MC-16-833 (2)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
BUILDING
PERMIT APPLICATION
❑BUILDING ❑ ELECTRIC ❑ ROOFING
MAR 2 9 20.16
S+A
FBC 2014
Master Permit No. RC 1 Sv'� 37
Sub Permit No. RC 8? 3
❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING J� MECHANICAL ❑PUBLIC WORKS [:]CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: wo CD M C'n " Q..'S
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Tf-Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): ,A V?,V—WO -6 L4--, d 601�-Phone#: q/ % 6S'7 07
Address: 5q2 QA li L10 c 1 'M o 1?
City:V V mi I nm State: TK A Zip:
Tenant/Lessee Name:
Email:
one#:�IT�
2 v
CONTRACTOR: Company Name: . ` � e ice{ems? e �� Phone#.:?'QM Z `Z ZS30
Address: -I-
City: *� I State: Zip:
Qualifier Name: J a L,-r•r ri Phone#:` �2rS� Z�Z Z5
State Certification or Registration #: C_� R 1'i ��2� Certificate of Competency #:
/+
DESIGNER: Architect/Engineer: /�� t �E 1 �, �� �l
kk� E1S�Oc�Phone#: Q S IP 1 2 / r4 1�i
Address: jW IQ (,�_k [' IV f City:Pay►. eA&m, tate: 14— Zip: �7T
Value of Work for this Permit: $ 7500 Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ,"K� Repair/Replace ❑ Demolition
Description of Work: �2 ��! ��/ c� "P5
lsfc > oa�n �� ►i cool
Specify color of color thru file:'
Submittal Fee $ f Permit Fee $
Scanning Fee $ Radon Fee $ _
Technology Fee $ C-> �4 Q Training/Education Fee $
Structural Reviews $0
_
�CF $ CO/CC $ 30
DBPR $ 3 , '�744 Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $
(Revised02/24/2014)
Bonding Company's Name (if applicable)
t
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
State
Zip
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 retarded 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.
Signatur
WNER or ENT
The foregoing instrument waslacknow ged before /me this
9- P-- day of /)1St,irG� 20 / (r� by
A�1/:I; Ili I� If Ss Q h?QrWho is personally known to
me or who has roduce r L �% A11od I�3
identification and who did take an oath.
NOTARY PUBLIC:
Signature
CONTRACTOR
The foregoing instrument was acknowledged before me this
zq day of ��' 20 /L by
laR�nnr ��Irl� ___,who is personally known to
me who has produced
identification and who did take an oath.
NOTARY PUBLIC:
as
Sign: v Sign:
Print: Print: do-W
Roslyn 0. Citrin
Seal: =?;' COMM ISSJN#EE829921 Seal --
t." HI
-A-EXPIRES-AUG, .23,2016 W
www.AAOTARY.com i � S 1 2141
APPROVED BY !' +Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
AIR CONDITIONING REPLACEMENT DATA
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax:(305) 756.8972�
Mq&4Q'c + z3��
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): 67
City: Miami Shores Village County: Miami Dade Zip Code:
3 313
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 F NO ❑ Contract Attached: YES ❑
UNIT BEING REPLACED
DATA
NEW UNIT
�IQ
;Q
MANUFACTURER
AHU or PKG. UNIT MODEL #
COND. UNIT MODEL #
Afka✓ 2_Z1
4196Z.06 4f-
AHU
0
MA"
CU
66
PKG
KW HEAT
NOM TONS
1) M.C.A
O
5md
AHLLe.5fU _JqPKG NIA
AHU
CU
PKG
2) M.O.P
AHUSo-66U &V PKG IVIW
AHU
CU
PKG
3) VOLTS
AHU CU PKG 1
PKG UNIT
PKG UNIT
EER/SEER
la.00
YES
NO
REPLACING DUCTS
YES NO
YES
NO
REPLACING THERMOSTAT
ES NO
YES
NO
NEW 4"CONCRETE SLAB
E NO
YES
NO
NEW ROOF STAND
YES .NO
YES
NO
NEW RETURN PLENUM BOX
YES NO
5 r
9
1. Minimum Circuit Ampacity (Wire Size): 141 lG tv/`2 '�Wor_'
2. Maximum Overcurrent Protection (Fuse/Breaker, Size): �40
3. Voltage of Circuit 208/240 80):
4. Size Disconnecting Means:
Contractor's Company Name:
Phone: ,3 --5 Zlo2 - Z530
State Certificate or Registration/8/7ZZU Certificate of Competency No.
Signature Date: /
(Qualifier's signature)
Certificate of Product Retinas
AHRI Certified Reference Number: 7434474 Date: 3/31 /2016
Product: Split System: Air -Cooled Condensing Unit, Coil with Blower
Outdoor Unit Model Number: RASL-060JEC
Indoor Unit Model Number: RH2V6024HTAC
Manufacturer: RHEEM SALES COMPANY, INC.
Trade/Brand name: RHEEM
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.
Rated as follows in accordance with AHRI Standard 2101240-2008 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): 57000
EER Rating (Cooling): 12.00
SEER Rating (Cooling): 18.00
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
7
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;
��-B
entered into a computer database; or otherwise utilized, in any torn or manner or by arty means, except for the users 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, dick 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.
131039094932985388
02014 Air -Conditioning, Heating, and Refrigeration Institute
CERTIFICATE NO.: