The URL can be used to link to this page

MC-14-2763 Miami Shores Village R `FITV17, . DEC 17 2014 Building Department r 10050 N.E.2nd Avenue,Miami Shores,Florida 33138P =- --------------- -- Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20 Q BUILDING Master Permit No. � � a PERMIT APPLICATION Sub Permit No. 0-) C 1%-4 —Z�-1 ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING n MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: ( ® �(� tv C,-j 'PAI& City: Miami Shores County: Miami Dade z1g): Folio/Parcel#: O' T 0 Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: / Flood Zone: BFE: FFE:9J-�) 7 OWNER:Name(Fee Simple Titleholder): l4 !� Phone#: ��_`�7S Addres ( 2 tv t ZZ t- City: i�0( f��7 State Zip: Tenant/Lessee Name: Phone#: Email: T /� CONTRACTOR:Company Name:� dc'� ! � / L'C�✓� Phone#: —5-001 Address: 6430Y afZ-) IY& 5�- City: Y"y State: 77 Zip: ��3 /'6 Qualifier Name: _ —1-n 66 0331 . Phone#: State Certification or Registration#: 0A e /11-340 _Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ 7i quare/Linear Footage of Work: Type of Work: ❑ Addition El Alteration Y New ❑ Repair/Replace ❑ Demolition Description of Work:TA Specify color ofcolor thru tile: / l� Submittal Fee$ :S-04Q Permit Fee$ _ CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$_ TOTAL FEE NOW DUE$ (Revised02/24/2014) 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$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be app ed and a reinspection fee will be charged. Signature _ —JAi;� Signature OWNER or AGENT CONTRACTOR The foregoing instrument was ackr1owledged before me this The foregoing instrument was acknowledged before me this G day of20 2 0,1.q by _day of 15 er��a'� ,� .20 `77 ,by � r , who is personally known to jk"-NOW C N 11% ,who is personally known to me or who has produced 7� as me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign: Print: b 7 Print: �...1=�/�i� �14 C� CECILI A Seal: - °. . ° MY COMMISSION#EE100114 SealCECILIA CAROOZO ?: : EXPIRES:JUN 05,2015 r° eO MY COMMISSION#EE100114 Pnno thrfwgh 1 st State Insurance �� EXPIRES:JUN 05,2015 B^_n0d through 1st State lrsuMnce k+kkbitMtlt+Mle&NB�NtIttMAtltMt�ktltitRt4�Y•�R�kSb&$tktNMtktitBMtktatitR#itRLititktlalt#4,k�kitbtPtRtRMM�itY if(nit•Q�'AEtAtit iMttlalaltitltl�8�itii APPROVED BY 6 Plans Examiner Zoning Structural Review Clerk (RevisedO2/24/2014) 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 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 n t acceptable. tt Job Address(where the work is being done): l 0 1 f b N -,) Aa City: Miami Shores Village County: Miami Dade Zip Code: 33 1 K1 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 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 NO REPLACING DUCTS YES NO YES NO REPLACING THERMOSTAT YES NO YES NO NEW 4"CONCRETE SLAB YES NO YES NO NEW ROOF STAND YES NO YES NO NEW RETURN PLENUM BOX YES NO 1. Minimum Circuit Ampacity(Wire Size): 2. Maximum Overcurrent Protection(Fuse/Breaker Size): 3. Voltage of Circuit(208/240/480): 4. Size Disconnecting Means: .r— Contractor's Company Name: 4t'C6 ,a a,.9 t/9 ✓ Phone;a95'-a State Certificate or Registration No.0M 16&I s/ Certificate of Competency No. Signature i Lei Date: /a - l Lo- (Qualiflees signature) (Revised02/24/2014) �►co v® CERTIFICATE OF LIABILITY I 2116101 INSURANCE 1?Jis/zo14 THIS CERTIFICATE 18 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: 9 the cerMcate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WANED,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 endomsement(s). PRODUCER C TAMARIA REYES QUINTANA 8 ASSOCIATES OF MIAMI INC. PH 5 FAX 305-445-8153 5200 S W 8 ST SUITE 250 E.Maa ° MIAMI FLA 33134 tN AFFORDING COVERAGE NAIL B MSURERA:UNITED SPECIALTY INS COMPANY RMREB INSURER 8: ARCO TEMP AIR CORPORATION Ric: 6804 N W 46 STREET e: MIAMI,FL 33166 INSURER E: AISIAU:R 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. L TYPE OF INSURANCE ADM R POLICY NUMBER POIJCY P EXP LIMITS (ISNERAI-LIABILITY CGDOD005588-01 i1t24/2014 11/24/2015EACH OCCURRENCE $ 1,000,000 COMMERCIAL GENERAL LIABILITY P (Ea occurrence $ 100 000 A wuMs-MADE X❑OCCUR MED EXP(An r am arson $ 5 Dao PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENS-AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 7POLICYF�PMETLOC $ AUYOMOSILE LIABILITYWNGL9 LIMIT ANY AUTO BODILY INJURY(Per ) $ ALL OWNEDSCHEDULED AUTOS AUTOS BODILY INJURY(Pe 8=wwQ $ NO HIRED AUTOS AUUTTOOSWNED PROPERTYDAMAG $ $ UM13REUALUMOCCUR EACH OCCURRENCE $ EXCESS LIAR HCLAIMS-MADE AGGREGATE $ RETENTION 11 I $ WORKERS CWPENSAMON I WC STATiS AND EMPLOYERS'EMPLOYERS'LIABILITY Y I N ANY PROPRIETORIPARTNERIEXECUITVE OFFICER(MEMBER EXCLIJOEp7 NIA E L EACH ACCIDENT $ INlendY In NN) EL DISEASE-EA EMPLOYE $ OE Rdl 9 N OAF r TEON8 EL DISEASE-POLICY UmT I$ DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 voom ES(Altaob ACORD 1L%,AddMcm l Remsris Scbeaft R more si—b requires AIR CONDITIONING INSTALLATION,SERVICE AND REPAIR POLICY SUBJECT TO POLICY TERMS AND CONDITIONS. CERTIFICATE HOLDER CANCELLATION CITY OF MIAMI SHORES/ BUILDING DEPARTMENT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES 89 CANCELLED BEFORE 10050 NORTHEAST 2ND AVE THE EXPIRATION DATE THEREOF, NOTICE WILL. BE DELIVERED IN MIAMI SHORES,FL 33138 ACCORDANCE WRH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE a 201 RD CORPORATION. AU rights reserved. ACORD 26(2010/05) The ACORD name and Ingo are registered marks of ACORD STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD "A �AC1816147 �� 4� � CLASS B AIR CONDITIONING CONTRACTORb . ied below IS CERTIFIED .. er the provisions of Chapter 489 FS. --- iration date: AUG 31, 2016 CHONG,ARNOLD F ARCO TEMP AIR CORP 7448 NW 8TH STREET MIAMI FL 33126 i, a ■ ISSUED: 07/17/2014 DISPLAY AS REQUIRED BY LAW SEQ# L1407170000869 • 3; ga s BUTATra OF FLORM :f�FINRFi4�tfa69t�r[9-t-'n ;; Or-MUMAL 2NIMMMIN WDUBTRY BIMP IOP_'- .s tits carms ote;"karlduul Ind Maw hm slac*to be 0.%wtcm mmift waft&leimp M Imv. z :a-MIVM DATA. 4fhp.H4 E.PM` ON DA's 41SWIS. i J6 CHOW AWOLFJ Mimi � d • O •700 SWa33 ST FL 33M.. 'S ES OF BI.1SUM OR T?jWIII£ AT ING,V LA-110Pv, j �'Uf�t Gr Gt�I��tG D3(Y�},F-�ar► oY n r�tl�n s7h� s atter�lhts fry�q�ec�ta'i�te�Y�ta�aa uad�t>d�s��y atmwv Bwftera 0t1tea'Q��q t aantto u ice, raofet¢manioaf,fit„sp '+ fbs r�etsa�na�sa� tt�t�at�ocAYma�se ,Ftea �cehga,tatst�ont�t� ta� � :tt48t�Ri'1(ra'c�:Lii:aivn�a�fill,7�r�t��FlRartiieaPUr� 7t �12a�w��,E48t�nuffio9tia7►9lttao��6s :onto Stt�lSe�oYtitNs ia�it>�tr �'u �,Tintt a� r n iaatefl tt istPati aYtde o�tu.m�if�Bte �i�3�euniv�ti��ica.- ; PS.F—o MJC,=i TlF OME,CF MACTION TO W BMIPTid 076,12 1M- pis-im .30-Oct-2014 05:46 PM arco temp air 3054063757 2/2 low Lo4sl BusinessCol Miami-Cads County, State ®f Flari a THO tS WTA HU m tag NUPAY { 639"21 sumaw A=TWP AM CORP mmvALespnmllm 3 2015 ivbUW= M4 IW 46 ST 666=1 ane C9808ved at atm PAW FL 33966 metes COU"W qdO drew..— M9QiO A i&AP M CORP iog SM RCWICAL CONTUMN BY YAN � It�ri$) 9 CACIMS147 FSM 06/05/1014 HOW-14-140536 t Yet � ls�st g 11� tap rY`arell3P1'�3�.a5agu8�di8play�dm�oll vat�fee� at��as@n-�'!B. 6�r��e i�sme+d�,et�tt s f g ORE, G m Miami shores Village p... Building Department ��R�A 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 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 CONTENT(& Signature: Owner State of Florida County of Miami-Dade The foregoing was acknowledge before me this day of �-A ,20 I� � lJ Q�� who is personally known to me or has produced By�l�� UXJE �L�: as identification. Notary: SEAL: #0 n Notary Public State of Florida F. Sindia Alvarez My Commission FF 158750 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-253594 Permit Number: MC-12-14-2763 Scheduled Inspection Date: February 29,2016 Permit Type: Mechanical - Residential Inspector: Perez,JanPierre Inspection Type: Final Owner: D'ALACIO, DIOGENES Work Classification: A/C Replacement Job Address: 10816 NW 2 Avenue MIAMI SHORES, FL 33168-4302 Phone Number Parcel Number 1121360020160 Project: <NONE> Contractor: NET TEMP CORP Phone: (305)994-9396 Building Department Comments NEW 3 TON AC UNIT Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-253273. CREATED AS REINSPECTION FOR INSP-225447. MISSING LOCK CAPS Failed Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid February 26,2016 For Inspections please call: (305)762-4949 Page 42 of 60 A Miami Shores Village Building Department OCT r� 2 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 2011b s BUILDING Master Permit No.Re m' 765' PERMIT APPLICATION Sub Permit No. Co[ Y- `�:76P 3 ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING SMMECHANICAL ❑PUBLICWORKS ZCHANGE OF CANCELLATION 0 SHOP CONTRACTOR DRAWINGS ` . 10B ADDRESS: 1 N ) a l;a\/Z ('� City: Miami Shores County: Miami Dade zip: 3316�`y Folio/Parcel#: 1 L 31® 002 Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: ) 6 OWNER:Name(Fee Simple Titleholder): I /Oqf!!� A I/k�:� Phone#: i ' ' 96 r 7275 Address: Zl7 v\j l'ZZ t2 _l- 5 / —City: PP�ppdS' p6 -Zip: Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: /v &'7' 75F-AIA G G x 1o_ Phone#:,30,5.924/22 Q% 6 Address:9 3 �2 Jry W 546 5T Pav A 4 7: Z 777 3 y City: Po A,4 Z, State: Zip: c3 3 / 6 b Qualifier Name: '41720^01D �i8+t.�>y •� Phone#:c3as' 52-5' -Z- 6 State Certification or Registration#:c.4r- o57712 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ ��✓" , 177 Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration [ New ❑ Repair/Replace ❑ Demolition Description of Work: GAJ'�M N P►- vf Specify color of color thru tile; 1 1 a Submittal Fee$ Permit Fee$ { ` ` CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ ® ' 0, (Revised02/24/2014) 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 n t be ap oved and a reinspection fee will be charged. Signature Signature OWNER or AGENT ONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this A, day of 00,1t)Gbei 20 15 by A day of 20 8-' by ' p�Q�ip �a13(1 ,who is personally knownto (1lpdc �i�1 .� who is personally knawn 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:. Sign: Print: Print: JANETTE MOUNA Seal: 10M�'' %'= MY COAAMISSION 0EE207253 Seal: EXPIRES June 11,2016 EXPIRES June 11.2018 Om 39bet53 PANN P a FloONWAkAOM APPROVED BY ( Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION g CONSTRUCTION INDUSTRY LICENSING BOARD CAC05-7719 F*s' The CLASS AAIR CONDITIONING CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31,2016 FARINAS,ANTONIO DE NET TEMP CORP 'y 3352 SW 134 PLACE 405 MIAMI FL 33175 ISSUED: 09/07/2014 DISPLAY AS REQUIRED BY LAW SEQ L1409070002724 Local Business Tax Receipt Miami-Dade County, State of Florida -THIS I;: NOTA t3LL - DO Plt9T PAS' 395i�B19 %,.LB r .., Btf5111'�SS NAM1EJ&OCAYM= HECEwr rm. EXPIRES NET TEMP CORP MEWA4. SE"EMBER 30, 2016 8335 NW 56 Sr UNIT 3 41930043 Must two displayed at plmm of busirt&�L3 DORAL FL 33166 t'ursawt to County Code Chapter&A-Art.R&t OVMER BEC.TYPE OF 047 NESS PAYMENT RECEIVED NT TEMP CORP ISE SPEC MECRANIC L CONTRAC UR BY TAX COLLECTOR Worker(s) I CAUG7719 $45.00 OT"/2915 ECHECK-15-156790 This LwaI 6twonsTax Receipt aaty eoutimuy psymat al Hee to®I Hasmen Tax.The Receipt inuut a RGect�, .moseniticafmnatthe 9m!>tar'squali6icat2aai.WdvHuldor mW coaqdVW&aeggarermentai ar 1U139GWvRMWW raVetary IWNS tiM raWromacts which apply to the taninegs 9f�RFCEtFt�.a6a9a mast he tfrsplx�ed as aIt eatca^.erBtgt Yt:l�-Rd�mE-UaS�Cade Sea�-27fQ Farman initnrnstiaa,wish wstvva.rrimmtdadu g texcoRecrnr NETTE-1 OP ID:ALYS ACORO' DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE F10/02/2015 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(ies) 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 Javier A. Fernandez iSure Insurance Brokers ONE NA 8700 W.Fla ler St.,Suite 270 AH1 No,EI:305-223-2533 ac Noy 305-220-0765 Miami,FL 33174 E-MAIL Certificates@iSureBrokerS.com Javier A.Fernandez ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURERA:MaXum Indemnity Co. INSURED Net Temp,Corp. INSURER B:Technology Insurance Co. 42376 Antonio Farinas 8325 NW 56 ST Unit 3 INSURER C: Doral, FL 33166 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. ILTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DDY EFF MM/DDY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 DAMAGE TO R CLAIMS-MADE a OCCUR BDG0080872-02 04/27/2015 04/27/2016 PREMISES Ea occurrence $ 100,000 MED EXP(Any one person) $ 1,00 PERSONAL&ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 1 POLICY PRO- ❑ JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,00 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATIONPER OR EMPLOYERS'LIABILITY STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N X TWC3485040 07/20/2015 07/20/2016 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? r N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Heating and Air Conditioning Installation,Service and Repair. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Shores Village ACCORDANCE WITH THE POLICY PROVISIONS. Building Department 10050 NE 2 Ave AUTHORIZED REPRESENTATIVE Miami Shores Village, FL 33138 ©11988-2014 ACORD CORPORATION. All rights reserved. ACORD 26(2014/01) The ACORD name and logo are registered marks of ACORD 1"C1932 Miami Shores Village y� Building Department ••ss �_ .....� 10050 N.E.2nd Avenue Miami Shores, Florida 33138 rljy Tel: (305) 795.2204 OR Fax:(305) 756.8972 AIR CONDITIONING REPLACEMENT DATA 'j�CM - 764 PERMIT NUMBER: MC u- 1-7 63 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. a G Job Address(where the work is being done):_/� N �' �� i � � l_"�L J�1 L O City: Miami Shores Village County: Miami Dade Zip Code: ?,�l (-2 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 0 NO❑ ARHI Sheet Attached:YES ❑ NO ❑ Contract Attached:YES UNIT BEING REPLACED DATA NEW UNIT MANUFACTURER AHU or PKG. UNIT MODEL# ASE1-4-1214 COND. UNIT MODEL# 6 SY i 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 / / PKG UNIT EER/SEER YES NO REPLACING DUCTS YES NO YES NO REPLACING THERMOSTAT YES NO YES NO NEW 4"CONCRETE SLAB YES NO YES NO NEW ROOF STAND YES NO YES NO NEW RETURN PLENUM BOX YES NO 1. Minimum Circuit Ampacity(Wire Size): 2. Maximum Overcurrent Protection (Fuse/Breaker Size): 3. Voltage of Circuit(208/240/480): 4. Size Disconnecting Means: Contractor's Company Name: rle-� -FP ID Czar f2 Phone: .305 Cl Q,4 93C1 1LP State Certificate or Registration No. r 1J��'S I �( Certificate of Competency No. Signature 00" Date: r 'L se (Q ifier's signature) (Revised02/24/2014) ® This combination qualifies for a Federal Energy Efficiency Tax Credit when placed in service , between Feb 17,2009 and Dec 31,2014. Certificate of Product Ratings AHRI Certified Reference Number: 8242079 Date: 10/2/2015 Product:Split System:Air-Cooled Condensing Unit, Coil with Blower Outdoor Unit Model Number:GSX160361F* Indoor Unit Model Number.ASPT47D14A* Manufacturer: GOODMAN MANUFACTURING CO., LP. Trade/Brand name: GOODMAN;JANITROL;AMANA DISTINCTIONS; EVERREST; ONE HOUR AIR CONDITIONING AND HEATING; ENERGI AIR Region:All(AK,AL,AR,AZ,CA,CO, CT, DC, DE, FL,GA, HI, ID, IL,IA,IN, KS, KY, LA, MA, MD, ME, MI, MN, MO, MS,MT,NC, ND, NE, NH, NJ, NM, NV, NY,OH, OK,OR,PA, RI,SC,SD,TN,TX, UT,VA,VT,WA,WV,WI,WY,U.S.Territories) Region Note: Central air conditioners manufactured prior to January 1,2015,are eligible to be installed in all regions until June 30,2016. Beginning July 1,2016,central air conditioners can only be installed in region(s)for which they meet the regional efficiency requirement. Series name: GSX16 Manufacturer responsible for the rating of this system combination is GOODMAN MANUFACTURING CO., LP. 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: Cooling Capacity(Btuh): 35000 EER Rating(Cooling): 13.00 SEER Rating (Cooling): 16.00 IEER Rating(Cooling): Ratings followed by an asterisk(')indicate a voluntary rerate of previously published data,unless accompanied with a WAS.whim 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 disclahrrs all liability for damages of any kind arising out of the use or performance of the product(sL or the unauthorized alteration of data listed on this Certificate.Certified ratings are valid only for models and configurations listed in the directory at t✓cvev.ahrid irectory.org. TERMS AND CONDITIONS This Certificate and Its contents are proprietary products of AHRL This Certificate shall only be used for individual,personal and - confidential reference purposes.The contents of this Certificate may not,in whole or in part,be reproduced;copied;disseminated; entered Into a computer database;or otherwise utilized,in arty form or manner or by any means,except for the user's individual, personal and confidential reference. AIR-CONDMONING,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 ie make life better" end 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 130882836116237408 lwl#%^A a e:..n_�.a:a:__:_1 ::__.:_� __�e+_s..:�_��:__ r_�..._ r=0T1=1eAT= AIA Net Temp Corp Proposal 8325 NW 56 St Unit 3 o•o Doral, FL 33166 1 10/2/2015 &� 6673 Tel: 305-994-9396 Fax: 305-994-9397 State Certified Air Conditioning Contractor Lic. CAC 057719 Bill To Job Location Diogenes D'alacio Diogenes D'alacio 1217 NW 122 Terrace 1217 NW 122 Terrace Pembroke Pines, FL 33026 Pembroke Pines, FL 33026 ProposalSUbmitted to good for •• Phone No, 30 Days DescriptionTotal For: Installation of a new ton (36,000 ) BTU air conditioning syst m 1,500.00 1,500.00 - Replace new Air Handler, Condensing Unit 5 and KW Heater f - Pull and pass inspection with Miami Shores Village Building f Department d New Unit Information: Make: Goodman Air Handler Model: ASPT47D14 Condensing Unit Model: GSX160361 t Seer: 16SEER o Warranty: 10 Years On Parts 1 Year On Labor I I j LIMITED WARRANTY All Materials,parts and exisiting equipment are warranted by the manufacturers or r Subtotal $1,500.00 suppliers written warranty only.Net Temp Corp.,makes no other warrantees or �- ------------ guarantees expressed or implied,and We agents or technicians are not authorized to Sales Tax (7.0%) $0.00 make any such warranties or guarantees on behalf of Net Temp Corp.Labor for service or worts performed on this invoice by Net Temp Corp is warranted for 30 days unless - ------ — -- otherwise indicated in writing. Total $1,500.00 Acceptance of Proposal-The above Prices,specifications and conditions are — satisfactory and are herby accepted.You are authorized to do the work as specified. Payment will be made as outlined above. Date of Acceptance: Signature: