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MC-12-826Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 173305 Permit Number: MC -5 -12 -826 Scheduled Inspection Date: July 25, 2012 Inspector: Perez, JanPierre Owner: VILLOLDO, J PATRICK Job Address: 1146 NE 97 Street Miami Shores, FL 33138- Project: <NONE> Contractor: AMI AIR CONDITIONING Permit Type: Mechanical - Residential Inspection Type: Final Work Classification: A/C Replacement Phone Number Parcel Number 1132050170160 Phone: (954)966 -2380 Building Department Comments NC CHANGE OUT qz?? -7l ,z Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments July 24, 2012 For Inspections please call: (305)762 -4949 Page 7 of 40 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 5 ia,---1A INSPECTION'S PHONE NUMBER: (305) 762.4949 BULL Permit No. Master Permit No. MAYO B212 9 2512 Y: PERMIT APPLICATION FBC 20 Permit Type: MECHANICAL OWNER: Name (Fee Simple Titleholder) :37 F'A-rPacx vt AddressdatoKEIEET Phonelt: -711.G aCia 4-149D., City. HQ RIES State: L. Tenam/Lessee Name: none* JOB ADDRESS: Gay: Miami Shores County: Miam i Dade gaLlstg polio/PareeN: la 3(9.05 *- 0 VI -016n Is the Building Historically Designated: Yes NO Flood Zone.: Ali- .331 g • CONTRACTOR: Company Name: kr% 3- AIR erAN-wr-rrnt\trmt,, Phonett: qs-tt. - qWe;z93.36 Address: MnajdACZE,Libilji City: Mit. E. State: FL. zap: 33 1 Qualifier Name: b lAut..1_23v‹ . Phone#: C1'-14-• q 4-a3o State Certificatimi or Registration #: CAC- %I 4 °el S certificate of competepcy contact Phcae#: ciR-14 (0 Lt-ig egt) Email Address: —1-"01- ; Acitnt t-,c ory, DESIGNER: Arehitect/Eagineer: Phone* Value of Work for this Permit : $ 95-G(4.M Square/Linear Footage of Work: Type of Work °Address °Alteration ONew )(Repair/Replace ODemolition Description of Work: AC_ CA f-VNGEzar_____,_. • 114****************************** ******************************************** Submittal Fee $ Permit Fee $ • 2 W 1 CCF $ CO/CC $ I Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ Company's Name (if applicable) mpany's Address Site Zip ortgage Lender's Name (if applicable). o r .► 's �Cu° 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 with all applicable laws regulating construction and zoning. 0 "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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person . whose property is subject to attachment: Also, a certified copy of the recorded notice of commencement nuwt'be posted at the job site for the jtrst?inspectlon which occurs seven (7) days after the building permit is issued In the absence of such posted notice, the inspection not be ed and a reinspection fee will be charged Signature er or Agent j Contractor The fore. _ ent was acknowledged before me this , 7 The foregoing instrument was acknowledged before me this day of' //i �� %/,_ 201,2,bbl -f IL \JtL CYtO day of /MN ,20 by LTG�iJiSIlkLf6-4,i0(l„ who is ,,.1:., • , known to me or who has produced is personally Imowner known who has produced 4 i <_/ r!' As identification and who did take an oath. as identification and who did take an oath.. NOTARY PUBLIC: NOTARY PUBLIC: APPROVEDBY , 0-/9* JO %2ES February 20, 2014 1_007)W8-01 3 . FlondallotaryService.com **** *,k4#RM ** ****## #** ****!M#$#*#b#*4* +D# #t //V2ansExwiner Structural Review (Revised o naronRevised 0611 Xae ised 3/15 /09) 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 COND1TIb s1INGREPLACEMENT 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): OA A Co q 1 c, , I`.E T City: Miami Shores Village County: Miami Dade Zip Code: 3 31 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 i1 ARHI Sheet Attached: YES NO ❑ Contract Attached: YES UNIT BEING REPLACED DATA MAOInD MANUFACTURER NEW UNIT AHU or PKG. UNIT MODEL # COND. UNIT MODEL # KW HEAT NOM TONS 1 M.C.A .4 ;j - "es Vid1a AHLI5 U.30 PKG CU a PKG La PKG PKG UNIT ZON BLD 1. 2. 3. U[3J[ TAIT 1.1111. 11111=10111111.1, [ 0. M1111r /I/paj ING DUCTS ING THERMOSTAT N - SLAB �; � re /., agi s F STAND Et0 COMPLN AYPCO1INT1�?�- AND AFOULATIONVS Minimum Circuit Ampacity (Wire Size): O NEW - TURN PLENUM BOX Maximum Overcurrent Protection (Fuse/Breaker Size): Voltage of Circuit (208/240/480): 6140 4. Size Disconnecting Means: GO Contractor's Company Name: V. __ R (fir a -f-Tom N 6 Phone: (3'5(.4' State Certificate or R . istratio Signature (Qualifier's signature only) - Certificate of Competency N. Date: 5 l ja SKETCH OF SURVEY c/4. 7S' 12 ,/ se` 4...w=1-kAo-"T SMIE.t■ST tP-01-a / PA.P,KWA.Y 12; AL. Infoattd *473,417.67. ff 14 o ., ' 12..30 010-.172 81440*V1 czz 'ass. t...10. it Lta. e-.1" , Kt,,abaNC) 4*810t...1 P•V£ to • i 1r1 in 3 brA.I.B., r-u-• • 4, 3.*;i: • * cot-1C. •rt.O• F3hz•-812, •c•a%.„,ht.:a Tr, 41* Te-P2T7:: SCALE: 1" = CO' 22-7 -7q3?' PROPERTY ADDRESS //4t A/ '7- -.5. natsr r, Ai, i skioees,. FL. FLOG . SOURCE OF LEGAL DESORPTION: ,4 Z 0 t2..1.9e)z- .5 d.140,0 LI LEGAL DESCRIPTION LOT 5 ■ BLOCK /81 • SUBDIVISION "1/4fr1, `5,-1414'a•S --ve'a 7-/t9 kJ c9 • • ACCORDING TO THE PLAT THEREOF A$ RECORDED IN PLAT BOOK 4.-A AT PAGE -,../ • . OF THE PUBLIC RECORDS OF ..41406- , COUNTY, FLORIDA. • 4 / „..----- • % III • . 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PO 0 ••4012.01.41.1.0.11 Pl. .1.79012.11008011..0. P. ••••1111 sm.* PIP •,0.14/1.0..P. a. -.10.09831. PhD -sot.........0 FP -$0.0.11.114•1 Pop-Praull PT-Itr. ...mai.: a.. HWP,O¢Hastv 118•LOW33lP0001.0 .11-1AVI IA 81.1.00•148841.100. 10.9-1.11PSUREO ....11-14.11.041 .14,00.008E00001 US -14191.0010 . 8000 -.0.0400= 18*.10.10A110$ 010080 PI I S -POP tOSCOS Dila •••OtOCIal 01.0201100. 0•41.010108890 Ow -0.0111DoWates ,„,,, .00011.P888I0TI ph -loam. PC - Mona COMO= On r141 CO 002.0011.110.... perm: p,y 7. a.. RA -14/0151 Pit,r0011.610501.....018.0. 908 -PC.00P WOO. POO -1010010.04.08 .17 MU p ..wee. WOW. 000031 a- Wan. 808 -80838 P. -..0. IOC -.MOM PM -MVO. Par- P.O. Paw- ra0.1110.0.1 nu .1.1.10A0 1:1.0* SIP -1.11111119P1 S. -..SPCO R POM BO O1•P0O0I6 O. 1 111V-21...••• Polt.01111.43A M.. 1..1000 O -WOW ISVP -1000*0 t 413.004 4k 1263 -11*11 03-1.1.1 pro -.0001.s. %of ......oart. vm,..041P1.02' a -UPOP...... •••••-•••••••0000POP., VS .........:....1.0act.01•••01.1 .880 .!..Esx.rogranan (0•••• r• I NOT VALID UNLESS SEALED W1114 AN EMBOSSED SURVEYOR'S SEAL SCALE: 1" ••• /00' . t 19 RCMP/CERTIFY: That the attached boundary survey ol Ibo above dasodbad properly IS Imo an Tulo • aheal ot my loordadha and We as 100800y suroyed under my daw"en tat hate are o aroud oesacuntus wns shwn. oaammon ohbract oUna wl have o be road* o dalamins eeccoadinsinnnem1* if any. affecting Ula (nopeny• Loudon and uleoldbahon la Wafts au andfor adiaconl to ; the propady osua aul secured as such infOnnatIon mas not ouhaulded. °mesh* as subject ih pim,. Di hue, I This ouvay m00% the minima It:cannibal standard. as set WM try Mu Rai= goad al fholassonal Land I Somas in chapter 81317-8 Pladdn Adniubstniloa Coda. Pursuant to whoa 472.027 Florida Stalues. *---** P/I P _, p_o.n,tNA, „i„,, ,,,,,- ,..,-, ,.. •....., J1/911. OF FLORIDA rwrcr% ,...--,T--i..L.G- /9 ,•••••:"*. 4 • DATE: .z...-5 162 • T DAE: DATE: .___,..; DATE: I. NATIONAL 7801 CORAL WAY • SURVEY' SUITE 123 MIAMI, FL 33165 E PV P 0 ES„ finc. PH.(305)287.9018 FOR' 1/ZZO 41,9 0 ORDER NO 7-‘ 66 '?-1 7 . 22-7 -7q3?' Project Summary Entire House AMI Air Conditioning 3700 Hacienda Blvd STE D, Davie, FL 33314 Phone: 954- 968 -2380 License: CAC1814995 Job: Date: May 08, 2012 By: ect Information For Patrick and Tracie Vi loldo 1146 NE 97 Street, Miami, FL 33138 Notes: Carrier Infinity 2 stage high efficiency equipment esi m n Information Weather. Miami, FL, US Winter Design Conditions Outside db Inside db Design TD 51 °F 68 °F 18 °F Summer Design Conditions Outside db Inside db Design TD Daily range Relative humidity Moisture difference 90 °F 72 °F 18 °F L 50 % 63 gr/Ib Heating Summary Sensible Cooling Equipment Load Sizing Structure 16781 Btuh Structure 35744 Btuh Ducts 5437 Btuh Ducts 5455 Btuh Central vent (47 cfm) 913 Btuh Central vent (47 cfm) 960 Btuh Humidification 0 Btuh Blower 0 Btuh 0 Equipment load 23131 Bttuuh Use manufacturer's data n Rate /swing multiplier 0.95 Infiltration Equipment sensible load 40219 Btuh Method Simplified Latent Cooling Equipment Load Sizing Construction quality Average Fireplaces 0 Structure 6822 Btuh Ducts 1902 Btuh Heating Cooling Central vent (47 cfm) 2039 Btuh Area (ft2) 2224 2224 Equipment latent load 10763 Btuh Volume (ft3) 17792 17792 Air changes/hour 0.36 0.19 Equipment total Toad 50982 Btuh Equiv. AVF (cfm) 107 56 Req. total capacity at 0.70 SHR 4.8 ton Heating Equipment Summary Cooling Equipment Summary Make Make Carrier Trade Trade Infinity Model Cond 24ANB160A0030 AHRI ref non/a Coil FE4ANB006 AHRI ref no4647149 Efficiency 100 EFF Efficiency 13.1 EER, 16.7 SEER Heating input 0 Btuh Sensible cooling 41300 Btuh Heating output 23131 Btuh Latent cooling 17700 Btuh Temperature rise 11 °F Total cooling 59000 Btuh Actual air flow 1967 cfm Actual air flow 1967 cfm Air flow factor 0.089 cfm/Btuh Air flow factor 0.048 cfm /Btuh Static pressure 0 in H2O Static pressure 0 in H2O Space thermostat Load sensible heat ratio 0.80 Calculations approved by ACCA to meet all requirements of Manual J 8th Ed. +1+ wrightsofr Comfort Builder by Wrightsoft 12.0.04 RSU03888 J:1 EngineeringlLoad- Calcs\2012 \vuloldo.rup Calc = MJ8 Front Door faces: N 2012- May-08 13:44:27 Page 1 A & A SUPPLY CO., INC. 2000S.W. 71d 1ER A-1 FT. LAUDERDALE, FL. 33317 954 -473 -1172 ATTACHMENT OE AC TO CONCRETE PAD EXAMPLE OF TYPICAL A/C UNIT LESS 11-IAN 36V X x 36L INSTAL!. 4 CUPS PER UNIT. EXAMPLE OF LOCATIONS: TWO CUPS AT 80T1.1 SHORT SIDES. ONE CLIP AT EACH CORNER, ONE CUP EACH SIDE • ALL UNIT ON APPROVED CONCRETE Pgj� 1. UNITS LESS THAN 38' W x 36' L USE 4 ANC AE CUPS. SEE BELOW (ONE EACH CORNER, ONE EACH SIDE, OR TWO EACH AT SHORT SIDES) WITH (2) STAINLESS sTEEI. OR ZINC PLATED #12 TEK SCREWS INTO UNIT. AND (1) }4' x 1%, TAPCOH CONCRETE SCREW INTO CONCRETE PAD. 2, UNITS OVER 36" LONG IN ANY DIRECTION, USE TWO (2) ADDITIONAL CUPS ALONG BOTH LONG SIDES. TYPICAL CONCRETE PAD OR DECI< _4 TYPES dF ANGLE CUPS TO CHOOSE FROM 1• ANGLE CUPS 13 ' WIDE x 2' BASE x4.5" AND 5.5 LONG 2. GALVA1 n2EL.g_g0 16 GAG, ANGLE CLJPS:11¢" WIDE x 2' BASE x 4.5' AND 5.5' LONG 3. ALUMINUM( ANGLE CLIP 3b' x 1 %%" WIDE X 2' BASE x 5' LONG 4. ALUMINUM ANGLE CUP 3/8' x 3" WIDE x 3" SASE X 1.8" LONG CUP 2010. IN ACCORDANCE WITH EW ASSCE ACCORDANCE 1 WIND LOAD LLOOADD THE AND CURRENT IN SECTION 301.12 OF THE MECHANICAL CODE AND SECTION 1620 OF THE BUILDING CODE MILTON CUBAS, P. E., INC. CONSULTING ENGINEERS P.E. # 51902 C.A. #27267 Si. # 6999901 1302NE125ST NORTH MIAMI, FLORICK 33161 PHONE (305) 891 -4174 FAX (305) 891 -4175 wwar.miitoncub6spe com E MAIL: miltoncubas@msn.com msn.com 00 /TO 39Vd VII:77 SOSOO 1;Z =L0 ZtOZ /30 /00 irwl RTIFI E I � ll wws aliridtrectory, o 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: 4647149 Date: 5/4/2012 Product: Split System: Air - Cooled Condensing Unit, Coil with Blower Outdoor Unit Model Number: 24ANB160A**30 Indoor Unit Model Number: FE4ANB006 +UI Manufacturer: CARRIER AIR CONDITIONING Trade /Brand name: INFINITY 21 PURON AC Manufacturer responsible for the rating of this system combination is CARRIER AIR CONDITIONING 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): 59000 EER. Rating (Cooling);_. 13.10 SEER Rating (Cooling): 16.70 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 products) fisted 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 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.ahrkiirectory.org. TERMS AND CONDITIONS This Certificate and its contents are proprietary products of AHRI. 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 forth 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.ahrkdirectory.org, click on `Verify Certificate" fink 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. u�, Air-Conditioning, Heating, ■/ a' and Refrigeration Institute ©2012 Air - Conditioning, Heating, and Refrigeration Institute CERTIFICATE NO.: 129808166848474218 05 -03 -2012 8 :01 AM 12676956181 A.A'i.1. Quality Service Since 1970 A.M.' Air Conditioning Frozen $cold Corp. 3794 Hacienda Blvd Ste A Davie,19.33314 Our Estimate Re: A/C Quote Date: April 28, 2012 19549852645 Pg 1/1 Broward 964- 966 -2380 Dade 306- 625 -8332 Fax 954-985 -2645 To: Mr. & Mrs, VQiletde I 146 NE 97 Sheet Miami Shores, Florida 33138 Mr. & Mrs. Vigaldo, Homeowners Attn: Phone: 786202 -4492 Eme&IJEax: tracietv2Obellsauth.not we hereby propose to: rumen ihatall, and *rim the egWpmant and retorts% latae below with the with Ilw conditlens ell sPedliestkom set forth In tls proposal New Equipment System 1 Manufacturer Cond. unit Air Handler all Package unit n!a Thermostat Heat Strip Other Capacity Seer Piping N/E Condensate Warranties $7.674.00 Farrier Performance 2stagc 24AC13760A003 FV4CNBO06T00 n/a Carrier Edge ...... 10 kw n/a 59.5 MBTU 5 ton 17 modified new Labor Yr Parts Yr Compressor Yr 10 10 Sys Carrier Infinity 2 stage 24ANB160A003 FE4ANB006T00 n/a n/a Infinity Control 10 kw n/a 59.0 MB'l'U 5 ton 16.7 modified new 10 10 System 3 511,098,00 Carrier Infinity Qreenspeed 25VNA060A003 FE4AN13006T00 ti/a n/a infinity Control heat pump 10 kw backup n/a 56.0 MBTU 18 modified new 1 10 10 Electrical x Connect to existing circuits New Outside Disconnect New Breaker Ductwork x Connect to existing ductwork New supply grills New duct system Miscellaneous Items x Mechanical building permits x Provide new concrete slab x Provide sheet metal base Other items Total Price Fpi Rebate Carrier Rebate Net Payable Please install system # System l $7,674.00 -- $1,285.00 - $50.00 $6,339.00 System 2 $9,569:00 System 3 $11,098.00 - $I,005.00 - $1,330.00 - $1,000.00 - $1,200.00 $7,564.00 58,565,00 Net Dire $ Deposit $ Balance Due S Amen, Terms so% down balance due upon completion NOTer This estimate does not include any building code upgrades that may be required, All work must be done during normal business hours. By AMI; tennis Mullins This estimate is valid for 30 days General Conditions: I have authority to order the work as outlined above. It is agreed that the seller will retain title to any equipment or materials that may be furnished until final payment 9e made. In case the total charges are collected by suit or upon demand of an attorney, the purchaser heraby'agr ss, to pay reasonab omey's fees for the making of suet. collection. • Signature; Print l' '.J 1r:�.4 % 2(5C 1 \/I ton to Proceed =. %."Date. � c NOTICE OF COMMENCEMENT A RECORDED COPY MUST BE POSTED ON THE JOB.SITS AT TINE OF FIRST INSPECTION PERMIT NO. TAX FOLIO NO: 11 -3205- 017 -0160 STATE OF FLORIDA COUNTY OF MIAMI -DADE 111111111111111111111111111111111111111111W CF H 2012RO:32921,3 .OR Bk 28104 Ps 0401E tips) RECORDED '05!09/2012 10:49:23 HARVEY MIN, CLERK OF COURT NIAIII -DADS COUNTY? FLORIDA LAST PAGE nc vwvrrwnal9cv - =.r • • . yi •. -r wel maa certain real property, and In accordance with Chapter 713, Fierida Statutes, the following information is provided in this Notice of Commencement I. Legal description of property and street address: 2. General description of improvement: 5-663 42 PB 43-51 REV PL MIAMI'SHORES SEC 8 LOT3 BLK 181 1146 NE 97 STREET MIAMI SHORES, FL. 33138 AC CHANGEOUT ' 3.•Owner(s) name and address: J. PATRICK VILLOLDO 1146 NE 97 STREET MIAMI SHORES, FL. 33138 Interest In property ' Name and address of fee simple titleholder (if other than owner) - 4. Contracto's name, address, and phase numbei- MI AIR CONDITIONING 3700 HACIENDA BLVD. #D : 954- 966 -2380 • DAVIE,FL. 33314 5. Surety: (Payment bond required by owner from contractor. if any) - - Name andaddress: Amount of bond $ - 6. Lender's name, address, and phone number: 7. Persons within the State of Florida designated by Owner upon whom notices or other documants may be served as provided by Section 7 313(1)(a)7,FlorldaStawtes: Name, address, and ptionenumber. • 8. In addition to himself or herself, Owner designates the following persons) to receive a copy of the Uenor's Notice as provided.hi Section 713.I3(I)(b), Florida Statute= - - Name, address, and phone number: . 9. Expiration date (Atha Notice of'Commencenent (the expiration date is I year from the date of recording unless a different date is .. specified): - NOVEMBER, 152012 WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 711, PART I, SECTION 713.13, FLORIDA STA TES,.AND CAN RESULT IN YOUR PAYING TWICE TOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE . F C ENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPE D TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFO a O, ;yy • �; I OR RECORDING YOUR NOTICE OF COMMENCEMENT. Name e foregoes instrument was admowledged before the this :S • I day of coo f7 -%'f2, 44 14,61,00as er Signat.ory's TitlelOffice - M ,lo /Z.� (type c uthority, e.g. officer, trustee, attorney in fact) for (name of on behalf of whom uutrument was executed). Identi icadon g Type of Identification Prodtmed. G DA • i(t t.. Print, Type; or Stamp ' , H•E • Roo�jCommissioned Name ,.co,.cnj of Notary Public �� . 12. za A . i declare that 1 have read the foregoing and that the facts mated in it are truezo best of i}7'knewIe g $td belief. 994 . g dIo , +p" ��,. •' - ��� #11411 111th O Notary Public =State of ingiViove urn Over for Insrt ctlois STATE OF FLORIDA, COUNT OF DADE I HEREBY CERTIFY that this rs a true copy of the •ayo , A D 20 hand and Official Si. ea IN, CLERK, of Circuit and County Courts D.C. Miami Shores Viiiage Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION FORM ALL CONTRACTORS MUST PROVIDE COPIES OF LICENCES AND INSURANCES EACH TIME A PERMIT IS SUBMITTED OR THE VILLAGE MAY MAINTAIN A FILE WITH YOUR INFORMATION FOR A $30.00 FEE PER YEAR. IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. COPY OF QUALIFIER'S STATE LIC CARD B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF LIABILITY INSURANCE (CERTIFICATE HOLDER TO BE MIAMI SHORES VILLAGE BLDG DEPT) D. COPY OF WORKERS COMPENSATION (EITHER CERTIFICATE OR EXCEMPTION) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER B. COPY OF MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT C. COPY OF LIABILITY INSURACE (CERTIFICATE HOLDER MUST BE MIAMI SHORES VILLAGE BLDG DEPT) D. COPY OF WORKER COMP INSURANCE (EITHER CERTIFICATE OR EXEMPTION) YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE HOLDER AS FOLLOW: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 COMPLETE CONTRACTOR'S INFORMATION BUSINESS NAME: MI. AzS Cc�NDrt -Fz ®tarkt (� BUSINESS ADDRESS: 3I DO )-} AC.r_E MCITY b RV� STATE 1 L. ZIP CODE .(- S ' BUSINESS PHONE: ( 954 RAO-c 3eig 0 FAX NUMBER (7 ) 9 8S- caCoi -tc CELL PHONE ( 6154) 1410- QUALIFIER'S NAME: DE J 1 S h u t_I�NS QUALIFIER'S LIC NUMBER: CA C.. \ S'-} q ctc E -MAIL ADDRESS (IF APPLICABLE): Created on 3119109 BY MLDV 1 RV 3126109 MLDV OP ID: J9 d %WKLY `,r._- CERTIFICATE OF LIABILITY INSURANCE DATE {MNwD/YYYY) 05/07/12 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 pollcy(les) 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 954- 776 -2222 Brown & Brown of Florida, Inc. 1201 W Cypress Creek Rd # 130 954-776-4446 P.O. Box 5727 Ft. Lauderdale, FL 33310 -5727 Scott H. Buser, CRIS CONTACT E` INC. No. Ext): FAX No): E -MAIL ADDRESS: PRODUCER AMIAI -1 CUSTOMER ID #: INSURER(S) AFFORDING COVERAGE NAIC # INSURED AMI A/C & Refrigeration - dba Frozen Solid Corp 3700 Hacienda Blvd, Ste D &E Davie, FL 33314 INSURER A:Old Dominion Ins. Co. 40231 INSURER B :American States Insurance Co+ 19704 INSURER c : Bridgefield Employers Ins. Co+ 10701 INSURER D : $ 1,000,000 INSURER E : DAMAGE rED PREMISES (TO Ea REN occurrence) INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POUCIES 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 POUCIES 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 ADDL INSR SUBR WVD POUCY NUMBER POLICY EFF (MM/DDIYYYY) POUCY EXP (MMIDD/YYYY) UMnS A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY OCCUR MPG76188 01/03/12 01/03/13 EACH OCCURRENCE $ 1,000,000 X DAMAGE rED PREMISES (TO Ea REN occurrence) $ 500,000 � CLAIMS -MADE X MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEL —1 AGGREGATE UMIT POUCY n Er- APPUES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 LOC $ B AUTOMOBILE UABILnY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS 01C12989023 01/03/12 01/03/13 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ X X $ UMBRELLA UAB EXCESS UAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DEDUCTIBLE RETENTION $ $ $ C WORKERS COMPENSATION AND EMPLOYERS' LU BILITY ANY PROPRIETOR /PARTNER/EXECl1TIVEY OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yyeess describe under DESCRIPTION OF OPERATIONS /N N / A 83035893 02/01/12 02/01/13 X WC STATU X OTH- TORY LIMITS ER EL. EACH ACCIDENT $ 1,000,000 E.L DISEASE - EA EMPLOYEE $ 1,000,000 below E.L DISEASE - POUCY UMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule If more space Is required) CERTIFICATE HOLDER CANCELLATIO MIAMISH Miami Shores Village Attn: Building Dept. 10050 NE 2nd Avenue Miami Shores, FL 33138 I 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 y 1/ 4f-44.2,4 ACORD 25 (2009/09) © 1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD DATE BATCH Arw 580625 -3 suTEN ECutlo W INN ONING DOING BUS IN DADE CO FIRST -CLASS U.S. POSTAGE PAID MIAMI, FL PERMIT NO. 231 THIS IS NOT A BILL - DO NOT PAY RENEWAL 605404 -3 ° bZEN SOLID CORP 1T9 %PI 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 CMES. NOR DOES. IT EXEMPT THE HOLDER FROM ANY OTHER PERMIT OR LICENSE REQUIRED BY LAW. THIS IS NOT A CEFMFICATION OF THE HOLDER'S QUALIFICA- TIONS. STATECCIKCN1 %14995 MECHANICAL CONTRACTOR WORKER /S 1 DO NOT FORWARD AMI AIR CONDITIONING DENNIS T MULLINS PRES 3700 HACIENDA BLVD SUITE D DAVIE FL 33314 PAYMENT RECEIVED MUUN -DADS COUNTY TAX . COLLECTOR: 07/19/2011; 60050000372 000075.00 SEE OTHER SIDE