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MC-17-2276Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 1279 NE 98 Street Miami Shores, FL Owner Information Permit Permit NO. MC -9-17-2276 Permit Type: Mechanical - Residential Work Classification: A/C Replacement Permit Status: APPROVED Issue Date: 9/27/2017 Expiration: 03/26/2018 Address Parcel Number 1132050090270 Block: Lot: 1279 NE 98 ST MIAMI SHORES FL 33138-2562 Applicant OLIMPIA BLUMENTHAL Phone Cell Contractor(s) Phone MILIAN AIR CONDITIONING & SERVIC (305)556-3706 CeII Phone Valuation: Total Sq Feet: $ 3,800.00 0 Tons: 5 Additional Info: REPLACE OLD A/C 5 TON GOODMAN FOR A Classification: Residential Approved: In Review Comments: Date Denied: Scanning: 3 Date Approved: : In Review Type of Work: REPLACE OLD A/C 5 TON GOODMAP Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Amount $2.40 $2.00 $2.00 $0.80 $133.00 $9.00 $3.20 Total: $152.40 Pay Date Pay Type Invoice # MC -9-17-65127 09/21/2017 Credit Card 09/27/2017 Credit Card Amt Paid Amt Due $ 50.00 $ 102.40 $ 102.40 $ 0.00 Available Inspections: Inspection Type: Final Review Mechanical 1 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 ►l� IT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating constructio ning. Fytthermore, I authorize the above-named contractor to do the work stated. A ‘.0t10 I Buildi g Department Copy ture: Owner / Applicant / Contractor / Agent September 27, 2017 Date September 27, 2017 1 • 1 BUILDING PERMIT APPLICATION ❑ BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 Master Permit No. RECEIVED C$EP 2,1(�),m1 S --, FBC 201q MC IR Sub Permit No. ❑PLUMBING I ✓I1AECHANICAL ❑ PUBLIC WORKS ❑ CHANGE OF CONTRACTOR JOB ADDRESS: / 2 / /V , ' 5 7 ' ❑ EXTENSION ❑ RENEWAL ❑ CANCELLATION ❑ SHOP DRAWINGS r City: Miami Shores County: Miami Dade Folio/Parcel#: // 3 2 O S - 00 q- o Z 1© Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: 1 BFE: ` FFE: OWNER: Name (Fee Simple Titleholder):OL//1P//4 8Luplc 4!ibeiL Phone#: 3a5 3�3 -0-7zi2 Address: ,, /a 7 9 WE 9F S?2Egr / • l City: 1 /1m r S /I o e E. S State: F6-- ' Zip: 331 3 b zip: 3313 is Tenant/Lessee Name: ////4 Email: 13% V M C )7/J t 0 e- a. co in Phone#: CONTRACTOR: Company Name: M/ 10 Pll� COnJfI 4Da/n4 1 5�rJlcel e Address: % NO / 5V yea one#: `312-1-1556*- city: VflI6frhi taitS Q Qualifier Name: �1 vs ci 4- c CAc�glg/(fl0 State Certification or Registration #: DESIGNER: Architect/Engineer: Address: 22q �y p1 Value of Work for this Permit: $ JO VV Square/Linear Footage of Work: State: Zip: 5304 Phone#0OS) 1,2f-036'4, Certificate of Competency #: Phone#: City: State: Zip: Type of Work: Description of Work: ❑ Addition ❑ Alteration ❑ New II Repair/Replace 1 pIa ce, a Id A(c 5 * n Demolition G mac✓ Specify color of color thru,tile: Submittal Fee $ • Scanning Fee $ Technology Fee $ Structural Reviews $ (Revised02/24/2014) Permit Fee $ " CF $ 'CO/CC $ +�' Radon Fee $ DBPR $ to � • Notary $ r Training/Education Fee $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ l) 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. Signatureil OWNER or AGENT The foregoing instrument was acknowledged before me this C t ii7day of 15 , 20 � % by i `�,_ `Vt'e.`�"�1Q_, who is personally known to me or who has produced identification and who did take an oath. NOTARY PUBLIC: as Pnn Seal: ********** okAN Marla Cellona Fernandez NOTARY PUBLIC STATE OF FLORIDA **************** e**********s***********s*s********************sane****** Signature �m CONTRACTOR The foregoing instrument was acknowledged before me this day of ✓�b/lf j92( ,20 /r ,by �e.T , who is personally known to me or who has produced identification and who did take an oath. NOTAR Sign: Print: Seal: �'I t Alka a' Notary Public • State of Florida 1•�':My Comm. Expires Feb 14, 2018 ton�:r',, Commission #r FF 083505 C: as APPROVED BY (Revised02/24/2014) n 'E Lm r Zoning Structural Review Clerk Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 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): 1 `1 fi S City: Miami Shores Village County: Miami Dade Zip Code: 3'5) bP 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 YES NO REPLACING DUCTS YES NO YES NO REPLACING THERMOSTAT YES NO YES 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: State Certificate or Registration No. Signature (Revised02/24/2014) ti 40 A(G serv(ces (Qualifier's signature) Phone: (?0,1)5570 ?-?o( Certificate of Competency No. Date: 1.11 fr.0vF