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MC-15-2192 � I Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores,FL Phone: (305)795-2204 Fax: (305)756.8972 Inspection Number: INSP-254613 Permit Number: MC-8-15-2192 Scheduled Inspection Date: March 16,2016 Permit Type: Mechanical - Residential Inspector. Perez,JanPlerre Inspection Type: Final Owner RASMUSSEN,CELESTE Work Classification: AIC Replacement Job Address:9454 NE 4 Avenue Miami Shores,FL Phone Number Parcel Number 1132060136050 Project: <NONE> Contractor: DIRECT AIR CONDITIONING INC Phone: 305-596-2666 Building Department Comments INSTALL 3 TON PACKAGE UNIT WITH 5K HEATER Infractio Passed Comments INSPECTOR COMMENTS False V !� Inspector Comments Passed Failed Correction a Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. March 15,2016 For Inspections please call: (305)762-4949 Page 19 of 31 r� Miami Shores Village � � 10050 N.E.2nd Avenue NE " k "^ Miami Shores,FL 33138-0000 Phone: (305)795-2204 ,_, .„ Expiration: 03/16/2016 Project Address Parcel Number Applicant 9454 NE 4 Avenue 1132060136050 Miami Shores, FL Block: Lot: CELESTE RASMUSSEN Owner Information Address Phone Cell CELESTE RASMUSSEN 9454 NE 4 AVE MIAMI FL 33138-2710 Contractor(s) Phone Cell Phone Valuation: $ 6,080.00 DIRECT AIR CONDITIONING INC 305-596-2666 Total Sq Feet: 0 Tons:3 Available Inspections: Additional Info:INSTALL 3 TON PACKAGE UNIT WITH 5K Inspection Type: Classification:Residential Final Approved:In Review Review Mechanical Comments: Date Approved::In Review Date Denied: Type of Work:INSTALL 3 TON PACKAGE UNIT WIT Scanning:3 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $4.20 DBPR Fee $s 20 Invoice# MC-8-15-56872 DCA Fee $3.20 08/26/2015 Check#:11052 $50.00 $189.40 Education Surcharge $1.40 09/17/2015 Check#:11090 $ 189.40 $0.00 Permit Fee $212.80 Scanning Fee $9.00 Technology Fee $5.60 Total: $239.40 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 inform i n is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore,I authorize the abovntra to do the work stated. 1�r'1-W September 17, 2015 Authorized Signature:Owner / Applicant / -eoVr-jfctor / Agent Date Building Department Copy September 17,2015 1 r (i Miami Shores Village %AUG15 Building Department10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION UNE PHONE NUMBER:(305)762-4949 FBC 20tq BUILDING Master Permit No. 01- g-t5-219Z PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP (�r" P , a '(• CONTRACTOR DRAWINGS JOB ADDRESS: 1 'f 54 l� � `t A V 6 2 City: {Miami Shores/' County: Miami Dade Zip: -193 13 6 Folio/Parcel#: l�' 3 2 0 i " 0136 0 5 IS _Is the Building Historically Designated:Yes NO V Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): Cells le, R4,31aMUS-S-et)--Phone#;IDS-7S7— EI3-3 Address: 1 q 54 I16 14 lel`/E' ,�•t 4 City: Miami S�re S State: t I o tr f CIS —Zip:.-13 (3A Tenant/Lessee Name: "� Phone#: Email: //°° CONTRACTOR:Company Name: l .i 1 Phone#:30-5-5�In "7 Rc 6 Address: `3 G VJr- .Com City:Aam1 State: +t-, lDI-ld- Cn; Zip: Qualifier Name: Phone# O State Certification or Registra ' Certificate of Competency#: DESIGNER:Architect/ Ines Phone#: ... Address: Lj City: State: r— Zip: Value of Work fo this Permit:$MAIteration Square/Linear Footage of Work: Type of Work: hion ❑ New C9 Repair eplace ❑ Demolition c � Description of Work: Specify color of color thru tile: I Submittal Fee$ Permit Fee$ °� v G $ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$- i TOTAL FEE NOW DUE$ ` (Revised02/24/2014) �� t 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 la o re will be delivered to the person whose property is subject to attachment. Also,a certified copy of the recorded notice of mmen cem nt m be posted at the job site for the first inspection which occurs seven (7) days after the building permit is iss ed. In the ab ice of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature)( Signature Signature OWNER or AGENT CONT CTOR The foregoing instrument was acknowledged before me this The foregoing nstrument wa acknowledged before me this llday of A So s ,20l _ ,by ;25 da .of S 20 j S ,by a� �i4t�a✓fS� ,who is r"onn5 yVmwrr90 u L �• who i ers6na y kno nw�to me or who has produced as me or who has produced as identification and who did take an o th. identification and who did take oath. NOTARY PUBUC- NOTARY PUBLIC- Sign: Sign: Print Print: 0 06 Gaut , MANtiEI ANMRAUMMM l • '• ;a°. o; Notary Public-State of FlpriOa Sea •�` %; Notary Public-State 01 F4ft Seal: 'N Comm.Expires Aug 25.2017 :. My Comm.Expires Aug 2S,2017 m, ;r y commission,#FF 29511 Po Commission#E FF 29511 .,; °.• Bo^den Through National Notary Assn. '��°;�Ott' Bonded Through National Notary Asen. **��*a��sw • �a �e: �x+xs *a��xaa�ss*s�ra��x ssss�s�s*�*s*�•��*�a��x+ss��s�a**e�a�**t��s*a�*sx��xx�a�� APPROVED BY IE Examiner Zoning Structural Review Clerk (Revised02/24/2014) Oct 28 14 01:1 Op Direct Air Conditioning 305-551-1546 .p.1 40STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD {850}487-1395 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 SOTOLONGO, JUAN JESUS DIRECT AIR CONDITIONING INC. 12921 SW 27TH STREET MIAMI FL 33175 Congratulationst With this license you become one of the nearly one million Floridian licensed by the Department of Business and Pro#'esskmai Regulation. Our professionals and buallnesses range STATE OF FLORIDA from architects to yacht brokers,from boxers to berbeque restaurants, DEPARTMENT.OF BUSINESS AND and they keep Florida's economy gong. PROFESSIONAL REGULATION i Every day we work to Improve the way we do business k1 order to CAC057328 �SSU!✓•0�-.:.10/1512014 serve you better. For Information about our services.please log onto wwvx fioridaltcaense.com. There cert find more information Oq ml► y� CFUtTIFiEDAIR .ND;0ONfiR•:.•:::. about our divisions and the lations that impact you,subscribe SOTOLONGOz . N to department newsletters and learn more about the Departments initiatives. DIRECTAIR CONAITIlNt3C�.::. i Our mission at the Department is:Ucense Efficiently.RWAde Fairly. We constantly strive to serve you better so that you can serve your +'- x•�e "< customers. Thank you for doing business In Florida, IS CERTIFIED under the`prouisions of Ch.488 FS. and congratulations on your new licensel Exph mdds:AUG 31,lora► 041015W=78 DETACH HERE RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY STATE OF FLORIDA DEPARTIfi W OF BUSINESS AND PROFESSIONAL.REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD TCOMS The CLASS AAIR CONDITIONING CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expin tin date: AUG 31,2016 SOTOLONGO,JUAN JESUSeo. DIRECTAIR CONDITIONING INC. 12921 SW 27TH STREET MIAMI FL 33175• ISSUED: 1WISM14 DISPLAY AS REQUIRED BY LAW SEQ# L1410150003075 1 LocalBusiness Tax Receipt Miami-Dade County, State of Florida Tf1S iS NOTA SU—d0 NOT PAY 3630473 NLBT BilSilt�SS NANMlLOCATI�i F=E11 T NO. EXPIRES gIRECTAIR CONDITIOMNGINC REIdEwAL SEPTEMBER 34„2015 12=SW 128 ST#7 3793271 Must be displayed at place of business IMI A ,FL 33186 Pursuara to Conray Code Chapter 8A—An.9&10 OW11 M Wit-TYPE OF BUSINESS. PAYMENT RECENED DIRECT AIR CONDITIONING INC 196 SPEC MECHANICAL BY TAX COLLECTOR C10 JUAN SOTOLONGO CONTRACTOR' . 75.00 082?J2014 Work”) 10 CAGO57328 0223-14 XXM TUsLocalBod mss Tax Reeelptoalp eos&ms papmea ddw Local Sodom Tax.The Reedptis seta Orme, permit,ers aerMalloo of do heMerisgaalleadesa todo 6asiaeas,flolder most eom*w16 any gowrsmexal • srpoagceeramaatai tegniaNrp bars sad regake�ntawdk6 apple a lGe Gamaoss. The KMT no.ebm a nd be ftkved=a1 oommmeW veaelea—k6=t-Qde We Seo ft M Format lafermaNe®,vfaft s J ACORD® CERTIFICATE OF LIABILITY INSURANCE DATE(M11%2015YY) o6/za2o15 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 NAME Automatic Data Processing Insurance Agency,Inc. PHC.N No 1 Adp Boulevard ADDRESS: Roseland,NJ 07068 INSURERS)AFFORDING COVERAGE NAIC# INSURERA: Technology Insurance Company,Inc. 42376 INSURED INSURERS: DIRECT AIR CONDITIONING INC INSURER C: 12200 SW 129th Court Miami,FL 33186 INSURER D: INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: 368997 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. LTR TYPE OF INSURANCE WyD POLICY NUMBER DIYYM LIMA COMMERCIAL GENERAL.LL40U rY EACH OCCURRENCE $ 33 CLAIMS-MADE 1-1 OCCUR PREMISES ocamern e $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PR F-1 LOC PRODUCTS-COMPIOP AGG $ OTHER: $ AUTOMOBILE LIABILITY accideSINGLE LIMIT ft nt) $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per acdderd) $ HIAUTOS TOS ANO-OWNED PERTY DAMAGE AUTOS (per acciderd) UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION X PER I AND EMPLOYERS'LUUNLITYY/N STATUTE I ER ANY PROPRIETORIPARTNERIEXECUTNE M E.L.EACH ACCIDENT $ 1,000,000 A OFFICERIMEMBER pfCLUDED? N IA N TWC3443160 12/01/2014 12/01/2015 (Mandatory in NH) EL DISEASE-EA EMPLOYEE $ 11000,000 if y s desmibe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCWPTKIN OF OPERATION!LOCATIONS/VEHICLES(ACORD 1D1,AddMotud Remarha SchW%do,nmy be a it more space is regrdrad) CACO573211 CERTIFICATE HOMER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Shores Village Building Department ACCORDANCE WITH THE POLICY PROVISIONS. 10050 North East 2nd Ave Miami Shores,FL 33178 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(NU M" 08/21312015 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 bolder Is an ADDITIONAL INSURED,the poiicy(Iss)must be endorsed. If SUBROGATION IS WAIVED,sd*d to the terms and conditions of the policy,certain policies may require an enclorsement A statement on this certtfioate does not confer rights to the certificate holder In lieu of such andorsernent(s). PRODUCER McIr Ltd Estrefla Accurate Group Uc P { 5}226-8727 A FAX N,. (305)226-8767 8300 West Hagler Suite 114 net Miami,FL 33144 INSUREIWAFFORDING COVERAGE NAKP$ Phone (305)226-8727 Fax (305A26-8767 n SURERA: Starr indemnity&Liability Company 13853 INSURED INSURERS: Direct Air Conditioning Inc C 12200 SW 129 C aaSURER D: INSURER E• Miami FL 33186- 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,TERRA 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. Tyl TYPE OF INSURANCE POLICY NUMBER LIMITS ® COMMERCIAL GENERAL LIAIELnY EACH OCC RRENCE $ 1,000,000.00 ❑ CLAIMS-MADE ® OCCUR OSI P occurrence) $ 50,000.00 A ❑ Y Y 1000359401151 04/10/2015 04/1012016 � one $ 5,000.00 ElPERSONAL&ADV INJURY $ 1,000,000.00 GEML AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000.00 ❑ POLICY ❑ ❑ Loc PRODUCTS-COMPIOPAGG $ 1,000,000.00 ❑ OTHER $ AUTOMOBI.E LIABII.Ii y SINGLE UM(T ❑ ANY AM BODILY IWURY(Per Person) $ ❑ ALLAUTO ElAAUUTOOS EUL� GODLY INJURY O er aoddeO $ ❑ HIRED AUTOS ❑ AUT ON-OWNED LO�AMAGE $ ❑ 0 $ ❑ UMBRELLA LIAR ❑OCCUR EACH OCCURRENCE $ ❑ LIAB ❑CLAIMS-MADE AGGREGATE $ ❑ DED D RErEtam$ $ WORKERS COMPENSAT�N PER AND EMPLOYED'LIABILnY YIN — OFFFFICEREl �EXCLUDED? ❑NIA EL EACH ACCIDENT Ir yae�lIn NH) EJ..DISE-EA EMPLOYE $ DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ ONCIM TION CF OPERATIOM I LOCAMm f V VM=h ACORD II",M*ftnei Rem SoWn*B.Wore"Woe M"ubed) CACOU328 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE Miami Shores VUlage Builidng Department THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH CY OVISIONS. 10050 NE 2nd Avenue Miami Shores,FI 33178 AUTHoRIZED REPREaENT jj Lucia EstreAa 61 CORPORATION. All rights reserved. ACORD 25(2014101)OF The ACOWFrame aftJogo are registered marks of ACORD 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: 7501858 Date:8/25/2015 Product:Single-Package Air-Conditioner,Air-Cooled Model Number:4TCC4036A1 Manufacturer:TRANE Trade/Brand name:TRANE Region: 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 regions)for which they meet the regional efficiency requirement. Series name:XR14 Manufacturer responsible for the rating of this system combination is TRANE Rated as bit r�.Sin 21 40 Air-4otic itiot o Air-Source Heat P i tv vercft ptd,in�t><t,third Party ;: .. . CD0ling.Qs-op"(Btuh): 37{ EER Rating(C004ng): 12.OV SEEP. �C ng}: 14.00 i l ). •Ratings followed by an ascerlsk(•)indicate a voluntary rerate of previously published data,unless accompanied with a was,which Indicates an Involuntary rerats. DISCLAIMER AHRI does not endorse the product(s)fisted on this Certificate and makes no representations,warranties or guarantees as to,and assumgs no responsibility for, the product(s)listed on this Certificate.AHRI expressly dlsciaims ag imbplty for damages of arty kind arising out of the use or performance of the product(s�or the unauthorized alteration of data Med on this Certificate.Certified ratings are valid only for models and configurations Med In the directory at www.shridirectory.org. TERMS AND CONDITIONS a "EMIR This Certificate and Its contents are proprietary products of AHRL This Certificate shag 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 any form or manner or by any means,except for the user's individual, AU= 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.ahrldfrectory.org,dict on'Verity Certificate"link we make life better"' and enter the AHRI Certilled 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 GE �Tr�ICATE NO.: f Apr 24 02 03:20a Direct Air Conditioning 3054533330 p.1 Mcg s .a►co t� rVYYYl CERTIFICATE OF LIABILITY INSURANCE °Al2!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 1SSUING 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.N 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 Hsu of such endorsement(s). CONTACT PRODUCER NAME: PHONE FAX Automatic Data Processing insurance Agency,Inc. N0-E9 D Ne i Adp Boulevard ADDRESS: Roseland,NJ 07068 INSMURIb7AFFORDING COVERAGE _ NAIC* INSURERA: Markel Insurance Company _ 38970 n"ED INSURERS. DIRECT AIR CONDITIONING INC INSURER c: 12200 SW 129th Court Wam),FL 33186 INSURER o: INSURER E• _ ENSURER F-. COVERAGES CERTIFICATE NUMBER: 424087 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. INSRCY EFF 'Y LTR TYPEOFINSURANCE IwD1wVD POLICYNUMBER M rmYMAw=JVyM LIMITS COMMERCIAL GENERAL LIABILITY EACh OCCURRENCE $ CLAMM54AADE F-1 OCCUR MED EXP(Any one eracn) S _ PERSONAL&ADV INJURY S C-Nt AGGREGATE UTAT APPLIES PER 1 GENERAL AGGREGATE S POLICY Q P E]LCC PRODUCTS-C06UPAGG S OTHER: S AUTOMOBILE LIABILITY E S ANY AUTO BODILYINJURYL°-P ) $ ALL OVINED SCHEDULED BODILY 14JLRY(Per eoddw1) $ AUTOS �� AUTOS RJ7 NA E $ TOS I,M MUR r A LWB OCCUR EACH OCCURRENCE S EXCESS UAB CS1t1NS MADE AGGREGATE $ OED RETENTION E 5 WORKERS COMPENSATION AND EMMOVERS'LIABILITY YIN X ATUTE ER A �ICCERRJUENS RERE DICLUDEEJ7fwCUTNE I -J N IA. N TWC3613538 12/01/2015 12I01t2018 E L EACH ACCIDENT 6 1,000,000 In 09 E.L.DISEASE-EAENPIOY3 $ 1,000,000 ay�,da�_ecr6eL.ndcr i,1I00,000 I DESCRIP'nON OF OPERATIONS halo. i E.L DISEASE-POLICY UNfr S i DESCFa"ON Of OPERAY/ONS f&OCATIMS!V12401.66I06CO11C'9M addidn"Al Remarks Schedule.maybe altadmd Nmore Maw Is reouked) Contractor License:CACOS7328 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Shares Village ACCORDANCE WITH THE POLICY PROVISIONS. 10050 N E 2nd Ave. Miami Shores,FL 33138 AUTHORIZED REPRESEWAT1VE AC 1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD Apr 24 02 03:20a Direct Air Conditioning 3054533330 p.2 b .. 000�sz _ • Local Business Tax Receipt Miami—Dade County, State of Florida —THIS IS NOT A BILL •- DO NOT PAY LBT 3630473 .� BUSINESS NAMEILOCATION RECOPT NO. EXPIRES DIRECTAIR CONDITIONING INC RENEWAL SEPTEMBER 30, 2016 12200 SUV 129 Cr 3793271 (Must be displayed at place of business MIAMI FL 33186 Pursuant to county Cone Chapter SA—Art.9&10 OWNER SEC.TYPE OF BUSINESS PAYMEW RECEIVEDDIRECT AIR CONDITIONING INC 196 SPEC MECI4ANICAL CONTRACTOR By TAX COLLECTOR Worker(s) TO CAC057328 $75.00 09/03/2015 CHECK21-15-120121 This Local HusinassTaz Receipt oady coaliraas paysneat of the Local 8vaiaeasTwL The Receipt is asot a Ilmanse, permit or a certiRcatlao of the holdoes quallsoadom to do baalows.Iteldoraomt comply wiib aaygovemmmrtai or rmagaveromentat regulatory laws and re quiremeaiswhich apply to the basiaass. The RECDPT NO.above Herat be displayed on all commercial vehiotoo—Miami—Dods Cods Sac So--276• For mora Wormaolor4 virat ADMy m lamidade amAncottact�x t 12200 SW 128 Court 3100 South Congress Aire.S7 Miaml,Fl.3M86 Boynton Beach,FL 33428 &ii ON,r, ok�yX - PHOW9-3 2ftS � , �J/ Pahn Beach:561.404-1100 FAX:305651-1546% Broward:854-289 123 oan Fax:561-336-2587 STM COUUMD CONMACM AIR CONDMONINO 12awn smm im $ YVFiy Direct.w?.Because'We Care0q I —�— DATE '� O PROPOSAL D CONTiL4CT CUSIOMt, srl&W5 mm 30 --)5 ADIMESS: Nt Cny/ST./M': PAIP&mi i �L 331 tom: tT ADN L L 3a 3�i t` �?lIIEFEIIW BY: �rtutivlr C AWa tAtT o WAT Ptd o MIXT!SYSTEM 'A'DW narmoft wak," SmSflel- . O OUTDOOR MOS.# 'Ce G O 3(o A1d�Q uto�R MOoa. O F,MSWM SIDE STAGE 07WO-STAM o mw CARR oVARWE SPEEI) 0 wpProww mxmuwr.lowmm OVARIES!'® oven= otlORtwA. nam name obwwmewsww mcm0sla JOS TOTAL S 0,0 gZ),- WARRANTY NOTES: / O Tfe-doh �AiE $ �o �S t'i -tom.!!!!=$ATE $ �'� YEARS PARTS OtaraW tM 300- mmmm rvi cc ) OAuxMwy them Pan -t ANY WWTE $ X00,- rA N s� N i k Coti i q'c 00 RM M*Pan PER T M !3 ® $c7 YEARS CKS ADet Newa�� 0C(m smvbn 76TAL S g�,' YEA10;LABOR o ® omwmwm oPAClt muw owwme OMR.TIsma O Boot MAKE TONS I Ism OBrealcer(s) OUTER MOQEt.# INDOOR MODB.B Ori wmpmsm I oSltmSTAG oTWO-ffm omKwmmmm ovmmEmm OEC INDOORtuww;I Ot11fPB 1 oVMIAB.ESPm DVMTM OHOIWONTAL OATTM o8ARAGE OLowVoltage JUTOTALS WARRANTY NOTES: Ot1i�VottagelRl� mWTE S OS Ve -COILPANY SATE $ YEARS PAM OR�tornVengs) S COBS cash M8n8g8ment Account® 1880 3 LABOR �IXM PEM sta'� ..o Fl. t Wo — MEAT� o MULTI SYSTEM S=VE DATE v $ 4' °'' ►De.O PAS OFL:.1 i ---- - E MSR OVANABLE SPEED DOLLARS13HORMWAL OATTIC oGARAGE 8`- � MTV NOTES: VAS OMPREM SprXarAs ---- _ 'v - 9RTS FOR:08430 L? 13 L54588 20 L880 XLS YEARS LABOR ALLP IAREAiVMFpL.a69A'FL *WMBMAP .S$DffYARRAN CWVAT®tLEM AM FMAW OFMMCSVSTM eau NOW vn MAN I A VISIM P MR"RESULT W PEMALTUMURM AT UUMM ESE -IBA Rum S `5O 1`� YEARS PARTS e ' �NE Ccl+.�c, p80 -MANY REBATE S 800 `� YEARS LAS 0 f2 K'�"' 4,1re� i oub Pa PET FEE $ pA 5 ems---__lj s" L S g C��.- YEARS LAIR TLS Services FAL 1O Lam., OPAL UNIT OIR:AT PUMP OMIU SYSTQdI ® _. BEERbddmk 3 ft MAKE TONS ] S) OUTDOOR MOS.# BIER MODEL# SM OwMSTAOE OT�ITO-STALK: OOtIAL OVARV�� 7F1 OPAL OATTiC 13MUM 7Elecit'ical Etter► B 1w. OIIYPEI�1 OVARU�.E SPLA OYERTE+AL. ]Low Voltam wLI JOB TOTAL $ VIARRAWT NOTES: Olt}�tV�eWbio9 O .111LiTY RMIrE $ YEARS COMPRESSOR -IBANW.REBATE $ YEARS PARTS OSW*Vwtt(s) .INMIPANYRtBTl1TE $ 13Rd=V0*) i LABOR .,..._.. Dash Apanagema�►t peccant® 1880 W-1700 30 O NEAT PUMP O MULTI SYSTEM WL4OHAVE FL nair� 1 � J!''�Q• °-%' DEI.# ------ 1OMPRESSOR OVARIABLESPEED �pRp R OFE I l� — `�..r—� DOLLARS s e... OHOtRZONTAI OATIIC 13BARAGE SIT NOTA owill LYSweavbiw; , - � FOR -�. o►. � �3 �54 Saa �� iaao I:oa 4 30 17 6 YEARS LABOR - - - — 90DArrt rlrOl+ttiPEROTSAM FURN"REPIACEMBITOFANNVAC81r8T3L -NO�EtALL PRIw AlREAFTETtFPffoWNMEKPENSL FANO PULLA PEROT COULD RESULT IN e � Cl FWAHM o MON.PAY=ff ocASH ocRED1T� oQt�ECK# ng: TOTAL.AMOUNT DEPOSIT$ �u04r BALANDE DUE S Atima*aliegualwoW tobewAfi+octobecowooWd bra subsWrM A exba coaft wM be DATE bacons On oft dmp arer ane abm to Tfds propyl may be dayL by byusK� a cernte.i and other reoa�+ - awqftdwPW wo mores convenswon i ooratsor�xe esemwtmy Est START DATE: and ere trereby '�me to�theaiortc es Faailf be malt as cubw above. DUE UPON C I.EI>011 1 tea+e itis erdF y ori the above sv* mrd so mw as mmnw ebwe-ltIS SWSW OW D�A �0s is orfug uw aw stat ATE meft w weed,itis edw dW tw"mmom� ot e remark Uri- "aor"be ireM Irerrrdesa for arty dmrm)lea www.directac123.com gt*° s 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 area not acceptable. Job Address(where the work is being done): 1 r'? Ll /�/t� 4-4yfl //ll�� City: Miami Shores Village County: Miami Dade Zip Code: 33 g A 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 R NO❑ Contract Attached:YES UNIT BEING REPLACED DATA NEW UNIT MANUFACT RER C C 03 AHU or&G.JJNIT MODEL# C e_ 41 3 COND.UNIT MODEL# KW HEAT 4 NOM TONS . 0 TOAkS 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 ESY NO YES NO NEW 4"CONCRETE SLAB NO YES NO NEW ROOF STAND YES YES NO NEW RETURNPLENUMBOX YES O 1. Minimum Circuit Ampacity(Wire Size): y AW G 2. Maximum Overcurrent Protection(Fuse/Breaker Size): 1 50 3. Voltage of Circuit /480): 2-*0 NOL S 4. Size Disconne ing Means: Contractor's Co pany Na f d Phone805- 596-2.666 Cv- State Certificate Re stration N Certificate of Competency No. Signature Date: 5 -2-66 (Quaimee ) (Revised02/24/2014)