Loading...
MC-16-1687 Perm=it N©. MC-6-16-1687 `SORES`' Miami Shores Village Wt Permit Type: Mechanical-Residential � 10050 N.E.2nd Avenue NW r l� ' Work Classification:A/C Replacement Miami Shores,FL 33138-0000 Permit Status:APPROVED ry� Phone: (305)795-2204 �<ORIP Issue Date:6/28/2016 Expiration: 12/25/2016 Project Address Parcel Number Applicant 101 NW 99 Street 1131010220380 Miami Shores, FL 33150- Block: Lot: JOANNE LABOSSIERE Owner Information Address Phone Cell JOANNE LABOSSIERE 101 NW 99 Street (305)235-7223 MIAMI SHORES FL 33150- 101 NW 99 Street MIAMI SHORES FL 33150- Contractor(s) Phone Cell Phone Valuation: $ 11,500.00 ARS/RESCUE ROOTER (305)235-7223 Total Sq Feet: 0 Tons:2.5 Available Inspections: Additional Info:A/C 2.5 TONS,ADD TWO MITSUBICHI MI Inspection Type: Classification:Residential Final Approved: In Review Review Electrical Comments: Date Approved: : In Review Review Electrical Date Denied: Type of Work: Review Mechanical Scanning:3 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $7.20 DBPR Fee Invoice# MC-6-16-60233 $6.04 06/17/2016 Check#:8253012: $50.00 $392.78 DCA Fee $6.04 Education Surcharge $2.40 06/28/2016 Check#:8253012'. $392.78 $0.00 Permit Fee $402.50 Scanning Fee $9.00 Technology Fee $9.60 Total: $442.78 In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans,drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DO S,ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing information i ac ur a and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore,I authorize the above-nam nt to do the work stated. June 28, 2016 Authorized Signature:Owner / Applicantctor / Agent Date Building Department Copy,/ ra June 28,2016 1 'l l RECEIVED Miami Shores Village AU1age � o1s 113 Building DepartmentY 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel: (305)795.2204 Fax:(305)756.8972 INSPECTION'S PHONE NUMBER:(305)762.4949 BUILDING Permit No, PERMIT APPLICATION Master Permit No. FBC 20 Permit Type: MECHANICAL JJ OWNER:Name(Fee Simple Titleholder):��b1Jl�]� l.,dP_,0'3Sk-SeE Phone#:505 ?'FIG C4572 Address: nu) -1 ST City: at t,t,� �'1©C�`� State: - gip; + t : Tenant/Lessee Name: Phone#• Email: JOB ADDRESS:.1Q_-� A)(A) ST' . City: Miami Shores County: Miami Dade Zip: 55 1 rJ Folio/Parcel#• Is the Building Historically Designated:Yes NO Flood Zone: CONTRACTOR:Company Name: °ca) az 1pel,T 6(- o tCk�$phoneC �S-:252 72?2,S Address: City: State: Zip: 7� Qualifier Name: ckf S P>ac)cx) n ° Phone#:. State Certification or Registration#:��C l 0_'4� �P ° Certificate of Competency*: Contact Phone#:-�• 97a- ZZSC9 Email Address: Gam..r_i� (Q 6y(3 .Co uN' DESIGNER:Architect/Engineer: Phone#: Value of Work for this Permit:$_� '. `J� Square/Linear Footage of Work: Type of Work: OAddress OAlteration ONew ®Repair/Replace ODemolition Description of Work: ""''-IC. 2° 5 `M , 212 IWC "A-T�Q_�n oLH i 9.ak;_ �r C 7 L-C � _ _T6 <__ LO S Submittal Fee$ 93 -OD Permit Fee$ CCF$ CO/CC$ _ Scanning Fee$ Radon Fee$ rod y" DBPR$ (o. Bond$ Notary$ Training/Educadon Fee$ 4 0 Technology Fee$ q_r(� Double Fee$- ,� Structural Review$ TOTAL FEE NOW DUE$_ �-(� • , a Bonding Company's Name(if applicable) Bonding Company's Address City State Zap 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 instaildfxon 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 ELECTRICAL WORK,PLUMBING,SIGNS, WELLS,POOLS,FURNACES,BOILERS,HEATERS,TANKS and 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. Signature 44Z eu-a��, z Signature v l� 4wner or Agent � Contractor The foreg ing instrument was acknowled ed before me this �� The foregoing instrument was acknowledge t`flli"s day of l� ,20 �O'by7 - � day of l�t� ,20-LrO,by who is personally known to me or who has oduced =° `who is personally known to me or who has As identificatio and who did tak ai' �s -• L • (L as identification and w di ...fake an oath. 0 NOTARY PUBLIC: o NOTARY PUBLIC: o 0 C) a m 3 3 v N m Q 0 n O Sign: H "' _ �' Sign: a At N Print: Print: My Commiss' x res: t 2 2 �o W N My Commi xpir s: Su 'Z VI.IUL/ / N / - c/2. w APPROVED BY Plans Examiner Zoning r Structural Review Clerk (Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) • 4� Miami Shores Village m� Building Department toatol► 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel:(305) 795.2204 AIR CONDITIONING REPLACEMENT DATA Fax:(305) 756.8972 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): 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 ARI(AHRI)DATA SHEET REQUIRED Change Disconnecting means:YES ❑ NO❑ ARHI Sheet Attached:YESR NO❑ Contract Attached:YESJ& UNIT BEING REPLACED DATA NEW UNIT MANUFACTURER AHU or PKG.UNIT MODEL# S COND.UNIT MODEL# KW HEAT --1KU , NOM TONS ,ea AHU CU PKG 1 M.C.A AHU 22CU I C;)PKG AHU CU PKG 2 M.O.P AHU CU2 PKG AHU CU PKG 3 VOLTS AHU CU PKG PKG UNIT I I PKG UNIT (—/ EER/SEER &6, 600 Z40. YES NO — REPLACING DUCTS ES NO YES NO REPLACING THERMOSTAT ES NO YES NO — NEW 4"CONCRETE SLAB NO YES NO — NEW ROOF STANDE NO YES NO NEW RETURN PLENUM BOX E NO '70g 23 1. Minimum Circuit Ampacity(Wire Size): 2. Maximum Overcurrent Protection(Fuse/Breaker Size): �v 3. Voltage of Circuit(208/240/480): 2 O F�- 2 4. Size Disconnecting Means: _ao Contractor's Company Name: � T IP%0AW-TI � )'CSS Phone:_ -MR-2-2>S- 720S State Certificate or Registration N.(2A . I f93Certificate of Competency N. Signature l Date: �� • �P (Qualifier':signature only) f LOAD CALCULATION AND SERVICE ENTRANCE General Lighting SQ. FT total Floor Area 1464 x 3 VA 4392 VA small appliance&laundry 1500 VA x 2 3000 VA 1500 VA x 1 1500 VA r equipment load: range 8000 VA refrigerator 1200 VA dishwasher 1200 VA dryer 5000 VA w. heater L•� 1200 VA kitchen hood 800 VA TOTAL 26292 VA Demand factor: first 10000 VA @ 100% 10000 VA remaining VA @ 40% 6516.8 VA A/C load @ 100% A.H.U. Heater7JUI �+ ] split-system heat pump 10000 VA MUZ-GE12NA Z 016 1200 VA MXZ-3C24NA BY: 1660 VA 29376.8 VA TOTAL KVA/240V 122.4033 A PROPOSE SERVICE: 1 set of 3W#1 THHN and 1W#6 THHN PROPOSE CONDUIT SIZE: 11/2"PVC DEMAND SERVICE LOAD: 150A JOANNE LABOSSIERE SPAR ELECTRIC INC. 101 N.W. 99 th Street 10357 S.W. 26 St. MIAMI, FL33165 MIAMI SHORE, FL33150 LIC#EC13006743 sloe . . .... ...... 0 . ...... .. . ...... 0.0.00 Miami Shores Village 0000 •• • .... . .. ..... APPROVED BY DATE 0.00•• 0.00 0.00• .. .. .... ...... ZONING DEPT 0.00•• •� "HLDG DFPT WJ-F WITH All FFDFRAI_ •• • • CONDUIT 11/2"PVC \• ONE SET OF 3W# 1THHN ` IW# 6THHN PANEL NEW METER WITH A M MAIN BREAKER 150A 150A M.L.O NEW UNDERGROUND SERVICE DROP PROPOSE 2"PVC CONDUIT NOTE:EXISTING DROP SERVICE IS AEREAL, IT WILL CHANGE OVER TO UNDERGROUND LOCATION/OWNER 1 JOANNE LABOSSIERE '+ R.i C 3AIC' 101 N.W.99 ST MIAMI SHORE,FL 33150 EC-13006743 786 286 8235 •• ••• • s • • • •• •• ••• •• • •. ELECTRICAL REVIEW /d "' ' "' so. so. APPROVED DATE .. . . . . . . .. . . .. . *00 • . • . .. .. . . . .. .. ... . . . ... . . .,_. y • . ••• • . . ... All, •• • 4 T 9 tt • • • t�-NLir� ••• w ' • 4�Ir T • • ' • Inco- • • • • cAtlAC�,Ea��1� �7C��n/{ • i'.�'•+'• • • • NEW � • • • • ••• • `Lu%Gtr G.oK7�jctp,E,S �'�lR7!?' •4�, •• • • •• •• "• •" NOTES: ••• IiLECTRICAL PANEL TO BE CHANGE - OR A NEW ONE. • � "' EXISTING METER BOX TO BE T a' t5bA • DISCONNECT AND REMOVE. mv,k.'f`r .0 y NEW METER BOX AND SERVICE TO BE IPitetE-4.- 4 FEED UNDERGROUND n 'Y.117HGJ1.f. ct-NLIr:� ►-. 11-1 a.•AT#f=n W _ f mer 1 �, rn•I n-e n- .P r~�r .v PA ry. /I;�GGJ CGKDaG7� 25jo5nN6 SCledl GOlvbuG�OR� rZ, �e ELECTRICAL REVIEW 2` AF�PROVE ATE JOINAZILW • + ; -7� ���� 6- /moi5- 7—�'& 24& 2_3 57 L c co-q 3. This combination qualifies for a Federal Energy CERTIFIED" Efficiency Tax Credit when placed in service between Feb 17, 2009 and Dec 31, 2014. www.ahrid � r . Certificate of Product Ratings AHRI Certified Reference Number: 7942888 Date: 10/16/2015 Product: Split System: Air-Cooled Condensing Unit, Coil with Blower Outdoor Unit Model Number: RA1642AJ1 Indoor Unit Model Number: RH1T4821STAN 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 responsible for the rating of this system combination is RHEEM SALES COMPANY, INC. f , Rated as follows in accordance'with AHRI Standard 210/240-2008 for Unitary Air-Conditioning and Air-Source Heat Pu n EgUipment and subject-to verification of ratifi§ accuracy by AH ERI-sponsored; independent,�third party teg: Cooling Capacity(Btuh): 41500. , EER Rating (Cooling): 13.00 '•SEER*Rating Rating (Cooling): 16.00 — ...:.. :•••�• •••• IEER Rating (Cooling): .... .... ..... ...... . ... ..... .. .. .. . ..... Ratings followed by an asterisk(')indicate a voluntary rerate of previously published data,unless accompanied with a WAS,which indicates an involuntary rerate. 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. 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; entered into a computer database;or otherwise utilized,in any form or manner or by any means,except for the user's individual, "9WM I 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 Cfe 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 FCERTIFICATE NO.: 130894979639786560 Air Performance Data a RA16 Series Performance Data @ AHRI Standard Conditions -Cooling (con't.) Air Handler Ratings Outdoor Total Capacity Net Sensible Net Latent Indoor CFM Unit Air Handler BTU/H[kW] BTU/H[kW1 BTU/H[kW] SEER EER IL/sl AHRI# RF1 P1821 SPAN 18000 [5.3] 13500[4.0] 4500[1.3] 15.50 13.00 550[259.6] 7940562 RF1T2421MTAN 18000 [5.3] 13500[4.0] 4500[1.3] 16.00 13.00 625[295.0] 7940563 RA1618AJ1 RBHP-17 18000 [5.3] 13500[4.0] 4500[1.31 16.00 13.00 600[283.2] 7940293 RH1 P1817STAN 18000 [5.3] 13500[4.0] 4500[1.3] 15.00 12.50 600[283.2] 7940564 RMT2417STAN 18000 [5.3] 13500[4.0] 4500[1.3] 16.00 13.00 600[283.2] 7940565 RHiV2417STAN 18000 [5.3] 13500[4.0] 4500[1.3] 16.00 13.00 650[306.8] 7940566 RFIT2421MTAN 24000 [7.0] 17500[5.1] 6500[1.9] 15.50 13.00 800[377.6] 7940889 RBHP-17 24000 [7.0] 17500[5.1] 6500[1.9] 15.50 13.00 800[377.6] 7940572 RH1P2417STAN 24000 [7.0] 17500[5.1] 6500[1.91 14.50 12.20 800[377.6] 7940890 RA1624AJ1 RMT2417STAN 24000 [7.0] 17500[5.1] 6500[1.9] 16.00 13.00 800[377.6] 7940891 RH2T2421MTAN 24000 [7.0] 17500[5.1] 6500[1.9] 16.00 13.00 700[330.4] 7940893 RHIIV2417STAN 24000 [7.0] 17500[5.1] 6500[1.9] 16.00 13.00 850[401.2] 7940892 RH2V2421HTAC 24000 [7.0] 17500[5.1] 6500[1.91 16.00 13.00 800[377.6] 7940894 RF1T3624MTAN 30000 [8.8] 22800[6.7] 7200[2.1] 15.50 13.00 1025[483.7] 7941341 RBHP-21 29200 [8.6] 19500[5.7] 9700[2.8] 15.50 13.00 1000[471.9] 7940903 RM P3017STAN 28400 [8.3] 21400[6.3] 7000[2.1] 15.00 12.50 975[460.1]._ _ 7941342_ RA1630AJ_1. RH1T3617STAN 29000 [8.5] 22100[6.5] 6900[2.0] 16.00 13.00 1000[471.9] 7941343 �+ RMT36211ATAN 30000 [8.8] 22800[6.7] 7200[2.1] 16.00 13.00 1000[471.9] 7941344 RH1V3617STAN 29000 [8.5] 22200[6.5] 6800[2.0] 16.00 13.00 1025[483.7] 7941345 RH1V3621MTAN 30000 [8.8] 22800[6.7] 7200[2.1] 16.00 13.00 1000[471.9] 7941346 RF1P3624SPAN 36000[10.6] 25100[7.4] 10900[3.2] 14.50 12.20 1100[519.1] 7941769 RF1133624STAN 36000[10.6] 25100[7.4] 10900[3.2] 14.50 12.20 1100[519.1] 7943763 RF1T3624MTAN 36000[10.6] 25100[7.4] 10900[3.2] 16.00 13.00 1025[483.7] 7941770 RBHP-21 36000[10.6] 25100[7.4] 10900[3.2] 16.00 13.00 1200[566.3] 7941354 RH1P3617STAN 35200[10.3] 25100[7.4] 10100[3.0] 14.00 12.20 1100[519.1] 7941771 RA1636AC1 RMP3621STAN 35200[10.3] 25100[7.4] 10100[3.0] 14.00 12.20 1100[519.1] 7941772 RMT3617STAN 36000[10.6] 25100[7.4] 10900[3.2] 15.50 13.00 1200[566.3] 7941773 RMT3621 WAN 36000[10.6] 25100[7.4] 10900[3.2] 16.00 13.00 1175[554.5] 7941774 RH1V3617STAN 35200[10.3] 24700[7.2] 10500[3.1] 15.50 13.009 •1025[483.7] 79417T5••; RH1V3621WAN 36000[10.6] 25100[7.4] 10900[3.2] 16.00 13.00 • 1-200[56Q3].. . 7941776 �. RH2V3624HTAC 36000[10.6] 25100[7.4] 10900[3.2] 16.00 13.00 • ;61200[566'.3] 7941 77 RF1 P3624SPAN 36000[10.6] 25100[7.4] 10900[3.2] 14.50 12.20 '*'-r100[519.1] 7942P0 .•• RF1P3624STAN 36000[10.6] 25100[7.4] 10900[3.2] 14.50 12.20. 1400[5191 • 7943;61... RFiT3624MTAN 36000[10.6] 25100[7.4] 10900[3.2] 16.00 13.00 1925[483.7] . . 7942":,.' RBHP-21 36000[10.6] 25100[7.4] 10900[3.2] 16.00 13.00..•..1200[5631.• : 79417.86.... RHiP3617STAN 35200[10.3] 25100[7.4] 10100[3.0] 14.00 12.20.....1900[519.1] . 7942205 • RA1636AJ1 RH1P3621STAN 35200[10.3] 25100[7.4] 10100[3.0] 14.00 12.20. 1;00[519t1j 7942206•• • RMT3617STAN 36000[10.6] 25100[7.4] 10900[3.2] 15.50 13.00• A200[56603] 794244.. RH1T3621MTAN 36000[10.6] 25100[7.4] 10900[3.2] 16.00 13.00 • 1T75[554.5? ;•; 79422b8 • RH1V3617STAN 35200[10.3] 24700[7.2] 10500[3.1] 15.50 13.00 1025[483.1• 7942209 RH1V3621WAN 36000[10.6] 25100[7.4] 10900[3.2] 16.00 13.00 1200[566.3] 7942210 RH2V3624HTAC 36000[10.6] 25100[7.4] 10900[3.2] 16.00 13.00 1200[566.3] 7942211 RBHP-24 41000[12.0] 26900[7.9] 14100[4.1] 16.00 13.00 1400[660.7] 7942223 RA1642AC1 RH1P4221STAN 40500[11.9] 29300[8.6] 11200[3.3] 14.50 12.20 1325[625.3] 7942552 RMT4821STAN 41500[12.2] 30700[9.0] 10800[3.2] 1 16.00 1 13.00 1400[660.7] 7942553 RH1V4821STAN 41500[12.2] 30700[9.0] 1 10800[3.2] 15.50 1 13.00 1400[660.7] 7942554 [ ]Designates Metric Conversions INTEGRATED HOME COMFORT o This combination qualifies for a Federal Energy Efficiency Tax Credit when placed in service between Feb 17,2009 and Dec 31,2014. Certificate of Product Ratings AHRI Certified Reference Number: 7505787 Date: 8/31/2015 Product:Variable Speed Multi-Split Heat Pump Outdoor Unit Model Number: MXZ-3C24NA Indoor Unit Type: Non-Ducted Indoor Units Manufacturer: MITSUBISHI ELECTRIC COOLING& HEATING Trade/Brand name: MR. SLIM Series name: Manufacturer responsible for the rating of this system combination is MITSUBISHI ELECTRIC COOLING& HEATING Rated as follows in accordance with AHRI Standard 210/240-2008 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):_ 22000 EER Rating (Cooling): _ 13.60 h" i SEER Rating (Cooling): - 20.00 ( ' ' Heating Capacity(Btuh)�@ 47 F: 25000 Region IV HSPF Rating (Heating): 9.80 '�� •••••• Heating Capacity(Btuh)@ 17 F: 14000 • ...... . ... .... .... . . .... .... ... ...... . ... ... .. .. .. . ... . ....:0 CERTIFIED RATINGS FOR VARIABLE-SPEED,MINI-AND MULTI-SPLIT SYSTEMS ARE VALID FOR ALL COMB%V8gS OF INQOQLRJJNITS;•• (BASED ON COMBINATION TYPES)WITH THE SPECIFIC OUTDOOR UNIT LISTED ABOVE AND IN THE AHRI DIRECTORY OFCPIWIP1ED EQUIPMENT.VISIT WWW.AHRIDIRECTORY.ORG TO VERIFY THAT THIS COMBINATION IS AN ACTIVE LISTING AND THE DAA LISTED ON THIS CERTIFICATE IS ACCURATE.SEARCH ON THE AHRI R%FFbRENCE#TO QUICKLY LOCATE THIS COMBINATION IN THE DIRECTORY. Ratings followed by an asterisk(*)indicate a voluntary rerale of previously pu lis ed data,unless accompanied with a WAS,which indicates an involuntary rerate. 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. 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; 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 belteN° 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. 130855214292306399 ©2014 Air-Conditioning,Heating,and Refrigeration Institute CERTIFICATE NO.: fftMITSUBISHI ELECTRIC COOLING & HEATING M--SERI-ES MULTI-INDOORSUBMITTAL DATA: MXZ-3C24NA Job Name: System Reference: Date: GENERAL FEATURES • Quiet Operation • Optional base pan heater to prevent ice in drain pan — • Limited warranty:five years parts and seven years compressors '�A_. T!���R R ACCESSORIES ❑ 3/8"x 1/2"Port Adapter(MAC-A454JP-E) Rill ' Li 1/2"x 3/8"Port Adapter(MAC-A455JP-E) kf ,. ❑ 1/2"x 5/8"Port Adapter(MAC-A456JP-E) ❑ M-NET Adapter(PAC-IF01 MNT-E) ❑ Base Heater(PAC-645BH-E) h Outdoor Unit:MXZ-3C24NA (For data on specific indoor units,see the MXZ-C Technical and Service Manual.) Specifications Model Name Unit Type MXZ-3C24NA Rated Capacity Btu/h 22,000/23,600 Cooling* Capacity Range Btu/h 12,600-22,000/12,600-25,500 (Non-ducted/Ducted) Rated Total Input W 1,620/2,100 Rated Capacity Btu/h 25,000/24,600 Heating at 47°F* Capacity Range Btu/h 11,400-30,600/11,400-29,400 (Non-ducted/Ducted) Rated Total Input W 1,750/1,900 Heating at 17°F* Rated Capacity Btu/h 14,000/14,000 (Non-ducted/Ducted) Rated Total Input W 2,120/2,230. • Power Supply Voltage,Phase,Hertz 208/230V•l-Phase. Hz see •• Electrical Requirements Recommended Fuse/Breaker Size A 15 MCA A 1 •""• .•• :• Voltage Indoor-Outdoor S1-S2 V A01208/230 :•• • Indoor-Outdoor S2-S3 V DC±24 Compressor INVERTF -driven ScrolleHermeft •• • Fan Motor(ECM) F.L.A. 1.9 • • Sound Pressure Level Cooling • 1 dB(A) • • • •• • (Non-ducted/Ducted) Heating ( ) •• '•55 • External Dimensions(H x W x D) In(mm) 31-1@IrA `V-13132 x Vf • (396x950x33 • •• "• Net Weight Lbs(k • 136(61) • • • External Finish M8wR 3 Y 7.8/1.4 ••• • • Refrigerant Pipe Size O.D.— Liquid(High Pressure) In(mm) 1/4(6.35) •• • Eight Ports Gas(Low Pressure) A Port:1/2(12.7);Other:3/8(9.52) Max.Refrigerant Line Length Ft(m) 230(70) Max.Piping Length for Each Indoor Unit Ft(m) 82(25) Max.Refrigerant Pipe Height If IDU is Above ODU 49(15) Difference If IDU is Below ODU Ft(m) 49(15) Connection Method Flared/Flared Refrigerant R41 OA *Rating Conditions per AHRI Standard: Cooling i Indoor:80°F(27°C)DB/67°F(19°C)WB Heating at 47°F i Indoor:70°F(21°C)DB/60°F(160C)WB Heating at 17°F i Indoor:70°F(21°C)DB Cooling i Outdoor.95°F(35°C)DB/23.9°C(75•F)WB Heating at 47°F i Outdoor:47°F(8°C)DB 1430 F(6°C)WB Heating at 17°F i Outdoor:17°F(-8°C)DB/15°F(-9°C)WB Specifications are subject to change without notice. 0 2015 Mitsubishi Electric US,Inc. This combination qualifies for a Federal Energy Efficiency Tax Credit when placed in service between Feb 17, 2009 and Dec 31,2014. Certificate of Product Ratings AHRI Certified Reference Number: 7064987 Date: 8/31/2015 Product:Variable Speed Mini-Split Heat Pump,with Remote Outdoor Unit Air-Source, Free Delivery Outdoor Unit Model Number: MUZ-GE12NA2 Indoor Unit Model Number: MSZ-GE12NA Manufacturer: MITSUBISHI ELECTRIC COOLING& HEATING Trade/Brand name: MR. SLIM Series name: Manufacturer responsible for the rating of this system combination is MITSUBISHI ELECTRIC COOLING& HEATING Rated as follows in accordance with AHRI Standard 210/240-2008 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): 12000 EER Rating (Cooling): 12.50 SEER Rating (Cooling): 22.70 I Heating Capacity(Btuh)t@ 47 F: 14400 r ' Region IV HSPF Rating (Heating): 11.40 < °i :000:0 Heating Capacity(Btuh)@ 17 F: 8800 '• • :•••0• ...... . .. ... . ...• ••.. • . • • • • • •• •• •• • t•• • •••••• • • • • *001 0 •••••• CERTIFIED RATINGS FOR VARIABLE-SPEED,MINI-AND MULTI-SPLIT SYSTEMS ARE VALID FOR ALL COMB;VJ?i;JS OF INQOQIJ JJNITS 0•• i (BASED ON COMBINATION TYPES)WITH THE SPECIFIC OUTDOOR UNIT LISTED ABOVE AND IN THE AHRI DIRECTORY OFCf_�RTIF:ED EQUIPMENT.VISIT WWW.AHRIDIRECTORY.ORG TO VERIFY THAT THIS COMBINATION IS AN ACTIVE LISTING AND THE DATA LISTED ON TI 4S CERTIFICATE IS ACCURATE.SEARCH ON THE AHRI RFbOff'NCE#TO QUICKLY L9CATE$THIS�COMBINATION IN THE DIRECTORY. abngs followed by an asterisk O indicate a voluntary rerate of previously pu lis a data,unless accompanied wit a A ,whic in icates an involuntary rerate. 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. 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; 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 hle 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. 130855211114816927 ©2014 Air-Conditioning, Heating,and Refrigeration Institute CERTIFICATE NO.: MITSUBISHI ffM ELECTRIC COOLING & HEATING M-SERIES tttWALL-MOUNTED Job Name: Location: Date: Purchaser: Engineer: Submitted to: For ❑Reference ❑Approval ❑Construction System Designation: Schedule No.: I C�' Indoor Unit:MSZ-GEI2NA-8 Most Efficient �Z'd I/� Wireless Remote ^� 201!K�V Controller www.energystar.gov Outdoor Unit:MUZ-GE12NA GENERAL FEATURES • Wall-mounted indoor unit • Standard Hybrid Catechin Prefilter is included with indoor unit • Quiet operation • Auto fan speed control:Quiet,Low,Medium,High,and Super High; • Hand-held Wireless Remote Controller • Indoor unit powered from outdoor unit using A-Control • Auto restart following a power outage • Base heater is available as an option ;••.;. • Anti-allergy Enzyme Filter • • • ••• •• • Limited warranty:five years parts and seven years compressor •00 0• • • 6666•• • 606.6• • 000600 • 000000 • • + ACCESSORIES "" 00000 Outdoor Unit 60000 •+••0 ""' ❑ Base Heater(MAC-640BH-U) 060066 • 6 ••• •6 6•• ❑ Drain Socket Assembly(MAC-860DS) • • •• • • •• •• •• • 008000 • Indoor Unit 000006 • + ❑ Condensate Pump(230V;S13100-230) • • • • Controller Options • • • ; •�; ❑ Wireless Wall-mounted Remote Controller Kit(MHK1)* '6�' ; • ••• • • ❑ Portable Controller(MCCH1)* • • + ❑ Outdoor Air Sensor(MOS1)* *See Submittal for information on each option. ❑ Wired Wall-mounted Controller (PAR-21 MAAU requires MAC-3331 F) ❑ System Control Interface(MAC-3331F) I ER R Specifications are subject to change without notice. 0 2013 Mitsubishi Electric US,Inc. s Cooling* Indoor Unit Rated Capacity. ... . .. ... .. . . .... . ..... . ..... .12,000 Btu/h MCA. . .. ... . ... ......... . .. ... ...... ... . .. . ..... . ..1 A Minimum Capacity ... . .. . .. . . .. .. . . .... . . .... . .3,800 Btu/h Blower Motor(ECM)...... . .. ... . . .... . .. . .. .....0.76 F.L.A. SEER....... . .. . . .. ..... . . .. .. . . .. ... . .....20.5 Btu/h/W Airflow(Quiet-Lo-Med-Hi-Super Hi) Total Input... . .. ... . ..... . . .. ... ..... . ..... .......960 W Cooling . . . . ..... ...... . 145-170-237-321 -399 Dry CFM Heating at 47°F* 109-134-201 -286-364 Wet CFM Rated Capacity. .. . . .. ..... . .. . .. . ..... . .. .. ..14,400 Btu/h Heating . . .. . ...... .. ... 145-170-237-321 -406 Dry CFM Minimum Capacity . ..... . .. . .. . ...... . .. .......5,500 Btu/h HSPF . ..... . ..... . ..... . .. ... . ..... . ... .. . 10.0 Btu/h/W Sound Pressure Level(Quiet-Lo-Med-Hi-Super Hi) Total Input. ..... . ..... . ..... . ..... . ...... ..... . . 1,170 W Cooling . ..... . ...... ... .. . ... ..19-22-30-37-45 dB(A) Heating at 17°F* Heating . . ..... . . .... . ...... . . ..19-22-30-37-43 dB(A) Rated Capacity.. . . ..... . .. .... ..... . ..... . .. ..8,800 Btu/h Rated Total Input ... . . . . ..... . .. ... . ..... . ... ... . ..900 W DIMENSIONS UNIT INCHES/MM Maximum Capacity** .. . . . . ..... . .... . . ..... ...11,200 Btu/h W 31-7/16/799 Maximum Total Input .. . . . ...... ..... . ..... . .. . . . . 1,200 W D 9-1/8/232 H 11-5/8/295 *Rating Conditions perAHRI Standard Weight.. ..... . . . .... ... .. . ..... ...... . .. . ..22 lbs./10 kg Cooling Indoor:80°F(270C)DB/670 F(190C)WB External Finish.......... . ..... . ....Munsell No. 1.OY 9.2/0.2 Cooling Outdoor:95°F(35°C)DB/75°F(24°C)WB Field Drainpipe Size O.D.... . ..... . ..... . ... ..5/8"/15.88 mm Heating at 47°F Indoor:70°F(21°C)DB/60°F(16°C)WB Heating at 47°F Outdoor:47°F(8°C)DB/43°F(6°C)WB Heating at 17°F Indoor:70°F(21°C)DB/60°F(16°C)WB Outdoor Unit Heating at 17°F Outdoor:17°F(-8°C)DB/15°F(-9°C)WB Compressor. ..... . ... . . . ... .. . ... ... ....DC Inverter-driven MCA.... . ... .. ... ... . . . . .. . . . . .. . . ........ . ..... . .12 A Fan Motor(ECM) . . ... .. ... . .. . .. . . ..... . .. . ....0.50 F.L.A. **Maximum Capacity is at full speed and performance for Sound Pressure Level INVERTER-driven System. Cooling . ..... . .. ... . ..... . ...... ..... . .. . ....49 dB(A) Heating . . .. ... . . .... . ...... . ... ......... .. . .. 51 dB(A) Electrical Requirements DIMENSIONS INCHES/MM Power Supply... . ..... . ..... . ....208/230V, 1-Phase,60 Hz Breaker Size. ..... . ..... . ..... . ..... . ...... .. ... . . . 15A W 31-1/2/800 D 11-1/4/286 OPERATING RANGE H 21-5/8/549 Indoor Intake Air Outdoor Intake Air Temp. Tem Weight . ... . ...... .. ... . ..... . .... 77 lbs./35 kg Maximum 90o F(32o C)DB 115°F(46°C)DB External Finish..... .. . .. . ..... . ..... Munsell No.3Y 7.8/1.1 Cooling 73 F 23 C WB 67°F(19°C)DB ° ° Refrigerant Type... . .. . . . . ..... . ... ........ . .. . .. ..R41 OA Minimum 57°F 14°C WB 14 F(-10 C)DB Refrigerant Pipe Size O.D. 80°F(27°C)DB 75°F(24°C)DB Gas Side. ... ... . .. .... ... ... ... ........ . .3/8"/9.52 mm Maximum67°F 19°C WB 65°F Liquid Side... . . . . .. . ...... ..... ...... ... . .1/4"/6.35 mm Heating 18°C WB Max.Refrigerant Pipe Length... . ...... ..... . . . . ..65 ft./20 m Minimum 70°F(21°C)DB -4°F(-20°C)DB Max.Refrigerant Pipe Height Difference ..... . ..,. . ..4p ft./12 m 60°F 16°C WB 1 5°F -21°C WB Connection Method ... ...... . ........... . ...e!!!.t. Flared Voltage ••• : • • Indoor-Outdoor S1-S2 . . ..... . ..... . ..... . ..AC 208/230V ••••• 00 Indoor-Outdoor S2-S3 . . ..... . ..... . ..... . .. . . . ..DC t24V • • • • Indoor-Remote Controller. ..... ... . .. . ... .. . ..MHK1 DC 3V • PAR-21 MAAU DC 12V "" • • PAR-FL32MA DC 3V •.••• • Notes: Specifications are subject to change without notice. ©2013 Mitsubishi Electric US,Inc. MSZ-GE12NA-8 Unit: inch 7/16-1 Oblong hole 7/16xl3/16 Oblong hole 3-1/88-7/8 8-7/8 3-1/8 Installation plate — — — — — r= 31-7/16 r 17 30.15/16 1/4 tO o � � 6-1/8 6-1/8 n 2-3/ 13-5/16 13-9/16 2-1/8 9-1/8 Indoor unit Air in Wall hole e2-9/16 3/16 n �J Installation plate Pi in a � � M M N N � 1-3/4 1-5/8 1-15/16 1II' 24-3/8 5-1/8 -' nfO 1 Drain hose 2-5/1� _ii 3/4 ro 4-3/8 I I 1�_ Air out Insulation e1-3/e O.D .a Liquid line et/4 19-11/16(Flared connection o1/4) 'a Gas line o3/816-15116 2-3/16 1-15/16 1. (Flared connection:e3/8(GE06/09112NA),of/2(GE15/16NA)) Drain hose Insulation of-1/8 0.0 Connected part o5/8 O.D MUZ-GE12NA Unit: inch 15-3/4 Drain hole 01-5/8 REQUIRED SPACE Air in Basically open 4 inch or more without any obstruction in front and on both sides of the unit. v r1 � Air in �2 ZZcn \ G1 mple 1 M \ Ain• � N r 47n or #18 Ore • • Air out • • : ••• ••• •• • Oval hole • 7/8 mo1�C •• • `Aj ori ••• • 01 • • ore • 29/32 11-1/4 17/32 •• •• handle •••• • • Open two sides d?Ilpil o ••o o•• •••Bee right,or rear side.000000 o ••• ••• • • • •••• i ••• •• Lo •• •• o N N • 000000 N • • • • • Liquid pipe :1/4(flared) ••• Voss: 11-29/32 Gas pipe :3/8(flared)(GROl9/12)9 ' ••• • 1511 19-11/16 1/2(flared)(GE15) ••• 31-1/2 NJ 1.2-23/32 6 23/32 01340 MITSUBISHI Ak ELECTRIC COOLING & HEATING Live Better Sniall HP US Satellite Boulevard T Suwanee,GA 30024 Intertek Tele:678-376-2900•Fax:800-889-9904 Toll Free:800-433-4822 www,mehvac.com FORM#MSZ-GE12NA-8–MUZ-GE12NA-201304 Specifications are subject to change without notice. ©2013 Mitsubishi Electric US,Inc. • • a . i, � s w • • � x w • • �t'i ° f� • i� p < F 4 • a r 1 _ t q - - t r t r �`,` , t lC WE ° ir` aya\i.A�tfc u�. _ _ �4 �6h�t. .:: t ;:a^ 'ki4 _ 4. a„ �Y,HTi►FAQ � f x =s . x y, e e } r S �3I r s M ro� ` ii. iFiM� - _ a t p o fj $ 7LA-- vu i ✓l C. i T _ t F d I k u MMMMOMMMW^ n M s 4 3 I s s N I • • C•• • • • • ••• w h , f, ,LLI e a : w r � t z d 1 f/ L l-_k-J-v— c,"-- ►tit(PT l Sgo go $s • .f f. .� II,II� r197n ;,,. « • • ff. •0 • f 00 =. "Soo 000fff a- goo It ---------- „ +r r C esa I 4 i I u. r 5r. �. to :. • • . • c+ Y AR 1 r F 9 f £ 4*! " } t Z r +7 .� r z � lir t1i. �i ��`��, ���,. .� .ii �'.a�a:..., •.:,.:]Fi1�.� `.l. ...� �.acS�.r..�-�c .. Via.-,`�*�o.r t�'�i,•{ ;��^s.,. d T (305)235-7213 Corporate Customer DISPATCH Y 18720 S.W,108TH AVENUE Relations \�p/,1�',,t 2 l i.i 4 .ti. MIAMI,FL33157 (866) 803-0 1 9 ,•••; TI EW W INVOICE: i IVA:- ' 8253- 061060 American Residential Services of Florida, Inc.CFC1427Ei70,CAC039629 � (� ( ww,�v.ARS.com: •.• . ' AIR CONDITIONING D••• AIR • DUCT CLEANING NAME �rj I,-� PH# 7 c L r� 'BILL TO r 6.1"►' .:C ❑RP MT DATE C' ADD 10 PH# BILL ADD : 0C 1:1 AW... ❑TO CALL# K �P� C/ST/ZP j 3 EMAIL C/ST. � � ❑OT TECH) , A. MEM, • • B. W . UCTION PSI SUPER HEAT LIQUID PRESS SUB-C COMP AMPS ODB OWB # 3 S J l I l I l IWB IDB FAN AMPS GAS PRESSURE ELECTRICHFATAMPS TEMP RISE RECOVERED REFRIGERANT I I / / LBS/ LBS DAMAGE? ❑ NO ❑ YES-See separate"Report".Tech initials_ I•: ' ' ' ' , • ORIGINAL SERVICE REQUEST ) � -7- 8 b_-A57--' f _ o See Recommendations Addendum Option# ritten customer authorization will be SUBTOTAL - o tained before beginning any unforeseen I additional or extended work. WARRANTY ITEM(S) DIAGNOSTIC , • ANYCLAIMSFORCONSTRUCTIONDEFECTSAREPARTS. BOR: FEE SUBJECT TO THE NOTICE AND CURE PROVISIONS +ORIG. EST. O SALES TAX PARTS: LABOR: SUBTOTAL OF CHAPTER 558, FLORIDA STATUTES I • BUYER'S RIGHT TO CANCEL Est.date of comp. ,• ❑.RENEW HSP "This is a home solicitation sale, and if you do ❑ CASH ❑ CHECK# PO# ❑ PURCHASE not want the goods or services,you may cancel this agreement by providing TRUCK OPERATING Written notice to the seller in person,b telegram,or mail.This,notice must ❑ VISA 0 M/C ❑ DISC ❑ AMEX ❑ OTHER $9.95 P Y 9 vY SUPPLIES 'indicate that you do not want the goods or services and must be delivered CC LAST 4#—___EXP AUTH# COMM TAX 0 or postmarked before midnight of the third business day after you sign this My signature below acknowledges that the work has been completed ' agreement. If you cancel this agreement, the seller may not keep all or part and I agree to thesumtotal of the charges and payment method. TOTAL of any cash down payment." •'I acknowledge that m right to cancel has been explained to me oral) and in Print Nam I 9 Y 9 p Y Please contact me about writing, and without waiving my right to cancel, I authorize the performance Signature Date 1 : future offers. l of the work, subject to all terms and conditions set forth on the reverse side hereof,'plus any taxes upon completion. ©2015 can Residential Services LLC.All rights reserved.(L 07/2014)Rev 033015 ARS1001 0 Signature:X Date: Miami Shores Village Building Department 10050 N.E. 2nd Avenue Miami Shores, FI 33138 Tel: 305-795-2204 Fax: 305-756-8972 5/19/2016 101 NW 99 Street Miami Shores FL 33150 RE: Process No.MC-11-15-2819 Address: 101 NW 99 Street Dear Owner, Our records indicate that the above referenced permit has expired without obtaining the proper permit approval. In order to serve you better, we need to keep our files up to date. As per section 105.3.2 of the Florida Building Code, "An application for a permit for any proposed work shall be deemed to have been abandoned 180 days after the date of filling, unless such application has been pursued in good faith or a permit has been issued." Please be advised that open permits will hinder your ability to refinance or sell this property. Please contact the Building Department,within 15 days of receipt of this letter in order to take care of this matter. Sincerely, J —) l 110 Ismael Naranjo, CBO Building Department Official 305-795-2204 ti LL J} • .T . ` �•....✓JL.eJ��/ ,kms,/ Miami Shores Village Nov s 2015 Building Department Ry:-- - -- 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel: (305)795.2204 Fax:(305)756.8972 INSPECTION'S PHONE NUMBER:(305)762.4949 BUILDING Permit No. ) PERMIT APPLICATION Master Permit No.El C 1 S- 2�0( 9 FBC 20 Permit Type: MECHANICAL--� OWNER: /Name(Fee Simple Titleholder):_ k 1C V)k)-Ca ��Sg(�QEPhone#:_5.758• g_ 7Z 1 Address: oA aJ city: . S01 1tate: .• Zip:_33 t� Tenant/Le'ssee Name: Phone#• Email: Q , JOB ADDRESS: City: Miami Shores County: Miami Dade Zip:. t>�JQ Folio/Parcel#: Is the Building Historically Designated:Yes NO Flood Zone: ,�IZ�j • UC 1-Op"12 CONTRACTOR:Company Name: ��••,,�� r �jCjj-2�S•?Z2� Address: I(a Z; QS City: UA &a-'. 2±; OO s tate .• Zip. I - 20 QualifierName: -V tk\k*15 U. �7e4n .1)K) Phon2PIJ-7225 State Certification or Registration#: c�_� 2 Qq q Certificate of Comp^^etency'#: Contact Phone#:_ 5.•87g• Email Address: DESIGNER:Architect/Engineer: Phone#: Value of Work for this Permit:$ , i Square/Linear Footage of Work: Type of Work: OAddress OAlteration ONew ,ORepair/Replace ODemolition Description of Work: A' _ 1J Submittal Fee$_�J�l W Permit Fee$ CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Bond$ Notary$ Training/Education Fee$ Technology Fee$ Double Fee$ Structural Review$ TOTAL FEE NOW DUE$ 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 ELECTRICAL WORK,PLUMBING,SIGNS, WELLS,POOLS,FURNACES,BOILERS,HEATERS,TANKS and 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 io attachment. Also, a certified copy of the recorded notice of commencement must be posted ai'the joie 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 f Signature Owner or Agent Contractor The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this(B+1-- day of ,20«,.by C � day of ,2016,by , 01FADW�� who is personally known to me or who has produced `� who is personally known to me or who has prodpced�` As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: g Sign: Si n: C HEI ?' = blic-State of Florida Print' Print' ? t Florida yComm. xpires un 22, c• . . My Commission X «;;° commission # FF 134896 Myy Comm.Expires Jun 22,2018 Commission # FF 134896 ""o of / 5p ans Examiner APPROVED BYn. Zoning Structural Review Clerk (Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) A`40R EP® CERTIFICATE OF LIABILITY INSURANCE 10/1/2016 1/5/2015 1DATE(MMI001YYYT� 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. IfSUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certiftcata does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER LOoktnn Companies NrA 1185 Avenue of the Americas,Suite 2010 PHONE FAx New York 10036 .tI= Arc Ne 646-572-7300 E WAIL INSURER s AFFORDING COVERAGE NAIC A INSUREDINSURERA:Lihert Mutual Fire Insurance Com an 23035 1073055 AMERICAN RESIDENTIAL SERVICES LLC INSURER B: ,�] 42404 RESCUE ROOTER INSURER C: $L1Tgnce Com lQ 42307 BRANCH 9700 965 RIDGE LAKE BOULEVARD INSURER D: MEMPHIS TN 38120-9401 INSURERS: COVERAGES AMERE02 CERTIFICATE NUMBER: 13750787 UAERF: THIS IS TO CERTIFY THAT THOLICIREVISION NUMBER: app { E PES 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 �O9It TYPE OP INSURANCE WVD POLICY NUMBER M COY EFF PO/LDICEXP Iw A X COMMERCIAL GENERAL LIABILITY MD LIMITS N N TB2631508631-025 10/1/2015 10/1/2016 EACH OCCURRENCE s 2 000 000 CLAIMS-MADE OCCUREMISES(E cu n S 1 000 000 MED EXP An one arson $ 10 000 PERSONAL a ADV INJURY s 2000000 GENL AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE S 4 000 000 POLICY ElJECOT- LDC OTHER: PRODUCTS-caMProPAGO $ 4 000 000 S A AUTOMOBILELIABILITYN N AS2631-508631-035 10/1/2015 l0/12016 COMB( INGLEL ZA AUTO S 2 OOO 000 OS � ASULED BODILY INJURY(Per person) S D AUTOS X NON-OWNEDBOOILY9WURY(Peracdderd) SAUTOS PROPERTY DAMAGE(Par agVd SSRELLALIAB OCCUR N N NYiSUMR715088IV 0/1/2015 10/(/2016 EACHocCURRENCE SESS LIAR CLAIMS-MADE 00O 000 AGGREGATE s 5,000,000 DED X RETENTION 10 000 WORKERS COMPENSATION S B AND EMPLOYERS,LIABILITY YIN N WC7-631-508631-015 10/(/2015 10/1/2016ANY X PER or - OFFRCEERR/MMEMBBER�EAXCLUOEDT CUnVE FN N 1 A EL EACH ACCIDENT $ 1,000,000 (Mandatory In NH) (lyes desalheunder EL DISEASE-EA EMPLOYEES 1,000,000 DESCRIPTION OF OPERATIONS bNow EL DISEASE-POLICY LiMiT S 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,AddlUcnal Remarks Schedule,may be attached If mon apace Is required) THE GENERAL LIABILITY POLICY S GENERAL AGGREGATE LIMIT APPLIES PER LOCATION AND IS SUBJECT TO A 520,000,000 GENERAL AGGREGATE POLICY LIMIT.RE:CMC 1249406 CERTIFICATE HOLDER CANCELLATION 13750787 CITY OF MIAMI SHORES SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 10050 NE 2 AVENUE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN MIAMI FL 33138 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRE ®19138-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD L/ L SLOZ-SO-LL LL:9Z:ZL 1VIiN3GIS3UNVDlH3Wbr E61,1,8£Z-SOE ' Miami Shores Village Building Department �oatvt► 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel (305) 795.2204 AIR CONDITIONING REPLACEMENT DATA Fax:(305) 756.8972 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):. 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 ARI(AHRI)DATA SHEET REQUIRED Change Disconnecting means:YES ❑ NO❑ ARHI Sheet Attached:YES NO❑ Contract Attached:YES UNIT BEING REPLACED DATA NEW UNIT MANUFACTURER 7 AHU or PKG.UNIT MODEL# 041-r ex7G COND.UNIT MODEL# KW HEAT NOM TONS • -1pl`� . 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 kHUiWU PKG PKG UNIT 1 / PKG UNIT / / EER/SEER icy 2 YES NO REPLACING DUCTS Y NO YES NO REPLACING THERMOSTAT (dES1 NO YES NO NEW 4"CONCRETE SLAB Eq NO YES NO NEW ROOF STAND YES N YES NO v NEW RETURN PLENUM BOX E NO �2 (g,*O- j oaZ5 1. Minimum Circuit Ampacity(Wire Size): BOG '� 2. . Maximum Overcurrent Protection(Fuse/Breaker Size): 3., Voltage of Circuit(208/240/480): — 235 4. Size Disconnecting Means: 3 Contractor's Company Name: iQXIA 3A3)iCQ4Phone: State Certificate or Registration N.C" -' Certificate of Competency N. Signature % Date: .7. I S (Qualifier's signature only) roperty Se arch Application-Miami-Dade County http://www.n lade.gov/propertysearcli/#/report/sunumry j= X. r OFFICE OF TRE PROPERTY APPRAISER Summary Report Generated On:8/17/2015 Property Information Folio: 11-3101-022-0380 Property Address: 101 NW 99 ST Owner JOCELYNE CENECAL& qu JOANNE LABOSSIERE " Mailing Address 101 NW 99 ST MIAMI SHORES,FL 33150-1742 awl Primary Zone 0800 SGL FAMILY-1701-1900 SO Primary Land Use 0101 RESIDENTIAL-SINGLE FAMILY: 1 UNIT Beds/Baths I Half 3/2/0 Floors 1 Living Units 1 Actual Area 2,393 Sq.Ft Living Area 1,464 Sq.Ft Adjusted Area 1,906 Sq.Ft Taxable Value Information Lot Size 9,225.36 Sq.Ft 2015 2014 2013 Year Built 1946 County Assessment Information Exemption Value $50,000 $50,000 $50,000 Year 2015 2014 2013 Taxable Value 1 $61,975 $61,087 $59,446 Land Value $150,079 $124,681 $83,120 School Board Building Value $132,658 $129,226 $129,226 Exemption Value 1 $25,000 $25,000 $25,000 XF Value $0 $0 $0 Taxable Value 1 $86,975 $86,087 $84,446 City Market Value $282,737 $253,907 $212,346 Exemption Value $50,000 $50,000 $50,000 Assessed Value $111,975 $111,087 $109,446 Taxable Value $61,975 $61,087 $59,446 Benefits Information Regional Benefit Type 2015 2014 2013 Exemption Value $50,000 $50,000 $50,000 Save Our Homes Assessment Taxable Value $61,975 $61,087 $59,446 Cap Reduction $170,762 $142,820 $102,900 Homestead Exemption $25,000 $25,000 $25,000 Sales Information Second Exemption $25,000 $25,000 $25,000 Previous Price OR Qualification Description Homestead Sale Book-Page Note:Not all benefits are applicable to all Taxable Values(i.e.County,School 06/01/2005 $0 23589-2092 Qual by exam of deed Board,City, Regional). 06/01/1988 $0 13732-3174 Qual by exam of deed 12/01/1984 $50,000 12456-2607 2008 and prior year sales;Qual by Short Legal Description exam of deed GOLD CREST PB 21-56 LOT 7 E1/2 OF LOT 8 BLK 5 LOT SIZE 85.420 X 108 OR 13732-3174 0688 4 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 Mami-Dade County assumes no liability,see full disclaimer and User Agreement at http://www.miamidade.gov/info/disclaimer.asp Version: 1 of 1 8/17/2015 12:55 PM