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MC-14-1273 P Miami Shores Village FEB 0 6 2015 Building Department 10050 N.E.2nd Avenue,Miami Shores, Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20 i BUILDING Master Permit No.' ,/ -/�- /3- PERMIT APPLICATION Sub Permit Nw. —J2_7_3 ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING > M ECHANICAL [:]PUBLICWORKS CHANGE OF [:] CANCELLATION ❑ SHOP I T CONTRACTOR DRAWINGS JOB ADDRESS: 5 /'7 Cn t4E O ST, , City: Miami Shores //�� County: Miami Dade Zip: 33138 Folio/Parcel#: 3�2 —C)I r i,51 () Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): 9,i AsAiq I) Phone#: Address: Mirke Z /n1 �S I_M) &I12AC !C 1) _ ` / City: CAD 0 State: M D • Zip: Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name:Ail- _5"Sk/n S ��L 1 Ll Phone#: :30.S—(may/ /0 y c0 Address: `1 �lofd . City: ���L(� r/ State: 6�'Z' Zip: Qualifier Name: v9ZA VC 2 Phone#: 52j'a/ /b y O State Certification or/Registration#: Jqd 0-3 S y Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: ,,,,VOW*-VVork for this Permit:$ Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration New Repair/Replace ❑ Demolition De ri tion of Work: ! / c.— 9V SR rA 3 A A)� 1/1c.r� iso e Lc _ Specify co or of color thru tile: Submittal Fee$ Permit Fee$ ��J Vl� CCF$ CO/CC$ Scanning Fee V2, Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ (Revised02/24/2014) Y . 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 ELECTRIC, PLUMBING, SIGNS, POOLS, FURNACES,BOILERS, HEATERS,TANKS,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 o a building permit with an estimated value exceeding 2500 the f 9 p applicant must 9$ promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. �zSignature w Signature OWNER or A NT CONTRAC The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this y day of --e Ep ( _ 20 15 by day of �i,6qV,4fy J 20 IS , by r71J6ru0r2 K A s personally known to 2 who is personally known to me or who has produced �L oK as me or who has produced &V A60 , as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: -- Sig Print: 1//-a&t. Print: ,•Spay Pia, ERNESTO RODRIGUEZ Seal: Seal: ;tea°. .`�"'; Notary Public-State of Florida ' %REBECA M.PASTRANA _MY Comm.Expires Sep 16,2015 MY COMMISSION#EE872624 -�,'lF °;' Commission#EE 96605 EXPIRES:F ��° :.•• ebruary o7,2017 Bonded through National Not r APPROVED BY v lans Examiner Zoning Structural Review Clerk (Revised02/24/2014) ,gt►O,�Es Miami Shores Village y� Building Department s c� 10050 N.E.2nd Avenue -� Miami Shores,Florida 33138 Tel:(305)795.2204 0iDp Fax:(305)756.8972 AIR CONDITIONING REPLACEMENT DATA PERMIT NUMBER: MC This form must accompany ALL air conditioning replacement permit applications. Each unit change-out must be on its own data sheet. Multiple units on single sheets are not acceptable. Job Address(where the work is being done):5226 6& 97 37 City: Miami Shores Village County: Miami Dade Zip Code: �13) 3 oe 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 AHRI DATA SHEET REQUIRED Change disconnecting means:YES❑ NO❑ ARHI Sheet Attached:YES NO❑ Contract Attached:YES UNIT BEING REPLACED DATA NEW UNIT MANUFACTURER AHU or PKG.UNIT MODEL# COND.UNIT MODEL# / KW HEAT NOM TONS AHU CU PKG 1)M.C.A AHU CU i,"- 4(6 AHU CU PKG 2)M.O.P AHU OCU "rr AHU CU PKG 3)VOLTS AH OCU 0mel nvr 11 IIT � � PKG UNIT EER/SEER YES REPLACING DUCTS YED NO YES NO REPLACING THERMOSTAT E NO YES NO NEW 4"CONCRETE SLAB YES N YES NO NEW ROOF STAND YES N YES NO NEW RETURN PLENUM BOX / YES CNO 1. Minimum Circuit Ampacity(Wire Size): 2. Maximum Overcurrent Protection (Fuse/Breaker Size):C,G( r, Uo "O 3. Voltage of Circuit(208/240/480): <;*3 4. Size Disconnecting Means: AIPA,,e4 Contractor's Company Name: Ar C— Phone:20;/;X f /0'( 0 State Certificate orRe stration No. y Certificate of Competency No. Signature Date: ' S/1�7 Qua e gnature) (Revised02/24/2014) This combination qualifies for a Federal Energy A got HE WRILI CERTIFIED" �1 Efficiency Tax Credit when placed in service www.ahridirectory.org between Feb 17,2009 and Dec 31,2013. Certificate of Product Ratings AHRI Certified Reference Number: 6528152 Date: 11/18/2014 Product: Split System: Air-Cooled Condensing Unit, Coil with Blower Outdoor Unit Model Number: DX16SA0601A* Indoor Unit Model Number: ASPT60D14A* Manufacturer: DAIKIN MANUFACTURING COMPANY, L.P. Trade/Brand name: DAIKIN Series name: DX16SA Manufacturer responsible for the rating of this system combination is DAIKIN MANUFACTURING COMPANY, L.P. 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): 54000 EER Rating(Cooling): 13.00 SEER Rating(Cooling): 16.00 IEER Rating(Cooling): 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 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; I JM 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. AIR-CONDITIONING.HEATING. CERTIFICATE VERIFICATION &REFRIGERATION INSTITUTE The information for the model cited on this certificate can be verified at www.ahridirectory.org,click on"Verify Certificate"link ee make life better" 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 at bottom right. 7 "–�– —- - ©2014 Air-Conditioning,Heating,and Refrigeration Institute CERTIFICATE NO.: 13066079079 67770791793 S ORE& Miami Shores Village Building Department „s u,,, 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel:(305)795.2204 01 Fax:(305)756.8972 AIR CONDITIONING REPLACEMENT DATA PERMIT NUMBER: MC This form must accompany ALL air conditioning replacement permit applications. Each unit change-out must be on its own data sheet. Multiple units on single sheets are not acceptable. Job Address(where the work is being done): `� / N City: Miami Shores Village County: Miami Dade Zip Code:,3 139 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 AHRI DATA SHEET REQUIRED Change disconnecting means:YES❑ NO❑ ARHI Sheet Attached:YES� NO❑ Contract Attached:YES UNIT BEING REPLACED DATA WNEWUNIT MANUFACTURER kVIIIA/1AHU or PKG. UNIT MODEL# +' COND.UNIT MODEL# KW HEAT NOM TONS AHU CU AKG 1)M.C.A AHU5 CU' ,3PKG AHU CU PKG 2)M.O.P AHU CU PKG AHU CU PKG 3)VOLTS AHU 0 PKG PKG UNIT / PKG UNIT EER/SEER YES NO REPLACING DUCTS YES NO YES NO I REPLACING THERMOSTAT NO YES NO NEW 4"CONCRETE SLAB Y NO YES NO NEW ROOF STAND YES YES NO NEW RETURN PLENUM BOX �,/`� YES NO 1. Minimum Circuit Ampacity(Wire Size): �!& - e3 H'f/ 53 W/v 2. Maximum Overcurrent Protection (Fuse/Breaker Size): !!!& ` i 3. Voltage of Circuit(208/240/480): 4. Size Disconnecting Means: laze a. Contractor's Company Name: k- -� < [_ 1,C L- Phone: -�bd'l COY 0 State Certificate or R istration No. 1JWQ 335 V_Certificate of Competency No. Signature Date: J u i e signature) (Revised02/24/2014) rectory.9A NO Onal CERTIFIED" Certificate of Product Ratings AHRI Certified Reference Number: 6524107 Date: 2/5/2015 Product: Split System: Air-Cooled Condensing Unit, Coil with Blower Outdoor Unit Model Number: DX13SN0181A* Indoor Unit Model Number:ASPT24B14A* Manufacturer: DAIKIN MANUFACTURING COMPANY, L.P. Trade/Brand name: DAIKIN Series name: DX13SN Manufacturer responsible for the rating of this system combination is DAIKIN MANUFACTURING COMPANY, L.P. 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): 17600 EER Rating(Cooling): 12.00 SEER Rating(Cooling): 14.00 IEER Rating(Cooling): 'Ratings followed by an asterisk(")indicate a voluntary rerate of previously published data,unless accompanied with a WAS,which indicates an involuntary rerate. DISCLAIMER AHRI does not endorse the product(s)listed on this Certificate and makes no 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 1 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. AIR-CONDITIONING.HEATING. CERTIFICATE VERIFICATION &REFRIGERATION INSTITUTE The information for the model cited on this certificate can be verified at www.ahridirectory.org,click on"Verify Certificate"link rve make life beitei°" 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 at bottom right. ; '- -- - --- �-- ©2014 Air-Conditioning, Heating,and Refrigeration Institute CERTIFICATE NO.: 130676389348420424- AIR SYSTEMS AC LLC AIR SYSTEMS AC LLC Proposal 4698 NW 133 St. O alocka Florida 33054-4406 : (305)681-1040 01/21/2015 17186 asacservice@gmail.com -— -- http://www.airsystemac.com ov21/zols ABOURIZK-ASSAD RESIDENCE 576 NE 97 ST. MIAMI SHORES,FL. 33138 i ORONI INC. GERALD F.DE MARCO a F: -, - T Acpvtty .Quarrtiiy. Rate< r A\rrtnl�# 01/21/2015 INSTALLATIO INSTALLATION OF NEW CENTRAL AIR 1 ! 11,890.00 11,890.00 N CONDITIONING SYSTEMS WITH DUCT WORK, REFRIGERATION LINES,VENTILATION, I PERMITTING AND LABOR.AS PER PLANS 101/21/2015 EQUIPMENT * l j O.W 0.00 DAIKIN 5 TON 16 SEER SPLIT SYSTEM CONDENSER MODEL#DX 16SA0601 j A/H MODEL#ASPT60D 14 i HTR MODEL# 10 KW (DAIKIN 1.5 TON 14.5 SEER SPLIT SYSTEM CONDENSER MODEL#DX13SN0181 A/H MODEL#ASPT30C 14 I * j I 12 YEARS WARRANTY ON PARTS I YEAR ON LABOR 01/21/2015 EQUIPMENT REFRIGERATION LINES,A/H STANDS,CONCRETE! 1 0.0010.00 SLAP,RIGID FIBER BOARD,FLEX,CAMS, GRILLS,VENTILATION FOR KITCHEN, j BATHROOMS EXHAUST,DRYER VENTILATION 01/2]/2015(FPL FPL REBATE ONLY FOR 5 TON UNIT. l -306.001 -306.00 !REBATE:FPL 154,000-57,000 FPL INCENTIVE REBATE IS PAID BY REBATE 4.5 FLORIDA POWER AND LIGHT.IF FOR ANY ! ;TON 16.0-16.9 REASON FPL DENIES PAYMENT CUSTOMER IS RESPONSIBLE FOR FULL PAYMENT. 14.5 SEER DOES NOT QUALIFY 01/21/2015(PLAN INFO. DATE: 10/22/13 SCALE: 1/4"= 1'-0"PROJECT NO: 1 0.00; 0.00 i 1329 DRAWING NO:M-1,M-2 j jContinue to the next page I � AMANA,CARRIER,DAIKIN,FHP,MAYTAG,NUTONE,TRANE,RHEEM,GOODMAN, FAX:305-681-1080,www.airsy3temac.com Page 2 of 3 {duan 01/21/2015 PAYMENT 10%TO START$1,158.40 _ 1 0.00' 0.00 30%FOR ROUGH$3,475.20 140%FOR UNITS$4,633.60 110%FOR GRILLS 1,158.40 10%AFTER FINAL$1,158.40 101/21/2015 EXCLUSIONS (EXCLUSIONS FOR THIS PROPOSAL:PERMIT I 0.00 0.00 (COST AND PROCESSING,ELECTRICAL POWER i (AND CONTROL WIRING.FIRE STOPPING OR 'PATCHING OF HOLES.HOLES IN CONCRETE I WALLS.INSULATION OF ATTIC OR WALLS. jCONCRETE SLAB.ITEMS NOT INCLUDED.. i i I I II I �i I Continue to the next page I i j j i AMANA,CARRIER,DAIKIN,FHP,MAYTAG,NUTONE,TRANS,RHEEM,GOODMAN, FAX:305-681-1080,www.airsystcmac.com 1 Page 3 of 3 01/21/2015 LEGAL The complete job will be installed in a workmanlike I 0.00 0.00 CONTRACT manner with guaranteed against mechanical defects for a period of one(1)year unless otherwise stated.Five(5) years factory warranty on compressor,unless otherwise stated. Installations shall be made in accordance with local codes governing such an installation. It is agreed and understood that title to the above mention equipment is to remain and owned by Air I 'Systems A/C LLC till final payment is paid in fiill.In case the account becomes delinquent or pass due,final j inspection will only be pass after final payment; purchaser is responsible for all cost of collections, jincluding all attorneys and administration,collection agency,court cost,sheriff fees. Interest will be at the rate of 1.5%per month,as may be necessary in order to effect collection of this account,(This includes bad checks for insufficient funds,close accounts,etc. � I It is further understood and agreed that immediately I upon delivery of equipment of any of the above equipment,whether instal led or not,the purchaser shall be liable for any damage done to the same for any cause whatsoever,excepting acts of the vendor or his employees.All agreements are contingent of strikes accidents,or delays of any kind beyond our control.We I are not responsible for water leaks to to roof penetration, Owner or Contractor must seal all penetrations done by us and cannot hold us responsible for water damages. lin no way shall us the contractor(Air Systems A/C LLC} for any of our employees be liable speculative or subsequent damages arising from use of,or failure of the equipment to operate properly. I Air Systems A/C LLC is not responsible for damages to i I I floors,walls,cabinets or ceilings unless cause by gross negligence vendor or its employs. � � I The price as stated above will expire Thirty(30)days from the date the proposal is delivered. When executed by both parties,this proposal becomes a 'legal binding contract. LICENSE AND INSURED C.A.C.033544 THANK YOU FOR THIS OPPORTUNITY TO SERVE YOU Totals 7�' Accepted By �/2-///jA :p led Date LIC AMANA,CARRIER,DAWN,FHP,MAYTAG,NUTONE,TRANE,RHEEM,GOODMAN, FAX:305-681-1080,www.airsysteinac.com . r FEB 0 6 2015 f NADIA& REDA ASAAD 576 NE 57 ST �-- MIAMI SHORES, FL 33138 January 7, 2015 Mr,Alfonso Correa PBC Air Conditioning 37 W Pine Tree Ave., Lake Worth, FL 33467 Re:Notice of Default and Termination relative to certain contract("Contract) by and between Mr.&Mrs.Reda and Nadia Asaad (Owners)and Stilcon Construction ("Stilcon")for the certain project at the property with a post office address of 576 NE 04 St.,Miami Shores, Florida 33138("The Project") Dear Mr.Correa: I write to notify you that Stilcon has breached and defaulted under the terms of the Contract and accordingly that contract has been terminated.Since you are listed In the city as a subcontractor under that Master Permit we are hereby notifying you that we are also terminating all contracts with the subcontractors related to this job address. Based on the foregoing neither Stilcon or its agents are to enter the Project Site or perform any other matter relative to the Project and must formally communicate to any party inquiring(including but not limited to a City official or inspector)that your company has been terminated from the Contract.relative to the Project and that your Company(nor you or anyone else from your Company) does not have any further right to enter the real property. Lastly,I enclose the original Change of Contractor/Architect Form. Please sign and have it notarized and mailed back the earliest possible to the following address—2385 Arch Creek Dr, North Miami,FL 33181 Thank you for your kind cooperation in this matter. Sincerely, Nadia&Reda Asaad )f ri u CERTIFIED MAIL, RECEIPT , .0 ,n (Varnestic Alail Oniy,'No insurance Coverage Provided) Co r For delivery Inlormation vWt our wabsite at W. -P. .11, GRATIGNY BRANCH' NIANI, Florida 331689998 Pns:aoa a $0.44 0112 1158540112 -0097 01/1412015 (800)275.8777 12:46:22 PN o CertHiedFee $3.30 07 m ri Sales Receipt _ o0 1 nenmaocturFa�di *`.. Product Sale Unit Final C3 oiaff,aeS $2.70 > o Description Otr Price Price Aest&W0°liv+n Poo $O.QO w `' .,�._.._�......_-_.._.._.._.._.. p lEndomword RaqufrDO LAKE WORTH FL 33467-4832 Zona-2 $0.49 Ncs 7ouAPae+xgeaFe" ,$ $6.44 101/1< '1015 ,f First-Class Nail Letter, m , 0.90 oz. a -- Expected Delivery. Fri 01/16115 rq f!� Return Rcpt (Green Card) $2.70 © S14W,' 1Q'a @@ .- w Certified $3.30 rPoemrnw USPS Cirrtified Nail #: ` 3 70133020000108994858 K,iJQA+1 FL Issue Postage: $6.49 FORT LAUDERDALE FL 33312-2656 $0.49 Zona-1 U.S.Postal Service First-Class Nail letter CERTIFIED . ■ 0.70 oz. Ln, am Expected Delivery: Fri 01/16/15 n Return Rcpt (Green Card) $2.70 co ONE @0 Certified $3.30 y&RAU 1 m T USPS Certified Nail #: o- 70133020000108994865 tr# Paaapa 5e $0.47 01 Issue Postage: $6.49• o c.ammo Pei $3.30 (! Relum RewWf Pee �.:' PbeanHrk Total: $12.98 C3 renousama tRagwna> $2.70 Hen FkeaiclW[MNyary Pas Paid by; ru p lEndorsoareMNaWhedl $ MasterCard $12.98 Account #: XXXXXXXXXXXX5207 m Tow Pospoea Faaa $ $b" bQ n"2015v Approval #: 74567K Transaction #: 167 M ' 23 903520641 a 3o-ewtAptNm �J�'15 1I .......... N o PO soxlJO l{MA..-�.w °rt),17 t,. @@ For tracking or inquiries 90 to i9<ysaie:zrki 1 """ USPS.com or call 1-800-222-1811. ".'Ie (Z Order stamps at usps.con/shop or call 1-800-Stamp24. Go to USpe.CoelClickriship to print shipping labels vith postage. For other information call 1-800-ASK-USPS. WAAAWAA#AAWw%*WAAW#%WAWA#*%AxAW##**WW#%# Get your ■ail when and where you want it with a secure Post Office Box. Sign UP for a box online at usps.com/poboxes. A*AWAAAAAAAA*W*AA*AAw%A#WAAWA#A*AWAAWA#w AAA*#ANA*AWw*##AWAA*%AW AWAW*#Art#WAAkAA#* 8111#: 1000306174599 Clerk: 07 All sales final on stamps,and postage Refunds for guaranteed services only Thank you for your business HELP US SERVE YOU BETTER TELL US ABOUT YOUR RECENT POSTAL EXPERIENCE Go to: https;//postalexperisnce.com/Pos Or scan this code with your mobile device. 0 1 � a YOUR OPINION COUNTS Customer Copy USPS.comb-USPS Tracking"A English Customer Service USPS Mobile Register I Sign In JiEvuspscom. ...................... ...... ........... g T11 Customer Service> USPS Trackin Have questions?We're here to help. Tracking Number 70133020000108994865 Expected Delivery Day-Friday,January 16,2015 Product & Tracking Information Available Actions Postal Product: Features: First-Class Mail® Certified Mail" Return Receipt Text Updates DATE&TIME STATUS OF ITEM LOCATION Email Updates January 15,2015,210 pm Departed USPS Origin Facility MIAMI,FL 33152 Y£- 20 0 January 14,2015,11:18 pm Arrived at USPS Origin Facility MIAMI,FL 33152 January 14,2015,12:44 pm Acceptance MIAMI,FL 33168 Track Another Package Tracking(or receipt)number Track It HELPFUL LINKS ON ABOUT.USPS.COM OTHER USPS SITES LEGAL INFORMATION Contact Us About USPS Home Business Customer Gateway Privacy policy Site Index Newsroom Postal Inspectors Terms of Use FAQs USPS Service Updates Inspector General FOIA Forms&Publications Postal Explorer No FEAR Act EEO Data Government Services National Postal Museum Careers Resources for Developers Copyright 0 2015 USPS.At Rights Reserved. https'/Itools.usps.com/go/TrackConfirmAcdon.achon?tRef--fUllpa,qe&tLc=1&teXt28777=&tLabels=70133020000108994965 1/2 Miami Shores VillageRE FBY: T�'F.� Building Department 7 20 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 i Tel:(305)795.2204 Fax: (305)756.8972 T -- INSPECTION'S PHONE NUMBER:(305)762.4949 FBC 20 BUILDING Permit No. ?I(— PERMIT ZLPERMIT APPLICATION Master Permit No. m CA` — (1-21-1'� Permit Type: MECHANICAL JOB ADDRESS: 1�ri 6 N E 91 ''�' ! 4 rk e_+ City: Miami Shores County: Miami Dade Zip: -33 t 3 Folio/Parcel#: 11 - 3d-04 - 00 - 1 -510 Is the Building Historically Designated:Yes NO Flood Zone: OWNER:Name(Fee Simple Titleholder):&'0 A ASAA 0 1 N P u iA ft k n uU' j LIC Phone#: 0-40) L) 9P --F(; 4 I Address: 3 --701 7 u rJ es- S r 4 n P_ 0 c"A City:�, y �i C h S State: rn 1) Zip: 010 81 Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: P��- A%r (condi 4ion(nq LL(._. Phone#: 5 4'I (a 76 ( 3 Address: 3 W 17� -['r•C r. A,.j en%Jr- City: 1-Ake W e'rA-h State: FL_ Zip: 3547 Qualifier Name: fa 1�yyis& Ger a S` Phone#: S State Certification or Registration#: C.! () (P Certificate of Competency#: Contact Phone#: Email Address: DESIGNER:Architect/Engineer: Phone#: Value of Work for this Permit:$ Square/Linear Footage of Work: Type of Work: ❑Addresss ❑Alteration ONew Wl�tepair/Replace ❑Demolition Description of Work: Pep(4ce S ji S,fiG I N IYS%drn ce . Submittal Fee$ Permit Fee$ ' CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Bond$ Notary$ Training/Education Fee$ Technology Fee$ Double Fee$ S Structural Review$ TOTAL FEE NOW DUES'_ `��j� 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 COM ENCEMENT:' Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Signa Owner or Agent Contractor The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of De-C ,20 G,by a l-I day of Apr%'k %14x,20 4,by k 1 fon So Co rrCct who is personally known to me or who has produced who is personally known to me or who has produced (�Q15 �Ce11lgZAs identification and who diidd ath. as identification and who did take an oath. NOTARY PUBLIC: "';�� .•...,. �ir • NOTARY PUBLIC: y ares ••.�+� a�,. �:;' NNCOLEWM SMITH MY COMMISSION t EE 133009 �' 0% ,A o EXPIRES: ber 27 2015 Si kt— .0 ;� �u o i C3 Sign: SepMm Print: Gi✓��, �E( mQ± Print: IL My Commission Expires: I ZI�3 1�` t5 ��'� r�e�::'f,o�;r' My Commission Expires: 9 a7 I I J APPROVED BY Plans Examiner zoning Structural Review Clerk (Revised3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) yNOREs Gam! Miami Shores Village sell ..... �- Building Department 10050 N.E.2nd Avenue �ORIDP' Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 AIR CONDITIONING REPLACEMENT DATA PERMIT NUMBER: MC RC,13 -c)-7Co 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): 5-74 1' r 1'7++% Sfiret- City: Miami Shores Village County: Miami Dade Zip Code: 3 3 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 ARI(AHRI)DATA SHEET REQUIRED , Change Disconnecting means:YES [�]'NO❑ ARHI Sheet Attached:YES[Z//NO❑ Contract Attached:YES [� UNIT BEING REPLACED DATA NEW UNIT MANUFACTURER ANttw> 9,n\Vem AHU or PKG.UNIT MODEL#4Wft- 9,AO L, - o 030 COND.UNIT MODEL# RtQ0 , 3(Qa1A KW HEAT to 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 / / PKG UNIT / / EER/SEER is . 5- YES NO REPLACING DUCTS -YEW NO YES NO REPLACING THERMOSTAT YES NO YES NO NEW 4"CONCRETE SLAB ES N YES NO NEW ROOF STAND YES NO E YES NO NEW RETURN PLENUM BOX NO 1. Minimum Circuit Ampacity(Wire Size): 2. Maximum Overcurrent Protection(Fuse/Breaker Size): 3. Voltage of Circuit(208/240/480): a o I a 3 D — \ — (Op 4. Size Disconnecting Means: Contractor's Company Name: tk�on��•t, LLC- Phone: 5-W- "f- d! S State Certificate or Registration N. C A(.-aS(o 935— Certificate of Competency N. Signature �&� Date: I>//S (Qualifiers signature only) (JWV 6716LYWS OM 34W MY CAC056935 PROPOSAL Date: 11/13/2013 Name: Abourizk-Assad Residence Job Site: 573 N.L. 9' St., Miami FL 33138 t Jnits Description Total 1 - 2 1/2 Tons *Remove and haul current units. 1 — 3 Tons *INSTALL A TWO NEW A/C SYSTEMS AS PER PLAN AND PER FLORIDA BUILDING CODE Work & *ALL materials and accessories will be used as indicated per Materials plans. Use ductwork R-6 and flexible duct as per code. Install &verify CFM as per design and plans. Install flow switch in principal and auxiliary line drain as per Florida Building Code. Thermostat *Install new Thermostat for each unit Warranty *Warranty 10yrs on all parts and l 0yrs on compressor * lyr Labor Warranty *TOTAL* *Total Amount is $4,500.00 Terms & Initial Deposit Required (50%) - Upon 1St inspection (25%) - after $4,500.00 Conditions the final inspection the remainder balance of (25%) is due. `Please feel free to contact us with any additional questions X Acceptance 'DtV1 lS _ X951n3, 24/7 Air Conditioning LLC. 37 W. Pine Tree Ave., Lake Worth, FL 33467 STATE OF FLORIDA ,� , DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 CORREA,ALFONSO A PBC AIR CONDITIONING LLC 814 VALLEY FORGE RD WEST PALM BEACH FL 33405 Congratulationsl With this license you become one of the nearly 1 one million Floridians licensed by the Department of Business and ; Professional Regulation. Our professionals and businesses range STATE OF FLORIDA from architects to yacht brokers,from boxers to barbeque restaurants, DEPARTMENT.OF BUSINESS AND and they keep Florida's economy strong. PROFESSIONAL REGULATION j Every day we work to improve the way we do business in order to CAC056935 ' ISSUED:04/17/2014 serve you better. For information about our services,please log onto Tr, www.myfloridalicense.com. There you can find more information CERTIFIED AIR COND:CONTR about our divisions and the regulations that impact you,subscribe CORREA,ALFONSO A�", to department newsletters and learn more about the Department's PBC AIR CONDITIONING initiatives. Our mission at the Department is:License Efficiently,Regulate Fairly. We constantly strive to serve you better so that you can serve your , IS CERTIFIED under the provisions or Ch.4841 FS. customers. Thank you for doing business in Florida, Me•AUG 31 2014 LIQV7000004 and congratulations on your new license! Exp"`i'^ DETACH HERE RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD i I I CAC056935 The CLASS B AIR CONDITIONING CONTRACTOR ;.. Named below IS CERTIFIED Under the provisions of Chapter 489 FS. qW Expiration date: AUG 31,2014 CORREA,ALFONSO A PBC AIR CONDITIONING LLC 37 W PINE TREE AVE LAKE WORTH FL-33467 �`�._' ''►`N ISSUED: 04/17/2014 DISPLAY AS RFOI uRFn Rv i ew SFo a L1404170OW854 Generated by CarnScanner A4'' CERTIFICATE OF LIABILITY INSURANCE DATE(MMfDD/YYYY) 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 CONTACT Sardine Insurance PHONE (561)439 0668 ac No: (561)964-3495 2535 Forest Hill Blvd. E-MAIL sardina@)bellsouth.net W.Palm Beach,FL 33406 INSURERS AFFORDING COVERAGE NAIC# Phone (561)439-0668 Fax (561)9643495 INSURER A: Mapfre insurance INSURED INSURER B: PBC Air Conditioning LLC INSURER C: 37 W Pine Tree Ave INSURER D: Lake Worth,FL 33467 (561)670-1636 INSURER E: 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. ILNTRR TYPE OF INSURANCE ADD UBR POLICY NUMBER MWDD EFFCY POLICYMW Cp�Y LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000.00 COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTEDPREMISES a occurrence $ 100.000.00 A ❑ ❑ CLAIM&MADE 0 OCCUR N N 4250130013388 05/09/2014 05/09/2015 MED EXP(Any one person) $ 5,000.00 F] PERSONAL&ADV INJURY $ 1,000,000.00 ❑ GENERAL AGGREGATE $ 2,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000.00 R] POLICY ❑ PRC- ❑ LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea aaident § ❑ ANY AUTO BODILY INJURY(Per person) $ ❑ AUL N� ❑ AUTO LED BODILY INJURY(Per accident) $ ❑ HIRED AUTOS ❑ AUTOS PROPERTY DAMAGE $ Per acciden ❑ UMBRELLA LIAB [—]OCCUR EACH OCCURRENCE $ ❑ EXCESS LIAB ❑CLAIMS-MADE AGGREGATE $ DED 0 RETENTION$ $ WORKERS COMPENSATIONWC STATU OTH- AND EMPLOYERS'LIABILITY Y/N IT11 ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑N f A (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT 1 $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Addttional Remarks Schedule,If more space is required) Air Conditioning Service. CERTIFICATE HOLDER CANCELLATION Miami Shores Village Bldg Dept 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 TH POLICY PROVISIONS. Miami Shores,FL 33138 A " AUTHORIZED EP E TryE 988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105)QF The ACORD nam and logo are registered marks of ACORD Producer Signature Tax Detail Page 1 of 1 Anne M.Gannon A.-4 e C^` °` Constitutional Tax Collector A CONSTI}UTIO.A,TAX COLLECTOR �' Serving Palm Beach County ., rr:.l,..s.,�,��L�,v,.�� 9 P.O.Box 3353 Serving tiWest Palm Beach,FL 33402-3353 Account Information LBTR Number Tax Type Status 201363645 Business Tax Active Mailing Address: Location Address: ROJAS SANCHEZ VLADIMIR 37 W PINE TREE AVE 37 W PINE TREE AVE LAKE WORTH , FL 33467 LAKE WORTH , FL 33467 Business Detail Business Name: PBC AIR CONDITIONING LLC Tax Year: 2014 Trade Name: PBC AIR CONDITIONING LLC License Number: 201363645 Phone Number: 561-670-1636 Lic. Status: Active New Business: 08/23/2013 Certificate: Business Type: ADMINISTRATIVE OFFICE (56-0001 ) Cert, Issued: 04/18/2014 Number of Units: 1 NAICS: 56-0001 Memo: REQUIRED: SUBMIT CURRENT VALID COPY OF CILB OR DBPR STATE CERTIFICATION, LICENSE, OR EXEMPTION FOR RENEWAL Tax Information Bill Number Due Date Bill Year Tax Penalty/Fee Interest Total Due B40228574 9/30/2013 2014 $0.00 $0.00 $0.00 $0.00 Total Due: $0.00 $0.00 $0.00 $0.00 Tax Payment Bill Bill Receipt Amount Last Paid Paid By Year Number Number Paid 2014 B40228574 U14.457079 $1.00 4/18/2014 PBC AIR CONDITIONING LLC 2014 B40228574 U13.710267 $33.00 8/23/2013 LANIA ROJAS httD://taxcollectorobc.manatron.com/TabsBusinessTax/AccountD... 5/5/2014 OR ♦ QN 1932 mail Miami shores Village Building Department �0R1Dp 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Notice to Owner - Workers' Compensation Insurance Exemption Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05 allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to obtaining a building permit. Pursuant to the Florida Division of Workers' Compensation Employer Facts Brochure: An employer in the construction industry who employs one or more part-time or full-time employees, including the owner, must obtain workers' compensation coverage. Corporate officers or members of a limited liability company (LLC) in the construction industry may elect to be exempt if: 1. The officer owns at least 10 percent of the stock of the corporation,or in the case of an LLC,a statement attesting to the minimum 10 percent ownership; 2. The officer is listed as an officer of the corporation in the records of the Florida Department of State,Division of Corporations;and 3. The corporation is registered and listed as active with the Florida Department of State,Division of Corporations. No more than three corporate officers per corporation or limited liability company members are allowed to be exempt. Construction exemptions are valid for a period of two years or until a voluntary revocation is filed or the exemption is revoked by the Division. Your contractor is requesting a permit under this workers' compensation exemption. In these circumstances, Miami Shores Village does not require verification of workers' compensation insurance coverage from the contractor's company. Therefore,you may be personally liable for the worker compensation injuries of any person allowed to work under this permit Please check with your insurance carrier since most property insurance policies DO NOT cover this type of liability. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Owner Contractor Print Name: Print Name: Sn (`rc1 Signature: Signature 4 . ti°`�. NME W.M.SW1H �¢N::� k rw.W.M.SMITH MY UNMISSIINI t EE 133109 State of Florida * 0* State of Florida MY SpA1M15SlON EE 133109 Count of Miami-Dade EXPIRES:SepEember27,2115 ) '� County ) '� ,� �pdd � ryg� County of Miami-Dade) +a� g �Y%Mt Sworn to and subscribed before me t1 is OL�f h Sworn to and subscribed before day of Wo, 20 day of Mkv 20 `{ By_ iii= By /� (SEAL) (SEAL) Type of Identification produced Type of Identification produced PLEASE CUT OUT CARD BELOW AND RETAIN FOR FUTURE REFERENCE IMPORTANT STATE OF FLORIDA Pursuant to Chapter 440.05(14),F.S.,an officer of a corporation DEPARTMENT OF FINANCIAL SERVICES who elects exemption from this chapter by tiling a certificate of election under this section may not recover benefits or DIVISION OF WORKERS'COMPENSATION F compensation under this chapter. CONSTRUCTION INDUSTRY EXEMPTION O CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA L Pursuant to Chapter 440.05(12),F.S.,Certificates of election to !. WORKERS'COMPENSATION LAW D be exempt...apply only within the scope of the business or trade EFFECTIVE DATE: 5/152013 EXPIRATION DATE: 5/15/2015 listed on the notice of election to be exempt. PERSON: ROJAS VLADIMIR !H Pursuant to Chapter 440.05(13),F.S.,Notices of election to be FEIN: 462751762 E exempt and certificates of election to be exempt shall be BUSINESS NAME AND ADDRESS: R subject to revocation if,at any time after the filing of the notice PBC AIR CONDITIONING LLC E or the issuance of the certificate,the person named on the notice or certificate no longer meets the requirements of this j section for issuance of a certificate.The department shall revoke 37 W PINE TREE AVE a certificate at any time for failure of the person named on the LAKE WORTH FL 33467 certificate to meet the requirements of this section. i SCOPES OF BUSINESS OR TRA !HEATING,VENTILATION, AIR-CON D DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 07-12 QUESTIONS?(850)413-1609 4&1