MC-11-2383Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
BUILDING
PERMIT APPLICATION
FBC20
Permit Type: MECHANICAL
Owner's Name (Fee �Simple Titleholder) /te t/ /SSfT /O/)
7
Owner's Address �
RECEIVED
DEC 21 2011
Permit No. 1 ( 52
Master Permit No. (r2s.G t "2a CO
City
/ate
Tenant/Lessee Name Phone # 99 —.1'#/a
Email sP l ifet y /r d t / , (, nl
Job Address (where the work is being done) 495:5— A/6' 9/
Phone # sos--- 7 9g ` 1' 1/ z.
State A7- Zip S31 tf
r��
City Miami Shores Village County Miami -Dade
FOLIO / PARCEL # JI"32-o t ` 3/''— O //
Is Building Historically Designated YES NO X
Contractor's Company Name
Contractor's Addres
City , e lie /4017/74/
State Zip 7,2 6°
Qualifier Name 676707-0 • f /762.0/, t/ Phone #
State Certificate or Registration No./ V3?/9!Z Certificate of Competency No.
Contact Pho ? VJ22 ���
Rfro/9
zip c5va?
Flood Zone
Phone (..?-e.-37).2‘,2.--/72,/ (..?-e.-37).2‘,2.--/72,/
E -mail
Architect/Engineer's Name (if applicable) Phone #
Value of Work For this Permit $
Type of Work: DAddition []Alteration
Square / Linear Footage Of Work:
ONew
Repair/Replace
❑ Demolition
*
****************************** F************* *** * * *** * * * * * * * * * * * * * * * * * * * * * **
vfll5V
Submittal Fee $
Notary $
Scanning $
Bond $
Permit Fee $
Training/Education Fee $
Radon $ DPBR $
Code Enforcement $ Double Fee $ ` ^ � • (ge
Total Fee Now Due $ 1✓h
CCF $ CO /CC
Technology Fee $
Zoning $
Structural Review. $
See Reverse side -�
\t
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 El.F,CTRICAL 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 $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first ins ' ion which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection wt e approved and a reinspection fee will be charged.
1›..4& Ara's. ibex,* 11-C_
Signatur
Owner or Agent
Contractor
The foregoing instrument was acknowledged before me this ,v? e The foregoing instrument was acknowledged before me this29
day of Dles...P 20 !t , by 4ec.ra. I St6 1% day of D6
who is personally known to me or who has produced rofit/P4S who is personally known to me or who has produced
As identification and who did take an oath.
as identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign:
Print: .SVti'S J. MrX
My Commission Expires: 4/42 /
Sign:44*
Print: -45-6 6=7W ei j✓
My Commission Expire .4.. ° %+', I,#8beth Daseoy
?: d� = COMMISSION #DD8836 22
:9'' ^`'e`O? EXPIRES:JUNE 15, 2013
WWW:AARONNOTAR1.com
*: k*: k*: I:***** *.Y=k***:********$e*.k* k.k** [:*$***** *oktkak **ek****ik****ik*** R***B **********. k*ik****************** **✓s** ** %**
n I
APPLICATION APPROVED BY
(Revised 07/10/07)
Itia ',Examiner
Engineer
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): /--/S:r7Ve i/.
City: Miami Shores Village County: Miami Dade Zip Code: 33/-5,
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 ❑
UNIT BEING REPLACED
DATA
NEW UNIT
MANUFACTURER jZ/,
e` c��'z.44,
AHU or PKG. UNIT MODEL #1/, //, f1(
g/1 /,94, el'2/
5#61.)
COND. UNIT MODEL # / c/q//e/
/ y/�L7 7 t/' ?/
KW HEAT /62
10 /C
OM TONS y' >WO
'7' 7‘?/1)
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 I l
PKG UNIT / /
EER/SEER /6
YES NO
REPLACING DUCTS /
NO
YES NO
REPLACING THERMOSTAT
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): tP
2. Maximum Overcurrent Protection (Fuse /Breaker Size): '5
3. Voltage of Circuit 20 /240/480): z b
4. Size Disconnecting Means: Coo ipt4
Contractor's Company Name: /9
State Certificate or Registration NC Oi3(9 .. Certificate of Competency N.
Phon6CA / ? Y /Z`
Signatu. e
(Qualifle s signature only)
Date: ///
••• MINION a • ■■ • vi • • — v • Emus .r•fl. • • ■n ••••, "MI • Si tU NI/ Om
12/27/2011
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(les) must 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 ALL CITY INSURANCE INC - ACIAC'T
7200 CORPORATE CENTER DR
SUITE 316
MIAMI FL 33126
JAVIER GUTIERREZ
F (305) 463 -9431 I ( Nn).(305) 629 -7808
E-MAIL D JGUTIERREZ( ALLCITYINS.COM
� CER 200248
INSURERS) AFFORDING COVERAGE
NAIL d
INSURED
RAMA AIR CONDITIONING, INC
310 NW 57TH CT
MIAMI FL 33126-
iNsuRER A :FLORIDA RETAIL FEDERATION
LIABILITY
COMMERCIAL GENERAL LIABILITY
INSURER B :MOUNT VERNON FIRE INSURAN
26522
INSURER C:
CL2609555
INSURER D:
11/09/2012
INSURER E :
$ 1,000,000
INSURER F :
PRFMISFS )
VERA
03
REVISION NUMBER: 00
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.
`I
TYPE OF INSURANCE
ADDL
wen
POLICY NUMBER
fMW»IVY YYI
!1 /D/YYYYI
Lis
B
GENERAL
LIABILITY
COMMERCIAL GENERAL LIABILITY
OCCUR
CL2609555
11/0912011
11/09/2012
EACH OCCURRENCE
$ 1,000,000
X
PRFMISFS )
100,000
CLAIMS -MADE
X
MED EIP (Any one person)
$ 5,000
PERSONAL &ADV INJURY
$ 1,000,000
GENERAL AGGREGATE
$ 2,000,000
GEN'L AGGREGATE UMIT
APPLIES PER
II LOC
PRODUCTS - COMP/OPAGG
$ 2,000,000
I POLICY irrar
$
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
COMBINED SINGLE LOOT
(Ea act)
$
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
(Per accident)
$
$
$
UMBRELLA LIAR
EWERS W1B
OCCUR
CLAIMS-MADE
EACH OCCURRENCE
3
$
_
AGGREGATE
DEDUCTIBLE
RETENTION $
_$
$
A
WORKERS COMPENSATION
AND EMPLOYERS UABDLTY
ANY PROPRIETOR/PARTNER/EXECUTIVE r
OFFICER/MEMBER EXCLUDED?
(Mandatory In NH)
If yes de sate under
DESCRIPTION OF OPERATIONS below
N/A
52036108-01
08/16/2011
08 /16/2012
I TORY STATU- I T O R
EL EACH ACCIDENT
$ 100,000
EL DISEASE - EA EMPLOYEE
$ 100,000
E.L. DISEASE - POLICY OMIT
500,000
$
DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (Attach ACORD 1111, Additional Remarks Schedule, B mom space is required)
NC CONTRACTOR
LICENSE #CAC043192
CERTIFICATE HOLDER
CANCELLATION
CITY OF MIAMI SHORES
BUILDING & ZONING DEPT.
10050 NE 2ND AVE
MIAMI SHORES
FL 33138-
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
X31;:: E� - s • .
DATE SA
• - s
f
'1AW
4W4?-.7.44511.?
• FIRST-CLASSSt
U.S. POSTAGE
BUSINESS NAME 1 LOCATION RECEIPT NO. 454742-9
RAMA AIR CONDITIONING ,
310 NW 57 CT
33126 „ • •
........„ PIIAMI
OWNER
RAMA AIR CONDITIONING INC
196 SPEC MECHANICAL CONTRACTOR
_ „.....,
• • •
EXISTING REGULATORY OR
ZONING LAWS OF filE
OUITIT-: OR NOR .
twee IT • . EXEMPT THE
HOMIER FRomloo011iert
RFCHERRO_._iyutfir mIS IS
VROHOMIERIk IMOHIF104--
MORS;
PAYIIEHE MRU( . .
IIMMIRAOFOOMRIXTAX
07/08/2011
I SEE OTHER SIDE
DONOTFORWAFID
RAMA AIR CONDITIONING INC
MANUEL BASCOY JR PRES
310 NW 57 CT
MIAMI FL 33126
II 111111
310 NW 57 Ct.
Miami, FL. 33126
Licensed & Insured
CACO 43192
Air Conditioning
Tel: (305) 262 -1121
www.ramaac.com
>STABLISHED
DATE
JOB. No.
IT cnim /')C1/Si 70),%) C>
° c_') 494 -7 VVz
I ram
sifiEET ti SS A. C . t ..51."
a
J41r?` i—:.
31/.7
We, ItAMA Air Conditioning, proposetofurnish, Install and service under warranty (stated on reverse side) heating andior air
conditioning products and relied equipment for you in accordance with the conditions and specifications set forth in this proposal.
SYSTEM Aklp TYPE OF MATERIAL USED: New Instaation
_,f Ton / 44 Super ligh EL Heat & Cool
LOYears Warranty on Compressor
Years On Coils
Years Labor
Years Parts ❑ Padcage Untt Air Handler& Condensing E2 Line Cover❑
Repiacementf
Flow Swtt
Digital
Thermostat
Model tafai
UNI /Ly' 2 ,i w/01,J / rg' ;/ rye
SUPPUES: SEER: 4�
J o b Price $ � ! S O .
Tax $
Rebate $ 7 e/e)
JOB TOTAL $ Lf900
REMARKS:
❑ KITCHEN
0 DINING ROOM ❑ RETURN
O BATHROOM
❑ FLORIDA ROOM ❑ WATER PUMP
O LIVING ROOM ❑ BEDROOM
❑ ADDITION
O FAMILY ROOM
❑ DEN
0
Local permits & Licenses
Equipment Foundation
Wiring from Building Panel ti Unit
Wiring Of Control System
New Electrical
NO
Drain Line
Refrigerant Lines
tutting Holes
Bathroom Exhaust
Others
/ A./Are/ix- /g "
INSTALLATION SCHEDULE
We will be ready to begin installation approximately by
Contract Expiration Date:
Owner purchase Acceptance Date:.
Seiler Approval: Installation Date:
w w.a rairectory.o
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: 3799429 Date: 12/29/2011
Product: Split System: Air - Cooled Condensing Unit, Coil with Blower
Outdoor Unit Model Number: 14AJM49
Indoor Unit Model Number: RHLL- HM4821 +RCSL -H *4821
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): 46000
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 indcates an Involuntary rams.
DISCLAIMER
AHRI does not endorse the products) listed on this Certificate and makes no reptesentations, warranties or guarantees as to, and assumes no responsIbMty ior,
the product(s) listed on this Certificate. AHRI expressly disclaims all liability for damages of any kind arising outof the use or performance of the product(s), or the
unauthorized alteration of data listed on this Certificate. Certified ratings are valid amiyior models and configurations listed he the directory ertwarreatirithrectory.org.
TERMS AND CONDITIONS
This Certificate and Its contents are proprietary products of AHRI, This Certificate shalt only be used forIndlfldnai, personal and confidential reference purposes.
The contents of this Certificate may not, In 'thole 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 LE
The intormation for the m odel on this certificate can be verified at twAmahridlrectory.org, Air - Conditioning, Hung,
click on "Verify C " link and enter the AHRI Certified Reference Number and the date on tin SE V
and Iteldgerafiari instilute
which the certificate was is sued, which Is listed above, and the Celibate No., which Is listed below
02011 Air- Conditioning, Heating, and Refrigeration Institute CERTIFICATE NO.: 129898451959187758