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MC-16-404 m rd--\ Miami Shores Village Building Department 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 l INSPECTION LINE PHONE NUMBER:(305)762-4949 F��,,'1BppC ZO ( H BUILDING Master Permit No. i� � L4 ®� PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ELECTRIC ❑ ROOFING ❑ REVISION ❑EXTENSION ❑RENEWAL ❑PLUMBING MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑SHOP CONTRACTOR DRAWINGS JOB ADDRESS:975 NE 94 Street City: Miami Shores County: Miami Dade Zip: Folio/Parcel#:11-3206-035-0020 Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder):BLACKWELL ESTATES LLC Phone#: Address:2425 N CENTER ST#348 City:HICKORY State:NC Zip:28601 Tenant/Lessee Name:VANESSA MAGGIE Phone#: Email: CONTRACTOR:Company Name: PROTOCOOL COOLING SOLUTIONS, INC Phone#:954-776-2665 Address: 1669 NW 144 TER, SUITE#203 • City:SUNRISE State: FL zip:33323 Qualifier Name:CHRISTOPHER POMPILIO Phone#:954-776-2665 State Certification or Registration#:CAC058577 Certificate of Competency#: DESIGNER:Archltect/Englneer.N/A Phone#: Address: City: State: Zip: Value of Work for this Permit:$3647.00 Square/Unear Footage of Work: Type of work: ❑ Addition ❑ Alteration ❑ New BE Repair/Replace ❑Demolition Description of Work: EXACT REPLACE 1.5 TON SPLIT SYSTEM Specify color of color thru the Submittal Fee$ Permit Fee$ a CCF$ CO/CC$ Scanning Fee �r�11 Radon Fee$ �� DBPR$ Notary$ Technology Fee$ Q ems® Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ (RBvisedO2/24/2014) Bonding Company's Name(if applicable) NIA s Bonding Company's Address City State Zip Mortgage Lender's Name(if applicable)N/A Mortgage Lender's Address City State Zip h 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 falth that a copy of the notice of commencement and construction lien low 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 flat inspection which occurs seven (7)days after the building permit Is Issued. In the absence of such posted notice, the inspection will not be appr ve and a reinspection fee will be charged. . Signature Signature 0 ERorAGENT CONTRACTOR The foregoing 1rument was acknowledged before me this The foregoing Instrument was acknowledged before a this day of 20 Q .by day of = -> 20 by JAMES HOLT whop rsonal kly�h to CHRISTOPHER POMPILIO wh s ersonally known to me or who has produced as me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Slgn: print:NICOLE F RGUSON Print: (COLE FER USON Seal: ao�';:::��� NIOOLEANTIONETfEFERGUSON Seal: �o� ':;�,°Go NiCOLEANT(ONETTEFERtIUSON * * MY COMMISSION#FF 159004 *AM, * MY COMMISSION#FF 15M pEXPIRES:Spep�t�e�m�b�yer�llee2015 , EXPIRES:September 11,2018 ############## #�YF4##i�kiYliWi�'Mi`W�!#�W�► 4 4 APPROVED BY �' r Plans Examiner Zoning Structural Review Clerk iaewsea02A4/20141 BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S.Andrews Ave., Rm.A-100, Ft. Lauderdale, FL 33301-1895—954831-4000 VALID OCTOBER 1,2015 THROUGH SEPTEMBER 3o,2016 DBA: Receipt#:183-1719 Busi ness Name:PROTOCOOL COOLING SOLUTIONS INC Business Type:HEATING/AIRCONDITION CONTRAd (AIRCONDITION CONTRACTR) Owner Name:CHRISTOPHER J POMPILIO Business Opened:04/01/2002 Business Location:1669 NW 144 TER 203 State/County/Cort/Reg:CAC 058577 SUNRISE Exemption Code: Business Phone: Rooms Seats Employees Machines Professionals 2 lS For Vending Business Only Number of Machines: Vending Type: Tax Amount Transfer Fee NSF Fee Penalty Prior Years Collection Cost Total Paid E 27.00 0.001 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: ic' CHRISTOPHER J POMPILIO Recelpt #OSA-14-00008149 1669 NW 144 TERRACE #203 Paid 08/04/2015 27.00 SUNRISE, FL 33323 ry 2015 . 2016 a a -r A Vlb-ej;��jjjl- - RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD 009399=11 I CAC058577 I The CLASS A AIR CONDITIONING CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31,2016 POMPILIO, CHRISTOPHER JOHN- PROTOCOOL COOLING SOLUTIONS INC 1669 NW 144TH TERRACE k63' ' SUNRISE FL 33323 ISSUED: 06/0512014 DISPLAY AS REQUIRED BY LAW SEQ 0 L1406060000806 A� CERTIFICATE OF LIABILITY INSURANCE F2111/2016 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)must be endorsed. If SUBROGATION IS WAIVED,subject to the terns 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 C&C Insurance,Inc. PHONE(AIC Nn 954 431-2008 FAx 954 704-0507 1921 NW 150 Ave. n AIL . Info andcinsurance.com Ste.101 INSURER(S)AFFORDING COVERAGE NAIC# Pembroke Pines FL 33028 . Montgomery Insurance INSURED INsugggs:Technology Insurance Company PROTOCOOL COOLING SOLUTIONS INC INSURER C:Ohio Casualty 1669 NW 144 TERR#203 INSURER D: SUNRISE FL 33323 INSURER E: INSURERF: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUB POLICY EFF POLICY EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE 1000000 TO A X COMMERCIAL GENERAL LIABILITY DAMAGE R(RENTED moo CLAIMS-MADE �OCCUR X X BLS55706369 08126/2015 08/26/2016 MED EXP oneperson) $15000 x Blanket Additional Insured PERSONAL&ADV INJURY 1000000 X Blanket Waiver of Subrogation GENERAL AGGREGATE s 2000000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG 2000000 POLICYX PRO- lrr.T F-1 LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNEDPROPERTY DAMAGE $ HIRED AUTOS AUTOS UMBRELLA LIABOCCUR EACH OCCURRENCE 1000000 C X EXCESS LIAR HCLAIMS-MADE X X US055706369 08/26/2015 08/26/2016 AGGREGATE 1000000 DED I X 10000 $ WORKERS COMPENSATION X ITC)IRY11MITR PR WC STATU- OTH- AND EMPLOYERS'LIABILITY YIN B �ICER/ME BER EXCLUDED?ECUTIV N/A TWC961 M 03/17/2015 03/17/2016 E.L.EACH ACCIDENT $10Ii0I�I0 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE 1000000 Me describe under IPTIOE.L.DISEASE-POLICY LIMIT 1000000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space Is required) Certificate holders are additional insured for liability as respects insured operations and as required by contract RE:CAC058577 CERTIFICATE HOLDER CANCELLATION MIAMI SHORES VILLAGE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN BLDG DEPT ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2ND AVE MIAMI SHORES,FL 33138 AUTHORIZED REPRESENTATIVES <> ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 26(2010/05) The ACORD name and logo are registered marks of ACORD .41C0R©® 2/11 CERTIFICATE OF LIABILITY INSURANCE DATE0D/YYYY) 2/11 �--'-� 0 /16 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder Is an ADDITIONAL INSURED,the policy(les)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER CONTACT Aon Risk Services,Inc of Florida NAME: Aon Risk Services,Inc of Florida 1001 Brlckell Bay Drive,Suite#1100 AX Miami,FL 33131-4937 AIC No Ext):800-743-8130 AIC No):800-522-7514 ADDRESS: ADP.COI.Center on.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: Illinois National Insurance Co 23817 INSURED INSURER B: ADP TotalSource CO XXI,Inc. 10200 Sunset Drive INSURER C: Miami,FL 33173 ALTERNATE EMPLOYER INSURER D: Protocool Cooling Solutions,Inc INSURERE: 1869 NW 144th Tenace Suite 203 Fort Lauderdale,FL 33323 INSURER F: COVERAGES CERTIFICATE NUMBER:1129445 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. LIMITS SHOWN ARE AS REQUESTED. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER M/DD MWDD LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ ToR CLAIMS-MADE F OCCUR PRAEM SES(E.=,..) Ea occurrence $ MED EXP(Any oneperson) $ PERSONAL&ADV INJURY $ rLAGGREGATELIMIT APPLIES PER: GENERAL AGGREGATE $ ICY �PROJECT❑LOC PRODUCTS-COMP/OP AGG $ ER $ COMBINEDSINGUE LIMIT AUTOMOBILE LIABILITY Ea accident $ ANY AUTO BODILY INJURY Per arson $ ALL OWNED SCHEDULED AUTOS AUTOSBODILY INJURY Per accident $ NON-0WNEDPRO UAMALik: HIRED AUTOS AUTOS Per accident $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEC I I RETENTION$ WORKERS COMPENSATION XSTATUTE ER A AND EMPLOYERS'LIABILITY Y/N WC 034123292 FL 07/01/15 07/01/18 ANY PROPRIETORIPARTNEWMCUTNE OFFICERIMEMBER EXCLUDED? NIA E.L.EACH ACCIDENT $ 2,000,000 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 2,000,000 If yw.describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached H more space Is required) Ali worksite employees working for PROTOCOOL COOLING SOLUTIONS,INC,paid under ADP TOTALSOURCE,INC.'s payroll,are covered under the above stated policy. PROTOCOOL COOLING SOLUTIONS,INC is an alternate employer under this policy. RE:CAC058577 CERTIFICATE HOLDER CANCELLATION MIAMI SHORES VILLAGE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE BLDG DEPT THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 10050 NE 2ND AVE ACCORDANCE WITH THE POLICY PROVISIONS. MIAMI SHORES,FL 33138 AUTHORIZED REPRESENTATIVE 0f01z 1-RL 1C(J8tVLt3", O iOZI+<iQ ©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD + " ,SNoltFs Miami Shores Village F I 2U 1 Building Department 10050 N.E.2nd Avenue Miami Shores,Florida 33138 hj " Tel: (305)795.2204 �oRIDp Fax:(305)756.8972 AIR CONDITIONING REPLACEMENT DATA PERMIT NUMBER: MC ((�)r YO 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):975 N E 94 Street 66696 •.•• ••.•.. City: Miami Shores Village County: Miami Dade Zip Codec•33.j138 6. 06 o 666.09 6 66 660066 ALL CONDENSING UNITS MUST BE ON A 4 INCH SOLID COUCRETE SLAB 6666.. ALL UNITS MUST COMPLY WITH F.E.M.A MINIMUM FLOOD ELEVQ'fl17N 6.660 A COPY OF THE CONTRACT IS REQUIRED WITH ALL SUBMITAIS6:•• :00 6• 00000 .. .. 6 66 666666 AHRI DATA SHEET REQUIRED 6..6,6 6• . . . . 666666 Change disconnecting means:YES NO 0 ARHI Sheet Attached:YES 0 NO❑ gongaft AttAViV c:VES ■[� • 6666 66 . 6666 IT BEING REPLACED DATA NEW UNIT MANUFACTURER TRANE AHU or PKG.UNIT MODEL# TMM5AOB24 ® L COND.UNIT MODEL# 4TTR4018 KW HEAT 5 KW NOM TONS 1.5 AHU CU PKG 1)M.C.A AHU U I PKG AHU CU PKG 2)M.O.P AHUCVIU_rOPKG AHU CU PKG 3)VOLTS AHU CU PKG PKG UNIT / / PKG UNIT EER/SEER YES Caw REPLACING DUCTS YES YES 0 REPLACING THERMOSTAT YES CNO) YES 0 NEW 4"CONCRETE SLAB YE NO YES NEW ROOF STAND YES N YES NEW RETURN PLENUM BOX YES O 1. Minimum Circuit Ampacity(Wire Size): i--A—_ 10 2. Maximum Overcurrent Protection (Fus Breaker Siz 3. Voltage of Circuit(208/240/480): 4. Size Disconnecting Means: Contractor's Company Name. PROTOCOOL COOLING SOLUTIONS, INCphone: 954-776-2665 State Certificate gistra",CAC058577 Certificate of Competency No. Signature Date: 2/8/2016 (Qualifier's signature) (RevisedO2/24/2014) 0000 000000 •Soo • 0 0 • • • • • •• • •• •s•o.6 00 • 60.•606 S••S•• • • • • 0000 0000• • 0000 • • ••6S• • •• 0000•• 0••66• •• • 00000 • • s 66.60• •60000 • • • • 0060•• • • • • •0000• 0 0 • • • Soso • •• • • 6 This combination qualifies for a Federal Energy ® Efficiency Tax Credit when placed in service t . between Feb 17,2009 and Dec 31,2016. Certificate ® PrOduct ati n s AHRI Certified Reference Number: 7932225 Date: 2/8/2016 Product: Split System:Air-Cooled Condensing Unit, Coil with Blower Outdoor Unit Model Number: 4TTR4018L1 Manufacturer:TRANE Indoor Unit Model Number:TMM5AOB24M21 SAA sees sees. Manufacturer:TRANE • ..s. • Trade/Brand name: TRANE •`f t' •• ""' sees.. sees.. Region:All(AK,AL,AR,AZ,CA, CO, CT, DC, DE, FL, GA, HI, ID, IL, IA, IN, KS, KY, W,,MQ, MD:M:s • MI,MN,MO, MS, MT, NC, ND, NE, NH, NJ, NM, NV, NY, OH, OK, OR, PA, RI, SC,SD,TN TX, • ••:••s UT,VA,VT,WA,WV,WI,WY, U.S.Territories) •• •• s• as 00000 .. .. . .. sees.. Region Note: Central air conditioners manufactured prior to January 1,2015,are ePWZ .to be s• Installed n all reg ons until June 30,2016. Beginning July 1,2016r central air conotidngs can only a Installed n reg on�s),for which the meet regional efficiency Y *sees. ••se•e s • sees.. Series name:XR14 •• ''•' • Manufacturer responsible for the rating of this system combination-is Tf;�ANE. Rated as follows in accordance,with AHRI Standard'2101240-2008 for,Unitary Air-Conditioning and Air-Source Heat Pump Equipment and subject to verification of rating accuracy by 4H on indep'end enf,'third party,testing Cooling Capacity(13tuh): 18000 EER Rating (Cooling): 13.00 SEER Rating (Cooling): 16.00 IEER Rating(Cooling): Ratings followed by an asterisk(•)indicate a voluntary cerate of previously published data,unless accompanied with a WAS,which indicates an involuntary rerete. DISCLAIMER AHRI does not endorse the product(s)listed on this Certificate and makes no representations,warranties or guarantees as to,and assumes no responsibli ty 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.ahrldlrectory.org. TERMS AND CONDITIONS This Certificate and Its contents are proprietary products of AHRI.This Certificate shall only be used for Individual,personal and confidential reference purposes.The contents of this Certificate may not in whole or in a be reproduced;copied;disseminated; AM P ►P Y part, p P . , entered Into a computer database;or otherwise utilized,in any form or manner or by any means,except for the user's individual, personal and confidential reference. AIR-CONDITIONING,HEATING, CERTIFICATE VERIFICATION &REFRIGERATION INSTITUTE The information for the model cited on this certificate can be verified at www.ahridirectory.org,click on'Verify Certificate*link we make life better- and enter the AHRI Certified Reference Number and the date on which the certificate was Issued, which is listed above,and the Certificate No.,which Is listed at bottom right. ©2014 Air-Conditioning,Heating,and Refrigeration Institute CERTIFICATE NO.: 130994227858987994 c � . ••/• 0000•• 0000 • • 0001•• •• • •••f•• • 0*0 •i•6•• • • • so ••• • •0100 • •••0 000.0 • 00 •06.00 ••0.0• •• i •• •• • w �y WOO'dX3CJN3'M M :•�'�HS�IdI� s : �auva�u�ano�umivnwanro�+� aioNaav ,-� n: O JISIA OdNI NOUVOO-1 MNVUO'dOd u slw.ol�t vwtl�wotlo'oM1Hol�troul u�. 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