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MC-15-1229 15 Miami Shores Village -. -- - - TED Building DepartmentDEC� �� 20,5 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 I By: INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 200 BUILDING Master Permit No. lee-/,p^/�/^cpel� PERMIT APPLICATION Sub Permit No. RC 15 - (2;' ❑BUILDING ❑ ELECTRIC ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ® MECHANICAL ❑PUBLIC WORKS Z CHANGE OF ❑CANCELLATION ❑ SHOP Z/( CONTRACTOR DRAWINGS JOB ADDRESS: D S ap.) Z/ City: Miami Shores County: Miami Dade Zip: 33 Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder):): PAW �L1Pr IN/, LZG Phone#: Address: .s9P f -4&d ` eI S c City: 1-114 A?l State: Zip: / Tenant/Lessee Name: Phone#: Email: �/� CONTRACTOR/:Company Name:17,6 �e' Aoe2 `Phone#: "o '3 FS® Address: ) PO Z 2---� City: l~ State: Zip: -33177 Qualifier NamePhone#: 74 "24-4 - 0- 7/ State Certification or Registration#: 1(f I.��I Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ '9t we . Square/Linear Footage of Work: a Type of Work: ❑ Addition ElAlteration ElNew Repair/ place ❑ Demolition Description o@ir S gln ? .:ldc`? A' Spedfy0 t r ► w Submittal Fee$ Permit Fee$ _ CCF$ CO/CC$ Scanning Fee$ °'LJL) Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ �L7 • �.�.) (Revised02/24/2014) r r Bonding Company's Name(if applicable) .14 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 NER or AGENT TRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of✓FLPyI/3 r-A ,20_/r� ,by day of 20 by BIZ g ,0 07/?,4 ,w i to A G`oJD�� ,wh pEcsei}aHgi o 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: L Sign: •�,� Nota7futift-State o Print: tea Print: • Commission#EE 145818 �;9 oQ: Commission#�EE 145818 ��'�•°.•• �, ,�' Seal: Bo�Med Through NOW Notary Assn. Seal: f o.. „�,.,t•� Bonded Throvh National"Ann. ***s*+r�**sss�sa�*sss*s****�x�xa�a�***a�ss*wwwx��*e na APPROVED BY 1 v ?'� ��Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) i 4 f STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL-REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850)487-1395 � 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 COLOMA,JUAN C THE ICE TEAM CORPORATION 16709 SW 117 AVE MIAMI FL 33177 -- -- Congratulationsl With this Ncense become one of the you - --------- one million Floridians Ocensed the Professional Regulation. Our � De�rtment of Business and _ - and businesses range STATE OF FLORIDA from architects to yacht brokers,from boxers to barbeque restaurants, DEPARTMENT OF BUSINESS AND and they keep Florida's economy strong. PROFESSIONAL REGULATION Every day we work to improve the way we do business In order to CAC1813831 I IED: 08)26/2014 serve you better. For information about our services,please log onto www myfloridalicense.com. There you can find more information CERTIFIED AIR GOND GONTR about our divisions and the regulations that Impact you,subscribe COLOMA,JUATJ t ' to deQartment newsletters and learn rrore about the Department's initiaWes. THE ICE TEAM GORFfORATION Our mission at the Department is:License Efficiently Regulate Fairly. VWe ' strive to serve you better so that you can serve your cxistomers. Thankyou for doing business in Florida. IS CERTIFIED under the'p'rovtsions of Ch.489 FS. and congratulations on your new license! dWs:AUG 31,2M6 L741414 RICK SCOTT,GOVERNOR KEN LA E AR STATE OF FLORIDA DEPARTMENT CCATION CONSTRUCTION INDUSTRY LICENSING BOARD CAC1813831 The CLASS B AIR CONDITIONING CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31,2016 COLOMA,JUAN C _ THE ICE TEAM CORPORATION Ir 16709 SW 117 AVE MIAMI FL 33177 _ ISSUED: 08021=114 DISPLAY AS REQUIRED BY LAW sEA a L1408'26> 1414 Local Business Tax Receipt Miami-Dade County, State.of Florida THIS NOTA HILL—DO NOrPAY LBT 4881190 , 1!{1Ci4,1Ittt11 RECEIPT 11HLT CarotanoN THE REI+IEwAL ' S>= 'TEQ, 2016 # 7# W 11 A 5094851 iwuslt ba of twaitr�sa ,,MlANtl F't» x:3977'' w,rt��rrode OWNER SEG TYPE OF BLISWESS PAYR40ff RMUMD ICE TEAM CORPORATION THE 198 SPEC MECHANICAL BY TAX COLLECTOR CIO JUAN C COLOMA PRES CONTRACTOR75.000711412015 Wwket(s) 1 CAC1813831 CHECK21-15-093343 ''`T�Laoal HTas<Ilea9iptaa�tttm��Local BasloeasTax.11�Reeeipt is�a Nceaae . pmmdLwa GortMagdn diftoh Ws queflecadom to do bushmm Holder mud COMOY wfth=I gevwmmnW or wguldw tmand wphemoub witbapplgtathaboaiaess. ThomanUgLalmamstbadbp{apdanaH commewN vdftIw—NbmW38ftCc"Sae&I718 Formam' a CERTIFICATE OF LIABILITY INSURANCE [1272%20D 5) 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 pollcy(les) must be endorsed. If SUBROGATION IS WAIVED, sWect 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 tieu of such en s. PRODUCER ROWN I E�AC—T A&D ALL—LINES INS ASSOC INC PHONE305 463-6781 FA (305)387-2918 5600 SW 135 Ave Ste 106 sameclorgibeliL south.ne Miami, FL 33183 DISURERIBI AFFORDING COVERAGE Nate ACCIDENT INSURANCE CO. INSURED THE ICE TEAM CORP. INSURER B:FLMWA , 3274 N.W. 38 ST. MIAMI, FL 33142 INSURER D 305-385-3880 INSURER E INSURER F COVERAGES CERTIFICATE NL00Bt REVISM NWAMR THIS 15 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 POLICES DESCRIBED HEREIN B SUBJECT TO ALL THE TERMS, EXCLUSIONS AND (EDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BYPAID CLAIMS em PARA. LTR TYPE OF INSURANCE LIMITS GENES LIABILITY EACH OCCURRENCE 1, 00,000 X COMMERCIAL GENER�A-L-U�AIIILR1f 100,000 CLAIMS-MADE MR OCCUR MED EXP aha 5,000 A X Y 090209000004862 7/1/15 /1/16 PERSONALBADVINJuRY s 1,000,000 GENERAL AGGREGATE s2,000,000 GENT AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGO 2,000,000 PRO- rl $ BINED AUTOMOBILE TITBIT tTY ANYAUTO BODILY INJURY(Per Person) $ ALLOWNED SCHEDULED BODILY INJURY(Peraaident) $ AUTOS AUTOS HIRED AUTOSNON-OWNED PROPERTY DAMAGE $ AUTOS UMBRELLA UABOCCUR EACH OCCURRENCE REXCESS LIAS HCLAIMS AGGREGATE DED L IRETEN110NS WORKERS COMPENSATION WCSTATU OTH AND EMPLOYERS LIABILITY YIN B OFFFF7 3VMEEM ER�EXCLUDER/EXECImVE ^ MIA Y E.L.EACH ACCIDENT5 00,000 MandatatyInNFQ U 10637648 4/1/15 /1/16 ELDISEASE-EA EMPLOYEE $ 500,OW rc descrft under below CY UlArr is 500-000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Add19ami Renmdm Schedule,B mom space is required) MECHANICAL CONTRACTOR CERBECAIE HOLDER CITY OF MIAMI SHORES BUILDING DEPARTMENT THE HE ANY of THE ABOVE DESCRIBED POLICES e£CANc BEFORE THEE EXPIRATION DATE THEREOF, 8 FINERED IN 10050 NE 2ND AVENUE ACCORDANCE WITH THE POLICY PROVI S. MIAMI SHORES, FL 33138 AUTHORIZED REPRESENTATIVE ®1988-2010 ACORD TION.All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD SENDER: COMPLETE THI�§SECTION C,0 FRY MPLETE THIS SEC hON ON DEL AlL ■'Complete items 1,2,and 3. A. BWFAMM ■ Print your name and address on the reverseX Agent so that we can return the card to you. D Addressee IN Attach this card to the back of the mallpleoe, B.Received by Ffinted ) •Date of Delivery or on the front If space permits. 1. Article Addressed to: v*z;' t}. Is delivery address different from Item 1? es If YES,enter delivery address below. p No Lj o 2,7 111A POVA Pio hfN I'L III IIII'I I'II I'IIIIIIiI I II III IIIiII II IIIIII III 3. s Type WM ❑Priority Map ExpreseD ❑Aduft Suture ❑Registered Md— Adult Signahse PMWDWd.Ddvery ❑=ed Map Resi rlated 9590 9402 1239 5246 2107 75 ❑ ,y, ❑pmm Pmelpt for ❑Collect an every Menem 2. Article Number(Thumfer from service ktW ❑ l Copect on Deliveryiestricted DeRM M-ftw - odMa ❑ ceno Waffed Restriced Delivery r1,1-5'D oop� y ovB = PS Form 3811,July 2015 PSN 7636-M-D00 SM ! ' Domestic Return Ribelpt USPSTRACMG# ;PIAs^� � paid Petm(t bio,G-f() 9590 9402 1239 5246 2107 75 lUnftd OWN this box' .P Spin Flip 10019 LLC 5901 SW 743t, Suite 410 Miami FL 33143 (305) 7905476 November 3rd 2015 VITAL AIR SOLUTIONS INC 4030 Northwest 4th Avenue Pompano Beach,FL 33064 Telephone: 954-821-8640 Hereby we want to notify you that from this moment we are changing Mechanical Contractor for the property located at 435 NW 111 St, Miami Shores FL, 33168. Please, don't hesitate in calling if further information is needed, os r in Flip 001 (305) 7905476 Miami Shores Village '"' ami Building Department 10050 N.E.2nd Avenue ��ORiDp' Miami Shores, Florida 33138 Tei: (305) 795.2204 Fax: (305) 756.8972 CHANGE OF CONTRACTOR I ARCHITECT --Permit N. t'ier's Name fee;Simpie Title Holder): 2V ��APs APPI, Ube Phone#. X90 Owner's Address: .�1`9©/ go W svirx iia City: Mi'd "-I/ State Zip Code: .3 3>jK3 Job AddreSS.pf where work is being done): 11341" 1.1"1 1114'71 City: Miami Shores State:—Florida Zip Code: 3 18� Contractor's Company Name; Phone#: Address: /&IN -".5rd/ II-)A -i City: State: T�," Zip Code:,:363/7 Qualifier's Name : 77 6D Lic. Number: 6>4e/J/3 a'3/ Architect/Engineer of Record Name: Phone M Address: City: State: Zip Code: Describe Works _ � P+Rc�• O1.9 .4k :5y57QA1 I hereby certify that the work has been abandoned and/or the contractorlarchitect is unable or unwilling to complete the contract. I hold the Building Official and the Miami Shores harmless for all legal involvement. Signature Signature aorto Sect The foregoing i aknbwledged before me The foregoing lnstrument s nowledged�before me// this day of tE[Fw1 O�t*,bY this day o �EEy 20/Ay Who' eta me or who has produced who is has produced as indentilicaft. as indentilicallom Nlotar P Nota Pu c•.••Rr • G„�ItALEEE�4L596 Notary r. �e., A-ifAtCApC Sign: '�r°` Sign: `:. i :s tttda �/�p�,,1 • y o�om�mm. .�� QQ,,,,,,1 COM18sjan#EE 14"Is Wal: ,'j5�FQi it ��, WIIYN m f OGaI. '�^f p�ii�p� BQ��1't1 ,/vAWW1. an,ua •'7 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores,FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-252562 Permit Number: MC-5-15-1229 Scheduled Inspection Date: February 10,2016 Permit Type: Mechanical- Residential Inspector: Perez,JanPierre YP Inspection Type: Final P Owner: Work Classification: Addition/Alteration Job Address:435 NW 111 Street Miami Shores FL 33168-3305 ' Phone Number (305)790-5467 Parcel Number 1121360010790 Project <NONE> Contractor. THE ICE TEAM CORPORATION Phone:3051385-3880 Building Department Comments REPLACE OLD AC SYSTEM,2 BATHROOMS FANS AND Infractio Passed Comments 1 DRYER VENT. INSPECTOR COMMENTS False d � Inspector Comments Passed Failed Correction Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid For Inspections please call: (305)762-4949 February 09,2016 Page 39 of 44 %oyol IS jn/J�"�� (/? �J� � I �At-, y�,��' � F V 1 ��"L � ► fl- S®L 1/'�i n r✓��IN y � JA1® � �-- �- }L a � C -^✓ G w /vl C' Nw N t G G.. 4,A Notary Public State of Florida Sindia Alvarez BAY Commission FF 158780 NOW Expires 09/03/2018 13 1 � -� �e7 ��v Miami Shores Village 10050 N.E.2nd Avenue NW Miami Shores,FL 33138-0000 Phone: (305)795-2204 �� ?n � ��' ��• � �, iE€� �iE1 �E.: £ � �i .'�� „�. � Expiration: 11124/2015 Project Address Parcel Number Applicant 435 NW 111 Street 1121360010790 CAPITAL INVESTMENTS LLC Miami Shores, FL 33168-3305 Block: Lot: Owner Information Address Phone Cell CAPITAL INVESTMENTS LLC P.O. BOX 2382 FAIRFAX VA 22031- P.O.BOX 2382 FAIRFAX VA 22031- Contractor(s) Phone Cell Phone Valuation: $ 4,000.00 VITAL AIR SOLUTIONS INC (954)821-8640 Total Sq Feet: 0 Tons:2 Available Inspections: Additional Info:REPLACE OLD AC SYSTEM,2 BATHROOMS Inspection Type: Classification:Residential Final Approved:In Review Rough Duct Comments: Date Approved::In Review Review Mechanical Date Denied: Type of Work: Underground Scanning:1 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $2.40 Invoice# MC-5-15-55684 DBPR Fee $2'10 05/22/2015 Check#:3222 $50.00 $103.60 DCA Fee $2.10 Education Surcharge $0.80 05/282015 Check#:3233 $ 103.60 $0.00 Permit Fee $140.00 Scanning Fee $3.00 Technology Fee $3.20 Total: $153.60 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 co fortuity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assu responsibility for al ork done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL,P UMBING,MEC WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS AFFI all th oing i ormation is accurate and that all work will be done in compliance with all applicable laws regulating construction a o ' F ,I au a the ab o a-named contractor to do the worts stated. May 28,2015 Sldirfft r plica / Contractor / Agent Date Buildi g Department C py May 28,2015 1 Miami Shores Village MAY 2 2 2015 Building Department 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 BY cA_ ---- Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20 BUILDING Master Permit No. Q'10(-1q-0-q Y PERMIT APPLICATION Sub Permit NO. C, 6 S7-1 22--1 ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑EXTENSION ❑RENEWAL ❑PLUMBING XMECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP /. CONTRACTOR DRAWINGS JOB ADDRESS: `i 3S lyw I l I 57&c-,7- City: Miami Shores County: Miami Dade Zin: 53)6 J Folio/Parcel#: 11' 146.6W 0701 Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: —7FFE: -7 OWNER:Name IF a Simple Titleholder): �!�/T P��o��?o� «� Phone#: 4k Address� City: , 4- Stat 140077 Zip: Tenant/Lessee Name: �� Phone#: Email: Z-714.0 a 60 � CONTRACTOR:Company Name: V_I-VA L A' ek SoUu7 iA �m9k,'� q Phone#: !5-4- hyZ ull Address: 6 U C',I IPW3 JA" J910V 6/PT L City: roMPA00 ' t-" State: 1rL Zip: 3306 Qualifier Name: W4Air7'1 V I i<'WL� Phone#: W10 State Certification or Registration#: CAC rl8034 Certificate of Competency#: r-c/r rpV DESIGNER:Architect/Engineer: 75 A Phone#: "_;P/'�.9 Y Address: City: State: Zip: Value of Work for this Permit:$ Square/Linear Footage of Work: Type of Work: ❑ Addition Alteration ❑ New K Repair/Replace ❑ Demolition Description of Work: [1r;kywo OLD ASG $y641000s T,9i✓1 0-0 / 2!yu VA/Y% - Specify color of color thru tile: Submittal Fee$ Permit Fee$ ttyCCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$_ O iv (Revised02/24/2014) Bonding Company's Name(if applicable) Bonding Company's Address City State 194 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 V V 1VU • OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of QP/J 20 _j5 by day of Aaw 20 �5 by A,44"ft )QW0 who is personally known to ey (/fj�a who is personally known to me or who has produced V*'Z?9 as me or who has produced FL",L as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC• NOTARY PUBUC NOTARY PUBLIC: NOTARY PUBUC: STATE OF FLORIDA STATE OF FLORIDA E853894 Cwnm#EES83894 Sign• gxpfts 2MM17 Sign: 1114 FRI Pri Print: Sea: NOTARY PUSIX Seal: OTARY PUBLIC STATE OF FLORIDA STATE OF FLORIDA Ctmmill EE$53804 •spa Comm#EE853894 Ex Ir w*$******six*a` �esr�J4 � iewx�**• e+t six**•sws*�*��x**+e***s�xrss*x�*T*i��i��t�s��s�x�r�**suss** APPROVED BY Plans Examiner Zoning Structural Review Clerk (RevisedO2/24/2014) RSEs 0 Miami Shores Village Building Department .... p„,M 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):435 koi (it Weq , h2igAi i Sh+94io ,41- 3316? 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 MA,— MANUFACTURER 6VcQ1A4.A1 L AHU or PKG.UNIT MODEL# MfrZqA LAAe COND.UNIT MODEL# Q W KW HEAT Y 1K Ulj r_/ NOM TONS a_YOA6 AHU $ CU I C PKG 1)M.C.A AHU,?,Zj CU /I PKG AHU CU,,Zq PKG 2)M.O.P AHU 3 a CU oZ$'PKG AHU 1ojrCU 20 PKG 3)VOLTS AH CUA** PKG PKG UNIT / / PKG UNIT / / EER/SEER 11.501 f O YES NO REPLACING DUCTS YES kv YES NO REPLACING THERMOSTAT tEy NO YES NO NEW 4"CONCRETE SLAB !YE NO YES NO NEW ROOF STAND YES NO NEW RETURN PLENUM BOX 1. Minimum Circuit Ampacity(Wire Size): ( S AMMO. 2. Maximum Overcurrent Protection (Fuse/Breaker Size): 3. Voltage of Circuit(208/240/480): ;Vt 4. Size Disconnecting Means: n� Contractor's Company Name: U 1 fink t, A iI- Soz,4,,h0A/3 . FA/C- Phone: State Certificate orR egistrationNo.. CAG �g'8®3 � Certificate of Competency No. Signature �U& Date: S,-1/.51W5 ( ualff es signature) (Revised02/24/2014) 1 1 ulertificate of Produt-A Ratings AHRI Certified Reference Number: 7515827 Date: 5/15/2015 Product: Split System:Air-Cooled Condensing Unit,Coil with Blower Outdoor Unit Model Number: GSX140241 K" Indoor Unit Model Number:ASPT24B14A" Manufacturer:GOODMAN MANUFACTURING CO., LP. Trade/Brand name: GOODMAN;JANITROL; AMANA DISTINCTIONS; EVERREST; ONE HOUR AIR CONDITIONING AND HEATING; ENERGI AIR Region: Series name:GSX14 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): 23000 EER Rating (Cooling): 11.50 SEER Rating (Cooling): 14.00 IEER Rating (Cooling): Ratings followed by an asterisk(')indicate a voluntary reate of previously published data,unless accompanied with a WAS,which indicates an involuntary rerate. DISCLAIMER AHRI does not endorse the product(s)fisted on this Certificate and makes no representations,warranties or guarantees as to,and assumes no responsibility for, the unauthorize(d)listed on alterationtofi data listed on this Certificate.isclaims Certifiedall ratingsity forare valid d only for models andamages of any kind rising out of the use oreonfigu configurations listed in Irformance of the product(s).or the e directory at www.ahridirectory.org. TERMS AND CONDITIONS Certificate and its contents are proprietary products of AH RI.This Certificate shall only be used for individual,person This al 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, AIR-CONDITIONING.HEATING, personal and confidential reference. &REFRIGERATION INSTITUTE CERTIFICATE VERIFICATION be The information for the model cited on this certificate can verified at www.ahridirectory.org,click on"Verify Certificate'link ,.i,ir .,,,, and enter the AHRI Certified Reference Number and the date on which the certificate was issued, which is listed above,and the Certificate No.,which is listed at bottom right. CERTIFICATE N O.: 130761803777924930 02014 Air-Conditioning,Heating,and Refrigeration Institute vuVw4w pug-q W4- al A4 1,v 93momm T 3 swd iI W 'o 909* X" IS 14, 14N TCA3MWMISSKMM8 $':S ?ec�TW InIA q.. elm Q$ ,;g: 'd HWWM 0=1 JjdM3V Wj IVWI 2 Certificate of Product Ra,,t!,,nqs ......................... AHRI Certified Reference Number: 7515827 Date: 5/15/2015 Product: Split System:Air-Cooled Condensing Unit,Coll with Blower Outdoor Unit Model Number. GSX140241K* Indoor Unit Model Number:ASPT24B14A* Manufacturer: GOODMAN MANUFACTURING CO., LP. Trade/Brand name: GOODMAN;JANITROL;AMANA DISTINCTIONS; EVERREST; ONE HOUR AIR CONDITIONING AND HEATING; ENERGI AIR Region: Series name: GSX14 Manufacturer responsible for the rating of this system combination Is GOODMAN MANUFACTURING CO., LP. Rated as follows in accordance with AHRI Standard 210/240-200$for.Unitary Air-Conditioning and Air-Source Heat Pump Etlulprnent�and subject to verification of rating acc.,U by AHRI-sponsored, independent,third party testiing; Cooling Capacity(Btuh): 23000 EER Rating(Cooling): 11.50 SEER Rating (Cooling): 14.00 IEER Rating (Cooling): Ratings followed by an asterisk(*)indicate a voluntary rerate of previously published data,unless accompanied with a WAS,which indicates an involuntary rerate. DISCLAIMER AHRI does not endorse the product(s)listed on this Certificate and makes no representations,warranties or guarantees as to,and assumes no responsibility for, the product(s)listed on this Certificate.AHRI expressly disclaims all liability for damages of any kind arising out of the use or performance of the product(s),or the unauthorized alteration of data listed on this Certificate.Certified ratings are valid only for models and configurations listed in the directory at www.ahvidirectory.org. TERMS AND CONDITIONS This Certificate and Its contents are proprietary products of AHRI.This Certificate shall only be used for individual,personal and confidential reference purposes.The contents of this Certificate may not,in whole or In part,be reproduced;copied;disseminated; AM entered Into a computer database;or otherwise utilized.in any form or manner or by any means,except for the user's Individual, personal and confidential reference. AIR-CONDITIONING,HEATING, CERTIFICATE VERIFICATION &REFRIGERATION INSTITUTE The information for the model cited on this certificate can be verified at www.ahridirectory.org,click on`Verify Certificate'link we make life better, and enter the AHRI Certified Reference Number and the date on which the certificate was Issued, which is listed above,and the Certificate No.,which Is listed at bottom right. 130761803777924930 ©2014 Air-Conditioning,Heating,and Refrigeration Institute CERTIFICATE NO.: Viiv�L- X4L So Lv Ti rsl� cy pis Loo. s l-n SAF PO M PmN oc--p<w CL �j?j 0 b DATE ORDERED ORDER TAKEN BY OS 15 ?.ol s SOLD TO PHONE NO. CUSTOMER ORDER# �l JOB LOCATION 35 NW l i l ST"rT JOB PHONE STARTING DATE TERMS t5 RIPTION OF WORK 02 to^� vnn:� znrS u � eo A AA10 1�"cvp \XArr Ar-/0 A- (t MISCELLANEOUS CHARGES TOTAL MISCELLANEOUS TOTAL MATERIALS TOTAL LABOR ORK ORDERED TOTAL LABOR DATE ORDERED TOTAL MATERIALS DATE COMPLETED TOTAL MISCELLANEOUS CUSTOMER SUBTOTAL APPROVAL SIGNATURE TAX AUTHOR1ffD SIGNATURE GRAND TOTAL OZ4S® A-2817-3817/T-3866 10-11 `� We 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: 12/17/2014 EXPIRATION DATE: 12/16/2016 PERSON: VITAL WARLEY B FEIN: 463980006 BUSINESS NAME AND ADDRESS: VITAL AIR SOLUTIONS INC 611 CYPRESS LAKE BLVD.APT.L POMPANO BEACH FL 33064 SCOPES OF BUSINESS OR TRADE: HEATING,VENTILATION, AIR-COND Pursuant to Chapter 440.05(14),F.S.,an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section may not recover benefits or compensation under this chapter.Pursuant to Chapter 440.05(12),F.S.,Certificates of election to be exempt...apply only within the scope of the business or trade listed on the notice of election to be exempt.Pursuant to Chapter 440.05(13),F.S.,Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation If,at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for Issuance of a certificate.The department shall revoke a DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS?(850)413-1609 Miami shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305)795.2204 Fax: (305)756.8972 Notice to Owner - Workers' Comppnsation Insurance Exernption MAI- 5111k 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-tune 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 fisted 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 an 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. Signatu;oe!��, owner— State of Florida County of Miami-Dade The foregoing was acknowledge before me this day of By &64rn /5;Wre, who is personally known to me or has produced as identification. Notary: T STA 0 PUBLIC SEAL:1. TARP FLORIDA Comm#EE853894 Expims 2MI201Z CERTIFICATE OF LIABILITY INSURANCE DATE Pnvm/YYY1f) 05/15/2015 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 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 Ileu of such endorsement(s). PRODUCER CONTACT H.G.Holdam Insurance PHONE (561)434-4451 FAX ; 561)434-3505 3830 dog Road E-MAIL craig@hgholdam.com Lake Worth,FL 33467 INSURERS AFFORDING COVERAGE NAIC A Phone (581)434-4451 Fax 561)434-3505 INSURER A: Federated National Insurance Cc INSURED INSURER B: Integon Preffered Insurance Co Vital Air Solutions Inc INSURER C: 4030 NW 4th Ave INSURER D INSURER E: Pompano Beach FL 33054 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 CONTRACTOR 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 LTR TYPE OF INSURANCE ADD UBR POLICPOLICY NUMBER MDY EFF POLICY EXP LIMITS GENERAL LIABILnY EACH OCCURRENCE $ 1,000,000.00 © COMMERCIAL GENERAL LIABILITY PREMISES SES Ea occurrence)GE TO RENTED $ 100,000.00 ❑ F] CLAIMS•MADE © OCCUR MED EXP(Any one person) $ 5,000.00 A ❑ N N GL-0000025647-00 12/20/2014 12/20/2015 PERSONAL&ADV INJURY $ 1,000,000.00 ❑ GENERAL AGGREGATE $ 2,000,000.00 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000.00 ©POLICY ❑ PRO- ❑ LOC $ AUTOMOBILE LIABILITY OIND cF entSINGLE LIMIT ❑ ANY AUTO BODILY INJURY(Per person) $ 25,000,00 B ❑ AUTOWNED © AUTOESDULED N N 20029822323 01/19/2015 0111912018 SCHBODILY INJURY(Per accident) $ 50,000.00 ❑ HIRED AUTOS NON-01NNED PROPERTY DAMAGE $ 25,000.00 ❑ AUTOS Perecddent ❑ UMBRELLA LIAR ❑OCCUR EACH OCCURRENCE $ ❑ EXCESS LIAB ❑CLAIMS-MADE AGGREGATE $ ❑ DED ❑ RETENTION $ WORKERS COMPENSATION ❑PER ❑OTH- AND EMPLOYERS'LUM31UTY Y f N ANY PROPRIETOR/PARTNER/EXECUTI E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? �N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1 $ DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more apace is required) AC Installation Service&Repair. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village Building Department THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN 10050 NE 2nd Ave ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores,FL 33138 AUTHORED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All tights reserved. ACORD 25(2014101)OF The ACORD name and logo are registered marks of ACORD 5/15/2015 IMG_1319 jpg(1195x1593) VITAL,INARLEY BELTRAM . vi`tALAIR SOLUTIONS,INC. 611 CYPRESS LAKE BLVD,APT L pOmPAN0 BEACH FL 33064 Conuratulationst With this Doerk1W you become one+ 0"I*arty s million Floridians licensed by the Department of BL and Professional Regulation, our pro age �� TAT � 11._C3f�iC?A Pram ar lrit tots to yacht tuc etas � " rams, DEPARTMENT F BUSINESS D and they keep Florida's et° �• �� 'f?C3FSlCtdAL REGULATION Every day we work to On ' we 4o,busin in,a rto CAC 1818037 l U D. ii1 i Serve you tetter. For its Vis'pleisse bo Onto www.myfforidaticensexom. Them you sat find more information CERTIFIED AIR COPD CONTR about our divisions and thefhat irng i yt�u. be VITAL,WARL BBL MB to department n rslotters s Learn more about t# Department's VITAL AIR Bt?LUT NSA INC ir€it'rativas_ CW mission at the Departrn nt is:License Efficiently,Regulate Fa rty, We constantly strive to serve you better so that you can serve your Customers. Thank you for doing business in Florida, a ccR71PIU a,ruder the prnvisfons or cn A V4 i s ICIO and ratulations on your new license! �� 7 -AVG a,,2M5L�3�� fw KEN.ALS SON,SECRETARY b z \\ PROFESS"AL REGULATION L INI�BOARD a \ �i ra r file://localhost/Users/neylorsilva/Downloads/IMG_1319.jpg BkyM COUNTY RECORDS, TAXES AND TREASURY D1' %LUi'C'f , FeiXC' 6i<'cGSi.t 3'y Div. P�,::�i. Sew :;.3mq Car ATTENTION TAXPAYERS: Please be advised of the NON-REFUNDABLE processing fees for credit and debit card transactions. Credit cards are charged 2.55%of the amount charged($2.00 minimum fee). Domestic Visa Consumer Check cards will be assessed a fee of$3.95 per transaction if you select'Debit Card'.Thank you. 2014 unpaid tax accounts are delinquent as of April 1,2015. An additional 3%interest for Real Estate Accounts, and 1.5% interest for Tangible Accounts, plus Advertising fee have been added to the delinquent balance. Please verify your balance due before remitting any additional payment to avoid any shortage. Final deadlines to pay 2014 taxes in full, in order to avoid a Tax Certificate are: By mail or at the Tax Collector's Office: Friday, May 22,2015;On-line:Midnight of Sunday,May 24, 2015. Payment postmark dates do not apply to delinquent tax payments:all mailed payments must be received by the Broward County Tax Collector by the close of business May 22,2015.Thank you. 2 DIS W — Bushes Tu AccwM VITAL.AIR SOLUTIONS INC Business Tax Account#123755 Account details Account history 2015 Paid Account number: 123755 Owner(s): WARLEY BELTRAME VITAL Business start date: 01/28/2015 611 CYPRESS LAKE BLVD STE L Business address: VITAL AIR SOLUTIONS INC POMPANO BEACH, FL 33064 801 NW 44 ST BAY#805 Mailing address: WARLEY BELTRAME VITAL OAKLAND PARK, FL 33309 611 CYPRESS LAKE BLVD STE L Physical business location: OAKLAND PARK POMPANO BEACH, FL 33064 © Print account application(PDF) ®' Print exemption application (PDF) Receipts And Occupations Receipt 183-266870 Paid 2015-01-28$27.00 CONTRACTORS 01/28/2015-09/30/2015 Units: 1 Receipt#03A-14-00004319 HEATING/AIRCONDITION CONTRACTR Additional documentation required: CAC1818037 State Certification OR Broward Cert.of Comp. (each year)