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MC-12-308JAN 17 201 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION Permit Type: MECHANICAL JOB ADDRESS: 102 NE 107th Street FBC 20 LO Permit No. MC -2-12-43462 Master Permit No., Z� City: Miami Shores County: Miami Dade gip; 33161 Folio/Parcel#: 11-2136-007-0240 Is the Building Historically Designated: Yes NO X Flood Zone: OWNER: Name (Fee Simple Titleholder): James Mills & Alphonso Martin Phone#: 305-632-0344. Add,,., -102 NE 107th Street City: Miami Shores Tenant/Lessee Name: N/A Email: State: Florida Zip: 33161 CONTRACTOR: Company Name: US Heating & Air Conditioning Phone#: 954-581-8333 Address: 624 Douglas Avenue #1402 City: Altamonte Springs State: Florida Qualifier Name: Russell Childress State Certification or Registration #: CMC056240 Certificate of Competency #: Contact Phone#: 954-581-8333 Email Address: sheilaushac@gmaii.com DESIGNER: Architect/Engineer: N/A Phone; Value of Work for this Permit: $ 2,050 Square/Linear Footage of Work: 32714 Type of Work: ❑Address OAlteration ❑New ORepair/Replace ODemolition Description of Work: A/C Change Out .... (3 Ton System) Submittal Fee $ Permit Fee $ CCF $ CO/CC $ Scanning Fee $ 3.0\3 Radon Fee $ DBPR $ Bond $. Notary Training/Education Fee $ Double Fee $ Structural Review $ Technology Fee $ TOTAL FEE NOW DUE $ It 3:S01 Bonding Company's Name (if applicable) N/A Bonding Company's Address City State Mortgage Lender's Name (if applicable) N/A 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 uilding permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice commencement and construction lien law brochure will be delivered to the person whose property is subV*ertfo attachme o, a certified copy of the recorded notice of commencementmust be posted at the job site for the first inspection ich oc even (7) days after the building permit is issued. In the ab nce of such posted notice, the inspection wjknot�itv a reinspection fee will be charged. "Owner 1% Agent Contractor oing ins ent was acknowledged before me this 17th The foregoing instrument was acknowledged before me this 17th day of January 2by James Mills day of January 20, by Russell Childress , who is perso llyown to me or who has produced DL # v io is pe , me or who has produced AK rsonally known As identification and who did take an oath. as identification and who did take an oath. NOTARY P IC: NOTARY PUBLIC: Sign: Sign G !�. (-1�- 4UQ 1. Print: Print: r My Commission Expires: �oN��lJ o�ov�o�,b My Commissi es:N - Uc a EIOZ'OL,lely S31ifdX3 St>e0a add®eE+�soaa * " < My commtsala+ D4 f fV01SS�IN10� ANI .° u %...: e o Expires oW04120 s kHaskakakkakakHasHsk�ask�askxeH+HaksksksRH&xaHa 8aaksklaskskakakakaAsksksRsAakBaskskakakakskIaa�asbsksMkk�SakakaHakaks�t'a�a sffi sg$aih� APPROVED BY Plans Examiner Zoning Structural Review Clerk Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) DBPR.- CHILDRESS, RUSSELL LUTHER; Doing Business. As: U S HEATING AND ... Page 1 of.1 7:3&:24 oW 8/26"12 Licensee Details Licensee Information Name: CHILDRESS, RUSSELL LUTHER (Primary Name) U S HEATING AND AIR CONDI'iiCiNIiYG INC (DOA Nettle) Main Address: 400 SAILFISH AVENUE CAPE CANAVERAL Florida 32920-2197 County: BREVARD License Marling: LicenseLocation: 658 DOUGLAS AVE STE 1102 ALTAMONTE SPRINGS F6_ 32714 County: SEMINOLE License Information License Type: CertiiW Mechanical Contractor Rank: Cert Mechanical License Number: CMG056240 Status: ' Current,Active Licensure hate: 08/01/1992 Expires: 08/31/2014 Special. Qualifications Qualification Effective Construction Business 02/20/2004 View Related License Information View License Complaint r 1940 North Marux Street, 7a_k_la FL 32339: email: C+ tps {` aatac* Gentgr :: customer Contact Center;. 850.487.1395 The State of Florida Is an AA/EEO envloyer. Wpyrlaht 2007-2010 State of Rorke. Privacy StaTmn e Under Florida law, email airdresks are public records. If you da net want your email address released in response to a publk-records request, do not send electronic mail to this entity. IMtead, contact the Otte by phone or by trad[denal mail, If you have any gUestions, pie— contact 850.487.1395. 'Pursuant to Section 455.275(1), Florida Statutos, effective October i, 2012, gcensees lkensed under Chapter 455, F.S. must provide the Departrnent with an email address If they have one. The emags provided may be used for official communkatibn with the Ikensee. tiovaever emall addresses are pubik record. If you do not wish to supply a peisoo address, please`provide the Department With an email[ address which can be made available to the public. Please see our Chapter 455 page. to determine if you are affected by this chang&. m https://www.tnyfloridalicense.core/LicenseDetail.asp?SID=&id=9F,74F84B21F2A l-94EF4. 8/29/2012 Altamonte Springs Business Control No.: Business Name: Business Address: City of Altamonte Springs 225 Newburyport Avenue Altamonte Springs, Florida 32701-3697 407-571-8116 Altamonte Springs BUSINESS TAX RECEIPT Provision: Ordinance No. 1570-07 0007444 U S HEATING & AIR CONDITIONING INC ARIE KONFORTE Expires: September 30, 2 013 624 DOUGLAS AVE 1402 ALTAMONTE SPRINGS FL 32714 RECEIPT NO. CLASS DESCRIPTION FEE PENALTY 13-00088236 CONTRACTORS -HEATING WOR AIR CONDITION $120.75 $ 0.00 13-00095880 SEMINOLE COUNTY REGULATED $ 45.00 $ 0.00 13-00099561 CONTRACTORS -ELECTRICAL $120.75 $ 0.00 13-00099571 CONTRACTORS -PLUMBING $ 120.75 $ 0.00 Restrictions: OFFICE ONLY -NO OUTSIDE STORAGE ® DO NOT ACCEPT WITHOUT V YING THE PRESENCE OF THE WATERMARK TAINS SECURITY FIBERS WARNING-PUPkEK THE DOCUMENT FACE CONTAINS A SECURITY BACKGROUND THE FACE CONTAINS A SPECIAL LINE WITH TEXT 'CITY OF ALTAMONTE SPRINGS v, a, ,cup. L u : *U : 53 AM PAGE 1/001 F8X $@I'afsr BROWARD COUNTY LOCAL BUSINESS TAX RECSFrr 195 S. Arx&� �IOBER 1,2012 THROUGH SEPTEMBER 2013 RP.CB�t*'%Z -$c» TYPES OONTRA@7tjti ;EJB ABATING & AIR C�ITIONM INC TV^i1�' ) Owner Ne+ RUSSELL L Badness Openada0/31/2009 BWInMLo=pn:3911 ON 47 AVE 907 Enmp��l4COS6240 IIAVIS BUShMM pboM 954-581-8333 !fes pruie fiaoaM 1 1 0 VendneTWW Muterof Mt eea ew Told Paid Tax ft ml Tmidw Fee NSF Fee �ftwh" PriorYeeraCatiacdonx.80 0.00 0.00 0.00 0.00 27.00 THIS RECEIPT MUST BE POSTED ©OMSpMOUSLY BI YOUR PLACE OF MADUM Tto BECOM A TAX REC13PT This teat b levied for the privilege of doing bce� M Vhhht Browwd cmw and is WHWWy k, no" you must meet al CW" anftr MwWpafiLy fbnnft and mnfng rem This &mess tax Rec W � foie have WHO VALIDATED ftthe f mmu is sold. baaseress bwAlwas h locWJOD. TW State or focal lae� and �RM � bO Orthat coup r asugj"#on-u-oQo2U82 DBgLU.Mg& Axs OMMMOWMr3311C Said 09/04/2012 27.00 3911 SW 47 AVE 907 Ffes' LNMNWMUA, ice+ 33312 ACC?Rl�® CERTIFICATE OF LIABILITY INSURANCE °A'�'"�"'°°""'"' 1/17/2013 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 does not confer rights to the Certificate holder in lieu of such endorsement(s). PRODUCER Blackadar Insurance Agency, Inc. 1436 N Ronald Reagan Blvd Longwood FL 32750 NAME PHONE -M:407 31-3832 ACC Noi.407-830-4681 E-MAIL RESS. r 60423933 1/1/2013 INSURER(S) AFFORDING COVERAGE NAIC # INSURER A 1 E TO RENTED PREMISES Ea nce $100,000 INSURED USHEATI-01 INSURER B:S8feC() f America 24740 INSURERc: US Heating 81 Air Conditioning Inc tNsuRERo:FFVA Mutual Insurance 624 Douglas Ave Ste 1402 I!d Altamonte Springs FL 32714 INSURER E : LUIBILITY ANY AUTO ALL OWNED SCHEDULED AUTOS NON -OWNED HIREDAUTOS X AUTOS INSURER F: COVFROGFS CFRTIFICOTF NIIMRFR_ 1A144R1An7 KtVIbIUM MUMOCK: 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 ADDLSUBR Miami Shores Village Building Department POLICY NUMBER EFF POLICY MMIDD/YYYY POLICY EXP LITS A GENERAL LIABILITY MERCIAL GENERAL LIABILITY N:7011CLAIMS -MADE � OCCUR 60423933 1/1/2013 /1/2014 EACH OCCURRENCE $1,000,000 E TO RENTED PREMISES Ea nce $100,000 MED EXP (Any one Person) $5,000 PERSONAL 8ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRO X LOC POLICY I X I PRODUCTS - COMP/OP AGG $2,000,000 $ B AUTOMOBILE X X LUIBILITY ANY AUTO ALL OWNED SCHEDULED AUTOS NON -OWNED HIREDAUTOS X AUTOS 02CE21522130 9/2012 9!2013 MI 1 Ea ddt$1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Par acdderd) $ PROPERTY DAMAGE $ Perecddent C X UMBRELLA LI►B EXCESS UAS X OCCUR CLAIMS -MADE PXSLBR00014001 1/1/2013 /1/2014 EACH OCCURRENCE $2,000,000 AGGREGATE $2,000,000 DED I I RETENTION $ 4 D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE a OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yy� describe under DESdRIPTION OF OPERATIONS below NIA 84000175532012A 5/2012 5/2013 X IMC STATUS O H - TORY LIMITS ER— E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYE $1,000,000 E.L. DISEASE - POLICY LIMIT 1 $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, K more space Is required) Certificate Holder is included as Additional Insured and Blanket Waiver of Subrogation applies; with regard to General Liability and Business Auto when required by written contract. Waiver of Subrogation applies to Workers' Compensation when required by written contract. f%L'MT M0%ATC LIf%1 r%Cn f-AA1PC1 1 ATInk] U JVUIJ-ZUTU At+UKU UUKrUr%^ I IUM. Au ngnts rtmerveu. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Shores Village Building Department ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2nd Ave Miamia Shores FL 33138 AUTHORIZED REPRESENTATIVE U JVUIJ-ZUTU At+UKU UUKrUr%^ I IUM. Au ngnts rtmerveu. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD 01/17/2013 12:57 FAX 1 800 885 7530 DATA SCAN FIELD SERVICES TRANSMISSION OK TX/RX NO RECIPIENT ADDRESS DESTINATION ID ST. TIME TIME USE PAGES SENT RESULT TX REPORT 3222 918545813236 01/17 12:56 00'22 1 OK Miami Shores Vi I lacyc In Duildino- Dpejolartment C) ::10.M1 N.h.2nd Avenue. Mi;(mi Shores. Florida .1313K I'Ll: 00. I 79S.2204 Fax: f i051 75o.8'97� INSPE(11ON'S I'llO.-NE NII.AtItElt: (30.91 762.4949 c- BVILDiNG Permit Nw.& �DL 'CATION Master Permit No. e F '*2` 0 n 0 �1 e 4— CHANICAL 01VNI-'1R- Nlmtiv ti'vt, LeAwso... W. ?�v PJ Phonc.4- ........ . ................................. II(MADDRIess: )oz. 33101 . .... ..... . . .... .. ............. . Is the Building lIkwt'j(:;jIlv Orsignated: Yc", 0001 c()NTI4A('T(W, ("simmmy Narn;r p4ev, A 0,p r4 bvT i oN I t4 o�-) Addlv"s: V&D PDA Zip:2,2+14*­ State: Nanv: S(aw Ccrliflcalwsn or tA* 0 ill irk-telwy U. cols el 11honuff: _rL111.61 Address: 0rSIGNI-I.I.R, . .... ....... .. V.,%bir of Work for this Pervilit, Square/linear Footage of W*ork: .. .. .. .............. ' I'YlworWorki: UAddi"s l.7Attcration th-scriptioll of Work, 7t I kJ C v Miami Shores Village FEB 2 3 2012 Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.49499pNSY MILD G i _ NG Permit NPI 2' � PE T A L CATION Master Permit No. FB 20 Pe CHAMCAL OWNER: Name (Fee Simple Titleholder) VAmES hll!1As i .��Phone#: Address: 10Z N. E, 1 Qq� S" C city: IMIAPA % Si1DkES State: 1'LO RA DA zip: 391 t� [p 1 Tenant/Lessee Name: w I A Phone#: Email: JOB ADDRESS: 102 N• f, 1 Oa�� ST City: Miami Shores County: Miami Dade zip: 331 (I Folio/Parcel#: ' 1 •- T13 to - 009 - U00 Is the Building Historically Designated: Yes NO Flood zone: CONTRACTOR: Company Name: �% +ill681 d AL a MDI?i ON 1A E?Phone#: Q94 • $r�� " 83� 7 Address: (024 bouelLAS '44-L # 1407 - city: A TAet1A)nM '90V N6 S State: V eP PDA zip: 92+1&4 Qualifier Name: P', % SE -U- Cwt Ia�ss Phone#: State Certification or Registration #: CM C OQ—Z L4(L4() Certificate of Competency #: Contact Phone#: Email Address: DESIGNER: Architect/Engineer: Value of Work for this Permit: $ 2 i DCO Square/Linear 7epair/Replace e of Work: Type of Work: ❑Address DAlteration ONew I ODemolition Description of Work: Mc_ _C'AAA1l 49-tei D U T • ID111i %41355m) Submittal Fee $GD. 00 Permit Fee $ t CCF $ CO/CC $ Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ DBPR $ Bond $ Technology Fee $ TOTAL FEE NOW DUE $ Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip 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, BORERS, 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. "WARMING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR EMPROVEMENTS 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection whichs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not b ap ed a reinspection fee will be charged. A Af The day NOTARY Sign: Print: My C APPROVED BY Owner or Agent —�oZefore int was acknowledged before me this The foregoing instrument was acknowlme this by 7AM:ES%x/11(, day of , 20 L, by me or who has produced who is persona known to me or who has produced As identificatioil and who did take an oath. as identification and who did take an oath. COMMSS19# E6989 g.S EXPIRES June 01, 2015 (Revised (7/10/07)(Revised 06/1 W009)(Revised 3/15/09) tPIdwrExaminer Structural Review NOTARY Sign: CAREOW 201 C- �I�AI ��S$ION # EE098976 EXPIRES June 01, 2015 Zoning Clerk Miami Shores Village Building Department 10050 N. E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 AIR CONDITIONING REPLACEMENT DATA PERMIT NUMBER: MC — V S 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): 107 N. & )� ST City: Miami Shores Village County: Miami Dade Zip Code: 331(e I 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 7ARHI RI)DATA SHEET REQUIRED Change Disconnecting means: YES F-1NO Sheet Attached: YES (/NO ❑ Contract Attached: YES ❑ UNIT BEING REPLACED DATA NEW UNIT -f MANUFACTURER iJ U r PKG. UNIT MODEL # C -OND. UNIT MODEL # KW HEAT W. NOM TONS AHU CU PKG 1) M.C.A AHU CU PKG AHU CU PKG 2 M.O.P AHU CU PKG AHU22b CU 72o PKG 3 VOLTS AHU CUZU PKG PKG UNIT ! ! PKG UNIT I / EER/SEER YES NO REPLACING DUCTS YES YES NO REPLACING THERMOSTAT YES NOV, YES NOJ NEW 4°CONCRETE SLAB YES NO YES NO ,/ NEW ROOF STAND YES NO YES NOJ NEW RETURN PLENUM BOX YES NO 1. Minimum Circuit Ampacity (Wire Size): 60 2. Maximum Overcurrent Protection (Fuse/Breaker Size): Ca a 3. Voltage of Circuit (20812401480): 24a 4. Size Disconnecting Means: 6!0 Mo Contractor's Company Name: l f Phone: State Certificate or Registra ' n N. &rtificate of Competency N. Signature �4 Date: only) R CENTRAL 4FLORIDA 624 Dd`Pas Ave. Ste. 1402 Altamonte Springs, Fl. 32714 REGIONAL OFFICE 407;774.0.850 Fil 407.774.4419 SOUTH FLORIbA 39111S.1 J. 4ith Avenue Ste.907 4avie, FI. 33314 REGIONAL OFFICE 954.581.8333 Fax 954.581.3236 WEST COAST 6418 56th Commerce Park Blvd. Tampa, Fl. 33610 REGIONAL OFFICE 813.623.5818 Fax 813.623.1931 INV # SAIJ MAK ,,j MODEL SERIAL' NUMBER NAME °" H.W.N. 2 7 " 'STREET DATE: / / law O COMPRESSOR 4 _d✓✓J SUCTIONSUCTIONUCTS ❑ Pel asQHM PSI CITY -y STATE •` ZIP 17? SUCT aMP �,. .�. ...: JOB LOCATION PHO �^` "� ALTERNATE PHON °°��" ❑ CONTACTS TIGHT CLEAN 000. LEVELAND CONDITION CITY STAT ZIP1� EMAIL "" / .m ❑ CONDENSER COIL , La„ TIME DISPATCHED TIME IN r -� TIME OUT , r,«y�� 4✓"'� 1..� CONT -W/0 # ry DISPATCH# C" `Prx. AUTH# ::T '. 11 ""r ., ., t A ❑ CHECK COIL $CHECK Phi FOND ❑ ENT_F LVG__F REFRIGERANT Qt1AtUTIPf 1bENIORPAR[.DESCRIPTIONR11 > -TION 0 LEAK O CHARGE + PAI 5 [IFAN & MOTOR ❑ VOLTS AMPS ❑ ELECTRICAL CONNECTIONS 1 .+A ❑ CONTACTS TIGHT $ CLEANED FAN PULLEYS {ADJUST BELT 4 9 T JO ❑ CHECK LUSE BEARINGS $ MOTOR - t CT ?-� y 2� ❑EVAPORATOR COIL ❑ CHECK COIL & CHECK PIN - ❑ ENT DB`F LVG OB —F ,`, ) ,L:' [I ENTWB,�_F LVG WS _F ❑CONDENSATE AREAS 0INSPECT $ CLEAN DRAIN PAN ❑ INSPECT 8 CLEAN DRAIN AIR FILTERS CLEANED ❑ REPLACED ❑ HEATING ASSEMBLY O BURNER & HEAT EXCHANGER 0 FUEL SUPPLY & PRESSURE 0 PILOT ASSEMBLY ❑ FLAM ADJUSTMENT ❑PRIMARY RELAY &FLUE LABOR CHAR SHRS@ $ PER HOUR TOTAL LABOR CHARGES O FAN & LIMIT SWITCH OPERATION TECH NAME: ❑ BLOWER ASSEMBLY O RV VALVE TOTAL PARTS PRICE 0 STRIP HEAT O DEFROST CYCLE PARTS WARRANTY ^ CUSTOMER'S °SIGNATURE ; AuPARTsAsREWNEDAMWARwwTEDASPER wwUFACTUMSKOI`41 u ltAN;ONDRAINLINES TRAVEL DIAGNOSTICS ELECTRICAL COMPONENTS LABOR GUARANTEE TI CHARGES 1] RELAYS ❑CONTACTORS D OVERLOAD E) PRESS SWITCH THE LABOR CIVwGE AS RECORDED HERE RELATIVE TO THE E01lIRUENT SERVICED AS NOTED, Bi (AUwANTEED FOR A PERIOD OF SO DAYS. DATE: WE DO NOT WARANTEE ODER PARTS THAN THOSE WE NSTALL IF REPNRS LATER RE=E NECESSARY WE TO OTHER DEFECTIVE PARTS, THEY %WL BE OWMED SUBTOTAL THERMOSTAT SEPARATELY. oOOK ca 402RrDER ❑REPLACE PREVENTATIVE MAINTENANCE SERVICE 0 RELOCATE THERE Is NO WARRARTY ON PREVENTATNE 6uN emm sr xE wuEss R,wrs ALD omu SERma ARE LENWREo I HAVE THEAUTHORITY TABOVE WORK AND DO SO ORDER AS OUTLINED TAX 1 ENVJRQNWiENt S S ' ® ASOVE. IT IS AGREED THAT THE SELLER WILL RETAIN TITLE TO ANY EQUIPMENT OR MATERIAL FURNISHED UNTIL FINAL & COMPLETE PAYMENT IS MADE, AND IF r a`�L� Y t �K�4iECI'J:OR ��:� SETTLEMENT IS NOT MADE AS AGREED. PURCHASER AGREES TO PAY ALL COSTS OF COLLECTION, INCLUDING A REASONABLE AMOUNT AS ATTORNEY FEES. INTEREST AT CUSTOMER DEDUCTIBLE 4 Ip lERe.DORp9®�p,®�&,g4P�/Agpgpg� p3f ,Lg �pe��ipe 6L ®R Os� ANNUAL PREVENTATIVE N ®A"A I Y MAINTENANCE LV1ANC THE TYPE THE RATE OF 18% PFR ANNUM WILL BE ADDED TO ALL DELINQUENT BALANCES SELLER SHALL ALSO HAVE THE RIGHT TO REMOVE SAID EQUIPMENT AND THE SELLER R ,m, REFRIGERANT P an, WILL BE HELD HARMLESS FOR ANY DAMAGES RESULTING FROM THE REMOVAL E THEREOF. THERE WILL BE A $30 CHARGE FOR ALL RETURNED CHECKS. THERE WILL f I F O RECOVERED +r 1 I _� f °e� k,..X L BE A $20 LATE CHARGE ON ALL INVOICES NOT PAID WITHIN 30 DAYS. ;I TOTALAMOUNT DUE19 R O RECYCLED? , 4 A t �ti ❑ MC ❑VISA [3 AMEX [I DISCOVER Please make checks payable to: 1 U.S. HEATING &AIR CONDITIONING G O RECLAIMED? ♦ l Cont actors License #EC00 E RETURNED TO SYSTEM ® L•• A CI•,I E K # v /1 ,P' 716247 Plumbing Contractors License #CFC057167 Plumbing R ® DISPOSAL Mechanical Contractors License #CMCOS6240 A NON USEABLE — The ` leted a ledge recelPI of my copy. T Mbeenco Q DlsPosaL SATISFACTION I,IARANTEE® /A kz Date: Miami -Dade My Home My Home Text Only Property Appraiser Tax Estimator 19 Property Appraiser Tax Comparison N- Portability S.O.H. Calculator Summary Details: Folio No.: 11-2136-007-0240 Property: 102 NE 107 ST Mailing JAMES T MILLS & Address: ALPHONSO F MARTIN Beds/Baths: 102 NE 107 ST MIAMI loors: SHORES FL Livin Units: 3161-7032 Prnnartu Infnrmafinn- rimary Zone: 1000 SINGLE FAMILY $83,734 ESIDENCE LUC: 0001 RESIDENTIAL - Taxing Authority: SINGLE FAMILY Beds/Baths: /1 loors: 1 Livin Units: 1 d' S Foote e: 1,753 Lot Size: 217.62 SQ FT ear Built: 1940 $84,240 6 52 41 PB 42-33 $50,000/ DUNNINGS MIAMI Legal SHORES EXT NO 3 LOT Description: BLK 208 LOT SIZE $50,000/ 74.940 X 123 OR 18216- 426 0798 4 COC $84,240 4971-1878 07 2006 5 Assassmant Informatinn: ear: 2011 2010 Land Value: $83,734 $83,734 Buildin Value: $154,2971154,42 Taxing Authority: Market Value: $238,031 238,162 ssessed Value: $136,253$134,24 Exemption Information: ear: 2011 1 2010 Homestead: $25,000 1 $25,000 nd Homestead: I YES I YES < Taxable Value Information: Year: 2011 2010 Applied Applied Taxing Authority: Exemption/ Exemption/ Taxable Taxable Value: Value: Regional: $50,0001 $50,000/ $86,253 $84,240 County: $50,000/ $50,000/ $86,253 $84,240 City: $50,000/ $50,000/ $86,253 $84,240 School Board: $25,000/ $25,000/ $111,253 $109,240 Sale Information: Page 1 of 2 Aerial Photography - 2009 0 � 112 ft My Home I Property Information I Property Taxes I My Neighborhood I Property Appraiser Home I Using Our Site I Phone Directory I Privacy I Disclaimer 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 © 2002 Miami -Dade County. All rights reserved. http://gisims2.miamidade.gov/myhome/propmap.asp Legend Property Boundary Selected Property Street Highway \ Miami -Dade County Water N 1ff E 2/23/2012 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. ---ZCOPY OF QUALIFIER'S STATE LIC CARD B. V/ 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 EXEMPTION) 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 BUSINESS NAME: Us � i N e3 '9 mg N M3 1-f i r4 6 BUSINESS ADDRESS: (OZZI b606LAS->�'Vc,l� CITYT�FM/ID�I` a�IWaz SPIZINC-�s STATE FL ZIP CODE BUSINESS PHONE: (AN) 36� - V404 FAX NUMBER (eS 1— CELLPHONE( ) QUALIFIER'S NAME: VNSS e ( 441 L1) Q16 -C's QUALIFIER'S LIC NUMBER: mn 091D 2t4 D E-MAIL ADDRESS (IF APPLICABLE): f;b94'VI 1`ff I N An @ CA1A(, US C • Ch W Created on 3119109 BY MLDV 1 RV 3126109 MLOV r,vv"K CERTIFICATE OF LIABILITY INSURANCEDATE (NIVl/DD/YYY1f) 02/23/2012 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 does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Blackadar Insurance Agency 1436 N. Ronald Reagan Blvd. Longwood, FL 32750 Pat DiPietro CONTACT NAME: Pat DiPietro Pti"�"o 407.831.3832MC No:407.830.4681 E-MAIL ADDRss: PRO UMER C R ID #: INSURER(S) AFFORDING COVERAGE NAICO INSURED US Heating & Air Conditioning Inc 624 Douglas Ave Ste 1402 Altamonte Springs, FL 32714 INSURER A: Southern—Owners Insurance Co 10190 INSURER B: American Economy Insurance Com 19690 INSURER C: Plaza Insurance Company 30945 INSURER D: FFVA Mutual Insurance Company 10385 INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: 12/13 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. INSR LTR TYPE OF INSURANCE ADDL INSR SUBR W111`0 POLICY NUMBER POLICY EFF M/DD POLICY EXP M/DD LIMA A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE T OCCUR X Incls Contractual 06468272677627 01/01/2012 01/01/2013 EACH OCCURRENCE $ 1,000,00 TO RENT DAMAGE ED$ 30O 0O PREMI ES Ea occurrence)� MED EXP (Any one person) $ 10,00( PERSONAL &ADV INJURY $ 1,000,00 X Liability GENERAL AGGREGATE $ 2,000,00( GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X JET X LOC PRODUCTS - COMP/OP AGG $ 2,000,00( $ B AUTOMOBILE X X X LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS 02CE2152213 02/09/2012 02/09/2013 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,00 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ `Per a Iiia DAMAGE $ $ $ C UMBRELLALUIB EXCESS LWB X OCCUR CLAIMS -MADE PXSLBR0001400 01/01/2012 01/01/2013 EACH OCCURRENCE $ 5,000,00 AGGREGATE $ S'000,00 DEDUCTIBLE RETENTION $ $ $ D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y ANY PROPRIETOR/PARTNER/EXECUTIVE f—I OFFICERIMEMBER EXCLUDED? (Mandatory in NIQ If yes, describe under DESCRIPTION OF OPERATIONS below N / A WC8400017 S S 32012 02/25/2012 02/25/2013 X I W RY LIMIUTS ER E.L. EACH ACCIDENT $ 1,000,00( E.L. DISEASE - EA EMPLOYEEI $ 1,000,00( E.L. DISEASE - POLICY LIMIT $ 1 000 00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Sefredule, if more space is required) 1..Cn I im in i C nVLUcn FAX: 305.756.8972 Miami Shores Village 10050 NE 2nd Ave MiaImia 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 p Partri ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD ACORq AGENCY CUSTOMER ID: LOC #: ADDITIONAL REMARKS SCHEDULE Page of AGENCY Blackadar Insurance Agency NAMED INSURED US Heating & Air Conditioning Inc Ste 1402 Altamonte Springs, FL 32714 POLICY NUMBER CARRIER NAIC CODE EFFECTIVE DATE: AUDI I IUIVAL FMCMAIYK, THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORMTITLE:ACORD Certificate of Liability Insurance Garage Liability LTR INSND POLICY NUMBER DATE ffi DD/YYE PDATE (MMM/DDD/YY N LIMITS AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ Automobile Liability INSR ADD L POLICY EFFECTIVE POLICY EXPIRATION LTR INSRO POLICY NUMBER DATE (MM/DD/YY) DATE MMD/YY) B Excess/Umbrella Liability INSR ADD'L POLICY EFFECTIVE POLICY EXPIRATION LTR INSRD POLICY NUMBER DATE (MM/DD/YY) DATE (MM/DD/YY) LIMITS C $ Other Liability INSR POLICY EFFECTIVE POLICY EXPIRATION LTR POLICY NUMBER DATE (MM/DD/YY) DATE W"D/YY) LIMITS © 2008 ACORD The ACORD name and logo are registered marks of ACORD ' + 225 Newbutyport AwAue Altt�monte $prdn0s Al o�S . MoMa3 1 369 Allomonte S rJnO 407-571-8116 BUSINESS TALC RECEIPT Provision: Ordinance No*. 7070-07 #3usinemControl. 000740 k$ustd4jm Asim; U S IMA,T�K -.& AIR 05Nb, INC ARIE KONMR'1M S s p t c an b e r 30, 2012 Business + 624 DOUGLAS AVE 1402 Address: ALTAMbN'TE SYd1M- S FL 32714 RECEIPT NO. CLASS 0 SCRI o ' FEE - PENALTY 12-000882316 CONTRACTORS-HEATIN01 WOR AIR CONDITION $ 120.75 $ 0.04 F2-00095$80 SEMINOLE COUNTY REGULATED $ 45.00 $ 0.00 12.00699561 Z0NTK-AC1}dki-ELEChUCAAlL t12035 $ 0.00 12-0409511 : CONTRACTORS PLUIVlUM.. $ I2i?.?S $ 0.00 Resliictions: OFFICE ONLY NODUTSIDE STORAGE W-ARNI_ ■G. THISDOCU" ISANIpITEDON9EWRITYyfmu MAli g PApEalWQ GDNTgINgsECUa�1Y i1REgs. ,�y■, • DONOTRCCPPTW(l*H=VEWPYWIMEPOSEM�DF-MVMkMM,W. T'E; DOCUMENT FACE 03MTA1NS ASECIMM BACKGFMUND. THE FACE DOMKaA SPECIAL LI)JE . .._.. _... WIM TEXT"CITY OF ALTAMOWE SPRINGS` 9N BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895 — 954-831-4000 VALID OCTOBER 1, 2011 THROUGH SEPTEMBER 30, 2012 DBA: Receipt #:189-8621 Business Name: US HEATING & AIR CONDITIONING INC Business Type. (MEOTHER TYPES CONTRACTOR (CHANICAL CONTRACTOR) Owner Name: RUSSELL L CHILDRES Business Opened:10/31/2008 Business Location: 3911 SW 47 AVE 907 State/Counp/Cert/Reg:CMC056240 NONEXEMPT DAVIE Exemption Code. Business Phone: 954-581-8333 Rooms seats Employees Machines Professionals 10 For Vending Business Only Vwndine Tvee: Tax Amount Transfer Fee NSF Fee Penalty Prior Years Collection Cost I Total Paid 27.00 0.00 0.00 o.00 o.00 0.00 27.00 THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT 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 WHEN VALIDATED 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. Mailing Address: - US HEATING & AIR CONDITIONING INC Receipt #138-10-00005439 3911 SW 47 AVE 907 Paid 07/06/2011 27.00 FORT LAUDERDALE, FL 33312 2011 -2012 Pi Pi 03 T Au 5038639 STATE OF FLOMDA i DEPARTMENT OE BU 88 AND PROFESSIONAL REQQL+ATIOId i C(3I�TSTRUCT MESS LICENSING BOARD SEM moo-nS0om j Wiffiblusal.-WES99 bmR ; • �__ t { 07 1 2010 098180413 CMC05fi240 ) -- — ! The NECI ANICAL COI+ MCTOR �'� Named below IS CERTIFIED :' � ,�• Under the provisions of Chapter ••A89 4S . �' 1 (� Expiration date: AUG 31, 2-012 CHILDRESS, RUSSELL LUTHER ' U S HEATING AND AIR CONDITIONING INC 6 58 illt3UGLAS &%VZ SIE 1102 ALTAMONT'E SPRINGS FG -32714 i CHARLIE CRIST CHARLIE LIE14 GOVERNOR INTERIM SECRETARY WSP AY AS REWIRED BY LAW } This combination qualifies for a Federal Energy Efficiency Tax Credit when placed In service between Feb 17, 2009 and Dec 31, 2011. ..Q.?4 ,• �� �� eI� ra AHRI Certified Reference Number: 3805983 Date: 2/23/2012 Product: Split System: Air -Cooled Condensing Unit, Coll with Blower Outdoor Unit Model Number: 14AJM36 Indoor Unit Model Number: RHLL-HM3821+RCSL-H*3821 Manufacturer: RHEEM MANUFACTURING COMPANY Trade/Brand name: RHEEM 14AJM 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): 37600 EER Rating (Cooling): 13.00 SEER Rating (Cooling): 16.00 * Ratings followed by an asterisk (*) indicate a voluntary cerate of previously published data, unless accompanied with a WAS, which Indicates an involuntary rerate. DISCLAIMER AHRI does not endorse the product(s) listed on this Certificate and makes no representations, warranties or guarantees as to, and assumes no 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 contends 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; copled; 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.ahridirectoryorg, A] Conditioning, Heating, click on "Verify Certificate" link and enter the AHRI Certified Reference Number and the date on and Refrigeration Institute which the certificate was issued, which is listed above, and the Certificate No., which is listed below. 02012 Air -Conditioning, Heating, and Refrigeration Institute CERTIFICATE NO.: 129744921232066871