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MC-16-2149 a Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores,FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-264486 Permit Number: MC-7-16-2149 Scheduled Inspection Date: November 02,2016 Permit Type: Mechanical - Residential Inspector: Perez,JanPierre Inspection Type: Final Owner: , Work Classification: A/C Replacement Job Address:101 NW 108 Street Miami Shores, FL 33168-4312 Phone Number Parcel Number 1121360100320 Project: <NONE> Contractor: GREENTREE AIR CONDITIONING INC Phone: (954)860-2152 Building Department Comments CHANGE OUT Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed Failed Correction Needed �� Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. November 01,2016 For Inspections please call: (305)762-4949 Page 15 of 51 Miami Shores Village ht ; ittff"TP 10050 N.E.2nd Avenue NW � n AJC Rip f Miami Shores,FL 33138-0000 %j yj yk (yy d! 0 ! R P £�3w9 C ,viz �lfi Gi7.il'4F �i 3,ay Phone: (305)7952204 Expiration: 021012 17 Project Address Parcel Number Applicant 101 NW 108 Street 1121360100320 Miami Shores, FL 33168-4312 Block: Lot: LAW INC Owner Information Address Phone Cell LAW INC P.O. BOX 211595 ROYAL PALM BEACH FL 33414- P.O.BOX 211595 ROYAL PALM BEACH FL 33414- Contractor(s) Phone Cell Phone Valuation: $ 3,700.00 GREENTREE AIR CONDITIONING INC (954)860-2152 Total Sq Feet: p Tons:4 Available Inspections: Additional Info:CHANGE OUT 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 DBPR Fee Invoice# MC-7-16-60810 $2.00 07/29/2016 Credit Card $50.00 $98.90 DCA Fee $2.00 Education Surcharge $0.80 08/05/2016 Credit Card $98.90 $0.00 Permit Fee $129.50 Scanning Fee $9.00 Technology Fee $3.20 Total: $148.90 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 required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS AFFIDA IT: rtil a !going info tion is accurate and that all work will be done in compliance with all applicable laws regulating construction an4—v,69* . FuWie reL � oC"ie-named contractor to do the work stated. August 05,2016 Authorized Signature:Owner / Applicant / Contractor / Agent Date Building Department Copy August 05,2016 1 Miami Shores Villa a C1FP,rF ? ' g L' .CA Building Department UL 2 9 2016 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 BY' Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 -( FBC 20 I y BUILDING Master Permit No. 21 Y PERMIT APPLICATION Sub Permit No. F-JBUILDING ❑ELECTRIC ❑ ROOFING ❑ REVISION ❑EXTENSION ❑RENEWAL ❑PLUMBING OMECHANICAL [-]PUBLIC WORKS p CHANGE OF ❑CANCELLATION ❑ SHOP p CONTRACTOR DRAWINGS JOB ADDRESS: /C)i Ajor � � 1 I City Miami Shores County: Miami Dade zip: � �1 Folio/Parcel#: /f ® 213 b - 010 Q 2-® Is the Building Historically Designated:Yes NO Occupancy"type:-5 F/Z Load: Construction"type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): 4AU INC° Je6'In 1e �)a -(g- Phone#: 5(6 a - 2 S 2-- Cie? Address: ( ftrfhWeLf I® th C5 C: City: Kan' 5 ho State. FL Zip: 3--P Tenant/Lessee Name: Phone#: Email- CONTRACTOR:Company Name: �1`P��i'�� 1 �l�®��+"iY --ZX•Phone#: C7 59- 860 - Z/`5 Z Address: A1 �-7-0 At It-3 7-"'45t ® City:-1-167 67 Leg State:,� 6 :3Qualifier Name: ch a Frue h .d'��L ) Phone#: 22J S'2 State Certification or Registration#: ® �� Certificate of Competency#: DESIGNER:Architect/Engineer: �j Phone#: Address: City: State: Zip: Value of Work for this Permf-$- ® Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace ❑ Demolition Description of Work: (� 6'/CAS Specify color off color thru tile: Submittal Fee$ n : + Permit Fee$ CCF$ 2- 4 CO/CC$ Scanning Fee$ Radon Fee$ .0 0 DBPR$ 2, W Notary$ Technology Fee$, 3° 220 Training/Education Fee$ Double Fee$ Structural Reviews$ 50 Bond$ 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 wion fee will be charged. Signature= Signature OWNER or ENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this 2� day of (�1�20 1 ( ,by .da of JU "� ,20 l .by r — E who is personally known to ho is personally known to me or who has produced EC.. (.t CC.VL as me or who has produced r r C- �-I���t��- as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign: Print: W I Print:_ r--J c4a rad e Lo 17 l Seal: Seal: ;�s""'• �;. ADAM HEWITT , , MY COMMISSION#FF998674 ��: ADAM HEFF19986-14 EXPIRES June 02,2020MY COMMISSIOaNMrySerrviceco 407 itiL3loriyallo[arySe APPROVED BY 6 tans Examiner Zoning Structural Review Clerk (Revised02/24/2014) ,Ns Miami Shores Village Building Department ..„ Mtn 10050 N.E.2nd Avenue —`-- Miami Shores, Florida 33138 Tei:(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 sheetsr�ar1e not acceptable. � a Job Address(where the work is being done): /'0 I A.!�!/ ®8> 1 et City: Miami Shores Village County: Miami Dade Zip Code:_ c,- 6,1 ALL CONDENSING UNITS MUST RE 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 F1 Nod ARHI Sheet Attached:YESO❑ Contract Attached:YESr NIT BEING REPLACED DATA NEW UNIT z Nil MANUFACTURER 1ne-e—W, (44Aw-k19Z-i AHU or PKG.UNIT MODEL# 9 -4v ?-B z)r N 131 LA rr COND.UNIT MODEL# A 1 KW HEAT NOM TONS AHU CU PKG 1)M.C.A AHU CU PKG AHU Lf5ICU PKG 2 M.O.P AHU(4. CU 4 bPKG AHU CU PKG 3)VOLTS AHU CU PKG PKG UNIT / / PKG UNIT EER/SEER YES NO REPLACING DUCTS YES YES NO REPLACING THERMOSTAT ES NO YES NO NEW 4"CONCRETE SLAB E4NOYES NO NEW ROOF STAND YESYES NO NEW RETURN PLENUM BOX YES 1. Minimum Circuit Ampacity(Wire Size): 2. Maximum Overcurrent Protection(Fuse/Breaker Size): 3. Voltage of Circuit(208/240/480): 10- 4. Size Disconnecting Means: Contractor's Company Name: ..,- 6ndiAbiv.6'u 1 phone: `/e 96® Z/5 a . State Certificate oi Cl$1 Certificate of Competency No. r Regi Signature Date: (Quenftes s tore) (Revised02/24/2m4) Property Search Application-Miami-Dade County Page 1 of 1 OFFICE OF THE PROPERTY APPRAISER Y ::.a...., Summary Report Generated On:7/29/2016 Property Information k=: Folio: 11-2136-010-0320 Property Address: 101 NW 108 ST Miami Shores,FL 33168-4312hl, OwnerLACJ INC PO BOX 211595 Mailing Address ROYAL PALM BEACH,FL 33414 Ei'e3 USA Primary Zone 0800 SGL FAMILY Primary Land Use 0101 RESIDENTIAL-SINGLE FAMILY:1 UNIT Beds/Baths/Half 2/2/0 Floors 1 � � Y Living Units 1 WA Actual Area 1,686 Sq.Ft Living Area 1,288 Sq.Ft Adjusted Area 1,484 Sq.Ft Taxable Value Information Lot Size 9,507.46 Sq.Ft 2016 2015 2014 Year Built 1951 County Exemption Value $0 $0 $0 Assessment Information Taxable Value $307,057 $296,914 $189,422 Year 2016 2015 2014 School Board Land Value $170,864 $170,864 $101,906 Exemption Value $0 $0 $0 Building Value $104,147 $105,008 $103,131 Taxable Value $307,057 $296,914 $226,305 XF Value $32,046 $21,042 $21,268 City Market Value 1 $307,057 $296,914 $226,305 Exemption Value $0 $0 $0 Assessed Value $307,057 $296,914 $189,422 Taxable Value $307,057 $296,914 $189,422 Regional Benefits Information Exemption Value $0 $0 $0 Benefit Type 2016 2015 2014 ITaxable Value $307,057 $296,914 $189,422 Non-Homestead Cap Assessment Reduction $36,883 Note:Not all benefits are applicable to all Taxable Values(i.e.County, Sales Information School Board,City,Regional). Previous OR Book- Sale PricePaQualcation Description 9e Short Legal Description Financial inst or"In Lieu of 05/20/2016 $322,500 30087-3734 DUNNINGS MIAMI SHORES EXT 6 Forclosure"stated PB 51-31 04/09/2014 $322,100 29128-4978 Financial inst or"In Lieu of LOT 16 BLK 213 Forclosure"stated LOT SIZE 77.930 X 122 09/01/2005 $439,900 23823-0791 Sales which are qualified OR 20520-3797 06 2002 1 1 06/01/2002 $190,000 20520-3797 Sales which are qualified 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/ 7/29/2016 Detail by Entity Name Page 1 of 2 Detail by Entity Name Florida Profit Corporation IN Filing Information Document Number P98000003366 FEI/EIN Number 65-0806778 Date Filed 01/13/1998 State FL Status ACTIVE Last Event CANCEL ADM DISS/REV Event Date Filed 11/24/2009 Event Effective Date NONE Principal Address 9647 SHEPARD PLACE WELLINGTON, FL 33414 Changed: 11/24/2009 Mailing Address P.O. BOX 211595 ROYAL PALM BCH., FL 33421 Changed: 08/24/2000 Registered Agent Name &Address DIAZ; JEREMY_Aj 9647 SHEPARD PLACE WELLINGTON, FL 33414 Name Changed: 11/24/2009 Address Changed: 04/15/2005 Officer/Director Detail Name &Address Title DST DIAZ, DIMAS A 9647 SHEPARD PLACE WELLINGTON, FL 33414 http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=Entity... 7/29/2016 Detail by Entity Name Page 2 of 2 Title P DIAZ, JEREMY A 9647 SHEPARD PLACE WELLINGTON, FL 33414 Annual Reports Report Year Filed Date 2014 01/28/2014 2015 01/06/2015 2016 02/21/2016 Document Images 02/21/2016 --ANNUAL REPORT View image in PDF format 01/06/2015 --ANNUAL REPORT View image in PDF for 01/28/2014--ANNUAL REPORT View image in PDF format 01/29/2013--ANNUAL REPORTI View image in PDF format 03/12/2012--ANNUAL REPORT View image in PDF format 03/28/2011 --ANNUAL REPORT View image in PDF format 09108/2010--ANNUAL REPORT View image in PDF format 02/23/2010 --ANNUAL REPORT View image in PDF format 11/24/2009 -- REINSTATEMENT View image in PDF for 03/10/2008 --ANNUAL REPORT View image in PDF format 04/13/2007--ANNUAL REPORT View image in PDF format 03/16/2006--ANNUAL REPORT View image in PDF format 04/15/2005 --ANNUAL REPORT View image in PDF for 04/27/2004 --ANNUAL REPORT View image in PDF format 04/22/2003 --ANNUAL REPORT View image in PDF format 05/01/2002 --ANNUAL REPORT View image in PDF format 01/25/2001 --ANNUAL REPORT View image in PDF for 08/24/2000--ANNUAL REPORT View image in PDF format 01/13/1998-- Domestic Profit View image in PDF format .oDVr i and PrivaCy Policies ._ .. ,.. _.. State of Florida,Department of State http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=Entity... 7/29/2016 soon OMNI Miami Shores Village Ry` Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305)795.2204 Fax: (305)756.8972 CONTRACTORS' REGISTRATION IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. IER'S STATE LICENCES i B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF LIABILITY INSURANCE* D. COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICATE OF COMPETENCY OF QUALIFIER B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF STATE REGISTERED CONTRACTOR LICENSE OR MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT. D. COPY OF LIABILITY INSURACE* E. COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) *YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE AS FOLLOW Certificate Holder: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES,FL 33138 Certificate must specify the description of operations or contractor license number. BUSINESS NAME: r R-%y- CoYz i % n Inc, . BUSINESS ADDRESS: C75=M IR—W 2.2z' Zfi CITY QY G1 e— STATE fL ZIP 3®b Ij BUSINESS PHONE:(_� FAX NUMBER(q5S l(1—+4—®8 4.S CELL PHONE( 54 9,W-2152. QUALIFIER'S NAME: C.S ACL6 14►�ye Y1 . QUALIFIER'S LIC NUMBER: C. A G ! 1 '9 6 V b 07/29/2016 14:40 FAX W001 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 2609 BLAIR STONE ROAD TALLAHASSEE FL 32399-0783 AITKEN, CHAD JOSEPH SR GREENTREE AIR CONDITIONING INC. 6570 NW 2ND ST MARGATE FL 33063 Congratulationsl With this license you become one of the nearly � � 4' 3w one million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range STATE OF FLORIDA from architects to yacht brokers,from boxers to barbeque DEPAR :t ., USINESS AND restaurants,and they keep Florida's economy strong. ; PROF ULATION Every day we'work to improve the way we do business In order CAC1818686 - =: 6/30/2016 to serve you better. For information about our services,please to onto www.myfloddalicense.com, There You can find more CERTIFIED A information about our divisions and the regulations that Impact AITON.CHA gou,subscribe to department newsletters and loam more about GREENTREE e Department's initiatives, , ,a Our mission at the Department is:License Efficiently,Regulate Fairly.We constantly strive to serve you better so that you can 14. . serve your customers. Thank you for doing business in Florida, §,.. '.I•s"CF;X"116 IEg•un'd'er th4..'prdV1,6.Lona'of.CIA.aea.FS. and congratulations on your new Iicensel •:1PiPW&mn aaT .,'AVG 3,.2018... . „ ..1160620=13 DETACH HERE RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY s STATE OF FLORIDA I DEPARTMENT OF BUST ESS AND PROFESSIONAL REGULATION r CONSTRUCTlq.N INDUSTRY LICENSING BOARD s '• CAC1818688' . tl iThe CLASS B AIR CONDITIONING CONTRACT + Named below IS CERTIFIED .Under`the"provisions of Chapter 4139 FS. "" E—xpir6fidn'date:•AUC3'31,,21718 -� ,..A KE,.•-�:CI-•IADAO EPH -... ., ti.' ,i t-• ...� r •G}�FEN'I'R E:AIR:CON . C.ell ISSUED: OW012016 DISPI A AS REQUIRED BY LAW SEQ 0 LING300000213 BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A-100. Ft. Lauderdale, FL 33301-1895— 954-831-4000 VALID OCTOBER 1,2016 THROUGH SEPTEMBER 30,2017 DBA: Receipt#:ENING/AIRCONDITION CONTRACT Business Name: 78053 GREENTREE AIR CONDITIONING INC Business Type:YP (HVAC) Owner Name:CHAD JOSEPH AITKEN SR Business Opened:06/30/2016 Business Location:6570 NW 2 ST State!County/Cert/Reg:CAC1818686 MARGATE Exemption Code: Business Phone: 954-860-8152 Rooms Seats Employees Machines Professionals 1 For Vending Business Only Number of Machines: Vending Type: Tax Amount Transfer Fee NSF Fee Penalty Prior Years Collection Cost Total Paid 27.00 0.00 0.00 0.00 0.00 0.00 27.00 THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT This tax is levied for the privilege of doing business within Broward County and is non-regulatory in nature. You must meet all County and/or Municipality planning WHEN VALIDATED and zoning requirements. This Business Tax Receipt must be transferred when the business is sold, business name has changed or you have moved the business location. This receipt does not indicate that the business is legal or that it is in compliance with State or local laws and regulations. Mailing Address: GREENTREE AIR CONDITIONING INC Receipt #04B-15-00006864 6570 NW 2 ST Paid 07/06/2016 27.00 MARGATE, FL 33063 2016 - 2017 �1 CERTIFICATE OF LIABILITY INSURANCE DATE a '"' 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: H the certificate holder is an ADDITIONAL INSURED,the policy(les)must have ADDITIONAL INSURED provisions or be endorsed. N 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($). PRODUCER CONTACT Mike Pride Insurance PHONE M, (954)485 8333 Fax , (954)485-1894 4261 North State Rd.7 "11191,11DDRFSB* mtv@prideinsurance.com Lauderdale Lakes,FL 33319 INSURER(S)AFFORDING COVERAGE NAIL s Phone (954)485-8333 Fax (954)485-1894 INSURER A: Federated National Insurance Company INSURED INSURER 8: Greentree Air Conditioning Inc INSURER C: 6570 NW 2nd Street INSURER D: INSURER E: Margate FL 33063 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 TRR ADDLTYPE OF INSURANCE IROR WVD BR POLICY NUMBER POLICY EFF POLICY EXP LIMITS Q COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000 000 NTED ❑ CLAIMS-MADE YJ OCCUR PREMISES EaGE TO Eoccurrence $ 100+000 © Al Blanket Endorsement MED EXP(Any one person $ 5,000 A ❑ Y N GL 0504014530-00 06/21/2016 06/21)2017 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLES PER: GENERAL AGGREGATE $ 2,000,000 POLICY ❑ jEC ❑ LOC PRODUCTS-COMP/OPAGG $ 2,000,000 ❑ OTHER $ AUTOMOBILE LIABILITY EOMBINE'SINGLE LIMIT $ ❑ ANY AUTO BODILY INJURY(Per person) $ OWNED❑ AUTOS ONLY ❑ AUTOS CHEDULED BODILY INJURY(Per accident) $ HIRED ❑ NON-OWNED PROPERTYDAMAGE $ ❑AUTOS ONLY AUTOS ONLY Per..derrt ❑ UMBRELLA LIAR ❑OCCUR EACH OCCURRENCE $ ❑ EXCESS LIAB ❑CLAIMS-MADE AGGREGATE $ ❑ DED ❑ RETENTION$ $ WORKERS COMPENSATION ❑ PER OTN- AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETORlPARTNER/EXECUT NSA E.L.EACH ACCIDENT $ OFFICER/MEMBEREXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attech ACORD 101,Addttlonal Renwks Schedule,It more space Is required) Air Conditioning Contractor 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 Building Department ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2 Ave AUTHORIZED REPRESENTATIVE Miami Shores Village FL 33138 Fax 305-756-8972 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03)OF The ACORD name and logo are registered marks of ACORD W5/2016. Report Viewer R 1 JEFF ATWATER STATE OF FLORIDA CHIEF FINANCIAL OFFICER 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: 7/5/2016 EXPIRATION DATE: 7/5/2018 PERSON: AITKEN CHAD FEIN: 475303076 BUSINESS NAME AND ADDRESS: l { GREENTREE AIR CONDITIONING INC i 6570 NW 2ND ST MARGATE FL 33063 SCOPES OF BUSINESS OR TRADE: HEATING,VENTILATION, AIR-COND Pursuanito Chapter 440.05{14),F.S.,en otFlcer of a eorporatien who elacia exemption from tlds rf�er M��a������mer tl��on may�rewvw benefits w oe�+�'r under tlda chapter Pursuatd to Chapter 440.05(12).F.S.,Ce�08ca within Ora scope of the busitress w bade listed an Ne rtotice of eleclion to ba erem�.Pursuaffi to Chapter 440.05(73j.F.S..Notices of eleci�n be exemq and cwa0cates otetection to be erempt sha0 Ue aubjedto revocation iL of etry iMre aRw Me 66rr0 of the rto6ce or Ore kava�e otthe cedi6cate, the person Warned on the notice w certificate rro longer meets the rogrdrernents otiMs sectiar far hsuanco of a cerli8rate.The depeNrerttshe8 revoke e DFSF2-0VtC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS?(850)413-1609 N GREENTREE AIR CONDITIONING INC. 6570 NW 2ND ST MARGATE, FL 33063 954-860-2152 GREENTREEAC247(PGMAIL.COM July 27, 2016 State of F10y1J GO County of OW"-amu v1=1 Before me this day personally appeared Chad h 04�tKcr) who, being duly swom, deposes and says: That he or she will be the only person worldng on the project located at: 1®1 NU) l®g fh t)be'=J Sworn to(or affied)and subscribed before me this k+day of JO)- 1--- 20 16 , by 'Adam He--w i++ . Personally Know Or Produced Identification L l cen Type of Identification Produced FL ADAM HEWITT My COMMISSION#FF998674 � q►„ EXPIRES June 02.2020 4071 153 FbgQa Cam Print,Type or Stamp Name of Notary .... Miami shores Village Building Department R 0050 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. 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 � � ,20 B� Il. �4L-- l� �/K.f�`7�who is personally known to me or has produced Q-1 Ccy, as identification. Notary: A� d a wi H e—w l f+ SEAL: ADAM HEWITT MY COMMISSION#FF898 674 ••A, IBES June 02,2020 (407)3 163 Fto�dallom , Estimate A Ply, Customer Jermey Diaz GreenTree 101 Northwest 108th Street air conditioning inc Miami Shores, FL 33168 From Chad Aitken Estimate Number 0182 GreenTree A/C Sent Date July 27, 2016 6570 NW 2nd St Margate, FL 33063 Expires July 27, 2016 greentreeac247@gmail.com Estimate for New Install Item Quantity Price Total 4 ton 16 Seer Rheem 1 $3,700.00 $3,700.00 (Votes: This includes all new hurricane rated pad for condenser hurricane strap down condenser to code. Install air handler in closet on aluminum stand and drain pan under unit with float switch. This includes a 10yr warranty on parts and a lyr on labor through GreenTree A/C Subtotal $3,700.00 Total $3,700.00 Notes Thanks you for your business we can be reached anytime by calling 954-860-2152 or email us at GreenTreeac247@gmail.com Estimate delivered by 0, breezeworkS breezeworks com Pape 1 of 1 o This combination qualifies for a Federal Energy Efficiency Tax Credit when placed in service between Feb 17,2M and Dec 31,2016. Certificate of Product Ratings AHRI Certified Reference Number:7943535 Date: 7/28/2016 Product:Split System:Air-Cooled Condensing Unit,Coll with Blower Outdoor Unit Model Number:RA16MAJ1 Indoor Unit Model Number:RH1T4821STAN J 2 9 2016 Manufacturer:RHEEM SALES COMPANY,INC. � y Trade>JBrand 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, Ri,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 reglon(s)for which they meet the regional efficiency requirement. Series name: Manufacturer responsible for the rating of this system combination Is RHEEM SALES COMPANY,INC. Rated as follows in accordance with AHRI Standard 21=40-2008 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): 45000 EER Rating(Cooling): 13.00 SEER Rating(Cooling): 16.00 IEER Rating(Coaling): Ratings followed by an asterisk(')indicate a vobin ary rusts of previously pubChahed data,unless marded with a WAS,wh ch Indicates an involuntary rerate. DISCLAIMER AHRI does not endorse the product(s)listed on this Certificate and makes no representations,warranties or,guarardees as to,and assumes no responsibility for, ;n the product(s)listed on this Certificate.AHRI expressly disclaims all Habfiity for damages of any kind ar s tg out of the two or perkmaorce of the product(s),or the unauthorh ed alteration of data listed on this Certificate.Certified ratings are valid only for models and conflgaratlons Ilsted In the directory at www.ahridIrectory.org. TERMS AND CONDITIONS This Cercmca a and Its contems are proprietary products of AHRI.This Certificate shall only be used for indh4dtal,personal and confidential refererhca purposes.The conterds of this Certificate may not,in whole or In pert,be reproduced;wed;disseminated: ANN entered Into a computer database;or Otherwise utilized.In arty farm or manner or by any means,except for the user's individual, pe sOnsi arid conweirw retere,ce_ AIR-CONDITIONING,HEATING, CERTIFICATE VERIFICATION REFRIGERATION INSTITUTE The information for the model cited on this certificate can bevadfled at www.ahridirectory.org,dick on"Verify Certificate"fink we make life better, and enter the AHRI Certified Reference Number and the date on which the certificate was fined, which Is limed abOwe,and the Certificate No.,which is iced at bottom right. 02014 Air-Conditioning,Heating,and Refrigeration Institute CERTIFICATE NO.: 131142021207651298 MIAMI•D1ADE MIAMI-DADE COUNTY • PRODUCT CONTROL SECTION 11805 SW 26 Street,Room 208 DEPARTMENT OF REGULATORY AND ECONOMIC RESOURCES(RER) Miami,Florida 33175-2474 BOARD AND CODE ADMINISTRATION DIVISION T(786)315-2590 F(76)315-2599 NOTICE OF ACCEPTANCE (NOA) www.mlamldadejEov1economy Rheem Sales Company,Inc. 5600 Old Greenwood Rd. Fort Smith,AR 72917 SCOPE: This NOA is being issued under the applicable rules and regulations governing the use of construction materials.The documentation submitted has been reviewed and accepted by Miami-Dade County RER-Product Control Section to be used in Miami Dade County and other areas where allowed by the Authority Having Jurisdiction(AHJ). This NOA shall not be valid after the expiration date stated below.The Miami-Dade County Product Control Section (In Miami Dade County)and/or the AHJ(in areas other than Miami Dade County) reserve the right to have this product or material tested for quality assurance purposes. If this product or material fails to perform in the accepted manner, the manufacturer will incur the expense of such testing and the AHJ may immediately revoke, modify, or suspend the use of such product or material within their jurisdiction. RER reserves the right to revoke this acceptance, if it is determined by Miami-Dade County Product Control Section that this product or material fails to meet the requirements of the applicable building code. This product is approved as described herein,and has been designed to comply with the Florida Building Code, including the High Velocity Hurricane Zone. DESCRIPTION: Mechanical Unit Steel and Aluminum Tie-Down Clips for Grade and Rooftop Applications APPROVAL DOCUMENT:Drawing No. 15-2543GA,titled"Wind Load Certification of Mechanical Unit Cabinetry and Steel/Aluminum Tie-Down Clips:At Grade and Roof Mounted Applications",sheets 1 through 7 of 7,dated 05/14/2015,revised on 11/20/2015,prepared by Engineering Express,signed and sealed by Frank L.Bennardo,P.E.,bearing the Miami-Dade County Product Control approval stamp with the Notice of Acceptance number and approval date by the Miami-Dade County Product Control Section. MISSILE IMPACT RATING:None LABELING: Each unit shall bear a permanent label with the manufacturer's name or logo,city,state, model/series,and following statement: "Miami-Dade County Product Control Approved",unless otherwise noted herein. RENEWAL of this NOA shall be considered after a renewal application has been filed and there has been no change in the applicable building code negatively affecting the performance of this product. TERMINATION of this NOA will occur after the expiration date or if there has been a revision or change in the materials,use,and/or manufacture of the product or process.Misuse of this NOA as an endorsement of any product,for sales,advertising or any other purposes shall automatically terminate this NOA.Failure to comply with any section of this NOA shall be cause for termination and removal of NOA. ADVERTISEMENT: The NOA number preceded by the words Miami-Dade County, Florida,and followed by the expiration date may be displayed in advertising literature. If any portion of the NOA is displayed,then it shall be done in its entirety. INSPECTION: A copy of this entire NOA shall be provided to the user by the manufacturer or its distributors and shall be available for inspection at the job site at the request of the Building Official. This NOA consists of this page 1 and evidence page E-1,as well as approval document mentioned above. The submitted documentation was reviewed by Carlos M.Utrera,P.E. NOA No. 15-0903.08 MIAMI-DADE COUNTY Expiration Date:February 25,2021 Approval Date: February 25,2016 0'LI/4`x(1+10 Page 1 Riteem Sales Company,Inc. NOTICE OF ACCEPTANCE: EVIDENCE SUBMITTED A. DRAWINGS 1. Drawing No. 15-2543GA,titled"Wind Load Certification of Mechanical Unit Cabinetry and Steel/Aluminum Tie-Down Clips: At Grade and Roof Mounted Applications",sheets 1 through 7 of 7,dated 05/14/2015,revised on 11/20/2015, prepared by Engineering Express,signed and sealed by Frank L. Bennardo, P.E. B. TESTS 1. Test report on Uniform Static Air Pressure Test per FBC, TAS 202-94 along with marked-up drawings and installation diagram of Rheem RA Series Mechanical Units, prepared by American Test Lab of South Florida, Test Report No. 0323.01-15, dated 05/18/2015, signed and sealed by Stephen W. Warter,P.E. C, CALCULATIONS 1. Anchorage calculations prepared by Engineering Express,dated 11/20/2015,signed and sealed by Frank L. Bennardo,P.E. D. QUALITY ASSURANCE 1. Miami-Dade Department of Regulatory and Economic Resources(RER) E. MATERIAL CERTIFICATIONS 1. None. F. STATEMENT 1. Statement letter of code conformance to the 5th edition(2014)FBC issued by Engineering Express,dated 08/24/2015,signed and sealed by Frank L. Bernardo,P.E. 2. Statement letter of no financial interest issued by Engineering Express,dated 11/20/2015,signed and sealed by Frank L. Bernardo, P.E. 3. Distributor agreement dated 11/12/2015. C rlos M.Utrera,P.E. 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