Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
MC-16-2170
Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Permit Permit NO. MC -8-16-2170 Permit Type: Mechanical - Commercial Work Ciassitcation: A/C Replacement Permit Status: APPROVED Issue Date: 8/4/2016 Expiration: 01/31/2017 Parcel Number Applicant 10690 NE 5 Avenue Number: SCHOOL 1122310430010 Miami Shores, FL Block: Lot: ST ROSE OF LIMA CATHOLIC CI Owner Information Address Phone Cell ST ROSE OF LIMA CATHOLIC CHURCH 9401 BISC BLVD MIAMI FL 33138-2970 (305)758-0539 Contractor(s) Phone SCREEN TECH SERVICES, INC (305)915-8029 Cell Phone Valuation: Total Sq Feet: $ 22,000.00 0 Tons: 7.5 Additional Info: REPLACE 2 7.5 AHU Classification: Commercial Approved: In Review Comments: Date Denied: Scanning: 3 Date Approved: : In Review Type of Work: Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Total:T Amount $13.20 $9.90 $9.90 $4.40 $660.00 $9.00 $17.60 $724.00 n L f, Pay Date Pay Type Invoice # MC -8-16-60837 08/04/2016 Credit Card 08/02/2016 Credit Card Amt Paid Amt Due $ 674.00 $ 50.00 $ 50.00 $ 0.00 Available Inspections: Inspection Type: Final Review Mechanical Review Mechanical 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. .ti OWNERS AFFIDAVIT: I certify that all t =-,foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Fu e mor -,//I��auth i e the above-named contractor to do the work stated. • ' it 'A 01 August 04, 2016 Authorized na e: Owner / "''scant / Contractor / Agent Building Dep rtment Copy August 04, 2016 Date 1 MI/lc° 3(') 1 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION UNE PHONE NUMBER: (305) 762-4949 BUILDING PERMIT APPLICATION ❑BUILDING ❑ ELECTRIC D ROOFING AUG 0 2ZO1& 5 FBC 2Qtt 1M Master Permit No. m �-'� `p —2110 Sub Permit No. 0 REVISION ❑ EXTENSION DRENEWAL ❑PLUMBING D MECHANICAL ['PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOBADDRESS: St. Rose of Lima School 10(eq0 S City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: 1122310430010 is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder):ArthbishOP Thomas Wenski Address:10690 NE 5th Ave Phone#: tge -604'1 City: Miami Shores State: Florida Tenant/Lessee Name: Archdiocese of Miami Zip: 33138 Phone#: Email: CONTRACTOR: Company Name: ScreenTech Services Inc. Address: 3400 SW 10th. Street City: Deerfield Beach state: Florida Qualifier Name: Joe Lopez Phone#: 305-915-8029 Phone#: Zip: 33442 State Certification or Registration #: CAC013562 Certificate of Competency #: 16-00030758 DESIGNER: Architect/Engineer: Phone#: State: Zip: Value of Work for this Permit: $ `A3 '10 33 Square/Linear Footage of Work: Type of Work: 0 Addition ❑ Alteration ❑ New 0 Repair/Replace 0 Demolition Description of Work: RePlace 7.5 Ton AHU 5 CivC 2Ok— 2P-7 d Address: City: Specify color of color thru tile: Submittal Fee $ 50 ' O3 Permit Fee $ /k1 1a i t/ • F$ k3• 2 V CO/CC $ 0 Scanning Fee $ q • W Radon Fee $ ! • 9 0 Technology Fee $ 1 f • Training/Education Fee $ Structural Reviews $ �i (Revised02/24/2014) � DB�P[R/$ 9 •90 Il• C" Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ 6a • Q Bonding Company's Name (if applicable) Bondi 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 CONDmONERS, 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 approved and a reinspection fee will be charged. Signature -)a-tet jai) OWN/ER or AGENT The foregoing instrumentwasacknowledged before me this �+ day yyaof WS( , 20 / id , by Sr'. rr�l Z Ll3 -tot Y US•i ✓✓J , who is personalltiknown to _me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: 6414 -1 - (IA &d- /eijY) . Qo�f ,.."'"•44... KATHLEEN M BOST •': MY COMMISSION # FF216826 EXPIRES April 02. 20 19 ********** 4C11390.0'43 fciId Nota•VServic aAr APPROVED BY (Revised02/24/2014) X13 Signature CONTRACTO The foregoing instrument was acknowledged before me this day of 6.)tAt , 20 i(, by Mr•Ve..he.>> esae.-% , who is personally known to me or who has produced iDrc%wegs.Ct�cs_ as identification and who did take an oath. NOTARY PUBLIC: Signa Print Seal: kr A qbfsh7 .. - ,,!,....--q IVES My Comm. Expires Sep 18.2017 "•;.... .,.aV Commission * FF 055509 aft • RISTINA ILBRIDE ********************************************************* s Examiner Zoning Structural Review Clerk POWER OF ATTORNEY } ' KNOW ALL MEN BY THESE PRESENTS: That the most Reverend Thomas Wenski, as Archbishop of the Archdiocese of Miami, his successors in office, a corporation sole, has made, constituted and appointed, and by these presents does hereby make, constitute and appoint Sister Elizabeth A. Worley, C.O.O., his true and lawful attorney for him and in his name, place, and stead. Giving and granting unto Sister Elizabeth A. Worley, C.O.O., his said attorney full power and authority to do and perform all and every act and thing whatsoever requisite and necessary to be done in and about the premises as fully, to all intents and purposes, as he might or could do if personally present, with full power of substitution and revocation, hereby ratifying and confirming all that Sister Elizabeth A. Worley, C.O.O., his said attorney or his substitute shall lawfully do or cause to be done by virtue hereof. In Witness Whereof, I have hereunto set my hand and seal this 20 day of February, A.D., 2015. Signed, sealed and delivered in the presence of: Witnes Witness . ignature t1 ,4n Iak Printed Name Witness Signature OJp fa.� fce /1emQ iI d" Printed Name STATE OF FLORIDA COUNTY OF DADE SS: The Most Reverend Thomas Wenski As Archbishop of the Archdiocese of Miami his successors in office, a corporation sole I hereby certify that on this day, before me, an officer duly authorized to administer oaths and take acknowledgements, personally appeared The Most Reverend Thomas.Wenski, as Archbishop of the Archdiocese of Miami, his successors in office, a corporation sole, known to me to be the person described in and who executed the forgoing instrument, who acknowledged before me that he executed the forgoing ins ment, who acknowledged before me that he executed the same, and an oath was not taken. Said person is personally known to me Said person provided the following type of identification: --- Witness my hand and official seal in the County and State last aforesaid this 20 day of February, A.D., 2015. My Commission Expires: • Prepared by and Return to: J. Patrick Fitzgerald, Esq. J. Patrick Fitzgerald & Associates, P.A. 110 Merrick Way, Suite 3-B Coral Gables, FL 33134 STATE OF FLORIDA 111111111111111111111111111 111111111111111111 CFN 201080419437 DR Bk 27328 Ps 07131 (lam) RECORDED 06/22/2010 11=00131 HARVEY RUVIN, CLERK OF COURT HIAHI—DADS COUNTY, FLORIDA LAST PAGE AFFIDAVIT OF ARCHBISHOP'S SUCCESSION ) SS: COUNTY OF MIAMI-DADE Before me, the undersigned authority, personally appeared The Most Reverend Thomas G. Wenski, who being duly sworn according to law, deposes and says as follows: 1. • that on June 1, 20 ] 0, I was installed as the Archbishop of the Archdiocese of Miami, succeeding The Most Reverend John C. Favalora. 2. that effective June 1, 2010, I am the Metropolitan Archbishop of the Archdiocese of Miami which embraces the counties of•Miami-Dade, Broward and Monroe in the State of Florida. 3. that pursuant to the Canon Law of the Roman Catholic Church, I have all rights of succession to The Most Reverend John C. Favalora. 4. that under the doctrine of corporation sole, the title to all property in the Archdiocese of Miami, which encompasses the counties of Miami -Dade, Broward and Monroe, was held by The Most Reverend John C. Favalora, as Archbishop of the Archdiocese of Miami, his successors in office, a corporation sole, as of December 20, 1994 through April 20, 2010, and as the Apostolic Administrator from April 20, 2010 through June 1, 2010. 5. that under the doctrine of corporation sole, the title to all property in the Archdiocese of Miami, which encompasses the counties of Miami -Dade, Broward and Monroe, is held by The Most Reverend Thomas G. Wenski, as Archbishop of the Archdiocese of Miami, his successors in office, a corporation sole, as of June 1, 2010. 6. That under penalties of perjury, 1 declare that I have examined this certification and to the best of my knowledge and belief it is true, correct, and complete. FURTHER AFFIANT SAYETH NOT. The Most Reverend Thomas G. Wenski The foregoing instrument was acknowledg before me this /� Reverend Thomas G. Wenski. (Check One) [ e is personally known to me o , as identification. 1rr%e,.A•111n/.ARCM! ISMO►• WENSKI•SUCCESSION•AFFIDA V IT of June, 2010, by The Most r [ ]He has produced TARY PUBLI rint, type or stamp Notary nam JANETH MCPHERSON p1/1MNA. Comm DD0678851 .Ifx ares 5/2812011 j i .•. 11 i. , Man.. Inc Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax:(305) 756.8972 AIR CONDITIONING REPLACEMENT DATA PERMIT NUMBER: MC This form must accompany ALL air conditioning replacement permit applications. Each unit change -out must be on its own data sheet. Multiple units on single sheets are notSacce able. (041 goo Job Address (where the work is being done): City: Miami Shores Village County: Miami Dade Zip Code: 3313% 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 IARHI Sheet Attached: YES ❑ NO ❑ Contract Attached: YES 1. UNIT BEING REPLACED DATA NEW UNIT n-1,19OQ ; � A- MANUFACTURER -71;••••••e- m. a0% -„+o( All or PKG. UNIT MODEL# 'TWE.090IJ'3on0,, COND. UNIT MODEL # ,enc. KW HEAT fUcif‘L MS- NOM TONS .195 AHU CU PKG 1) M.C.A AHU) CU PKG AH CU PKG 2) M.O.P H CU PKG AH CU PKG 3) VOLTS SAH CU PKG KG UNIT / / PKG UNIT / / EER/SEER YES NO REPLACING DUCTS YES YES REPLACING THERMOSTAT YES g • YES IJ) NEW 4"CONCRETE SLAB YES (T YES ►_=• NEW ROOF STAND YES o YES O,' NEW RETURN PLENUM BOX YES NO Minimum Circuit Ampacity (Wire Size): 2. Maximum Overcurrent Protection (Fuse/Breaker Size): tiC34+,. 3. Voltage of Circuit (208/240/480): i oV 4. Size Disconnecting Means: Contractor's Company Name: State Certificate or Registrati Signature (Qu (Revised02/24/2014) /^ �l-y-Pc Se S LU4.Phone: as� I S'°C3ag CRCs) I a ure) Certificate of Competency No. Date: 7/a fti l ie Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax:(305) 756.8972 AIR CONDITIONING REPLACEMENT DATA PERMIT NUMBER: MC This form must accompany ALL air conditioning replacement permit applications. Each unit change -out must be on its own data sheet. Multiple units on single sheets are not acceptable.) �� S Avit Job Address (where the work is being done): rUarnmS\Nar•e.S 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 0 Contract Attached: YES UNIT BEING REPLACED DATA NEW UNIT X QBE MANUFACTURER "70.0.1.4E Tc. P-- cock& 0 2 o0 A C—AHi r PKG. UNIT MODEL # n -LADE Q98 O 3o° A (cr.-,. apo -9.0-1 t ND. UNIT MODEL Mom KW HEAT 1. S NOM TONS AHU CU PKG 1) M.C.A AH CU PKG AHU CU PKG 2) M.O.P 4 CU PKG AHU CU PKG 3) VOLTS Imo► CU PKG PKG UNIT / / PKG UNIT / / EER/SEER YES a REPLACING DUCTS YES (NV YES Q)♦ REPLACING THERMOSTAT YES YES NEW 4"CONCRETE SLAB YES YES NEW ROOF STAND YES NO YES YES NO RETURN PLENUM BOX _ YES NO, 1. Minimum Circuit Ampacity (Wire Size): 3• Awa. 2. Maximum Overcurrent Protection (Fuse/Breaker Size): 3o &r fS 3. Voltage of Circuit (208/240/480): Q4C.,V. 4. Size Disconnecting Means: Amc2.c. a Contractor's Company Name:�sct+ 4�C� lw� Phone: S i1 S-C6CVXCI State Certificate or Registrati eq co 1354) Certificate of Competency No. Signature Date: "7) 2.� J � G (Quit' _• ure) (Revised02/24/2014) ACORil CERTIFICATE OF LIABILITY INSURANCE `...--- DATE(MM/DD/YYYY) 08/03/2016 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 Get Smart Insurance Inc. 20286 NW 2 Ave Miami FL 33169 CONTACT NAME: Gregg Ditzian PHONE FAX (ac. No. Ext); (305) 653-7977 (A/c, No): (305) 654-0293 E-MAIL info@ ADDRESS: insure-smart.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: AXIS SURPLUS INSURANCE COMPANY 26620 INSURED ScreenTech Services Inc 3400 S W 10 St Deerfield Beach FL 33442 INSURER B: PROGRESSIVE EXPRESS INSURANCE COMPAN 10193 INSURER C : AMTRUST FINANCIAL SERVICES, INC. 11/04/2016 INSURER D : Commerce and Industry Insurance Company 19410 INSURER E: INSURER F : X COVERAGES CERTIFICATE 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 LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) UMITS A X COMMERCIAL GENERAL LIABILITY FLGLN02110AX 11/04/2015 11/04/2016 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $ 50,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GE X 'L AGGREGATE POLICY OTHER: LIMIT APPLIES JECT PRO - JECT PER: LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 1,000,000 $ B AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS % X SCHEDULED AUTOS NON -OWNED AUTOS 03304615-1 10/02/2015 10/02/2016 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ 1,000,000 BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ C X UMBRELLA LIAB EXCESS UAB X OCCUR CLAIMS -MADE EBU036027136 07/28/2016 07/28/2017 EACH OCCURRENCE $ 2,000,000 AGGREGATE $ 2,000,000 DED RETENTION$ $ C WORKERS COMPENSATION AND EMPLOYERS' UABIUTY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N N N/A AWC1042888 01/21/2016 01/21/2017 X STATUTE ER E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYEE $ 500,000 E.L. DISEASE - POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) JOE LOPEZ- CAC0013562 MITCHELL SCREEN LIC # CAC013562 CERTIFICATE HOLDER CANCELLATION Miami Shores Village Building Department Village Building Department 10050 NE 2nd Ave Miami Shores FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE GregkreirAtz_ia.r 0692 iG ACORD 25 (2014/01) © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ACOR1 CERTIFICATE OF LIABILITY INSURANCE kr.----- DATE(MM/DD/YYYY) 08/03/2016 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 Get Smart Insurance Inc. 20286 NW 2 Ave Miami FL 33169 CONTACT NAME: Gregg Ditzian (A/C No. Extl: (305) 653-7977 FAX No): (305) 654-0293 E-MAIL info@i ADDRESS: nsure-smart.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: AXIS SURPLUS INSURANCE COMPANY 26620 INSURED ScreenTech Services Inc 3400 S W 10 St Deerfield Beach FL 33442 INSURER B; PROGRESSIVE EXPRESS INSURANCE COMPAN 10193 INSURER c: AMTRUST FINANCIAL SERVICES, INC. 11/04/2016 INSURER D: Commerce and Industry Insurance Company 19410 INSURER E: INSURER F : X 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. INSR LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY FLGLN02110AX 11/04/2015 11/04/2016 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $ 50,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L X AGGREGATE POLICY OTHER: LIMIT APPLIES JECT PER: LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 1,000,000 $ B AUTOMOBILE UABIUTY ANY AUTO ALL OWNEDSCHEDULED AUTOS HIRED AUTOS X X AUTOS NON -OWNED AUTOS 03304615-1 10/02/2015 10/02/2016 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ 1,000,000 BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ C X UMBRELLA UAB EXCESS UAB X OCCUR CLAIMS -MADE EBU036027136 07/28/2016 07/28/2017 EACH OCCURRENCE $ 2,000,000 AGGREGATE $ 2,000,000 DED RETENTION $ $ C WORKERS COMPENSATION AND EMPLOYERS UABIUTY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y/N N N / A AWC1042888 01/21/2016 01/21/2017 X PER PEATUTE OTH ER E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYEE $ 500,000 E.L. DISEASE - POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) JOE LOPEZ- CACO013562 MITCHELL SCREEN LIC # CAC013562 CERTIFICATE HOLDER CANCELLATION Miami Shores Village Building Department Village Building Department 10050 NE 2nd Ave Miami Shores FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE t1'. i. at f-: 069236 ACORD 25 (2014/01) © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ' CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 LOPEZ, JOSE JESUS SCREEN TECH SERVICES, INC. 8622 NW 49 DR CORAL SPRINGS FL 33067 Congratulations! With this license you become'one of the nearly one million Floridians licensed by the Department of Business and Professional Regulation, Our professionals and businesses range from architects to yacht brokers, from boxers to barbeque restaurants, and they keep Florida's economy strong. Every day we work to improve the way we do business in order to serve you better. For information about our services, please log onto www.rnyfioridalicense.com. There you can find more information about our divisions and the regulations that impact you, subscribe to department newsletters and team more about the Department's initiatives. Our mission at the Department is: License Efficiently, Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, and congratulations on your new ticense4 RICK SCOTT GOVERNOR DETACH HERE v 0 N STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CAC013562 ISSUED: 07/24/2014 CERTIFIED AIR COND CONTR LOPEZ, JOSE JESUS SCREEN TECH SERVICES, INC-. IS CERTIFIED under the provisions of Ch.489 FS. Exp iarica data ; AUG 31, 2015 11407240000730 KEN LAVUSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD The CLASS AAIR CONDITIONING CONTRACTOR Named below IS CERTIFIED Jnder the provisions of Chapter 489 FS. Expiration date: AUG 31, 2016 LOPEZ, JOSE JESUS SCREEN TECH SERVICES, INC. 3400 SW 10TH STREET SUITE C DEERFIELD BEACH FL 33442 ISSUED' 07/24/2014 DISPLAY AS REQUIRED BY LAW SEQ # L1407240000736 S€reenTec 11 set-c.e5 inc '-16'3':r Vents: i:i. ,: 8 i- Co4Idt{:c114:)q CoftSUitar.14, Customer Saint Rose of Lima School Location: Girls and Boys 2A° Floor Settvooms Atbi: Paul Fluty: Owner Reprasentatfvs Archdioceses For Classrooms 206-207 and 208.209 Address: 415 NE 105^ Street Miami Shortie, FL 33138 Email: pIgcgyahoo.com PeTri Uterrf4. u1COts5h� Phone: (305) 758-0539 Fax: (305) 751-8398 RE: Replace and Relocate 2 Etdating 7.5 Ton Air Handling Units and RefrIgerent Vales Screen Tech Services Petra Certified Factory Agent is providing a proposal to perform the alr con- ditioning work in accordance with the following: System is out of refrigerant We have INCLUDED the foltowtng In this proposal: • Recover existing refrigerant from 2- 7.5 Ton Split Systems • Removed end discard 2 Trona Air handling Units In existing Girls and Boys Bathroom ceiling STOWS • Supply and Install 2 -Trane Alt handling Units: M/N-TWE0900300A R -410A Refrigerant 208-230 Volt i3 phase vertical AHU's, Relocate one in the maintenance closet next to the bathroom (Classroom 207-208) and the other M the maintenance area of the boys bathroom (Classroom 206-207) which will become a closet provided by contractor in new area's to elimi- nate liability of water in existing bathroom floors • Pipe in both AHU's to existing refrigerant piping of existing systems • Reconnect supply ductwork to new units and existing retum ductwork to R/A Grilles / With Fil- ters In Ceding to both closet area's • Reconnect AHL) drains to existing drains • Reconnect to existing electrical and controls • Install new TXVs in AHU for existing refige-ant charge • Supply and install 2- AHU Stands and secure units • Replace liquid line refrigerant driers • Pressurize, batt check and evacuate units • Re -charge systems with recovered refrigerant • Start up end check system operation on both units • Warranty 1 year Parts on AHU's and 90 days tabor We Have EXCLUDED from this proposal: • Any additional work or materials required outside the scope of the quote • Any Construction worts required • Permit and Engineering ALL WORK tiS TO BE PERFORMED Monday through Friday 8:00AM To 4:00 PM Excluding Holi- days Price for the work or service performed; Written Amount Total Cost $ 22,000.00 ;,N,fr • it 4114,4r 4:r t *441-4 lbcr":I,* r: 4 lL t; 1342' 7• r'Flq; `1,,AX4440 F 1'u5: 442 1-2:1r I'"t:,. T: C.`T V:. F`1":c .A .�. a. :cc rtlt:h,. ^It::,. .,44r,, --r Terms of Payment: 50% Deponit due upon acceptance and 50% due upon completion Page 2 All payments shall be due in accordance with the terms described above. Customer agrees to pay aN court costa end attorneys fees should legal means be necessary for collection. This proposal shalt be valid for a pe- riod of 30_ days horn the date submitted below. Submitted by: Screen Tech Servtee,1 License CAC013585 Mitch sil Screen Operations Manager —305.915.8029 Date: 05130/16 Accepted by 3400 5.W. I 041 Slrect. SUM C t tcdi:W acad.. FL. 33442 ; P 1714) 12341804 t: lits) 421-22107 ,n(. NYIC!"1tcttan% lomt owl Nts..A-rcentcch,cnicc..cu,: w Saint Rose of Lima Unit Dimensions - Split System Air Conditioning Units (Large) Item: Al Qty: 2 SUPPLY OPEN 251/2"- 1 70" 16 1/4" 11 11/16" 47 1/2' 24 1/16" DUCT FLANGE 1" HEIGHT CONTROL WIRING LINE VOLTAGE CONTROL BOX ACCESS PANEL 25 1/2" 3 1/2' 8 13/16' i 16" 1 3/16" DRAIN CONNECTION FOR HORIZONTAL (SEE NOTE 2,3,5) June 01, 2016 NOTES: 1 PANEL DEPTH 1/2" (TYP.ALL PANELS). 2. REMOVABLE DRAIN PAN AND ATTACHED DRAIN CONNECTION MAY BE INSTALLED ON END OF UNIT IN EITHER THE VERTICAL OR HORIZONTAL CONFIGURATION, PLASTIC DRAIN PAN ACCESS PLATE ON THE END OF UNIT OPPOSITE DRAIN CONNECTION MUST BE REMOVED TO SLIDE DRAIN PAN OUT OF UNIT CLEANING. ACCESS PLATE MUST BE RE -INSTALLED AFTER SLIDING DRAIN PAN BACK INTO UNIT. 3. IF PERIODIC DRAIN PAN CLEANING IS REQUIRED, ALLOW ROOM FOR PARTIAL REMOVAL OF DRAIN PAN CONNECTION AT END OF UNIT. 4. 1" FEMALE SCHED. 40 PVC PIPE DRAIN CONNECTION VERTICAL CONFIGURATION. 5. 1" FEMALE SCHED. 40 PVC PIPE DRAIN CONNECTION HORIZONTAL CONFIGURATION. REMOTE BULB TXV SUCTION LINE 22 7/8" 16 11/16" b b d FILTER ACCESS PANEL 22" MIN. DISTANCE / BOTH SIDE LIQUID LINES SEE NOTES 2,3,4 1 3/16"--1 3 5/8" 6 3/4" 10 7/16' (4) - HOLE FOR HORIZONTAL SUSPENSION SIDE RETURN COPPER LIQUID LINE FIELD CONNECTION COPPER SUCTION LINE FIELD CONNECTION BOTTOM RETURN SUPPLY VERTICAL - RETURN HORIZONTAL / RETURN VERTICAL 7 1/2 TON AIR HANDLER (SINGLE CIRCUIT) 17 3/8" 16 11/16' � d SUPPLY OPENING 1 9/16" 3 1/2" SEE NOTES 2,3,4 (4) HOLE FOR HORIZONTAL SUSPENSION BOTTOM RETURN '4*100. SIDE RETURN FILTER DIMENSIONAL DRAWING SUPPLY HORIZONTAL - RETURN VERTICAL / RETURN HORIZONTAL FLD = Furnished by Trane U.S. Inc. /Installed by Equipment Proposal Others Page 2 of 8 Saint Rose of Lima Unit Dimensions - Split System Air Conditioning Units (Large) Item: Al Qty: 2 June 01, 2016 AIR HANDLER ELECTRICAL DATA CONDENSER 'ELECTRICAL DATA Model: Unit Operating Voltage: Minimum Circuit Ampacity: Maximun Fuse Size: Maximun Circuit Breaker. Convertible 460 Voltages TWE090 TWE090 187-253 414-506 6.6 - 6.3 3.1 15.0 - 15.0 15.0 15.0 -15.0 15.0 EVAPORATOR FAN MOTOR (9) Convertible 460 Voltages No.:1 1 Volts:208-230 460 Phase: 3 3 Motor HP: 1.50 1.50 Amp -FLA: 5.3 - 5.0 2.5 Amp -LRA: 34.3 - 34.3 17.0 34.3 - 34.3 GENERAL DATA SYSTEM DATA INDOOR COIL - TYPE No. Refrigerant Circuits 1Tude Size: 3/8" Suction Line (in.) OD 1 1/8" Face Area: 8 1/8" Liquid Line (in.) OD 1/2" Row/FPI 4 / 14 Refrigerant Control EXPANSION VALVE Drain Connection Size 1" PVC INDOOR FAN FILTER Type: CENTRIFUGAL Type: ' THROWAWAY No. Used/Diameter x Width: 1 / 15"X15" Furnished: YES Drive Type/No. Speed: BELT/ADJUSTABLE No. Size Recommended: (3)16"X25"X1" CFM: 3000 No. Motor. 1 Motor HP - Standard/Oversized: 1.5 / 2.0 / 3.0 Motor RPM: 1725 Motor Frame Size: 56H HEATER DATA ELECTRICAL DATA Notes: Heat Rating (kW): 7.45 / 9.96 1. KW ratings are at: 208/240V for 208-230V air handlers Control Stages: 1 480V for 460V air handlers Power Supply: 208-230/60/3 600V for 575V air handlers Minimum Circuit Ampacity: 32.5/36.0 _Voltage_ Maximun Fuse Size: 35.0 / 40.0 35.0 / 40.0 For other than rated voltage. capadN = f Rated vows ) x 2 Rated Capacity 2. Any power supply and circuits must be wired and protected in accordance Maximun Circuit Breaker: 7.45 / 9.96 with local electrical codes. 1 3. The HACR circuit breaker is for U.S.A. installations only. 208-230/60/3 32.5/36.0 35.0 / 40.0 35.0 / 40.0 NOTES: 1. Cooling performance is rated at 95 F ambient, 80 F entering dry bulb, 67 F entering wet bulb. 2. Gross capacity does not include the effect of fan motor heat. AHRI capacity is net and includes the effect of fan motor heat. Ratings shown are tested and certified in accordance with AHRI Standard 340/360 or 365 certification program. 3. Condensing Unit Only Gross Cooling Capacity rate at 45 F saturated suction temperature and at 95 F ambient. 4. AHRI Net Cooling Capacity is calculated with matched blower coil and 25 ft. of OD interconnecting tubing. EER is rated at AHRI conditions and in accordance with DOE test procedures. 5. Integrated Part Load Value is based on AHRI Standard 340/360 or 365. Units are rated at 80 F ambient, 80 F entering dry bulb, and 67 F entering wet bulb at AHRI rated CFM. 6. Sound Rating shown is tested in accordance with AHRI Standard 270. 7. Refer to refrigerant piping program for line sizing and line length. 8. Refrigerant (operating) charge is for condensing unit (all circuits) with matching blower coils and 25 ft. of interconnecting refrigerant lines. All units are shipped with a small nitrogen holding charge only. 9. Second Column data Coverable to 460 volt FLD = Furnished by Trane U.S. Inc. / Installed by Equipment Proposal Page 3 of 8 Others Saint Rose of Lima Weight, Clearance & Rigging Diagram - Split System Air Conditioning Units (Large) Item: Al Qty: 2 #1 0 0 #3 #2 HORIZONTAL E> RETURN AIR FLOW • `J WEIGHTS AND CORNER WEIGHTS Shipping: 360.0 Ib Net 323.0 Ib VERTICAL Comer 1: 67.0 Ib Comer 2: 99.0 Ib Comer 3: 75.0 Ib Comer 4: 82.0 Ib HORIZOTNAL Comer A: 56.0 Ib Comer B: 92.0 Ib Comer C: 87.0 Ib Corner D: 88.0 Ib B June 01, 2016 0 0 0 0 A HORIZONTAL RETURN f`"V, • • VERTICAL VERTICAL RETURN RETURN WEIGHTS AND LOAD POINT LOCATION FOR CONDENSOR C D E> AIR FLOW WEIGHT AND RIGGING FLD = Fumished by Trane U.S. Inc. / Installed by Others Equipment Proposal Page 4 of 8