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RC-16-1500Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 1223 NE 102 Street Miami Shores, FL 33138- Owner Information denlls#tiraic DANIEL & MARYANNE DAMMRICH Address Parcel Number 1132050250140 Block: Lot: 1223 NE 102 Street MIAMI SHORES FL 33138- 1223 NE 102 Street MIAMI SHORES FL 33138- Alt ►PPROV Expiration: 12106/2016 Applicant DANIEL & MARYANNE DAMMRII Phone Cell Contractor(s) HOME OWNER Phone CeII Phone Valuation: Total Sq Feet: $ 17,000.00 230 Approved: In Review Comments: Date Approved: : In Review Date Denied: Type of Construction: KITCHEN AND 1 BATH RENOVATIC Stories: Front Setback: Left Setback: Bedrooms: Plans Submitted: No Certificate Date: Bond Return : Occupancy: Single Family Exterior: Rear Setback: Right Setback: Bathrooms: Certificate Status: Additional Info: Classification: Residential Fees Due CCF CO/CC Fee DBPR Fee DCA Fee Education Surcharge Notary Fee Permit Fee Scanning Fee Technology Fee Total: Amount $10.20 $50.00 $7.65 $7.65 $3.40 $5.00 $510.00 $9.00 $13.60 $616.50 Pay Date Pay Type Invoice # RC -6-16-59990 06/09/2016 Credit Card 06/01/2016 Credit Card Amt Paid Amt Due $ 566.50 $ 50.00 $ 50.00 $ 0.00 Available Inspections: Inspection Type: Final PE Certification Window Door Attachment Framing Insulation Drywall Screw Fill Cells Columns Window and Door Buck Review Planning Review Electrical Review Electrical Review Mechanical Review Plumbing Review Building Review Structural 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 AFFIDI IT: Icertify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating , I authorize the above-named contractor to do the work stated. Owner / Applicant / Contractor / Agent Building Department Copy June 09, 2016 Date June 09, 2016 1 \\C° (0\, f(-- Building Department Miami Shores Village BUILDING PERMIT APPLICATION 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 �� FBC 200 R Master Permit No. L- 6 ®B oci Sub Permit No. BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL Ei PLUMBING ❑ MECHANICAL 0PUBLIC WORKS ❑ CHANGE OF CONTRACTOR JOB ADDRESS: `223 S`klrr'QA-- ❑ CANCELLATION ❑ SHOP DRAWINGS City: Miami Shores County: Miami Dade Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: Zip: OWNER: Name (Fee Simple Titleholder): J /l.\a'1AI.‘52 4J6i=6)C)V---- Phone#: Sbert.Q3B� Address: `25L -S N \r-52� City: S� ���1 r �S State: Zip: -313)-• Tenant/Lessee Name: Phone#: Email: MN -10-1,N-10 & 6r-AJ'A, C OJv,KQ i PJ+C.�/L- Phone#: 3 -Sa. lQ \ Address: VIZI lJ SAV. k a City: '1��)1 A State: Zip: CONTRACTOR: Company Name: Qualifier Name: Phone#: State Certification or Registration #: Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: y (' / City: State: Zip: VValue of Work for this Permit: $ I 1 -- Square/Linear Footage of Work: Type of Work: ❑ Addition Erlteration ❑ New ❑ Re�airO/ROep\'la-c.e ❑CDemolit QioJn Description of Work: (..2A/QA. ' A\* -� _" SLickv,c9eV-k Y\ (v-C.Q it • ...ALI ' IPA& -1C(�,1 \VNMAA .1' ► !� , oo & , 1 Yig .\N!! a �—= V__ 1L Spety color o color !hr t, Submittal Fee $5C.) Scanning Fee $ Technology Fee $ 13.60 Permit Fee $ CCF $ (0 • 2- 0 Co/CC $ EO .00 Radon Fee $ • G a DBPR $ G 5 Notary $ ° Structural Reviews $ (Revised02/24/2014) Training/Education Fee $ 3 ° 4 0 Double Fee $ O Bond $ TOTAL FEE NOW DUE $ 66 �� 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signatu Alt WNER or AGENT The foregoing instrument was acknowledged before1me this day of \SIaSL , 20 1l , by CLAY•12.. _,*is personally known to me or who has produced v � ‘-X2-(\-/ identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: . ..g���•� x.11 "" v' bbl as .• .?a$�nn ',vs - 42 '• s • SEs • o (4� CcAra o^ L.);" i0lF14dt►r'����sa �Nli� Signature CONTRACTOR The foregoing instrument Was acknowledged before me this 1 day of C 1,IA/N-Q-- , 20 III/ , by Cv is personally known to me or who has prcfiuced identification and who did take an oath. NOTARY PUBLIC: as Sign: Print: Seal: *********************************************************************************************************** APPROVED BY (Revised02/24/2014) Plans Examiner Structural Review Zoning Clerk Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 �, 1 aOWNER BUILDER DISCLOSURE STATEMENT 1 NAME: 1v\vvitaxeuNc2 1C DATE: � `j �1 ADDRESS: \ZZS S ®®7 S�t Do hereby petition the Village of Miami Shores to act as my own contractor pursuant to the laws of the State of Florida, F.S 489.103(7). And I have read and understood the following disclosure statement, which entitles me to work as my own contractor; I further understand that I as the owner must appear in person to complete all applications. State Law requires construction to be done by a licensed contractor. You have applied for a permit under an exception to the law. The exemption allows you, as the owner of your property, to act as your own contractor even though you do not have a license. You must supervise the construction yourself. You may build or improve a one -family or two-family residence. You may also build or improve a commercial building at a cost of $25,000.00 or less (The new form states 75,000). The building must be for your own use and occupancy. It may not be built for sale or lease. If you sell or lease a building you have built yourself within one year after the construction is complete, the law will presume that you built for sale or lease, which is a violation of this exemption. You may not hire an unlicensed person as a contractor. It is your responsibility to make sure the people employed by you have licenses required by state law and by county or municipal licensing ordinances. Any person working on your building who is not licensed must work under your supervision and must be employed by you, which means that you must deduct F.I.C.A and with -holdings tax and provide workers' compensation for that employee, all as prescribed by law. Your construction must comply with all applicable laws, ordinances, buildings codes and zoning regulations. Please read and initial each paragraph. 1. I understand that state law requires construction to be done by a licensed contractor and have applied for an owner -builder permit under an exemption from the law. The exemption specifies that I, as the owner of the property listed, may act as my own contractor with certain restrictions even though I do not have a license. Initial 1kil) 2. I understand that building permits are not required to be signed by a property owner unless he or she is responsible for the construction and is not hiring a licensed contractor to assume responsibility. Initial VAIN) 3. I understand that, as an owner builder, I am the responsible party of record on a permit. I understand that I may protect myself from potential financial risk by hiring a licensed contractor and having the permit filed in his or her name instead of my own name. I also understand that the contractor is required by law to be licensed in Florida and to list his or license numbers on permits and contracts.co ' Initial k" '�v 4. I understand that I may build or improve a one family or two-family residence or a farm outbuilding. I may also build or improve a commercial building if the costs do not exceed $75,000. The building or residence must be for my use or occupancy. It may not be built or substantially improved for sale or lease. If a building or residence that I have built or substantially improved myself is sold or leased within 1 year after the construction is complete, the law will presume that I built or substantially improved it for sale or lease, which violates the exemption. Initial I . U� 5. I understand that, as the owner -builder, I must provide direct, onsite supervision of the construction. Initial 6. I understand that I may not hire an unlicensed person to act as my contractor or to supervise persons working on my building or residence. It is my responsibility to ensure that the persons whom I employ have the license required by law and by�county or municipal ordinance. � Initial N�y2>• 7. I understand that it is frequent practices of unlicensed persons to have the property owner obtain an owner -builder permit that erroneously implies that the property owner is providing his or her own labor and materials. 1, as an owner -builder, may be held liable and subjected to serious financial risk for any injuries sustained by an unlicensed person or his or employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an owner -builder and am aware of the limits of my insurance coverage for injuries to workers on my property. Initial Mii) 8. I understand that I may not delegate the responsibility for supervising work to be a licensed contractor who is not licenses to perform the work being done. Any person working on my building who is not licensed must work under my direct supervision and must be employed by me, which means that I must comply with laws requiring the withholding of federal income tax and social security contributions under the Federal Insurance Contributions Act (FICA) and must provide workers compensation for the employee. I understand that my failure to follow these may subject to serious financial risk. Initial \Alt) 9. I agree that, as the party legally and financially responsible for this proposed Construction activity, I will abide by all applicable laws and requirement that govern owner -builders as well as employers. I also understand that the Construction must comply with all applicable laws, ordinances, building codes, and zoning regulations. Initial -) 10. I understand that I may obtain more information regarding my obligations as an employer from the Internal Revenue Service, the United States Small Business Administration, and the Florida Department of Revenues. I also understand that I may contact the Florida Construction Industry Licensing Board at 850.487.1395 or http://www.myfloridalicense.com/dbpr/pro/cilb/index.html Initial 11. I am aware of, and consent to; an owner -builder building permit applied for in my name and understands that I am the party legally and financially responsible for the proposed construction activity at the following address: 122; N.?- IcrLvp 9-v €_- _ NlL0,6, "t. 2,312A. Initial ` A/1 12. I agree to notify Miami Shores Village immediately of any additions, deletions, or changes to any of the information that I have provided on this disclosure. Initial • Licensed contractors are regulated by laws designed to protect the public. If you contract with a person who does not have a license, the Constr4uction Industry Licensing Board and Department of Business and Professional Regulation may be unable to assist you with any financial loss that you sustain as a result of contractor may be in civil court. It is also important for you to understand that, if an unlicensed contractor or employee of an individual or firm is injured while working on your property, you may be held liable for damages. If you obtain an owner -builder permit and wish to hire a licensed contractor, you will be responsible for verifying whether the contractor is properly licensed and the status of the contractor's workers compensation coverage. Before a building permit can be issued, this disclosure statement must be completed and signed by the property owner and returned to the local permitting agency responsible for issuing the permit. A copy of the property owner's driver license, the notarized signature of the property owner, or other type of verification acceptable to the local permitting agency is required when the permit is issued. day of y , 20 lQ Was acknowledged before me this By ithaitla.76,1tiiktliti( • who was personally known to me or who has Produced there License or NOTARY Miami Shores Village 10050N.€. 2nd Avenue Miami Shores, FL 33138-0000 Phone: (305)795-2204 Fax (305)756-8972 INSPECTION REQUESTS: (305)762-4949 or Log on at http s://bldg.miarnishoresvillage comlcap REQUESTS ARE ACCEPTED DURING 8:30AM - 3:30PM FOR THE FOLLOWING BUSINESS DAY. Requests must be received by 3 pm for following day inspections. Residential Construction Parcel #:1132050250140 Owner's Name: DANIEL & MARYANNE DAMMRICH Job Address: 1223 NE 102 Street Bond Number: Miami Shores, FL 33138- Contractor(s) 3138 Contractor(s) HOME OWNER Phone Primary Contractor Yes Owner's Phone: Total Square Feet: 230 Total Job Valuation: $ 17,000.00 WORK IS ALLOWED: MONDAY THROUGH FRIDAY, 8:OOAM 7:OOPM. SATURDAY 8:OOAM - 6:00PM. NO WORK IS ALLOWED ON SUNDAY OR HOLIDAYS. • BUILDING AND ROOFING INSPECTIONS ARE DONE MONDAY THROUGH FRIDAY. 1 r4,lj,s,6:-- 0,k iz,1 - A9444... 04,Ct. p-hy-4,,i of- it...kitC.A, I„,t4 he& /J As- r,•t. / - ' 4\r'. - hT k17Yiti(.e4. 1 S 40u) q' G A c TAt<4���T3d{'-S dF Q Y01,4G NO INSPECTION WILL BE MADE UNLESS THE PERMIT CARD IS DISPLAYED AND HAS BEEN APPROVED. PLANS ARE READLY AVAILABLE. IT IS THE PERMIT APPLICANT'S RESPONSIBILITY TO ENSURE THAT WORK IS ACCESSIBLE AND EXPOSED FOR INSPECTION PURPOSES. NEITHER THE BUILDING OFFICIAL NOR THE CITY SHALL BE LIABLE FOR EXPENSE ENTAILED IN THE REMOVAL OR REPLACEMENT OF ANY MATERIAL REQUIRED TO ALLOW INSPECTION. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN --YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. INSPECTI STRUCTURAL INSPECTION DATE Foundation Stemwall Slab Columns (1st Lift) Columns (2nd Lift) Tie Beam Truss/Rafters Hoof Sheathing Bucks Windows/Doors Interior Framing a... Insulation Ceiling Grid Drywall Firewall Wire Lath Pool Steel Pool Deck Final Pool INSP Final Fence Screen Enclosure Driveway Driveway Base Tin Cap 'Roof In Progress Mop in Progress 'Final Roof Shutters Attachment Final Shutters Rails and Guardrails Soil Bearing Cert_._ Soil Treatment Floor Elevation Survey Reinf Unit Mas Cert Insulation Certificate- Spot Survey Final Survey Truss Certification STRUCTURAL COMMENTS ZONING INSPECTION DATEINSP; Zoning Final ZONING COMMENTS ELECTRICAL INSPECTION DATE ;INSP Temporary Pole 30 Day Temporary -- Pool Deck Bonding Pool Wet Niche Underground Footer Ground Slab Wall Rough Ceiling . s gra--.. Telephone " ouch one Final TV Rough able lntereom Intercom Phial Alarm Rough Alarm Final Fire Alarm Roup Fire Alarm Final FIRE INSPECTION DATE INSP IME=2111111111 Fina) Alarm FINAL. e Rough Top Out Fire Sprinklers Septic Tank i4. Sewer Hook -u Roof Drains Gas LP Tank well Lawn Sprinklers MainDrain Pool Piping Backflow Preventor Interceptor Catch Basins Condensate Drains frAit 1„a4 o 1( Ir' ECHAN1CAL INSPECTION DATE INSP Underground Pipe Rough Ventilation Rough Hood Rough Pressure Test Anal Hood Final Ventilation Final Pool Heater Final Vacuum MECHANICAL. COMMENTS ti Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-271274 Permit Number: RC -6-16-1500 Scheduled Inspection Date: November 21, 2016 Permit Type: Residential Construction Inspection Type: Final Building Owner: DAMMRICH, DANIEL & MARYANNE Work Classification: Alteration Inspector: Diaz, Guillermo Job Address: 1223 NE 102 Street Miami Shores, FL 33138 - Project: <NONE> Contractor: HOME OWNER Phone Number Parcel Number 1132050250140 Building Department Comments KITCHEN AND 1 BATH RENOVATION Infractio Passed Comments INSPECTOR COMMENTS False Passed Failed Correction Needed Re -Inspection Fee No Additional Inspections can be scheduled until re -inspection fee is paid. Inspector Comments CREATED AS REINSPECTION FOR INSP-271128. 11/16/2016 cancelled > maryan D \-2dC November 18, 2016 For Inspections please call: (305)762-4949 Page 35 of 45 NOTICE OF COMMENCEMENT A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION PERMITNOO,(.4Q -1(9— 1SDIAX FOLIO NO.k\-'3Z-OS-0.--OKi0 STATE OF FLORIDA: COUNTY OF MIAMI-DADE: THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property, and in accordance with Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement. no 19thk4,l C642:614 111110 11111 11111 11111 1111111111 11111 1111 1111 CFN 20 a:i1.6R.a 0439884 OR BK 30170 F's 42 (1F'ss ) RECORDED 07/28/2016 11:19 W HARVEY RUVIN CLERK OF COURT M NI-DADE COUNTY! aOR DH ^ l Space above reserved for use of recording office 1. Legal description of property and street/address:- 1A�_ o 0DC M'.O JAAA 91ID12G-S 11 T)2z, %e, Description of Improvement: 113(942- Vacommit, 1rv�,wlcuvveti2. VaAtvtnaaAc to 1243 0e, VD -Lt -t• SrF IULLUAAA sbto � 3313f gibeig 3. Owner(s) narfie and address: Interest in property: Div h,QJr Name and address of fee simple titleholder: 4. CoRtractor's/,tnamaddressehone number: ,L. .�-:_ �� ►_� u.,..r�- - � l"; -„ ter •rs 5. Surety: (Payment bond required by owner from contractor, if any) Name, address and phone number: N` N. Amount of bond $ (U/Ir 6. Lender's name and a dress: Nth 7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided by Section 713.13(1)(a)7., Florida Statutes, Nam ,`address and phone number: mamiamtQ_ 1OO W.4MdttCi' tris . 107_, St . MAGi mt S1r1UY2- E 1 _s7j b -7,B5-588-(Osla: 8. In addition to himself, Owners designates the following person(s) to receive a copy of the Lienor's Notice as provided in Section 713.13(1)(b), Florida Statutes. Name, address and phone number: L* W\ ,W1.IC, thk �[ °U lS IRNA,\ �NQ, c�-e_ I L Glob tr. SBErl — 214 — yl ca 9. Expiration date of this Notice of Commencement: (the expiration date is 1 year from the date of recording unless a different date is specified) WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713.13. FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING VOUn NOTICE OF COMMENCEMENT. 33188 Signature(s) of Owner(s) or Owner(s)' Authorized Officer/Director/Partner/Manager Prepared By Wct2' Pt1nk�G ViVIA,:Indil (Ai\ Prepared By M Print Name P % i/244”, Q. t P Mi &f 4 Gin Print Name Title/Office �IJ'1�- Title/Office STATE OF FLORIDA COUNTY OF MIAMI-DADE The fgregoing instrument w acknowledged before me this 2 g day of '.J (Al By MM 0r% Cknrve. Cnwar) rick ❑ Individually, br ❑ as for ❑ Personally known, or -produced the following type of identific Signature of Notary Public: Print Name: (SEAL) VERIFICATION PURSUANT TO SECTION 92.525. FLORIDA STATUTES Under penalties of perjury, I declare that I have read the foregoing and that the facts stated in it are true, to the best of my knowledge and belief. 2rcp Si _• nat B s of 0 - - - . r Owner(s)'s Authorized Officer/Director/Partner/Manager who signed above: IA A../ 1,/ 123.01-52 PAGE 3 3/10 ALEXANDRA BLANCO NOTARY PUBLIC STATE OF FLORIDA Comm# EE846875 Explres 10/28/2016 By a. f cont a tvVv r t G I- YI 12 23 SIE 10 1(4tatAt Skm; FL s-stss Leved 1 Atk'0I10 n Miami S lures ViNao^e APPROVED BY DATE 7O Wr \ DE -PT fp. Cj nr-PT .� j//t. CT?C)flO r'IVI! II1 LHN wo,'11- 41(5 aft et, ADD SMOKE/CARBON MONOXIDE uE i EC R'ORS. ANY AND ALL CLOTH AND RUBBER INSULATED CONDUCTORS TO BE REPLACED, BATHROOM RECEPTACLE ON 20 AMP CKT AND G.F.I PROTECTED ;gvLIC uw zU HMP CKT AND G.F.I PROTECTED lNol-t( Jo,4 Qv.)Tti-b (JQ,v, van L f /Sl \Je,A) To I k* 'New FOOA,Cc,T Otpiactivvn4- of -45.6( aoacg J u9 1Vl Pac S O ca. REC JUN 01 MAY 0 9 201 This formmust�ac company ALL air conditioning replacement permit applications. Each un' chahg-out!musii be orris heet. Multiple units on single sheets are not acceptable. w k ores Village epartment d Avenue rida 33138 5) 795.2204 5) 756.8972 AIR CONDITIONING REPLACEMENT DATA PERMIT NUMBER: MC Job Address (where the work is being done): 1223 NE 102 ST. City: Miami Shores Village County: Miami Dade Zip Code: 3 ALL CONDENSING UNITS MUST BE ON A 4 INCH SOLID CON RFT AU. UNITS MUST COMPLY WITH F.E.M.A MINIMUM FLOOD ELEVATI + N A COPY OF THE CONTRACT IS REQUIRED WITH ALL SUBMITALS AHRI DATA SHEET REQUIRED Change disconnecting means: YES ❑ NO Q ARHI Sheet Attached: YES Q NO ❑ Contract Attached: YES UNIT BEING REPLACED DATA NEW UNIT jheeAy MANUFACTURER c AeeIER l 1%''L 2. V a"// al-V31r PKG. UNIT MODEL # F)(14 PA/F o s/ 12 -A/c A 01/F COND. UNIT MODEL # Z v' A e C 6 4, 1 O KW HEAT I v 61 NOM TONS 4 AHU Ify CU 2,/,_ PKG 1) M.C.A AHU `f i4 Cu 18 PKG AHU Co CU ti 0 PKG 2) M.O.P AHU eo CU 40 PKG AHU 230 CU l) PKG 3) VOLTS AHU 23oCU?. o PKG PKG UNIT / / PKG UNIT / / I 'L EER/SEER 1G. YES NO REPLACING DUCTS YES �O: YES NO REPLACING THERMOSTAT L:.:.�' NO YES NO NEW 4"CONCRETE SLAB YES NO YES NO NEW ROOF STAND YES N YES NO NEW RETURN PLENUM BOX YES O) 1. Minimum Circuit Ampaciity (Wire Size): ? + l� 2. Maximum Overcurrent Protection (Fuse/Breaker Size): 4 0 60 3. Voltage of Circuit (208/240/480): -1 = : • • • • • • CSeS ..• U A 15 rs� •• • • • •.• 4. Size Disconnecting Means:•'� � � = .' Phone: 954-7924942 Contractor's Company Name: CAPITAL AIR, INC. 71./6-' ' • • • State Certificate or Registration No. CACO 8746 Certificate of CompV.anctNo.• • • • • •• • • • /` ' St • ... . Signature Date:• • • • • (Qualifiers signature) • ••• (Revised02/24/2014) ••• • . • • • • • • • • • . • •• •• •.• • • • • ••• • • • • • • • ••• • • • • • • • • • • •• • • • • • ••• • - CERTIFIED www.ahridirectory.org This combination qualifies for a Federal Energy Efficiency Tax Credit when placed in service between Feb 17, 2009 and Dec 31, 2016. Certificate of Product Ratings AHRI Certified Reference Number: 6937499 Date: 5/6/2016 Product: Split System: Air -Cooled Condensing Unit, Coil with Blower Outdoor Unit Model Number: 24ABC648A**31 Indoor Unit Model Number: FX4DN(B,F)049L Manufacturer: CARRIER AIR CONDITIONING Trade/Brand name: CARRIER 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, ND, NE, NH, NJ, NY, OH, OR, PA, RI, SD, UT, 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: COMFORT SERIES PURON AC Manufacturer responsible for the rating of this system combination is CARRIER AIR CONDITIONING 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): 46500 EER Rating (Cooling): 13.00 SEER 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 • • ••i • • • • ••• AHRI does not endorse the product(s) listed on this Certificate and makes no representations, warranties or guarantees Aso, aaassuruesiio jesMIbiTliav for, the product(s) listed on this Certificate. AHRI expressly disclaims all liability for damages of any kind arising out of the use or peArntepCe dIfIlle p odect(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.ahrldirectory.org. TERMS AND CONDITIONS • • • • • • This Certificate and its contents are proprietary products of AHRI. This Certificate shall only be used for Individual, trsenal end • ,L • • confidential reference purposes. The contents of this Certificate may not, in whole or in part, be reproduced; copied; di$seninate41; • •. • • • - • • entered Into a computer database; or otherwise utilized, in any form or manner or by any means, except for the user sindiWdeai, • • • personal and confidential reference. • AIRCONDITIQI G, RENING, CERTIFICATE VERIFICATION & REFRIGERATION INS•TRUTE 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. • • •• •• • • • • ©2014 Air -Conditioning, Heating, and Refrigeration Institute CERTIFIcAT.IV��"4 • 310/0343452832163 • ••• • i • ••• • • • • • • • e• • 4 • • • •ft• CARRIER CUBE UNITS BASED ON A REVIEW AND ANALYSIS THE FOLLOWING UNITS CONFORMS TO THE 2014 FLORIDA BUILDING CODE AND THE ASCE 7-10 WIND ANALYSIS CODE. SEE ENCLOSED ANCHORING DETAIL REQUIREMENT AS SPECIFIED IN SECTION 1620 , HIGH VELOCITY HURRICANE ZONES- WIND LOADS FOR MAX WIND SPEED OF 180 MPH AND MAX HEIGHT OF 60 FEET. CARRIER AIR CONDITIONER MODEL LIST FOR UTC 'CUBE STYLE BASE PAN UNITS" UNITS UP TO ag' HIDE FOR 180 MFH WIND VELOCITY WITh A MAXIMUM BUILDING HEIGHT OF 53 EXPOSURE "D'' UNITS OVER 39- I-PIGH TO 44' HIGH FOR 180 MPH WIND VELOCITY` WITH A MAXIMUM BULDING HIBGHT OF 5.0 EWOSURE -D`' UNITS OVER 44HIGH TO AG' E-110-1 FOR 180 MPH WIND VELOCITY WITH A MAXIMUM BUILDING HEIGHT OF CO EXPOSURE -C" FA12NR (1.5-3.5 ton, 5 ton) PA13NR (4 tort) PH 13NR 15 ton) CA13 (all tonnag ..) CA18 (1.5 -4 Ton) CA15 (E- Ton) 24A,BEZ Ian tonnage) 24.ABB3C fall tonnag ) 24.419D5 NZ thru 4 Tun( 244.EICE 15 Ton) 24ACEE3 (all tonnages) 24ACCS (1.5-4 Tcn) 24ACCS( 5 Ton) 24ACB7 (2-4 Ton) 24ACB7 15 Ton) 24ANB5 (1.5-3 Tun) 24AN Be (3.5-4 Ton) 244,14E5 (5 Ton) 24ANB7 (.2-3 Tun) 24AN B714 Ten) 24ANB7 t5 Ton. sees 0) 24ANB7 ( 5 T011, series 1) 24AN81 (2 -3,4 .5 Ti. serbE 1) 24ANI31(2 -3,4 ,5 Tort. series 1) 2IAN9136 (3 ton) 24AN83.48 fa ton) 24AN 8260 (5 ton) CARRIER HEAT PUMP MODEL UST FOR UTC -CUBE STYLE BASE FAN UNITS' UNITS UP TO 39' HIGH FOR 180 MPH vVIND VELOCITY WITH A MAXIMUM BUILDING HBG -IT OF 50" EXPOSURE 'ID' UNITS OVER 39" HIGH TO 44 ' HIGH FOR 180 MF1-E WIND VELOCITY WITH A MAXIMUM BUILDING HEIGHT OF 50 EXPOSURE "D" UN ITS OVER 44' HIGH TO 48- HIG-E FOR 180 MFH WIND VELOCITY WITH A 1),14.4 MUM BULDING HBGHT OF 50 ENPIMURE PH12NR 11.5-4 thrt) Chk'd By: R. Samara PH 13NR 15 ton) CI -113 1911 tonnages) 2.51-1BE3 (all tc•nriages) 251-1BE3C (all tonnages) 2.,.c•I-IBC3 (all tortnagt) 251-IBC5 (911 to rtn alg ) 253-1CO3 (all tonnag ) 2.51-I CD4 f ell tam sgE.:1 251-ECC5 (all tortnag t) zHcee fall tonnages) 2514C13.5 (5ton) 2.5H NI35 (1.5-4 tan) 01-INB5 (5 ton) 251-INH5 (2-3.5 ton) 251-lNH5 (4 ton) 01-INB•512-4 ton) 25HNBS (5ton) 251-11189 12 ton series 11 251-114B9 (2 ton series 0) 251-INB9 (3-5 ton) 25VNALI (all tonnages) NOTE: ALL OF THE WIND RESISTING EXTERIOR PANELS, INDIVIDUALLY MEET OR EXCEED THEIR CAPACITY TO RESIST THE DESIGN WIND LOADS AS STATED IN THE CALCULATIONS AS REQUIRED BY THE FLORIDA STATE BUILDING CODE 2014. DUE TO THE INDETERMINATE NATURE OF THESE UNITS, DISTORTION AND DEFLECTION CANNOT BE ACCURATELY EVALUATED, BUT WITH DIAPHRAGM ACTION OF EXTERNAL COMPONENTS AND INTERNAL STIFFENERS, THE BASE UNIT HAS THE CAPACITY TO WITHSTAND THESE FORCES WITH INDIVIDUAL EXTERNAL PARTS BEING CONTAINED. YEARLY INSPECTIONS OR DURING EQUIPMENT MAINTENANCE, ALL TECH SCREWS, CABINET COMPONENTS, CLIPS AND ANCHOR BOLTS ARE TO BE VERIFIED BY THE A/C CONTRACTOR. ALL DAMAGED CABINET COMPONENTS, LOOSE, CORRODED, BROKEN TECH SCREWS OR ANCHOR BOLTS SHALL BE REPLACED TO ENSURE STRUCTURAL INTEGRITY FOR HURRICANE WIND FORCES • • 4 • 4 •1 • • • • * • • • • •• • • • • • • • USE TD042 - 2°X4", 15 ga, °STEEL TIE DOWN CUPS, BY BMP INT. INC (G-90 GALV) AS SHOWN. PRODUCT APROVAL FL#14239R3 SEE DETAIL . BASE PAN (.045" MIN THICK.) CLIP DETAIL CONCRETE USE TD042 - 2"X4', 15 ga, "STEEL TIE DOWN CLIPS, BY BMP INT. INC jG-90 GALV) AS SHOWN. PRODUCT APPROVAL FL#14239R3 SEE DETAIL . ALUM. STAND (BY OTHERS) .41161111112a, 2" GENERAL NOTES 1. SECTION PROPERTIES WERE DERIVED BY THE MANUFACTURER. 2. ALL UNIT COMPONENT (PARTS) ATTACHMENT TO EACH OTHER HAVE A MINIMUM OF (3) 10-16 TECH SCREWS PROVIDING A CAPACITY OF 2,595 LBS IN SHEAR (S.F.=3) 2 lin z <_ lTrr y LITI 'I BASE PAN (.045" MIN THICK.) f•-• \ Art -)1 ALUM. STAND RAIL (BY OTHERS) ALUMINUM STAND WOOD CURB (BY OTHERS) USE 2" X 8°, 15 ga, STRAP (G-90) AS PER PLAN SEE DETAIL • • (2)124u1L • • • • • • mi#1011:11/W1K-FLEX- • • • t. • •• Ss -FORKING SLIEL • • • SeVIV raAS:lifi6 1I. • (OR EQUIVALENT) • • • • • • • • • USE .2" X V•15 g L •ASZERiPLAN- • • G MR,A P. • • • • • • ii iII . \s•••k. .•. • •o 1kV, WOOD SCREWS * • • g (4)#12x2°LG •• • •• ••• • • •• • V 4 • • • • .• • • • ••• •• • • •• • • • • • • •• • • ••• • • •• •• • • • •• •• • • 4 ••• • • • ••• 1•441 • • • •• ••• • • • • • (2) #12-14 x 1' LG (HWH#3) HILTI KWIK-FLEX SELF DRILLING STEEL SCREW w/ WASHERS FOR CONCRETE FOUNDATION AlTACHMENT USE: (2) '�X 2-k LG HEX HEAD STAINLESS STEEL BUILDEX TAPCON STEEL SCREWS (SHW4-214) AND 0 STAINLESS STEEL WASHERS OR (2) .1.12/X 2 LG HEX HEAD BLUE COATED BUILDEX TAPCON SCREWS (HW4-214) AND fr� STAINLESS STEEL WASHERS OR (2) in0 X 3" LG POWERS WEDGE BOLT HEAVY DUTY CONCRETE ANCHORS. ..** ••• N• r t2, •Cr Z. CO u Cr) 1-- (2)#12-14 x 1" LG (HWH#3) HILTI KWIK-FLEX SELF DRILLING STEEL • • NNJ. SCREW w/ WASHERS USE TD042 - 2° X4", 15 ga, "STEEL 11E DOWN CLIPS, BY BMP INT. INC (G-90 GALV) AS SHOWN. PRODUCT APPROVAL FL#14239R3 (2) SS 1/4"0 x 1-1/2" LG THRU BOLTS w/ SS WASHERS CLIP DETAIL CAULK AROUND PERIMETER OF BASE PAN ,/ WOOD CURB BASE PAN (.045" MIN THICK.) WOOD CURB (BY OTHERS) STRAP DETAIL ROBERT E. SAMARA P.E.,P.A. email: samara@ppsenginc.com Consulting Engineers "--- Structural PE # 19649 4675 PONCE de LEON BLVD, #303 CORAL GABLES, FL 33146 Ph: 305-662-1916 Fax: 305-662-2491 JOB V • I•Z 6(45: NAME: CARRIER CUBE UNITS vNA L EIA"," TITLE: MODELS LIST AND ATTACHMENT DETAILS .0 ,- 6 — g .0 L0 - (9 , 0" <6 - • t o Chk'd By: R. Samara Id a m <4 or, 2 o s — 1