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MC-16-953 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores,FIL Phone: (305)795-2204 Fax: (305)758-8972 �---' Inspection Number: INSP-256557 Permit Number: MC-4-16-953 Scheduled Inspection Date:April 20,2016 Permit Type: Mechanical - Residential Inspector. Perez,JanPierre Inspection Type: Final Owner. HANSON, DONALD Work Classification: A/C Replacement Job Address:490 NE 103 Street Miami Shores,FL 33138- Phone Number Parcel Number 1132060170700 Project <NONE> Contractor: AMERICA'S ECONOMIC AIR CONDITIONING CORP Phone:(305)378-6168 Building Department Comments A/C CHANGE OUT 5 TONS lnfractio Passed Comments INSPECTOR COMMENTS False � 6 Inspector Comments Passed Failed Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee Is paid April 19,2016 For Inspections please call: (305)762-4848 Page 28 of 46 Miami Shores Village 10050 N.E.2nd Avenue NE '• Miami Shores,FL 33138-0000 v Phone: (305)79 5-22 04 E , � ti � Expiration: 10/11/2 1 6 . Project Address Parcel Number Applicant 490 NE 103 Street 1132060170700 DONALD HANSON Miami Shores, FL 33138- Block: Lot: Owner Information Address Phone Cell DONALD HANSON 490 NE 103 ST MIAMI SHORES FL 33138-2457 Contractor(s) Phone Cell Phone Valuation: $ 3,700.00 AMERICA'S ECONOMIC AIR CONDIT[((305)378-6168 Total Sq Feet: 0 Tons:5 Available Inspections: Additional Info:A/C CHANGE OUT 5 TONS Inspection Type: Classification:Residential Final Approved:In Review Review Mechanical Comments: Date Approved::In Review Date Denied: Type of Work: Scanning:3 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $2.40 Invoice# MC4-16-59354 DBPR Fee $2.00 04/14/2016 Credit Card $103.90 $50.00 DCA Fee $2.00 Education Surcharge $0.80 04/08/2016 Credit Card $50.00 $0.00 Notary Fee $5.00 Permit Fee $129.50 Scanning Fee $9.00 Technology Fee $3.20 Total: $153.90 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 requi ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS A)and VIT: I ce ' at 1 the fmoing in ormation is accurate and that all work will be done in compliance with all applicable laws regulating construdi ort)rtg. h autho the a named contractor to do the work stated. April 14,2016 'Rut ortzed Signature:Owner / Applicant / Contractor / Agent Date Building Department Copy April 14,2016 1 04114/2016 10:45 305227649600 NESPRAL.INSURANCE PAGE 01 GATE(MWDDIYY) O TM EW1412018 PRODUCER THIS CBRTIFICATB IS ISSUED ASA R OF INFO ION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE NESPRAL INSURANCE,INC. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 2000 SW 107 AVENUE SUITE 38 ALTER THE COVEWE AFFORDED BY THE POLICIES BELOW. MIAMI,FLORIDA 33165 COMPANIES AFFORDING COVERAGE TEL:305227-6417 C00.II'ANY A ASCENDANT COMMERCIAL INSURANCE � INSURED M AMERICA'S ECONOMIC AIR CONDITIONING CORP. CCMPANY 18822 NW 48 AVE B • MIAMI,FL 33055. COMPANY " C COMPANY D THIS 13 TO CERTIFY THAT TWE POLICIES OF INSURANCE LISTW BELOW HAVE SEEN ISSUED TO T14E 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 SE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED B Y THE POUCIRS 0E3CRISED HEREIN 13 SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, 00 LTR TYPE OF INSURANCE Policy NUAIISERLDATE FMOMM �RVIRATION LIMITS MM GENERALLIASIItf Y GENERAL AGGREGATE $ 3W,000 A X OMWEROM GENERAL LIABILITY OL-37693-2 08/2912015 06/29/2016 PRODUCTS-COMPIOP AGO S INCLUDED CLAIMS MADE ❑OCCUR PERSONAL&ADV INJURY S 300,000 OV01ra S&CONTRACTOWS EACH=URR@PICE $ 300 000 PRE DAMAGE(Any one flm) S 100,000 MED BMP(Any am pefAM) $ 5,000 AUTOMOD"LIABILITY ANY AUTO COMINNED SINGLE LIMIT S ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY ffi (Par parxt) HIRED AUTOS NON-OWNED AUTOS (�ULL�Y I�1 $ PROPERTY DAMAGE ffi GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN AM ONLY, EAOH ACCIDENT $ AGGREGATE L $ EXCESS L,IABII-I'fY UMBRELLA FORMEACH OCOURttLNCE $ $ OTHER THAN UMBRELAGGREGATE LA FORM ,L $ wOWAn CIAIP'BINISATION AND A EMPILOYEW UABU Y Y t E SL EACH ACCIDENT S YIIB PROPRB'FOAI PARTM3WfflXWAM INCL EL DISEASE-POLICY LIMIT $ OPMEM AHE: REXCL EL DISEASE-EA EMPLOYEE $ OTHER UMENiFffo-N Op LIPURAION P IT 13 SHOULD ANY OF THE ABOVE 068010=POLICIGN BE CANCELLED BEFORE THE MIAMI SHORES VILLAGE GrnIRAMN DATE THOMOK TNH ISSUM COMPANY VALL ENWAVOR TO MAIL 10060 NE 2ND AVENUE 30 DAYS WRITM NOTICK TO THE CERTIFICATE HOLDER NAM TO THE Le", MIAMI SHORES FL 33138 BUT PAB URE To MIL SUCH NOTIM OHALL IIIIIPM NOOBLIGAmON OR LI UNUTY LICENSE 9 CAC0577 of THE connp ns ROWTATIVE Miami Shores Village ������l;m 1 Building Department All 0; i 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 / Tel:(305)795-2204 Fax:(305)756-8972 BY: INSPECTION UNE PHONE NUMBER:(30S)762-4949 ! F)B/C++ 2014 BUILDING Master Permit No. t I6- q;51) PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ELECTRIC ❑ ROOFING ❑ REVISION ❑EXTENSION ❑RENEWAL ❑PLUMBING [ MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS p JOB ADDRESS: Y i 1D #j (5 3 J T City: Miami Shores County: Miami Dade Zip: 3 � � Folio/Parcel#: N the Building Historically Designated:Yes NO Occupancy Type: . Load: °Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder):_ �JA a."a t I B A u-so AI Phone#: 3 04-WriF 8 3 a Address: 0 IV IF a z S Tr City: I M r O K e.s —State: 'r' Trp: 13 a Tenant/Lessee Name: Phone#: Email: Le 1CONTRACTOR:Company Name: AMeAi[4 !GD#J 0,AA C. A /f. Phone#: 3Ar 3 o wD L! L Ir Address: d921 MW 4 f Aµ e- Ki A•4ft i City: A&'# 4 M 1 State: FL Zip: s 3 a s'r Qualifier Name: y i Co 3 t, ,,,,,,�//��+4 A G �° Z Phone#: Of'3 p *fO G 14 Y L.'_ State Certification or Registration#: A C OM 1 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: —City: State: Zip: Value of Work for this Permit:$ Square/Linear Footage of Work: 6 0 V. Type of Work: ❑ Addition ❑ AI eration ❑ New Repair//RReRepair/ReplaceF-1Demolition Description of Work:--A,& 4 ov 67 /r*) Specify color of color thru tile: rim Submittal Fee$ Sd ` utz. Permit Fee$ VIACCF$ CO/Cc$ Scanning Fee$ `t ,ccl Radon Fee$ 4;�-'C0ZS DBPR$ Notary$ ' Technology Fee$ S, Training/Education Fee$ n Double Fee$ 0 Structural Reviews$ Bond$ 0 TOTAL FEE NOW DUE$ 103 . r C� (Reviwd02/24/2014) q; 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. 1 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." 11ialce to Applicant: Asa ooncition to the issuance of a lw lcffng pearat with an estimated value me esoirg$2500,the*#;cant must promise in good faith tient a appy of the notice of cn►nmeXwent and construction lien law brodwre wilt be delivered to the person whoea propsrtyiss tyect to attadhment. Also,a aertlfied aWof the receded nottoe of cot,nw asment must beposted at the job ate for the first inspection whicfi oaams sin M days after the baldng permit is issued in the abeam of such posted notice, the inspection will not be approvedanda reinspection fee wilt bedrargsd Signature Signatu OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this ThefregoIng instrument was acknowledged before me this TT day of AMA1. 20 1 � by day oft�_— .20_% ,by t1� wh 3'. o is personally known to V 1 C���1'Z- S �Nib is'personally known to me or who has produced �'(� as me or who has produced �--t V i� 2 as Identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: \`a���N1H1�liftl//// �N1i1111t10/�/// /j Sign: Sign: 4P Print: ��.'1 � ® ��•• Print: - ''�.?a Seal: =o o° ,� � Seal: a• Of "010000 #i#ii#ilii#!#iiii!lliiii!##!lliiiilliii#iii#!!!###$ YWi!##iii APPROVED BY ` I Examiner Zoning Structural Review Clerk (ReOsed02/24/2014) Pro pe Search Application - Miami-Dade County Page 1 of 1 "A' OFFICE OF THE PROPERTY APPRAISER Summary Report Generated On :4/8/2016 Property Information x Folio: 11-3206-017-0700 ......... __....._ Property Address: 490NE103ST � " ' Miami Shores,FL 33138-2457 Owner DONALD HANSON 932„ 490 NE 103 ST Mailing Address MIAMI SHORES, FL 33138-2457 Primary Zone 1000 SGL FAMILY-2101-2300 SQ ' 0101 RESIDENTIAL-SINGLE Primary Land Use FAMILY: 1 UNIT Beds/Baths/Half 3/2/0 , �x Floors 12 Living Units 1 , ti Actual Area 2,612 Sq.Ft ( ���� 01 Living Area 2,338 Sq.Ft , Adjusted Area 2,275 Sq.Ft Taxable Value Information Lot Size 9,320.63 Sq.Ft Year Built 1950 _..............._____._ _......_........... 2015,, 2014' 2013 County _... .___........... ..._... __..............................._........-...........__ ..__ Assessment Information Exemption Value $50,000 $50,000 $50,000 Year 2015 2014 2013 Taxable Value ®J $126,4421 $125,042 $122,456 Land Value $201,280 $166,431 $147,227 School Board Building Value $134,589 $131,108 $131,108 Exemption Value $25,000 $25,000 $25,000 XF Value $528 $528 $528 Taxable Value $151,442 $150,042 $147,456 Market Value $336,397 $298,067 $278,863 City Assessed Value $176,4421 $175,042 $172,456 Exemption Value $50,000 $50,000 $50,000 Taxable Value $126,442 $125,042 $122,456 Benefits Information Regional BenefitType 2015 2014 2013 Exemption Value $50,000 $50,000` $50,000 m . Save Our Homes Assessment Taxable Value $126,442 $125,042' $122,456 Cap Reduction $159,955 $123,025 $106,407 Homestead Exemption $25,000 $25,000 $25,000 Sales Information Second Previous Sale Price OR Book-Page Qualification Description Exemption $25,000 $25,000 $25,000 ............. Homestead 12/01/1982 $75,000 11656-3380 Sales which are qualified Note:Not all benefits are applicable to all Taxable Values(i.e.County, School Board,City, Regional). Short Legal Description AMD PL OF MIAMI SHORES SEC 4 PB 15-14 LOT 1 &E1/2 LOT 2 BLK 92 LOT SIZE 77.030 X 121 OR 11656-3380 1282 1 The Office of the Property Appraiser is continually editing and updating the tax roll.This website may not reflect the most current information on record.The Property Appraiser and Miami-Dade County assumes no liability,see full disclaimer and User Agreement at http://www.miamidade.gov/info/disclaimer.asp Version: http://www.miamidade.gov/propertysearch/ 4/8/2016 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESINAL REGULATION CAC057797 ISSUE& 06/22/2014 CERTIFIED AIR M CONTR SANCHEZ,VIt'! AMERICASEC5 :AMC(*D'CORP ' a IS CERTIFIED under the provisions of Ch.489 FS. w Expiration date:AUG 31,2018 L140= 0=14 .._... F MY 77 4032S2Z, h f y 'R"bd l �IiN tie-dFsWad a aFbel cl, ersA�Ar.�� � SBC.TV"OF PAYMENT RECMVSP. OwimmaAMERI( `ECONOAAIC AIR CO 3 CORP .A G�67� L t 3 {ACTOR. y tax F> wo* F3) CREDR©CARD7/08/26is.00 —15-034389 at, �all mei r;aidsies— ttte 'ao.ea8�sc Ire tam aee8-zee. F� fB : i Report Viewer Page 1 of 1 /1 100°6 PLEASE CUTOUT CARD BELOW AND RETAIN FOR FUTURE REFERENCE MIPORTANT STATE OF FLORIDA Pam=Mt0Ch8P 4 14jF.B..aaoNclaamporation eimb of,DEPARTMENT OF FINANCIAL SERVICES ,, "�rata u DIVISION OF WORKERS!CONATION F PumttatRtD4*ao�It2�,F.B..Cev �abmHaa to CONSTRUCTION INDUSTRY EXEMPTION O besxea�_�qy aagrwiUdntbe eot9rebretrreaemtreN L B dm9re no8oe aleka 10bea t "calmOF FRMRJDRM D P�ae�re�Rto F.B..N00=0teh%0mtebe aaar�mA�uar mcmnp3ana �ADbe sha96e nveam MGM OWUNImum msem7 mreraoadangatanyt§ae ampe�rao�eA BTng 0 r6enotbe aAmmmz H is ne me ra of E Ear bawaleae thapatbnmd sba ►m ee E to�aa�Uw' afm a ra0asa otlre BUS NAMEANDADlN _ AMERICA'S ECONOMIC AIR CONonwNwetX>RP 18822 NW 48 AVE MIAMI FL SigSB = SCOPES OF SUSMUM OR TRA EATING,VENTILATION, R-COND 0F6-F2-DW—'2f2 CERTIFICATE OF ELECTION TO BE EXEMPT FWSED 0813 QUESTIONS?(00)413.1808 https.//apps8.fldfs.com/crreportviewer/reportViewer.aspx?data=kdvpginc9D7Q3gH6TER6... 5/27/2015 iami bhores Village •r" Building Department 10050 N.E.2nd Avenue R Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305)756.8972 Notice to Owner— Workers' Compensation Insurance Exemption -r f ,u 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 i1 1. The officer owns at least 10 percent of the stock of the corporation,or in the case of an LLC,a statement attesting to the minimum 10 percent ownership; 2. The officer is listed as an officer of the corporation in the records of the Florida Department of State,Division of Corporations;and 3. The corporation is registered and listed as active with the Florida Department of State,Division of Corporations. No more than three corporate officers per corporation or limited liability company members are allowed to be exempt. Construction exemptions are valid for a period of two years or until a voluntary revocation is filed or the exemption is revoked by the Division. Your contractor is requesting a permit under this workers'compensation exemption and has acknowledge that he or she will not use day labor,part-time employees or subcontractors for your project The contractor has provided an affidavit stating that he or she will be the only person allowed to work on your project In these circumstances,Miami Shores Village does not require verification of workers'compensation insurance coverage from the contractor's company for day labor,part-time employees or subcontractors. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature: Owner State of Florida County of Miami-Dade The foregoing was acknowledge before me this day of A9 -- ,20 By11sonally known to me or has produced Notary: 9S ®•� :�- SEAL: s®e S�N3113'� a�� AMERICAS ECONOMIC AIR COND CORP 18822 NW 48 AVE MIAMI GARDENS FL 33055 3053786168 Date: State of y C County of e t Before me this day personally appeared i r— e A,1 e J F! t.GAm e whooping sworn, deposes and says: That he or she will be only person working on the project locate omir}Mi �\@Ae .% FL '3 "',.� t3 � Sworn to (or affirmed and subscribed before me A 128 l L; �Y of 201-�--by (' f Personally know _ Or Produced Identifications Type of Identfication roduced P , type or stamp Name of Notary MNotary Public State of Florida Sindia AlvarezMy Commission FF 158750 Expires 09!03!2018 n M 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' Compensation Insurance Exemption 'IVA,0"REP-2-11 Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Stautes. Fl& 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 W-time employees,including the owner,must obtain workers'compensafdon coverage. Corporate officers or members of a limited liability company (ILC) 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 cue of an LLC,a statement allesting 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 Deparl3nent of State,Division of Corporations. No mom 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 exemptaon and has acknowledge that he or she will not use day labor,part-time employees or subcontrwors 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 contractoes company for day labor,part-time employees or subcontractors. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ TIHS NOTICE AND UNDERSTAND ITS CONTENTS. Sigrtatureck�, Owner State of Florida County of Miami-Dade The foregoing was acknowledge before me this day of 20-L�f A- r,-Al-i %%%J11111111q, By '11-pn2ft is personally known to me or has produced V 06 0 Notary: ;5 SEAL: rel Y'iF This combination qualities for a Federal Energy Efficiency Tax Credit when placed In service between Feb 17,2009 and Dec 31,2016. certificate of Product Ratings 11111 AHRI Certified Reference Number:7943714 Date:4/8/2016 Product:Split System:Air-Cooled Condensing Unit,Coil with Blower Outdoor Unit Model Number:RA1860AJ1 Indoor Unit Model Numbs:RH1T6024STAN Manufacture:RHEEM SALES COMPANY,INC. Trade/Brand name:RHEEM;RUUD ,Rion:All(AK, M'�AR,AZ,CA,CO,CT,DC,DE,FL,GA,HI,ID,IL,IA,IN,KS,KY,LA,MA,MD,ME, MIN,MO,MS, ,NC,ND,NE,NH,NJ,NM,NV,NY,OH,OK,OR,PA,RI,SC,SD,TN,TY, 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,cental air conditions can only be installed in region(e)for which they meet the regional efficiency requirement. Swiss nee Manor r6Mc: rr"ung t�'thhs r b1t is gfifEEM IA1F.R CYC, Ratedwfows Indencewrih/AHRI Stas � �amu' Afr�ortdtoi�aourr� HeatIPA pd~ ritlutlC of 1nurtt'DJtor +1 ituird Perh►� 1 IEER R�fi n9(Coolirncl): Rafe followed by an asterisk V)Indicate a voluntary rerste of previously pub dam,unless acco needed with a WAS,which Indicates,an Involuntary rerate. DISCLAIMER AHRI does not andwae the product(s)listed on this Certificate and makes no representations,warranties or guarantees as to,and assumes no responsibility for, the product(s)lamed on this Certificate.AHRI expressly disclaims all HablI@y 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 valkl only for models and configurations listed in the directory at www.ahridirectoryorg. TERMS AND CONDITIONS This Cerdfkxhte and its contents are proprietary products of AHRL This Certificate shall only be used for individual,personal and rwnfideet d retarence purposes.Tim contents of this Certificate may not,In whole or In part,be reproduced; disseminated; entered into a computer database;or otherwise utilized,in any form or manner or by any means,except for the user's IndMiduai, AM personal and confidential reference. AIR-CONOMONff^HEATING, CERTIFICATE VERIFICATION A REFRIGERATION INSTITUTE The Information for the model cited on this certificate can be verified at www.ahridireatoryorg,dick on'Verify Certificate*link .m make lib betbn- and enter the AHRI Certified Reference Number and the date on which the certificate,was issued, which Is Noted above,and the Certificate No.,which is IMO at bottom right 1 S. 02014 Air-Conditioning,Heating,and Refrigeration institute � F� TE,No ` t. M 4 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 are not acceptable. 410 Job Address(where the work Is being done): t City: Miami Shores Village County: Miami Dade Zip Code: 3 3 3 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 a NO❑ Contract Attached:YES UNIT BEING REPLACED DATA NEW UNIT MANUFACTURER A, ST,4 v 6&Q, ePr► A AHU or PKG.UNIT MODEL TTW VOW 7T COND.UNIT MODEL# © (i0~ IO� KW HEAT O O NOM TONS AHU CU PKG 1)M.CA AHU CU PKG AHU CU PKG 2 M.O.P AHU CU PKG AHU CU PKG 3)VOLTS AHU CU PKG PKG UNIT / / PKG UNIT / / EER/SEER YES NO REPLACING DUCTS YES 60 YES NO REPLACING THERMOSTAT NO YES NO NEW 4"CONCRETE SLAB YES 40 YES NO NEW ROOF STAND YES YES NO NEW RETURN PLENUM BOX YES 1. Minimum Circuit AmpacltV(Wire Size): 2. Maximum Overcurrent Protection(Fuse/Breaker Size): 3. Voltage of Circuit(2084L40)4W): 4. Size Disconnecting Mens:a Contractor'smpany Name: i`*I'S A w/0 C- Phone: 3 S T3 State Certificate o egistra, on Certiflcate of Competency No Signature .! r Date. g l Li (Queuaers fie) (Revised02/24/2014) This combination qualffles for a Fetle'al Energy Efficiency Tax Credit when placed In servicn� between Feb 17,2009 and Dec 31,2016. ,Ceretificate of Product Ratings AHRI Certified Reference Number:3799429 Date:2/2/2016 Product:Split System:Air-Cooled Condoning Unit,Coll with Slower Outdoor Unit Model Number:14AJM49 Indoor Unit Model Number:RHLL-HM4821+RCSL-W4821 Manufacturer:RHEEM SALES COMPANY,INC. TradelBrand name:RHEEM;RUUD;WEATHERKIN© 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,NFJ,NV,NY,OH,or.,OR,PA,RI,SC,SD,TN,TX, UT,VA,VT,WA,WV,WI,WY,U.S.Territorles) Rulon Note:Central air conditioners manufactured prior to January 1,2015,are eligible to be Installed in all rereggions until June 30,2016. Beginning July 1,2016,central air condidoners can only be instelNed in regions)for which they meet the regional eifldency requirement. Se1es a F e d er zt 7� t z �sars .� Vis. ^ 3r'.. 9 f M rthe°nttln� ' S+ P� R 1 rdance°witltlftlRl04 tltilhiflefl � ource Had„ to tt ahUd r el t t 9 IEER Rating(Cooling): 'PAUr qp fotlowed by an asUnisk(q k dlm to a voluntary.erste of previously published data,unless ac ffW ted Wim a WAS,which indicates en hrvokmiaryremte. 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(sL or the unauthorized alienation of date listed on this Certificate.Certified ratings are valid only for models and configurations listed in the directory at www.abridirectory.org. TERMS AND CONDITIONS This Certificate and its contents are proprietary products of AHRI.This Certificate shall only berated for individual,personal and AM € 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, personal and confidential reference. AIR CONDmONiNO,HttATINB, CERTIFICATE VERIFICATION &RERUGERNIMINSTrtUiE The information for the model cited on this certificate can be verified at www.ahrklirectory orM dick on°Verify Certificate"link and enter the AHRI Certified Reference Number and the date on which the coruscate was Issued, we make better which is listed above,and the Certificate No.,which Is listed at bottom right Gp s 4 sgot Ir I�iAI E h�h �h ' T 02014 Air-Conditioning,Heating,and Refrigeration Institute N�.: y i AMERICA'S ECONOMIC AIR CONDITIONING CORP. ' 18822 NW 48th Ave. • Miami Gardens, FL 33055 Ph: 305-378-6168 STATE LICENSMNAMUM CAC057797 p; X1 8COMAERCIAL. s<mIrrEDTo .tawuW 8TREET `/ / O AYE 1 V -3 S-T JOB LOCATION(STREEn CRY,$TATE.ZIP CODE � � � �tO, �� � � � CITY.STATE.ZIP CODE i Mi �q A� t Q t� PHONE 3 V O (i 3 T V JOB PRONE We hemby submR specifications and esUmates for. / e 4"' -!� <1e,,i 12N P C U IL Tk 10 ® A 'i as 1 b hLA,, j9 Q P) 4 t all "f 4 1 41, 1 Ow aL'.V nA OJ CA &0AJ14A ItPt GO ys Atij1q lv e t4l PROPOSAL To furnish material and labor in accordance with the aboveagplmifkatlons for the sum aftS Payment to be made as follows: I r G/ d khe v G p - A Work to be glad as follosm AN material Is guaranteed to be specified.Any awn or deviation from above .wowing extra costs-..be executed only Bryon wrWen orders.and will become an extra charge over and above the estimate.Ern of all agreements c ondngent upon atrpcm accidents or delays beyond our control. Homeowner to carry fire,tomado end other necessary Instoence.Our workers are fully covejiid,by tftftran's Corrosmadon Insurance. This proposal may be withifninim by us N not accepted wltftnn( U)days. ACCEPTANCE OF PROP�AL—The sped and conditions are se tory.You authorized to do the work as speciflet. Payment will be made SUBMITTED BY / / ACCEPTED Ls DATE 1f� DATE AUTHORIZED SIGNATURE AUTHORIZED SIGNATURE You Payment;Late Fees Payment is due in full as stated on your bill.If we do not receive payment in full by the dab specified on your bill,a late payment charge,which may be charged at the highest rate permissible by law,may be applied to the total unpaid balance.We may also large you any costs we pay to a collection agency to collect unpaid balances from you.if we bill you for amounts on behalf of a third party,payments received are first applied to our charges.You maybe charged additional fees for certain methods of payment.We may nil rgeyoy upto the hVrestsmourdpermitted by lam forrebuned checks by wed do"for any reason byafbwai bobbrtion.Acceptance of payments (evaaeffaarhed"pakfinfMdoesrwtwal" ourrighttocoNedapanwurlsdmdpuaweu&Wemoymob**yaupaynmdme#mxlstocaaldwlscheck,moreeycrderor otherof -Na ssoureformofpayment I tbaeforgoodreason. AU goods remain the properly of America's —OcndMm Oorp.until payment has been received in full. In the event payment in full has not been received within 80 days ofthedateofinvolceAmerica'sOng , In AlrOondltlonCorp.reserves the rightto remove equipment sh In r on customer's Invoice. i American`s Economic Air Conditioning Isnot responsible for any pre-existing and/or post-existing code.violations. All violations are in breach of this contract and are solely the responsibility of the customer If the Installation of the Central Air Conditioner is completed without permit s as required by the customer and as a result the company suf fers a code violation(s)penalty then it Is the customer 's responsibility to p ay all cost s incurred as a result of said violation.All guarantee of labor is voided in the event that another technician not represented or employed by American's Economic Air Conditioning Corp.conduct s inspections,work and/or rep airs and will be at the owner 's risk. America's Economic Air Conditioning reserves the right to cancel this contract if th a customer is not in compliance with all part sof said contract. This contract is neither transferable nor negotiable to another customer or tenant not already specified In this contract. Damages,malfunctions,or failures resulting from or caused b y misuse,accident,contaminated or corrosive atmosphere, vandalism,fire,flood,freeze,lightning,acts of war ,acts of God and the like,or used in connection with normal main tenance, such as cleaning or replacing air filters,refrigerant,ther mostats,battery replace to thermostat,tubing,copper lines refrigerant leak or concrete p ads.Covered Equipment which is not Inst ailed or rep aired by a qualified,trained HV AC professional in accordance with applicable codes,ordinances and good trade practices.Or damages,malfunctions,or failures caused by the use of any att achment,accessory or component not authorized by America's Economic Air Conditioning Corp. Shipping Cost s: This Limited W arranty does NOT cover shipping cost s. You are responsible for the cost of shipping warranty replacement parts from factory to the Manufacturer 's distributor and from the distributor to the location of your covered equipment.You are also responsible for the cost of shipping,failed part s to the distributor and for incidental cost s incurred locally, including handling charges. This agreement does not cover high volt age electrical work,blown fuses,disconnected circuit breakers,plumbing or piping,or other equipment beyond that listed herein.This also includes non-working p arts of equipment,Including dif fusers,ductwork,trim, pipes,support s,insulation,etc. Additional equipment used in conjunction with the ope ration of the system,such as humidifiers, air cleaners,electronic thermost ats,etc...is not covered under the agreement.In addition to liability for injury or damage to persons or property or consequential damage resulting from defect s in or non-operation of equipment or it s accessories,nor resulting damage from emergency drain p ans or clogged condensate drain lines.Default by Customer .Comp any reserves the right to terminate agreement without notice or refund if any of the following occur:Customer permit s any person other than an employee or authorized represent ative of the Company to perform services on customer 's equipment.Payment- The owner shall pay for the services provided in accordance with the payment terms listed on invoices submitted by AEACC.Unp aid balances remaining of ter 30 days from the date of the invoice shall accrue interest at a rate of 20%per month. The owner is also responsible for paying all attorney fees and expenses,court cost s,and any other costs incurred by the service provider to collect any overdue balances and interest. Termination-failure to pay may result in the service provider terminating the agreement without notice and shall have no further obligations and reserves the right to reclaim the equipment(s)and supplies from the location from which it was installed not later than 30 days from the inst allation date.