MC-13-1781Miami Shores Village
0 AUG 0 6 256
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
BUILDING Prob,P a CWM-PS11 P1 Permit No.
PERMIT APPLICATION r Permit No. W 3- .
FBC 20 CANCELLET
PermitType: MECHANICAL
OWNER: Name (Fee Simple Titleholder):yt \5 Phone#:
Address: X900 f\ -C- - NOS% 4'. Ad • z\(a
city: k1aL-,:Xk State: - zip:
Tenanv'Ulsee Name: Phone#:
Email:
a
JOB ADDRESS k 9 00 NR -E .
City: Miami Shores County: Miami Dade zip:
Folio/Parcel#: 1.I n1 - Ise— 00 14
Is the Building Historically Designated: Yes NO Flood Zone:
CONTRACTOR: Company Name: O.(�� �v Phone#: aj-5 3e8 5 2-3�,10
Address: t to?)
City: _
Qualif
Sfaie (
Contac
DESIGNtR: ATchiteAngineer: Phone#:
,. 't.: t 0
e O
Value_of Work for- this Permitt: S"� Q Q Square/Linear Footage of Work: F
rAddmss ��• QQAlteratibn ONew - `" a pair e �y�`
' k"'Y1 t' PidCe' ODemolition
M
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s;t4S .St c:ea ���i4x3 .inr^�� vtR Y•�`! .�1�?
rizzA YyEtnh !gt!o�l64� !'�uo�tlT U�t):r,� ''••"„' .� . •
.rv.rrs.rtvwcres�+aar� xr I m _. � r n
Submittal Fee $ Permit Fee $ CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Doulife Fee $ Structural Review $
TOTAL FEE NOW DUE $ •
C� -
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 ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and 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.
Signature ���� G Signature
Owner or Agent Contractor
The fore oing instrument was a�21al
Medged before me this 70X— The foregoing instrument was acknowledged before me this
day of , 20 L, by _ V—/ 2 S�1% Z5 day of , 20 _, by ,
who is pers ally known to me or who has produced who is personally known to me or who has produced,_,r;.,�
As identification and who did take an oath. as identification and who did take an oath. a
NOTARY PUBLIC: NOTARY PUBLIC:,,
J
PATRIG A. STUBBS
Sign:
C MI ION OEES85101 SignRmNJsWf66h"'
LYDIA LOPEZ
Notary Public -;ebw 09
Print: J - PrinMy Comm. Expires Feb i7.2015 '
r 0 e8 on
My Commission Expires: My E1111pif through National Notary ABsn,
APPROVED BY FT, Plans Examiner Zoning
I. t. r . .. _. • 1,
Structural Review Clerk
(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)
Miami Shores village
Building Department
. 10050 N.E.2nd Avenue
Miami Shores, Florida 33136
Tel: (305) 795 2204
AIR CONDITIONING REPLACEMENT DATA Fax: (305) 756 8972
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. I
Job Address (where the work is being done):.)C�
City: Miami Shores Village County: Miami Dade
Zip Code:
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
ARI (AHRI) DATA SHEET REQUIRED
Change Disconnecting means: YES ❑ NO P ARHI Sheet Attached: YES 'P
NO ❑ Contract Attached: YES ❑
1. Minimum Circuit Ampacity (Wire Size):
2. Maximum Overcurrent Protection (Fuse/Breaker Size): '30
3. Voltage of Circuit (208/240/480): % c/0
4. Size Disconnecting
Contractor's Company Name:
State Certificate or Registration
Signature
(Qualifier's signature only)
Certificate of Competency
Phone:—HICJ--� �> i � Z 6
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
REPLACING DUCTS
YES 0
YES
NO
REPLACING THERMOSTAT
S NO
YES
NO
NEW 4"CONCRETE SLAB
YES
YES
NO
NEW ROOF STAND
YES
YES
NO
NEW RETURN PLENUM BOX
YES
1. Minimum Circuit Ampacity (Wire Size):
2. Maximum Overcurrent Protection (Fuse/Breaker Size): '30
3. Voltage of Circuit (208/240/480): % c/0
4. Size Disconnecting
Contractor's Company Name:
State Certificate or Registration
Signature
(Qualifier's signature only)
Certificate of Competency
Phone:—HICJ--� �> i � Z 6