MC-12-104.
Miami Shores Village
FEB
2 2
Building Dep ent
10050 N.E2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (MS) 762.4949
BUILDING Permit No. MC1ZiQ
cr,w--110(6
PE T APPLICATION Master Permft No.
EBC 20
Permit Type: MECHANICAL
OWNER: Name (Fee Simple Titleholder): 130-0Y (AN) vasery Phone:
Address: 11, 300_4g '44 kUk
city: MI Wt state: F-1/ Zip: TA (3 1
Tenant/Lessee Name: Phone:
Email
Jos ADDRESS: EAGLY S LP( — Mt:4Mb 4-4-3
City: Mani Shores County: MillVd Dade
Folio/Pareekt:
Is the Building Hbtorleally Designated: Yes
CONTRACTOR: "". N
Address: Z
I I
City: ft) e
Qualifier Name:
Zip:
NO Flood Zone:
/L (r4ssj
State:Irlu
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0
Fir
Phoneit:
State Certification or Registration #: 6 itc. f/(75( Cenifit _este of Competency #:
Contact Phone#: 7-5...-35 7 Email Address: AINv avvv%.5 C.010/
DESIGINKR: Architect/Engineer: Phone*
Value of Work for this Permit: $
Type of Work: ()Address
Description of Work.
%AC>
e)
Square/Linear Footage of Work:
f ;5
tJew ()Repair/Repace
'MeV —Waseiti4
***411******************Sht***************Fees
Submittal Fee $ Permit O? $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ TraininglEducedon Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $
sr
r° y
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 COM ENCEMENT."
Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved a reinspection fee will be charged.
f
Signature
Owner or Agent }�
The foregoing instrument was acknowledged before me this 1 -�
day of K$RJ4,h+t�(, 20 by t3t0 Gti 44(140S
who is personally known to me or who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
/r�
Print: ■.r•► ti�j.4'iA,,!`�.�.1. _ •
irk TT
My Commission E
i
12.2414
Notary Discount Ass c
Signature
Contractor
The foregoing instrument 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:
Sign:
Print:
My Commission Expires:
**** k******k*** Y Yatr**** sY*3r4r3e9FFr** sY*aY4r* 4t*9e*9e***** 9r3t9i9roYataY9Y. 4*9e*aY9t**** 4r*3raY :tr*3Y9e4e **:Y9taY9r9t &: ** 4*9rararsY9e4t*3t*** tr**4e*****
APPROVED BY
Plans Examiner
Engineer
(Revised 07 /10 /07XRevised 06/10/2009)
Zoning
Clerk checked
Miami shores Village
Building Department
10050 W.E.2nd Avenue
Miami Shores, Amide 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):
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.MA 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 0 NO 0 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.CA
AHU CU
PKG
AHU CU
PKG
21 M.O.P
AHU CU
PKG
AHU CU
PKG
3) VOLTS
AHU CU
_
PKG
PKG UNIT
1
1
PKG UNIT
/ 1
EEWSEER
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 Ampaclty (WTire Size):
2. Maximum Overcorrect Protection (Fus Breaker ate):
3. Voltage of Circuit (208/240/480):
4. Size Disconnecting Means:
Contractor's Company Name:
State Certificate or Reg