REV-16-2993 Miami Shores Village p,EcFYVED
Building Department NOV 2 2 16
1
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY:
Tel: (305)795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 20
BUILDING Master Permit No.cc-12-15-3013
PERMIT APPLICATION Sub Permit Noric
❑BUILDING ❑ ELECTRIC ❑ ROOFING REVISION EXTENSION ❑RENEWAL
` ❑PLUMBING MECHANICAL ❑PUBLIC WOKS �BoI SHOP
RV. TO DRAWINGS
JOB ADDRESS: 11300 NE 2nd fine arts quad, miaml ,
t
Citv: Miami Shores County: Miami Dade . Zip:
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name(Fee Simple Titleholder):Barry University Phone#:
Address:11300 NE 2nd Ave, Miami Shores, FL 33161
City: State: Zip:
Tenant/Lessee Name: Jeffrey Ya0 Phone#:
Email:Jyao@barry.edu
CONTRACTOR:company Name: southeast mechanical contractors Phone#: 954-981-3600
Address. 2120 sw 57 terrace '
city: pembroke park state: fl Zip: 33023
Qualifier Name: Robert Macklin Phone#: 954-605-4805
State Certification or Registration#: CMC1250173 Certificate of Competency#: 183-1180'
DESIGNER:Architect/Engineer: Harvard Jolly Phone#: (561) 478-4457
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Ad'dress:2047 vista parkway City: West palm beach State: fl Zip: 33411
Value of Work for this Permit:$ Square/Linear Footage of Work. 0
Type of Work: ❑ Addition ❑■ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of work: Elimination of hot tap chilled water connections (existing indoor lines will be used)
Fan coil units 3 and 4 eliminated at north wing (substituted by larger units 1 and 2) air distribution
• j
Specify color of color thru the: r
Submittal Fee$ Permit Fee fr'in CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
F TOTAL FEE NOW DUE$ S
(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
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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.
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"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 th absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature Signature
i.
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
?1 1 34"" day of OC(OWL .20 16 by / �I_ day of �C&bcr 20 it by
SUSQIV R�oSbn►t64QL
who is persona lvJca.c�crn to ("2-Ore-4 Mack f&\ who" ersonally known to
me or who has produced as me or who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
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Sign: Sign:
Prin L Print: 8ACZANS1a E
a..
Seal Notary Public State or odda _°�' ��+= DAY COMMdSS{GN 4 2018
'
-Jeffry J Yao Seal: _•: EXpINES.June
My Commission FF 188481 + QF11�0?' Bonded Th ru Notary
Publk UnderHriters
q Expires 11112/2018
APPROVED BY ' 4 Pla s Examiner Zoning
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Structural Review Clerk
(Revised 02/24/2014)
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,SNORES`L Miami Shores Village
7- Building:Department
in
Igo �_ 111911" . .10050 N.E.2nd Avenue
Miami Shores, Florida 33138
�tN— e,�o Tel: (305)795.2204
�oRNA 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):
City: Miami Shores Village County: -Miami Dade Zip Code:
ALL CONDENSING UNITS MUST BE ON A 4 INCH SOLID CONCRETE SLAB
r 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# fi
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: I
Contractor's Company Name: Phone: r
State Certificate or Registration No. Certificate of Competency No. ?
Signature Date:
(Qualifier's signature)
f
(Revised 02/24/2014)