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MC-11-19-2800, 1092 NE 94 StBUILDING PERMIT APPLICATION Miami Shores Village RECEIVED Building Department N, V 2 2 ,s 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 BY1AA INSPECTION LINE PHONE NUMBER: (305) 762-4%9 FBC 20 ``i Master Permit No. 11A C�,_ � 1-1 17 J Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF [:]CANCELLATION ❑ SHOP (� �ij CONTRACTOR DRAWINGS � JOB ADDRESS: `n� � �r Vj S T City: Miami Shores County: Miami Dade Zip: Folio/Parcel#:. ' 3 Z. 0 5 , ® 6 -4 ­6 19 d Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): 'A Phone#_y 565 • L1 �' b Address: oc%. �_NE_ !a `ems k City: State: i:� ` Zip: Tenant/Lessee Name: Email 305 , Ln+ 9tgq CONTRACTOR: Company Name:�`� `Phonejal�) Address: Ca -' 1 'gl �_Aoc_ City: Qualifier Name: s °A "_ �y��X)s__) Phone State Certification or Registration #: C 18 t 5 12 Certificate of Competency #: �- Zip: -7 8(:� Z3� 3q'40 DESIGNER: Architect/Engineer: Phone#: Address: J-- City: State: —zip: '— Value of Work for this Permit: $ / Ob Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ew ❑ Repair/Replace ❑ Demolition Description of Work: 14-�lSt��\ ly u 1 - 2`T cor\! S l.1 �T S tJ ( h,S+R, Specify color of color thru tile: Submittal Fee $ `- ' (y O Permit Fee $ Scanning Fee $ Radon Fee $ Technology Fee $ Training/Education Fee $ Structural Reviews $ CCF $ CO/CC $ DBPR $ Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ (Revised02/24/2014) 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. 1 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. Signatur-e'�,� OWNER or AGENT The foregoing instrument was acknowledged before me this 2 day of IV O ' J . 20 k Ct , by AL A>a R K $rL Y%-e;vv , who is personally known to me or who has produced identification and who did take an oath. NOTARY PUBLIC: APPROVED BY Signature CONTRACTOR The foregoing instrument wasr acknowledged before me this 20 day of N C2 y . 20 1 C by ry S-1✓ L. Gu e K D . who is personally known to as me or who has produced identification and who did take an oath. NOTARY PUBLIC: as Sign: Print: Seal: WCM#ASM#FF91M 1 8: NW*Itw 1S, 2019 ! T1uu Hairy P�lie 1�ede�wlMa L I ns miner Zoning (Revised02/2412014) Structural Review Clerk Property Search Application - Miami -Dade County Page 1 of 1 =_= - OFFICE OF THE P APPRAISER Summary Report Property Information Folio: 11-3205-007-0180 Property Address: 1092 NE 94 STMiami Shores, FL 33138-2945 Owner ALANA N STINSON PLOTKIN Mailing Address 1092 NE 94 ST MIAMI SHORES, FL 33138 USA PA Primary Zone 1400 SGL FAMILY - 3001-3250 SQ Primary Land Use 0101 RESIDENTIAL - SINGLE FAMILY: 1 UNIT Beds I Baths I Half 4/2/0 Floors 2 Living Units 1 Actual Area 3,772 Sq.Ft Living Area 3,172 Sq.Ft Adjusted Area 3,252 Sq.Ft Lot Size 9,275 Sq.Ft Year Built 12001 Assessment Information Year 2019 2018 2017 Land Value $350,595 $333,900 $333,900 Building Value $512,840 $341,460 $320,647 XF Value $29,835 $30,193 $30,553 Market Value $893,270 $705,553 $685,100 Assessed Value $893,270 $705,553 $685,100 Benefits Information Benefit Type 2019 2018 2017 Homestead Exemption $25,000 Second Homestead Exemption $25,000 Note: Not all benefits are applicable to all Taxable Values (i.e. County, School Board, City, Regional). Short Legal Description 5-6 53 42.21 AC PL OF GOVT LOT 4 PB 5-90 BEG NE COR LOT K W133FT S TO N/L OF S80FT LOT K E TO W/L E DIXIE HWY NE TO POB Generated On : 11/20/2019 Taxable Value Information 2019 2018 2017 County -- Exemption Value $50,000 $0 $0 Taxable Value $843,270 $705,553 $685,100 School Board Exemption Value $25,000 $0 $0 Taxable Value $868,270 $705,553 $685,100 City Exemption Value $50,000 $0 $0 Taxable Value $843,270 $705,553 $685,100 Regional Exemption Value $50,000 $0 $0 Taxable Value $843,270 $705,553 $685,1000 Sales Information Previous Sale Price OR Book -Page Qualification Description 08/24/2018 $1,175,000 31133-4094 Qual by exam of deed 04/01/2008 $850,000 26343-3559 Sales which are qualified 08/01/2002 $690,000 20606-2406 Sales which are qualified 02/01/2001 1 $507,500 19543-1432 Sales which are qualified The Office of the Property Appraiser is continually editing and updating the tax roll. This website may not reflect the most current information on record. The Property Appraiser and Miami -Dade County assumes no liability, see full disclaimer and User Agreement at hftp://www.miamidade.gov/info/disclaimer.asp Version https://www8.miamidade.gov/Apps/PA/propertysearch/ 11 /20/2019 Date:10/24/2019 Sumitted to : ANDY MIAMI SHORES AIR COOLING INC Air Conditioning Certified State Contractor 7966 West 30 Lane Hialeah Florida 33018 (786) 236 3440 (786) 236 3441 Fax (305) 8271042 Email: joseluis@yaircooUn inc.comjoel@oircoolinginc.com ESTIMATE 2019/M.S ESTIMATE NEW MINISPLIT 2 TON. INVERTED SYSTEM. 18 SEER. R410 A SCOPE WORK 1) INSTALLED NEW MINISPLIT SYSTEM 2 TON. R410A 2) LOCATED THE AIR HANDLER ABOVE THE SIDE DOOR 3) RUN NEW FREON LINES 4) RUN NEW DRAIN LINE,COMMUNICATION WIRE 5) INSTALLED NEW BRACKET IN THE CONDENSER UNIT 6) MOUNT AND SUPPORT THE AIR HANDLER ,CONDENSER UNIT PROPERTY BY CODE 7) FLUSH OUT THE FREON LINES DRY NITROGEN PRESSURE 8) VACCUM THE SYSTEM TO PREVENT HUMINITY 9) START UP THE UNIT ADJUST THE FREON PRESSURE 10) INSTALLED NEW LOCK CAP ON THE CONDENSER UNIT FUJITSU. 2 TON. 18 SEER. R410 A $2845.00 10 YEAR WARRANTY ON COMPRESSOR AND PARTS / 1 YEAR WARRANTY ON LABOR � 4A N S 04 �W via( S % &kACA t, r e : . - / G/Zo/2o Licensed & Insured . 16 O CERTIFICATE OF LIABILITY INSURANCE fir' DATE 019 11l20/2019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Jessica Perez NAME: PHC N Ext : (305) 273-4530 Fvc No): (305) 273-4409 IPC Insurance of Florida LLC EMAIL jessica@ipcfl.com 10481 SW 88TH ST STE D204 INSURERS AFFORDING COVERAGE NAIC # MIAMI, FL 33176-1528 INSURER A: Ascendant Commercial 13683 Phone (305) 273-4530 Fax (305) 273-4409 INSURED INSURER B : _ INSURER C : Air Cooling Inc. INSURER D : 7966 W 30 Ln7966 WEST 30TH LANE7 Hialeah FL 33018 INSURER E : INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSR UBR WVD POLICY NUMBER POLICY EFF MM/DD POLICY EXP MWDD LIMITS A COMMERCIAL GENERAL LIABILITY ❑ CLAIMS -MADE OCCUR ❑ Y Y RFLA209105-00 10/26/2019 10/26/2020 EACH OCCURRENCE $ 1,000,000,00 DAMAGE TO TED PREMISES (Ea occurrence) $ 100,000.00 MED EXP (Any one person) $ 5,000.00 ❑ PERSONAL & ADV INJURY $ 1,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: ❑ JECT POLICY ❑ PRC ❑ LOC ❑ OTHER GENERAL AGGREGATE $ 1,000,000.00 PRODUCTS - COMP/OP AGG $ 2,000,000.00 $ AUTOMOBILE LIABILITY ❑ ANY AUTO OWNED ❑ AUTOS ONLY ❑ AUTOS SCHEDULED ❑HIRED ❑ NON -OWNED AUTOS ONLY AUTOS ONLY ❑ ❑ COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ $ ❑ UMBRELLA LIAB OCCUR ❑ EXCESS LIAB ❑ CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ ❑ DED ❑ RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y f N ANY PROPRIETOR/PARTNERIEXECUTIVE❑ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below. N / A ❑ PTATUTE ❑FOR E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE- POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) MECHANICAL CONTRACTOR LICENSE # CAC1815729 CERTIFICATE HOLDER CANCELLATION Miami Shores Village 10050 NE 2nd Ave Miami Shores, FL 33138 FAX 305-756-8972 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) QF The ACORD name and logo are registered marks of ACORD Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Location Address Parcel Number L092 NE 94TH ST, Miami Shores, FL 33138 1132050070180 ontacts ALANA STINSON PLOTKIN Owner AIR COOLING INC Contractor 1092 NE 94 ST, MIAMI SHORES, FL 33138 JOSE LUIS BUENO Other: 3054948484 alanasl6@gmail.com 7966 W 30, HIALEAH , FL 33018 Business:7862363440 joel@aircoolinginc.com s I o Inspection Requests: Description: MINISPLIT UNIT 2 TONS FUJITSU INSTALLATION Valuation: $ 2,845.00 a ,57 44.E \ ; Total Scl Feet: 0.00 y tE•: Fees Amount Application Fee - Other $50.00 CCF $1.80 DBPR Fee $2.00 DCA Fee $2.00 Education Surcharge $0.60 Permit Fee (Manual) $50.00 Scanning Fee $9.00 Technology Fee (Manual) $2.50 Total: $117.90 Payments Date Paid Amt Paid Total Fees $117.90 Check # 5550 10/13/2020 $67.90 Credit Card 11/22/2019 $50.00 Amount Due: $0.00 Building Department Copy In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AFFIB)�/IT: I c i that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating co6str5' tion an oning. Futhermore, I authorize the above named contractor to do the work stated. Authori ture: Owner / Applicant / Contractor / Agent Date 13, 2020 Page 2 of 2 c�u Cry �.p.��'CA 4AGt(?ry NC11,1 MC 2'F4rd,$ MIN+ PUT 'Y.FOrab i(vt,ll3+ S9t tT Sy,SIStA C r�olMS MINA 'SPW I o Z s N I � f L,1.1 N C, Roo in s--11F-E7 //�� II �L � \N kacl(o.ss: PCs -CNar�,C` Itil�,axn� 51n�,tie� f l_. 33138 itFR��` ` Miami shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795 2204 Fax: (305) 756.8972 Notice to Owner — Workers' Compensation Insurance Exemption F lorida Las\ requires \\ of kei s' Compensation insurance coverage under Chapter -f 41) of the Florida Statutes. Fla. Stat. § -Idn.t)� all,ms corporate officers in the construction industr\ to exenipt thenisekes from this requirenient Ibr am construction project prior to obtaininL a building perniii. Pursuant to the f lorida Division ol'\\'orkers' Conipensalion f_mplo}er Facts Brochure: \n eniplo\er in the construction industn %\ho cniplo\� one or more part-tinic or full-time eniplowes. including the owner. must obtain workers' eonipensalion cmerage. Corporate officers or member, of a limited liabilii\ compam tLL0 in the construction industr\ nia\ elect to be e\enirt if: 1. The officer owns at least 10 percent of the stock of the corporation. or in the case of an LLC. a statenient attesting to the niininnun 10 percent ownership: 2. The officer is listed as an officer of the corporation in the records of the Florida Depannneni of State. Dkkion ol'Corporations: and 3. I he corporation is registered and listed as active %%ith the Florida Department of Slate. Dig ision of Corporations. \o niore than three corporate officers per corporation or limited liahilin compam numbers are allowed to be exempt. Construction exeniptions are valid for a period of mo Nears or until a soluntar> revocation is tiled or the exemption is re\oked by the Di\ision. YOU contractor is requesting a permit under this workers' compensation exemption and has acknowledge that he or she will not use kla\ labor. part-time eniplo\ces or subcontractors for sour project. I he contractor has provided an at idacit stating that hr or the will he the onas person allowed to work on sour project. In these circumstances. Miami Shores \'illa2e does not require verification of %%orkers' conpensation insurance cm erage from the contractor's compam for da\ labor. part-time employees or subcontractors. 131 SIG\i\G BFI.O\\ YOU \CK\O\\'LEDGE THAT \'OC HA" VE READ THIS NOTICE AND h1DERST \\D 1TS CONTENTS. I Sienature: YLLJ�K\ 0%%net j State of F lorida I Countv of\liami-Dade The toresoing was acknoWcdge belore me this f das• oI' GC-J�o b / —' 20 z o � f3\AG 0C( o �l ti _ whir(is personally known to m� has produced as Identification. e, l w Y_C lt3N f Sl : 1 �= EXPI ES: November 19,2023 w Bonded Thru Notary Public Underwrites Y� (S) AAJ ADVANCE ELECTRICAL CORP. 2035 SW 123cT. Miami, FL 33175 1TA(305) 221-3201 Ce1L(305)986-0435 F..C. No. 13005475 Mss: Ana Stinson Plotkin Job Address: 1092 NE 94 St Miami Shore FL 33138 / Ph: 561-715-7370 Panel (A) Circ. No Description of Load Volts Strip Wire Cond. 1,3 W/LIEATER #1 240 30 2 # 10 THWN 3/4" 2,4 1IANDLEll #1 FIRST FLOOR 240 60 2 # 6 THWN 3/4" 5,7 W/I IEATER #2 240 30 2 # 10 THWN 3/4 " 6 DISPOSAL, 120 20 # 12 THWN '/2" 8 DISIIW;\SIIER 120 20 # 12'1'HWN 1/2" 9,11 A/C 1IANDL,ER #2 SI?D. FLOOR 240 60 2 # 6 THWN 3/4" 10,12 RANGE/OVEN 240 50 2 # 6 THWN 3/4" 13,15 DRYER 240 30 2# 10 THWN 3/4" 14 .... S/APPL,IANCI? 120 20 # 12 THWN 1/2" 16 .... RNI,RIG44tATOR 120 20 # 12 THWN 1/2" 17 • • • S/APPLIJNCE 120 20 # 12 THWN 1/2" 18 • •• S/ArP�IAJCF, 120 20 # 12 THWN 1/2" 19 • W/ E 120 20 # 12 THWN 1/2" 20 • • • • - • MIqM VE 120 20 # 12 THWN '/2" 21 .. :. GFI IV,(4$PTACLES BATI IRS 120 20 # 12 THWN 1/2" 22 • • G/LIWA161Ei M/BEDROOM 120 15 # 14 THWN 1/2" 23 SP:\' 120 20 # 12 THWN '/2" 24,21,29,3p• G/I JGI L: ,S SECD. FLOOR 120 15 # 14 THWN 1/2" 25 • • • • GA A �E OOR 120 15 # 14 THWN 1/2" 29 • • • • G/1,IGIITS ENT1tACF; & GAR/AG. 120 15 # 14 THWN /2" 31 G/LIGHTS FIRST FLOOR, L/R 120 15 # 14 THWN 1/2" 32 ALARM PNI, 120 15 # 14 THWN '/2" 33,35,37 G/LIG[ITS 1'V&I'A1'IO 120 15 # 14 THWN 1 /2" 34 G/LIGII'1'S FIRST 1�1,UOR 120 15 # 14 THWN '/2" 36,38 NF:W MINI SPLIT A/C 240 20 # 12 THWN '/2" 39,41 G/LIGI ITS 120 15 # 14 THWN 40,42 SPACE r (S) AAJ ADVANCE ELECTRICAL CORP. 2035 SW 123Cf. N iam, FL 33175 Tcl:(305) 221-3201 Ccll:(305)986-0435 F,.C. No. 13005475 Mss: Ana Stinson Plotkin lob Address: 1092 NE 94 St Miami Shore FL 33138 / Ph: 561-715-7370 Load Calculation Living Area 3,772 Sq. Ft X3 =11,316 Watts 2 Appliance = 3,000 Watts (1500 Watts Each Laundry CE/Machine.) = 1,500 Watts Refrigerator = 750 Watts T-Compactor = 000 Watts Disposal = 750 Watts Dishwasher — 750 Watts Microwave = 750 Watts Wine.('—oo?ar — 000 Watts • • • •: Pool Motor • • = 2,231 Watts .... , Watetile r #1 7 = 3,000 Watts '. Water Heater #2 :.:..: = 3,000 Watts a:*** Dryer... • .. .. = 5.000 Watts • • • • • Ranges 0,,en • • • • • • = 9,776 Watts " • • • • TotaFDf? • =41, 823 Watts •••••• • First; 20,�M0 �jatt�U,100% = 10000 Watts .;.. a 9 Remaittder 31,82 Vads (a, 40% = 12,729 Watts 2- A%Gol"tW Strip HTR Each Q 100% = 20,000 Watts New Mini Split A/C & 100% = 1,500 Watts Total Connected Load = 44,229 Wlatts Total = 44,229 Watts / 240 Volts = 184.5 Amps. Existing Electrical Panel OF 200 AMPS, 3 CU/W # 2/0 THWN Signature of Qualifier _t*ry rlSv Print Name ALANA STINSON I11-01 KIN: 1092 Nt 94 S I MIAMI SI-10RI i I ; , I, AAJ ADVANCE ELECTRICAL CORP. 2035 SW 123 C;t (Vann. Vi_ 331 P5 305-221-3201 C',e11:305-986-0435 Phi: 561 715 7.370 Lm<�il: clstinson(n�kx�ll�,c�r.rtlr.nci AM y ", . t S X y � ' t rK4 1ZK11`15 z 64 I_ (VAIll I L t71sG.-20At�,tS' � Allyfin . Lj It ¢r e. 21 •iT pf SKT • f • • • • • ! • k (z at t'w o Tale A �t $fit �ji�V+.y4 (j} (�1�� • •� ��h� .,. i.d $'gyp �� ! e 7I aAA l F �uA' f • �• }q f x ! tr C r q�l '} �h��x "}� 1 , '.'Y�r • • • • i:M to , • ♦ • • y .+r Spa I +' jt u _ > • • • • • • • • • • • •• •• • • • •• •• ••• • • • ••• 0 • AHRI Certified Reference Number: 7940753 Date: 11-20-2019 Model Status: Active AHRI Type: HRCU-A-CB-O Outdoor Unit Brand Name: FUJITSU Outdoor Unit Model Number: AOU24RLB Indoor Type: Mini -Splits Indoor Model Number(s) : ASU24RLB Rated as follows in accordance with the latest edition of ANSI/AHRI 210/240 with Addenda 1 and 2, Performance Rating of Unitary Air -Conditioning & Air -Source Heat Pump Equipment and subject to rating accuracy by AHRI-sponsored, independent, third party testing: Cooling Capacity (95F) : 24000 EER (95F) : 10.00 SEER: 18.00 High Heat (47F) : 24000 Low Heat (17F) : 15300 HSPF : 10.60 Sold in?: USA, Canada -rActive" Model Status are those that an AHRI Certification Program Participant is currently producing AND selling or offering for sale; OR new models that are being marketed but are not yet being produced "Production Stopped" Model Status are those that an AHRI Certification Program Participant is no longer producing BUT is still selling or offering for sale. Ratings that are accompanied by WAS indicate an involuntary re -rate. The new published ratinq is shown along with the previous (i.e. WAS) rating. 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 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;'' entered into a computer database; or otherwise utilized, in any form or manner or by any means, except for the user's 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, click 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. ©2019Air-Conditioning, Heating, and Refrigeration Institute CERTIFICATE NO.: 132187412770680466 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): i Z) C1 2 ( L'1 S City: Miami Shores Village County: Miami Dade Zip Code: 3 3 3 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 ❑ NOA ARHI Sheet Attached: YES �] NO ❑ Contract Attached: YES 0 UNIT BEING REPLACED DATA NEW UNIT MANUFACTURER E 07 AHU or PKG. UNIT MODEL # i COND. UNIT MODEL # A O U LVS KW HEAT $Ttd 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 O YES NO REPLACING DUCTS YES YES NO REPLACING THERMOSTAT YES NO YES NO NEW 4"CONCRETE SLAB YES WET - YES NO NEW ROOF STAND YES onb YES NO NEW RETURN PLENUM BOX YES 1. Minimum Circuit Ampacity (Wire Size): 2. Maximum Overcurrent Protectior 4sBreaker Size): 2l� INM'P 5 3. Voltage of Circuit (208/240/480): Z 3 O V. 4. Size Disconnecting Means: 'ZO A. m P S Contractor's Company Name: � //�� L 1 2 do o// H 4 3-✓1 C Phone: i S 34 " 3 L/ V, O State Certificate or Signature signature) of Competency No. Date: (Revised02/24/2014)