type: Final Work Classification: A/C Replacement Phone Number Parcel Number 1122300530360 Phone: (954)788 -8907 Building Department Comments EXACT A/C REPLACEMENT 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- 164067. October 07, 2011 For Inspections please call: (305)762 -4949 Page 15 of 22 41i i\14441.4 BUILDING PERMIT APPLICATION 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 A Permit No. IV O )lfto2i 213 Master Permit No. FBC 20 Permit Type: MECHANICAL lommEgyyzn At SEP A 1 2011 BY: Phonel'J02) 89.E -S33/ 33/3 Phone#: OWNER: Name (Fee Simple Titleholder): A) I' &) LOC-0)4 15 Address: /5—'60 di1 /0.x,9 City: fri/ 24174 i fi(llY f State: fi . Tenant/Lessee Name: /,2 Email: c--. JOB ADDRESS: City: Folio/Parcel #: /Soo ,e)6 /oS-' rt Miami Shores County: 14412404- C, i': , pi') 10 Mdle, jt■ Is the Building Historically Designated: Yes NO /VO Miami Dade zip:33 /3 g / LIO / /-d,a3D -03-'3 Odd Flood Zone: CONTRACTOR: Company N1�e: -/tai t J4 � � G .�c5'J1L61 • Phone#-'J1) 7 211-0 67 Address: 3 5 X 13 & 6111 ' e ' .Z-- City: f PAJc) ip&„I State: , . Zip: C (,gyp Qualifier Name: aada, t� .r. non- . X88.. 9 ®! State Certification or Registration #: CF/g/ 3 >7? Certificate of Competency #: Contact Phone#: ( Sb 788,- g 91,7 Email Address: DESIGNER: Architect/Engineer: ,C),A Phone#: Value of Work for this Permit: $ v?ds°P. J Square/Linear Footage of Work: Type of Work: UAddress O D J _Alteration New 2 . I air/Replace ODemolition Description of Work: r C.O. e)r 4 0 /0 / ,IleA r Submittal Fee $ Permit Fee $ 1 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 ,3/11 Mortgage Lender's Name (if applicable) /11/1) Mortgage Lender's Address City State Tap 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Owner or Agent The foregoing instrument was acknowledged before me this day of x�r. ,20_,by who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Print My Commission wwawawawawwwaaawaw APPROVED BY Signature Contractor The foregoing instrument was acknowledged before me this/ day of ,20 // , by 60/11- 0fr✓t-$ C•1/111 who is personally known to me or who has produced A/ • �icJ���✓ as identification and who did take an oath. NOTARY PUBLIC: fi K:HSign TLEEN tY$ THALE Print �i ► P er My Commission Expires: SP«190/1/ **** ** *s *s**** * ** **** ** ** **** **** **a*a* *ass*** ************** ** *** *away * *** Plans Examiner Structural Review (Revised 07 /1007)(Revised 06/10/2009XRevised 3/15/09) Zoning Clerk AC# 5 07/14 /:2;;(T.1 The CI1S S Named be1Qw,;2CT TIF Under the pi by . ons. Expiration date: AUG 11/1Z 2I4(1SC 3 S.2 NV+ ` $ V't POMPANO:. BEACI$` • IssIni MA, w- ■.411•11111111PI IM■►•11111111M∎1=■ ..1 •111.4.1u 11i,r■■•∎ 7.x.1•-r1•11r1J111 115 S. Andrews Ave., Rm. A -100, Ft. Lauderdale, FL 33301 -1895 — 954 - 831 -4000 VALID OCTOBER 1, 2010 THROUGH SEPTEMBER 30, 2011 DBA: Receipt #:183 -863 Business Name: EMERGENCY A C SERVICES INC Business T yp e:HEATING /AIRCONDITION CO (A /C CONTR) Business Opened:II /01/1989 State /County /Cert/Reg: CAC 1813 7 7 9 Exemption Code :NONEXEMPT Owner Name: SANFORD THALER LAWRENCE Business Location: 3521 NW 8 AVE 2 POMPANO BEACH Business Phone: 954 - 788 -8907 Rooms Seats Employees 10 Machines Professionals For Vending Business Only Number of Machines: Vending Type: Tax Amount Transfer Fee NSF Fee Penalty Prior Years Collection Cost Total Paid 27.00 0.00 0.00 0.00 0.00 0.00 27.00 THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT WHEN VALIDATED Mailing Address: SANFORD THALER LAWRENCE 3521 NW 8 AVE BAY 2 POMPANO BCH, FL 33064 This tax is levied for the privilege of doing business within Broward County and is non - regulatory in nature. You must meet all County and /or Municipality planning and zoning requirements. This Business Tax Receipt must be transferred when the business is sold, business name has changed or you have moved the business location. This receipt does not indicate that the business is legal or that it is in compliance with State or local laws and regulations. 2010 - 2011 Receipt *05A -09- 00030352 Paid 09/10/2010 27.00 MIAMI-DADE COUNTY TAX :COLLECTOR 140 W. FLAGLER ST, 1st FLOOR MIAMI, FL 33130 435786 -9 BUSINESS NAME / LOCATION EMERGENCY A C SERVICES INC DOING BUS IN DADE CO 2011 LOCAL BUSINESS ; FIRST -CLASS MIAMI -DADE COUNT' STALE F FLO IDA U.S. POSTAGE EXPIRES PT 30, 20 PAID MUST BE DISPLAYED AT` PLACE OF BUSINESS; MIAMI, FL PURSUANT TO COUNTY CODE CHAPTER 8A: ART 6 81.-10 PERMIT NO. 231 THIS IS NOT A BILL — DO NOT PAY RENEWAL STATE# 3779 454844 -3 CAC181 OWNER EMERGENCY A C SERVICES INC 1T96 SPEB�R MECHANICAL CONTRACTOR WORKER1 /S THIS IS ONLY A LOCAL BUSINESS TAX RECEIPT. IT DOES NOT PERMIT THE HOLDER TO VIOLATE ANY EXISTING REGULATORY OR ZONING LAWS OF THE COUNTY OR CRIES. NOR DOES IT EXEMPT THE HOLDER FROM ANY OTHER PERMIT OR LICENSE REQUIRED BY LAW. THIS IS NOT A CERTIFICATION OF THE HOLDER'S QUALIFICA- TIONS. PAYMENT RECEIVED MIAMI -DADE COUNTY TAX COLLECTOR: 07/07/2011 60080000551 000075.00 SEE OTHER SIDE DO NOT FORWARD EMERGENCY A`C SERVICES INC LARRY THALER PRES 3521 NW 8 AVE #2 POMPANO BEACH FL 33064 1, 111 „II,iGIIIIIIlIhI1UI1l lUI,IIIIII,I,IIU,fhIhhki '4`.°R° CERTIFICATE OF LIABILITY INSURANCE 5/24/20111 ) 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 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 Frank H. Furman, Inc. 1314 East Atlantic Blvd. P. O. Box 1927 Pompano Beach FL 33061 CONTACT Toni Enslen NAME: (A/C. NNa ExU: (954) 943 -5050 rec. Noj: (954)942 -6310 E -MAIL ADDRESS: toni @furmaninsurance.com PRODUCER 00001399 _ _CUSTOMER ID #: INSURERS) AFFORDING COVERAGE INSURERA:Associated Industries Ins Co NAIC # 23140 INSURED Emergency A/C Services, Inc 3521 N W 8th Ave Pompano Beach FL 33064 INSURER B: INSURERC: INSURERD: EACH OCCURRENCE INSURER E : INSURERF: $ CERTIFICATE NUMBER :2011 -12 Master • 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 ADM INSR SUER WVD POLICY NUMBER (MMO/UDDYIVYYY I (MM/DDIYYAYY) LIMITS GENERAL UABIUTY COMMERCIAL GENERAL LIABILITY OCCUR EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES (Ea occurrence) $ CLAIMS -MADE MED EXP (Any one person) $ PERSONAL 8 ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ POLICY PRO- JECT LOC $ AUTOMOBILE UABIUTY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ $ UMBRELLA LIAB EXCESS UAB _ OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DEDUCTIBLE RETENTION $ $ $ A WORKERS COMPENSATION AND EMPLOYERS' UABIUTY ANY PROPRIETOR/PARTNER /EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS Y / N N /A AWC1007825 5/27/2011 5/27/2012 1 WC STATU- OTH- 1 TORY LIMITS ER $ 500 000 E.L EACH ACCIDENT IE.LDISEASE - EAEMPLOYE $ 500,000 $ 500, 000 below E DISEASE - POLICY LIMIT DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, it more space is required) CERTIFICATE HOLDER VILLAGE OF MAAMI SHORES BUILDING & ZONING DEPT . 10050 N.E. 2ND AVENUE MIAMI SHORES, FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Frank Furman, Jr /TE L� �� . r r ) f •<- L - + -. - - �� . ACORD 25 (2009/09) INS025 (200909) ©1988 -2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD I %WRL CERTIFICATE OF LIABILITY INSURANCE PRODUCER Allstate Insurance Agency 3921 N. Federal Highway Pompano Beach, FL 33064 Phone (954)946 -9001 INSURED Emergency NC Services Inc. 3521 NW 8 Ave Pompano Beach, FL 33064 COVERAGES Fax (954)946 -9005 DATE (MM /DD/YY) 12/09/10 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 POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC'# INSURER A: MOUNT VERNON INSURER B: ALLSTATE INSURER C: INSURER D: } INSURER E: I INSURER F: THE POLICIES OF INSURANCE LISTED 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 AMYL LTR INSRD TYPE OF INSURANCE GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY 51 ❑ ❑ ❑ CLAIMS MADE ❑ OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: ❑ POLICY ❑ PROJECT ❑ LOC AUTOMOBILE LIABILITY ❑ ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON OWNED AUTOS GARAGE LIABILITY ❑ ❑ ANY AUTO EXCESS/UMBRELLA LIABILITY ❑ OCCUR ❑ CLAIMS MADE ❑ DEDUCTIBLE ❑ RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR / PARTNER / EXECUTIVE OFFICER / MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below OTHER POLICY NUMBER CL2360724B 1048920625 'POLICY EFFECTIVE POLICY EXPIRATION DATE (MM/DD/YY) DATE (MM /DD/YY) LIMITS EACH OCCURRENCE 12/10/10 12/10/11 PREMISES SES (a occurence) MED EXP (Any one person) PERSONAL & ADV INJURY 1,000,000 100,000 5,000 1,000,000 GENERAL AGGREGATE 2,000,000 PRODUCTS - COMP /OP AGG 2,000,000 COMBINED SINGLE LIMIT 10/27/10 10/27/11 (Ea accident) BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) AUTO ONLY - EA ACCIDENT OTHER THAN EA ACC AUTO ONLY: AGG EACH OCCURRENCE AGGREGATE [J WC STATU- L j OTH- TORY LIMITS ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS CERTIFICATE HOLDER VILLAGE OF MIAMI SHORES BUILDING & ZONING DEPT 10050 NE 2ND AVE MIAMI SHORES FL 33138 CANCELLATION 1,000,000 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED tisteiUE(AGENT # 60123 - BOOTH # 68E) LICENSE # W018228 ACORD 26 (2001/08) QF © ACORD CORPORATION 1988 Miami -Dade My Home My Home to idea •e. Show Me: Property Information Search By: Select Item • IN Text only Property Appraiser Tax Estimator 13 Property Appraiser Tax Comparison 1+ Portability S.O.H. Calculator Summanr Detalis: f oilo o.: 11- 2230 - 053 -0360 =11111 500 NE 105 ST C12 ,u, , - YMOND D LA COMBE W DORIS J �1I ='l1 = 1500 NE 105 ST MIAMI !r"”' fl1T MORES FL Value: "138 -2116 Property Information: Assessment Information: 2011 2010 =11111 •�;•MINIUMI- it nA. o �1I ='l1 = �.,, t- t:,, ,,, „a, ,,c,„u !r"”' fl1T $197 025 MIKEE Value: Value: Regional: of Size: , e= ii 1989 $50,000/ 'F17Ti R CLUB $147,025 LLAS CONDO City: LOpW1N[H1O7UI]S'EE C-12 v -: • • • '•ri mum 0 " "` $172,025 LERKS FILES c 143006 & 100201 Assessment Information: Exemptlan Intonation: ear. 2011 2010 i=mui --- :, iii, Fu - nA. o �1I ='l1 = �.,, t- t:,, ,,, „a, ,,c,„u !r"”' fl1T $197 025 MIKEE Exemptlan Intonation: ear. 2011 2010 025,000 $25,000 nd. Homo ead: 'i Q Taxable Value Information: Year 2011 2010 Applied APP6ed Taxing Auhmritr Taxable Tin/ Value: Value: Regional: $50,000/ $147,025 $50,000/ $144,114 $50,000/ $50,000/ $147,025 $144,114 City: $50,000/ $147,1 ,. $50,000/ 0144,114 School Board: 0 " "` $172,025 $25,x/ $169,114 Additional Information: Page 1 of 2 ACTIVE TOOL: SELE -CT t Q Q Aerial Photography - 2009 0 nant=t= 2006 My Home 'Property Information 1 Property Taxes 1 My Neighborhood 1 Property Appraiser ome l Using Our She 1 Phone Directory 1 Privacy 1 Disclaimer t If you experience technical difficulties with the Property Information application, or wish to send us your comments, questions or suggestions please email us at Webmaster. Web Site O 2002 Miami -ale County. All rights reserved. Legend /e Property Boundary N Selected Property eo eo El Street Highway Mani -Dade County water S http: / /gisims2. miamidade .gov /myhome /propmap.asp 8/31/2011 Miami -Dade My Home Page 2 of 2 Click here to see more information for this property: Community Development District Community Redevelopment Area Empowerment Zone Enturprivu Zone Zoning Land Use Urban Development Boundary Zoning Non -Ad Valorem Assessments Environmental Considerations http: / /gisims2.miamidade.gov /myhome /propmap.asp 8/31/2011 Family Owned Business Since 1971 EMERGENCY AC SERVICES, INC. Main Office Toll Free # 1 -800- 785 -6455 3521 NW 8th Ave. Pompano Beach, FL 33064 Broward: (954) 788 -8907 • License #CAC1813779, License #QB27471 BILL TO SERVICE ORDER INVOICE BK2003 PLEASE NOTE: FOR SERVICE AFTER WORKING HOURS CALL: 954 - 788 -8907 OR 1- 800 -785 -6455 NAMF RA YIIt 0 ALA A Coel .a- DESCRIPTION OF WORK PERFORMED sI. '0`1 E ( 05 _ 3i ,4Uc 1/ Pc- `-ro D ZI P �1 1 � �. ZIP CODE a ,r �",® -- C, imp L T 7T s) - [ ° HOME PHON WORK PHONE TFI;NNI( 'IAh / 413 COD CHARGE :Si ' l ,/� {/� c Rl� AlTr c_- 3-T• /3 s REECY✓� /�. 'fI c6 A. A/C WOR✓. TO BE PC nV..IRM " Pc, c, T \) /�► �/ �e,►� `�/) .y�� / Ain) yp /°! SYr-r --: VI ° i :'o Ain) d V --+`a f- /'V aa, QO q.� __. p Lcg�..�+pr, 1p C. cr, DR i 0,3 �!`5,ft CU.PACKAGE EQUIPMENT AHU , ,[3.-d 1 CCIL..///rrr, �r /tF.111eT,�"Tll'i , f A.Fk 5 NAME NAME MODEL MODEL �..Lei—rI 0'" 1 1,s� /q Apr.sp' 5 Y. A P4 AZ r /�)y� �� I SERIAI NUMBER SERIAL NUMBER LOCATION _ CUSTOMER HISTORY otv -71-1-E, fdT Cmius, Wc, N- cH&kG , k -2 m OFP'CE 3c,16 qg 1101)1 1%) cl 1 4L1 -In k PA e P) Y. f k ,I - OTT. MATERIALS & SERVICES UNIT PRICE AMOUNT —FT.../1 A PSI x j4 SF K (� t RECOMMENDATIONS / ESTIMATE - s� � .$ r ° J�-f+ 35 S C jf / REFRIGERANT RECOVERY ,_,R AL U ' ��. �� f' _,5 RECOVER AMOUNT LBS. CHARGE AMOUNT �, LBS. f 7 � .�' I� C.(,„ ENVIRONMENTAL LIMITED WARRANTY: AU materials, parts and equipment are warranted by the manufacturers' or suppliers' written warranty only. All labor performed by the above named company is warranted for 30 days or as otherwise indicated in writing. The above named company makes a e ttortechnicia s express o r implied, and its agent or techn�ians are not authorized to make any such warranties on behalf of above named company. TOTAL MATERIALS TOTAL LABOR TERMS: NOT RESPONSIBLE FOR WATER DAMAGE REBATE I 1 nave authority to order that Server retains tale not made as agreed, Seller resulting from said removal without any penalty or Pans Returned. ro^-�i the work to equipment can remove shall obligation. outlined above which has been satisfactorily completed.' agree /matenals furnished until final payment is made. N payment is said equipment/materials at Seller's expense. Any damage be the responsibility of Seller. You may cancel this transaction, within three business days from the above date. No Electrical A Or- I G" �� " `^ �0 DISCOUNT 0 REGULAR 0 WARRANTY TOTAL J ❑ SERVICE CONTRACT TAX INCLUDED �nk 9rpur _ .LY)tA NIL ER NATIruF DATE . We except Visa, Mastercard, Discover, American Express Members of the Better Business Bureau 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. p Job Address (where the work is being done): /s-2/0 ,04/ O® J/ City: Miami Shores Village County: Miami Dade Zip Code: 363436 ALL CONDENSING UNITS MUST BE ON A 4 INCH SOLID CONCRETE SLAB ALL UNITS MUST COMPLY WITH F.E.MA MINIMUM FLOOD ELEVATION A COPY OF THE CONTRACT IS REQUIRED WITH ALL SUBMITALS ARI (AHRI) DATA SHEET REQUIRED Change Disconnecting means: YES ❑ NO ARHI Sheet Attached: YES Er NO ❑ Contract Attached: YES UNIT BEING REPLACED DATA NEW UNIT �f,,,I y MANUFACTURER /FA" - a-/�A/ R ANA 12 l / AHU or PKG. UNIT MODEL # eek 6 44P. 7.. COND. UNIT MODEL # /?A//P i , rd 3 g AO / /6 KW HEAT /o 3 t NOM TONS AHU 'd6U ,),3 PKG 1) M.CA AHU ICU , .,PKG AHU eo CU q 'PKG 2) M.O.P AHU AoCU 5 PKG AHUAio CUA0 PKG 3) VOLTS AHU CU PKG PKG UNIT / / PKG UNIT / 1 dig.. 0 EERISEER ,,,..„ YES REPLACING DUCTS YES I NO REPLACING THERMOSTAT5�%% NO YES ( NEW 4°CONCRETE SLAB YES YES 40, NEW ROOF STAND YES YES • NEW RETURN PLENUM BOX YES , 0 1. Minimum Circuit Ampacity (Wire Size): ("). 2. Maximum Overcurrent Protection (Fuse/Breaker Size): ma 6 /4 3. Voltage of Circuit (2081240/480): 01®6710/41() ^ / — 0 4. Size Disconnecting Means: Contractor's Company Name: 11/1124d-A)4)1 AL le/m/1 Phone') 7 "8Pt 7 State Certificate or Registration N. C46/0/39)9 Certificate of Competency N. Date: ���� A . 1.1 .c:ERTI www, ayridirector' Certificate of Product atings AHRI Certified Reference Number 4525743 Date: 9/1/2011 Product: Split System: Air - Cooled Condensing Unit, Coil with Blower Outdoor Unit Model Number 13AJN36 Indoor Unit Model Number RBHP-21+RCHL-38A1 Manufacturer. RHEEM MANUFACTURING COMPANY Trade/Brand name: RHEEM 13AJN SERIES Manufacturer responsible for the rating of this system combination is RHEEM MANUFACTURING COMPANY Rated as follows in accordance with AHRI Standard 210/2402008 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): 36000 EER Rating (Cooling): 11.50 SEER Rating (Cooling): 14.00 *Ratings followed by an asterisk (`) Indicate a voluntary rerate of previously published data, unless accompanied wet a WAS, which Ind an hwoluntary rerate. DISCLAIMER AHRI does not endorsethe product(s) lamed al tide Certificate and makes no representations, warranties or guarantees as to, and assures no responsibility fax the produc (s) lamed on this Cam. AHRI expressly disdakns all liability for damages of any kind arising out of tie use or pertorman a of the product(s), or the unauthorized alteration of data fisted on tits Carte Certified rags are valid ady for models and confirmations Iced In the directory at www.ahridirectay.org. TERMS AND CONDITIONS mis Certificate and its contents are proprietary products of AHRI. This Certificate shall ody be used for ktdivletsl, pentane' and confidential reference pmposea. The contents of this Certificate may not, in whole or In part, be rep odrxed; copied; disseminate* entered Ma aconmuter database; or othavdse utilized, kr any foe or manner or by any means, ernceptforthe user's kalivWrsl, persona and confidential reference. CERTIFICATE VERIFICATION The infomratkm for themodelctedantl� ecanbeve rilledatvwyva.ahndirectory.org, Air - Conditioning, Heating, cUck a' "Verr� oer �" � � the AHRI Number � � d an ®® IK® and Refrigeration Institute width the certilIcate was issued, which Is listed above, and the CatMcate No., which Is listed below. 0201 1 Air- Conditioning, Heating, and Refrigeration Institute CERTIFICATE NO.: 129593519690806228 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. _ p Job Address (where the work is being done): /'Yad �4, /4 mss J, City: Miami Shores Village County: Miami Dade Zip Code: ,331-30 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 ErARHI Sheet Attached: YES Er NO ❑ Contract Attached: YES UNIT BEING REPLACED DATA NEW UNIT ,,t/'6;cw, MANUFACTURER ,,,(/ 1 de c ' 7 7 ) AHU or PKG. UNIT MODEL # p _a./.1 // R-4 f+ $d-.4 V, COND. UNIT MODEL # / And 36 AO / /(`j KW HEAT /0 3 t NOM TONS 3 AHU3 ICU ,),3 PKG 1) M.C.A AHU.SSCU , -PKG AHU 6'o CU? PKG 2) M.O.P AHU CCU 5.1rPKG AHU,Vo MAO PKG 3) VOLTS AHU CU PKG PKG UNIT / / PKG UNIT / / /.7- • 0 EERISEER if/ YES ira't5) REPLACING DUCTS YES NV REPLACING THERMOSTAT ("E5/ NO YES (111' NEW 4 °CONCRETE SLAB YES YES le NEW ROOF STAND YES YES • NEW RETURN PLENUM BOX YES 1. Minimum Circuit Ampacity (Wire Size): .4(/# S C,//f t.2-- 2. Maximum Overcurrent Protection (Fuse/Breaker Size): M/ 60 6R ,1 3. Voltage of Circuit (208/240/480): 020 /kV G ^ / 6 0 4. Size Disconnecting Means: Contractor's Company Name: fi�vee'2-4c Ly/ AG J 4."eGei Phone(2Je 2 —95147 State Certificate or Registration N. Csottati 3'7 9 Certificate of Competency N. Date: /// rtificate of Product Ratings AHRI Certified Reference Number: 4525743 Date: 9/1/2011 Product: Split System: Air - Cooled Condensing Unit, Coil with Blower Outdoor Unit Model Number: 13AJN36 Indoor Unit Model Number: RBHP -21 +RCHL -36A1 Manufacturer: RHEEM MANUFACTURING COMPANY Trade /Brand name: RHEEM 13AJN SERIES Manufacturer responsible for the rating of this system combination is RHEEM MANUFACTURING COMPANY 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): 36000 11.50 14.00 * 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 mpresentations, wanatgtes or guarantees as to, and esmhn es 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 perfannance of the product(s), or the unauthorized alteration of data listed on this Certficate. Certified ratings are valid only for models and configurations lid in the directory et www.ahridlrectory.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 Certificate may not, in whole or In part, be reproduced; copied; disseminated; entered Into a compuOcr database; cr otherwise utlllzed, in any form or manner or by any means, except for the user's individual, personal and confidential reference. CERTIFICATE VERIFICATION The Information fortre model cited on this certificate can be verified at www.ahridirectory+.org, click on "Verity Certificate" link and enter the AHRI Certified Reference Number and the data on which the certificate was issued, which Is listed above, and the Certificate No., which is listed below ® �®Air - Conditioning, Heating, and Refrigeration Institute ©2011 Air - Conditioning, Heating, and Refrigeration Institute CERTIFICATE NO.: 129593519690806228 4 DETAIL COMPLIES WITH FBC MECH. 301.12 AND FBC CHAPTER 16 1/2" " -1 -11/2 "WIDE STEEL STRAP 1 -1/2" STRAP VERTICAL SCREW SPACING PROVIDE 1 -1/2 "WIDE 16 GA GALV.STEEL STRAP (2) PER SIDE SECURE STRAP TO STAND WITH (2) 3/4" #10 SHEET METAL SCREWS WITH WASHERS NOTES: ROOF TOP STAND SHALL BE CAPABLE OF WITH STANDING 140 MPH /HR GUSTS FOR 3 SECONDS. r II CONDENSING UNIT SECURE STRAP TO UNIT WITH (2) 3/4" #10 SHEET METAL SCREWS WITH WASHERS EXISTING ROOF "Z-- MOUNTED CU STAND APPROVED PERMIT THRU BUILDING I PLANS. ROOF MOUNTED CONDENSER DETAIL rm CONSULTING 1 640 N.W. BCCA RATDN BLVD. BDCA RATON, FL 33432 TEL: (561) 391 -9292 FAX: (561) 391 -9898 CERTIFICATE OF AUTHORIZATION NO. 28107 HAROLD R. TUSSLER, P.E. LICENSE #19315 E-MAIL: INFO @FAECONSULTINO. COM PROJECT: