The URL can be used to link to this page

MC-13-1902Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 205565 Permit Number: MC -8 -13 -1902 Scheduled Inspection Date: January 13, 2014 Permit Type: Mechanical - Residential Inspector: Perez, JanPierre Inspection Type: Final Owner: , B&L REALTY HOLDINGS LLC Work Classification: A/C Replacement Job Address: 973 NE 96 Street Miami Shores, FL 33138- Phone Number Parcel Number 1132060143230 Project: <NONE> Contractor: BLUE BREEZE AIR CONDITIONING Phone: 305 -865 -1220 Building Department Comments REPLACE EXISTING 5 TON AC AND DUCTWORK Infractlo Passed Comments INSPECTOR COMMENTS False 13 Inspector Comments Passed Failed Correction Needed Re- Inspection ❑ Fee No Additional Inspections can be scheduled until re- inspection fee is paid. January 10, 2014 For Inspections please call: (305)762 -4949 Page 17 of 23 a Miami Shores Village AUG 2 ' 2a13 Building Department' 10050 N2 2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762A949 BUILDING PERMIT APPLICATION FBC 20th Permit Type: MECHANICAL Permit No. _ Master Permit No.� k�IC't OWNER: Name (Fee Simple Titleholder):. L Q—C Address: 00 t J \N City:1 a .a State• �= t _ Zip• I �- 9 . r Tenantss Name• Phone#: Email: JOB ADDRESS: City: Miami Shores County: Miami Dade Zip: 1c Folio/Paroel#: 4° - CD Is the Building HistorimIly Designated: Yes NO Flood Zone: CONTRACTOR: Company Name:._ ) U Address: (p �5 5 NAIV 1 %B t° City: a State: Zip: ---?5 1 L � Qualifier Name: -?BG -- 18;4 —I® S(-::, State Certification or Registration #: -1 t U I h L) Certificate of Competency #: Contact Phone#: Email Address: rnG4i ct S � 4o r,t-v a a S D DESIGNER: Architect/Engineer. Phone#: Al V*lue of Work for this Permit: $ ' f 1 �1 Square/Lineor Footage of Work: - Type of Work: OAddress []Aheration ONew tepair/Replace %]Demolition Descriptlow of%rk: Ca G : ®� =1r� �f � C° Submittal Fee $ Permit Fee $ i 1 CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ NotnT $ Training/Education Fee $ Technology Fee $ Double Fee $ Stmdural Review $ TOTAL FEE NOW DUE $ ` T� V 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be d ' ered to the person whose property is subject to attachment. Also, a certifted copy of the recorded notice of commencemen must b osted at t b site for the first inspection which occurs seven (7) days after the building permit is issued. In the abs a of s h notice, the inspection will not be approved and a reinspection fee will be charged Signature Signature wner or gent for The foregoing ' ent was acknowledged before me this The foregoing instrument was acknowledged before me this day o , 20 3by '�� I day of 20 3 by _ i��C. +— a s..T ®rte i � who is Wally kno o me or who prol( "J who is •ovally Irnown to me or who has produced •1 , as identification and who did take an oath. NOTARY Notary Public State of Flori Em! EE 185282 Sign: rea o5M202016 l-Z My Commission Expires: APPROVED BY (Revised 07 /10/07)(RrAwd 06/10t2009)(Reviwd 3/15/09) Examiner Zoning Structural Review ;Clerk Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795 2204 : (305) 756.8972 AIR CONDITIONING REPLACEMENT DATA Fax PERMIT NUMBER: MC This form must accompany ALL air conditioning replacement permit applications. Each unit change -out must be on its own data sheet Multiple units on single sheets are not acceptable. l =r" s being C County: Miami Dade Zip Code: 1 36 ALL CONDENSING UNITS MUST BE ON A 4 INCH SOLID CONCRETE SLAB ALL UNITS MUST COMPLY WITH F.E.M.A MINIMUM FLOOD ELEVATION A COPY OF THE CONTRACT IS REQUIRED WITH ALL SUBMITALS ARI (AHRI) DATA SHEET REQUIRED Change Disconnecting means: YES ❑ NOP!r ARHI Sheet Attached: YE$ !rNO ❑ Contract Attached: YES 2( UNIT BEING REPLACED DATA NEW UNIT Q MANUFACTURER AHU or PKG. UNIT MODEL # "TrA0GO COND. UNIT MODEL # I KW HEAT NOM TONS AHU CU PKG 1 M.CA AHU CU PKG AHU CU PKG 2 M.O.P AHU CU PKG AHU CU PKG 3 VOLTS AHU CU PKG PKG UNIT I I NIT I I 11 EERISEER YES NO REPLACING DUCTS OYES NO YES NO REPLACING THERMOSTAT YES NO NEW 4 °CONCRETE SLAB No YES NO NEW ROOF STAND YES . NO NEW RETURN PLENUM BOX NO 1. Minimum Circuit Ampacity (Wire Size): 2. Maximum Overcurrent Protection (Fuse/Breaker Size): 3. Voltage of Circuit (208/2401480): O U 4. Size Disconnecting Means: GO AKP-k Contractor's Company Name: A— . Phone: State Certificate or Registration N. Certificate of Competency N. Signature Date: op. u s ai ongrl �� M This combination qualifies for a Federal Energy Efficiency Tax Credit when placed in service between Feb 17, 2009 and Dec 31, 2013. AHRI Certified Reference Number: 4431680 Date: 8/19/2013 Product: Split System: Air - Cooled Condensing Unit, Coil with Blower Outdoor Unit Model Number: SSX160591A* Indoor Unit Model Number: CA *F4961 *6D * +MBVC2000 * *- 1A * +TXV Manufacturer: GOODMAN MANUFACTURING CO., LP. Trade /Brand name: GOODMAN, JANITROL, AMANA DISTINCTIONS, EVERREST, ONE HOUR AIR Manufacturer responsible for the rating of this system combination is GOODMAN MANUFACTURING CO., LP. 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): 57000 EER Rating (Cooling): 13.00 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 rerale DISCLAIMER AHRI does not endorse the product(s) listed on this Certificate and makes no representations, warranties or guarantees as to, and assumes no responsibility for, the product(s) listed on this Certificate. AHRI expressly disclaims all liability for damages of any kind arising out of the use or 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 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 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, Air- Conditioning, Heciing. click on "Verify Certificate" link and enter the AHRI Certified Reference Number and the date on Elm Q1 and Refrigerction Instituk -, which the certificate was Issued, which is listed above, and the Certificate No., which is listed below. 02013 Air - Conditioning, Heating, and Refrigeration Institute CERTIFICATE NO.: 130213984966938845 ! i YAP Garage 8x8 6x6 83 cfm 27 cfm Hallways 2 4" Landry 4 x 12 10x8 133 cf G.Bedroom 4x6 G.Cte 60 cfm 81, Sheet 1 Kitchen 12 x 12 209 cfm 6x10 Family Room 181 cfm 12 x 10 8.. 255 cfm M.Bedroom 8" 12 x 10 175 cfm 12x10 12x10 8 8 175 cfm 181 cfm 8" 12 x 12 Cn 14 x 14 W Q t LL � 4 M _� 24 x 24 1900 cfm Hall ays > n 2 N 3 Cn m .® R v J Cn s - 4x12 L _ i E p ` 10x8 275 cfm 101, O W C) W a Z U L Uj Z �- r�ti c. 0_1 Q NJ m YAP Garage 8x8 6x6 83 cfm 27 cfm Hallways 2 4" Landry 4 x 12 10x8 133 cf G.Bedroom 4x6 G.Cte 60 cfm 81, Sheet 1 Kitchen 12 x 12 209 cfm 6x10 Family Room 181 cfm 12 x 10 8.. 255 cfm M.Bedroom 8" 12 x 10 175 cfm 12x10 12x10 8 8 175 cfm 181 cfm 8" 10x8 191 cfm Den r( Job #: Performed by Matias Torroija for: B &L Realty Holding, LLC 973 NE 96th Street Miami Shores, FL 33138 Bedroom 2 M.Bath 6x6 115 cfm Cte ue Breeze One Hour Air Condition... Scale: 1 : 102 Page 1 655 NW 118th Street Right -Suite Residential Miami, FL 33168 6.0.110 RSR39400 Phone: 305-865-1220 Fax: 305 -865 -7779 2013- Aug - 1911:33:04 w.onehourairmiami.com matias.torroija @onehourair... V: \ONE HOUR \Wrightsoft HVAC \B &L... 12 x 12 14 x 14 Dining /Living 8„ 4 — 24 x 24 1900 cfm Hall ays 20 x 2 12 x 12 .® R 0-6 4r 4x12 10 x 12 10x8 275 cfm 101, 10x8 191 cfm Den r( Job #: Performed by Matias Torroija for: B &L Realty Holding, LLC 973 NE 96th Street Miami Shores, FL 33138 Bedroom 2 M.Bath 6x6 115 cfm Cte ue Breeze One Hour Air Condition... Scale: 1 : 102 Page 1 655 NW 118th Street Right -Suite Residential Miami, FL 33168 6.0.110 RSR39400 Phone: 305-865-1220 Fax: 305 -865 -7779 2013- Aug - 1911:33:04 w.onehourairmiami.com matias.torroija @onehourair... V: \ONE HOUR \Wrightsoft HVAC \B &L... Project Summary j Date: 08!1612013 Entire HODS@ By: Matias Torroija Blue Breeze One Hour Air Conditioning & Heating Proj =010 fo�mati'o For: B &L Realty Holding, LLC 973 NE 96th Street, Miami Shores, FL 33138 Notes: Replace existing 5 Tons AC unit and it duct work. n Ilnfor Rawfion esrgt Weather: Miami, Int'I AP, FL, US Winter Design Conditions Summer Design Conditions Outside db 50 OF Inside db 70 OF Design TD 20 OF Heating Summary Heating Equipment Structure 28917 Btuh Ducts 4637 Btuh Central vent (36 cfm) 786 Btuh Humidification 0 Btuh Piping 0 Btuh Equipment load 34340 Btuh Infiltration Method Simplified Construction quality Average Fireplaces 0 Efficiency Heating input Heating output Temperature rise Actual air flow Air flow factor Static pressure Space thermostat 80 AFUE 0 Btuh 00 Btuh OF 1900 cfm 0.057 cfm /Btuh 0.40 in H2O Outside db Heating Cooling Area (ft2) 1659 1659 Volume (ft') 13272 13272 Air changes /hour 0.38 0.20 Equiv. AVF (cfm) 84 44 Heating Equipment Summary Make 50 Trade Moisture difference Model gr /lb Efficiency Heating input Heating output Temperature rise Actual air flow Air flow factor Static pressure Space thermostat 80 AFUE 0 Btuh 00 Btuh OF 1900 cfm 0.057 cfm /Btuh 0.40 in H2O Outside db 90 OF Inside db 75 OF Design TD 15 OF Daily range L Btuh Relative humidity 50 % Moisture difference 55 gr /lb Sensible Cooling Equipment Load Sizing Structure 35255 Btuh Ducts 4366 Btuh Central vent (36 cfm) 590 Btuh Blower 0 Btuh Use manufacturer's data n Btuh Rate /swing multiplier 0.95 ton Equipment sensible load 38200 Btuh Latent Cooling Equipment Load Sizing Structure 2450 Btuh Ducts 1677 Btuh Central vent (36 cfm) 1334 Btuh Equipment latent load 5460 Btuh Equipment total load 43661 Btuh Req. total capacity at 0.70 SHR 4.5 ton Cooling Equipment Summary Make Amana 0.88 Trade SSX16 Series Cond SSX160601A* Coil CA *F4961 *6A * +TXV +A *V80905C ** Efficiency 16 SEER Sensible cooling 39900 Btuh Latent cooling 17100 Btuh Total cooling 57000 Btuh Actual air flow 1900 cfm Air flow factor 0.048 cfm /Btuh Static pressure 0.40 in H2O Load sensible heat ratio 0.88 Printout certified by ACCA to meet all requirements of Manual J 8th Ed. -� Wi6�iltSc:> t Right -Suite Residential 6.0.110 RSR39400 2013- Aug -19 11.14. 49 >1 VAONE HOUR \Wrightsoft HVAC\B &L Realty_973 NE 96 St Marie.rrp Calc = MJ8 Orientation = N Page 1 CERTIFICATE OF LIABILITY INSURANCE 10/30/°°"""' Tin CBRTIFII IU 10 !iS'e3ULD AS A MATTER Of INFORMATION ONLY AND CONFERS NO MONTS UPON 1 H9 GEFtTiFIt,P►T91 110 -Amt THIS CEtiyfflCATI? D= NOT APFIRMATMY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COWRAOE AFFORDED BY THE POLICIES BELOW. T.NIB CERTIFICATE= OF INSURANCE DOI5$ NOT CON$TftTE A MNTRACt BETWEEN THE IM UING INSURER(S), AUTHORED REPRE$WITA"M 4R PO DUCM AND THE COMPICATH NOL.DER. IMPORTANT: VV; aertifleate holder is an ADDITIONAL INSURED. the poUaypes) must be endorsed. it $UaROGA-n0N 18 WAIVED, subject: to She tomes add amrdidons of the policy, certain polwas may require an endorsement. A statement on this esrNflcate does not confer rights to the eerdScats holder M Itau of such endorse s . Prignom Eagtern Insurance Group, Inc. 9570 SIN 107 Avenue Suits 104• Miami FL 33176 DaVi d M. ime FMILEW (305)585 -3323 (305)896 -nW MUM esr0asaaersiiasysmeaae,not StG � NABS Ar- astleftint Florida Insurance you mm B.C.A. hit Coadit:ioning, Inc., till: Blue ISM mw 11e street v� 33 p Mimi FL 168 C: 6asmReR<IY RAt�ES CERTIFICATE NUMBERtaster 13 -14 REVISION NUMSM THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. ' NOTWITHSTANDING ANY REQU REMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 16 SUBACT TO ALL THE TERMS, EXCLUSHMAND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN UCED BY PAID CLAW$. t9EIMM UAMUW EACH OCCURP&NM 8 „ CoMMbMAL O¢ ORAL UAMU'IY i CUVUS twE M OCCUR Msa exP a+e n 9 5 ADMTNAJRY s CMWM T9 9 tmpT PER; FILM d �xtr sL° 'qty ' - .,IMM.MYA-I.MNIM-. ,A.I ANY AM ti0O1LY INJURY (Pbtp�soA) $ " SGW60UU3Q 940n Y tNJUAY �Parseddotaj $ HIRED AUTOS 9 LI AO hotttlq 6 OMM&MME 6 ANY TIN e4EACHACCIDENT s ioo obo wwwJ NIA gnsr0eox lxe/zas3 /aa /2asa EkbiBf 96- n�P Y' 100 4000 HE AWN M sRAn mow IL4. qs • POLICY MR 0 0 0F0WA=as r6coAn0NS IVEHIQLE9 IAil�eh AOaSRO �w, Ad etorml �a sel,��w, n r rs �am�1 Air Conditioning sery Ce CANCRLLATION (SHOULD ANY OF THE ARM DESCRIBED POUGIES BE CANCELLED BEFORE THE EXPIRATION DAIN T OF, NOTICE WILL BE 661,NERED IN ACOOk"NCB WITH THE POLICY PROVISIONS. baam shares Village Building Department woRI DIwnwh6MTM 10050 xR 8 Awake bft mi 8hoxes, FL 33139 David Lopez /AH& 1"$ -201 Q ACQRD CORPORATION. An rtgM reserved. IM3oza rm +roan nr TM Arran nwne enA Inn^ are rant*tworl omrka nF ACnDn SK'A'TE OF FLORIDA DRPARTI"SO1"RtECTS ©�Ui9TRY LC$ TTON �; • ' =C R 107129020ii, , '213y•��• R� � :.w 'iii• ' :..; ' 11aTaeld b�:�aw 'a�I Unde): th6 PrOvilaiozia 'oi° 'ci1=� >sipisatioa date I AUG' 3 �. � 2� 4 � 'X A Tyis, iYOS `I r ETaNG T RR1afljtS . CN' AIR CON BLUE 655 118TPI 9TR8$T ..: FL 33168 NUMI . .f • • r .. KEN LAWSON •3 R1Cit SCOTT ;'',.' 3RCMARY 'dQV$RWOR DISPLAY A$ REQUIRED BY LAW Q I DongMtuiationsl With this license you become one of the nearly one million ; � r, �'t, " C38' BUSS INKS S. AND Floridians lice by the Depertment of Susiness and Professional Regulation. i :• 'R B .01QI. Ab.! R2G= ATr0N . Uur prole ale and twslnOSSee range I`rum oi�',itacffi to yacht brokers, from < •: ; boxers to barb @qm Mstgurents, and they keep Floddra's economy strong, CAD l g 1 28 g • :r ' j?'•.I2 * 12 129011648 Every day we work to improve the way we do business in order to serve you better.' For tMormatlOn about Our services, please Idg onto www.mytloridalleense.com, ' •• Ci3RT j?;GSO ., t1Ee.: COX= Thera you can and more Information about our divisions and the regulations that RR ;TA; :: �� , oll . ' impec# you, subs�ibe to depsetment rs and team more about the : $R J i� t7R ••AIR CDYJAiTZ Department's initlmgvtm. Our mlWon at the Department is: License Efficlently. Regulate Fairly. We confitAntly s#riva to serve you better so th ®t you can serve your customers. =g r,t+!t¢7"tt tts� ,a a� rae apov3ascao Of m.909 :e Thank you for doing business in Florida, and congratulations on your new ticenset ; : ; ? :a lretiaon aata :'7e►tT0 '3i, '.20.14 7513012900173 OA1862 Local Business Tax Receipt Miami -Dade County, State of Florida THIS IS NCriA BILL— OD NOT PAY 4900068 LBT OWE alp coNamlannNO RENEWAL $EPTEM'09910, 201$ 635'NW.118 ST 6114$14 Must be dl�alevrul At "prwm 4 r»w;neVe MIAMI FL 331611 Pursuant i4 CM Code, Chapter BA — Alt, 9 & 10 86C. TYPE or 6US SSE ECAAA NR CONDMONIN0 INC 196 SPEC MECHANICAL CO BY roc COLLECTOR g �° Wodcer{sj i cwCtstsxsa :! $75.00 0811112013 • TXHSI— i3- 06i57i Tift Lml Ouslun Tax sculpt Hl" of 6te l aael ir: ,'fie Be Is to a iiaaam iSbhflil, or a oetriflcetioa ofihe ladder s 40 assts do>�iat�s, p Vaud eop guammeeMl or doagaseraatOaltVr regaIMM ta= sad ioquiremesrs which t rio The RECRrMIM shave mast be d4Wped -unalt a s Code Sea 0dr 4T6 FalSllAfo iMarmsUas. � ' ...Fa •• ". . C d3O 1303 ,38p suburban fox 9648441899 p.2 ACkAffe CER11FiCATE OF LIAR LITY INSURANCE PMA3 rHq CMIPICATS IS tWUSD All A MATTER OF INFORMATION ONLY AND "WEBS NO RIG"" lI" TITS CERTIFICATE HOLUM 71"19 CWRWCATt3 RM NOT ARRRMATIV®,Y OR musAT1v m AWDO, OMWD OR ALTER THE COVERAGE AFFORDED BY THE POLICIES goj= " awmF=Ta CF WSURAWW DOES NCI' 0ON+N9TnWE A MNTR Ae:T RI=Tn Pll T"F +VAC;} NNSURER(S), AUTHERIZED iI<I; OvTf'ATIVE OR PRODUCER' AND TtM CERTIRCATE HOLDER. J 111WORTANTs W Go C91911400 Irolder 19 an ADDrrR mAL INBu [><, the puIaj es) a damd. If SURROM , to "twwo rmrt rdww iEnemo all tlm pmfley. a mtoln pal[elea *mW mgtdre m ands mwmtL A statgrnsrtt an thli cmSicato do= RGt coder, rWft to the IIt►1dIJ1' 61 IFdSi+tpFJ31dC1S @IttloroeNlrs Wauthan AtumitibuN Inc mm. ) 54444..1899 17071 W KIM HOW" burb4rTassodaleanee 1460 Mlaml 80806 I `L 33160 wAmq AVamle Cmuft InA err nae Cc c : We= Insumce +Cer IiCA AirColttMiordrt9 DDA Slue Sramm One I-our AIr a: ID 617867 os ' em NW 118 street ly( FL 32168 p i COVENAGN CORTSWE INI MBER, ISIQI MBSRc THE M To MM TjJAT THE POLICIES OF INSURANCE LISTED MCW HAVE iRN— UMM TO THE IhMURED NJ &W AWW FOR THE PO.IGY PERWD ==ATM..NoTfay"STANMe AW Rrj&WjRWuW ' QAk CR CONU' ON OF ANY CONTRACT OR OTHER DOCUMENT WITH RJBSPCT To Vow" THIS TE NytY I J9iQlt$d ASR mAy PEnTAIN Tma 1NStJRlWC6 AR=P XWW MY THE POLICIES CON WAIDW HEREIN is Suamar TO ALL THE TERMS. t3L1fi1tI'SCA >i37tK� ySIOldsAm wNDITIGNN,S OF SUCH POLwc . LWITS SH" R AY HAVE BEN RE=ED SY PAID CLA IM& SHOULD AM OF THE ABOVE DUC MIM POL00 Be CAN09UM B ;TiY�d4P� THE °TILE a s �'' � �' �" 10050 CIE 2nd Ave >r Ill aml Shores, FL 33138 L94rra A x lum Ex • occum +cAtBnseJtat6AU�P8At ` x I L040tib10Q9-tN 481S�J18 ( 06V?J14 4 7, Zm rmeS ,�,, „, t �04.coo tuEC tit erm mr++>nl s S.IIOD • a 00v Ieumw s t 40G iOd �� ' mmm-ampJapAmm 1, s E , pINfJ�O I JJ .nv _ L” ALLOWNED 7I L" J V= ME HIf�AVfO$ x WPM 093im 00 � 04MI/19 I OW 114 s 1Q0,ti0E1 Jsnaav INJASRY{pe J>s>t s BOGILYIArJWlYO�*R9ddi�R} S .... uea KgNN4.Aea0J? ftGAM a 011AI Ntt�) � Ti0N91 LDCATibti9 J VEN�LE! (AMU WanW Additional Irm ured tptfp to tgRmthi0a11IrAn(a 6p36C Y MOM I kami Shores 'J age SHOULD AM OF THE ABOVE DUC MIM POL00 Be CAN09UM B THE °TILE a s �'' � �' �" 10050 CIE 2nd Ave ACCMDAHCEeWrrrt Ptacw�t" Ill aml Shores, FL 33138 ACOR086 jM? a" That ACORD namWW kW oft Mgistmvd to ft ofAC ORD .