MC-17-681 Permit No. 111C-3-17-681
Miami Shores Village � Pet7t7t h0ohanical-Residential
10050 N.E.2nd Avenue NE �{�j) „��/b Viµ' ' /�yry M [� �y��� {
n qp V ata CISS01caffow AIC,Repla �acrrent
Miami Shores,FL 33138-0000 e�
h ie Phone: (305)795-2204 ' li 'StetU$.APPROVED
�t RivA
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Is$u :4l10f2017 Expiration: 10/07/2017
Project Address Parcel Number Applicant
86 NE 109 Street 1121360110330
Miami Shores, FL 33161- Block: Lot: THOMAS AND REBECCA TELES f
Owner Information Address Phone Cell
THOMAS AND REBECCA TELESCO 86 NE 109 Street (305)751-1786
MIAMI SHORES FL 33161-7040 1
Contractor(s) Phone Cell Phone Valuation: $ 9,900.00
SERVICE EXPERTS HEATING&AIR C (305)264-2020
Total Sq Feet: 0
Tons:4 Available Inspections:
Additional Info:EXACT CHANGE OUT 4 TON A/C SYSTEM W Inspection Type:
Classification:Residential Final
Approved:In Review Review Mechanical
Comments: Date Approved::In Review
Date Denied: Type of Work:EXACT CHANGE OUT 4 TON A/C SY
Scanning:3
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $6.00
DBPR Fee Invoice# MC-3-17-63301
$5.20 03/14/2017 Credit Card $50.00 $331.90
DCA Fee $5.20
Education Surcharge $2.00 04/10/2017 Credit Card $331.90 $0.00
Permit Fee $346.50
Scanning Fee $9.00
Technology Fee $8.00
Total: $381.90
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.
OWNERS AFFIDAVIT: I certify t t a I the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zoning. Futhermo e,I a onzA�ab named contractor to do the work stated.
April 10, 2017
Authorized Signature Owne . / Applicant / Contractor / Agent Date
Building Dep a t Copy
April 10, 2017 1
50S• 323 OSfl
,-kSS, CA An-os+
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972 [
y ` INSPECTION LINE PHONE NUMBER:(305)762-4949 13 mss/
FBC 201LA
BUILDING Master Permit No. MC-
PERMIT APPLICATION Sub Permit No.
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING •MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
` CONTRACTOR DRAWINGS
JOB ADDRESS: 0� "" 10 �
City: Miami ShoresCounty: Miami Dade Zip: 53 '(0 1
Folio/Parcel#: I I ° -2 1 3 0 - ()I i , 0 3 30 Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE::d FFE:
-2
OWNER:Name(Fee Simple Titleholder): ak— Phone#: `1 ` 2— (a 6�
Address: �JU 10
0/
City: ( 'dt i Stater l Zip:
Tenant/Lessee Name: J v/ Phone#:
Email: C�
CONTRACTOR:.Company Name: e (�� � � Phone#: 3 u's _j !� � ��30
Address: is 2- 1 !vu-)
City: �o-"�� State: Zip: 3-� �—
Qualifier Name:
` 4 ,� Phone#:
State Certification or Registration#. Zltertificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: // City: State: Zip:
Value of Work for this Permit:$1;;—t 0o Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ,�.� Repair Replace ❑ Demolition
Description of Work: ' _' �®` ckki- `l & :50SL=c*`
1,01 t jeAe
Specify color of color thru tile:
Submittal Fee$ Permit Fee$ CCF$ CO/CC$
Scanning Fee$ Radon Fee$ z® DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$ `
TOTAL FEE NOW DUE$ I • ��
(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.
r-' I /-2x2,-�,
Signature—Y Signature
OWNER or AGENT ONTRACTOR
The foregoing instrument was ack wledged before me this The foregoing instrument was acknowledged before me this
21- day of +' 20 J by — day of dll� 20 by
9 J l�ld;ih9is personally known to �,` o sonally known t
me or who has produced-L,I r�n ' as me or who has p oduced as
identification and who did take an oath. 12-D'67 identification and who did take an oath.
NOTAR Pt� LIC: f 6�) 6® NOTAR BLIC:
.°e�•�
JESSICA ACOSTA
Sign: MY COMMISSION#FF 010901 Sign: o� "'��,� JESSICAACOSTA
EXPIRES:May 13,2017
Print: =,FQ�,o�°P BondedThruBudgetNotaryServices Print: * * EXPIRES:May 13,2017
BondedThru 9e
Seal: Seal:
\ �x**�x**�*aux+�t*a�*�*��x��aa�a��*�*��*+�x*m����*���x*�x�x�x�xa��x��a�**�x��x
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
I
5 ° yam Miami Shores Village
Building Department
�.... p,n 10050 N.E.2nd Avenue
Miami Shores, Florida 33138
jry 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.
Job Address(where the work is being done): 6 ! S� f
City: Miami Shores Village County: Miami Dade Zip Code:f
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 Eg/ARHI Sheet Attached:YES EVN O❑ Contract Attached:YES
UNIT BEING REPLACED DATA NEW UNIT
MANUFACTURER 1`0b
AHU or PKG. UNIT MODEL#
® D COND. UNIT MODEL#
KW HEAT
NOM TONS
AHU CU 2f--.-,PKG 1)M.C.A AHU CU PKG
AHU CU,40 PKG 2)M.O.P AHU CU P G
AH G 3)VOLTS AHIf'
PKG UNIT / / PKG UNIT
EER/SEER
YES NO REPLACING DUCTS YES NO
YES NO REPLACING THERMOSTAT YE -Wo-
YES
0
YES NO NEW 4"CONCRETE SLAB YES NO
YES NO NEW ROOF STAND YES
YES NO NEW RETURN PLENUM BOX YES O
1. Minimum Circuit Ampacity(Wire Size): 10 d
2. Maximum Overcurrent Protection (Fuse/Breakers e): 0 ��
3. Voltage of Circuit(208/240/480): 240
4. Size Disconnecting Means: / o
Contractor's Company Name: S41a-jo- Phone: 3or5 � 151q' i
tD
State Certificate or Registration No. Certificate of Competency No. ®`
Signature Date: 31 All ?
(Quaiifle signature)
(Revised02/24/2014)
® �k
Certificate of Product 'Katin s
AHRI Certified Reference Number. 7621928 Date:3/2/2017
Product:Split System:Air-Cooled Condensing Unit,Coil with Blower
Outdoor Unit Model Number:XC16SO48-230-04
Indoor Unit Model Number:CBX32MV4W+TDR+TXV
Manufacturer: LENNOX INDUSTRIES,INC.
Trade/Brand name: LENNOX
Region:Southeast and North(AL,AR,DC,DE,FL,GA,HI,KY,LA,MD, MS,NC,OK,SC,TN,TX,VA
AK,CO,CT,ID,IL,IA,IN,KS,MA,ME,MI,MN,MO,MT,NO,NE,NH,NJ,
NY,OH,OR,PA,RI,SO,UT,VT,WA,WV,WI,WY,U.S.Territories)
Region Notre: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 regionis)for which they meet the regional efficiency requirement
Series nameFUdT *C�18SCt1ES
r
ManufcrI resririrg't �ttE11 �qtr
Ratedfollvins in. rdaahcewrtlitHRIS ta1l �1001fs�C tTn A�€cSrldii�tlrt arc A Source
Heat #+ern+ �tMeratifiguRtrA for#s�s�rtitird
party -
R :: = 8,NM -
v
1l= Rating{Cooling):
I�.
Ratings followed by an asterisk i9 indicate a voluntary terata of previously published data,unless accorypanied with a WAS,wNch Indicates an involuntary retate.
DISCLAIMER
AHRI does not endorse the produd(s)listed on this CerHflrate and makes no representations,warranties or guarantees as to,and assumes no responsibility for,
the product(s)[Wed on this Certificate.AHRI egressly disclaims all Raiff ft 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 ordy for mods and oorrflguratiors listed In the
dlretdory at mw ah"Yoctory.org.
€. TERMS AND CONDITIONS
This Certificate and Its contents are proprietary products of AHRI.This CerW=te stroll only be used for individual,personal and �...w
confidential reference purposes The contarft of this Certifhcatq may riot.In whole or in part,be reproduced;ccos4 dissemhtated;
entered into a computer database-,or othisn ds®utilize.In any form or marateir or by any means,apt for the users btdividuai,
personal and confidential reference ti T4roe,
CERTIRCATE VERIRCATiON REFFgeERA11ON INSTITIiTE
The Information for the modal cited on Uds oertiRcate can be verifled at maw.alaidtrectorp org,dick on`Verify Ce°°RRcate"link
use make lift ix_ttrr"
and enter the AHRI Certified Reference Number and the date on which the cedWaWA was Issued.
which Is listed above,and the Certificate No,which Is lied at Iroitom rightx "` ]3] 51544
02014Air-Conditioning, Heating,and Refrigeration Institute �����������
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