MC-10-1425Sndi
BUILDING
PERMIT APPLICATION
FBC 20
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
Miami Shores Village
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
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Permit No. L ) O — l 423
Master Permit No.
Permit Type: MECHANICAL , /
OWNER: Name (Fee Simple Titleholder): W / / 1, AA/ ea; C k. Phone #: - 73,-006'a—
Address: 13 �` 14 / 0 7 5 r
City: /4 / ,eft / 6- 4,0 res State: FL. Zip: 3 3 / 6 /
Tenant/Lessee Name: // / Phone #:
Email:
JOB ADDRESS: / d 4/6 / a ? S r
City: Miami Shores County: Miami Dade Zip: 3 3 f C
Folio/Parcel #: / / " 2/36 - ®® - 0 o SO
Is the Building Historically Designated: Yes NO Flood Zone:
CONTRACTOR: Company Name: (.J /tl i tl ,P r -d gig ,j- /4 +eJJ Phone #: 9S &/ 50-706)
Address: - x'7" 4 () !et/ , 5 % i- d &' 44 e /
City: L /4 V/ F State: FC--- Zip: 5 / V.
Qualifier Name: F.
C 144 e / pp 6 f6 e9 4 Phone #: 9v - - S �f° /- 7 / / 6
State Certification or Registration #: 6-4-d-- - .. 0 9" / (/ a Certificate of Competency #: eke o s > /5e,
or
Contact Phone #: % 54 - S I-7 116 Email Address: i/ I- 0 (14 mg C. , C-6
DESIGNER: Architect/Engineer: Ai Phone #:
4373
Value of Work for this Permit: $ Square/Linear Footage of Work:
Type of Work: ❑Address . I ❑Alteration ❑New 1pair/Replace ❑Demolition
Description of Work: /1- 4 (! ( (Oi f ' .3 • V1 (kA-14-
*'F,kik=F *>F9Fi$Rx$i*&. AY**** *$as$rc.'P,FA4*$sM*aF>¢****. * *,*Fee 'z* • A b3 ,z *sa****ak>aaaxsax**** kik **3+***,k ****** ** *
Submittal Fee $ Permit Fee $ Y j CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Technology Fee $
TOTAL FEE NOW DUE $
SIG
HERE
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
OVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN
CING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RDING YOUR NOTICE OF COMMENCEMENT."
ce,tg Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must
Ise good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
roperty is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
peron will not be approved and a reinspection fee will be charged.
Signature
APPROVED BY
Owner or Agent
The foregoing instrume t
t,0
was acknowledged before me this 9
day of
20 k L W ann. t4
who is personally known to me or who has produced
As identification and who di
NOTARY PUBLIC:
(Revised 07 /10/07)(Revised 06 /10 /2009)(Revised 3/15/09)
Sign:
t: , � • g �'
Prin 3 ' .P'
My Commission Expires: 73 : �.. �\
^ S� by
*ri, ****** ******* • ***X3 •x. * **S MYC, ' yC •M ',� •%% •x. >.< \ u. �\...
/,, `!s • ��X�sks 'f•>k % %Se % %u % %aa % %Xe xxxxo-
Sign
Structural Review
Contractor
The foregoing instrument was acknowledged before me this 6
day of
by Al e °fAbitiev t)
ersonally known tobr who has produced
as identification and who did take an oath.
NOTARY PUBLIC:.
Si
Prin
My
0 .00 0 04 4. Notary Public State of Florida
o -% n Ission EE011418
o r a` twos 7/25/2014
Zoning
Clerk
Inspection Number: INSP - 149844
Scheduled Inspection Date: September 16, 2010
Inspector: Perez, JanPierre
Owner: REICH, WILLIAM & LAURA
Job Address: 138 NE 108 Street
Project: <NONE>
Contractor: UNIVERSAL AIR & HEAT
Building Department Comments
NC CHANGE OUT 3.5 TON UNIT
16 ip
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
September 15, 2010
Miami Shores, FL 33161-
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
For Inspections please call: (305)762 -4949
Permit Number: MC -8 -10 -1425
Permit Type: Mechanical - Residential
Inspection Type: Final
Work Classification: A/C Replacement
Phone Number (305)216 -1942
Parcel Number 1121360090050
Phone: 954/581 -7110
Page 9 of 23
08/13/2010 09:39 9545819232
UNIVERSALAIRANDHEAT PAGE 01
This combination qualifies for a Federal Energy
Efficiency Tax Credit when placed in service
between Feb 17, 2009 and Dec 31, 2010.
AHRI Certified Reference Number: 3806012 Date: 8/13/2010
Product: Split System: Air-Cooled Condensing Unit, Coil with Blower
Outdoor Unit Model Number: 14,11.11142
Indoor Unit Model Number: RHLL- HM31121+RCSL 1
Manufacturer RHEEM MANUFACTURING COMPANY
Trade/Brand name: RNEEM 14AJM SERIES
Manufacturer responsible for the rating of this system combination is RHEEM MANUFACTURING COMPANY
Rated as follows in accordance with AHRI Standard 2101240.2006 for Unitarryy Air - Conditioning and Air- Source
Heat Pump Equipment and subject to verification of rating accuracy by AHRI. sponsored, Independent, third
party tasbng:
Cooing Capacity (Btuh): 40000
EER Rating (Cooling): 13.00
SEER Rating (Cooling): 15.00
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DISCLAIMER
AHRI does not endorse the prothic sl led on this Cedrtests and makes no representations. warranties or guarantees as to. and assumes no'esporrsib9ity for,
the product(s) kited an Mb Certificate. PHR7 expose ij dimmnr aR tiaidettilsr dammngaam es any kind arising oat ottha use or performance of the prods s?, or the
unaudscatxed aaeratlae or data meted on this C and /Ica& C9.d rations billillikettytes models and ca gipara cow bled in the directory at
TERMS AND CONDITIONS
This Certificate and Its careen* are propsietuy iaC W` . r or* be used for indsrisluca. pares drat area confidential mittens-0 p+itpo et.
The contents airlift Certificate nay not in whore or In part be :. mod; entered Into a computer database: or ogle s45e utilized, ei any
toren or manner at by any means, except far del user's ir+dividrnt • aoetlafenttat ieRmere e.
CERTIFICATE VERIFICATION
Tim inkawattan tar sm modes Med Wes ce* Icaiecanbew rwldiRaf••
each om ° * N* and ems dye ARM Cennted Winnow 100,10er an t are dab on
which the certtrloate wan Issued. which is listed aAove, and the Ceditlpp vNdch Is Wed be8aw.
02010 Air - Conditioning, Heating, and Refr$gesaboniesilute CERTIFICATE NO.: 129261804285929398