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MC-11-2274Miami Shores Village 4s5)'6.3 a''` l-r( 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 Permit Type: MECHANICAL ED DEC 0 7 2011 Permit No.fle --; '"1 Master Permit N �� Owner's Name (Fee Simple Titleholder) X,/hn 'S # 4w� J «(-- Phone # 3c) .T ? 95 93 SS Owner's Address )7 7 %. -S 1/\-) City 1 /A.1 G %i 6 f r State f- L. Zip (l Q Tenant/Lessee Name Phone # .v r 72 l 52Z Email Li Q cS pt,+� )4^/:1/e. <n� Job Address (where the work is being done) 9 / In ti L`/ is City Miami Shores Village County Miami -Dade FOLIO / PARCEL # // / o / -- 6 / 6' - a <i 3� Q Is Building Historically Designated YES NO Contractor's Company Name "! \ Zip 3 3 / S t) ) ?✓ (d- - Phone # Contract 's Address / i £ Q- ' P City rr-0C4 r- (2) Zee State F C Zip JJ h G % Qualifier Nam e t.....--s t - Flood Zone Phone # 7 �c State Certificate or Registration No. '.. Q' C 7l'.. Certificate of Competency No. C' Contact Phone -f—,- E -mail Architect /Engineer's Name (if applicable) Phone # Value of Work For this Permit $ Type of Work: ['Addition Describe Work: /U-.4& -L �J v� CZ Square / Linear Footage Of Work: ]Alteration New ❑ Repair /Replace ❑ Demolition due / q N e-IW 96L/ ,,1i.c L l ****** *** * * * * * * * * * * * * * * * * * * * * * * ** * * * *F Submittal Fee $ Notary $ Scanning $ Double Fee $ pp. Permit Fee $ ************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Training /Education Fee $ Radon $ CCF $ CO /CC $ DPBR $ Violation date: Technology Fee $ Bond $ Structural Review. $ Total Fee Now Due $ 1 See Reverse side ---> `v 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 wner or Agent The foregoing instrument was acknowledged before me this day of __ 0 4i , by ,%}/32a/ `� /' /I , who is personally known to me or who has produced J C- 7/ /?' -LS As identification and who did take an oath. NOTARY ' UBLIC: Print: Contractor The foregoing instrument was acknowledged before me this S day of , 20 11 , by IA i45-1 (y who is personally known to me or who has produced 0---C) as identification and who did take an oath. NOTARY PUBLIC: 0i,iinu4�i, /4/////, My Commission Expires: • 01:"' ; JAMAL L4 SCOTT . MY COMM 1OT"EE076226 EXPIRES Mag r1, 2015 r76,- t `2 / �(07),3 sa Fiondallocary�yccommission Expires: ** * * * * * * * * * ** * * * * * * * * * * * * * * * * ** ******** t***,******** * * * * * * * * * * * * * ** * * * * *** * * * * * **** APPROVED BY `il jns Examiner Engineer (Revised 07 /10 /07)(Revised 06/10/2009) * * * * * * * * * * * * * * * * * * * * ** Zoning Clerk checked 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): Slyer / et/e- City: Miami Shores Village County: Miami Dade Zip Code: Z-T1 T) 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 It NO ❑ ARHI Sheet Attached: YES Le NO ❑ Contract Attached: YES 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 / / EERISEER YES NO REPLACING DUCTS YES NO YES NO REPLACING THERMOSTAT YES NO YES NO NEW 4 "CONCRETE SLAB YES NO YES NO NEW ROOF STAND YES NO YES NO NEW RETURN PLENUM BOX YES NO 1. Minimum Circuit Ampacity (Wire Size): / 2. Maximum Overcurrent Protection (Fuse /Breaker Size): D 3. Voltage of Circuit (208/240/480): o V-- / �° ? 4. Size Disconnecting Means: .4 0 Contractor's Company Name: l/rq I /e64•/7 Gygerc_®ov Phone: --egg a 7� State Certificate or Registration N. (its - -C77 Certificate of Competency N. Signature L-- = (Qualifier's signature only) Date: /.,°-40— .- mil/ CERTIFIED Ewww,ahr idirectoryiorg Certificate of Product Ratings AHRI Certified Reference Number: 3896049 Date: 12/7/2011 Product: Split System: Air - Cooled Condensing Unit, Coil with Blower Outdoor Unit Model Number: GSX130481B* Indoor Unit Model Number: AR *F486016C* Manufacturer: GOODMAN MANUFACTURING CO., LP. Trade /Brand name: GOODMAN, JANITROL, AMANA DISTINCTIONS, EVERREST, ONE HOUR AIR CONDITIONING AND HEATING, ENERGI AIR Manufacturer responsible for the rating of this system combination Is GOODMAN MANUFACTURING CO., LP. 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): EER Rating (Cooling): SEER Rating (Cooling): 46000 11.00* 13.00 • 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 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 AHRL 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" link 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 below. ©2011 Air - Conditioning, Heating, and Refrigeration Institute rein Air - Conditioning, Heating, ® ®® and Refrigeration Institute CERTIFICATE NO.: 129677438843531373 II i'; " r, - i LOCAL - Si 1 rREC® 115 S. Andrews Ave., Ian. A-100, Ft Lauderdale, FL 33301 -1895 — 954- 831 -4000 VALID OCTOBER 1, 2011 TRH SEPTEMBER 30, 2012 08A: Bushmen mole: &MIN REFRIGERATION & 8;183 -1333 Business T �mrar.0 ITIOR W .�comm Owner MIME IFINSYCN A FOE= /4UAL :11/19/2003 li Business Loraiiomc 1667 Per ECNAB RD .CAco57102 POMPANO Btu Exemption Cow Business Phone 954 -783 -9294 Dams 11o•6aafYaebinew FerYado9 Redness oay r• Tax Mood Tama Fee t+iSF Fee Pew PriorYeas .�— Collection Goat Total Pad 27.00 0_00 0.00 4.05 0_08 0.00 31_05 TM RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECBPT This tar is levied for the privilege ofdoig bushiest; wain Bmward County and is non-regulatory in nature. You worst meet all County ardfor IlunidpaRy planning and zoning rte. This Business Tax Receipt must be hars#erred when the business is sold, brsiress crane has changed or you have moved the baseness localcm. This receipt does net include that the bra is legal or that # is er ©ompiarce will State or loud laws and MENYAL®ATED Ilaling Addles= ourincer A FORDS /QUAL 1667 ■ mum RD NANO BEACH, FL 33069 Receipt #03B -11- 00000532 Paid 11/01/2011 31.05 Proposal and Contract SOVRIN REFRIGERATION AND AIR CONDITIONING, INC. License: Slate of Florida No. CAC 057102 1667 McNab Road Pompano Beach, Florida 33069 a Phone 954.783.9294 Fax 954.783.9293 WINSTON FORDE 954 -868 -0720 Customer's Name: -5' F-6, 1 QA i7 Phone: FAX Date : /1 /6 —0 1/ . w.r uct(on7 . 7v �. S h e e t i6 8 " At c ).l A v e. Job Name: . 9. /, CY N / ` ,c).1/Q., City, Slate and Zip.. l)/.9s', 5 tee. e ILi/cabon: oboe! 5‘°-cc9 A---e 3 3) ,ro Architect/Engineer: Date of Plans PROJECT NO. I SHEET NO. SOVRIN Refrigeration and Air Conditioning, Inc. ( "Contractor") proposes to furnish equipment and materials for the below described Work pursuant to the attached Terms and Conditions. EQUIPMENT /FABRICATION- MATERIALS ARE 5-6 WEEKS LEAD TIME, AND ANY REQUEST FOR FASTER SERVICE WILL INCUR SURCHARGES. LIST SPECIFICATION SECTIONS AND /OR WORK TO BE PERFORMED. ��6V/�� grrel lti�1r�LC �/v o��.r� ry L`Cii 2}7Q 36_4,1 r3 /may a/ 2 damsel 3 i,■ "7-Z72:2 arc -7c Aer L� - 4 A DEPOSIT OF $35% DOWN UPON SIGNING OF THE CONTRACT. CONTRACT PRICE: ALL WORK WILL BE PERFORMED IN COMPLIANCE WITH STATE OF FLORIDA CODES. NO CUTTING, PATCHING, PAINTING, ! OF REPAIR, PERMITS OR ELECTRIC INCLUDED. A�N /YADADDyIITI L MECHANICAL WO - • NE OR'REQUIRED WILL INCUR ADDITIONAL CHARGES ConYA. L /: �. �L� Customer Date of Proposal: //-2r->- Date of Acceptance: This Proposal shall be effective for a period of sixty (60) days.