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MC-15-2994 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-248588 PermitNumber: MC-12-15-2994 Scheduled Inspection Date: December 16,2015 Permit Type: Mechanical - Residential Inspector: Perez,JanPierre Inspection Type: Final Owner: , Work Classification: A/C Replacement Job Address:9301 NE 9 Place Miami Shores, FL Phone Number Parcel Number 1132050070060 Project: <NONE> Contractor: G R AIC AND APPLIANCES SERVICES LLC Phone: (786)295-3439 Building Department Comments CHANGE OUT A/C UNIT(#3 SYSTEMS 2 21/2 TONS AND Infractio Passed Comments 1 3 TONS INSPECTOR COMMENTS False Inspector Comments Passed Failed Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid December 15,2015 For Inspections please call: (305)762-4949 Page 27 of 51 Miami Shores Village pe` � 10050 N.E.2nd Avenue NE w �� Miami Shores,FL 33138-0000 P� � 33 ' a = 'r. E 3 ' I�q Phone: (305)795-2204 FLOR1Of' ilas Expiration: 06/06/2016 Project Address Parcel Number Applicant 9301 NE 9 Place 1132050070060 Miami Shores, FL Block: Lot: JONATHAN S CROSS&W&JEN Owner Information Address Phone Cell JONATHAN S CROSS&W&JENNIFER 9301 NE 9 PL --- - MIAMI SHORES FL 33138-2973 Contractor(s) Phone Cell Phone G R A/C AND APPLIANCES SERVICE: (786)295-3439 Valuation: $ 11,500.00 �.._.__ ..._.__ ___ _•_. Total Sq Feet: 0 Tons:5 Available Inspections: Additional Info:CHANGE OUT A/C UNIT(#3 SYSTEMS 2 2 Inspection Type: Classification:Residential Final Approved:In Review Review Mechanical Comments: Date Approved::In Review Date Denied: Type of Work: Scanning:3 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $7.20 DBPR Fee Invoice# MC-12-15-57908 $6.04 12/09/2015 Credit Card $392.78 $50.00 DCA Fee $6.04 Education Surcharge $2.40 12/01/2015 Credit Card $50.00 $0.00 Permit Fee $402.50 Scanning Fee $9.00 Technology Fee $9.60 Total: $442.78 In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore, ut nze the above-named contractor to do the work stated. December 09,2015 Authorized Signature:Owner / Applicant / Contractor / Agent Date Building Department Copy December 09,2015 1 Miami Shores Village Building Department 01 2015 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20 (� BUILDING Master Permit No. MCI 5-2-q q PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING V40ECHANICAL ❑PUBLIC WORKS [:] CHANGE OF ❑ CANCELLATION ❑ SHOP CONTR TCTOR DRAWINGS JOB ADDRESS: City: Miami Shores Countv: Miami Dade Zip: --3 13)A Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Title Ider : /-t T ® �rte' Phone#: �5 - e)6 �I �� Address: City: _S State: Zip Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: C- (A4C..,�7-5 ✓i Q�- �> Address: �-t1/ City: a= StaLI Zip: Qualifier Name: &t)e Phone#: State Certification or Registration#: �C ' � '1(Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ Square/Linear Foota of Work: Type of Work: ❑ Additio ❑ Alteration New IU/ pair/Re lace Demolition D cripti n of Work: 0 J ��/ i S Specify color of color thru tile: Submittal Fee$ _ iite$ ®7— CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ a (Revised02/24/2014) A 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 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 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 Signature OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before rrre this day fA/ .��t<z 20 7'� by day of ,20 bJ C��dl •9.4i.' S a`LZS,who is personally known to ,�'�, JZ . 9 lac +vho is personally known to me or who has produced as me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: �y� C� Ce'�� r ' Sign: _ zc��/ Print: , �✓v, � Print: Seal �, EDUARDO MARTINEZ Seal: p°, Notary Public-State]FI .da,, A- Owded = Commission#FF 126080M1Y Comm.Expires JExpires July 22,2018 ,, (e�r Commission rr FFTlwTrayF841MWW NW85-7018 I�' �init+`� BWWIft Nallon� rkk*rk**��* *rk +kkrkrkk kek#+k**#*+krk*krk rkrk# k**+krkakkrk*+kik &4+k*k+krkrk*rkrk APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) ,yam Miami Shores Village Building Department au 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 B being done): 4� City: Miami Shores Village County: Miami Dade Zip Codes 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 El 11 Contract Attached:YES lJ UNIT BEING REPLACED DATA NEW UNIT MANUFACTURER AHU or PKG.UNIT MODEL R COND.UNIT MODEL d 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 / / PKG UNIT EERAEER - REPLACING DUCTS YES NO ryo NO REPLACING THERMOSTAT NO YES NO NEW 4"CO111CRETE SLAB YES NO YES N NEW ROOF STAND YES YES (U61 NEW RETURN PLENUM BOX YES O 1. Minimum Circuit Ampacity(Wire Size): /® 2. Maximum Overcurrent Protection(Fuse/Breaker Size): 0 6 A' -*) .. r' fz ci 3. Voltage of Circuit(208/240 480): 4. Size Disconnecting Means: X® _ Geractor's Conl�rly �'_ �. �-' ��`• �' __ - State Certifl�te Nld&l . Certificate of Competency No. Signature Date: ��-��_✓:� (Rev1sed02/24/2M) Miami Shores Village �y Building Department noun p,„M 10050 N.E.2nd Avenue Vn .1 Miami Shores,Florida 33138 p�R 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- -3(31 /J City: Miami Shores Village County: Miami Dade Zip Code: -� 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 1/1AiZ MANUFACTURER – AHU or PKG.UNIT MODEL# COND.UNIT MODEL# KW HEAT cJ`5 fC NOM TONS r 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 14L (� YES N REPLACING DUCTS YES N REPLACING THERMOSTAT (YEV NO YESNO NEW 4"CONCRETE SLAB YES N YES CA NEW ROOF STAND YES O YES NEW RETURN PLENUM BOX YES O 1. Minimum Circuit Ampacity(Wire Size): l �- �f,1 .��— Wj"08 2. Maximum Overcurrent Protection(Fuse/Breaker Size): 3. Voltage of Circuit(208/240 480): 4. Size Disconnecting Means: ®/ Contractors Company Name: A4� A�J@� c�;ZIK'✓Y vL ��� '^ � one: State Certificate r Reei9traticin 000/ '90- Certificate of Competency No. Signature Date: 1/- 3-1�6' (Revised02/24/2014) Miami Shores Village Building Department 1W50 N.E.2nd Avenue Miami Shores,Florida 33138 Rim Teel:(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): d` Aj �/`'� City: Miami Shores Village County: Miami Dade Zip Code: J ALL CONDENSING UNITS MUST BE ON A 41NCH 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 L5' UNIT BEING REPLACED DATA NEW UNIT MANUFACTURER AHU or PKG.UNIT MODEL# COND.UNIT MODEL# KW HEAT NOM TONS r 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 / / PKG UNIT EER/SEER YES O REPLACING DUCTS YES O NO REPLAONG THERMOSTAT YES NO YES O NEW 4"ODNCRETE SLAB YES YES N NEW ROOF STAND YES NO YES (N-9 NEW RETURN PLENUM BOX YES 1. Minimum Circuit Ampadty(Wire Size): 2. Maximum Overcurrent Protection(Fuse/BreakerSize):1 3. Voltage of Circuit(208/390W): 4. Size Disconnecting Means: Cotluadoes Company Names N 0,0 -Scc z ' e&a� - 8,�lp State Certi tate or R n No. / 1 Certificate of Competency No. Signature Date: ff-Z 3 -Xi lam$ (ReAsed02/24/2014) OMR 7 71. Phone: 786-295-3439 *Fax: 305-819-9441 �■ greyes1171 @gmail.com ri :+1'' II ISI'!ti ;l ' 3 1 el.=i I(-.C.. ,:,1 ,1 1;' fi, i , ;:'i l 1:-h:.;ti, 11: wf'I!'1i, .•!!; 11 � �, / , ��Ijllllll EMIM" .... ... ... ..... y 1*.1 asAIi-- " i 7OR 1 ,,lam W"Wg , I -,fall 111G ,;11100; ;IrlE i fl H� ,I :.YFI%1 i r 1'il t!E- ;fY ;fi; .71 1 I-°filii ;if els+ Iih l�ilf:.r (1) li ? y 711 1411 WMIT s Lrl:- ilt+, ;�ru,;�a I l.; ;;;i3:;srv,l; ;- ;c p !:n :no-• � i�n; :!1Q, ffT ��;.nl3ir h,lrl h`. :lf,; Mf:;I�i3 1 ;F,i: ,;!, s 1 ;;I" .J R:-1 ';;i! ;:f ii 1;11•It?;; Ia 1 "C:-Fi{r"I i'. SIJ !�1 ;il.iulL f:; �a1QR93� Miami hores Village 24 BuildingDepartment �R�p 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. OPY OF QUALIFIER'S STATE LICENCES B. COPY OF LOCAL BUSINESS TAX RECEIPT C.__COPY OF LIABILITY INSURANCE* e7 a D. COPY OF WORKERS COMPENSATION INSURANC (Workers Compensation EXEMPTION must ha e NOTICE TO OWNER form and Contractor Affidavit) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF CO A. COPY OF CERTIFICATE OF COMPETENCY OF QUALIFIER B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF STATE REGISTERED CONTRACTOR LICENSE OR MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT. D. COPY OF LIABILITY INSURACE* E. COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) *YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE AS FOLLOW: Certificate Holder: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 Certificate must specify the description of operations or contractor license number. nomoomaoetetn®ate■®nottee�e�■®o ■emtso eoa®tef�m®®�os�®rtemamoeae m/me■te�taae�mr■®®vaeemmmme BUSINESS NAME: 1'L C LL C BUSINESS ADDRESS: ,5-33 CITY ',4- (— 4 STATE ZIP a�r� I.':;) BUSINESS PHONE: ( ) FAX NUMBER CELL PHONE I-3AQ QUALIFIER'S NAME: QUALIFIER'S LIC NUMBER: _�A 10 CONSTRUCTION INDUSTRY LICENSING BOARD (850)487-1395 � 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 RODRIGUEZ, [VAN RICARDO G R A/C AND APPLIANCES SERVICES LLC 9369 FONTAINEBLEAU BLVD APT J227 MIAMI FL 33172 Congratulations! With this license you become one of the nearly 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 barbeWe DEPARTMENT OF BUSINESS AND restaurants,and they keep Florida's economy strong. 1 P' PROFESSIONAL REGULATION Every day we worts to improve they we do business in order CAG1818190 ISSUED: 10/12/2015 to serve you better. For hrformation atmut our services,please tog onto www.myfloridalicanse.com. There you can find more CERTIFIED AIR GOND CONTR information about our divisions and the regulations that impact RODRIGUEZ,IVAN RICARDO you,subscribe to department newsletters and learn more about G R A1C AND APPLIANCES SER1lICES LL the Department's initiatives. Our mission at the Department is:license Efficiently.Regulate Fairly.We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, IS CERTIFIED under the provisions or Ch.489 FS. and congratulations on your new license! ExphVilandde:AUG 31,216 L151012=995 DETACH HERE RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION , CONSTRUCTION INDUSTRY LICENSING BOARD CAC1818190 The CLASS B AIR CONDITIONING CONTRACTOR Named below IS CERTIFIED Ps Under the provisions of Chapter 489 FS. Expiration date: AUG 31,2016 RODRIGUEZ, NAN RICARDO, G R AIC AND APPLIANCES SERVICES LLC. 5336 WEST 9TH AVE HIALEAH FL 33012 ■ ISSUED: 1oMW015 DISPLAY AS REQUIRED BY LAW SEQ# L151012OW1995 Local Business Tax Receipt Miami—Dade County, State of Florida —THIS ISNOT AHILL—DO NOT PAY LBT 7193188 BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES GR A/C AND APPLIANCES NEW BUSINESS SEPTEMBER 30, 2016 SERVICES LLC 7475147 5336 W 9 AVE Must be displayed at place of business HIALEAH, FL 33012 Pursuant to County Code Chapter 8A—Art.9&10 OWNER SEC.TYPE OF BUSINESS RECEIVED GR A/C AND APPLIANCES SERVICES 196 SPEC MECHANICAL BY TAXNCOLLECTOR LLC CONTRACTOR r/n r;l III I FRMrI RFYFG Mr;R 75.00 12/01/2015 Worker(s) 1 CAC 1818190 0224-16-001530 This Local Business Tax Receipt only confirms payment of the Local Business Tax.The Receipt is not a license, permit,or a certification of the holder's qualifications,to do business.Holder must comply with any governmental or nongovernmental regulatory laws and requirements which apply to the business. The RECEIPT N0.above must be displayed on all commercial vehicles—Miami—Dade Code Sec Ba-276. ®M=A-0 For more information,visit www.miamidede.gov/taxcollector � e GRACS-3 OP ID:LEGO ACORO CERTIFICATE OF LIABILITY INSURANCE D 11123/20/5 ' 11/23/2015 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 terns 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 NAME. Gabriela F.Dominguez Avante Insurance Agency,Inc 305-648_7070 (Air,FAXN,:305-648-7090 7490 West Fller Street UTENN,Eft Miami,FL 331" E-MAIL Gabriela F.Dominguez ADDRESS: INSU AFFORDING COVERAGE NAIL d INSURER A:Granada Insurance Company INSURED G.R.A/C Appliance Services INSURER B: 5336 West 9th Avenue Hialeah,FL 33012 INSURER c INSURER D: 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. INSR ADDL SUOR LTR TYPE OF INSURANCE POLICY NUMBER SMO EFF EXP LATS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE _ $ 1,000,00 CLAIMS-MADE XOCCUR 0185FL0O076391-0 11/03/2015 11103/2016 NTED PREMISES Ea „ce $ 100,000 MED EXP(Arty one person) $ 5,00 PERSONAL 8 ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,00 POLICY F—I JEC LOC PRODUCTS-COMP(OP AGG $ 2,000,00 OTHER: F $ AUT(MBILE LIJUMJ Y COMBINED SINGLE LIMB(Ea accident) $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ NON-OWNED =.PEE DAMAGE $ HIREDAUTOS AUTOS UMBRELLA LAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS LIABILITY YIN STATUTE I ER ANY PROPRETORIPARTNER/EJECUTn/EEl N/A EL EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? (Mandatory In NH) EL DISEASE-EA EMPLOYEE $ If yes,describe rmdar DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached B more space Is regWnedl A/C Installation&Repairs CERTIFICATE HOLDER CANCELLATION MIAMISH SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Villas THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Building Department 1000 NE 2 Avenue AUTHOR®REPRESENTATIVE Miami Shores,FL 33138 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD 11/20/2015 Report Viewer ;1 1 100 i 1 JEFF ATWATER CHIEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS'COMPENSATION CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS'COMPENSATION LAW' CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers'Compensation law EFFECTIVE DATE: .1120/2015 EXPIRATION DATE: 11/1912017 PERSON: RODRIGUEZ IVAN R FEIN: 272762665 BUSINESS NAME AND ADDRESS: G R AIC AND APPLIANCES SERVICES LLC 9369 FOUNTAINBLEAU BLVD APT J2 MIAMI FL 33172 SCOPES OF BUSINESS OR TRADE: HEATING.VENTILATION, AIR-COND R.,s re Ct�!e•»L7.C5(t»;F.S.a^oqraiasr 4wyw Pas *'crzpm,n".066 .vc crapsv by bl,ryaceret cafe rN wec:m u+a+srs<ec:c+� ' a,rkY r tiWer tMef tS a G.F`JW`-'•m,laR 1^s cnao:et.?Jsuar A:0 Cna�:er 34U.lYrl'21.F.S.. - w.tnn Pe scMed^e nsrm5s tY 7a'#' stmmtne rot,cedrecnm:o ne eaem:u.Purswnl io Cnq»et»»005(131 FS..Noeces�J e,ttto::oce e.e^p:aw ccr:f,�yes.if elec:,,n:°nesnemN s + :.es,.:�a::tv rcvo.;�an if.aary time afu+:.x`i:ng of:renr.:cev:ne sswrv:edtt>e cerl;flc�e_ :tee oercm;ra;n,n�Ire ra;cea cm:r.cae ru Iv.cµa^.eets t1s:reeurements d ms secwn fs resa�ce at acc+1 fica;e'-a arra-tm.r.:sra,--ew.1.e a DFS-F2-DWC-252 CERTIFICATE Or'ELECTION TO BE EXEMPT REVISED 0&13 QUESTIONS?(856)413-1609 https://apps8.fldfs.comicrreportviewerlreportViewer.aspx?data=kdvpginc9D703gH6TER6ePlKMZ%2fSz5bXKYfBxkrekeESoPVy',v4NPOPN42XeirDRGXVW.. 112 Report Viewer Page 1 of 1 1 1 :R00% a JEFF ATWATM a guff FIS APx9pL oFrTCER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIMON OF WORKERS'COMPENSATION u •'CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS'COMPENSATION LAW p CONSTRUCTION INDUSTRY EXEMPTION This Certifies that tits individual fined bebw has elected tD be exempt from Florida VftimW Cmipensation law. EFFECTIVE DATE: 10/28/2015 EXPIRATION DATE: 10/27/2017 i PERSON: REYES GUILLERMO 9 FEIN- 272782685 SUSBWESS NAME AND ADDRESS: u GR AIC AND APPLIANCES SERVICES LLC. 4 5336 WEST 9TH AVE HIALEAH FL 33012 i SCOPES OF BUSINESS OR TRADE: j HEATING,VENTILATION, AIR-GOND + Patmmnf m Clap-448 (14),F.8,eA oteeer of a ompowtlmi wlw elerffia rtmuCtls m by emote of Amsm undo aft mGim� o nmy not mowrarhan�orompeaseEian welerthbtlmpa P�medta ChaPtm440.DRI F.e..Ce teadelectbntobe arertp--.epph�Y wro�0b aeopa al0n bus�sarbaft BabOw Ou�e clel�ebbe�0m�a.�Pmm�LLb 440.x(73),F-B.Notlreadelavimilo be oan3admtbe nomtm or�oer mfaopof aft aecum Qm h—Wealth. m>fFAat&The depmbard aaei FVPWW a DFS•F24Mr-252 CERTIFICATE OF ELECTION TO BE BU3WT REVISED 08-13 QUESTIONS?(&W1316DO i t� t 3 i E https://apps8.fldfs.com/crreportviewer/reportViewer.aspx?data=kdvpginc9D7Q3gH6TER... 10/29/2015 Bill Miami shores V A. �,$��� Building Department �loRivA 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Notice to Owner — Workers' Compensation Insurance Exemption r iwx, 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 and has acknowledge that he or she will not use day labor,part-time employees or subcontractors for your project.The contractor has provided an affidavit stating that he or she will be the only person allowed to work on your project.In these circumstances,Miami Shores Village does not require verification of workers'compensation insurance coverage from the contractor's company for day labor,part-time employees or subcontractors. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature:;` Owner State of Florida County of Miami-Dade The foregoing was acknowledge before me this day of ���� 6�%� ,20 /5l By 44X_ 41L� S, who is personally known to me or has produced as identification. 4�� `� , 1;a4, EDUARDO MARTINEZ Notary: �'le- *= Commission#FF 126080 • Expires Jul 22,2018 SEAL: E. P Y %i,°�,pf V�?.•' Baided TFw Troy Fin Insicanee HOOJ85.7019 MECHANICAL REVIEW APPROVED ____._DATE DEC 0 12015 0 TROY S.BISHOP,P.E. RREEM SALES COMPANY, INC. WIND LOAD CERTIFICATION OF MECHANICAL UNIT CABINETRY AND STEEL/ALUMINUM TIE-DOWN CLIPS: AT GRADE MOUNTED APPLICATIONS 06/10,2015 VALD POR I PERMIT MYUAQ 4 )—!1.000' \3s.,y H 1 VNS1s MPx 35> cry 0.7sD• APPROVED DESIGN ASCE7-10 VWlt-175MPH Z o�< 35• 35• �il- ATGR136 MPH).EXPOSURE'D', 1.250 CRITERIA: AT GRADE INSTALLATION ONLY W 'i lil) 'IT 4 1 W J ZQ >mu W a as DESIGN NOTES: (� W Z O 5,061 THIS SYSTEM HAS BEEN DESIGNED IN ACCORDANCE WITH ASCE 7-10 AND Z� N O u'¢ x O THE FLORIDA BUILDING CODE FIFTH EDITION(2014)FOR USE WITHIN AND W W " w f w O OUTSIDE THE HIGH VELOCITY HURRICANE ZONE.THE DESIGN CRITERIA CONSIDERS ASCE 7-10 SECTION 29.4.1 FOR'OTHER STRUCTURES-SOLID W C 3 t Yn v z of FREESTANDING WALLS'INSTALLATIONS AT GRADE.ALL DESIGN VARIABLES o O ARE IN ACCORDANCE WITH ASCE 7-10 CHAPTERS 26&29. ,f0.4 O o a GENERAL NOTES: A [ O 1. THIS SYSTEM HAS BEEN DESIGNED AND SHALL BE FABRICATED IN Z ACCORDANCE WITH THE REQUIREMENTS OF THE FLORIDA BUILDING CODE 4--4 OFIFTH EDITION(2014)&ASCE 7-10.THIS SYSTEM MAY BE USEUNITHIN• } O AND OUTSIDE THE HIGH VELOCITY HURRI E Z0��11E.THIS DES�CaN�S�i10 •• CONCRETE INTENDED TO CERTIFY IMPACT RESISTANCE OF gTOf VCHANICJR UNIT CONCRETE SUPPORTING 2. NO 333%INCREASE IN ALLOWABLE STRA HAS AEN USED=ftESUPPORTING •• 8 STRUCTURE BY STRUCTURE BY 0.306" �O DESIGN OF THIS SYSTEM. •••••• • ••• 0•• f• OTHERS,TYP. B OTHER''TVP. CONTROL BOX D TYP. 3. DESIGN&CERTIFICATION OF THE UNIT CASINE$LY IS APPROVED THROLKaH U w TESL'REPORTS0323.01-15 BY AMERIC4N41"L68"SOUTH FLORIDA ..• 1 MECHANICAL UNIT 2 MECHANICAL UNIT 4. ALL DIMENSIONS AND THE MINIMUM WEIGHT(255 LB MINIMUM) =y t—t 1.000• MECHANICAL UNIT SHALL CONFORM TO LIMW*rf S STATED HER NAM wW 1 N.T.S. FRONT ISOMETRIC 1 N.T.S. BACK ISOMETRIC TIE-DOWN MECHANICAL SPECIFICATIONS(CLEAR sPRCE,TONN'RiE,ETC.)!HALL BE • AS PER MANUFACRJRER RECOMMENDATIONS ltVD ARE THE EXPRE"•• (�•• RESPONSIBILITY OF THE CONTRACTOR. • -• THESE ISOMETRICS ARE INTENDED FOR BRACKET S. STRONG BOLT 2 REFERRED TO HEREIN SF�A& I' SON STR • •••49 DIAGRAMMATICAL PURPOSES ONLY,ALTERNATE RHEEM yyy'''QQQ •• MIAMI TECH CUP:L(CU(0.07)ASTM A653 BRAND&WEDGE BOLT+SHALL S POWE GR.5 to UNITS LISTED HEREIN MAY VARY IN APPEARANCE \ T5I GGGRRREEETTIEEE L�•• J \\ Fu-90 KSI STEEL(CUTD10)OR 0.080" STEEL OR EQUIVALENT ONLY,INSTALLED 0 3000 MIN CON SEE � � (4)-C10 NTERNAL POSY, \\�" 5052-H32 ALUMINUM(CUTDA10),MIAMI ANCHOR SCHEDULE FOR ANCHOR REQUIFWrb%6*4k..SHEET METAL • a SMS PER ADJACENT-70 -` TECH KIT S RRCUTDLK OR RRCUTDALK SCREWS USED TO FASTEN BRACKETS TO MECHANICAL UMTS SHALL BE 010 BRACKET, CONTROL BOX (14 MIN THREADS PER INCH)ASTM F593 010 STATNL•SS STEEL&R • •Y�i• OWER TYP. \ - �,,.R...�-�,» EQUIVALENT ONLY.PROVIDE(5)PITCHES MINIMUM PAST THE TO*"•• pp,M E- zR �� �. PLANE FOR SHEET METAL SCREWS.ALL F&TEN"SHALL HAVL• • APPROPRIATE CORROSION PROTECTION*,rPESEN1•ELECTROLYSIS. •• 7YP e `I P 4 ` � \ *37.25° 5. ALL CONCRETE SPECIFIED HEREIN IS NOT PA[t OF TATS CERTIFjQ(TI�1•• • B O AS A MINIMUM.ALL CONCRETE SHALL BE STRUCTURAL CONCRETE 4'MIN. THICK AND SHALL HAVE MINIMUM COMPRESSIVE STRENGTH OF OQ PSI, y UNLESS NOTED OTHERWISE. ra 6 UNIT BASE UNIT BASE Q UNIT BASE c>, A - 7. THE CONTRACTOR IS RESPONSIBLE TO INSULATE ALL MEMBERS FROM cgg ANCHOR PER PAN PAN DISSIMILAR MATERIALS TO PREVENT ELECTROLYSIS. e SCHEDULE -s y4`q�� a++t n 8. ELECTRICAL GROUND,WHEN REQUIRE),TO BE DESIGNED&INSTALLED BY z 5g 9. THEOTHE•ADEQUACY OF ANY EXISTING STRUCTURE TO WITHSTAND t�£� t. v SUPERIMPOSED LOADS SMALL BE VERIFIED BY THE ONSITE DESIGN 3000 PSI MIN. S CONCRETE BY • g s A DIM.1 S PROFESSIONAL AND IS NOT INCLUDED IN THIS CERTIFICATION.EXCEPT AS �� §'` D EXPRESSLY PROVIDED HEREIN.NO ADDITIONAL CERTIFICATIONS OR OTHELS,TVP. ® (p t&{('} O \,0. CONTROL AFFIRMATIONS ARE INTENDED. g A&CARE SIM CL 001 SETD]MENSION SHALL _ _ BOX__ 10.THE SYSTEM DETAILED HEREIN IS GENERIC AND DOES NOT PROVIDE 5 � O O INFORMATION FOR A SPECIFIC SITE FOR SITE CONDITIONS DIFFERENT a AND OCCUR ON BE TAKCN QOM TFIIS SIDE ONLY DATUM FACE FROM THE CONDITIONS DETAILED HEREIN,A LICENSED ENGINEER OR y DPP.FACES 4 TIE-DOWN BRACKET LAYOUT SE CONJUISTERED N CTION TWISHALL PREPARE SITE TH THIS DOCUMENT.SPECIFIC DOCUMENTS FOR 3 TIE-DOWN BRACKETS ' ' ' Ll.WATERTIGHTNESS OF EXISTING HOST SUBSTRATE SHALL BE THE FULL OOPfiM#lf FRNlLLBBQMIa70 PE 1 N.T.S. ELEVATION 1 N.T.S. PLAN RESPONSIBILITY OF THE INSTALLING CONTRACTOR CONTRACTOR SHALL 15-2543 ENSURE THAT ANY REMOVED OR ALTERED WATERPROOFING MEMBRANE IS ANCHOR SCHEDULE: RESTORED AFTER FABRICATION AND INSTALLATION OF STRUCTURE SCALE: KT.& TIE-DOWN BRACKET OFFSETS: APPLICABLE MODELS: PROPOSED HEREIN.THIS ENGINEER SHALL NOT BE RESPONSIBLE FOR ANY PAGE DESCNIIRIIXL SUBSTRATE DESCRIPTION RA1642A,RA1648,RA166Q RP1360, WATERPROOFING OR LEAKAGE ISSUES WHICH MAY OCCUR AS Sr TALL UMTB �E DIM.1 4.SG-MAX OFFSET FROM DATUM FACE aT'-T}-■Is•T,FaoTPR¢'iT (1I-I/a•0 CARBON STEELSMPSON STRONG BOLT 2,IA•MIN EMBED TO RP7460,RP1548,RD1448,RP1560, WATER-TIGHTNESS SHALL BE THE FULL RESPONSIBILITY OF THE CONCRETE; DIM.2 30.00`MIN OFFSET FROM DATUM FACE RD7460,RAAlA1T48,RAAJA1780, INSTALLING CONTRACTOR CONCRETE,3•MIN.EDGE OSTANCE,3 MIN.SPACING M ANY ADJACENT ANCHOR = (4'THICK MIN. RAIUA2048,RAAJA2060,RPAJP1748, 12.FOR AN EXPLANATION OF EXPOSURE CATEGORIES THAT ACCOMPANY THE Q• 30M OHI MIN.) 3.) 4•N.�R8�57�POWERS Y�GE PACING TO MIN ANED .CON[RETE, DIM.3 31.00"MIN OFFSET FROM DATUM FACE RPIUP1760,RPIUP2048,RPIUP2060, Vuft WIND SPEEDS USED IN THIS DOCUMENT,SEE SECTION 26.7.3 OF ASCE LjI 8 SUPPORTING CONCRETE SUBSTRATE DEPTH SHALL BE A MINIMUM I.SxANCHOR EMBED. DIM.4 13.00'MAX OFFSET FROM DATUM FACE 7-10. EITHER ANCHOR FROMTHIS SCHEDULE MAY BE USW FOR BbTADATION. ... . . ... •.•• . . .. .. •. . .. . . . . . . . . . 0% . . . . ... . . Installation Instructions for Pad Mount Tie Down Kit . .. •• • . • • •• .. . . . . . . . . • • • • • New Platform,A-heetirgituud•Outdoor Units ••• ••Kit_R1ZAmber3 ; ••• RRCUTDUG(AlW'kzec;b;aclws) RRCUTDALK(aluminum brackets) 1) Carefully review included installation drawing before beginning installation of kit. Kit must be installed per this drawing and the following instructions to maintain certification of the tie-down method. 2) Center unit on concrete pad built with minimum dimensions shown on included installation drawing. Use appropriate drawing for the unit model being installed. The applicable unit models are listed on each drawing. 3) With the bottom of"L" bracket resting on the pad, attach the four(4) "L" brackets included in kit with four(4)#10 x 3/" self-drilling screws per bracket. Do not attach brackets to the louver panels, but rather to the posts as shown in the included installation drawing. 4) Drill a 2" deep pilot hole for the%" Carbon Steel Powers Wedge Bolt into the pad for each of the four(4) "L" brackets, using the holes in the base of the attached brackets as a guide. These holes must be at least 3.0" inches from the edge of the pad. 5) Secure "L" brackets to pad with one (1)%" Carbon Steel Powers Wedge Bolt per bracket.