MC-19-2993Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address Parcel Number
140 NE 105TH ST, Miami Shores, FL 33138 1121360130670
Contacts
Permit,NO.: MC42-1
Permit Type: Mechanical - Residential
Work Classification: A/C Replacement
Permit Status: Approved
Expiration: 07/20/2020
HENRY & BRENDA DEGRAFF Owner NEW SERVICE COMPANY Contractor
140 NE 105 ST, MIAMI SHORES, FL 331382033 PEDRO PEREZ
Business: 305324754
Other:3057987383
Description: A/C REPLACEMENT IN SAME AREA Valuation: $ 6,600.0Inspection Requests:
0 305-762-4949
Total Sq Feet: 0.00
Fees
Amount
Application Fee - Other
$50.00
CCF
$4.20
DBPR Fee
$3.47
DCA Fee
$2.31
Education Surcharge
$1.40
Permit Fee
$181.00
Scanning Fee
$9.00
Technology Fee
$5.78
Total:
$257.16
Payments
Date Paid Amt Paid
Total Fees
$257.16
Credit Card
01/22/2020 $207.16
Credit Card
12/23/2019 $50.00
Amount Due:
$0.00
Building Department Copy
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 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. Futhermore, I authorize the above narned-cantractor to do the work stated.
Authorized Signature: Owner / Applicant / Contrabtarf- Date
January 22, 2020 Page 2 of 2
BUILDING
PERMIT APPLICATION
❑BUILDING ❑ ELECTRIC
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
RECEIVED
o 23 zoos
BY
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949 e
FBC20 i
Master Permit No. C_ �Z� ( �� 2913
Sub Permit No. '
❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING Do MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: I v .o Ai(5 10
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: // -a / 3 (, - Of - 0& 7 0 Is the Building Historically Designated: Yes NO ✓
Occupancy Type: Load
OWNER: Name (Fee Simple Titleholder): i
Arlrirpt \ O 1•SL'C. O
Construction Type: Flood Zone:
.5_ rw► G,
T�
BFE: FFE:
City,��. z —� State: Zip:
Tenant/Lessee Name: Phone#:
Email: AK-• �1- SxtLCz Dr., CC,�.._�
CONTRACTOR: Company Name: N CIA) S C-y V (C e CB n t-r+�-f Phone#: 2 ar.-3 �' 7d N
Address:.sd .S j�(,/ f S7302,
City: AAA State: Zi p: 2 -3 / 3 ® c r
Qualifier Name: C' e.d'S Phone#: 303-3 2¢l 71-0
State Certification or Registration #: Certificate of Competency #:
DESIGNER: Architect/Engine Phone#:
Address: ity: State: Zip:
Value of Work for thi Permit.401 _0 Squar Linear Footage of Work:
Type of Work: ❑ ddition ❑ Alteration ❑New Repair/Replace El Demolition
Description of Work: C I j N S
Specify color of color thru tile:
Submittal Fee $ Permit Fee $
Scanning Fee $ Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $
(Revised02/24/2014)
CCF $
DBPR $
CO/CC $
Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $ '' 1�
a
Bonding Company's Name (if applicable)
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 $1500, 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 reinspecti�n fee will be charged.
Signatu
ENT
The foregoing instrument was acknowledged before me this
- 0 day of b J1154 20 19 by
1 cyuky bcCRA who is personally known to
me or who has produced - - s h T L n L as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print: 4 6
Seal:
APPROVED BY
(Revised02/24/2014)
Signature
(:2A�
NTRACT
The foregoing instrument was acknowledged before me this
2-3 da of b EC , 20 'T by
Z w4 is oersona I kknow to
r= or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
fN Print: e1<41
#GS314W Seal: pprn i�314643
Expires: March 20, 2023 = , * Expires: Match 20, 202?
Sodded Thru Aaron #0*1 . Iooded Thtu Aaron Notar;
_ 1X �PI Ex miner
Structural Review
as
Zoning
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): t Q to N i= 10 S s f-
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
AHRI DATA SHEET REQUIRED
Change disconnecting means: YES ❑ NO 5d ARHI Sheet Attached: YES VO ❑ Contract Attached: YES
UNIT BEING REPLACED
DATA
NEW UNIT
MANUFACTURER
yore yj C. ,
AHU or PKG. UNIT MODEL #
'
COND. UNIT MODEL #
. T'
KW HEAT
NOM TONS
4-
AHU j/ CU k- PKG
1) M.C.A a fir. 1
AHU ✓'CU vPKG
AHU Cu PKG
2) M.O.P 4 C2,
AHU CU PKG
AHU CU PKG
3) VOLTS
AHU CU PKG
PKG UNIT / /
PKG UNIT
LZ6EER/SEER
YES
REPLACING DUCTS
YES
Ica NO
REPLACING THERMOSTAT
NO
ES N
NEW 4"CONCRETE SLAB
YES
YES
NEW ROOF STAND
YES
YES
NEW RETURN PLENUM BOX
YES (7025
1. Minimum Circuit Ampacity (Wire Size): Z
2. Maximum Overcurrent Protection (Fuse/Breaker Size): 40
3. Voltage of Circuit (208/240/480): O,
4. Size Disconnecting Means: IFAA k-6
Contractor's Company Name: Q% t_UL_ 1r- cY(C_L 0-byn P-Ao w % Phone: __3 OZf- 3'ZYr ?"T`o
State Certificate or R n No. e A C 19-1 q N L( '2-Certificate of Competency No.
Signature Date: /Z- Z3—-�f
(Qua' i r' gnatur
(Revised02/24/2014)
Estimate
501 SW 1 Street, Suite 302
Miami, FL 33130
Phone # 305-324-7504
Fax # 305-468-6357
Name / Address
HENRY DEGRAFF
140 NE 105TH ST
MIAMI SHORES FL 33168
nsc33126@yahoo.com
Date
Estimate #
12/18/2019
3900
Ship To
HENRY DEGRAFF
140 NE 105TH ST
MIAMI SHORES, FL 33168
P.O. No. Terms