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MC-15-1214 Miami Shores Village 7 Department OCT x 2&00 e ue,Miami Shores, Florida 33138 V111743? 9 -2204 Fax:(305)756-8972. NS I L E HONE NUMBER:(305)7624949 FBC 2010 BUILDING Master Permit No. PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING REVISION ❑ EXTENSION [-]RENEWAL F-1 PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP ((�� (� � CONTRACTOR DRAWINGS JOB ADDRESS: ii I0�`✓ ' -'`-' AUE City: Miami Shores `Q County: Miami Dade zip: Folio/Parcel#: I I- 'V � \\2 ' r)(0 Is the Building Historically Designated:Yes NO Occupancy Type: V Q Load: Construction Type: Flood Zone: BFE: FFE: OWNER: rNaaymee(Fee Simple Titleholder): [Fff 1 > Phone#:qWo - b� -59 l AddresssDC50 1e� ��LT� /�I(� y�9 City: t` l C� I" I ( State: Zip: Tenant/Lessee Name: Phone#: Email: 1 CONTRACTOR:Company Name: Phone#:goA- q lLJ l- II(��("�(� � Address: F A City: �44V I State: Zip: [ Qualifier Name: 1`�l N Phone#: State Certification or Registration#: C/Tc ®lb I lI Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ v f) Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ De oIi Description of Work: Specify color of color thru tile: Submittal Fee$ Permit Fee$ CCF$ ( ° CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ -Z. CA-) Notary$ Technology Fee$ i C) Training/Education Fee$ C:) Double Fee$ Structural Reviews$ Bond$ uo TOTAL FEE NOW DUE$ ®' Q- (Revised02/24/2014) Bonding Company's Name(if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name(if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS, FURNACES, BOILERS,HEATERS,TANKS,AIR CONDITIONERS,ETC..... OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. 1 e abse ce of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Signature OWNER or AGENT CONTRACTOR The foregoing instrumen wa acknowledged before me this The foregoing instrument cwas acknowledged before me this day of 20 by day of_ 1® 20 ° , by ' ® / who is pe —onally known to _ io Is personally know or who has produced as who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: (1 �> Sign: � ® Sign: Print: Print: ``- DASSILLE N.DURAN . ".••'"v"o"� DASSILLE N.OUAAN Seal: Notary Public-State of Florida Seal: : ''s;o Notary Public-State of Florida g• Commission#FF 193782 Commission N FF 193782 My Comm.Expires Jan 28,2019 '%s, P.o;=My Comm.Expires Jan 28,2019 •,°i..:;``� Natlonat Notary Assn. APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) 16 details-Business Tax Account AFFORDABLE AIR&HEAT INC-TaxSys-Mia... Page 1 of l M3 ............... Ta;:C,)V ftor Home Search Reports Shopping Cart Please do not include any special characters in the name,address,and e-mail field such as#,&,hyphens,comma, dashes. i We have moved.Our new address is: j 200 NW 2nd Ave.Miami,FL 33128 I The information contained herein does not constitute a title search or property ownership. 2015 2nd Quarter Tax Bills are Payable on September 1,2015. ..............____._ .___._............. ._.____._ Business Tax Account 42102424 Account details Account histol 2016 2095 2014 2093 2090 PAN" AID "MAI Al 'A� Account number. 2102424 Owner(s): AFFORDABLE AIR&HEAT INC Business start date: 10/0111989 515 NE 190 ST Business address: AFFORDABLE AIR&HEAT INC MIAMI,FL 33179 515 NE 190 ST bailing address: AFFORDABLE AIR&HEAT INC MIAMI,FL 33179 515 NE 190 ST Physical business location. UNIN DADE COUNTY MIAMI,FL 33179 �-`1 Print accoumt?pt iicatic' (PDF) And Occupatto'ls 'AID 2015-07-15$75.00 I Contracting 10/01/2015 NAILS code: Receipt#CHECK21-15-094579 - Print l SPEC MECHANICAL —09130/2016 238990 this bill CONTRACTOR Units: 1 Additional iocumentation required:CAC048111 State/County License or Certificate � https://www.miamidade.county-taxes.com/publ`iic'/business ttax/accounts12102424?yeas=20... 9/28/2015 , ALCOR" CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 16-� 1 10/15/2015 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 pollcy(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 Greta Nielsen Corporate Insurance Advisors PHONE (954)315-5000 FAX C No:(954)315-5050 1401 E Broward Blvd ��ESS:gnielsen@ciaf1.net Suite 103 INSURERS AFFORDING COVERAGE NAIC q Ft. Lauderdale FL 33301 INSURERAAssociated Industries Ins Co 23140 INSURED INSURER B: Affordable Air & Heat, Inc. INSURER C: 515 NE 190TH ST INSURER D: INSURER E: MIAMI FL 33179 INSURER F: COVERAGES CERTIFICATE NUMBER:2015-16 WC REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR I TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LTR POLICY NUMBER M DArrM (MM/DDArN1Q LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS ADE OCCUR DAMAGE TO RENTED PREMISES Ea occurrence) $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY D JECTPRO- [�]LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY Per accident $ AUTOS AUTOS ( ) HIRED AUTOS NON-OWNED PRPERTY DAMAGE $ AUTOS (Pero accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ IXCESS LIAR CLAIMS-MADE AGGREGATE $ DED I I RETENTION $ WORKERS COMPENSATION I SPER OTH- AND EMPLOYERS'LIABILITY Y/N TATUTE ER E.L.EACH ACCIDENT $ 500 000 ANY PROPRIETOR/PARTNER/EXECUTIVE N/A A �CdatryInN�EXCLUDED? AWC1035459 8/8/2015 8/8/2016 E.L.DISEASE-EA EMPLOYE $ 500,000 f Yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required) License #CAC048111 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City Of Miami Shores THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 10050 NE 2nd Avenue ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores, FL 33138 AUTHORIZED REPRESENTATIVE Mark Schwartz/JUDYt ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INSO25 tpntami 41 /Z- ?,� 3 Inspection Worksheet Miami Shores Village I / 10050 N.E.2nd Avenue Miami Shores, FL V Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-259542 Permit Number: MC-5-15-1214 Scheduled Inspection Date: May 25, 2016 Permit Type: Mechanical - Residential Inspector: Perez,JanPierre Inspection Type: Final Owner: TAVARES,TIERES Work Classification: Addition/Alteration Job Address: 10050 NE 12 Avenue Miami Shores, FL Phone Number (305)244-2356 Parcel Number 1132050190370 Project: <NONE> Contractor: AFFORDABLE AIR& HEAT INC Phone: (305)940-0777 Building Department Comments REPLACE EXISTING 5 TON SPLIT SYSTEM WITH Infractio Passed Comments DUCTWORK. INSPECTOR COMMENTS False C ZI;5 Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-253670. CREATED AS REINSPECTION FOR INSP-235137. OK FOR TCO Failed Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid May 24,2016 For Inspections please call: (305)762-4949 Page 25 of 34 Permit NO. MC-5-15-1214 Miami Shores Village Permit Type: Mechanical-Residential 10050 N.E.2nd Avenue NE e r m i Work Classification:Addition/Alteration Miami Shores,FL 33138-0000 Permit Status:APPROVED Phone: (305)79-r-2204 Issue Date:7/10/2015 Expiration: 01/06/2016 Project Address Parcel Number Applicant 10050 NE 12 Avenue 1132050190370 BEYOND ALL REVOCABLE TRU Miami Shores, FL Block: Lot: Owner Information Address Phone Cell BEYOND ALL REVOCABLE TRUST 10050 NE 12 Avenue (305)244-2356 (786)709-3909 - --- - --- MIAMI SHORES FL 33138- 10050 NE 12 Avenue MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone Valuation: $ 10,000.00 AFFORDABLE AIR&HEAT INC (305)940-0777 ------ Total Sq Feet: 0 Tons:5 Available Inspections: Additional Info:REPLACE EXISTING 5 TON SPLIT SYSTEM 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 �Date Pay Type Amt Paid Amt Due CCF $6.00 Invoice# MC-5-15-55655 DBPR Fee $5.25 07/10/2015 Credit Card $379.50 $0.00 DCA Fee $5.25 Education Surcharge $2.00 Permit Fee $350.00 Scanning Fee $3.00 Technology Fee $6.00 Total: $379.50 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 it I ass onsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required fo ECT ICA , LUMBI G,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNE S JAFFIAVIT: I certi th all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating constru iozoning.'Fut ermore,I authorize the above-named contractor to do the work stated. July 10,2015 Authorized Signature:Owner / Applicant / Contractor / Agent ate Building Department Copy July 10,2015 1 Miami Shores Village -- ; Building Department MAY 21 ZOiS 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 —� Tel:(305)795-2204 Fax:(305)756-8972 BY: INSPECTIONLINE PHONE NUMBER:(305)762-4949 FBC 20 lb BUILDING Master Permit No. �--L �"�— aj3 PERMIT APPLICATION Sub Permit No. i` I -�2-�H ❑BUILDING ❑ ELECTRIC ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL F-]PLUMBING ,KI MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP /,� CONTRACTOR DRAWINGS JOB ADDRESS: 100-50 P& (2-`1- - P(ue City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: kk" 3ZOS- o lol "03Z)"y Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder):&YONd A4-(- juunoo-tL(�, Ttius r phone#:305 Z zN 2,3-116 Address: -413S k"q�ST At-• PSL City:IVOL` if A& U(LCA v� State: L Z;p: Tenant/LesseeName: Phone#: Email: j "V1 I GC3IL-L @& NA r-. C,;10^ CONTRACTOR:Company Name: AFFQ�&J� 40 12— t 4T�� Phone#: �a�� Address: �� `` -,— PC ST City: M(A-M � State: 17i— zip: I Qualifier Name:ax) I Phone#: State Certification or Registration#: N 1` Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: / City: State: Zip: Value of Work for this Permit:$ IM, M o Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: �1� � �� r� �C'1 �5 --f(r)N—t IT Specify colo of color thru tile. Submittal Fee$ P@l�rtlt 8 CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$�� I • C� (Revised02/24/2014) Bonding Company's Name(if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name(if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS, FURNACES, BOILERS, HEATERS,TANKS,AIR CONDITIONERS, ETC..... OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attach me Iso,a certified copy of the recorded notice of commencement must be posted at the job site for the first inspecti whi h oc rs seven,(7) days after the building permit is issued. In the absence of such posted notice, the inspection will no a approved nd a reinspection fee will be charged. Signature Signature OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoi . strument was acknowledged before me this -2-0 day of r"*`1 il- 120 is by D( day of t20 )'�—) by 7-oF-orb 3 -FAV -,who is personally known to ,who is personally known to me or who has produced—F-L— 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: r �� Arlt?Q• //'/, Sign: n Print: _�` ��'/Xp��';iG Print: �p ,��PpY Ptieii DASSILLE N.DURAN Seal: - —ya Co `� �8' = Seal: Notary-Public State of fl orida � Commission#FF 1493762 . s9� \\ '" F`aP°oma Nly Comm.Expires Jan 28,2019 +miw� BmIded through Natlonai Notary Asst. APPROVED BY v Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) �,SNoR 0 Miami Shores Village d Building Department ... o.., 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 OR 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 acceptable. Job Address(where the work is being done): 11 oo V e 12 xt 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❑ NOZ ARHI Sheet Attached:YES LrZ__"1NO❑ Contract Attached:YES UNIT BEING REPLACED DATA NEW UNIT MANUFACTURER ®9 YJ t- b AHU or PKG. UNIT MODEL# O,&6* COND. UNIT MODEL# 41TOU00 I Qj KW HEAT ((� NOM TONS AHU Cu PKG 1)M.C.A AHU CU PKG AHU CU PKG 2)M.O.P AHU CU PKG AHU CU PKG 3)VOLTS AHU CU PKG PKG UNIT / / PKG UNIT EER/SEER YES NO REPLACING DUCTS NO YES NO REPLACING THERMOSTAT ES NO YES NO NEW 4"CONCRETE SLAB YE NO YES NO NEW ROOF STAND S NO YES NO NEW RETURN PLENUM BOX YES NO 1. Minimum Circuit Ampacity(Wire Size): 61� 2. Maximum Overcurrent Protection (Fuse/Breaker Size): 3. Voltage of Circuit(208/240/480): 4. Size Disconne Means:/� 0�,,�,� , p,� g� Contractor's Co any N me:A �Ai:,G � Phone: State Certificate o Regist ation N Certificate of Competency No. Signature (QuaRflees signature) (Revised02/24/2014)