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MC13-2711 Miami Shores Village 4 r kood Building Department RMCMVETT 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 DEC 0 3 2013 Tel: (305)795.2204 Fax: (305)756.8972 INSPECTION'S PHONE NUMBER: (305)762.4949 BY• FBC 20 B LDING Permit No. 22 —7 I PERMIT APPLICATION Master Permit No.MC I J� 2 [ ) l Permit Type: MECHANICAL JOB ADDRESS: �f (�t- I(7 City: Miami Shores County: Miami Dade Zip: 3 I g Folio/Parcel#: Is the Building Historically Designated: Yes NO Flood Zone: OWNER:Name(Fee Simple Titleholder):,Tcnn, f eryi 1 Phone#: Address: 5 N t 6 �_1 f C-`P City: 1'11 i C Ni-v �Yl(`s( f S State: (_ Zip: l � � Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: C V#/V Phone#: xr 6—6 X �1 3 ilr Address: a /ve 1? S City: /V �� ;1-&/ State: — Zip: ,� 16 Qualifier Name: o S,' r Phone#: State Certification or Registration#: C-�q-C z c/ S9 741 Certificate of Competency#: Contact Phone#: Email Address: )Wive r 1�-G (1'- /t'fl5t/iL •��� � DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ �sj a 9 Square/Linear Footage of Work: Nl- Type of Work: ❑Addresss ❑Alteratio/n ❑New 6lJRepair/Replace ❑Fu olition Descri tion of Work: /� � G'1������ 77 �Le f 't'GL�At � Submittal Fee$ C) Permit Fee$ CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Bond$ Notary$ Training/Education Fee$ Technology Fee$ Double Fee$ Structural Review$ TOTAL FEE NOW DUE$ f"�� 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$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be r ed. Signature Signature Owner or Agent / Contractor The foregoing instrument was acknowledged before me this �U The foregoing instrument was acknowledged before me this,/) V day of � JV 20 1.3 ,by Movo Lowmal1 day of 20 ,by /) S 2 who is p rsona ly known me or who has produced who isersonally known me or o has produced As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: ;�.►'►.r: SARA MONTERO MY COMMISSION#EE022532 Sign: Sign: EXPIRES September 01,2014 Prim ^ Print: 01 l OW*"EE 181581 jY C'6dnMl SSIOM#EE 181597 My Commission Expires: EXPIRE$;January 19,2016 f January 19,2016 + kidW B*dIt"1110_0 !!!�:u Budget Notary Services "O APPROVED BY Plans Examiner Zoning Structural Review Clerk Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) a SNORE s Miami Shores Village Building Department Ro may` 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 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): 7 S N 45 d / 7— City: City: Miami Shores Village County: Miami Dade Zip Code: a'; lak 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 V NO❑ ARHI Sheet Attached:YES 1� NO❑ Contract Attached:YES UNIT BEING REPLACED DATA CNEW UNIT s MANUFACTURER . /L N C AHU or PKG. UNIT MODEL# —/5l COND.UNIT MODEL# E KW HEAT < NOM TONS AHU CU PKG 1 M.C.A AHU CU PKG AHU CU PKG 2 M.O.P AHU CU PKG AHU CU PKG 3 VOLTS AHU CU PKG PKG UNIT I I PKG UNIT EER/SEER YES NO REPLACING DUCTS YEZ., 4uo) YES NO REPLACING THERMOSTAT 0 YES NO NEW 4"CONCRETE SLAB NO YES NO NEW ROOF STAND ES YES NO NEW RETURN PLENUM BOX YES 1. Minimum Circuit Ampacity(Wire Size): 2. Maximum Overcurrent Protection(Fuse/Breaker Size): 3. Voltage of Circuit(208/240/480): —410 4. Size Disconnecting Means: 3 0 11 M e Contractor's Company Name: - T"P e e- /gin ` Phone: Ifo"6 '3-i 7 3 State Certificate or Registration N C-A-C- NY 7ef Certificate of Competency N. Signature Date: 0 / ali JOSE C. YANES AIR CONDITIONING & APPLIANCES SERVICES, INC. 1021 NE 132nd STREET, NORTH MIAMI; FL 33161 CONTRACT LICENSED& INSURED CELL: 786.683.9345 FAx: 305.895.3565 PROPOSAL O DATE WORK TO BE PERFORMED AT- NAME ADDRESS ADDRESS CITY,STATE CITY STATE DATE OF PLANS PHONE NO ARCHITECT We hereby propose to furnish the materials and perform the labor necessary for the completion of _ — e�F © 7— jte t C pe G� All material is guaranteed to be as specified, and the above work to be performed in accordance with the drawings and specifications submitted for above work an5dagmipleted in a sub tantial workmanlike manner for the sum of: Dollars with payments to be as follows Any aftmo r a dsvuWn Mom above VOCAc8bMs Xwdwg eWa COS'' Respectfully submitted w•W eceaAed 0*We^wrftn MW MW vA became an ex"large over anaabove M estlna.. As apresnrents oor*M"Upon ab*". ao wwft.m ds*s Wyant o aaroot. Per Note-This proposal may be withdrawn by us if not accepted within days- ACCEPTANCE OF PROPOSAL ACCEPTANCE OF CONTRACT The above prices,specifications and conditions are satisfactory and are hereby accepted. Y�au ed to do the work a peciFied. yments will be made as outlined above. / SIGNATURE DATE SIGNATURE ` Nov 22 2013 07:12PM Florida Cooling #162 3055911952 page 1 A"IMP This combination qualifies for a Federal Energy sm Efficiency Tax Credit when placed in service ad CERTIFIED,. between Feb 17, 2009 and Dec 31,2013. Certificate of Product Ratings AHRI Certified Reference Number:4058662 Date: 11/2212013 Product:Split System:Air-Cooled Condensing Unit, Coll with Blower Outdoor Unit Model Number: NXA6420KA* Indoor Unit Model Number. FXM4X48**A* Manufacturer:TEMPSTAR Trade/Brand name:16 SEER N SERIES R410A AC Manufacturer responsible for the rating of this system combination is TEMPSTAR Rated as follows in accordance with AHRI Standard 2101240-2008 for Unitary Air-Conditioning and Air-Source Heat Pump Equipment and subject to verification of rating accuracy by AHRI-sponsored,Independent,third party testing: Coaling Capacity(Btuh): 42000* EER Rating(Cooling): 13.00* SEER Rating(Cooling): 16.00* IEER Rating (Cooling): Ralings followed by an asterlrk('indicate a voluntary rorate of previously published data.unless occompmiad with a WAS,which indicatas an krvolurdary remie. DISCLAIMER AHRI does notendorse the Product(s)Nftd on this Certs faate and makes no represvrtations,warrarmas or guawntees u to,and names no responsibility for, the prodw%al Noted onphis C•rtlncals.AHItI expressly dfsclakna all/abfllq+for dsm-gas of try kind arising out ofthe ase or performance of the produclls).or" unauthorised alteradon of daft fisted on this CerHflcats.CwW*d ratings are vetid ony for models and configursYone Noted in the d Irectovy at wwwabridimatury.org. TERMS AND COMMONS This CerdliesW end Itscontents are proprietary products of AHM.Thte Certffkaae shall only be used for Indbidusk Personal end confidential raWlence purposes, The corhew+a oftitia Certificate nay nat,In whole or in part.be reproduced;copied;disseminsetdt entered into t computer dstabese:or ofh owlas utilized,in any forth or manner or by any means,awspt for the users indvidual,personal and carOd.nual reference. CERTIFICATE VERIFICATION ��� The IrAorma6o fo o kw the model cited on oftcortifkats can be verified at wwwahfk1recaorxor9, Air-Conditioning,Heating, cNakonWarlfyCerdticats"Iirkand enter the AHRI CerttrodRokronceNumber and the deft on A"W .oand Refrigerollonlnttituts which tim eertlRcate was issued.which Is hated oboe,and the Certificate Wo.,whish In Hilted below. 02013 Air-Conditioning,Heating,and Refrigeration Institute CERTIFICATE NO.: 130296205986907920 Nov. 7. 2013 11 :54AM TORRES INSURANCE AGENCY No. 7129 P. 1/1 ACORCERTIFICATE OF LIABILITY INSURANCEi 7/2013 i NIS CERTIFICATE 13 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOBE NOT AFFIRMATNHLY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANM DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDRIL N the Omffloate holder Is an ADOMONAL.MMM,the polky0m)must los wWbmod SUBROGATION IS WAIVED,sWod to the tames and condkion of the policy,oertain polioia may tequln an endomomwL A statsmsnt on this cetM=*does not comer rights to the certl mo hokW In Neu of such endommenent(s. Pao6ou 3orgo Riwxe Torras Insurance Agency Inc. (305)512-5980 (,os)fis-stiff 6135 JW 367 STREBT # E25is ivwaltosrosinsv:eenomag66►a .car MP 0004949 Pruni Lakes$ n 33015 ,__._. _ APPOPU a1B COV6a6 M NAIL 61 Mr#URaD INSURW= CQWANY m 5UR11 e o IC&q,l int Florida InsIzz"06 Jose C Yanes Air Conditioning S; A,Mlianoes 1021 NZ 132 Street MIR fm a 3 North Miami FL 33161 r _ COVERAGES CERTIFICATE NUER-OL13103117187 RKV101ON NUMBER: THIS Ili TO CERTIFY THAT THE POLICIES OF INSURANCE UBTED BELOW HAVE BEEN ISSUED TO THE INSURED NAIKEP 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 PAN)CLAIMS. AM TV"oOINO RtANCE UNITS oIINRRALUNKM am"0000RRENCE : 1, 0,00 DOWN TO IUMor— X Ce#IMERCIAL GBNOM" U'�NILRY f __3100,00 A CLAMAI-wm IR OCCUR 000323760-8 1/13/9018 1/13/2014 SFJ}p0' eggE~ f 5,00 MOCO &AOVIUM 1,000,000 OENEW AGGREGATE f 2 000 00 SM AGGREGATE UMNI<APP=P6R. PROMM•COMP/OP AGG 4 1,000,000 X Lac f AUTONO LIANUTY I0100061mmum s 100,000 ANYAUM OWLY i1 6"(pow i A ALL OWMAUTOf 150120006143 /x7/2013 /19/2014 e0MY KAMYPs' U i X =am=affas PROEM DAMAOE HVMDAUT08 (� $ NOMMED AU70 f PP Bob f 10,000 f U1RMlAIJe um 000118 aAmM OCC<IRvmft 667CCal6i LasH cw�rsa4wE AOGREOME f osoucr�s f .. .. $ INO W10001004AMN CTF4 pAtND 11111 tp.0Ynls'tuvlt M YIN OPfICBlt11A si feR PARTMIRMIMMA MIA EL EAOHACOM>W 6 f 100, pihnsueeytnHH1 0043$48 0/81/803' 0/91/2014 IsLA�iCAfF-5ARIOYa1 f - 100.0 0 — aL -FftcyL"T 0 500,006 OaeCI0PTI0N OF omm"o"I1=76"/Va"Imm 000"M 1".AOMO N 16;tmft UM",It mm"m%y,mmw.* J►ir con tiani" Instsllatioa s, 2>*ad awleer small Tack 45,000/ 1300 Ded, 1001k Coins. s)0ammmaiat Auto: vah 1: 1498 Pond/ looaoline 1250 vise# 1PIM42710I270518 I vele 2e 2002 lard/ IROOAoldae 2250 via# I TI0142=513.9S •k+(ro Co>t0xWwwaive 4 Collision CQ'O'YL*e)*** CERTIFICATE LLMM CANCELLATION sHOMD ANY OF TME ASM OBSCRtlBED POLMS BE CANCBIJ=B04M THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELNYBRBD IN Miami Shores Village ACCORDANCE WITH THE POLICY PROWBIONs. Building Department 10050 NE 2nd Avenue AUT>rol�Ec� `T"m Miami Shores,Florida 33138 ACOlW 2a(2008/08) Q 1992008 ACORD CORPORATION. AN rights mereed. INSOm moioil The ACORD rams and logo aro mgisMred marks of ACORD AC# 6221910 STATE OF FLORIDA DEPARTMENT 01 BUS6NBSS AND PROFESSIONAL REGULATION CONSTUCTI N INDUSTRY LICENSING BOARD SEQ#L12072300708 =72'37 - LICENSE NBR2012 52003712 CAC181597 The ASS B AIR CONDITIONING CONtAt�`R Tamed below S CERTIFIEDY Under the provisions of Chapters 1E# : i Expiration date: AUG 31, 2014 YANES, JOSE CLEMENTL � a JOSE C YANSS AIR CONDITIONING ;& AP SS SERVICES INC 1021 NE 132ND ST NORTH MIAMI FL 33161 RICK SCOTT KEN LAWSON GOVERNOR SECRETARY DISPLAY AS REQUIRED BY LAW BTI, Local'Busy Tai R�ceit Miami-Dade County, State Of Flofida -THIS IS NOT A BILL-DO NOT PAY 6392.957 gU$q.1Ess NAlulr/a+ocArwN �IEtPT No. EXPIRES iOS C YAnE'AIR CONDMONING&APPLu►M S e LSEPT, BER 30, 2414 11721 NE Must be displayed at place of business Puraua6t to CouhW Code NORTH MIAMI R.33161 Chaptor SA-Art.9&10 OWNER SEC.WPE OF BUSINESS PAYMENT RECEIVED LOW C PANE A/C&APPI*�RV'INC 196 C MECHANICAL CONTRACTOR BY TAX COLLECTOR CAC161W4 $45.00 07/09/2013 Worker(s) 1 TXHS1-13-0167003 This Local Businaq Tax Receipt only confirms Itatarmt of Lbs tonal Business Tax.The Receipt is not a License. l w a cortifica*n of the77am11Za qualifications,is de basbless•Holder Must CaaApiY with anY govemmentel or nenplremmentaf r"Watory laws and requiremeets which oto the bueimeas The RECEIPT N0.above=Wb6 displayed On all commercial vehiciee^!MI8m1-De de Code Sec be-t7fi.. 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