REV-16-743 Miami Shores Village
� J � - ,
R 2��2 2016
Building Department
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 (b
BUILDING Master Permit No. P_c ZkS - 3_)`S
PERMIT APPLICATION Sub Permit No aeo((�-3 q
❑BUILDING ❑ ELECTRIC ❑ ROOFING ( REVISION ❑ EXTENSION ❑RENEWAL
F-IPLUMBING ❑■ MECHANICAL PUBLIC WORKS CHANGE OF CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 9935 NE 13th Ave
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: () 3 Z Q9' 001 f9 Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
e—
OWNER:Name(Fee Simple Titleholder): '&0kM'r4t (-Cve—t Phone#:&-�"k Z3f0173
Address:I'', jj 3',` nhE �� An/
City: 1("l� c Jl{-o-+� 5 State: Zip: 313 O
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: Mechanical &Air Conditioning services corp. Phone#: (305)726-6715
Address: 137 west 11th street
City: Hialeah State: Florida Zip: 33010
qualifier Name: Osbel Rodriguez Phone#: (305)726-6715
State Certification or Registration#: CMC1250511 Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$_ Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration 54 New ® Repair/Replace ❑ Demolition
Description of Work: tie*)
Specify color of color thru tile:
Submittal Fee$ A \\ Permit Fee$ �r W CCF$ CO/CC$
Scanning Fee$ 2> W Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$
(Revised02/24/2014)
,SNORFs Miami Shores Village
Building Department
evil gloom 10050 N.E.2nd Avenue
Miami Shores, Florida 33138
47Oy� Tel: (305) 795.2204
ZOR Fax:(305) 756.8972
AIR CONDITIONING REPLACEMENT DATA
PERMIT NUMBER: MC
This form must accompany ALL air conditioning replacement permit applications. Each unit change-out must
be on its own data sheet. Multiple units on single sheets are not acceptable.
Job Address(where the work is being done): "/j 3� "CE +tk
City: Miami Shores Village County: Miami Dade zip Code: 3 3�
ALL CONDENSING UNITS MUST BE ON A 4 INCH SOLID CONCRETE SLAB
ALL UNITS MUST COMPLY WITH F.E.M.A MINIMUM FLOOD ELEVATION
A COPY OF THE CONTRACT IS REQUIRED WITH ALL SUBMITALS
AHRI DATA SHEET REQUIRED
Change disconnecting means:YES❑ NO❑ ARHI Sheet Attached:YES ❑ NO ❑ Contract Attached:YES ❑
UNIT BEING REPLACED DATA NEW UNIT
MANUFACTURER
AHU or PKG. UNIT MODEL#
COND. UNIT MODEL#
KW HEAT
NOM TONS
AHU Cu PKG 1) M.C.A AHU CU PKG
AHU Cu PKG 2)M.O.P AHU CU PKG
AHU CU PKG 3)VOLTS AHU CU PKG
PKG UNIT / / PKG UNIT
EER/SEER
NO REPLACING DUCTS YES NO
NO REPLACING THERMOSTAT YES NO
NO NEW 4"CONCRETE SLAB YES NO
YES NO NEW ROOF STAND YES NO
YES NO NEW RETURN PLENUM BOX YES NO
1. Minimum Circuit Ampacity(Wire Size):
2. Maximum Overcurrent Protection (Fuse/Breaker Size):
3. Voltage of Circuit (208/240/480):
4. Size Disconnecting Means:
Contractor's Company Name: Mechanical &Air Conditioning Services Corp Phone: (305)726-6715
State Certificate or
Registration No.CMC 125051 1 Certificate of Competency No.
SignatureDate: 3 21 1201(,
ualifier's signature)
(Revised02/24/2014)
Bonding Company's Name(if applicable)
Bonding Company's Address _
City State Zip
Mortgage Lender's Name(if applicable)
Mortgage Lender's Address
City State Zip
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS,
FURNACES, BOILERS, HEATERS,TANKS,AIR CONDITIONERS, ETC.....
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all
applicable laws regulating construction and zoning.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING
YOUR NOTICE OF COMMENCEMENT."
Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding$2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
ialy. W
Signature Signatur
OWNER or A NT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of 4�Ch 20 �by �t day of i A'Olf CJA- 20 ` �Q by
Q- �.�•. , V�� , who is personally known to QS n � \2-,who is personally known to
me or who has produced '�l.- as me or who has produced `TJ(— as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: Sign:
Print: 2" Print: 2-
Seak JOSEFINA GEREZ JOSEFINA GEREZ
;• Seal:
Notary Public-State of Florida Notary Public State of Florida
.�?My Comm.Expires Sep 30,2018 ;•?My Comm.Expires Sep 30,2018
Commission#FF 164325 M Commission#FF 164325
********** **�1w,►r5k**�BPrlds�l *** *********************** *�k%k,�;;`�'ltS�'*�'1111`dIJ�PI`I `Ifdtid'�`it4�1�. **
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)