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MC-13-833V_ Inspection Worksheet Miami,Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-197632 Permit Number: MC-4-13-833 Scheduled Inspection Date: August 22,2013 Permit Type: Mechanical - Residential Inspector: Perez,JanPlerre Inspection Type: Final Owner: JOSHUA WALLACK, DAVID WALLACK Work Classification: A/C Replacement Job Address:254 NE 101 Street Miami Shores, FL Phone Number Parcel Number 1132060134620 Project: <NONE> Contractor: 32 DEGREES SERVICES INC Phone: (305)625-3232 Building Department Comments REPLACE EXISTING MINI SPLIT Infractio Passed Comments INSPECTOR COMMENTS False v l Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-189781. REALTOR-ROBERT BOURNE 786-289-8376 ***CALL CONTRACTOR BEFORE GOING..... JORGE 305-915-1432 Failed ❑ NO ACCESS. JPP 8/19/13 Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. August 21,2013 For Inspections please call: (305)762-4949 Page 26 of 38 ow Miami Shores Village Buildin g Department artment APR 2 20'3 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 No.ry) (3--a J PERMIT APPLICATION Molter Permit No. FBC 20 LO Permit Type:MECHANICAL OWNER:Name(Fee Simple Titleholder): OJ 0� � �� Phone#• ZS.� T4 Z6"� Address: a City: f ! �l�° State: .�� � zip; Tenantl-e§see Name: 3 r Phone#: Email: JOB ADDRESS: , D City: Miami Shores P�County: Miami Dade Zip:C3•3/01p Folio/Parcel#: �4` 46�� Is the Building Historically Designated:Yes NO Flood Zone: CONTRACTOR:Company Name: � � �� �� ,� Phone#: Address: I 1 City: o Mate: Qualifier Name: �° '� Phone#:_ State Certification or Registration#: !r 110 Certificate of Competency#: Contact Phone#: CO- Address: gje g d1c C C.) 7 OF DESIGNER:Architect/Engineer: Phone#. Value of Work for this Permit:$cg. "d/ SquarelLlnear Footage of Work: Type of Work: OAddress OAlteration ONew air place ODemolition Description of Work: Submittal Fee Permit Fee$ 1 DO , CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Bond$ Notary$ T nduing/Educ ation Fee$ Technology Fee$ Double Fee$ Structural Review$ r TOTAL FEE NOW DUE$ r 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,PLyMBING,SIGNS, WELLS,POOLS,FURNACES,BOII ERS,HEATERS,TANKS and AIR CONDITIOktkS,LTrC..... 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$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be,delivered to the,person whose property is subject to attachment Also, a certified copy of the recorded notice of c mmencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issue In the a e of such posted notice, the inspection will not be approved and a reinspection fee will be charged Signature Sign Owner or Agent Contractor The foregoing instrument was acknowledged before nme this The foregoin instrument was acknowledged before me this day of�,20 a by :l 00'-- �c�tdl� day of 20 J3 by who i y known me or who has produced who iqjEjrsonally kno to me or who bas prodgced,_,,,_ As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: NOTARY UBLIC: Sign: Sign: Print: Z Print 1s My Co -=o4rR �AYRA l'EREZ My ;+�y+' AYRA PEREZ My COMMISSION#DD920218 r MY COMMISSION#DD920218 EXPIRES August 26,2013 ,g 1.1 ogqee'� EXPIR ES August 26,2013 Rkd&BeA+k (4159 t o12Nofe SS*,IRS I M k+6� �k+k k�A�#kd`+I`8k9�+6#f148B8di k$� k98+k +k tB�Rp APPROVED BY Pis Examiner Zoning Structural Review Clerk (Revised 07/10/07)(Revised 06/1=009)(Revised 3/15/09) Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel:(305) 795 2204 AIR CONDITIONING REPLACEMENT DATA Fax:(305) 756.8972 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): >�73'Y ee City: Miami Shores Village County: Miami Dade Zip Code: c2�349F 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[2r ARHI Sheet Attached:YES❑ NO❑ Contract Attached:YES ❑ UNIT BEING REPLACED DATA NEW UNIT MANUFACTURER eovrh AHU or PKG.UNIT MODEL# / )��7 � COND.UNIT MODEL# KW HEAT NOM TONS 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 CU PKG PKG UNIT / t PKG UNIT / EERISEER YES REPLACING DUCTS YES YES REPLACING THERMOSTAT YES YES NEW 4°CONCRETE SLAB YES YES NEW ROOF STAND YES 0 YES NEW RETURN PLENUM BOX YES 1. Minimum Circuit Am ac fiY(Wire Size): oe 2. Maximum Overcurrent Protection(Fuse/Breaker Size): /Se im-a� 3. Voltage of Circuit(208/140/480): 4. Size Disconnecting Means: Contractor's Comp Name: .� Phone: State Certificate or R is Certificate of Competency N. .! Signatur Date: (auaUws signature only) y Ice rt�'']] IBe ` affEvseffa V 19431NW 59 PLACE MIAMI FL 33015 �'fflC@ 305 625-3232 Fax ( 305 ) 625-3231 Air Conditioning Refrigeration•Ice Machines FPL E-mail 32service @gmaii.com Installation'Service Contract`Warranty PARTICIPATING STATE CONTRACTOR CACIS15180 INDEPENDENT Date 4/12/2013 CONTRACTOR Work To Be Performed At: Proposal NAME Josh Wallack ADDRESS 254 NE 101 St CITY,STATE CITY,STATE Miami , FI CELL NO. PHONE NO. E-MAIL itwCa7man O MR OPTS FREON I BRAND COND. UNIT AIR HANDLER M# S.E.E.R JEATER TONS ARI# A Mitsubishi Mini muygenl2na msygenl2na8 20.5 hp 1 3575943 B R-410 1 Air con C Air con A1864c4m12 a18m4c4m12 17 hp 1 INSTALLATION OF EQUIPMENT YES DRAIN SAFETY SWITCH PERMIT FEE(S)&PLANS REQUIRED EXTRA AUXILLARY DRAIN PAN NO REFRIGERATION PIPE SIZE S 1/2 WITH L._318 YES ELECTRICAL POWER WHIP YES FREON FILTERS YES ELECTRICAL CONNECTION TO EXISTING YES CONCRETE SLAB yes GRILLS( ) RETURN( ) AIR HANDLER SUPPORTS y AIR FILTER YES THERMOSTAT-ENERGY STAR- SERVICE PROGAM TWICE A YEAR ELECTRICAL WIRING CONTROL YES BOOSTER CONDENSATION PUMP NO AUL CONDENSER STAND DRAIN PIPING YES ti r„ E OF LABOR WARRANTY-( ONE(I)YEAR )FROM THE DATE OF INSTALLATION,IT ONLY INCLUDES installation of new mini unit over the Closet doors EQUIPMENT AND MATERIALS PROVIDED WITH INSTALLATION.32DEGREES SERVICES WILL NOT BE Condenser In existing location RESPONSIBLE FOR SYSTEM DESIGN OR ITS PERFORMANCE IN MAINTAINING DESIGN CONDITIONS EXCEPT THROUGH FAILURE OF EQUIPMENT COVERED HEREIR.BUILDING AIR QUALITY IS s6LEY IS Removal of old unit and sealing of ceiling by other RESPONSIBILITY OF CUSTOMER.32 DEGREES SERVICES WILL NOT BE LIABLE FOR ANY DAMAGES 0 ice.,,,,, CAUSED BY OBSOLESCENCE OR ACT OF GOD,DAMAGE CAUSED BY ACCIDENT,MISAPPLICATION. PART WARRANTY(YRS) 5 1 ASUSEALLTERATiON,TAMPERING OR SERVICE BY SOMEONE OTHER THAN 32 DEGREES SERVICES COMPRESSOR WARRANTY(YRS) 5 1 LABOR MONDAY-FRIDAY SAM TO 5 PM ".� ' 7,.JoshWalladt-041213 t TAB ' OPT QUOTE FPL REBATE T ,,; 1.T.... . ... A $ 2,780.00 $ 180.00 $ 2,600.00 B C $ 2,260.00 $ 160.001 $ 2,100.00 Any a orations or deviations from above specifications involving extra cost <.. , will be executed only upon written order,and will become an extra charge over and above the proposal. PERMIT FEES(extra)$ 400.00 LOAD CALULATION EXTRA 9 E Terms Investment All materials is guaranteed to be as specified, and the above work to be performed in accordance with the drawing and specifications submitted for above work and completed in a substantials workmanlike manner for the sum of- uollars with payment to be as follows BY 10R0CADORM NOTE-This proposal may be withdrawn by us if not accepted within_20_days .��,�;«�✓F if ':. �ir y •` 6 F yr% A � The above price,specifications and conditions are satisfactory and are hereby accepted.You are authorized to do the work as specified.Payment Will be made as outline above. OPTION PLEASE PRINT DATE SIGNATURE 04/15/2013 MON 9151 VAX 0001/006 Submittal Sheet ubn iIW fbip C]Approval ❑Record Job Name: Jz5olww � �. Date: Contracto f • Location: Engineer: Tag: 17-22 SEER SUver Serks DC Inverter Indoor Units: AI7EM4C4MO9 Outdoor Unitas: A17CI4C4MO9 18EM4C4M12 �18CI4C4M12 Al A19GI4C4M18 A22EM4C4M24 A22CI4C4M24 Notes: qa)• .V!i6•]S.•igdli...9.s.9 ....Fld..................................................................................................................12060.6.6 .......... � .� . .:^•:iii t ;1�1s Gt��;,m?�'�'�' .•1 � 17�- 22 Ii�r Mini Split� F • ph-Y,A4 7"�Q.230V�60H4 l 71�770V^ d011a 2�O.Z34V^•�lz �4� Rht& 9000 12000 18098 2m w 920 1100 1730 cs� e�mt A 3.7 1,4.5 8.0(I -10.2) 99 A- S)3�t AMA 17 ze 17 22 idk 1A 1.2 1.5 2.8 1A1 1900 1990 2909 3200 WFk 1. AuIrILaO CFM 2Bl.SR35.4►206 3708r2943r264.9 429.7198261129.6 647.4!618!529.7 Nmwtwd d 371MI 39lifi/i9 43140/37 4914942 14 28x7.7s9A 3LIz7.7s10.4 36.2z89a11S 42.919.0x13 (Nrm m Wz101z13A 34.4a112xI4.9 4CzIIAzi4J 439:1731128 lhb(Jtoa 169 MY193 19.B1M.2 25. 13 34.1145.1 OM.,Wz w CFM 9712 1019.4 MO 1589 Qdduwmiaelael 55 55 se 36 111 in 27.6X9.31 .1 30.7roexall 29.9111.2123.2 33.3z13207A Oewbaunk ( Dqo in 32,1z128z22.e 35.8z13.21228 349g,Ift 25A R115AR20.7 %YAM FA 550.4 69 818.5 BL4B9.1 OMIMA tyF 161 8410AtIM UM Ram urn A1s R410Al2 Fx PAIDAta8 ffia OWFUM -PA 6=17 609Y?17 699/Z17 40110oft MMOVA WMIC0.530wimm 2? 33 19M 114'I w") W"ImIsAomim 63.6 63.8 92 ON et di8�me®lstt•1 S 26.2 26.2 322 32.e OF 6346 69.86 63-86 Am6�n11rmp(aoauuBmSyl °F 64-1'2 64-122 64.122 I 6122 Eduardo O.Rader Cr.me)32328-34113 �•�® TerAOrYS Pax(Na)M4418 hm Intertek S O NW I SW MS FOkt Laudendeb,FL SM FFDA/KIN eduerdo.�dse49ahoonPraam vv�ua-Bltop�ancaom P W N O r w rK O x �o r htl 9 Yh-VAS 1Pb,2�- t'4 6�Fa lid 320-230V 6Mi 1&220••ZY6Vd IPA.22D-M—M Camay Bti 99©0 12008 189110 24M 820 1104 1750 Rated maeat A 33 5.0 9s sm Btww.h 17 i8 17 22 mdstmRmmd L& 1.0 12 La 16 km w 1960 1940 29M 3204 csQmt A 8.5 83 13.0 145 !i•ftr(tci+E Ao) CFM 2825MSAW 379.VM-V263k9 429:7139l.6t3 A 647.414181 197 %UMLarel A) dw 37..501 3W36M 43dVW 41z1 a;. it 281?.1x9.8 31.1x7.7aiO4 362a89si15 42300113 b&wma Padft MM in 31.ixi0.6a134 34.41lUil4l 44x11<6ai43 459a17.SKIU e4ccamwv * bs 1b5lls 148'142 253/319 341453 Od&wakfbw c2:m 973.2 1089.4 WO 1389 .. alewd am 53 33 S8 in 375x93x213 30.7x9$x213 299x11?x232 933zMx27A in 3atg12.8x223 35.8a132x22A 349a14a25-4 38x13.$s291 in 43.BW 81.41 1 9626036 tppe 1hs $410AJ133 Bps 1L419A M l s > OULIN R410At2.6 ms Dodo page psi 609217 40917 609237 X17 ssle j cm site mm 1 X433 "1318'} ep633 182? 1J 3": 1Z3 0933 19M 3J8'} Rdd-*M&l him nftmdp111e loon 8 6i fi 65.6 82 hfir dffinocemlmd R 262 36? 328 328 t PpwftTeol - i OF 43-86 43-616 43-26 6346 ►ieodlsg�lY} OF 64-122 63-M 63-M d1-122 , a 0 N • 4 p OY F ..................................................................................................................�0 G'J 7'0 0 5.......... Indoor Unit:Dimension f. 1 - Dinia"ons W D Unit A17EM4C4M09 710 250 195 A18EM4C4M12 790 265 195 A17EM4C4M18 920 292 225 A22�1VI4C41VI24 1080 330 228 04/15/2013 14ON 9152 FAX goo 04/008 Outdoor Unit:Dimensions LA i L1 Dimensions W t-1 D Ll L2 L3 Unit A17MA4C4MO9 00 535 - 335 . 459 250 535 A1SEM4C4M12 780 540 250 549 250 540 A17EM4C4M18 760 590 285 530 315 590 A22EM4C4M24 845 695 335 560 335 695 ...................................................................................................................... .......... 04/15JiGi� i�6ri"'9's�Z""FAx 445/006 A 1 ti r to 'N' JY:' 7: 'I t•'Y High of Mcy WO Saving: DC kwerter adopts an advanced control method allowing power to adW In wide wM. The system stars up trot law speed to hlgh speed ditft tly,reaching the desist t emperahffe rapidly and mahteMg operation under a MUMMed enerff Ming speed. . ,C�•a-Frlendty.5up�r� System opera with ea ftbl aware m refrtgermnt R-410k.hexing prat our fiqk envtrwmwL Active Crbon Mar Our units have an acdvo varbon filar,which gmstty reduces the amount of dust,pollen,and other particles in your room. jbbgftn KitIncludad: Comply sly eopped with 15 feet of copper tubfeg and kwul®iton fbr%ft and nos convenient Inollation. warranty Coverogec Our*Mw is supported with a 5 year hard warranty on the compressor and 1 year warranty on all eel parr Coal Units: These units art M Veffled,guaranteeing their dRdeM rating. D signStar Load Calculation Result are intended for use with fern heating and cooling systerns 0 .n £ a< r latitude, Lo iIu.-d : 25.77910, +80:19780 Hate Sq p e.fo t ge; - 285 q ew+n.N-4••w•••- •w^:•e^NN+..:•W-• •M^v wC* m�F.v^wr v� •v�+'r•wwj .a.s.v+rw+ww.w.w�w•.^nrv..�+4r✓w.+n% ..•YU.+.....^^ :iw+.�amrv+rv+M.•w^yrran hu .•M'"M^ wtin•�m'S•.^ $.M yF dar es joshb Wal ack ........�r-.n.rn..—..�.me—..•w^�•� ..w�...rMvW�w• .....�...�:�.•--m'm•mm'-�'.^r•.rM'^r—rA—r�•n w-n.«en..:.:. +r^+n^ nrr one, 78�-24 x»2621 ...«.w....-.w. ..w..a.u..w wa.0 u+...•+..aw.w.w......wu..w.....uuw uv„uuaau wuuu'uavunYafi�.ww. Email: SH R .75 Number f esi ents Ceiling height 9 Wa1 -v o vii ti t 09 Floor U-value l R-value 0.215 Cii � v i vie. ,05 ; Window U-value 1 WI �F 185 F. Moisture grains 5 Duct gain % 10 os Heating infiltration (ACH) 0.8 Wiry_ vlat oh Summer ventilation 0 �`. 6 a ruu .z € a E a� E.a, ,€ x r �Y r "w7s�av,w>� -xg' �r 4651 Nn x\ 3 ' ;..nwr P 3 it ts' S ,X, �}..s`7(C''$ �hd ��• t 3 ��� d -„&'``� k�';. € x� t E` Rl a. 4 � b ' ' v,G..,..,.:.>w:..tivw,a „«wa w.s;wwry 6w ur»ws.` 'cs,zw,wj �fyj� �'' ✓�- - jad : ' X09.1 >3 ' Y X w ' +rTt 8 4 h: «+++..+.+a..n�....>r.' ...f.:LiuE»YY.tw.,m.��tw.i «..�.,..-�-�-...enFfxu.n....,.,.... •:• Cool i ng Loads 11.540 BTU/hr Sensible Infiltration !j Internal Ceiling Mme-System Efficiency Windows Latent Infiltration Latent People Load Wall Sensible People Load AED Graph 7500 .......................... --............................................................................._............._..._.................._........................ ...................._._........................................................................................................... 5000 ..................................................................................................................._.__..............._.................................. _..........__.. ....._.............._....._....... ._. V 0 3 2500 .........................................................._. ......... - ......-_.......................................-.._._._.._...-....-................................................_ ..............---.........—...... — ...._....._..—........._......-....................._......._...........-........... 0 ......._. .................................................. .............. ....._....... ..........._... _. ... 8am 9am 10am 11am 12pm 1pm 2pm 3pm 4prn 5pm 6pm 7pm 8pm --Hourly Loads --Average System equipment selection will be made using the tollotaing derived values. Glass (E) sq. ft.. Glass (N) sq. fit. Glass (VV} 30 sq. fi" " Summer Outdoor 90°F Summer t et Bulb 77'F Summer Indoor 75°F St�rir9ir Ielgrt Gras 50° ---------- ._.�..,._.. Minter Outdoor 50®F W( tr indoor 74f Sensible Cooling 9,449 Btuh Latr�t coC ,g � s Bah Required Cooling Airflow 430 CFM Seible K 0 � Required:Heating Airflow 130 CFM All calcuiations are,based taperer appp oveO hvac lndttstr r st nd rds:ancl;prareedt es aid ecrmply with alb 1pcal, sfiatrtd federat coife.requirerrnents'AI[computdd results are 5stimates.Product.' raduet prc�atltted by j+'dsign Systems,and idea Trey Outdoor Heating Cooling Dula (I ) Daily range L Relative humidity SOW Moisture difference 58 Indoor Heating Cooling Indoor t6rn' perature (IF) 0 75 Design temperature difference(OF) 20 15 Area Stuh % of load aI;I 975 ' 9 . Floor 5800 C-elij 2 . Windows 1320 13.2 lnfil °ation :System Efficiency Liss 910 9.1 cs l m 0007 Heating Loads 10,007 BTU/hr Ceiling Infiltration System Efficiency Los Wall Floor i RIM', a Windows x r , � spy x Miami shores Village 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 wo' B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF LIABILITY INSURANCE(CERTIFICATE HOLDER TO BE MIAMI SHORES VILLAGE BLDG Dgmpoor D. COPY OF WORKERS COMPENSATION(EITHER CERTIFICATE OR EXCEMPTION)v 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 EXEMPTIONI 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: 32 Degrees Services, Inc. BUSINESS ADDRESS: 1 9431 NW 59th PI CITY Miami STATE FI ZIP CODE 33015 BUSINESS PHONE: 3( 05 625-3232 FAX NUMBER 3(05 625-3231 CELL PHONE 3( 05 ) 915-1432 QUALIFIER'S NAME: Jorge Calderin QUALIFIER'S LIC NUMBER: CAC1815180 E-MAIL ADDRESS(IF APPLICABLE): 32service@gmail.com Created on 3190 SY MM 1 RV 3!28!09 IMLDV JEFF ATWATER 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:, 3/11/2013 EXPIRATION DATE: 3/11/2015 PERSON: CALDERIN JORGE FEIN: 141963531 . BUSINESS NAME AND ADDRESS: JMT REFRIGERATION SERVICES INC 19431 NW 59TH PL MIAMI FL 33015 SCOPES OF BUSINESS OR TRADE: HEATING,VENTILATION, AIR-COND Pursuant to Chapter 440.05(14),F.S.,an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section may not recover benefits or compensation under this chapter.Pursuant to Chapter 440.05(12),F.S.,Certificates.of election to be exempt...apply only within the scope of the business or trade fisted 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 election to be exempt shall be 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 certificate no longer meets the requirements of this section for issuance of a certificate.The department shall revoke a certificate at any time for failure of the person named on the certificate to most the requirements of this section. DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 07-12 QUESTIONS?(850)413-1609 • .„ _..,. 4 ff 3. 'fit i- �4aYS>� r b yr Y •� .{ ,: •*o y�}-<.,1/i k+.y F S; '1. r k < s`` r r / a F! ZJ T. 1 yy x t ,p. F i `•` .". j v Ada +ems N�.'7F. ry . �q vi / ���"•�6'— Dom° 'A !'` Aqi Y r� tS r� -� a 3 n R�• '�<x_ �. t a.5• 4 - ?,: NA d I [ q��� ��. Y i= ���e•j DRS Y AS';R EOUtRE A FIRST-CLASS U.S.POSTAGE PAID MAK FL PERON 231 ���r qq'��n�33�� THIS IS NOT A BILL—DO NOT PAY BUM M4 /LOCATION RECIRT lg�NEWAL 32 DEGREES SERVICES 616529-4 19431 NW 59 PL STATER CAC1815180 33015 UNIN DADE COUNTY OWNER ft,JW&jf RATION SERVICES INC WORKER/S - IRAL MECHANICAL CONTRACTOR 1 omI= �rm MW UM ,r a COMM � m DO NOT FORWARD Dose R ear THE HOLDBI PERW on ItIMISOM BY NOT A cATro�Cw TIM HOLDING TIOUL aiAURCA- 32 DEGREES SERVICES JORGE CALDERIN PRES PAY111W FMCBM 19431 NW 59 PL- couN„rTAx MIAMI FL 33015 ¢ i 09/06/2012 60050000146 SEE OTH R SIDE 111 lips dt+lis I sit sill ii13+j11Jf1+dloho 11+*1t111f11srr148 111 m , '4�c°R°® CERTIFICATE OF LIABILITY INSURANCE DATEI 0�"3) 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 Ileu of such endorsement(s). PRODUCER E CSryn Osborne The Fairway Insurance Group, LLC PHONE (954)772-9819 a No:(954)772-9564 5461 North Federal Highway ADDRESS:L INMJ S AFFORDING COVERAGE NAIC S Fort Lauderdale FL 33308 INSURER A:Brid afield Casualty Insurance INSURED INSURER B: JMT Refrigeration Services, Inc., DBA: 32 INSURERC: Degrees Svcs. 19431 NW 59th Place INSURER 0: INSURER E Miami FL 33015 1 INSURER F: COVERAGES CERTIFICATE NUMBER-CL134807020 REVISION NUMBER: 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. IL R TYPE OF INSURANCE POLICY NUMBER POLICY ID EFF POLICY EXP T LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY E T RENTED PREMIS S Ea oxurrence $ CLAIMS-MADE F—I OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ ML AGGREGATE LIMIT APPLIES PER: PROD UCTS-COMPIOPAGG $ POLICY PRO- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea. dam ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $AUTOS H R OSAUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Peracddent $ UMBRELLA LIAB HOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ A we COMPENSATION X WC STATU OTH- AND EMPLOYERS'LIABILITY YIN ANY PROPRIETORRARTNERiEXECUTIVE E.L.EACH ACCIDENT Is 100,000 OFFICERIMEMBER EXCLUDED? NIA 96-31046 /29/2013 /29/2014 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEd$ 100,000 If yea describe under DESdRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT I$ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Rernaft Schedule,9 more space is required) Certificate is subject to the terms, conditions, & exclusions of the policy. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Shores Village ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2nd Avenue Miami Shores, FL 33138 AUTHORIZED REPRESENTATIVE Edward Brown/CARYN ACORD 25(2010105) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025 onirvii m Then Ar.npn narna anti Innn am rnnlataraA marira of Ar.npn CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 104-18-2013 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(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 dots not confer rights to the certificate holder in lieu of such endomement(s). PRODUCER CONTACT ME A.B.S.Insurance Consultants PHONE 305 582-4144 FAX 305 715-7227 C. 11402 N W 41st Street . Slas@absinsurancefl.com Suite 213 INSURER(S)AFFORDING COVERAGE NAIC# Miami FL 33178 INSURER A:CYPrOSS Property&Casualty INSURED INSURER 8: JMT Refrigeration Services Inc. INSURER C: dba:32 Degrees Services INSURER 0: 18431 NW 58th Street INSURER E: Hialeah FL 33015 1 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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. rA TYPE OF INSURANCE ADD SUB POLICY NUMBER POLICY EFF POLICY EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $100,000 CLAIMS-MADE FX I OCCUR GFL-1018513 06130112 06130/13 MED EXP(Any one rson 5,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 X POLICY PRO- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ WORKERS COMPENSATION W72 A OTH rR AND EMPLOYERS'LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIV� E. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? u N l A (Mandatory m NH) E.L.DISEASE-EA EMPLOYEE $ If yes describe under F OPERATIONS below E.L.DISEASE-POLICY LIMIT DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,AddRional Remarks Schedule,If more space Is required) CERTIFICATE HOLDER CANCELLATION Miami Shores Village SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 10050 NE 2nd Avenue ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores,FL 33138 AUTHORED REPRESENTATIVE <DA> ©1888-2010 ACORD CORPORATION. All rights reserved. ACORD 26(2010105) The ACORD name and logo are registered marks of ACORD Page 1 of 1 MIAMI-DADE COUNTY : . OFFICE OF THE PROPERTY APPRAISER PROPERTY SEARCH SUMMARY REPORT Cados toper-Canters P-POHY APPrelser a Property Information: Folio 11-3206-013-4620 Property Addres 254 NE 101 ST a �� OwnerName(s) DAVID WALLACK JOSHUA WALLACK : Mailing Address 254 NE 101 ST } MIAMI SHORES FL 33138- Primary Zone 1000 SGL FAMILY-2101-2300 SQ Use Code 0001 RESIDENTIAL-SINGLE FAMILY Beds/BathslHalf 3/211 ' Floors Living Units 1 Adj.Sq.Footage 2,128 xy Lot Size 8,625 SQ FT Year Built 1938 AeNar Photography 2012 N Legal Description MIAMI SHORES SEC 1 AMD PB 10-70 W1/2 OF LOT 5&LOT 6 BLK 34 Taxable Value Information: LOT SIZE 75.000 X 115 OR 19891-3620 08 20011 Current Previous OR 27697-0719 051101 Assessment Information: Year 2012 2011 Current Previous Exemptionrraxable Exemption/Taxable Year 2012 2011 County $0/$377,905 $50,000/$267,410 Land Value $123,627 $107,502 School Board $0/$377,905 $25,000/$292,410 Building Value $254,278 $209,908 City $0/$377,905 $50,000/$267,410 Market Value $377,905 $317,410 Regional $0/$377,905 $50,000/$267,410 Assessed Value $377,905 $317,410 Sale Information: Exemption Information: Date Amount OR Book-Page Qualification Code Current Previous 5/2011 $530,000 27697-0719 Sales qualified as a result of Year 2012 2011 examination of the deed Homestead $0 $25,000 8/2001 $307,500 19891-3620 Sales which are qualified 2nd Homestead $0 $25,000 112001 $0 19472-3109 Sales which are disqualified as a result of examination of the deed Senior $0 $0 4/1993 1$121,000 15898-3828 Sales which are qualified Veteran Disability $0 $0 12/1989 $73,500 14374-3253 Sales which are qualified Civilian Disability $0 $0 911989 $0 14285-2375 Sales which are disqualified as a Wdow(er) $0 $0 result of examination of the deed 11/1976 $44,000 00000-0000 Sales which are qualified Disclaimer. The Office of the Property Appraiser and Miami-Dade County are continually editing and updating the tax roll and GIS data to reflect the latest property information and GIS positional accuracy.No warranties,expressed or implied,are provided for data and the positional or thematic accuracy of the data herein,its use,or Its interpretation.Although this website is periodically updated,this information may not reflect the data currently on file at Miami-Dade County's systems of record.The Property Appraiser and Miami-Dade County assumes no liability either for any errors,omissions,or inaccuracies in the Information provided regardless of the cause of such or for any decision made,action taken,or action not taken by the user in reliance upon any information provided herein.See Miami-Dade County full disclaimer and User Agreement at httpJMrww.miamidade.govMfoldisclaimer.asp. Property information Inquiries,comments,and suggestions email:pawebmall@miamidade.gov GIS inquiries,comments,and suggestions email:gis@miamidade.gov Generated on:Thu Apr 18 2013 http://izisweb.miamidade.gov/PropertySearch/printMap.htm 4/18/2013