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MC-11-2202Miami 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 BUILDING PERMIT APPLICATION FBC 20 EECEIVT NOV 28 "011 Permit No.M,l Master Permit No. Permit Type: MECHANICAL OWNER: Name (Fee Simple Titleholder): (v5r/ VcP R®�an Phone #: 305 76Y 609'S Address: $`tZ/ NE rot 4VE T% City: MIAMI 5#0/L CS State: FL- Zip: 33/32 Tenant/Lessee Name: Phone #: Email: lict;I/ y ebioo JOB ADDRESS: $?Z I NE el "' City: Miami Shores County: Miami Dade zip: 313C Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: `EW a c, A z a- Otki ""-�" Phone#: 305-- 3 Z q 2, g 3 Address: 5-4(6 6 co 1 / '7A-e-1- ' 6®y City: / State: C Zip: 3 3 (3 Qualifier Name: klt Gsvil 0`9■40 -1-- Phone #: 3 ©$ 3 2.c `l - 3 State Certification or Registration #: GAL 1 i I. Z . 0 Certificate of Competency #: Contact Phone #: 30 J 3Z Zg 3 Email Address: DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ 3 Square/Linear Footage of Work: Type of Work: ❑Address ❑Alteration ❑New Zepair/Replace ❑Demolition A-�- 1- -' Description of Work: 'e �� C^- C � L.,"6-"-4, ,-"' ,-(-- Submittal Fee $ �- , `- ermit Fee $ ` ° CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ Technology Fee $ TOTAL FEE NOW DUE $ 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. Signatur Owner or Agent The foregoing instrument was acknowledged before me this day of — _a,120 by Signature ontractor The foregoing instru ent was acknowledged before me this , day of 20 )/ , by who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: / ' '0 41.•! P 4:...„_.flaTATE OF ' ••" '•. suelo Perez Print: ®n qc e to • :�T sion #DD969024 My Commission Expires: ••''•���� °' Expires: MAR. 09, 2014 BOND• TEBU ATLANTIC BONDING CO., INC. 1 ;_II <Y P E T.. OF FLORIDA Sign: Lam. '> ' -' %��% • ,I e: Al Print: CO 'I Com I 69024 ''�....,,...�� Exp 5. U9, 2014 My Commission Expires BOX ZOTHIWATLANTICEONDING CO., INC. * * * *_ * * ***** * ******** * **L 4,55 *rr**** * * * * * * * *_ * * * * * * * * * * * *, * ** * * * * * * * *, *** * ***** * * * * *** * ** ** * APPROVED BY Plans Examiner Structural Review (Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09) 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): 0-7—( cr- '4 ` • • 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 ARHI Sheet Attached: YES NO ❑ Contract Attached: YES 4-. UNIT BEING REPLACED DATA NEW UNIT MANUFACTURER j 3 - f t, 1 • AHU or PKG. UNIT MODEL # e � �. MIMI ' R�� to`-, -S CYL COND. UNIT MODEL# - 4 ° _,„ I 1 Fysm 36A LO KW HEAT i V NOM TONS U 0 _ AHU CU PKG 1) M.C.A AHU CUZ'3 PKG AHU CU PKG 2) M.O.P AHU CU 3r PKG AHU CU PKG 3) VOLTS 'f 244 AHU CU PKG PKG UNIT I I PKG UNIT I I I 0 EER/SEER 1(0 YES i4 REPLACING DUCTS YES • NO REPLACING THERMOSTAT ,0 YES NO NEW 4 "CONCRETE SLAB IP YES NEW ROOF STAND YES ea YES rr' NEW RETURN PLENUM BOX YES 0i 1. Minimum Circuit Ampacity (Wire Size): 2. Maximum Overcurrent Protection (Fuse /Breaker Size): (mss 3. Voltage of Circuit (208/240/480): % ficto 4. Size Disconnecting Means: 3)0 kikIK Contractor's Company Name: 4441,1 -i 4-rit. "`'� Phone: 3 Or State Certificate or Registration N. Certificate of Competency N. C (F7 `% 3ga(T Signature Date: /` c ' (( This combination qualifies for a Federal Energy Efficiency Tax Credit when placed in service between Feb 17, 2009 and Dec 31, 2011. Certificate of Product Ratings AHRI Certified Reference Number: 3805983 Date: 11/28/2011 Product: Split System: Air - Cooled Condensing Unit, Coil with Blower Outdoor Unit Model Number: 14AJM36 Indoor Unit Model Number: RHLL- HM3821 +RCSL -H *3821 Manufacturer: RHEEM MANUFACTURING COMPANY Trade /Brand name: RHEEM 14AJM SERIES Manufacturer responsible for the rating of this system combination is RHEEM MANUFACTURING COMPANY Rated as follows in accordance with AHRI Standard 210/240 -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): 37600 EER Rating (Cooling): 13,00 SEER Rating (Cooling): 16.00 • 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 products) listed on this Certificate. AHRI expressly disclaim all (lability 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. CERTIFICATE VERIFICATION The information for the model cited on this certificate can be verified at www.ahridirectory.org, click on "Verify Certificate" Zink and enter the AHRI Certified Reference Number and the date on which the certificate was Issued, which N listed above, and the Certificate No., which is listed below. ©2011 Air - Conditioning, Heating, and Refrigeration Institute CERTIFICATE NO.: 129669578951186658 Air- Conditioning, Heating, ail ®E and Refrigeration institute 444 IAA AIR CONDITIONING REFRIGERATION & APPLIANCES LICENSED & INSURED (305) 325 -9283 CAC 1814210 RESIDENTIAL COMMERCIAL & INDUSTRIAL acreliable @aol.com NAME 546 S.W.1 ST # 604 MIAMI, FL 33130 WWW,ACRELIABLE.COM MAKE MAKE \ MODEL MODEL SERIAL NUMBER SERIAL NUMBER J 4 4" >'� h-��A t �e.2s P'Nos 7S4 PROMISED CONDENSING UNIT COND'SATE DRAINS CALL BEFORE ❑ A.M. ❑ P.M. TECHNICIAN AUTHORIZED BY WO O BE PERFORMED EMAIL: ❑ RECOVERED ❑ RECYCLED ❑ RECLAIMED ❑ RETURNED LEVELED ❑ DISPOSAL ❑ DISMANTLED CHANG D OUT - EPLACED TOTAL $ REFRIGERANT R- LBS. CLEANED COIL CHECKED REPAIRED LEAK IN COIL REPAIRED LEAK IN COPPER CHECKED MOTOR CHANGED MOTOR REPLACED BELT REF. P /(7 ADJUSTED BELT CONT• ACTOR FILTERS FILTERS x BELTS REPL REPL STARE CLEANED MAIN DRAIN MIND DRAIN CLEANED PAN DRAIN REPAIRED PAN DRAIN FURN. OR FAN COIL REPLACED BELT ADJUSTED BELT PULLEY ADJUSTED PULLEY CLEANED BLOWER BEARINGS° OILED MOTOR REPL START. CAPACITOR REPLACED RUN CAPACITOR E CLEANED A ADDJ. J. CONTACTOR REPAIRED REPLACED FUSE OILED BEARINGS CLEANED HEAT EXCH. REPLACED HEAT EXCH. CLEANED OR ADJ. PILOT REPLACED THERMOCOUPLE I.... c 9�� ��„ COMPRESSOR VALVE EVAPORATOR COIL VALVE CED ............. I �,.., 5,e2...... IXR VALLV° BURNERS NN I I A DUSTED EXR VALVE I REPLACED CAP. TUBE CLEARED I CAP. TUBE REPAIRED I I COIL LEAK REPAIRED • P CONN. •3 DUCT REPAIRED ADJUSTED THERMOSTAT REPLACED CLEANED COIL ADJUSTED TOTAL MATERIALS MATERIALS 8 LABOR MAY BE CONTINUED ON OTHER BIDE TOTAL LABOR TERMS LEVELED COIL ELECT. HTR. CLG TOWER REPLACED LINK CLEANED REPLACED KUX REPAIRED WIRE PUMP (S) REPLACED CONE GREASED LIMITED WARRANTY: All materials, parts - and equipment are warranted by the manufacturers' or suppliers' written warranty only. All labor performed by the above named TOTAL company is warranted for 30 days or as MATERIALS otherwise indicated in writing. The above named TOTAL company makes no other warranties, express LABOR or implied, and its agents or technicians are not authorized to make any such warranties on behalf or above named company. TRAVEL ❑ REGULAR ❑ WARRANTY CHARGE I have authority to order the work outlined above which has been satisfactorily completed. I agree that Seller retains title to equipment/materials furnished until final payment is made. If payment is not made as agreed, seller can remove said equ' I -, , materials at Seller's expense. Any damage resulting from said removal shall not be the res ,; a ". - =ller. We are not EP.L CUSTOMER SIGNATURE DATE REPAIRED FILTERS ❑ CLEANED ❑ REPLACED Not responsible for water damage TAX TOTAL