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MC-16-1161 44,61,- ,46 est? 4, Miami Shores Village 11, * 0116 Revidientlat, 10050 N.E.2nd Avenue NE Fla 1" Miami Shores,FL 33138 0000 Phone: (305)795-2204 f 3 #17IEtt#1 . � Expiration: 10/30/2 1 Project Address Parcel Number Applicant 1273 NE 92 Street 1132050270260 Miami Shores, FL Block: Lot: JULIO GONZALEZ Owner Information Address Phone Cell JULIO GONZALEZ 1273 NE 92 Street (754)423-3867 MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone Valuation: $ 6,000.00 COOL HOUSE CORP (305)207-2660 (305)720-3981 Total Sq Feet: 0 Tons:6 1/2 Available Inspections: Additional Info:REPLACE WEATHERHEAD/EMERGENCY PERM 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 $3.60 invoice# MC-4-16-59593 DBPR Fee $3.15 05/03/2016 Credit Card $ 184.90 $50.00 DCA Fee $3.15 Education Surcharge $1.20 04/29/2016 Credit Card $50.00 $0.00 Permit Fee $210.00 Scanning Fee $9.00 Technology Fee $4.80 Total: $234.90 In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are require LECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNE S AFFIDA I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construc n and zonin F re,I authorize the above-named contractor to do the work stated. I May 03, 2016 Autho ' ed Signature:Owner / Applicant / Contractor / Agent Date Building ment Copy May 03,2016 1 j Miami Shores Village Building Department APR�2V20 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 BY: INSPECTION LINE PHONE NUMBER:(305)762-4949 S 9 FBI C M q BUILDING Master Permit No. 4C i G— { */ PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING I&MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP O� �- CONTRACTOR DRAWINGS JOB ADDRESS: ,� `� 5 1 �/ City: Miami Shores County: Miami Dade Zip: '��,��i Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: ((,, OWNER:Name(Fee Simple Titleholder): \J�0y ��h7�`� Phone#. Address: --� City: n, State: L Zip: Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: Cdto Phone#: a S Address:_k 4 Ssc 4 � c1 City: �f(�-U�� State: — Zip: c1 S Qualifier Name: C. C ��( Phone#: State Certification or Registration#:- < QAC 1%1 2A�N Certificate of Competency M DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: 6or Value of Work for this Permit:$ � � Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New M-Repair/Replace ❑ Demcglition Description of Work: tk- r o►JQ `J o rz Specify color of color thru tile: Submittal Fee$ Permit Fee$ CCF$ COICC Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ v(J TOTAL FEE NOW DUE$ ` 0 ` • �� (Revised02/24/2014) Bonding Company's Name(if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name(if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS, FURNACES,BOILERS,HEATERS,TANKS,AIR CONDITIONERS,ETC..... OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be a prove a d a r 1 spection fee will be charged. Signature Signature -""t, OWNER or ONTRACTOR The foregoing i stru t was acknowledged before me this The foregoing instrument was acknowledged before me this X day of e "� 20 `Y by �� day of /inh I 20 /�Q ,by who is personally known to •�1(�� ` 1� 0 / ,who is personally known to me or who has produced as me or has produced as identification and who did take an oath. identi i tion and who did take an oath. NOTARY PUBLIC: NOTARY U Sign: Sign: Print: ®• Print: CZ//7�lil {ilC Seal: "'Nti JUAN C.CASMO Seal: ,,,,,,,,,, ' MY COMMISSION 1i FF 948136 a�A '% o�P °a,'% YAIMA FERNANDEZ e EXPIRES:May 6,20'20 ?r: ,° Notary Public-State of Florida handed Thor Notxry PM Umlaiwifto :•. .•_ 9 0;; My Commission Expires Aug 11,2017 >x�' �xa�*Ott#�ii9tS6B#I'ifel'I35''/ *+xm �xr+x APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) EN LAWSON,SECRETARY Mort bw I I.LiuvtlawK ` STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUS'T'RY LICENSING BOARD CAC1Z317484 The CLASS B AIR CONDITIONING CONTRACTOR", ; ; r x Named below IS CERTIFIED , Under the provisions of Chapter 489 FS. Expiration date: AUG 31,2016 CASTILLO, JUAN CARLOS-;" r COOL MOUSE,CORP ` ' • 4180 SW 134 AVE U �h! p q �� �s iE ? t• h 2 � Mb ISSUED: 05/20/2014 DISPLAY AS REQUIRED BY LAW SEQ# L1405200001176 OOM6 pf 18Ei 134 �� Y N If40 ri�'�fg ��ber'`�ACcx+at-Q�iANfptl@ � r r � ! OWN@I ...... SEC. OP > r C0O1 I5E CORP 196 S MEC PavMerotr Ilecenrl�r z "_. CAC1817484 _ , #V TAX COLLECTpt� y i lu, 54 '$l5 00 01102/2015 _ Ot ITCAiD—i 5--032359 �Basiaaitecaipt nfinns Busiaa6sTax T6a� b aota Kansa a Me 60�' liii men* ry •: �ffi h aaY 9ae�talmenlal 464iiIiT N0. an an a6o horst ba 6a 276 9d �lmercialiYelslales M " � 'a`C" 'RO� CERTIFICATE OF LIABILITY INSURANCE DAT 04/201 6 a4rx@/15 THIS CERTIFICATE 13 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 cartilia o-holder Is an ADDITIONAL INSURED,the pollcy(lss)must be endorsed. if SUBROGATION IS WAIVED,subject to the twins and conditions of the policy,certain politics may require an ondorsamenL A statement on this certificate does not confer rights to the certificate holder In liou of such endamement(s). PRODUCER INT _ACT ANIET BIGORRA It Estrella Insurance#123 Na (2105)653-4800 PAX 305 553.9050 12460 SW 8th Strout,Suite 10,1 M s8: managorlow—m--pelna"Ce.com Mlaml,FL 33184 INSURBR(1AFFORDING COVeMOE _ Nate 0 Phone 305 553.4800 Fax (30§)553.8050 INSURER A: ASCENDANT INSURANCE CORP . INSURED INSURER 0: COOL HOUSE CORP _INs.U.BeRc__ 4180 SW 134 Ave Mlami,FL 33175 (308)720.3981 INSURaR e: _ _ I INSURQR R; COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE USTEO BELLOW HAVE BEEN ISSUED TO THE INSURE4 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 MAYBE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS ANDCONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, _ ADO UBR - -- PO{{,,ICY�pp_. (AR CYtiXP .. . TYPE OP INSURANCE _ IHS POLICY NUMBER (MMtDD _. UMI'm _ OENERAL LIA8111M EACH OCCURRCNCC 61000,000.00 rn/ COMMERCIAL GENERAL LMDILITY °fABCMt`3EE9(OY.RaRDIca1 s 100.000,00 A ❑ ❑ CLAIMS-MADE [VI OCCUR GL42D30.2 06/02/2015 05/02/2018 MEDEXP ArtywwP"w) 4 S.OD0.00 ❑ PERSONALS ADV INJURY 8 1,000,0013.. ❑ OCNERALAGGREGATE S 1.000,000.00 CEWI,AGGREGATE LIMprr APPLICS PCR: PRODUCTS.COMPIOP AGO S 1,000,000.00 __ ❑ POLICY ❑.JCT ❑ LOC @LIFO BCOD 8 AUTO M0DIL8 LIADI ITV PMqIN SINGLE IN LE LIMIT iJ ANY AUTO BODILY INJURY(Por Pon=) 3 r-� ALL OWNCO SCHEDULeD BODILY INJURY(Par lwditnl S L=1 AUTOS ❑ AUTOS❑ I IIRCD AUTOS ® NAUTO�SWNED Pl�wAMAGE I I UMDRELLA LIAD ❑OCCUR PACH OCCURRENCE 5 k UtOL°88 LIAR nCLyly,MAoe AGORCOATE ❑-TORYLIMITti=�, ❑ DCO I I N s__ WORKERS COMPENSATION C AT TH• AND EMPLOYERS LIABILITY Y!N ANY PROPRICTORIPARTNER/EXQCUTWE E.L.EACH ACGIDCNT S MC OFFICERIMWA CXCLUOCD7 NIA - (Mandatory In NH) I , 2.L DISEASE•EA EMPLOYG S If daeantm under I DESCRIPTION ON Opt RRTION tmlow BLL DISEASE•POLICY LIMIT S J , DESCRIPTION OF OPBRATIONS I LOCATICNS I VEHICLES(Aasah ACORD 101,Additional Rsroarks SahedWo,If maro space Is mqulrod) AIR CONDITIONING SYSTEM CERTIFICATE HOLDER CANCELLATION _ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 3ull.d Department, . 10060 NE 2nd Aim AUTHORIZED RBPRES r Miami,FL 33138 ttp i88 TION. All rights reserved. ACORD 25(2010/06)OF , The ACO name n d logo aro rog s d marks of ACORD PLEASE CUT OUT CARD BELOW AND RETAIN FOR FUTURE REFERENCE r ------------- r IMPORTANT STATE OF FLORIDA Pursuant to Chapter 440.05(14),F.S.,an officer of a corporation DEPARTMENT OF FINANCIAL SERVICES I who elects exemption from this chapter by filing a certificate of DIVISION OF WORKERS'COMPENSATION a F elecompensation coon u r this section his chapter.not recover benefits or CONSTRUCTION INDUSTRY EXEMPTION O CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA I L Pursuant to Chapter 440.05(12),F.S.,Certificates of election to WORKERS'COMPENSATION LAW D be exempt...apply only within the scope of the business or trade EFFECTIVE DATE: 3/26/2015 EXPIRATION DATE: 3/25/2017 I listed on the notice of election to be exempt. PERSON: CASTILLO JUAN C I H Pursuant to Chapter 440.05(13),F.S.,Notices of election to be FEIN: 651095978 I E exempt and certificates of election to be exempt shall be subject BUSINESS NAME AND ADDRESS: I R to revocation if,at any time after the filing of the notice or the COOL HOUSE CORP I E 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 certificate 4180 SW 134 AVE at any time for failure of the person named on the certificate to MIAMI FL 33175 I meet the requirements of this section. SCOPES OF BUSINESS OR TRA CHEATING,VENTILATION, LAIR-COND ----___-- -- DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS?(850)413-1609 Cool House Corp Date: Oqv l llu ) � 7 0 1 ka, State of County of Before me this day personally appeared who, being duly sworn, deposes and says: That he or she will be the only person working on the project located at: Sworn to or affirmed) and subscribed before me this day of �� /l 20 by Jt)014 Personally know OR Produced Identification Type of Identification Produced _:nL T-vne cawr Stamp, e of -motary f YAIMA FERNANDEZ cmc My Public-State of Florida 0 MY Commission Expires Aug 11,2017 ql Commission#FF 11357 ♦rpt ,Es n full „,„» 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 % Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05 allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to obtaining a building permit. Pursuant to the Florida Division of Workers'Compensation Employer Facts Brochure: An employer in the construction industry who employs one or more part-time or full-time employees,including the owner,must obtain workers'compensation coverage. Corporate officers or members of a limited liability company (LLC) in the construction industry may elect to be exempt if- 1. f1. 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 insur a cov a from the contractor's company for day labor,part-time employees or subcontractors. BY SIGNING BEL W O A OWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature: Owner State of Flo ' County of Miami-Dade The foregoing was acknowledge before me this day oft'\1, ,20�. By who is personally known to me or has produced as identification. Notary MY COMMISSION t FF 9039 SEAL: EXPIRES.May 8,2M0 = Bonded Thm No”Pubf c Unhiw*to •N Miami Shores Village Building Department sun 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): `Z9 3 NO O Z 57 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 F] NO`® ARHI Sheet Attached:YES [K NO ❑ Contract Attached:YES ❑ UNIT BEING REPLACED DATA NEW UNIT MANUFACTURER DCat,& AHU or PKG. UNIT MODEL# O tv u�'�kQT' COND.UNIT MODEL# P•\I 1kT },y KW HEAT NOM TONS N 5 N.AHU CU PKG 1)M.C.A A CU PKG AHU CU PKG 2)M.O.P U CU PKG AHU CU PKG 3)VOLTS X01 d • AHU CU PKG PKG UNIT / / PKG UNIT EER/SEER YES NO REPLACING DUCTS YES NO YES NO REPLACING THERMOSTAT YES NO YES NO NEW 4"CONCRETE SLAB YES NO YES NO NEW ROOF STAND YES NO YES NO NEW RETURN PLENUM BOX YES NO� 1. Minimum Circuit Ampacity(Wire Size): A6 �0`� i� 2. Maximum Overcurrent Protection (Fuse/BreakerSiize): v k0,\ 3. Voltage of Circuit(208/240/480): -:2a / 2 �4 4. Size Disconnecting Means: �^ Contractor's Company Name: C^�(xl, ��J� �� Phone: 3oS ®"I_c10�P 60. State Certificate or i No. l _ �61 TWA Certificate of Competency No. Signature Date: alffiees signature) (Revised02/24/2014) i R Miami Shores Village Building Department ■■■■ �.� 10050 N.E.2nd Avenue Miami Shores, Florida 33138 �r R 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):. �nlq-_ZL�' 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 MANUFACTURER CQaQNkA4J AHU or PKG.UNIT MODEL# 01,(o COND. UNIT MODE # C S KW HEAT NOM TONS AHU CU PKG 1)M.C.A AH CU PKG AHU CU PKG 2)M.O.P AHU U PKG AHU CU PKG 3)VOLTS AHU CU PKG PKG UNIT / / PKG UNIT EER/SEER \ S�-(L ME sg YES NO REPLACING DUCTS YES NO YES NO REPLACING THERMOSTAT YES NO `4f YES NO NEW 4"CONCRETE SLAB YES NO YES NO NEW ROOF STAND YES NO YES NO NEW RETURN PLENUM BOX YES NO 1. Minimum Circuit Ampacity(Wire Size): 7� �S%� 2. Maximum Overcurrent Protection (Fuse/Breaker Size): 3. Voltage of Circuit(208/240/480): 12cyr 423 L'r 4. Size Disconnecting Means: Contractor's Company Name: /�CJC�� Clit e Phone: State Certificate or R gistratio o._( `%EOVCertificate of Competency No. Signature _ Date: 4t__J Al_ alifler's signature) (Revised02/24/2014) ilk b� CERTIFICATE OF LIABILITY INSURANCE °t--;""D°"""' 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)trust be endorsed. H 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 endoreement(s). PRODUCER CNAOME:NTACT ANIET 816ORRA Estrella Insurance#123 PHONE (305)553«4800 AIG , (305}553-9050 -MAIL.Eadl 12460 SW 8th Street,SUlte 101 QD rl;ss managerl23@estrenalnsurance cam Miami,FL 33184 INSURER(S) AFFORDING COVERAGE NAIC# Phone (305)553-4800 Fax (305)553-9050 INSURER A: ASCENDANT INSURANCE CORP: INSURED INSURER B COOL HOUSE CORP INSURER C I 4180 SW:.134 ave INSURER D Miami.FL 33175 (305}720=3981 INSURER E II3 INSURER F: COVERAGES CERTIFICATE NUMBER REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. I v TYPE OF INSURANCE � UBR POLICY NUMBER POUCYEFF MPMIUOCYEXP LIMITS MOM I L GENERAL LIABILITY EACH OCCURRENCE S 1,000,000.00 © COMMERCIAL GENERAL LIABILITY DAMAGES(Ee oea Re $ 100,000.00,: A ❑ ❑ CLAIMS-MADE OCCUR GL-42030.2 0510 MED EXP one rsm) $ 5.000.00: ❑ 2/2015 05!0272016; :� PERSONAL&ADV INJURY $ ;1:000,000.00 :.:: ❑ GENERAL AGGREGATE $ 1;000,000.00 GENL AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $ 1,000,000-00. ❑POLICY ❑ E a El Loc I.BVPD SDOD ; S ; AUTOMOBILE LIABILITY N eD1SINGLE LQdR ❑ ANY AUTO BODILY INJURY(Per parson) $ E] AALL t1T01SNNED ❑ AUTOSU t' BODILY INJURY(Per accident, S NON-OWNED f i ROPER DAMAGE ❑ HIRED AUTOS ❑ AUTOS a $ r ❑ ❑ $ . ❑ UMBRELIALUIB ❑OCCUR EACH OCCURRENCE S ❑ EXCESS LIAB ❑CLAIMS-MADE i. AGGREGATE $ ❑ DED ❑ RETENTION$ WORKERS COMPENSATION ❑WC STATU- ❑OTH- AND EMPLOYERS`LIABILITY Y t N JQRY �AII _ ANY PROPRIETORIPARTNERIEXECUTIVE S ELL EACH ACCIDENT _ $ OFFICERIMEMBEREXCLUDED? NIA (Mandatory In NH) ElE.L.DISEASE-EA EMPLOYEIr S I ye describe under OES RIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 181,Additional Remarks Schedule,If more space Is required), AIR CONDITIONINCrSYSTEM `:'.' ..! I CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE ESCRIS POLICIES BE CANCELLED BEFORE MIAMIBHORESSYSTEM THE EXPIRATION DATE THER OF,NOTI E WILL BE DELIVERED IN ACCORDANCE WITH THE PO CY PROV IONS. BUIEDING DEPARTMENT �' 10050 NE 2ND AVE AUTHO RESENTATIVE MIAMI FL`33136 1 88- ORD CORPORATION. All rights reserved. ACORD 25(2010105)OF O D na a and logo are registered marks of ACORD q � , CORO ATe jna#s� ®nrYYvl,..� CERTIFICATE OF LIABILITY INSURANCE 65103116 � .._ .m, THIS CERTIFICATE-IS$oIED AS A MATTER OF INFORMATION ONLY AND CONFERS NO R1GHTa 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 I I DING iNSURER(S),At�tTHCIi�I D REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER, IMPORTANT' if tfi q 44-0 cyto 11010t to art AD TIONAL INSURED.Wo padfoy(loo)muot bo nndomod.V SUBROGATION 141 WA MED,subloat to the tormoand ovidiltion s of the polity,certain policies moy require an andorsomorIL A sU tomont on thls cerlifleeto does not cantor rlphts to,the eor0floato holder In lieu of purtl#endotsement(s}, PROW= ANIET BIGORRA 12460I6tH Sirl8ttl#a„101 �.. e EBtrella tnBurlttt�flN1$$ PiN+tae� 3 (305)553y9080. immawg �. � �,..�.....1_taAc.Holt . A•aD ` lioh ouranrei; Miami,FL 33184 INSUR BI AIWORDWO COWRAOC _ NAIC B Phgn {396}5a 480fl FOX (305}553.9050 n�tiu n A r ASCENDANT INSURANCE COAP INBUR6D INBURUR t# COOL.HOUSE CORP:. INSI7RiLk 4180 W 134 Avta , . tfjR a Mtaml,F>.,33175 (3fl6)'t2�9id1 1NBUN@RCa _.. ..w. COVERAGES CERTIFICATE NUMBER; REVISION NUMBER- THIS 13 TO CERTIFY THAT THE POLICIES DF INSURAN09 LIED OELOW HAVE SEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWIYHS'TANDINO ANY REOUIR NT'TERM OR CONDITION OF ANY CONTRACTOR OTHER 00CUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IB SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICES.LpyItT3sHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,,, _._,.... TYM OF NUVOIC1111Ic aoiaCY u,!`9P (atm It EACH OCCURRM.NC_ LI�91T>S �I o00oflQ,Otl 3 j tlRNCItA taIABILITY .F r COMMERCIAL osNERAL LlAAILITY bAMA to NkN IkD s 100,000.00 f , t�e;t tea orracl� _ M I CLAIMS MADE OCCUR -450 30022617nseu Exp( p ,�) .... s SiOOO oO A ,tt,.w� oSfO$l201 t1 LJ _ P SONAL&ADV INJURY S 1,000,000.00 CCNCanGAaot CATE s 1,006,000.flfl _.. s (01!WL AGGREGATE LIMIT APPLLIC4 PM f PRODUCTS CrsRAPKIP AOO f^S 1,f3oQ+Q�IQ.o�} © Pt$I,ICY I<.-.I.JEC7 0 LaO AUTOMOttX H UAt d ITT Mtl Nkp INOLE LIMIT uctattant# ( ANY AUTO 00014Y INJURY{Par pw"”) 3 } AUTOSD A 0QDItYuuJUtdY(Pat aacatUant) S _ HIRCLI AUTOS AUTOS w � ® UMBRBLLA UAD Lj OCCUR W.-..y EACH OCCUFMN61! �9 _ I[� 9XCI!SS UAD CWMS*MADACORECATTE _�.. . S'rATU. .. I � WONtttCFtiI COMNNSATIL'IW M. 'AI#IS E<NPI.OYE 'LIANILITY Y f N ANYPROPRICY# Af3TNEftfMCUTNE W�EL l±A{ dACCipC'NT 3 0 FIC ERtMEMiIERCXCLUDO'OT141Al--- NlmnaatQry In NNI F� I C.L,DISEASE»FA C<MPLt�sP� S I I It as.daura O SCRIPTION RF ttP4*RATi SNS b#kW.. _ C L DISEASE»POLICY LIMIT 1 ORSCRIPTICIN OP CPE1lATIONS f LOCATIONS f va"l ,Jt3 1Attash ACDRD#ef,.Addlttanal Rarnsrko Sahodela,i#mora 013600 18 roquireM , AIR CON) ITIONING SYSTEM; 1 CERTIFICATE 'HOLDER CANCELLATION t SHOULD ANY OF THE ABOV CIES RISED POLICIES BE CANCELLED SUORE Miami am$Village THE EXPIRATION DATE THE OF, OTICE WILL BE DELIVERED IN BUlidittg�IXE#dflS fit ACCORDANCE WITH THE P LICY P OVISIONS. 100#0�OE$nd AV8 a PINTS Mlatsll, _ I S ACORD CORPORATION. All rights roOarved, ACORO 25(2010105)OF ACO n me and logo ore registered marks of ACORD LAM CERTIFIED r rq Certificate of Product Ratings AHRI Certified Reference Number: 7491226 Date:4/29/2016 Product:Split System:Air-Cooled Condensing Unit,Coil with Blower Outdoor Unit Model Number:RA1430AJ1 Indoor Unit Model Number: RH1T3617STAN Manufacturer: RHEEM SALES COMPANY,INC. Trade/Brand name: RHEEM; RUUD Region:Southeast and North(AL,AR,DC,DE,FL,GA,HI,KY,LA,MD,MS,NC,OK,SC,TN,TX,VA AK,CO,CT,ID,IL,IA,IN,KS,MA,ME,MI, MN,MO,MT,ND,NE,NH,NJ, NY,OH,OR,PA,RI,SD,UT,VT,WA,WV,WI,WY,U.S.Territories) Region Note: Central air conditioners manufactured prior to January 1,2015,are eligible to be Installed in all regions until June 30,2016. Beginning July 1,2016,central air conditioners can only be Installed In region(s)for which they meet the regional efficiency requirement. Series name Manufacturer.responsible for the rating of this system coM potion is RHEEM rSALES COMPANY,INC. Rated pa follows in accordance with AHRI Standard 2101240-2008 for UnItai y Air-Conditioning'and Air-Source Heat Putriip:;Equipment anc subject to_verification of rating accuracy by AHR14ponsored,Independent,third party�, n9� Cooling Capacity(Btuh): 29400 EER Rating(Cooling): 13.00 SEER Rating(Cooling): 15.50 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 f any kind unauthorized)listed on this alteration of date listed on this Cte.AHRI ertificate.Ceressly laims rtifledall ratings liability re valid only ffor damages or models and configuratioout of ns listuse ed In theormance of the produd(s)or the directory at www.ahridlrectory.org. TERMS AND CONDITIONS This Certificate and Its contents are proprietary products of AHRI.This Certificate shall only be used or Individual,personal and confidential reference purposes.The contents of this Certificate may not,in whole or in part be reproduced;copied:disseminated ; r%MW 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 INsTrruTE CERTIFICATE VERIFICATIONuv make life better" The Information or the model cited on this certificate can be verified at www.ahridlrectory.org,click on'Verity Certificate'link and enter the AHRI Certified Reference Number and the date on which the certificate was issued, 131084159757127226 which is listed above,and the Certificate No„which is listed at bottom right FCERkTIF�ICATTE NO.: ©2014 Air-Conditioning,Heating,and Refrigeration Institute : :• This combination qualifies for a Federal Energy A HURL: CERTIFIED o 1i Efficiency Tax Credit when placed In service Qfg between Feb 17,2009 and Dec 31,2016. Certificate of Product R AHRI Certified Reference Number:7943535 Date:4/29/2016 Product: Split System:Air-Cooled Condensing Unit,Coil with Blower Outdoor Unit Model Number: RA1648AJ1 Indoor Unit Model Number: RHIT4821STAN Manufacturer. RHEEM SALES COMPANY,INC. Trade/Brand name: RHEEM; RUUD Region:All(AK,AL,AR,AZ,CA,CO,CT, DC, DE,FL,GA,HI,ID,IL,IA,IN,KS, KY, LA, MA, MD,ME, MI,MN,MO,MS,MT,NC,ND,NE,NH,NJ,NM, NV, NY,OH,OK,OR,PA,Rl,SC,SD,TN,TX, UT,VA,VT,WA,WV,WI,WY,U.S.Territories) Region Note: Central air conditioners manufactured prior to January 1,2015,are eligible to be Installed in all regions until June 30,2016. Beginning July 1,2016,central air conditioners can only be installed in region(s)for which they meet the regional efficiency requirement. Series name: ManufliIiresponsible for the rating of this system combination is RHEEM;SALES COMPANY,INC. Rated as follows in accordance with AHRI Standard 210/240-2008 for Unity 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): 45000 EER Rating"Ing): 13.00 SEER Rating(cooling): 16.00 IEER Rating (Cooling): 'Ratings followed by an asterisk(')indicate a voluntary rerate of previously published data,unless accompanied with a WAS,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.ahridireatory.org. TERMS AND CONDITIONSlull 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: 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 INSTffVTE CERTIFICATE VERIFICATION The information for the model cited on this certificate can be verified at www.ahfldlrectory.org,click on'Verity 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 13106416020MIS4301 ©2014 Air-Conditioning,Heating,and Refrigeration Institute CERTIF=ICATE NO.: Air Air Conditioners ' 0 RA14 Series The new degree of comfort:" Rheem Classic° Series Air Conditioners RA14 Series Efficiencies up to 16 SEER/13 EER Nominal Sizes 11/2 to 5 Ton [5.28 to 17.6 kW] Cooling Capacities 17.3 to 60.5 kBTU [5.7 to 17.7 kW] k ME s� � _ In Proper sizing and Installation of equipment Is critical to achieve optimal performance.Split system air conditioners and heat pumps must be matched with appropriate coil components to meet Energy Star. Ask your Contractor for detalls or visit www.energystargov." • New composite base pan—dampens sound,captures louver • Diagnostic service window with two-fastener opening— panels,eliminates corrosion and reduces number of fasteners provides access to the high and low pressure. needed • External gauge port access—allows easy connection of • Powder coat paint system—for a long lasting professional finish "low-loss"gauge ports • Scroll compressor—uses 70%fewer moving parts for higher • Single-row condenser coil—makes unit lighter and allows efficiency and increased reliability thorough coil cleaning to maintain"out of the box" • Modern cabinet aesthetics—increased curb appeal with visu- performance ally appealing design • 35%fewer cabinet fasteners and fastener-free base—allow • Curved louver panels—provide ultimate coil protection, for faster access to internal components and hassle-free enhance cabinet strength,and increased cabinet rigidity panel removal • Optimized fan orifice—optimizes airflow and reduces unit • Service trays—hold fasteners or caps during service calls sound • QR code—provides technical information on demand for • Rust resistant screws—confirmed through 1500-hour salt faster service calls spray testing • Fan motor harness with extra long wires allows unit top to be • PlusOneTM Expanded Valve Space—3"-4"-5"service valve removed without disconnecting fan wire. space—provides a minimum working area of 27-square inches for easier access • PlusOneTM Triple Service Access—15"wide,industry lead- ing corner service access—makes repairs easier and faster. The two fastener removable corner allows optimal access to internal unit components. Individual louver panels come out once fastener is removed,for faster coil cleaning and easier cabinet reassembly INTEGRATED HOME FORM NO.Al 1.220 REV.4 Property Search Application- Miami-Dade County Page 1 of 1 PRAISER OFFICE OF THE PROPERTY Summary Report Generated On:4/29/2016 Property Information . Folio: 11-3205-027-0260 1273 NE 92 ST r, Properly Address: Miami Shores,FL 33138-2936 R'E JULIO G GONZALEZ Owner RITA FERNANDES Mailing Address 1273 NE 92 ST MIAMI SHORES,FL 33138 USA Primary Zone 1100 SGL FAMILY-2301-2500 SQA , Primary Land Use 0101 RESIDENTIAL-SINGLE FAMILY: 1 UNIT t ' Beds/Baths/Half 2/2/0 Floors 1 Living Units 1 Actual Area Sq.Ft E.. Living Area Sq.Ft Adjusted Area 2,232 Sq.Ft Taxable Value Information Lot Size 9,375 Sq.Ft 1 2015 2014 2013 Year Built 1971 County Exemption Value $0 $0 $0 Assessment Information Taxable Value 1 $404,154 $367,413 $334,012 Year 2015 2014 2013 School Board Land Value $285,750 $253,500 $171,000 Exemption Value $0 $0 $0 Building Value $164,409 $161,418 $162,679 Taxable Value 1 $450,482 $415,246 $334,012 XF Value $323 $328 $333 City Market Value 1 $450,482 $415,246 $334,012 Exemption Value $0 $0 $0 Assessed Value $404,154 $367,413 $334,012 Taxable Value 1 $404,154 $367,413 $334,012 Regional Benefits Information Exemption Value $0 $0 $0 Benefit I Type 2015 2014 2013 Taxable Value $404,154 $367,413 $334,012 Non-Homestead Cap Assessment Reduction 1 $46,328 $47,833 Note:Not all benefits are applicable to all Taxable Values(i.e.County, Sales Information School Board,City,Regional). Previous OR Book- Sale Price PageQualification Description Short Legal Description 30001- Corrective,tax or QCD;min 5 53 42 07/15/2015 $100 4218 consideration BAY LURE PB 44-63 29470- Financial inst or"In Lieu of Forclosure" LOT 15 BLK 2 01105/2015 $413,000 1890 stated LOT SIZE 75.000 X 125 9- Financial Inst or"In Lieu of Forclosure" OR 19451-0246 12 2000 4 03/03/2010 $210,100 467 4679 stated 12/01/2000 $0 19451- Sales which are disqualified as a result 0246 of examination of the deed 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/ 4/29/2016