REV-16-2023 0 Miami Shores Village IRECRT
Building Department artment JUL192016
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�s ' 10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972v
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BUILDINGRV Sa e emitivo. -
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PERMIT APPLICATI - Sub Permit No. �� I �
BUILDING ❑ELECTRIC ❑ ROOFING REVISION ❑ EXTENSION [-]RENEWAL
❑PLUMBING )�MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF [:] CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 1713 f' %S�Ay�� ?�G-V1)
City: Miami Shores County: Miami Dade Zip: 33134
Folio/Parcel#: �(A ®��� - 41 ® Is the Building Historically Designated:Yes NO
Occupancy Type: 0WAVE2 Load: tC�onstruction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): �1��I iM C SA C 0 �-t I&V� 1 ff T) c C Phone#:
Address: �� 1�� � �r-�
City:&Q(2T H (��dt I 8Zticli State: �C.. zip: 33Ii'
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: 961.2Z;%:�k W 1'2P Phone#:
Address: 1221-V .610-4y6T 6C--r �r^
City: /V1i 4 A4 State: TL Zip: 35111,
Qualifier Name: ;Q68&Q,-r0 146A4)AAJDft- Phone#:(A
State Certification or Registration#: Coke, 18"044(o Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ Square/Linear Footage of Work:
Type of Work: Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: (may, +�^- r7�� =nNkfiw�5�
Specify color of color thru tiler
Submittal Fee$ Permit Fee$ CCF$ CO/CC$ P
Scanning Fee$ �( Radon Fee$ 703 DrB'PRR$ Q (0-3 Notary$
Technology Fee$ ( ��� Training/Education Fee$ 3 Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$ �v
(Revised02/24/2014)
e
Bonding Company's Name(if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name(if applicable)
Mortgage Lender's Address
City Stat@ 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,,I3A1LERS,HEATERS,TANKS,AIR CONDITIONERS,ETC.....
OWNER'S;_AFFIDAVIT: I certifVAhat all the foregoing information is accurate and that all work will be done in compliance with all
i ap lid FaleJaws 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.
SignatureSignaturJe OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foret was acknowledged before me this
rlb
day of� p .20 � by 20 kU ,by
�!� t ®0 ��who is personally known to fl ✓ZD N who is personally known to
me or who has produced as me or who has producedAu%—
identification and who did take an oath. ,.��t+►Ni!!r+!tlll identifica 'on and who did take an oath.
NOTARY PUBLIC: "g°°' •����ii NOTARY UBLIC:
o • yam
Sign: Sign
Print: % •,°oJ,� � °T PrintWA I IMA
Seal: �Illlllll 1111��P \\` Seal: . 'c EXPIRES: larch 19,2017
'„IN ' Bonded Tluu Ndvy PuW UrJwmbm
APPROVED BY I s miner Zoning
Structural Review Clerk
(Revised02/24/2014)
6
RZTE. CH C0RP044T10N
ROBERTO HERNANDEZ
305-205-4135
AGREEMENT OF SERVICES
Date: June 20, 2016
Attn: Klein & Salome Investments LLC
Tel: 305-972-7139
Email: thiagomiami@hotmail.com
Re: For the following services at:
9310 Biscayne Blvd. Miami Shores, FL. 33138
t "Replacement and installation of central air conditioning
units. Includes the following:
• Condenser unit RHEEM 2.5 tons/14 Seer. R-410A
(Model#: RA1430AJ 1 NA)
• Air handler unit, heating and condenser unit RHEEM
4 tons/ 14 Seer, R-41 OA
(Air Handler Model #: RBHP-24J07SH4)
(Condenser Unit Model #: RA1448AJ1 NA)
*TOTAL.;FOR. PARTS & LABOR: $ 5,850.00?
Terms of Payment:
50% deposit due at commencement of job ($ 2,9 25.00
50% balance due when work is completed ($ 2,925.00
r
r
Roberto Hernandez ` Klein & Sa ome Investments, LLC
Herztech Corpr Thiago Salome
Date: O ��.UI �� Date: Q w ZG A(
.______..... ._..............._.__...........
HERZTECH CORPORATION
ROBERTO HERNADEZ
305-205-4135
Date:
State of � rl �
County of A 0M 9 0 A
Before me this day personally appeared RV64?940 who, being sworn,
deposes and says:
That heor she will be the onlerson working on fhproject
e
Sworn to (o affirmed) and subscribed before me this-10—day of M
20 , by � 0�� � �
Personally Know
Or Produce Identification
Type of Identification Produce ��� 4&.55'F -U-4-4 2-0)
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EXPIRES: 1u, 17
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DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS RDDED BY ENDORSSMEN/SPECK PROVISIONS
Air Conditioning Contractor
Lic# CAC 1616646
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GER7I�IIdA H9�Die4: 'Sp Qu�nNYOF s4n> PS�
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Miami Sores Village p pfATdEO8UTFAR 11RQ A6HM�
Building Department oRua»*�Asr�uPonl r
11050 N.E.2nd Avenin
Miami.Shores,FL.33138
0 ACpRWPO 1Of41988
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•••• d� 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 — Workers3 Compensation Insurance Exemption
�F
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-titre
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,parttime employees or subcontractors.
BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS
CONTENTS.
4� ,Vvv-�Signature:
Owner
State of Florida
County of Miami-Dade rra�yy
The foregoing was acknowledge before me this day of tJ 20 1�0 .
By ' 1 �'` 0 Q bo ,f`' perso y known o or has produced
Notary-
SEAL:
otarySEAL p #FF 954760 a��
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s � y to
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SatsREVISIONI Miami Shores Village
B ' i partment
..., nd Avenue
e
°` itiV ores;, ori
33138
95.2204
5)756.8972
AIR CONDITIONING REPLACEM
P >. ' C
This form must accompany ALL air conditioning replacement permit appli unit change-out must
be on its own data sheet.Multiple units on single sheens are not acceptable. f Q
Job Address(where the work is being done): )r G r✓1, �/'�� '•.IC.V_0
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(2 ARHI Sheet Attached:YES NO❑ Contract Attached:YES Ea
UNIT BEING REPLACED DATA NEW UNIT
MANUFACTURER
AHU or PKG.UNIT MODEL# �c
COND.UNIT MODEL 4 Id��
KW HEAT NIA
NOM TONS
AHU CU KG 1)M.C.A AHU CU KG'
AHU CU PK 2)M.O.P AHU CU 2MG
AHU CU 3)VOLTS AHU CU
PKG UNIT / / PKG UNIT
13 EER/SEER
YES REPLACING DUCTS YES
YES N REPLACING THERMOSTAT YES
YES NEW 4"CONCRETE SLAB YES
YES NEW ROOF STAND YES
YES NO NEW RETURN PLENUM BOX YES NO
..� 1. Minimum Circuit Ampacity(Wire Size):
2. Maximum Overcurrent Protection(Fuse/Breaker Si )
3. Voltage'of Circuit(208/240/480): 20
x.14. Size Disconnecting Means: 6O.AswrP
Contractor's Company Name: Phone:
State Certificate or Registratio 6/9/416
Certificate of Competency No.
Signature Date:
gnature)
(RevAsed02124/2014)
-i
a 0
Cwftfficate of Product Ratings ,.
AHRI Certified Reference Number: 7493661 Date: 7/15/2016
Product: Split System:Air-Cooled Condensing Unit, Coll with Blower
Outdoor Unit Model Number: RA1448AJ1
Indoor Unit Model Number: RBHP-24
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, 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 region(s)for which they meet the regional efficiency requirement.
Series name:
Manufacturer�respansit>1 dor the ri ltlrlg"i�f ti coni►bYn�i ion is 3RHEE1fA ALES"OMP�4N MIC.
Rated>its:followsineaccordance with AHRIStandard'2101240-2008forUnitar.y lr4londitidtjgnganci:Air4ource
Heat.Pump Equipment ansubje ct to ri cation of rating accuracy by AH1RI spon'soi6d, iwadep+ nd00t,=third j
a testin
Cooilla .Ca a 41 55t
0 P t
::EERirtt) tlinA
EPR Ati966g Cooling):
IEER Rating (Cooling):
3
. 4
1
j
a
"Ratings followed by an asterisk(`)indicate a voluntary rerate of previously published data,unless accompanied with a WAS.which indicates an involuntary cerate.
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.ahridirectory.org.
AM
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 part,be reproduced;copied;disseminated; xJ
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,
&REFRIGERATION INSTITUTE
CERTIFICATE VERIFICATION
The Information for the model cited on this certificate can be verified at www.ahrldirectory.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.
1311306139Q24020300
02014 Air-Conditioning,Heating,and Refrigeration Institute C IMCATE NO.: