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CC-12-1181Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 nspection Number: INSP - 187576 Permit Number: CC -6 -12 -1181 Inspection Date: March 15, 2013 Inspector. Bruhn, Norman Owner: DE LA ROSA, TANYA Job Address: 9713 NE 2 Avenue Miami Shores, FL 33138- Project: <NONE> Contractor: F &F CONSTRUCTION SERVICES INC Permit Type: Commercial Construction Inspection Type: Final Building Work Classification: Alteration Phone Number (305)756 -6110 Parcel Number 1132060134220 Phone: (954)454 -1948 Building Department Comments INTERIOR BUILT OUT FOR NEW PEDIATRICS OFFICE Infractio Passed Comments INSPECTOR COMMENTS True ?, r Passed Inspector Comments CREATED AS REINSPECTION FOR INSP- 182494. CREATED AS REINSPECTION FOR INSP- 181202. / J Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled re- inspection fee is paid. until March 19, 2013 For Inspections please call: (305)762 -4949 Page 1 of 1 Certificate of Occupancy Miami Shores Village 10050 NE 2 Ave, Miami Shores FL, 33138 Tel: 305 -795 -2204 Fax: 305 - 756 -8972 Building Inspection Department This certificate issued pursuant to the requirements of the Florida Building Code 106.1.2 certifying that at the time of issuance this structure was in compliance with the various ordinances of the jurisdiction regulating building construction or use. For the following: Bldg. Permit No. F &F CONSTRUCTION SERVICES NC Type OF Business MEDICAUPROFESSIONAL USE (SHORES PEDIATRIC) 9713 NE 2 AVE Miami Shores FL 33138- Not Transferable POST IN A CONSPICUOUS PLACE ' � a.�pt" -M ry�,�`�^,�„�xa`"c a, . ��',�,^. -Y ama „�:�:i��.,�G.. °., m+=a,� .es��;x.�'�4,�:. w.�, ��r�.,'��. ,xa. ; rS��``., ��'t:�..�•:.�- a.� ��'�� i � �'h�a�ici'a��+�"4� 8a�:`°.�k3 - k�.vi�`��s.. ,�.� .�;n. r�aa` , Certificate of Occupancy Miami Shores Villa e 10050 NE 2 Ave, Miami Shores FL, 33138 Tel: 305 -795 -2204 Fax: 305 -756 -8972 Building Inspection Department This certificate issued pursuant to the requirements of the Florida Building Code 106.1.2 certifying that at the time of issuance this structure was in compliance with the various ordinances of the jurisdiction regulating building construction or use. For the following: Bldg. Permit No. Contractor F &F CONSTRUCTION SERVICES NC Type OF Business MEDICAUPROFESSIONAL USE (SHORES PEDIATRIC) 9713NE2AVE Miami Shores FL 33138- Not Transferable POST IN A CONSPICUOUS PLACE Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 181187 Permit Number: CC -6 -12 -1181 Inspection Date: November 05, 2012 Inspector: Bruhn, Norman Owner: DE LA ROSA, TANYA Job Address: 9713 NE 2 Avenue Miami Shores, FL 33138- Project <NONE> Contractor: F&F CONSTRUCTION SERVICES INC Permit Type: Commercial Construction Inspection Type: Final PE Certification Work Classification: Alteration Phone Number (305)756 -6110 Parcel Number 1132060134220 Phone: (954)454 -1948 Building Department Comments INTERIOR BUILT OUT FOR NEW PEDIATRICS OFFICE Infractlo Passed Comments INSPECTOR COMMENTS False Passedj f Inspector Comments Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled re- inspection fee is paid. until November 05, 2012 For Inspections please call: (305)762 -4949 Page 1 of 1 r Miami Shores Village Building Department 10050 NE 2nd Avenue Miami Shores, Florida 33138 October 30, 2012 Location: Shores Pediatrics 9713 -15 NE 2nd Avenue Permit: 12 -1181 Re: Final Inspection Norm Bruhn, I have visually observed and inspected the project at said location and have found it in compliance with FBC 2010 and the approved drawings for this project. Sincerely, Victor J. Bruce President & Archit AR- 0017103 LEE AP 370 NE 101d Street Miami Shores,, Florida 33138 telephone 305 - 310 -5030 fax 1- 877 - 408 -8280 email vbruce@ai- associates.net Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 nspection Number: I NS P- 181184 Permit Number: CC -6 -12 -1181 Inspection Date: November 05, 2012 Inspector: Bruhn, Norman Owner: DE LA ROSA, TANYA Job Address: 9713 NE 2 Avenue Miami Shores, FL 33138- Project: <NONE> Contractor: F&F CONSTRUCTION SERVICES INC Permit Type: Commercial Construction Inspection Type: F. Insulation Certificate Work Classification: Alteration Phone Number (305)756 -6110 Parcel Number 1132060134220 Phone: (954)454 -1948 Building Department Comments INTERIOR BUILT OUT FOR NEW PEDIATRICS OFFICE Infractio Passed Comments INSPECTOR COMMENTS False Passed //- Inspector Comments Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled re- inspection fee is paid. until For Inspections please call: (305)762 -4949 November 05, 2012 Page 1 of 1 F &F Construction Services , Inc. 2617 Park Road, Pembroke Park, FL License CGC 060569 954-454-1948 o / 954-454-1259 fax A. ci I IkDIAAUJi PURPOSE: LTG This form is provided to aid the contractor/ owner in complying with Building Division requirements. The form once completed will certify that the construction complies with the Florida Model Energy Efficiency Code the applicable sections of the Standard Codes as required. This form is to be presented to the stnictural inspector at the time of final inspection. To be completed by permit qualifier/ owner. MASONRY WALLS: Manufacture TYPe Thickness R Value TYPe Thickness R Value FLOOR / CEILING: FRAME WALLS: ri I is Pi �, CO ilk I 5 I do hereby certify A ° the building, equipment and systems referenced below, as governed by the Florida Model Energy Efficiency Code including, but not limited to, exterior envelope component materials, U values of the envelope systems, R value of insulating materials, size and type of apparatus and equipment, equipment system controls and the data specified above are in conformance with the requirements of the Florida Model Energy Efficiency Code, the Standard Codes as amended and the permitted plans and specifications. Permit Number l ii 3 Site 1 cation Cerc ()wo ,r‘g License # Permit Number: CC -6 -12 -1181 I Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 181183 Inspection Date: November 05, 2012 Inspector: Hernandez, Rafael Owner: DE LA ROSA, TANYA Job Address: 9713 NE 2 Avenue Miami Shores, FL 33138- Project: <NONE> Contractor: F&F CONSTRUCTION SERVICES INC Permit Type: Commercial Construction Inspection Type: HRS Approval Work Classification: Alteration Phone Number (305)756 -6110 Parcel Number 1132060134220 Phone: (954)454 -1948 Building Department Comments INTERIOR BUILT OUT FOR NEW PEDIATRICS OFFICE Infractlo Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed \� Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. November 05, 2012 For Inspections please call: (305)762 -4949 Page 1 of 1 STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DIPOSAL SYSTEM CONSTRUCTION I=.11EL.TION AND FINAL APPROVAL APPLICANT: �r AGENT: PERMIT NO. %Y ihr52470 DATE PAID: FEE PAID: RECEIPT #: PROPERTY ADDRESS: !� /S , -2 c2... -�. LOT: BLOCK: SUBDIVISIQN: PROPERTY ID #: CHECKED [X] ITEMS ARE NOT IN COMPLIANCE WITH STATUTE OR RULE AND MUST BE CORRECTED. TANK [01] [02] [03] [04] [05] [06] [07] [08] [09] INSTALLATION TANK SIZE [1] TANK MATERIAL OUTLET DEVICE MULTI- CHAMBERED [ Y("/ N ] �j�� OUTLET FILTER / LEGEND /3 ~-07 40 <5:1`, C"',, WATERTIGHT LEVEL DEPTH TO LID DRAINFIELD INSTALLATION [ ✓l [10] AREA [1]J3 q 7[2] 53-5—SQFT [/]- [11] DISTRIBUTION BOX _ HEADER [..---] [12] NUMBER OF DRAINLINES f -2 , [_,J. [13] DRAINLINE SEPARATION /Z ,j [ [14] DRAINLINE SLOPE [ ]- [15] DEPTH OF COVER /-2" [ ,,,.] [16] ELEVATION [ABOVE • -ELO ' BM [ ] [17] SYSTEM LOCATION.,.._. [ ] [18] DOSING PUMPS •°"S✓ I --4. [ ] [19] AGGREGATE SIZE /V !- :I. [ ] [20] AGGREGATE EXCESSIVE FINES [ ] [21] AGGREGATE DEPTH /V /. FILL / EXCAVATION MATERIAL [22] FILL AMOUNT oz 1 [23] FILL TEXTURE [24] EXCAVATION DEPTH [25] AREA REPLACED [26] REPLACEMENT MATERIAL EXPLANATION OF VIOLATIONS / REMARKS: SETBACKS [27] SURFACE WATER [28] DITCHES [29] PRIVATE WELLS [30] PUBLIC WELLS [31] IRRIGATION WELLS [32] POTABLE WATER LINES [33] BUILDING FOUNDATION [34] PROPERTY LINES [35] OTHER FT FT FT FT FT FT FT FT FILLED / MOUND SYSTEM [36] DRAINFIELD COVER [37] SHOULDERS [38] SLOPES [39] STABILIZATION /1/7 ADDITIONAL INFORMATION [40] UNOBSTRUCTED AREA [41] STORMWATER RUNOFF �C [42] ALARMS [43] MAINTENANCE AGREEMENT [44] BUILDING AREA [45] LOCATION CONFORMS WITH SITE PLAN [46] FINAL SITE GRADING , 95Le /p [47] CONTRACTOR cct4 -tf //` ' . [48] OTHER ABANDONMENT cO, / [49] TANK PUMPED ‘ /'Z� / //Z qk [50] TANK CRUSHED & FILLED o/ // Z. CONSTRUCTION FINAL SYSTE PPROVE APPROVE DISAPPROVED]: G (�,�VL�t�ft'+� ��C CHD DISAPPROVED]: DH 4016, 08/09 (Obsoletes all previous editions Incorporated: 64E- 6.003, FAC which may not be used) DATE: 6 / DATE:6 - 6 -/ Page 2 of 3 DIVISION OF Environmental Health Florida Department of Health Miami -Dade County Health Department OSTDS /Well Division 11805 SW 26 St. • Miami, FL 33175 Inspector Date s Address # i99 Pi©_S- -26 7C.) "See/Z: 2acryeZ c75 Signature Comments 111111111111111111111111111111111111111111111 NOTICE OF CONIMENCEMENT A RECORDED COPY MUST BE POSTED ON THE .JOB MU' TIME °SAW _INSPECTION PERMIT NO.Ctrdr' 1 C.O. 1 TAX FOLIO NO. STATE OF FLORIDA COUNTY OF MIAMI-DADE: THE UNDERSIGNED hereby glyeerpticethatimpinvellents will be made to certain real property, and In accordance with Chapter 713, Florida Statutes, the following Information Is provided in this Notice of Commencement 1. Legal description of property and street/address: 97,3 4,-C At" 2 2. Description of improvement tif-eW/e-- 3.Onjieandadc Interest in proFteity: Name and address of fee simple titleholder 4. Contractor's riame, address ne nuibi Amount it( e1 4'..e 0i -L er L., fl4 ari6, CFN 2012R0523809 OR Bk 28203 Ps 0069; (1os ) RECORDED 07/25/2012 15=1900 HARVEY RUVINt CLERK OF COURT MIAMI-DADE COUNTYy FLORIDA LAST PAGE recanting office . to andf ho Z11 r 0-1 tr rA4 5. surety: (Payment bond required by owner from contractor, if anyb Name, address and phone huMber: 1 Ht-Rafte Cbc?17FY that this is a true copy cif tIV TATEO F FLORIDA, COUN'TV OF DADE -.- 6. Lender's`niarne and addnine:' ce 017 al fl 7. Persons Within the State of Florida designated by Owner upon Section 713.130)(a)7., Aorida Statnes, Name, address and phone number: Of COrcf# TA 8. In addition to himself, Owners designates the follOwing person(s) to receive 713.13(1)(b), Florida Statties. Name; address and phone ninnbe tAX t 1,1• .d1 od\ 9. Expiretion date of this Notice of Commencement the explratlon date Is 1 ear from the ciata.dt recording (*ea a dliferadete Is spedfled) WARNING TO owNER:.Ahri F,,AYMENTS MADE BY THE OWNER AFTER THE EXPIRATION...0E3.HE NOTICE OF COMMENCEMENT ARdCONSIDERED impRoPtizi PAYMENTS. UNOER OHAPTER 713, PART li.SECTION 713.13:FLORIDA STATUTES', AND CAN RESULT IWYODR'PAYINGTWICE FOR IMpROVEMENTS TO:YOUR FF,1QPEPTY. A NOTICE OF cOMMEIVCEMENT MUSFBEIIECORDED-ANO POSTED' ON THEIi0EttSITE BEFORE THE FIRSTINSPECTION. IF YOU INTEND TO OBTAIWFWANCING, oONSULT WITH YOUR ,LENDER ORAN ATTORNEY BEFORE,COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT: •- Signatuag4otOwner(s),or Ownerfsy Authorlz Prepared By Print Name a cdN, Titleptce . STATE OF FLORIDA COUNTY OF MIAMI-DADE The foregoing instrninent was acknowledged before' me this cr-4?? day of or/Pariner/Manager ••—` Prepared By f Print Name r $ Title/OffIce BY U I U for Persona* known, or CI peodticed the folloWing type& Identificatio unsint Signature of Notary Pbblic: At411.1MIKI Print Name: (SEAL) VERIFICATION PURSUANT TO SECTION 9'2.5_25—FLORIDA STATUTES Under 'fierialties' of perjOiy, I declare that I have read the fotegOing and that the facts stated in it are true, to the best of 'y knowledge and belief. Signature(s) of Owner(s) or Ownet(s)s A razed Oflicer/Director/partner/M By 129.01-52 PAGE 9 3/10 By Miami Shores Village rEgmEWkr Buildin g Department artment JUN 212 Y2 Li 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: BUILDING ROOFING Permit No. Cf Master Permit No. °756 OWNER: Name (Fee Single Titleholder): O v(4M 1,_ ,, -t�' Phone #: s 0 A. t I a Address: gilt. yo V tc b .v- City: _) i f 0 (A.(∎ (0k. C. VSetic Zip: 34 t `33" Tenant/Lessee Name: 6 hove' , t�' C el et.. i-vN. S Phone #: Email: City: Miami Shores Folio/Parcel #: Is the Building Historically Designated: Yes County: Flood Zone: CONTRACTOR: Compant Name: �''�` F G ktsT?? (1 i' y i a W Phone #: 5 (94':-.c.25 . �. 1,7 Address: 2 17 1 Ci [ -� City: 3 tAk Y (Ct tr State: ' .- / ) Zip: Qig �- t „t f L.-9 ' lV Phone #: Qualifier Name: `"' U`-' 1C- State Certification or Registration #: C G C- (:)(0o .C1. Q Certificate of Competency #: Contact Phone #: Email Address: F Co T4 33® >400/.. C fl DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ t�� Square/Linear Footage of Work: Type of Work: Addition DAlteration New URepair/Replace ODemolition Description of Work: 1 i` Tela t 0? `&c.A. p c�3 j A u.,kg *********************** *** * * *****:xa **** *FFeee7s* ** �x******** �xx��nx�x : *+xx��x** **�x�x*** *�x ****�x�x� *** Submittal Fee $ Permit Fee $ / .) C/ CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ a, ) rl .50 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 Owner or Agent The foregoing instrument was acknowledged before me this day of, who is 0 112"-, by Contractor The foregoing ins � ment was acknowledged before me this , day of 0 Ulte., 20 i —by own to me or who has produced mar wn to me or who has produced As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Ex NOTARY ' UBLIC: Sign: Print: My Co *** * * * *** * **** **** ** **** * ********* ** x* *x :***x:x:***+x*+x****** :a:******* ********* * *** x******* ************ **+x*x:**** APPROVED BY Plans Examiner Structural Review (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) Zoning Clerk STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT CONSTRUCTION PERMIT FOR: OSTDS New APPLICANT: (Odamise, LLC) PERMIT #: 13-SC- 1378540 APPLICATION #: API052670 DATE PAID: FEE PAID: RECEIPT #: DOCUMENT #: PR860145 PROPERTY ADDRESS: 9713 -15 NE 2 Ave Miami, FL 33168 LOT: 12 BLOCK: 31 SUBDIVISION: Miami Shores PROPERTY ID #: 11- 3206 -013 -4220 [SECTION, TOWNSHIP, RANGE, PARCEL NUMBER] [OR TAX ID NUMBER] SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF SECTION 381.0065, F.S., AND CHAPTER 64E -6, F.A.C. DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE SATISFACTORY PERFORMANCE FOR ANY SPECIFIC PERIOD OF TIME. ANY CHANGE IN MATERIAL FACTS, WHICH SERVED AS A BASIS FOR ISSUANCE OF THIS PERMIT, REQUIRE THE APPLICANT TO MODIFY THE PERMIT APPLICATION. SUCH MODIFICATIONS MAY RESULT IN THIS PERMIT BEING MADE NULL AND VOID. ISSUANCE OF THIS PERMIT DOES NOT EXEMPT THE APPLICANT FROM COMPLIANCE WITH OTHER FEDERAL, STATE, OR LOCAL PERMITTING REQUIRED FOR DEVELOPMENT OF THIS PROPERTY. SYSTEM DESIGN AND SPECIFICATIONS T [ 1,050 3 GALLONS / GPD Septic CAPACITY A [ ] GALLONS / GPD CAPACITY N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS] K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ D [ 542 ] SQUARE FEET bed configuration drainfile SYSTEM R [ ] SQUARE FEET SYSTEM A TYPE SYSTEM: [x] STANDARD [ ] FILLED [ ] MOUND [ ] I CONFIGURATION: [ ] TRENCH [x] BED [ ] N F LOCATION OF BENCHMARK: CL NE 2 ave., 9.22' NGVD. I ELEVATION OF PROPOSED SYSTEM SITE [ 0.96 ] [) INCHES r FT ] I) ABOVE r BELOW ] BENCHMARK /REFERENCE 1 29.04 ] [) INCHES r FT ] [ ABOVE 4 BELOW II BENCHMARK /REFERENCE E BOTTOM OF DRAINFIELD TO BE L D FILL REQUIRED: O T H E R 1 0.00 ] INCHES EXCAVATION REQUIRED: [ 72.00] INCHES POINT POINT Inspector to verify the existing septic tank is properly abandon before final approval. *Potable water line within 5 ft of drainfield shall not be located at an elevation lower than the drainfield absorption surface. *Invert elevation of drainfield to be no less than 7.30 ft. NGVD. *Bottom of drainfield elevation to be no Tess than 6.80 ft. NGVD. *Install 42" of slightly limited soil under the bottom of the drainfield. - Perimeter of excavation area shall be at least 2 ft wider and longer than the proposed absorption bed or drain trench. (Comments Continued on Page 2.) SPECIFICATIONS BY: APPROVED BY: DATE ISSUED: Carlos M Icaza Carlos M Ioaza 11/30/2011 TITLE: TITLE: Dade CHn EXPIRATION DATE: 05/30/2013 DH 4016, 08/09 (Obsoletes all previous editions which may not be used) Incorporated: 64E- 6.003, FAC v 1.1.4 AP1052670 5E1157062 Page 1 of 3 NOTICE OF RIGHTS A party whose substantial interest is affected by this order may petition for an administrative hearing pursuant to sections 120.569 and 120.57, Florida Statutes. Such proceedings are governed by Rule 28 -106, Florida Administrative Code. A petition for administrative hearing must be in writing and must be received by the Agency Clerk for the Department, within twenty -one (21) days from the receipt of this order. The address of the Agency Clerk is 4052 Bald Cypress Way, BIN # A02, Tallahassee, Florida 32399 -1703. The Agency Clerk's facsimile number is 850 -410 -1448. Mediation is not available as an altemative remedy. Your failure to submit a petition for hearing within 21 days from receipt of this order will constitute a waiver of your right to an administrative hearing, and this order shall become a 'final order'. Should this order become a final order, a party who is adversely affected by it is entitled to judicial review pursuant to Section 120.68, Florida Statutes. Review proceedings are govemed by the Florida Rules of Appellate Procedure. Such proceedings may be commenced by filing one copy of a Notice of Appeal with the Agency Clerk of the Department of Health and a second copy, accompanied by the filing fees required by law, with the Court of Appeal in the appropriate District Court. The notice must be filed within 30 days of rendition of the final order. DocvMENT # : PR860145 -The licensed contractor installing the system is responsible for installing the minimum category of tank in accordance with sec. 64E- 6.013(3)(f). F.A.C. Permit No: 12 -1181 Job Name: June 29, 2012 Miami Shores Viiiage Building Department Building Critique Sheet rovide all permit applications prior to any further review. Provide corrections for Plumbing. 3) Identify the hourly rating and tested assembly for the tenant demising walls. ! hour minimum is required. 4) Indicate the elevation of the exterior walking surfaces compared to finish floor. 5) The north corridor must have a minimum of 42' for maneuverability at doors. 6) The second bath is labeled as private. Identify that this is for the useof owner or manager only and it must be adaptable. 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Page 1 of 1 Plan review is not complete, when all items above are corrected, we will do a complete plan review. If any sheets are voided, remove them from the plans and replace with new revised sheets and include one set of voided sheets in the re- submittal drawings. Norman Bruhn CBO 305 -762 -4859 Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Permit No. Job Name , g/ c5 PLUMBING CRITIQUE SHEET P 0. P h 4';--m sz-vA° w • _ . 1 Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Permit No. Job Name ✓i CRITIQUE SHEET i/. dlifw'F 4, P PERMIT #: IVI iami Shores Vivage Building Department RECEIPT __ZZL/ZcfL__ DATE: 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 j -Contractor o Owner o Architect Picked up 2 sets of plans and (other) Address: From the building department on this date in order to have corrections done to plans And /or get County stamps. I understand that the plans need to be brought back to Miami Shores Village Building Dep. ment - ''ntinue permitting process. Acknowledged by: PERMIT CLERK INITI RESUBMITTED DATE: PERMIT CLERK INITIAL: E 2-6G Environmental Services, LLC July 1, 2011 EE&G Project No. 2011 -2389 Mr. Victor J. Bruce A & I Associates, Inc. 370 NW 101St Street Miami Shores, Florida 33138 Subject: Limited Asbestos Pre- Renovation Survey Shores Pediatrics 97138915 NE 2nd Avenue Miami Shores, Florida Dear Mr. Bruce: 5751 Miami Lakes Drive Miami Lakes, Florida 33014 Tel (305) 374 -8300 Fax (305) 374 -9004 www.eeandg.com EE&G Environmental Services, LLC (EE&G) conducted a limited asbestos survey the Shores Pediatrics located at 9713 and 9715 NE 2"d Avenue in Miami Shores, Florida. The purpose of this asbestos survey was to identify the presence, extent, and condition of asbestos - containing materials (ACM) in the surveyed areas of this facility. The area surveyed during this inspection was limited to the interior renovation areas shown by the client in the on the provided plans at the time of the inspection scheduled for renovation (See attached Figure). Observed suspect materials were either sampled to determine asbestos content or assumed to contain asbestos. SUMMARY EE &G collected a total of seven samples of the following materials: drywall system, wall plaster, and vinyl floor tile. None of the samples collected were found to contain asbestos. SURVEY METHODS The interior renovation areas of the building were inspected for suspect ACM, unless otherwise noted. Each observed suspect material was assigned a homogenous area number, described, and measured. Each observed suspect material was either sampled or assumed to be asbestos- containing. Samples of suspect ACM were collected using procedures established by the United States (US) Environmental Protection Agency (EPA) Code of Federal Regulations (CFR) Title 40 Part 763 Subpart E, Asbestos - Containing Materials in Schools. Samples were sent to American Asbestos Laboratories, Inc. in Tampa, Florida for analysis. Upon arrival at the laboratory, the samples were logged -in and stored for analysis. Analyses were performed using the polarized Tight microscopy (PLM) method of asbestos detection using guidelines and procedures established in the Method for the Determination of Asbestos in Bulk Building Materials (EPA - 600 /R- 93-116 July, 1993). Miami Melbourne Orlando Tampa Houston, TX Mr. Victor J. Bruce July 1, 2011 Page 2 LIMITATIONS OF SURVEY This asbestos inspection report has been prepared by EE &G in a manner consistent with industry standards exercised by members of the profession practicing under similar conditions. No other warranty, expressed or implied is made. The intent of this survey report is to assist the owner or client in locating ACM. Under no circumstances is this survey to be utilized as a proposal or a project specification document without the expressed written consent of EE &G. The survey was conducted to identify suspect ACM in accessible areas of space 9713 and 9715 as specified in the provided plans during the time of this inspection only (See attached Figure). If other areas at this location are to be impacted during planned or future renovations, a separate asbestos survey of these areas will be required. Some ACM may not have been discovered due to inaccessibility or missing/incomplete plans. Any suspect materials discovered subsequent to the issue of this survey report should be sampled and analyzed to determine asbestos content and to initiate appropriate responses. Analyses were carried out by PLM. While the most commonly accepted analytical method for detecting asbestos in bulk materials, PLM is known to have limited resolution and may not detect extremely small asbestos fibers. Certain materials, notably vinyl floor tiles, may contain extremely fine asbestos fibers that are beyond the resolution of PLM. EE &G's interpretations and recommendations are based upon the results of sample collection and analyses in compliance with environmental regulations, quality control and assurance standards, and the scope of work as indicated in EE &G's proposal. The results, conclusions, and recommendations contained in this report pertain to conditions observed at the time of the survey. Other conditions elsewhere in the subject building(s) may differ from those in the inspected/surveyed locations and, such conditions are unknown, may change over time, and have not been considered. This report was prepared solely for the use of EE &G's client, and is not intended for use by third party beneficiaries. The client shall indemnify and hold EE &G harmless against any liability for any loss arising out of or relating to reliance by any third party on any work performed thereunder, or the contents of this report. EE &G will not be held responsible for the interpretation or use by others of data developed pursuant to the compilation of this report, or for use of segregated portions of this report. SURVEY AREA DESCRIPTION AND OBSERVATIONS The structure was observed to be constructed of concrete block on a concrete slab foundation. Interior walls were observed to be finished with drywall and plaster; ceilings were finished with laid-in ceiling tiles, floors were fished with wood and vinyl floor tile. Exterior walls and structural columns were finished with stucco. No fireproofing was observed at the time of this inspection. RESULTS The results of the PLM analyses and assessment of suspect ACM are as follows: SHORES PEDIATRICS SURVEY Mr. Victor J. Bruce July 1, 2011 Page 3 Asbestos- containina materials Asbestos was not identified in amounts greater than 1 percent in the sampled materials. Nonasbestos- containing materials Asbestos was not detected in the following materials: • Drywall system. • Wall plaster. • Vinyl floor tile. The original laboratory report is included as an attachment. CONCLUSIONS None of the materials sampled within the inspected area were found to contain asbestos. If other specific areas at this location are to be impacted during planned renovations or demolition, an asbestos survey of these areas will be required. Suspect materials discovered after this inspection should be sampled and analyzed to determine asbestos content and to initiate appropriate responses. Notification to the Miami -Dade County Department of Environmental resource Management (DERM) of intent to renovate is not necessary, however, the general contractor should have a copy of this survey at the construction site during the entire construction project as proof of compliance with 40 CFR 61 (NESHAP). EE &G appreciates the opportunity to provide A & I Associates, Inc. with environmental consulting services. If you have any questions or require further clarifications, please do not hesitate to contact us at (305) 374-8300. Sincerely, '><44rAslir‹. . Hiram Aguiar Senior Project Professional Attachments: Appendix A: Appendix B: Appendix C: Appendix D: SHORES PEDIATRICS SURVEY Laboratory Report Figures Photographs Certificates Reviewed by Daniel J. Co rell, Ph.D., P.G. Senior Technical Advisor, EE &G Asbestos Consultant #DD0000010 Mr. Victor J. Bruce July 1, 2011 Appendices APPENDIX A PLM LABORATORY REPORTS SHORES PEDIATRICS SURVEY American Asbestos Laboratories SENT A & I ASSOCIATES, INC. TO: 370 NE 101 STREET MIAMI SHORES, FL 33138 VICTOR BRUCE 305 - 310- 5030/FAX:877- 408 -8230 Thank you for your business. REPORT PREPARED BY: June 30, 2011 16:39 AAL Asbestos Department 5005 WEST LAUREL STREET SUITE 110 TAMPA, FL 33607 NVLAP Code 101775 (813) 287 -1005 Analysis: Polarized Light Microscopy (PLM) with dispersion staining techniques according to the United States (US) Environmental Protection Agency (EPA) "Method for the Determination of Asbestos in Bulk Building Materials," EPA /600/R -93 -116, July, 1993. Sample Type #Of Samples Work Order# EE&G Project# Project Analyzed By: : BULK :7 : M106098 : 2011 2389 : SHORES PEDIATRICS Khandaker 1. Anam Date in Date out Collected by Delivery by Received by : June 30, 2011 : June 30, 2011 . H.A.A. : FEDEX : KIA Authorized Signature Due to the small size of asbestos fibers associated with vinyl fiob containing <1% or no detectable asbestos by visual estimation. This report may not be reproduced except in full, without the written approval of AAL. AAL will not be held responsible for the use of its reports issued in part to third parties or authorized agents of the client. This report shall not be used by the client to claim product endorsement by NVLAP nor any agency of the United States Government. All NVLAP reports displaying NVLAP logo must have at least one signature to be valid. The following analytical results presented in this report pertain only to the samples analyzed. American Asbestos Laboratories assumes no responsibility for whether the samples accurately represent the material in question. • EM analysis is recommended for all floor ti June 30, 2011 16:39 AAL LABORATORY BULK SAMPLE ANALYSIS REPORT CLIENT : A & I ASSOCIATES, INC. PROJECT : SHORES PEDIATRICS WORK ORDER NUMBER: M106098 Page 1 Samples were analyzed in accordance with the Interim Method as described in 40 CFR, Part 763, Vol. 52, No. 210 IDy ANA DESCRIPTION PERCENT ASBESTOS FIBERS LOCATION SAMPLE NUMBER CHRY AMOS CROC TREM ANTE OTHER 01A KIA WHITE WALL PLASTER 9713- N.DIVID. WL 062911HA01 NO ASBESTOS DETECTED 02A KIA WHITE DRYWALL SYSTEM 9713 -EAST WALL Layer 1: NO ASBESTOS DETECTED IN WHITE DRYWALL Layer 2: NO ASBESTOS DETECTED IN WHITE JOINT COMPOUND 062911 HAO2 NO ASBESTOS DETECTED %NON -ASB FIBERS 1 -2 10 -15 02B KIA WHITE DRYWALL SYSTEM 9713- RESTRM WALL 062911HA03 Layer 1: NO ASBESTOS DETECTED IN WHITE DRYWALL Layer 2: NO ASBESTOS DETECTED IN WHITE JOINT COMPOUND NO ASBESTOS DETECTED 10-15 03A KIA GREY 12 "X12" VFT ® Comments: 9713- RESTRM 062911HA04 NO ASBESTOS DETECTED 1 -2 NO ASBESTOS DETECTED IN YELLOW GLUE 04A KIA WHITE DRYWALL SYSTEM 9715 - RECEPTION Layer 1: NO ASBESTOS DETECTED IN WHITE DRYWALL Layer 2: NO ASBESTOS DETECTED IN WHITE JOINT COMPOUND 062911HA05 NO ASBESTOS DETECTED 10 -15 045 KIA WHITE DRYWALL SYSTEM 9715 -5. OFFICE Layer 1: NO ASBESTOS DETECTED IN WHITE DRYWALL Layer 2: NO ASBESTOS DETECTED IN WHITE JOINT COMPOUND 062911HA06 NO ASBESTOS DETECTED 10-15 04C KIA WHITE DRYWALL SYSTEM 9715-5. OFFICE Layer 1: NO ASBESTOS DETECTED IN•WHITE DRYWALL Layer 2: NO ASBESTOS DETECTED IN WHITE JOINT COMPOUND 062911HA07 NO ASBESTOS DETECTED 10 -15 Analytical results pertain only to the sample(s) analyzed. ACCEPWLE I 41,1 Quality Control Officer) ABBREVIATIONS: ANA - Analyst; ASB =Asbestos; CHRY- Chrysotile; AMOS- Amosite; CROC =Crocidolite; TERM - Term/Act; ANTH- Anthophylite; ACT =Actinolite; AL— Aluminum; ANTH =Anthophylite; BLK—. Black; BACK Backing; BL Blue; BRN —Brown; C = Cellulose; CALC— Calcareous; CPT — Carpet; CTL— Ceiling tile; CEM- Cement; COV =Cover, DEB — Debris; FG— Fiberglass; FIB= Fibrous, fibers; MAS -Mastic; MAT —Material; MIC -Micaceous; MW- Mineral wool; ORG— Orange; PAI — Paint; PAP= Paper; PL Plaster, PLAS— Plastic; PWDR- Powder; RCF -Refractory ceramic fiber; RUB - Rubber, SIL— Silver; SR— Sheet rock; SUB— Substance; S— Synthetic; TEXT— Textured; TR— Trace; TRAN— Transite; TREM — Tremolite; VERM- Vermiculite; VYL- Vinyl; W— Wollaston ite; WH- White; YE. — Yellow. EEbG EE &G Environmental Services, LLC 5751 Miami Lakes, Drive Miami Lakes, Florida 33014 M 0 BULK TRANSMITTAL. FORM CHAIN OF CUSTODY CUENT: r1 PROJECT: PROJECT NUMBER: l CUENT CONTACT: DATE COLLECTED: DATE SENT: STOP AT FIRST POSITIVE: Y (circle one) BILL GROUP /PHASE: DATE VERBAL NEEDED: 5�.�% fr DATE WRITTEN NEEDED: SAMPLE PREFIX SAMPLE NUMBER � COLOR 1. iA°� 9/1/ `%� / 41I roc -, 2. e2 3. e23 4. 04'I ‘.1e- 5. 6. 0-7 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. SAMPLE DESCRIPTION L)-V 'e I/b".4 CHAIN OF CUSTODY: DATE/TIME PRINT NAME/SIGNATURE ".0),0 •��•. C= Collection T= Transportation A= Anali§ 1 # !MN 1:111 S+ /AMPLE LOj`CATION qR/! I 43 . ' -4;Li; /'sue!' r/ Y /.Xe q .7 /5 /E'c .v./1 PURPOSE A T A Mr. Victor J. Bruce July 1,2011 Appendices APPENDIX B FIGURES SHORES PEDIATRICS SURVEY I Mr. Victor J. Bruce July 1,2011 Appendices APPENDIX C INSPECTION PHOTOGRAPHS SHORES PEDIATRICS SURVEY Mr. Victor J. Bruce July 1, 2011 Appendices Photo 1: East side entrance to Shores Pediatrics Space 9713. Photo 2: Typical interior view of space 9713 at the subject site. SHORES PEDIATRICS SURVEY Mr. Victor J. Bruce July 1,2011 Appendices Photo 3: East side entrance to future expansion to Shores Pediatrics Space 9715 Photo 4: Interior view of space 9715 at the subject site. SHORES PEDIATRICS SURVEY Mr. Victor J. Bruce July 1, 2011 Appendices APPENDIX D CERTIFICATES SHORES PEDIATRICS SURVEY M'E'TA Mayhew Environmental Training Associates INCORPORATED Certificate # 7ME04151101A1R0005 This is to certify that Hiram Aguiar has on 4/15/11, in Miami Lakes, FL completed the requirements for asbestos accreditation under Section 206 of TSCA Title 11, 15 U.S.C. 2646 AHERA Asbestos Building Inspector Refresher Course as approved by the State of Florida and the U.S.E.PA. under 40 C.F.R. 763 (AHERA) on 4/15/11 - 4/15/11 and passed the associated examination on 4/15/11 with a score of 70% or better CM = 0.5 Provider #: FL49- 0001221 Course #: FL49 -0004718 Soc. ai #: (e(1 01 Accra ita ion xpires: 415/12 President Thomas Bradford Mayhew 800 -444 -6382 VM1 Ins7Fuctor Bill Young (94 7 M ETA - P.O. Box 786 - Lawrence KS 66044 L. ' , , United States Department of Commerce National Institute of Standards and Technology Certificate of Accreditation to ISO /IEC 17025:2005 NVLAP LAB CODE: 101775 -0 American Asbestos Laboratories, Inc. Tampa, FL is accredited by the National Voluntary Laboratory Accreditation Program for specific services, listed on the Scope of Accreditation, for. BULK ASBESTOS FIBER ANALYSIS This laboratory is accredited in accordance with the recognized International Standard ISO/!EC 17025:2005. This accreditation demonstrates technical competence for a defined scope and the operation of a laboratory quality management system (refer to joint ISO- ILAC -IAF Communique dated January 2009). 2011 -04-01 through 2012 -03 -31 Effective dates For the National Ins ute of Standards and Technology NVLAP -01C (REV. 2009- 01 -28) Miami Shores V Building Department CoI2Ili 4a_ RECEIPT Ck reAba0 PERMIT #51A-M8 � 1. /1 )CcSIpATE: 'Gk',l_/ "digtr)' 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 V(-1t9\9--J, tgUC o Contractor o Owner Architect Pi L u 2 sets of plans and (o Qc j , Address: N\E-- From the building department on this date in order to have corrections done to plans And /or get County stamps. I understand that the plans need to be brought back to Miami Shores Village Build' De artmet to co tinue permitting process. Acknowledged by: PERMIT CLERK INITIAL: RESUBMITTED DATE: PERMIT CLERK INITIAL: xr } LOCATION SKETCH SCALE: NTS SCALE: 1" =20' BLOCK 31 130.00' (R &M) ASPHALT "PARKIN :: ONE STORY COMMERCIAL BUILDING # 9713 -9715 15' ALLEY N.E. 97th STREET A/C 130.00' (R&M) LOT 13 BLOCK 31 NOT VALID UNLESS EMBOSSED WITH SURVEYOR'S SEAL ABBREVIATIONS: S Wi(= SIDEWALK CBS= CONCRETE BLOCK STRUCTURE, CLF =CHAIN LINK FENCE, PL =PROPERTY LINE, DUE = DRAINAGE UTILITY EASEM ENT, IP =IRON PIPE, F= FOUND, A/C =AIR CONDITIONER PAD, P /C= PROPERTY CORNER, D/H =DRILLED HOLE, WWF =WOODEN FENCE, RES= RESIDENCE, CL- CLEAR, RB= REBAR, UE =UTILITY EASEMENT. CONC = CONCRETE SLAB. RIW RIGHT OF WAY, DE =DRAINAGE EASEMENT, C/L= CENTER LINE, O =DIAMTER, TYP =TYPICAL, M- MEASURED. R =RECORDED, ENCR= ENCROACHMENT, COMP= COMPUTER, ASH = ASPHALT, N/D =NAIL & DISC, S =SET, FEE = FINISH FLOOR ELEVATION, O /S= OFFSET, P/P =POWER POLE, OHP= OVERHEAD POWERLINE, WVI =VOTER METER WOOD FENCE - MASONRY WA I. L= CONCRETE- '• _ ELEVATION BASED ON LOC. # 3100 MAINTENANCE& DRAINAGE EASEMENT= M &D.E•' I DCBiVI# N -568 ELV 9.65° TYPE OF SURVEY: BOUNDARY SURVEY SURVEYOR'S NOTES: 1) OWNERSHIP SUBJECT TO OPINION OF TITLE. 2) NOT VALID WITHOUT THE SIGNATURE AND RAISED SEAL OF A FLORIDA LICENSED SURVEYOR AND MAPPER. 3) THE SURVEY DEPICTED HERE IS NOT COVERED BY PROFESSIONAL LIABILITY INSURANCE, 4) LEGAL DESCRIPTION PROVIDED BY CLIENT. 5) „ UNDERGROUND ENCROACHMENTS NOT LOCATED. 6) ELEVATIONS ARE BASED ON NATIONAL GEODETIC VERTICAL DATUM OF 1929. 7) OWNERSHIP OF FENCES ARE UNKNOWN. 8) THERE MAY BE ADDITIONAL RESTRICTIONS NOT SHOWN ON THIS SURVEY THAT MAY BE FOUND IN THE PUBLIC RECORDS OF THIS COUNTY. 9) CONTACT THE APPROPRIATE AUTHORITY PRIOR TO ANY DESIGN WORK FOR BUILDING AND ZONING INFORMATION. 10) EXAMINATION OF THE ABSTRACT OF TITLE WILL HAVE TO BE MADE TO DETERMINE RECORDED INSTRUMENTS, IF ANY, AFFECTING THIS PROPERTY, SURVEY OF: 9713 -9715 N.E. 2ND AVE., MIAMI SHORES, FL. 33138. LEGAL DESCRIPTION: LOT 12 OF AMENDED PLAT OF MIAMI SHORES SECTION NO. 1 ACCORDING TO THE PLAT THEREOF AS RECORDED IN PLAT BOOK 10 OF THE PUBLIC RECORDS MIAMI -DADE COUNTY, FLORIDA REVISED: • 10 -_i_ 70 REFERRED TO AN ASSUMED VALUE OF SAID PB G 1 HEREBY CERTIFY That the survey represented thereon meets the minimum.technical requirements adopted by the STATE OF FLORIDA Board of Land Surveyors pursuant to Section 472.027 Florida Statutes. There are no encroachments, overlaps, easements appearing on the plat or visible easements other than as shown hereon. ADIS N. NUNEZ REGISTERED LAND SURVEYOR STATE OF FLORIDA #5924 BLOCK SUBDIVISION AT PAGE 70 SINCE 1987 BL.ANCO SURVEYORS INC. Engineers - Land Surveyors . Planners . LB # 0007059 555 NORTH SHORE DRIVE MIAMI BEACH, FL 33141 (305) 865 -1200 Email: blancosurveyorsinc @yahoo.com Fax: (305) 865 -7810 FLOOD ZONE: x PANEL: 0302 SCALE: 1 " =20' SUFFIX: L DATE: 9/11/09 BASE: N/A COMMUNITY# 120652 DWN. BY: F. Blanco 11 -671 SYSTEM SIZING SUMMARY System: AC#2 Location: Miami Shores, ShoresPediatrics.F1 Prepared by: ARPE Engineering, Inc. Block Load 3.05 July 11, 2011 Page: 1 TABLE 1. SIZING DATA (COOLING) 1 Total Coll Load Sensible Coil Load Total Zone Sensible Supply Temperature Supply Air (Actual) Supply Air (Standard) Ventilation Air Direct Exhaust Air Reheat Required Floor Area Overall U -Value Vent Air Vent Air TABLE 2. SIZING DATA Heating Coil Load Ventilation Load Total Zone Load Ventilation Airflow 54,303 BTU/hr 41,148 BTU/hr 35,940 BTU/hr 56.0 F 1,752 CFM 1,751 CFM 200 CFM 0 CFM 0 BTU/hr 1,548 sqft 0.159 BTU/hr/sgftiF 0.13 CFM/sqft 20.00 CFM/Perann (HEATING) 31,379 BTU/hr 5,118 BTU/hr 26,261 BTU/hr 200 CFM Load Occurs Outdoor Db/Wb Coil Conditions: Entering Db/Wb Leaving Db/Wb Apparatus Dewpoint Bypass Factor Resulting Zone RH Total Coil Load Sensible Coil Load SQFT/fon Cooling Cooling August 17:00 90.1/77.1 F 76.7/65.0 F 55.0/54.5 F 53.8 8' 0.050 52. % 4.53 Ton 3.43 Ton 342.08 35.08 BTU/hr /sqft 1.13 CFM /soft 1 Heating Heating Floor Area Overall U -Valve Vent Mr 20.27 BTU/hr/sgft 0.00 CFM/sqft 1,548 sgft 0.159 0.00 CFM/sqft TABLE 3. INPUT DATA (WEATHER) Location Data Source Latitude Elevation Atmospheric Clearness 4 TAB' _ . .17.7777:" Miami Shores, ShoresPediatrics.F1 User Defined 25.8 Degree 7.0 ft 0.90 Summer Dry -Bulb Coincident Wet -Bulb Daily Range Winter Dry-Bath 91.6 F 77.5 F 15.0 F 46.3 F System ivnme System Type System Start Duration SIZING SPECIFICATIONS Supply Ventilation Exhaust FACTORS Coil Bypass Safety (Sens) Safety (Latent) Heating Safety Clg and Electric Ht 6:00 24 hrs 56.0 F 20.00 CFM/person 0.00 CFM 0.050 0 % 0 % 0 % ir11;.RMt,3r &e:TPOlir•. Cooling (Occ.) 75.0 F Cooling (Unocc.) 80.0 F Heating 70.0 F RETURN AIR PLENUM No FAN Configuration Draw -Thru Static Pressure 1.50 in. wg. TABLE 5. TOP TEN COOLING COIL LOADS Time 1) August 17:00 2) August 16:00 3) July 17:00 4) July 16:00 5) June 17:00 Sensible Ton Total Ton 3.43 4.53 3.42 4 .51 3.41 4 .50 3.39 4.48 3.35 4.47 Time Sensible Ton Total Ton 6) June 16:00 333 4.45 7) August 15:00 3.34 4.44 8) September 17:00 3.36 4.42 9) September 16:00 336 4.42 10) July 18:00 332 4.42 SYSTEM SIZING SUMMARY System: AC#2 Location: Miami Shores, ShoresPediatrics.FI Prepared by: ARPE Engineering, Inc. Block Load 3.05 July 11, 2011 Page: 2 TABLE 6. ZONE SIZING DATA Max. Cooling Design Airflow Max. Heating Design Flow Sensible Rate Load Rate Zone Name (BTU/hr) (CFM) Design Time (kW) Office Space 35,940 1,752 August 17:00 7.7 Total: 1,752 Total: .00 SYSTEM INPUT REPORT System: AC#2 Location: Miami Shores, ShoresPediatrics.FI Prepared by: ARPE Engineering, Inc. Block Load 3.05 July 11, 2011 Page: 1 TABLE 1. HVAC SYSTEM DESCRIPTION 1 System Type System Start Duration SIZING SPECIFICATIONS Supply Ventilation Exhaust FACTORS Coil Bypass Safety (Sens) Safety (Latent) Heating Safety Clg and Electric Ht 6:00 24 hrs 56.0 F 20.00 CFM/Per 0.00 CFM 0.050 0 % 0 % 0 % THERMOSTAT SETPOINTS Cooling (Occ.) Cooling (Unocc.) Heating RETURN AIR PLENUM FAN Configuration Static Pressure 75.0 F 80.0 F 70.0 F No Draw Thru 1.50 in. wg. TABLE 2. SYSTEM ZONING INFORMATION System Arrangement: All zones served by a common air handler Total Zones Selected: 1 Selected Zones: 1) Office Space SYSTEM SIZING SUMMARY System: AC#2 Location: Miami Shores, ShoresPediatrics.F1 Prepared by: ARPE Engineering, Inc. Block Load 3.05 July 11, 2011 Page: 1 TABLE 1. SING DATA (COOLING) 1 Total Coil Load Sensible Coil Load Total Zone Sensible Supply Temperature Supply Air (Actual) Supply Mr (Standard) Ventilation Mr Direct Exhaust Air Reheat Required Floor Area Overall U -Value Vent Air Vent Mr TABLE 2. SIZING DATA Heating Coil Load Ventilation Load Total Zone Load Ventilation Airflow 54,303 BTU/hr 41,148 BTU/hr 35,940 BTU/hr 56.0 F 1,752 CFM 1,751 CFM 200 CFM 0 CFM 0 BTU/hr 1,548 sqft 0.159 BTU/hr/sgft/F 0.13 CFM/sqft 20.00 CFM/Person (HEATING) 31,379 BTU/hr 5,118 BTU/hr 26,261 BTU/hr 200 CFM Load Occurs Outdoor Db/Wb Coil Conditions: Entering Db/Wb Leaving Db/Wb Apparatus Dewpoint Bypass Factor Resulting Zone RH Total Coil Load Sensible Coil Load SQFT/Ton Cooling Cooling August 17:00 90.1/77.1 F 76.7/65.0 F 55.0/54.5 F 53.8 F 0.050 52. % 4.53 Ton 3.43 Ton 342.08 35.08 BTU/hr/sqft 1.13 (:FM /soft Resting Heating Floor Area Overall U -Valve Vent Mr 20.27 BTU/hr /sqft 0.00 CFM/sqft 1,548 Kft 0.159 0.00 CFM/sqft TABLE 3. INPUT DATA (WEATHER) r Location Data Source Latitude Elevation Mhuni Shores, ShoresPediatrics.FI User Defined 25.8 Degree 7.0 ft Atmospheric Clearness # 0.90 �TABT E 4. INPUT (HVAC SYSTEM) System Name System Type System Start Duration SIZING SPECIFICATIONS Supply Ventilation Exhaust FACTORS Coil Bypass Safety (Sens) Safety (Latent) Heating Safety Summer Dry -Bulb Coincident Wet -Bulb Daily Range Wintpr 1)ry -Bulb 91.6 F 77.5 F 15.0 F 46.3 F AC#2 Og and Electric Ht 6:00 24 hrs 56.0 F 20.00 CFM/person 0.00 CFM 0.050 0 % 0 % 0 % r THERMOSTAT SETPOINTS Cooling (Occ.) 75.0 F Cooling (Unocc.) 80.0 1? Heating 70.0 F RETURN AIR PLENUM No FAN Configuration Draw -Thru Static Pressure 1.50 in. wg. TABLE 5. TOP TEN COOLING COIL LOADS 1 Time 1) August 17:00 2) August 16:00 3) July 17:00 4) July 16:00 5) June 17:00 Sensible Ton Total Ton 3.43 4.53 3.42 4 .51 3.41 4.50 3.39 4.48 3.35 4.47 Time 6) June 16:00 7) August 15:00 8) September 17:00 9) September 16:00 10) July 18:00 Sensible Ton 3.33 3.34 3.36 3.36 3.32 Total Ton 4.45 4.44 4.42 4.42 4.42 SYSTEM SIZING SUMMARY System: AC-#2 Location: Miami Shores, ShoresPediatrics.F1 Prepared by: ARPE Engineering, Inc. Block Load 3.05 July 11, 2011 Page: 2 TABLE 6. ZONE SIZING DATA Zone Name Office Space Max. Cooling Design Airflow Max. Heating Design Flow Sensible Rate Load Rate (BTU/hr) (CFM) Design Time (kW) 35,940 1,752 August 17:00 7.7 Total: 1,752 Total: .00 SYSTEM INPUT REPORT System: AC#2 Location: Miami Shores, ShoresPediatrics.F1 Prepared by: ARPE Engineering, Inc. Block Load 3.05 July 11, 2011 Page: 1 TABLE 1. HVAC SYSTEM DESCRIPTION System Type System Start Duration SIZING SPEC1P1CATIONS Supply Ventilation Exhaust FACTORS Coil Bypass Safety (Sens) Safety (Latent) Heating Safety Clg and Electric Ht 6:00 24 hrs 56.0 F 20.00 CFM/Per 0.00 CFM 0.050 0 % 0 % 0 % THERMOSTAT SE POINTS Cooling (Occ.) Cooling (Unocc.) Heating RETURN AIR PLENUM FAN Configuration Static Pressure 75.0 F 80.0 F 70.0 F No Draw Thru 1.50 in. wg. TABLE 2. SYSTEM ZONING INFORMATION System Arrangement: All zones served by a common air handler Total Zones Selected: 1 Selected Zones: 1) Office Space L- .Tet•zz' c LOCATION SKETCH SCALE: NTS BLOCK 31 SCALE: 1 " =20' 130.00' (R &M) 60.05 ONE STORY COMMERCIAL. BUILDING # 9713 -9715 EPTI 15' ALLEY :PA: ES. ).: REQUEST ❑ ALL ❑ BLDG'£t�l� ❑ HCAP ❑ LANDSCAPING ❑ tvh-CH ❑ ROOF ❑ SIGN ❑ STRU Building & Neighborhood Compliance Herbert S. Saffir Permitting and Inspection Center 11805 SW 26th Street Miami, Florida 33175 -2474 786 - 315 -2100 K:VrEWS ❑ ELEC ❑ PLUM ❑ ZNPR miamidade.gov ❑ ENRG FIRE ❑ PWKS ❑ PWCC WASD ❑ PERMIT BY AFFIDAVIT CHECK ❑ SHORTTERM EVENT AFFIDAVIT CHECK ❑ OPTIONAL PLAN REVIEW U BLDG U ELEC UMECH ❑ PLUM U STRU Dear Applicant: Please complete the following information for notification on the status of your plans. Applicant's First Name: (PRINT CLEARLY) VICV ' Cellular Number: '3C1- '1V• 50S0 EMAIL Address: Last Name: (PRINT CLEARLY) 43RICE Office/Home Number: Stlikker \43ic' @, "NI .SSvx4AT . eT Comments: "A• QOM/. Xb Figia+T giks N Iwt�M� Atk+ 1oio NOTE: IF AN EMAIL ADDRESS WAS PROVIDED YOU WILL BE NOTIFIED VIA EMAIL AND /OR AUTOMATIC TELEPHONE CALL CONCERNING THE STATUS OF YOUR PLANS -FOR OFFICE USE ONLY- Building NLY TO BE COMPLETED BY BUILDING AND OCCUPANCY REPRESENTATIVE OR PLANS PROCESSING SPECIALIST: Application Date // / / Clerk Name: L u rz(L.,s C Arrival Time: I( • L 7 Process No(s): 0 L/ - / ❑ Walk -Thru ❑ Residential -Off ❑ Rework ❑ Re -Issue mmercial ❑ Plan Revision ❑ Shop Drawing 1 TO BE COMPLETED BLDG QA IUD UN DERM UA UD UN ELEC UA UD UN ENRG UA UD UN FIRE UA LID UN BY BUILDING AND OCCUPANCY REPRESENTATIVE OR PLANS PROCESSING SPECIALIST: HCAP ❑A UD UN ROOF ❑A UD UN LAND DA DID UN SIGN UA UD UN MECH UA UD UN STRU ❑A UD UN PLUM QA IUD UN ZNPR ❑A IUD UN WASD UA UD UN HRS UA UD UN Customer Notified By: Date: / / Time: 123_01-117 12/09 a 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 BUILDING PERMIT APPLICATION FBC 20 Permit Type: BUILDING ROOFING RECEIVED NOV 16 2011 .-QT. Permit No. 54012X-3 VED A-T -I c.�S Master Permit No. OWNER: Name (Fee Simple Titleholder): Odamise, LLC Phone#: Address: 9300 North Bayshore Drive City: Miami Tenant/Lessee Name: Shores Pediatrics Email: (aura slMd yOjelDO. C state: Florida JOB ADDRESS: 9713 -15 NE 2nd Avenue City: Miami Shores Folio/Parcel #: 11- 3206 -013 -4220 County: zip: 33168 Phone #: Phone #: Is the Building Historically Designated: Yes NO Flood Zone: N/A CONTRACTOR: Company NameiVf Address:. 1 City: . \ . - - Qualifier Name: Phone#: State Certification or Registration #: Ns. it Certificate of Competency #: Contact Phone #: w'u. DESIGNER: Architect/Engineer: A &I a,ociatesictor J. Bruce) Phone#: 305.310.5030 &)5 1 Zip: 1 Address: Value of Work forpis Permit: $ 90,000 Type of Work: AI Ii s �r_ L�JAlteration Description of Work: ~V' Square/Linear Footage of Work: +/- 2,000 ❑New ❑Repair/Replace ❑Demolition 'F +.S 1 vii —V-1. a. l■]•C! IU 1E11 IVILV1k.1 111 Ak1.I 1. ■R ∎I•l'i;7 ■■ I ■ P1 L IN•I•Ii ■ ∎ irti .Z. eun • rm N. a• *a alai, alxlx t********>k+x+x+x*+ ***mlal**>klxlr*al>r*** Fees*lu*al****** *al*+ xal*+ x+ x+ x+ xw*> H> klx***>r******al***+x**** Submittal Fee $ Permit Fee $ CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ 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 wt not e approved and a reisp ction fee will be charged. Signature wner or Agent The foregoing instrument was acknowledged before me this 1 day of W , 2011 g , by Nq i Di, LA- Yt A , who is personally known to me or who has produced .,1 D As identification and who did take an oath. . 0% NOTARY NOTARY PUBLI Sign: Print: My Commission Expires: 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: ********* ****** *+ x+ x* ************* ** ***************** ****+ x*****+x*+x+x*m****** **+ *** APPROVED BY Plans Examiner Structural Review (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) Zoning Clerk Permit No: PREPLAN 9715 NE 2 "d Ave Job Name: December 6, 2011 Miami Shores Village Building Department Building Critique Sheet Provide approval from Miami Dade County Fire Dept. Provide approval from Miami Dade County DERM. ) Provide approval from HRS /DOH/ �,4) Provide all permit applications prior to any further reviews. •'�' S� orrections must be made for Plumbing, Electrical, Mechanical, Zoning, and Structural. rovide a separate permit for the parking lot renovation. Indicate the occupancy /use of adjoining tenants. Indicate the hourly fire rating of the tenantdemising walls and provide the rated assembly �,( UL design. V) The door schedule does not match the plans and all doors are not identified. Rease provide a complete schedule of all doors. 10) Indicate the elevation of the exterior walking surface compared to finish floor-identify the path of travel from the parking area to the entrance. 1 Provide dimensions on the floor plan. Show the size of corridors and rooms. 1 Provide a detail for the new ceiling at the vestibule. 0,1.3) Completely dimension the existing and new toilet rooms to show compliance with all � /accessible codes including fixture location, height, dear floor space, turning radius, ect. Y4) Show the approach and clear floor space to the refrigerator and sink in break room. 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Page 1 of 1 Plan review is not complete, when all items above are corrected, we will do a complete plan review. If any sheets are voided, remove them from the plans and replace with new revised sheets and include one set of voided sheets in the re- submittal drawings. Norman Bruhn CBO 305 - 795 -2204 Fax_ r --$'rl — yp�_ tc28o Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 180747 Permit Number: ELC -10 -12 -2027 Scheduled Inspection Date: October 29, 2012 Inspector: Devaney, Michael Owner: DE LA ROSA, TANYA Job Address: 9713 NE 2 Avenue Miami Shores, FL 33138- Project: <NONE> Contractor: AJL ELECTRIC INC Permit Type: Electrical - Commercial Inspection Type: Final Work Classification: Addition /Alteration Phone Number (305)756 -6110 Parcel Number 1132060134220 Phone: 305 - 895 -4971 Building Department Comments LOW VOLTAGE Infractio Passed Comments INSPECTOR COMMENTS False Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments C-7- .2 12_ October 26, 2012 For Inspections please call: (305)762 -4949 Page 21 of 27 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 BUILDING PERMIT APPLICATION Permit Type: Electrical JOB ADDRESS: 7 (3 / \-I FBC 20 1,D Permit No. 12-1-C12— gQ7\--1— Master Permit No. EX- �-- t t'l City: Miami Shores County: Miami Dade Folio/Parcel #: Is the Building Historically Designated: Yes Flood Zone: OWNER: Name (Fee Simple Titleholder): t Z L Dr) Z Phone #: Address: en/ % / S sv E Z� City: I (1,_ I' Y� / State: Zip: /_ zip: 3 -3 13 8' Tenant/Lessee Name: Phone #: Email: CONTRACTOR: Company Name: t �L �- e= C 1''i�a -1 L Phone #: O S 8 —‘44 1 I Address: (c 5,�s" f'i S C ��t I? �, BL v D '4 '2 6, City: . 1 /?rvl • State: Qualifier Name: nl'i lfi o Pat/ � I•- L..-i 9 U �: State Certification or Registration #: Contact Phone#: Email Address: DESIGNER: Architect/Engineer: Phone#: Zip:. 2.? Y / Phone #: 2 o.s' r 9 S":"" ti rt 7/ C / .� c9- O 1' 4' Certificate of Competency #: A v ;%' t. e /c Ce-o. Cow 00 ❑Alteration $ Square/Linear Footage of Work: New ❑Repair/Replace Value of Work for this Permit: Type of Work: Address Description of Work: t-'O ❑Demolition 7) Cr) tA4 cv+ * * * * * * * * * ** * * * * * * * ** gees******* *************** ******x :*************** Permit Fee $ / Pea. i 't' Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ CCF $ DBPR $ Technology Fee $ CO /CC $ Bond $ TOTAL FEE NOW DUE $ 1 D 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Owner or Agent The foregoing instrument was acknowledged before me this day of v , 20 j, by w is personally kn wn to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Conuniss Sv nn; 4 a 3276 ices. 2015 ora I.8OO4. ADTA Signature a.. Contractor The foregoing instrument was acknowledged before me this day of 02..(1. 0c4 , 20(Z , by /411/1'/1 O d / who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commissi ***** * # * * *** * * * * ** * ** * * * * * * **ij ************ *, k********************$ l< *, k, k* ***,k,1:,k,k**** * * * * * ** * ** * *N ************** APPROVED BY _ et, , - P l a n s Examiner Structural Review (Revised 3 /12/2012)(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) Zoning Clerk s. Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 180444 Permit Number: ELC -10 -12 -1988 Scheduled Inspection Date: October 29, 2012 Inspector: Devaney, Michael Owner: DE LA ROSA, TANYA Job Address: 9713 NE 2 Avenue Miami Shores, FL 33138- Project: <NONE> Contractor: FLORIDA STATE SECURITY INC Permit Type: Electrical - Commercial Inspection Type: Final Work Classification: Addition /Alteration Phone Number (305)756 -6110 Parcel Number 1132060134220 Phone: (954)987 -7141 Building Department Comments ADD DEVICES TO EXISTING FIRE ALARM SYSTEM UNIT# 9713 SHORES PEDIATRICS Infractto Passed Comments INSPECTOR COMMENTS False Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments October 26, 2012 For Inspections please call: (305)762 -4949 Page 16 of 27 BUILDING 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 OCT 222012 FBC20tO Permit No. 1-t-C 1 PERMIT APPLICATION Master Permit No. C. C.— 6— k — Iv')( Permit Type: Electrical JOB ADDRESS: ?7/5"-- Al, E, 2-4 Avet City: Miami Shores County: Miami Dade Zip: 33f?6P Folio/Parcel #: /1— 3 20.4 — 013— 92 2P Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple Titleholder): Odrt,hlt t'j -g,' LL_ e• Address: ?300 Al Ra ,f�e�e S r. �-^ City: ! " l 1►'► i / State: !— �_ Tenant/Lessee Name: , s/ g-re3 PP,o1 o L 5 Email: Phone#: 30T r 7 8 0 f Q Zip: 331 b S Phone #: CONTRACTOR: Company Name: Flo 4dw 5411"-to Soccer L7 /AC Phone #: '9f 9 9 7 % i g / Address: 622/ Jkk. Id / City: ( i s i) State: P� zip: 31,D23 Qualifier N e: I/ /VIGe,- f ,12e-jt Phone #: 9.r4 9I' 7 7/ V) State Certification or Registration #: CFO 0 9 9 20 Z Certificate of Competency #: Contact Phone#: qv / 9r-7 7/ L1 1 Email Address: e u 5 41'rvverSeiktn c e e -Pipe 4 u ved j .e VII DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ 3/ 7 So Square/Linear Footage of Work: Type of Work: °Address ,Alteration °New ` ORepair/Replace Demolition Description of Work: A (eiJI C -/ 4.5 , PX r54/ n e� 'Fite akt, riv% f7em *** *** * * * * * *** * ***** * * * *** x************ Fees *** **+x**** ** * * ** x******** ***** ** **** * * * * * ** Submittal Fee $ l 5 � Permit Fee $ / , ® CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ I 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, BOIT.RRS, HEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S ANNII)AVIT: 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 hill n be approved and einspection fee will be charged. Signature Owner or Agent The ,, _o'ng 'nstru u nt was acknowled ed be 're m thus day o .11FA t . 20 tk,,r , by �/i %` . ay of who is pe sonally known t me or who h• produced 1. who i. �ersonail known to me �r who has produced `entification and who did take an oath. as identification and who did take an oath. NOTAR P II LIC: NOTARY PUBLIC: Signature Contractor The foregoing instrument was acknowledged before me this 2 Ztei 0 C-FoJer , 20 7, by V IAGe", FG,C2e - , Sign: Print: My Commission Expires: * * * * * * * * * * * * * * * * * * * * * * * ** APPROVED BY Sign: Print: My Commission Expires: 2 MY COMPASS= 8EEZ23�4 EXPIRES August 2% 2018 t�ao�Q1�7 f1adQWpt�6MNo�„mo ®'C r" Plans Examiner Zoning Structural Review (Revised 3 /12/2012)(Revised 07 /10 /07)(Revised 06/10/2009)(Revised 3/15/09) Clerk LCCAL:BUSIN TAX ' i ADE. STATE t, v. , COUNTY a0EXPIRES S T& LAY : IUSTBE`DISPE AT,PI.A TO COUNTY CODE C 368832-3 BuRb AE SATVE .66RIT T DOING BUS IN in...a CO OWNER FLORIDA STATE SEC1^1TY I:C Sec. Type gfidupi 21/ 5LCUMY SYSTEMS Male:I :": THIS IS ONLY A LOCAL BUSINESS TAX RECEIPT. R DOES NOT PERMIT THE HOLDER TO VIOLATE ANY EXISTING REGULATORY OR ZONING LAWS OF THE COUNTY OR CITIES. NOR . DOES IT EXEMPT THE HOLDER FROM ANY OTHER PERMIT OR UCENSE REQUIRED BY LAW. THIS IS NOT A CERTIFICATION OF THE HOLDER'S QUALIFICA- TIONS. PAYMENT RECEIVED MIAMI -DADE COUNTY TAX . COLLECTOR: 07/23/2012 09010064001 000250.00 SEE OTHER SIDE OC i•JfT RAY RENEWAL RCCE Lr r:0. 385308 -3 FIRST -CLASS U.S. POSTAGE PAID MIAMI, FL PERMIT NO. 231 DO NOT FORWARD FLORIDA STATE SECURITY INC 6221 PEMBROKE RD HOLLYWOOD FL 33023 1I ti!rrr IIr 11111 rr�r �rr Itrrr�r�r r�rin tII h It rr1r Irrr 1h II I 395 Tf IIS UOCIM!`N U HAS A COLORED BACKGROUND • MICROPRINTING •'L1,NEMAI -U< TR; F. FLORIDA 5. PROFESS RAC RS RS LICEN Vial =p;T TION SEW TAUS:0202349 The ' A S S ElettONT Named . .:tOW::rS CB XF] Ei Under e provisions' Of Chapt Expiration date: :A 2014 DA , ,._. BATCH NUMBER. - LICENSE NBP.0, :V . 212 r " ,�'"' '...° rR,......., r OS 4 r�� y. ,A818,-.. •� s}i E .0.00.020 7 ,, a f i � ti q ° =d tl. Vr y Jt The ' A S S ElettONT Named . .:tOW::rS CB XF] Ei Under e provisions' Of Chapt Expiration date: :A 2014 a� DJ CERTIFICATE OF LIABILITY INSURANCE 10/22/2012 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(Ies) 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 BB Insurance Marketing Inc 11870 W. State Road 84, C -15 Ft. Lauderdale FL 33324 NAME: Marcia Hammer Ext 308 PHONE (A/C. Ext):954- 452 -4900 FAX No):954- 452 -0450 I�o. ADDRESS:Marcia@bbimi.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A :Scottsdale Ins Co INSURED FLORI -4 Florida State Security, Inc.& Florida State Leasing, Inc. 6221 Pembroke Road Hollywood FL 33023 INSURER B :Progressive Express Ins Co 10193 INSURERc:Commerce & Industry Ins Co 19410 mullet Ins Co 10701 INSURER E : MED EXP (Any one person) INSURER F : COVERAGES CERTIFICATE NUMBER: 982245888 REVISION NUMBER: 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. INSR LTR TYPE OF INSURANCE ADOL INSR SUER WVD POLICY NUMBER POLICY EFF IMM/DD/YYYY) POIJCY EXP (MM/DD/YYYY) LIMITS A GENERALLIABIUTY X COMMERCIAL GENERAL LIABILITY CPS1513591 12/20/2011 12/20 /2012 EACH OCCURRENCE $1,000,000 PREEM PREMISES (EaE rote) $100,000 MED EXP (Any one person) $5,000 CLAIMS -MADE X OCCUR PERSONAL &ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 PRODUCTS - COMP /OPAGG $2,000,000 GEN'L AGGREGATE POUCY X UMIT APPLIES PELT PER: LOC $ 3 AUTOMOBILE X LIABILITY ANY AUTO ALL OWNED SAUTOS HIRED X X SCHEDULED NON-OWNED 06473408-4 6/12/2012 6/12/2013 (Ea a dED t bINGLE LIMIT $1,000,000 $ BODILY INJURY (Per person) BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ $ C X UMBRELLA LIAB EXCESSLIAB X OCCUR CLAIMS -MADE BE 033082724 12/20/2011 12/20/2012 EACH OCCURRENCE $1,000,000 AGGREGATE $1,000,000 Products /Completed Op $1,000,000 X DED RETENT ON $10,000 p WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N N 1 A 830 17478 0000 4/1/2012 4/1/2013 X WC STATU- OTH- TORY LIMITS ER E.L. EACH ACCIDENT $500,000 E.L. DISEASE - EA EMPLOYEE $500,000 E.L. DISEASE - POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS / LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarks Schedule, H more space Is required) Alarm installation, servicing and repair. CERTIFICATE HOLDER CANCELLATION Miami Shores Village Building Department 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. AU ORIZED REPRESENTATIVE ACORD 25 (2010/05) ©1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD IVI iami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION FORM ALL CONTRACTORS MUST PROVIDE COPIES OF LICENCES AND INSURANCES EACH TIME A PERMIT IS SUBMITTED OR THE VILLAGE MAY MAINTAIN A FILE WITH YOUR INFORMATION FOR A $30.00 FEE PER YEAR. IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. ____COPY OF QUALIFIER'S STATE LIC CARD B. .%< COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF LIABILITY INSURANCE (CERTIFICATE HOLDER TO BE MIAMI SHORES VILLAGE BLDG DEPT) D. COPY OF WORKERS COMPENSATION (EITHER CERTIFICATE OR EXCEMPTION) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER B. COPY OF MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT C. COPY OF LIABILITY INSURACE (CERTIFICATE HOLDER MUST BE MIAMI SHORES VILLAGE BLDG DEPT) D. COPY OF WORKER COMP INSURANCE (EITHER CERTIFICATE OR EXEMPTION) YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE HOLDER AS FOLLOW: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 c COMPLETE CONTRACTOR'S INFORMATION BUSINESS NAME: 7' JC1siai A 5-41-e ce'c,uP r-})7 lit BUSINESS ADDRESS: ‘2.21 PeiAr, k.e Io‘ CITY - b 1 I?I lnl ,9 p STATE P1,._ ZIP CODE 3302-3 BUSINESS PHONE: (? r Y ) 76- 7 70 1 FAX NUMBER ( qsy) l r-) V9?-3 CELL PHONE QUALIFIER'S NAME: V1-± Fa (ZK-+ +1' QUALIFIER'S LIC NUMBER: EP (D Q q 0 29 Z E -MAIL ADDRESS (IF APPLICABLE): C (A5-/Giv-Ner service 5S-e C lrI t- zoo Created on 3119109 BY MLDV 1 RV 3126109 MLDV Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 176090 Permit Number: ELC -7 -12 -1337 Scheduled Inspection Date: October 29, 2012 Inspector: Devaney, Michael Owner: DE LA ROSA, TANYA Job Address: 9713 NE 2 Avenue Miami Shores, FL 33138- Project: <NONE> Contractor: AJL ELECTRIC INC Permit Type: Electrical - Commercial Inspection Type: Final Work Classification: Addition /Alteration Phone Number (305)756 -6110 Parcel Number 1132060134220 Phone: 305 - 895-4971 Building Department Comments ELECTRICAL INTERIOR REMODEL FOR NEW OFFICES Passed v Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments /5-7 October 26, 2012 For Inspections please call: (305)762 -4949 Page 7 of 27 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 BUILDING PERMIT APPLICATION Permit Type: Electrical ctrica ( JOB ADDRESS: ` l I ✓ 1 �' FBC 2010 Permit No. E LC- 12 -13 31 Master Permit No. CC -1 Z - (181 v E, City: Miami Shores Folio/Parcel #: Is the Building Historically Designated: Yes County: Miami Dade Zip: Flood Zone: OWNER: Name (Fee Simple itleholder): .- -6. Phone #: Address: [ [ ( ruN (C,... Y LL City: (u V4.4. t 5 t".. (r,ll, State:._ ( zip: 3 ?7 f r Tenant/Lessee Name: -5 [� n N e'. .. Pe /1., k.4 V' lG --s' Phone #: Or 7s7 Poi O Email: CONTRACTOR: Company Name: 4 L EL 0 / Phone#: 3 O ?3�/S —� 7 ( Address: ! o9- 5 S 4.3 / c cc rf4 F2, G City: Ni . 114 'I"' State: 4 • Qualifier Name: %4 d-774 co./6/ (4100 State Certification or Registration #: E C /.3 0 0 a-d 8 R Certificate of Competency #: Contact Phone #: Email Address: A: L 8' 2 Q Ya 4( Q-0 , C0oti DESIGNER: Architect/Engineer: Phone #: zip: .E3 7 / Phone #:.3 6-r 8 q q ? t Q 00 Value of Work for this Permit: $ o, Square/Linear Footage of Work: Type of Work: DAddress DAlteration UNew URepair/Replace ODemolition Description of Work: v dte Info ✓ Ne (AAA dip ® L.E'.S' + x** ***** *+ x+ x+ x** ***** *********+x********** Fees**** *x: *****+ x*+ x**** ********+x*+x ******* ******** Submittal Fee $ Permit Fee $ Z4' 't° ® CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review$ 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. Signature - Owner or A!lr The foregr' g instrument was acknowledged before me day of ..' ,20r'",by pertly -own to me or who has produced Is As identification and who did take an oath. NOTAR &UBLIC: Sign: Print: My Commiss MAWR eS4Y OMMISSION # EE53276 pt; March 16, 2015 Fl. Notary t Co. 1.800.3410TARY * * * * * * * * * * * * * * ** ** APPROVED B Signature C.s11E.4m -- %poi . Contractor The foregoing instrument was acknowledged before me this i?. day of �-Y , 20 tZ,, by A +h: Live, Jd who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission ***************************** *= k***+ k+ k*+ k*** ***** ******rk***N= **+ k***+ k**NrNa****+krkrhrk *+k*** ,UIY�ar z, L. Z l Plans Examiner Zoning Structural Review (Revised 3 /12/2012)(Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09) Clerk BATCH NUMBER NORTH MIAMI L L U R I D A City of North Miami 776 N.E.125 Street • North Miami, FL 33161 • 305 - 893 -6511 Business Tax Receipts Issued Date: 10/1/2011 Expiration Date: 9/30/2012 Business Tax Receipt #: BT- 002364 A J L ELECTRIC, INC. 12555 BISCAYNE BLVD BOX 826 NORTH MIAMI, FL 33181 ELECTRICAL CONTRACTOR Business Name / Address: A J L ELECTRIC, INC. 12555 BISCAYNE BLVD, BOX 826 NORTH MIAMI, FL 33181 itv Clerk NOTICE: BUSINESS AX RECEIPT MUST BE TRANSFERED WHEN BUSINESS IS MOVED OR SOLD. NON- TRANSFERABLE • POST IN A CONSPICUOUS PLACE • NON - TRANSFERABLE 192974 -5 BUM 12408 H BA S, 33181 NORTH OWPIER AJL ELECTRIC TNS IS ONLY A LOCAL BUSINESS TAX RECEIPT -TT DOES NOT PERMIT THE !OLDER TO VIOLATE ANY EXISTING REGULATORY OR ZONY70. uws OF THE CoIBRY OR - CITES. NOR DOES IT .. EXEMPT THE HOLDER FROM. ANY OTHER PERMIT BLAX-THIS NOT A CER 1FICA11O I OF THE; HOLDERS OwLLiRCA- DO NOT FORWARD AJL ELECTRIC INC ANTHONY JAMES LUPO PRES 12555 BISCAYNE BLVD BOX 826 AIf1DTU MTAMT CI 'LZIAI AJLEL -1 OP ID TR ai�E(oI+rYYti3 rT1 1 TE LIABILITY INSURANCE ji' fi T CERT `I issJeD t!IS A MATTER OF INFORMATION ONLY SNb c N1 =ERs No RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOSS HOT / 11 4TtELY OR NEGATIVELY AND; EXTEND OR ALTER THE COVERAGE AFFORDED BY THE PO:L(CIES. BELOW. THIS CERTIFLC!>TE OF IIU;�a1IRMCE .DOFF• NOT CONSTITUTE CONTRACT:BET'WEEN THE ISSUING INSIJRER(SI, AUTHORIT p REPRESENTATIVE O.R PRODUCER,AI4O THE,cERTJFICATEH0LDER: PORTA11i?F Ifs ootottcato -hatior -arrApor11014At IN REt tfie pogey(es) most to 'endorsed. 1!'SUBROGATION 1S WAiVED, subjecf-to. t e tOnns and corn" lops of.1 a pofcir, certain polielas na .r±aqulre. an endorsement. A statement on this certiflcate does not confer rights 'toll* certHicate: hotderin <lieu.:of.sucttendorsenenttsl. k .LLCOs Inswance eitbanow 59 rSleY te, #.301 Rote, FL 3S328 4544f6.48.60 NAME 1 [. ( ND): INSURERS) AFFORD NG.COVERAGE NAIC *: INSURERA: <Novo Casualty Insurance Co. NsUREb AJL Etectric Inc. 12408 N. Bayshore Drive N. Miami Beach, EL 33181 INSURERB : Guarantee Insurance Company INSURER C : .INSURER D : INSURERS: _'INSURERF _* ES I RTII`TCAT#E N NIEER • R dISION NUMBER ... i$ > 810 MI5 +P At f I; E5 `ri tE a tilt i E . F AR'EHE I t y po$101: 1 ICATED NO WITHSTANDING REQUIREMENTT`, TERM tl CO rriON OF ANY cdt4Tt;ACT OR OTTHER DOCUMENT WITH RESPECT” TO WHICH THIS CERTIFICATE M Y SE tSSUED OR MAY PERTAIN THE INSURANCE .AFFORDED HY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, E CI.USIQNSANDOONDIT'IQNSOFSUCH POLIO ES. LIMITS lNMAT HA1 SEEN REDUCED BY'PAJD CLAIMS. INSR ADOLSUBfa POLICYEFF POLICY EXP TYPE OF INSURANCE nosio Awn ROIXVI UMBER: ti+ M DDAVIDI AMM/DDAIM I GENERAL. LIABlur1 ( c lAl GENERAL PABI .TTY E CcCUR, CI kGGRE.GAIE;LIMITAppt mER; `.; 1 POLICY 1Ft ° AUFCMOBU.ELMLI Y _ ANY AVM _ AIL _.AUTO a�C OS HIREPAIlr0S 0MAL201205t5 05/15112 EACI ACC E 3 05115113 =TO-RENTED s {Fe Boc rr Y MED EXP (Annl pers ) $ 1,0110,0 0 100.000 PERSONAL B ADV IN:ICJRY GENERAL AGGREGATE PRODUCTS - COMPIOP'AGG Aires' totroNtLtsiNfJW LIPAI I Me accident) BODILY INJURY (Per person) 3 DDD4X INJURY {Per ecadent) $ EXCESS.LARB DED I'RenarnO14 :4 OER ... ANYPROPREr. tIPARTt XE OFFIGE�RA IMaridgo y kI R 3(CLUDED? NH) �D IPT1 OF under PLNM rMAPE EACH AG REGATE. YIN .IA 351000505480112 XITO Y l sI I° 05/115112 05//5113 E.L. EACHPCCIDENT L. DISEASE- 100,001) Whet .EL DISEASE - POLICY` !Aar *ROTOR tL VOW VEHICLES ORB 101 „Afl**rpiii,i ernesk*;Bch l Vmore space,is required) CERTIFICATE HOIDER M!Iihores Pillage Bolding Dept 10NE 2Avenue: Miami Shore8, Pk-33138 CANCMLLAT N 8HC= NT/ OF THE ABOVE OESCRIBEI? POLICIES BE OANCEP.Ea ;SPORE THE IERLEATION bAT>: THEREOF, NOTICE WILL BE DIE4VENED ui ACCORDANCEINITH THE POt:ICY PiIOVIS Ot S. ACCORD 25 (2010/05) Z? 1'988 -2010 ACORD CORPORATION. All rights resterved. The -ACORD name and Logo are registered marks of ACORD Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 180973 Permit Number: MC -7 -12 -1339 Scheduled Inspection Date: October 31, 2012 Inspector: Perez, JanPierre Owner: DE LA ROSA, TANYA Job Address: 9713 NE 2 Avenue Miami Shores, FL 33138- Project: <NONE> Contractor: SANSONE CORPORATION Permit Type: Mechanical - Commercial Inspection Type: Final Work Classification: New Phone Number (305)756 -6110 Parcel Number 1132060134220 Phone: 954 -428 -8919 Building Department Comments NEW A/C UNIT Infractio Passed Comments INSPECTOR COMMENTS False qC .3(v Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments CREATED AS REINSPECTION FOR INSP- 176106. missing outside air October 30, 2012 For Inspections please call: (305)762 -4949 Page 36 of 44 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 BUILDING PERMIT APPLICATION FBC 20 Permit Type: MECHANICAL OWNER: Name (Fee Simple Titleholder): Gt_ V4 I S► e VI ltd Address: City: Tenant/Lessee Name: Permit No. (A G - t 2 - 1339 Master Permit No. CC-2- " 1 81 W� Phone #: zip: 3I3er C S Phone#jOdJ 75-7 S-104 Email: JOB ADDRESS: C 7 1 CJr City: Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: Phone #: Miami Shores County: Miami Dade Zip: % 1 3g1T-- CONTRACTOR: Company Name: (( � �+ S d w e Address: `Le? tD ®l °7 I L C./ A City. .Y a Ct- State. Qualifier Name: Zip: 3 Phone#: State Certification or Registration #: ( C 1 97 (a Certificate of Competency #: Contact Phone#: T q( l Q Email Address: DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ (p 6-6-0 Square/Linear Footage of Work: Type of Work: °Address DAlteration °New °Repair/Replace °Demolition Description of Work: Submittal Fee $ Permit Fee $ 2. 6 c $ co/CCs Scanning Fee $ Radon Fee $ DBPR $ _ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ 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 A1Nr'IDAVIT: I certify that all the foregoing information is accurate and that all work will be dole 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. iSignature fokiLd Owner or Agent Contractor The foregoing i, strument was acknowledged before me this day of l �`L. 20 `)- by who is,ponall own to me or who has produced who • As identification and who did take an oath. NOTARY PUBLIC: The foregoing , day of Sign: C,Or &— Print: CLL., My Co ul Cc cat LAURA FARLEY MY COMMISSION #,EE53276 EXPIRES: March 16, 2015 P in6tpkPH****14 4Maphaallalthial*Ftatk APPROVED BY strument was acknowledged before me this , 20t?, by known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: My Commissio "' LAURA FARLEY MY COMMISSION # EE53276 6 F EXPIRES: March 16, 2015 ¢f * * * * * * * * �k�F+ H+ k�k�k�k�k�k* �k+ k�k+ k�k *** *�k+i��#�k+N�k�k�k�k�k�I�k�k ******** h .�k�ksk** Pl xaminer Zoning Structural Review Clerk (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 180941 Permit Number: PLC -7 -12 -1338 Scheduled Inspection Date: October 31, 2012 Inspector: Hernandez, Rafael Owner: DE LA ROSA, TANYA Job Address: 9713 NE 2 Avenue Miami Shores, FL 33138- Project: <NONE> Contractor: PRONTO PLUMBING INC Permit Type: Plumbing - Commercial Inspection Type: Final Work Classification: Addition /Alteration Phone Number (305)756 -6110 Parcel Number 1132060134220 Phone: (305)978 -7755 Building Department Comments INSTALL SINK/WATER FOUNTAIN Infractio Passed Comments INSPECTOR COMMENTS False Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments CREATED AS REINSPECTION FOR INSP- 176099. October 30, 2012 For Inspections please call: (305)762 -4949 Page 33 of 44 ACCPREF PRODUCER CERTIFICATE OF UAB INSURANCE INDUSTRIES INC 953 NE 125th St N Miami, F1i 33161 (305) 8,91-2808 INr'ruRED PRONTO PLUMBING, INCORPORATED COVERAGES ILITY INSURANCE Dim(MavDONYYY) INFORMATION CERTIFICATE EXTEND OR BELOW. NAIL# ____________1/19/2012__ THIS CERTIFICATE IS ISSUED AS A MATTER OF ONLY AND CONFERS NO RIGHTS UPON THE HOLDER. THIS CERTIFICATE DOES NOT AMEND, ALTER THE COVERAGE AFFORDED BY THE POLICIES INSURERS AFFORDING COVERAGE INSURER A: ERMA ETATES =ABILITY =EOM= GROUP LA( S INSURER B. US S CT3RITY MS CE INSURER C: LIABILITY COMMERCIAL GENERAL LIABILITY —I CLMMSMAPE LL OCCUR INSURER b; 06/28/12 INSURER E: EACH OCCURRENCE $ 100,000 $ 50,00Q_ THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDfTION 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. PTA und n TYPF AP INSURANCE POLICY NUMBER D ,FH p � DI I RA 1 LA( S GNERAL J _, LIABILITY COMMERCIAL GENERAL LIABILITY —I CLMMSMAPE LL OCCUR CL23504395 06/28/12 06/28/13 EACH OCCURRENCE $ 100,000 $ 50,00Q_ PREMISES "atIrena) NIEa EXP (ARV ona Aareor,) $ 5.000 PERSONAL &ADvINJVRY $ 100,00_, GENERAL AGGREGATE s 200J 000 $ 200,000 GI:N'L AGGREGATE LIMIT APPLIES PER POLICY n EC n LOG PRODUCTS - COMP/OP AGO _ B AUTOMOSILE _ _ 'X, LIABILITY ANYAUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON.OWNEO AUTOS CA- 0000113419 -00 02/12/12 02/12/13 COMBINED IdtSINGLE LIMIT $ BODILY RY (Par POW) $ 10,000 ODIILYINJURY $ 20,000 (Par ROmid j AMAGE $ 10,000 GARAGE LIABILITY 1 ANYAUTO AUTO ONLY - EA ACCIDENT s QTHER THAN EA ACC $ AUTOONLYt Al G $ EXCESS j _ ^ / UMBRELLA LIABILITY OCCUR 0 CLAIMSMADS DEDUCTIBLE RETENTION $ EACH OCCURRENCE $ AGGREGATE $ WCSTATU- 1 rQTH- rrXRY LIMITS FR $ WORKERS GQMPENBATION AND EMPLOYERS' LIABILITY YIN ANY PRCPRIETORPANTNER1SX CCUTIVE mi OPPICER/MELMSER E)CCL D$OT DamulWay In Nil [Nos atfaaiba under SPECIAL PROVISIO 8 blow B.L. EACH ACCIDENT $ BL. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ OTHER OESCRIPrION aP OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED NY ENDORSEMENT i SPECIAL PROVISIONS RESIDENTIAL PLUMBING ERTIFICATE HOLDER CANCELLATI � 'i E� MIAMI SHORES VILLAGE 10050 N.E. SECOND AVE MIAMI SHORES, FL 33138 snow ANT OF THE ABOVE bESCRIBSP DATE THENEOP, THE IS$UINE NOTICE TO THE cERTIPICAY6 HOLDER OPPOSE NO OBLIGATI POISONS BE CANCEU- n BEFORE THE EXPIRATION INSURER WILL L'NDEAVCR TO BAIL 10 DAYS WRITTEN NAND TO THE LEFT, BUT FAILURE TO DO SO SHALL _' op ANY KIN UPON THE INSURER ITS AN Th OE AIHOR 4. ACORD25(2009/01) TO /TO 3EIVd 9 U -2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD S3I LLSIlUNI 3SNVi•IIISNI 1'9E916890E 9Z :T0 ZIOZ /6T /L0 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 c IV JUL 19 2012 BUILDING Permit No. PLC - l 2- 1335 PERMIT APPLICATION Master Permit No. CC- I Z- 1 181 FBC 20 Permit Type: PLUMBING OWNER: Name (Fee Sir Titleholder): t �� Phone#: le k. twrs Address: City: ant/Lessee Name: State: Zip: 10 [S Phone#:3c T -7 57 &0' b Email: JOB ADDRESS: 97(.3 1%-i & City: Miami Shores County: Miami Dade Zip: 0 - Folio/Parcel #: Is the Building Historically Designated: Yes CONTRACTOR: Company Name: 13,.4n1.4 Address: / 2-'/3 S AlE City: Qualifier Name: NO . Flood Zone: Phone�t.S` p -,z 2 Zip: 33/(// Phone # :3i5 —,V 77 i PC .� S 62 Certificate of Competency #: State Certification or Registration #: Contact Phone #: 3Z r- )r- 775 Email Address: DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ Type of Work: ❑Address Description of Work: °Alteration Square/Linear Footage of Work: °New DRepair/Replace °Demolition Submittal Fee $ Permit Fee $LZS Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ CCF $ CO /CC $ DBPR $ Bond $ Technology Fee $ TOTAL FEE NOW DUE $ Alo 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 AFF'IDAVIT: 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 poste# inspection will not be approved and a reinspection fee will be charged. Owner or Agent The forego' g, instrument was acknowledged before me this The foregoin: ' strument was acknowledged before me this day of it 20 b day of : , 2a? ; by wh ' pens' nown to me or who has produced a's a _. own to me or who has produced As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: LAURA FAILLE 276 MY C� March 16, 2015 aa�� g FJO11�: * * * * * * * * * * * ** '3x.3.11114 * * *ti �t j` �k�k�kd��k�k�k** **�N�k�k+k *+l�** * *�k *+N+U�k�k** 1,gppYNOT .. - NOTARY PUBLIC: Sign: Print: My Comm APPROVED BY Plans Examiner Structural Review (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) Zoning Clerk COMMERCIAL FIRE ALARM CONTROL PANEL Model 5207 Fire Control Panel with Digital Communicator and Accu -Zone® Your All -In -One Answer For Fire Protection. The Model 5207 is an all -in -one fuseless local evacuation control panel and digital communicator designed for applications requiring manual fire alarm, automatic fire alarm and water flow for sprinkler supervision. The basic unit offers fire alarm for one to eight zones, expandable to 16 with the optional 5210 expansion module. It is compatible with both two - and four -wire smoke detectors. Compact, easy to install and service, it delivers the features you'd expect to find in fire systems costing much more. Features • Eight zones, 6 Class B (Style A) and 2 Class A (Style D). 8 expander zones and Class B (Style A). Zones are interchangeable using the Model 7181 Zone Converter. • UL, FM, MEA (BSA), CSFM listed and Approved. • Event Memory. • Fuseless design reduces service time. • 24 VDC power supply. • Compatible with 2- and 4 -wire smoke detectors as well as water flow and sounding devices. • ANSI cadence pattern output. • Four programmable (Style Y) supervised signal circuits, including steady, pulse and temporal. • Programmable smoke verification, pre -alarm delay, and cross - zoning can minimize false alarms. • Four general purpose relays (Form C 24 V at 2.5 A resistive). • Built -in approved digital communicator with UL required priority reporting. • Flexible programming capabilities including up /downloading and use of remote annunciator. • Accu -Zone® diagnostics facilitate local and remote troubleshooting. • Walk Test. 5207 Specifications Operating Voltage: 24 VDC Primary AC: Total DC Load: Current: Standby Alarm Dimensions: 120 VRMS @ 60 Hz 2A 5A @ 24 VDC 120 mA 700 mA (max) 16" W x 26.4" H x 4"D (40.6 cm W x 67 cm H x 10.2 cm D) 4 form C Relays: 24 Volts @ 2.5 amps resistive Operating Temperature: 32 °F to 120 °F (0 °C to 49 °C) Indicator Lights: AC /DC (Green) Alarm (Red) Trouble (Yellow) Silence (Yellow) Memory (Yellow) Set Mode Report (Yellow) ON= System running on AC Flashing =On DC Power ON= Supervisory Alarm Flashing =Fire Alarm ON= Trouble Condition OFF =No Troubles ON =If trouble or alarm has been silenced ON =if an Alarm is reset ON =If panel is in test or program mode Flashing =Panel reporting COMMERCIAL FIRE ALARM CONTROL PANEL Model 5207 Fire Control Panel with Digital Communicator and Accu -Zone® Optional Accessories Model 5230 Remote Annunciator This 4 -wire, 16 -zone remote annunciator English- language is easy to operate. Its fourteen function keys can perform the same operations as the main system annunciator, including silencing, resetting, and the displaying of alarms, troubles and alarm memory. The Model 5230 can be used to program all programmable options and with the use of access codes prevent unwanted tampering. Zone Expansion The 5210 adds eight additional Class B (Style A) zones to the 5207, enabling use of both 2- and 4 -wire smoke detectors. Model 4180 Status Display Module The 4180 provides 16 outputs to give alarm and trouble conditions by zone. Two units can be connected to annunciate all 16 zones on a 5207 control. The 16 outputs can be used to drive LEDs or a graphic annunciator. (Non - supervised) Model 7181 Fire Zone Converter Converts Class B zones to Class A and vice versa. Model 5220 Direct Connect Module Used for city box and polarity reversing direct wire applications. Model 5530 Downloading Modem SIA format modem for remote programming the 5207. 5541 Downloading Software For remote programming the 5207 with an IBM or compatible personal computer. Requires a 5530 modem. The modem and software can be purchased as a package, order P/N 5561. 5260 Printer Interface Allows connection of a standard computer printer to provide a printed record of the 5207 system activity. (Printer not supplied.) Engineering Specifications The contractor shall provide a complete electrically supervised fire alarm and communications system. The system shall contain a fire alarm control /communicator and panel to supervise and operate heat and product of combustion detection devices, alarm signal devices, visual annunciator and an integral digital communicator to transmit fire alarm and supervisory signals to a central station. The control /communicator shall be UL listed or FM approved for under NFPA 72 for Central Station, Local Protection, Remote Signaling, and Auxiliary Signaling standards. It shall provide power and control for eight supervised detection zones, four supervised alarm signal circuits and a dual phone line digital communicator. The control /communicator shall be expandable to sixteen supervised detection zones and shall be able to communicate to a central station in SIA, SK FSK1, SK 4/2 or Radionics BFSK formats. The control /communicator shall be model 5207. There shall be two Class A and six Class B detection zones. They shall accommodate heat detectors, products of combustion detectors, manual pull stations, sprinkler flow switches and gate valve supervisory switches intermixed as permitted by NFPA 72. Products of combustion may either be 2- or 4 -wire and shall be cross listed by UL for use on the system. The detection zones shall be programmed to (1) be cross zoned so that two individual zones must sense products of combustion, (2) automatically reset a detector to verify that products of combustion exist, (3) see a single detector in alarm before the alarm is sounded and a signal is transmitted to the central station. There shall be four 1 amp supervised (Style Y) alarm signal circuits. They shall cause the notification appliances to ring steady /pulsing /temporal throughout the premises until reset or silenced. The control shall be equipped with four auxiliary relays that shall be programmed to operate on (1) pre - alarm, (2) tamper alarm, (3) special alarm, (4) fire alarm, (5) trouble, (6) no- silence, (7) alarm by specific zone (1 -16). The relays shall remain energized until the panel is silenced, reset or the trouble condition is cleared, unless "no- silence" is selected. The control /communicator shall have an integral annunciator to indicate sequentially zones in trouble and system functions. LEDs shall augment the display to make clear to an operator the system status. Am integral touchpad shall be provided to operate and interrogate the system. Vital operations such as alarm silencing or reset shall be simple and obvious to an operator. Authorization pass codes may or may not be used. The control /communicator shall have the capability to supervise two telephone lines, seize the phone line, and send the alarm signal on one or both lines without the addition of any more equipment. It shall sound a local trouble signal if the telephone service is interrupted for longer that 45 seconds and it shall transmit a signal indicating the loss of phone line service to the central station over the remaining phone line. A signal shall also be transmitted indicating the restoral of phone service. The control /communicator shall be able to report the loss of either phone line without regard to which line failed initially. If both lines fail, a local signal shall sound. The control /communicator shall have the ability to send a test signal to the central station every 24 hours. the test signal shall be able to be transmitted at a specific time of day or night by setting a program feature within the panel. The alarm signals transmitted to the central station shall indicate which of the eight zones is in alarm and which zones are in trouble, depending on which format is used. Restoral from alarm or trouble signals shall also be transmitted by zone. The control /communicator shall be capable of communicating to Silent Knight, Radionics or Ademco central station receivers. 7550 Meridian Circle, Maple Grove, MN 55369 -4927 800 - 446 -6444 or in Minnesota 612 -493 -6435 FAX: 612- 493 -6475 World Wide Web: http: / /www.silentknight.com MADE IN AMERICA FORM# 350376, Rev. 12/98 Copyright © 1998 Silent Knight GENTEX CORPORATION fl Smarter Vision" Commander2 Series Low Frequency Evacuation Signals Applications The Commander2 Series is a low profile strobe, horn or horn/strobe combination that offers dependable audible and audible /visual alarms and the lowest current available. The GE Series is available in fixed candela options of 15, 30, 60, 75, 110, 177 and 15/75. The Commander2 Series horn offers a continuous or synchable temporal three in 2400Hz and mechanical tone, a chime as well as a whoop tone. All tones are easy for the professional to change in the field by using switches. The GE Series has a minimal operation current and has a minimum flash rate of 1 Hz regardless of input voltage. The Commander2 Series is shipped with the standard 4" mounting plate which incorporates the popular Super - Slid& feature that allows the installer to easily test for supervision. The product also features a locking mechanism which secures the product to the bracket without any screws showing. The Commander2 Series also features the CheckmafeTM - Instant Voltage Verification feature which allows the installer to check the voltage without removing the signal. The GE Series appliances are UL 464 and UL 1971, listed for use with fire protective systems and are warranted for three years from date of purchase. Standard Features • Nominal Voltage 24 VDC (12 VDC available on GEH) • Fixed Candela Options of 15, 30, 60, 75, 110, 177 and 15/75 • Unit Dimensions: 5" high x 4.5" wide x 2.5" deep • Prewire Entire System, Then Install Your Signals • Super- SlideTM Bracket - Ease of Supervision Testing • CheckmateT"" - Instant Voltage Verification • Lower Installation and Operating Costs • Input Terminals 12 to 18 AWG • Switch Selection for High or Low dBA • Switch for Chime, Whoop, Mechanical and 2400Hz Tone • Switch for Continuous or Temporal 3 (not available on whoop tone) • Tamperproof Re- entrant Grill GEC /GES /GEH 24 VDC S E R I E S Product Listings tTE Cl • BFP (City of Chicago) • BS +A/MEA #285 -91 -E - XV • CSFM 7135 - 0569:122 (GEH, GEC) 7125 - 0569:123 (GES) 7135 -0569: 130 (GEH -12) • FM Approved • UL 464, UL 1971 & UL 1638 Listed • CANNLC S526 -M87 Listed ULSZ7.S3406 Listed (GEC24, GEH24 & GEH12) Product Compliance • NFPA 72 • Americans with Disabilities Act (ADA) • Surface Mount with the GSB ( Gentex Surface Mount Box) • Synchronize Strobe and /or Horn by Using the Gentex Synchronization Module (12 VDC product must use the AVSM Module) • Silence Horn While Strobes Remain Flashing • Wide Voltage Range 16 -33 VDC or FWR • Faceplate Available in Red or Off -White GEH 12 and 24 VDC Low Profile Evacuation Horn Model Number Part Number Nominal Voltage Reverberant dBA @ 10ft. Per UL4641 In Anechoic Room dBA 410ft. GEH12 -R 904 - 1239 -002 12 VDC 70 -82 100 GEH12 -W 904 - 1241 -002 12 VDC 70 -82 100 GEH24 -R 904 - 1205 -002 24 VDC 70 -82 100 GEH24 -W 904 - 1207 -002 24 VDC 70 -82 100 GEC 24 VDC Low Profile Evacuation Horn /Strobe o 'um•er a 'um•er omina Voltage ro•e Candela GEC24 -15WR 904 - 1125 -002 24 VDC 15 ever•erant dBA @ 10ft. Per UL4641 70 -82 nec oic Room dBA @ 10ft. 100 GEC24 -30WR • • • 904 - 1129 -002 24 VDC 30 70 -82 100 [el Xlla!RI ATATAII. MU= arm mom =gm =gm [el MIMIS:IrIriU :' VIZ 5IBRI •11 num mum =is 11 G1/A 1 .1 11 DC 70 -82 100 CelOM5 MAW= pae5iricW1/ InITM IIIIIIMMI MIN MILMIE • It' ••• 11 Hill rrrl •1,_ . _11 • yi 75 (UL1638) 75 (UL1638) GES 24 VDC Low Profile Evacuation Strobe Model Number Part Number Nominal Strobe Voltage Candela higiiiiiMEMBAMMINga CN�.`YZIid1�4q:illllllll� • 1 � . • 11 � � � MiMIEMMMMEME Chi cf�Zli:Ill MII •11 C 11 t MUM CN�cYZlNaMW 11MIM CNMWM • 1 I 11 • CN�.`YZlSL�4Uh1� • 1 • 1 1 r � CN�•z5f[:I1�11a• • 1 /1 : CCIaZSir:P I •1, • • 11 EI�I ply • a aYZ5ma• •1 :c 11 .`YZ CN 5rr1/i/1 i • 1 1 c 11 Y7. •1 ■ - . -11 • 1 • 75 (UL1638) GES24- 15/75WW 904 - 1187 -002 24 VDC 15 (UL1971) 75 (UL1638) Notes: • The GE Series is not listed for out- door use. • Operating temperature: 32° to 120 °F (0° to 49° C) • For nominal and peak current across UL regulated voltage range for filtered DC power and unfiltered (FWR [Full Wave Rectified]) power, see installation manual. • Gentex does not recommend using a coded or pulsing signaling circuit with any of our strobe products (see technical bulletin number 014). • To obtain the horn /strobe current draw, add the strobe current draw and the horn current draw. Model designations: "W" = Wall Mount "R" = Red Faceplate "W" = Off -White Faceplate "P" = Plain (no lettering) - available on all models. Plain units are non - returnable. "Agent" bezel also available. GE -24 Product Strobe Current Ratings Candela 15cd 30cd & 15/75cd 60cd 75cd 110cd 177cd 24 voC 55mA 63mA 88mA 112mA 136mA 186mA UL Max2 78mA 96mA 137mA 180mA 224mA 288mA The listed horn current draws are for the continuous tone mode. The temporal 3 tone has a reverberant dBA @ 10ft. per UL 464 is 77 -83 with a horn current draw of 34mA. 2 RMS current ratings are per UL average RMS method. UL Max Current Rating is the maximum RMS current within the listed voltage range (16 -33VDC for 24VDC units) (8 -17VDC for 12VDC units). For strobes the UL Max Current is usually at the minimum listed voltage (16VDC for 24VDC units) (8VDC for 12VDC units). For audibles the Max Current is usually at the maximum listed voltage. For unfiltered FWR ratings, see installation manual. GE -24 Product Horn Current Ratings Horn Mode Minimum dBA @ 10ft. per UL464 (HIGH) Minimum dBA @ 10ft. per UL464 (LOW) Regulated 24VDC Max. Operating High Setting (mA) Temp 3 2400Hz 78 71* 28 Temp 3 Mechanical 76 70* 25 Temp 3 Chime 70* 66* 15 Continuous 2400Hz 81 74* 28 Continuous Mechanical 80 72* 25 Continuous Chime 70* 66* 15 Whoop 82 69* 56 GEH -12 Product Horn Current Ratings Horn Mode Minimum dBA @ 10ft. per UL464 (HIGH) Minimum dBA ( 10ft. per UL464 (LOW) Regulated 24VDC Max. Operating 6 High Setting (mA) Temp 3 2400Hz 76 69* 29 Temp 3 Mechanical 75 68* 26 temp 3 Chime 62* 60* 13 Continuous 2400Hz 79 74* 29 Continuous Mechanical 78 72* 26 Continuous Chime 63* 61* 13 Whoop 78 71* 55 * Operating the hom in this mode at this voltage will result in not meeting the minimum UL reverberant sound level requi ed for public mode fire protection service. These settings are acceptable only for private mode fire alarm use. Use the high dBA setting for public mode application (not applicable when using the chime tone. The chime tone is always private mode). Notes: The sound output for the temporal 3 tone is rated lower since the time the hom is off is averaged into the sound output rating. While the hom is producing a tone in the temporal 3 mode its sound pressure is the same as the continuous mode. Mounting Super- SlideTM Die Cast Metal Mounting Plate: Mounts to single gang, double gang 4" square boxes or GSB box. Switch Locations CheckmateTM - Instant Voltage Verification The access holes are provided in the back of the terminal block to allow the voltage to be measured directly without removing the device. Typically this would be done at the end of the line to confirm design criteria. Most measure- ments will be taken using the S+ and S- locations although access is provided to other locations. NOTE: Care should be taken to not short the test probes. Mechanical -Temp. Mechanical -Cont. Hi -Te rrp. Hi -Cont. Chime -Temp. Chime- Cont Whoop Whoop SWITCH POSITION 3 4 ON OFF ON ON 5 ON ON ON OFF ON OFF ON OFF OFF OFF ON ON OFF OFF ON ON OFF OFF OFF OFF Switch Position 6 ON > HIGH dB OFF> LOW dB Switch positions 1 and 2 in the off position to select isolated horn and strobe power inputs. g q R P R q p1\0411;IR 12 3 4 5 6 15 El 11 11 11 Conventional GES /GEC Series Wiring Diagrams UL Listed Control Panel Supervised Signal Circuit + UL Listed Control Panel Supervised Signal Circuit Signal S+ S+ S- H+ H- Signal S+ S+ S- H+ H- Signal S+ s+ s- H+ H- Signal 9 s+ s+ S. H+ 11 o o o o o I9 S 0 SI �" 19 0 '' \ \ O END 1"' RESISTOR II RESISTNE END Oi IIOR 1 iLuu.iu......iu.ii / ERE IS OF LIRE RESISTOR Wiring Diagram GE Series with Gentex Synchronization Module F.A.C.P. ENO LINE RESISTOR FOR CLASS WRING ONLY. AUDIBLE SIGNAL 'i T CIRCUIT VISIBLE SIGNAL CIRCUIT mm 8 !i SYNCHRONIZATION MODULE WTI NEW re+arn. Ar END OF LINE RESISTOR FOR CUSS S MARINO ONLY Signal S+ 5+ 8- 5+ H- S see I i I I i TO NEXT SIGNAL + — �y TO NOTIFICATION ALARM CIRCUIT TO NEXT SIGNALS REMOVE JUMPER FOR INDEPENDENT SYNCHRONIZED STROBE AND HORN OPERATION LEAVE JUMPERIN PLACE TO ELIMINATE NEED FOR HORN INPUT ON AVSM AND OPERATE SIGNAL IN UNISON MODE Signal 5+ S+ 5- H+ 5- 5 5 55®1 Z 12:Tcb_i_, TO NOTIFICATION ALARM CIRCUIT HEM 1111. SYNCHF ONIZATION MODULE ®gym Z2 LEAVE JUMPER IN PLACE ON SLAVE UNITS UNLESS SEPARATE CONTROL OVER HORN CKT IS REQUIRED. ENO OF LINE RESISTOR FOR CUSS WRNO ONLY. "TT Note: See Technical Bulletin 015 for proper synchronization module for application. Note: When synchronizing the GEH -12 VDC Series, the AVSM synchronization module MUST be used. 3 ENOGF FO Cuss E WIRING ONLY Architect & Engineering Specifications: The audible and/or visible signal shall be Gentex GE Series or approved equal and shall be listed by Underwriters Laboratories Inc. per UL 1971, UL 1638 and/or UL 464. The notification appliance shall also be listed with the California State Fire Marshal (CSFM) and the Bureau of Standards and Appeals (NYC). The notification appliance (combination audible /visible and audible units only) shall produce a peak sound output of 100dBA or greater as measured in an anechoic chamber. The signaling appliance shall also have the capability to silence the audible signal while leaving the visible signal energized with the use of a single pair of power wires. Additionally, the user shall be able to select either continuous or temporal tone output with the temporal signal having the ability to be synchronized. The audible /visible and visible signaling appliance shall also maintain a minimum flash rate of 1 Hz or up to 2Hz regardless of power input voltage. The appliance shall also be capable of meeting the candela requirements of the ADA (75Cd) for the combination listed (UL 1971/UL 1638) listed models. The appliance shall have an operating current of 63mA or less at 24 VDC for the 15/75Cd for the strobe circuit. The appliance shall be polarized to allow for electrical supervision of the system wiring. The unit shall be provided with a mounting bracket with termi- nals with barriers for input/output wiring and be able to mount to a single gang or double gang box or double workbox without the use of an adapter plate. The unit shall have an input voltage range of 16 -33 volts with either direct current of full wave rectified power. The appliance shall be capable of test supervision without disconnecting wires. Also the appliance shall be capable of mounting to a surface back box. The unit shall also be able to verify voltage at the unit without removing unit. GENTEX CORPORATION Fire Protection Products: www.gentex.com 10985 Chicago Drive Box 310 • Zeeland, Michigan 49464 616.392.7195 • 1.800.436.8391 • 616.392.4219 Fax Gentex corporation reserves the right to make changes to the product data sheets at their discretion. 24 units per carton 27 pounds per carton Important Notice: These materials have been prepared by Gentex Corporation ('Gentex') for informational purposes only, are necessarily summary, and are not purported to serve as legal advice and should not be used as such. Gentex makes no representations and warranties, express or implied, that these materials are complete and accurate, up -to -dale, or in compliance with all relevant local, state and federal laws, regulations and rules. The materials do not address all legal considerations as there is inevitable uncertainty regarding g interpretation of laws, regulations and rules and the application of such laws, regulations and rules to particular fact patterns. Each person's activities can differently affect the obligations that exist under applicable laws, regulations or rules. Therefore, these materials should be used only for informational purposes and should not be used as a substitute for seeking professional legal advice. Gentex will not be responsible for any action or failure to act in reliance upon the information contained in this material. 551 - 0049 -01 C) Printed on Recycled Paper er Commander4 Series Selectable Ceiling Mount Strobe and Horn Strobe Applications The GCS /GCC Series is a ceiling mount strobe or horn /strobe combination that offers dependable audible and visual alarms and the lowest current available. The GCS /GCC offers tamperproof field selectable candela options of 15, 30, 75, 95, 115 and 150 candela. The GCC horn offers a continuous or synchable temporal three in 2400Hz or mechanical tone. These tones are easy for the professional to change in the field by using switches. The models are shipped from the factory in the temporal three alarm mode. The GC Series has a very minimal operating current and has a minimum flash rate of 1 Hz regardless of input voltage. The Commander4 Series comes standard with the 4" mounting plate which incorporates the popular Super - Slide® feature that allows the installer to easily test for supervision. The Commander4 also features the patented Checkmate® - Instant Voltage Verification feature which allows the installer to check the voltage without removing the signal. The GC Series appliances are UL 464 and UL 1971 listed for use with fire protective systems and are warranted for three years from the date of purchase. Standard Features • Nominal Voltage 24VDC • Tamperproof Field Selectable Candela options of 15, 30, 75, 95,115 & 150 • Super - Slide® Bracket - Ease of Supervision Testing • Checkmate® - Instant Voltage Verification (Patented) • Unit Dimensions: 6" x 2.6" • Synchronize GC Series by using Gentex Series Control Module • Prewire Entire System, then Install Your Signals • Input Terminals 12 to 18 AWG • Switch Selection for High or Low dBA • Switch Selection for 2400Hz or Mechanical Tone • Switch Selection for Continuous or Temporal 3 • Tamperproof Re- entrant Grill • Surface Mount with the GCSB (Gentex Ceiling Surface Mount Box). • Silence Horn While Strobes Remain Flashing • Wide Voltage Range 16 -33 VDC or FWR • Faceplate Available in Red or Off -White GENTEX CORPORATION GCS /GCC 24VDC SERIES Product Listings atfl LISTED • UL 464 and UL 1971 Listed • FM Approved • CSFM: 7135 - 0569:122 (GCC) 7125 - 0569:123 (GCS) • BS +A/MEA #285 -91 -E • BFP (City of Chicago) Patents • 7,375,617 May 20, 2008 Product Compliance • NFPA72 • Americans with Disabilities Act (ADA) • Quality Management System is certified to: ISO 9001:2008 GCS Series 24 Volt Ceiling Mount Selectable Strobe Model Number Part Number Nominal Voltage 30cd 75cd Candela 115cd GCS24CR 904 - 1213 -002 24VDC 15, 30, 75, 95, 115, 150 GCS24CW 904 - 1215 -002 24VDC 15, 30, 75, 95, 115, 150 GCS24PCR 904 - 1214 -002 24VDC 15, 30, 75, 95, 115, 150 GCS24PCW 904 - 1216 -002 24VDC 15, 30, 75, 95, 115, 150 GCC Series 24 Volt Ceiling Mount Selectable Horn/Strobe Model Number Part Number Nominal Voltage 30cd 75cd Candela 115cd Reverberant dBA @ 10ft. In Anechoic Room dBA 72mA 101mA 167mA 200mA 214mA 286mA UL Maxi 120mA 120mA Per UL 464 @ 1 Oft. GCC24CR 904 - 1209 -002 24VDC 15, 30, 75, 95, 115, 150 81 -86 90 GCC24PCR 904 - 1210 -002 24VDC 15, 30, 75, 95, 115, 150 81 -86 90 GCC24CW 904 - 1211 -002 24VDC 15, 30, 75, 95, 115, 150 81 -86 90 GCC24PCW 904 - 1212 -002 24VDC 15, 30, 75, 95, 115, 150 81 -86 90 Notes: • The GC Series is not listed for outdoor use. • Operating temperature: 32 °to 120 °F (0° to 49° C) • For nominal and peak current across UL regulated voltage range for filtered DC power and unfiltered (FWR [Full Wave Rectified]) power, see installation manual. • Gentex does not recommend using a coded or pulsing signaling circuit with any of our strobe products (see technical bulletin number 014 for more information). Model designations: "P" = Plain (no lettering) "C" = Ceiling Mount, "R" = Red Faceplate "W" = Off -White Faceplate GC Series Product Strobe Current Ratings Candela 15cd 30cd 75cd 95cd 115cd 150cd 24VDC 72mA 101mA 167mA 200mA 214mA 286mA UL Maxi 120mA 120mA 200mA 220mA 290mA 321 mA GC Series Product Hom Current Ratings Hom Mode Minimum dBA @ 10ft. per UL 464 (HIGH) Minimum dBA @ 10ft. per UL 464 (LOW) Regulated 24VDC Max. Operating @ High Setting (mA) Temp 3 2400Hz 83 75 23 Temp 3 Mechanical 81 73* 22 Continuous 2400Hz 86 78 23 Continuous Mechanical 84 76 22 *Operating the horn in this mode at this voltage will result in not meeting the minimum UL reverberant sound level required for public mode fire protection service. These settings are acceptable only for private mode fire alarm use. Use the high dBA setting for public mode application. Notes: The sound output for the temporal 3 tone is rated lower since the time the horn is off is averaged into the sound output rating. While the horn is producing a tone in the temporal 3 mode its sound pressure is the same as the continuous mode. To obtain the horn /strobe current draw, add the strobe current draw and the horn current draw. 1 RMS current ratings are per UL average RMS method. UL max current rating is the maximum RMS current within the listed voltage range (16 -33VDC for 24VDC units). For strobes the UL max current is usually at the minimum listed voltage (16VDC for 24VDC units). For audibles the max current is usually at the maximum listed voltage. For unfiltered FWR ratings, see installation manual. Mounting Super - Slide® Checkmate® Instant Voltage Verification (Patented) Switch Locations Locations ra ^f6:7illT I l \ \. O 0 , /o • (K-"iiN"i »?) t....: 1747. I s. 5- H+ H• The access holes are provided in the back of the terminal block to allow the voltage to be measured directly without removing the device. Typically this would be done at the end of the line to confirm design criteria. Most measurements will be taken using the S+ and S- locations although access is provided to other locations. NOTE: Care should be taken to not short the test probes. Switch positions 1 and 2 in the down position to select isolated horn and strobe power inputs. Switch 3 selects between temporal or non - temporal tone. Up is temporal. Switch 4 selects between mechanical or high frequency tone. Up is mechanical. Switch 5 selects between high or low dBA. Up is high dBA. Conventional GC Series Wiring Diagrams UL Listed Control Panel Supervised Signal Circuit O f Signal 54 S. 5- H+ H- 9g S®® Signal 54 S. 5- HF H- END OF LINE RESISTOR UL Listed Control Panel Supervised Signal Circuit O O \o Signal S. 5+ 5- H+ H- IyS1SSSI Signal S+ 5. 5- H. H- S O S s 3 ENO OF UNE RESISTOR ERE RE RESISTOR Wiring Diagram GCS /GCC Series with Gentex Synchronization Module F,A.C,P e N. rsnca aoa FwRmc et..Y AUDIBLE SIGNA1( CIRCUIT VISIBLE SIGNAL CIRCUIT i 1ONi:XI Si :NAL TO NEXT SIGNAL REMOVE JUMPER FOR INDEPENDENT SYNCHRONIZED STROBE AND HORN OPERATION LEAVE JUMPERIN PLACE TO EUMIMATE NEED FOR HORN]NPUT ON AVSM AND OPERATE SIGNAL IN UNISON MODE TO NOTIFICATION ALARM CIRCL/IT 1 �I I o o i SYNCHRONIZATION MODULE SYNCHRONIZATION MUUULb O TO NOTIFICATION ALARM CIIitUTI LEAVE JUMPER IN PLACE ON SLAVE UNITS UNLESS SEPARATE CONTROL 0000 HORN CRT IS REQUIRED. PE S VOR F;ft • hA,C <R w VV•ONLY RESIETCR •OR M. ASS R!RR.00A.v .11 Note: See Technical Bulletin 015 for proper synchronization module for application. Architect & Engineering Specifications The visible and audible /visible signal shall be Gentex model GCS or GCC or approved equal and shall be listed by Underwriters Laboratories Inc. per UL 1971 for the GCS and also UL 464 for the GCC. The notification appliance shall also be listed with the California State Fire Marshal (CSFM) and the Bureau of Standards and Appeals (NYC). The notification appliance (combination audible /visible units only) shall produce a peak sound output of 90dBA or greater as measured in an anechoic chamber. The signaling appliance shall also have the capability to silence the audible signal while leaving the visible signal energized with the use of a single pair of power wires. Additionally, the user shall be able to select either continuous or temporal tone output with the temporal signal having the ability to be synchronized. The audible /visible and visible signaling appliance shall also maintain a minimum flash rate of 1 Hz or up to 2Hz regardless of power input voltage. The appliance shall have an operating current of 72mA or less at 24VDC for the 15 candela strobe circuit. The appliance shall be polarized to allow for electrical supervision of the system wiring. The unit shall be provided with a mounting bracket with terminals with barriers for input/output wiring and be able to mount to a single gang or double gang box or double workbox with the use of an adapter plate. The unit shall have an input voltage range of 16 -33 volts with either direct current or full wave rectified power. The appliance shall be capable of test supervision without disconnecting wires. Also the appliance shall be capable of mounting to a surface box. The unit shall also be able to verify voltage at the unit without removing unit. GENTEX CORPORATION Fire Protection Products Group • www.gentex.com 10985 Chicago Drive • Zeeland, Michigan 49464 616.392.7195 • 1.800.436.8391 • 616.392.4219 Fax Gentex Corporation reserves the right to make changes to the product data sheet at their discretion. 24 units per carton 29 pounds per carton Important Notice: These materials have been prepared by Gentex Corporation ('Gentex') for informational purposes only, are necessarily summary, and are not purported to serve as legal advice and should not be used as such. Gentex makes no representations and warranties, express or implied, that these materials are complete and accurate. up -to -date, or in compliance with all relevant local, state and federal laws, regulations and rules. The materials do not address all legal considerations as there is inevitable uncertainty regarding interpreta- tion of laws, regulations and rules and the application of such laws, regulations and rules to particular fact patterns. Each person's activities can differently affect the obligations that exist under applicable laws, regu- lations or rules. Therefore, these materials should be used only for informational purposes and should not be used as a substitute for seeking professional legal advice. Gentex will not be responsible for any action or failure to act in reliance upon the information contained in this material. 551 - 0051 -04 0 Printed on Recycled Paper e ow M uct smoke Det Features ,;. ..... �.. .• A Oivigion ',of Pittway 825Ohio :\vet ue. St: Charles. IL 6017,1 1- 800- SENSOR2 (736- 7672) Fax 630- 377 4+195 ltttv,,,untnt slstefllscns0l.corrt Models Available DH10OACDCI4 -wire Ionization Detector DH10OACDCP 4-wire Photoelectronic Detector • Outside mounting tabs • Telescoping sampling tube* • Built -in reset button • Interconnectability* for multi -fan shutdown (up to ten air handlers) • Cover tamper trouble signal* • Easy to clean • 24 VAC /DC or 120/240 VAC operation • High -Low voltage barrier • Ion or photo models available • Remote test station option • Remote sounder option • Air velocity rating from 500 to 4000 FPM • Equipped with two DPDT Form C relay contacts • Easy and quick mounting to round or rectangular ducts from 1' -12' wide • Textured cover for convenient visual inspection • UL 268A listed • 3 -year warranty Specifications System Sensor DH1O0ACDC 4 -wire duct duct smoke detector is available as either an ionization or photoelectric model. This new design allows for simplified cleaning and maintenance, or a change in application without removing the duct housing. The DH100ACDC samples air currents passing through a duct and gives dependable performance for management of fans, blowers, and air conditioning systems, preventing the spread of toxic smoke and fire gases through the protected area. WARNING: Duct smoke detectors have specific limitations. DUCT DETECTORS ARE: NOT a substitute for an open area smoke detector, NOT a substitute for early warning detection, and NOT a replacement for a building's regular fire detection system. Refer to NFPA 72 and 90A for additional duct detector application information. Length: 143/8 inches (14 cm.) Depth: 23/4 inches (7 cm.) Shipping Weight: 3.75 lbs. (1.7 kg.) Operating Temperature Range: 23° to 131° F ( -5° to 55° C) • Patent pending ® System Sensor 1/98 Operating Humidity Range: Air Duct Velocity: 10% to 93% relative humidity noncondensing 500 to 4000 ft. /min. This document is not intended to be used for installation purposes. A05- 977 -00 Architectural /Engineering Specifications The air duct smoke detector shall be a System Sensor Model DH100ACDC Series Duct Smoke Detector. The detector housing shall be UL listed per UL 268A specifically for use in air handling systems. The detector shall operate at air velocities of 500 feet per minute to 4000 feet per minute. The unit shall be capable of controlling up to ten (10) air handling systems when interconnected with other detectors. The detector shall be capable of providing a trouble signal in the event that the front cover is removed. It shall be capable of local testing via magnetic switch or remote testing using the RTS451KEY Remote Test Station. The unit shall be reset by local reset button or remote test station. The duct detector housing shall incorporate an airtight smoke chamber in compliance with UL 268A, Standard for Smoke Detectors for Duct Applications. The housing shall be capable of mounting to either rectangular or round ducts without adapter brackets. An integral filter system shall be included to reduce dust and residue effects on detector and housing, thereby reducing maintenance and servicing. Sampling tubes shall either be telescoping or be easily installed by passing through the duct housing after the housing is mounted to the duct. The unit shall provide a spacial separation of no less than h /4' and /or a physical barrier between the high and low voltage terminals. The enlosure shall meet all applicable NEC and NFPA standards regarding electrical junction boxes. Terminal connections shall be of the strip and clamp method suitable for 12 -18 AWG wiring. Electrical Ratings - DH100ACDC (Includes Detector) Power supply voltage: Input capacitance: Reset voltage: Reset time (with RTS451): Reset time (by power down): Power up time: Alarm response time: Sensitivity Test: 20 -29 VDC 270 µF max. 3.0 VDC min. .03 to 0.3 sec. 0.6 sec. max. 34 sec. max. 2 to 17 sec. See detector label 24 VAC 50 -60 -Hz 270 uF max. 2.0 VAC min. .03 to 0.3 sec. 0.6 sec. max. 34 sec. max. 2 to 17 sec. See detector label 120 VAC 50 -60 Hz N/A 10 VAC min. .03 to 0.3 sec. 0.6 sec. max. 34 sec. max. 2 to 17 sec. See detector label 220/240 VAC 50 -60 Hz N/A 20 VAC min. .03 to 0.3 sec. 0.6 sec. max. 34 sec. max. 2 to 17 sec. See detector label Power Supply Voltage 20 - 29 VDC 24 VAC 50 - 60 Hz CURRENT REQUIREMENTS (USING NO ACCESSORIES) I 120 VAC 50 - 60 Hz I 220/240 VAC 50 - 60 Hz Max. standby current 15 mA 35 mA RMS 25 mA RMS* 15 mA RMS` Max. alarm current 70 mA 125 mA RMS 35 mA RMS' 25 mA RMS' CONTACT RATINGS Alarm initiation contacts (SPST) 2.0A @ 30 VDC (resistive) Alarm auxiliary contacts (DPDT) 10A @ 30 VDC 1OA @ 250 VAC Note: Alarm auxiliary contacts must switch 100 mA minimum at 5VDC. Alarm auxiliary contacts shall not be connected to inititaing circuits of control panels. Use the alarm initiation contact for this purpose. Trouble contacts (SPDT) 2.0A @ 30 VDC (resistive) Page 2 ACCESSORY CURRENT LOADS AT 24 VDC DEVICE STANDBY ALARM APA451 12.5mA Max. 30mA Max. PA400 OmA 15mA Max. RA4002 OmA 10mA Max. RTS451/ RTS451KEY 12mA 7.5mA Max. NOTE: when a unit is powered at the 120VAC or 220/240VAC input, any combination of accessories may be used such that the given accessory loads are: 60 mA or less in the standby state, 110 mA or less in the alarm state. A05- 977 -00 DH100ACDC Wiring Guide POWFR INPUT* ACCEPT 24 VDC, 24 VAC 50-60 HZ, 120 VAC 50 -60 HZ, OR 220/240 VAC 50-60 HZ. CONNECT POWER SOURCE TO APPROPRIATE TERMINALS OF EACH DETECTOR. AUX CONTACT RATINGS 10A 130 VDC RESISTIVE 10A 250 VAC 100mA MINIMUM 5 VDC NOT INTENDED FOR CONNECTION TO CONTROL PANELS. TROUBLE CONTACT RATING 2.0 A 2N 30 VDC resistive ALARM INITIATION LOOP AVAILABLE POWER INPUTS 9 10 A (2242 B C 120 VAC 220/240 VAC ALARM AUXILIARY CONTACTS FOR FAN SHUTDOWN, ETC. 18 6 17 7 18 N.C. ALARM AUXILIARY CONTACTS SHOWN IN STANDBY. CONTACTS TRANSFER DURING ALARM AS INDICATED BY THE ARROWS. SUPERVISORY TROUBLE CONTACTS 3 14 0 C. AVAILABLE POWER INPUTS 9 10 A (224V B C L 120 VAC 220/240 VAC ALARM AUXILIARY CONTACTS FOR FAN SHUTDOWN. ETC. 18 6 17 7 18 8 ALARM AUXILIARY CONTACTS SHOWN IN STANDBY. CONTACTS TRANSFER DURING ALARM AS INDICATED BY THE ARROWS. SUPERVISORY TROUBLE CONTACTS TROUBLE CONTACTS CLOSED IN ALARM AND STANDBY CONTACTS OPEN WHILE DETECTOR HERO OR POWER IS REMOVED OR WHEN TAMPER FEATURE TIMES OUT. OPEN CONTACTS SIGNAL TROUBLE CONDITION TO PANEL. 0 0 C. CONNECT POWER SOURCE TO APPROPRIATE TERMINALS OF EACH DETECTOR. SEE SPECIFICATIONS FOR ADDITIONAL POWER SUPPLY INFORMATION. FOR WIRING OF AUXILIARY DEVICES. REFER TO MANUFACTURER'S INSTALLATION INSTRUCTIONS OR CONTACT MANUFACTURER. NOTE: THE SUPERVISORY RELAY NOW PROVIDES A "FORM C. CONTACT FOR CUSTOMIZED APPLICATIONS. FOR STANDARD APPLICATIONS, ONLY THE ''NO" CONTACT IS USED TROUBLE CONTACTS CLOSED IN ALARM AND STANDBY. CONTACTS OPEN WHILE DETECTOR HEAD OR POWER IS REMOVED OR WHEN TAMPER FEATURE TIMES OUT. OPEN CONTACTS SIGNAL TROUBLE CONDITION TO PANEL. ALARM CONTACTS SHOWN INITIATION OPEN IN STANDBY. CONTACTS CONTACTS CLOSE IN ALARM. ALARM CONTACTS SHOWN INITIATION OPEN IN STANDBY. CONTACTS CONTACTS CLOSE IN ALARM. UL LISTED 4 -WIRE FIRST DETECTOR IN THE LOOP CONTROL PANEL DH100ACDC LAST DETECTOR IN THE LOOP DH100ACDC 601 RESISTOR SPECIFIED BY PANEL MANUFACTURER System wiring diagram for 4-wire duct smoke detectors (detectors powered from initiating circuit) DH100ACDC Alarm Signal Aux. Power + Sup. N. O. Sup. COM Aux. Power — APA451 Alarm Power Common NOTE: Wiring diagram shown is for DH100ACDC 4 -wire duct dectector system equipped without a control panel. Wiring diagram for DH100ACDC to APA451 DH100ACDC Alarm Signal Aux. Power + Sup. N. O. Sup. COM Aux. Power — Reset Test Interconnect + Interconnect — DH100ACDC 12 RTS451KEY 0 (Red LED) Alarm O(Green LED) Power Common 03 ?Reset 0 Common O ?Test NOTE: Wiring diagram shown is for DH100ACDC 4 -wire duct detector system equipped without a control panel. Wiring diagram for DH100ACDC to RTS451KEY and interconnect feature Page 3 A05- 977 -00 Ordering Information Part No. DH100ACDCI DH100ACDCP A5052 -00 A5069 -00 A5064 -00 Accessories ST -1.5 ST -3 ST -5 ST -10 T80 -71 -00 P48 -55 -00 Description 4 -wire ionization duct detector 4 -wire photoelectronic duct detector Replacement ionization sensor board Replacement photoelectronic sensor head 4 -wire power board Metal sampling tube duct widths 1' -2' Metal sampling tube duct widths 2' -4' Metal sampling tube duct widths 4' -8' Metal sampling tube duct widths 8' -12' Replacement telescoping sampling tube Replacement end cap for T80 -71 -00 Accessories RTS451KEY RTS451 APA451 MOD400R RA400Z F36 -09 -00 M02 -04 -00 P48 -21 -00 S08 -39 -01 PA400B PS24LOB PS12 /24LENSC PS12 /24LENSW Remote test station with key lock (see below) Remote test station Remote annunciator with piezo alarm Sensitivity test module Remote annunciator alarm LED (see below) Replacement air filters (two per package) Test magnet End cap for metal sampling tubes Photo replacement screen Mini -Alert sounder Mini -Alert add -on strobe Ceiling -mount "SMOKE" lens Wall -mount "SMOKE" lens System Sensor provides system flexibility with a variety of accessories, including two remote test stations, and several different means of visible and audible system APA451 Piezo Annunciator (UL S4011) RTS451KEY Remote Test Station with Key (UL S2522) annunciation. As with our duct detectors, all duct detector accessories are UL listed. 1 r R E PA400 with PS24LOW Add -on Strobe (PS12 /24LENSW smoke lens option available) (UL S3593) RTS451 Remote Test Station (UL S2522) System Sensor Worldwide Manufacturing & Distribution RA400Z Remote Annunciator (UL S2522) In Canada: Telephone: 905 - 812 -0767 Fax: 905 -812 -0771 In China: Telephone: 852- 2191 -9003 Fax: 852- 2736 -6580 Page 4 In the Far East: Telephone: 852 - 2191 -9003 Fax: 852 -2736 -6580 In India: Telefax: 91- 022 - 8202564 In Italy: Telephone: 39 -40- 9490 -111 Fax: 39- 40- 382137 In Singapore: Telephone: 65- 273 -2230 Fax: 65- 273 -2610 In the United Kingdom: Telephone: 44- 1403 - 276500 Fax: 44 -1403- 276501 A05- 977 -00 BG-1 2 Series Manual Fire Alarm Pull Stations DF- 52004:A1 • F -050 FireuyeAtarms by Honeywell Conventional Initiating Devices General The Fire•Lite BG -12 Series is a cost - effective, feature - packed series of non -coded manual fire alarm pull stations. It was designed to meet multiple applications with the installer and end -user in mind. The BG -12 Series features a variety of mod- els including single- and dual- action versions. The BG -12 Series provides Fire•Lite Alarm Control Panels (FACPs), as well as other manufacturers' controls, with a man- ual alarm initiating input signal. Its innovative design, durable construction, and multiple mounting options make the BG -12 Series simple to install, maintain, and operate. Features • Aesthetically pleasing, highly visible design and color. • Attractive contoured shape and light textured finish. • Meets ADA 5 Ib. maximum pull- force. • Meets UL 38, Standard for Manually Actuated Signaling Boxes. • Easily operated(single - or dual- action), yet designed to pre- vent false alarms when bumped, shaken, or jarred. • PUSH IN /PULL DOWN handle latches in the down position to clearly indicate the station has been operated. • The word "ACTIVATED" appears on top of the handle in bright yellow, further indicating operation of the station. • Operation handle features white arrows showing basic opera- tion direction for non - English- speaking persons. • Braille text included on finger -hold area of operation handle and across top of handle. • Multiple hex- and key -lock models available. • U.S. patented hex -lock needs only a quarter -turn to lock/ unlock. • Station can be opened for inspection and maintenance with- out initiating an alarm. • Product ID label viewable by simply opening the cover; label is made of a durable long -life material. • The words "NORMAL" and "ACTIVATED" are molded into the plastic adjacent to the alarm switch (located inside). • Four - position terminal strip molded into backplate. • Terminal strip includes Phillips combination -head captive 8/32 screws for easy connection to Initiating Device Circuit (IDC). • Terminal screws backed -out at factory and shipped ready to accept field wiring (up to 12 AWG /3.1 mm2). • Terminal numbers are molded into the backplate, eliminating the need for labels. • Switch contacts are normally open. • Can be surface- mounted (with SB -10 or SB -1/0) or semi - flush mounted. Semi -flush mount to a standard single -gang, double -gang, or 4" (10.16 cm) square electrical box. • Backplate is large enough to overlap a single -gang backbox cutout by 1/2" (1.27 cm). • Optional trim ring (BG12TR). • Spanish versions (FUEGO) available (BG- 12LSP, BG- 12LPSP). • Designed to replace the Fire•Lite legacy BG -10 Series. • Models packaged in attractive, clear plastic (PVC), clam- shell- style, Point -of- Purchase packages. Packaging includes a cutaway dust/paint cover in shape of pull station. Construction • Cover, backplate and operation handle are all molded of durable polycarbonate material. • Cover features white lettering and trim. • Red color matches System Sensor's popular SpectrAlert® Advance horn /strobe series. Operation The BG -12 manual pull stations provide a textured finger -hold area that includes Braille text. In addition to PUSH IN and PULL DOWN text, there are arrows indicating how to operate the sta- tion, provided for non - English- speaking people. Pushing in and then pulling down on the handle activates the normally -open alarm switch. Once latched in the down position, the word "ACTIVATED" appears at the top in bright yellow, with a portion of the handle protruding at the bottom as a visible flag. Resetting the station is simple: insert the key, twist one quarter - turn, then open the station's front cover, causing the spring - loaded operation handle to return to its original position. The alarm switch can then be reset to its normal (non - alarm) position manually (by hand) or by closing the station's front cover, which automatically resets the switch. DF- 52004:A1 • 04/22/08 — Page 1 of 2 Specifications PHYSICAL SPECIFICATIONS: 52004dirn.tbl ELECTRICAL SPECIFICATIONS: Switch contact ratings: gold - plated; rating 0.25 A @ 30 VAC or VDC. ENGINEERING/ARCHITECTURAL SPECIFICATIONS Manual Fire Alarm Stations shall be non -code, with a key- or hex - operated reset lock in order that they may be tested, and so designed that after actual Emergency Operation, they cannot be restored to normal except by use of a key or hex. An operated station shall automatically condition itself so as to be visually detected as activated. Manual stations shall be constructed of red colored LEXAN (or polycarbonate equivalent) with clearly visible operating instructions provided on the cover. The word FIRE shall appear on the front of the stations in white letters, 1.00 inches (2.54 cm) or larger. Stations shall be suitable for surface mounting on matching backbox SB -10 or SB -I /O; or semi -flush mounting on a standard single -gang, double -gang, or 4" (10.16 cm) square electrical box, and shall be installed within the limits defined by the Americans with Disabilities Act (ADA) or per national /local requirements. Manual Stations shall be Under- writers Laboratories listed. NOTE: The words 'FIRE/FUEGO" on the BG -12LSP shall appear on the front of the station in white letters, approximately 3/4" (1.905 cm) high. PUSH H HAMA Al PULL Kw Agency Listings and Approvals The listings and approvals below apply to the BG -12 Series pull stations. In some cases, certain modules may not be listed by certain approval agencies, or listing may be in process. Consult factory for latest listing status. • C(UL)US: S711 • FM Approved • CSFM: 7150-0075:184 • MEA: 67-02-E • Patented: U.S. Patent No. D428,351; 6,380,846; 6,314,772; 6,632,108. Product Line Information BG -12S: Single- action pull station with pigtail connections, hex lock. BG -12SL: Same as BG -12 with key lock. BG -12: Dual- action pull station with SPST N/O switch, screw terminal connections, hex lock. BG -12L: Same as BG -12 with key lock. BG- 12LSP: Same as BG -12L with English /Spanish (FIRE/ FUEGO) labeling. BG- 12LOB: Same as BG -12L with "outdoor use" listing. Includes outdoor listed backbox, and sealing gasket. BG -12LO: Same as BG -12L with "outdoor use" listing. Does not include backbox. BG -12LA: Same as BG -12L with auxiliary contacts. BG- 12LPS: Dual- action pull station with pre - signal option. BG- 12LPSP: Same as BG -12LPS with English /Spanish (FIRE/ FUEGO) labeling. SB -10: Surface -mount backbox, metal. SB -I/O: Surface -mount backbox, plastic. (Included with BG- 12LOB.) BG12TR: Optional trim ring for semi -flush mounting. 17003: Keys, set of two. (Included with key -lock pull stations.) 17007: Hex lock, 9/64 ". (Included with hex -lock pull stations.) NOTE: For addressable BG -12LX models, see data sheet DF- 52013. Fire•Lite® Alarms, SpectrAlert® Advance, and System Sensor® are registered trademarks of Honeywell International Inc. ©2008 by Honeywell International Inc. All rights reserved. Unauthorized use of this document is strictly prohibited. ISO 9001 E R T 1 F 1 E IfIRINEERIN1 S MANUFACTURING QUALITY SYSTEMS This document is not intended to be used for installation purposes. We try to keep our product information up -to -date and accurate. We cannot cover all specific applications or anticipate all requirements. All specifications are subject to change without notice. For more information, contact Fire•Lite Alarms. Phone: (800) 627 -3473, FAX: (877) 699 -4105. www.firelite.com Made in the U.S. A. Page 2 of 2 — DF- 52004:A1 • 04/22/08 pull station SB -I /O SB -10 Height 5.5 inches (13.97 cm) 5.601 inches (14.23 cm) 5.5 inches (13.97 cm) Width 4.121 inches (10.47 cm) 4.222 inches (10.72 cm) 4.121 inches (10.47 cm) Depth 1.39 inches (3.53 cm) 1.439 inches (3.66 cm) 1.375 inches (3.49 cm) 52004dirn.tbl ELECTRICAL SPECIFICATIONS: Switch contact ratings: gold - plated; rating 0.25 A @ 30 VAC or VDC. ENGINEERING/ARCHITECTURAL SPECIFICATIONS Manual Fire Alarm Stations shall be non -code, with a key- or hex - operated reset lock in order that they may be tested, and so designed that after actual Emergency Operation, they cannot be restored to normal except by use of a key or hex. An operated station shall automatically condition itself so as to be visually detected as activated. Manual stations shall be constructed of red colored LEXAN (or polycarbonate equivalent) with clearly visible operating instructions provided on the cover. The word FIRE shall appear on the front of the stations in white letters, 1.00 inches (2.54 cm) or larger. Stations shall be suitable for surface mounting on matching backbox SB -10 or SB -I /O; or semi -flush mounting on a standard single -gang, double -gang, or 4" (10.16 cm) square electrical box, and shall be installed within the limits defined by the Americans with Disabilities Act (ADA) or per national /local requirements. Manual Stations shall be Under- writers Laboratories listed. NOTE: The words 'FIRE/FUEGO" on the BG -12LSP shall appear on the front of the station in white letters, approximately 3/4" (1.905 cm) high. PUSH H HAMA Al PULL Kw Agency Listings and Approvals The listings and approvals below apply to the BG -12 Series pull stations. In some cases, certain modules may not be listed by certain approval agencies, or listing may be in process. Consult factory for latest listing status. • C(UL)US: S711 • FM Approved • CSFM: 7150-0075:184 • MEA: 67-02-E • Patented: U.S. Patent No. D428,351; 6,380,846; 6,314,772; 6,632,108. Product Line Information BG -12S: Single- action pull station with pigtail connections, hex lock. BG -12SL: Same as BG -12 with key lock. BG -12: Dual- action pull station with SPST N/O switch, screw terminal connections, hex lock. BG -12L: Same as BG -12 with key lock. BG- 12LSP: Same as BG -12L with English /Spanish (FIRE/ FUEGO) labeling. BG- 12LOB: Same as BG -12L with "outdoor use" listing. Includes outdoor listed backbox, and sealing gasket. BG -12LO: Same as BG -12L with "outdoor use" listing. Does not include backbox. BG -12LA: Same as BG -12L with auxiliary contacts. BG- 12LPS: Dual- action pull station with pre - signal option. BG- 12LPSP: Same as BG -12LPS with English /Spanish (FIRE/ FUEGO) labeling. SB -10: Surface -mount backbox, metal. SB -I/O: Surface -mount backbox, plastic. (Included with BG- 12LOB.) BG12TR: Optional trim ring for semi -flush mounting. 17003: Keys, set of two. (Included with key -lock pull stations.) 17007: Hex lock, 9/64 ". (Included with hex -lock pull stations.) NOTE: For addressable BG -12LX models, see data sheet DF- 52013. Fire•Lite® Alarms, SpectrAlert® Advance, and System Sensor® are registered trademarks of Honeywell International Inc. ©2008 by Honeywell International Inc. All rights reserved. Unauthorized use of this document is strictly prohibited. ISO 9001 E R T 1 F 1 E IfIRINEERIN1 S MANUFACTURING QUALITY SYSTEMS This document is not intended to be used for installation purposes. We try to keep our product information up -to -date and accurate. We cannot cover all specific applications or anticipate all requirements. All specifications are subject to change without notice. For more information, contact Fire•Lite Alarms. Phone: (800) 627 -3473, FAX: (877) 699 -4105. www.firelite.com Made in the U.S. A. Page 2 of 2 — DF- 52004:A1 • 04/22/08 V, SYSTEM ® Photoelectric Smoke Detectors System Sensor /3,M series smoke detectors represent significant advancement in conventional detection. The i3 family is founded on three principles: installation ease, intelligence, and instant inspection. Features • Plug -in detector line, mounting base included • Large wire entry port • In -line terminals with SEMS screws • Mounts to octagonal and single -gang back boxes, 4- square back boxes, or direct to ceiling • Stop -Drop 'N Lock attachment to base • Removable detector cover and chamber • Built -in remote maintenance signaling • Drift compensation and smoothing algorithms • Simplified sensitivity measurement • Wide - angle, dual -color LED indication • Loop testing via EZ Walk feature • Built -in test switch Agency Listings LISTED 5911 APPROVED 3011446 7272 - 1653:152 MEA MSFM approved approved °! US 290 -01 -E 2093 3180932 Installation ease. The i3 line redefines installation ease with its plug -in design. This allows an installer to pre -wire bases (included with heads). The large wire entry port and in -line terminals provide ample room for neatly routing the wiring inside the base. The base accommodates a variety of back box mounting methods as well as direct mounting with drywall anchors. To complete the installation, i3 heads plug into the base with a simple Stop -Drop 'N Lock" action. Intelligence. i3 detectors offer a number of intelligent features to simplify testing and maintenance. Drift compensation and smoothing algorithms are standard with the i3 line to minimize nuisance alarms. 2 -wire i3 detectors can generate a remote LED - indicated maintenance signal when connected to the 2W -MOD2 loop test /maintenance module or a panel equipped with the P protocol. The SENS -RDR, a wireless device, displays the sensitivityof i3 detectors in terms of percent - per -foot obscuration. Instant inspection. The i3 series provides wide -angle red and green LED indicators for instant inspection of the detector's condition: normal standby, out -of- sensitivity, alarm, or freeze trouble. When connected to the 2W -MOD2 loop test/maintenance module or a panel with the i3 protocol, the EZ Walk loop test feature is available on 2 -wire i3 detectors. This feature verifies the initiating loop wiring by providing LED status indication at each detector. Cb Smoke Detector Specifications Architectural /Engineering Specifications Smoke detector shall be a System Sensor i3 Series model number listed to Underwriters Laboratories UL 268 for Fire Protection Signaling Systems. The detector shall be a photoelectric type (Model 2W -B, 4W -B) or a combination photoelectric/thermal (Model 2WT -B, 4WT -B) with thermal sensor rated at 135 °F (57.2 °C).The detector shall include a mounting base for mounting to 31/2 -inch and 4 -inch octagonal, single -gang, and 4 -inch square back boxes with a plaster ring, or direct mount to the ceiling using drywall anchors. Wiring connections shall be made by means of SEMS screws. The detector shall allow pre- wiring of the base and the head shall be a plug -in type.The detector shall have a nominal sensitivity of 2.5 percent - per -foot nominal as measured in the UL smoke box. The detector shall be capable of automatically adjusting its sensitivity by means of drift compensation and smoothing algorithms.The detector shall provide dual - color LED indication that blinks to indicate power up, normal standby, out of sensitivity, alarm, and freeze trouble (Model 2WT -B, 4WT -B) conditions. When used in conjunction with the 2W -MOD2 module, 2 -wire models shall include a maintenance signal to indicate the need for maintenance at the alarm control panel and shall provide a loop testing capability to verify the circuit without testing each detector individually. Electrical Specifications Operating Voltage Nominal: 12/24 V non - polarized Minimum: 8.5V Maximum: 35 V Maximum Ripple Voltage Standby Current Maximum Alarm Current Peak Standby Current Alarm Contact Ratings 30% peak to peak of applied voltage 2 -wire: 50 pA maximum average; 4 -wire: 50 pA maximum average 2 -wire: 130 mA limited by control panel; 4 -wire: 20 mA @12 V, 23 mA @ 24 V 2 -wire: 100 pA; 4 -wire: n/a 2 -wire: n/a; 4 -wire: 0.5 A @ 30 V AC/DC Physical Specifications Dimensions (including base) 5.3 inches (127 mm) diameter; 2.0 inches (51 mm) height Weight 6.3 oz (178 g) Operating Temperature Range Operating Humidity Range Thermal Sensor 2W -B and 4W -B: 32 °F to 120 °F (0 °C to 49 °C); 2WT -B and 4WT -B: 32 °F to 100 °F (0 °C to 37.8 °C) 0 to 95% RH non - condensing 135 °F (57.2 °C) fixed Freeze Trouble Sensitivity Input Terminals Mounting 2WT -B and 4WT-B only: 41 °F (5 °C) 2.5 % /ft nominal 14 to 22 AWG 31/2-inch octagonal back box 4 -inch octagonal back box Single -gang back box 4 -inch square back box with a plaster ring Direct mount to ceiling LED Modes Power -Up Sequence for LED Indication LED Mode Green LED Red LED Condition Duration Power up Blink every 10 seconds Blink every 10 seconds Normal (standby) Blink every 5 seconds off Out of sensitivity off Blink every 5 seconds Freeze trouble off Blink every 10 seconds Alarm off Solid Initial LED status indication 80 seconds Ordering Information Model Thermal Wiring Alarm Current 2W -B 2WT-B 4W -B 4WT -B Accessories No Yes No Yes 2 -wire 2 -wire 4 -wire 4 -wire 130 mA max. limited by control panel 130 mA max. limited by control panel 20mA@ 12V,23mA @24V 20mA @12V,23mA @24V 2W -MOD2 SENS -RDR 2 -wire loop test / maintenance module Sensitivity reader RT Removal / replacement tool A77 -AB2 Retrofit adapter bracket, 6.6 inch (16.76 cm) diameter SYSTEM $ SENSOR' 3825 Ohio Avenue • St. Charles, IL 60174 Phone: 800- SENSOR2 • Fax: 630 - 377 -6495 ©2009 System Sensor. Product specifications subject to change without nonce. 6011 systemsensor.com for current product information, including the latest version of this data sheet. A05 -0318-007.6/09'62169 NOTE: ALL SHEET MUST BE REVIEWED MIAMI -DADE COUNTY BUILDING DEPARTMENT Herbert S. Saftlr Permitting and Inspection Center 11805 SW 26th Street (Coral Way) • Miami, Florida 33176 -2474 • (786) 315 -2100 APPLICATION FOR MUNICIPAL PERMIT APPLICANTS THAT REQUIRE PLAN REVIEW FROM MIAMI -DADE FIRE FESCUE AND /OR DEPARMENT OF ENVIRONMENTAL RESOURCES MANAGEMENT PROVIDE MUNICIPAL PROCESS NUMgEER, HER _17:7- Job Address 9 71 r / /E 2ao 4C /4 a te° 5 °C O 2 Contractor No. EF00 0® 2S 2 Fono 11 - 3 294-013-- �' 2 _ Q ' Last four (4) digits of Qualifier No. 5-(') 1 Contractor Name IA es /J & 5kJ,e .fie, vrr/ Lot 8lads Wagner Quan Name v 3_[ i "4- rf a z,e 1 -1' i , Subdivision Pt3pg Address 62-2i fembtrike 12d Metes and bounds aty o l S} Et_ 7Ip 3 3 @Z5 woa1) a•.e I 1 Lund cti� on tit Alteration Interior r 11 Alteration Exterior I 3 Relocation 01 Shuatura (1 I 1 Repair Due to Fire (1 Demolish [ ] Shell Only ( 1 Addition Attached 13 Addition Detached ( 1 Re -Roof f Foundation Oniy Current use of property i S 0 S Desaripdon of Worts As,T 7e1; Z. "L _____96-0- ms's' _ - ;. if r", Sq. R. Units Floors Value of Work ' 1 73- ) g ( I MELD' category _ P g I I 3 Chg. Contractor (] Re-Issue I I Re -Stamp I 1 Revision ( 3 Not Applicable for Fire Owner. Ool &Mi3'r L I-C, Address qwo L .� SLoTt P MELE City 0. State.EZip 3 31$V' ,Mfg! Phone-_,:. 3(73- -757 al® tf D I 3 MLPG ( 1 MMEC Last four (4) digks of Owner's SW01 Security No. 3FE-5- ! FIRE id. zAddress la Name ., Owner Address City State Zip ._ City State Zip Phone Phone _ 1!1 iP"° 1 am requecbhg a Special Request Plan Review {SAAQ to be scheduled as soon as possible at the rate of $190 for the first hour and S65 per each additional hour hi addition to the review fees. Minimum charge one -hour. Id Request Date west: Date:_._... 34 Request Date: 1 I341 1 am requesting Optional Plan Review (OPR) to be scheduled as soon as possible at the rate 01575 'or each dsc/p e. Additional review tees may apply. i• Request: Date: 2q0 Request: Date: Request Date:_,...,_ *13.01.182 Bros Miami -Dade Fire Rescue Fire Alarm Pre - Submittal Checklist Based On NFPA 72 2007' Ed. & NFPA 1 and 101 2009' Ed. Designed by: Signature: Vi P ,N+ F-412:6171 Phone#: 1 ,' ?� 7 -7/(// Created by: MDFR 08 / 2012 THIS IS A REQUIRED DOCUMENT ON ALL FIRE ALARM PLAN SUBMITTALS 10F2 Building Dept. Process Num er is (Begins with C or M): Date: / / 1 Project Name: al, - S ('&' Iri GJ Is provided in title block of plans. YES NO N/A 2 Address in title block shat a ch a• • ress in "Building Dept. Computer System" and attached permit application. If address contains a specific building, floor, suite, or unit number or letter, it shall be provided in title block, to match Building Dept. Computer System. 3 The total cost of the installation to the customer is $ 3 � Q A 0 t9 and a copy of the contract or a notarized affidavit from the owner showing this amount is attached. 4 Fire Alarm Systems costing more than $5,000 are sealed or stamped by a Florida Registered Professional Engineer. X 5 The total number of DEVICES and COMPONENTS being installed is 2-0 . 6 The alarm qualifier's state license number is (EC EH EY) # ®Q00 2-.Q - and a copy is attached to plans. 7 Complete, current manufacturer's Specification a Installation sheets are attached for all control units, components, devices, modules and relays listed on Legend. 8 Is this permit application for fire alarm work a result of a Notice Of Violation (NOV) issued by Miami -Dade Fire Rescue? If yes, a copy of the Notice of Violation is attached. 9 This fire alarm: (>() is required unde( ) 11703. / (fill in the Occupancy Chapter & Section from NFPA 101 OR, ( ) is a life safety equivalency OR, ( ) is a non - required system or component. 10 This is an "EXISTING (Local) Are Alarm System" and is stated as such on the plans. AHJ will require documentation of prior approval of system as a (Local) Fire Alarm System in the form of the original Fire Dept. approved Job copy set of fire alarm plans or certified microfilm copy of same. 11 This is a "NEW (Local) Fire Alarm System" and is stated as such on plans. 12 This is an "EXISTING Central Station Service Fire Alarm System" and is stated as such on the Plans. A copy of the existing BUILDING UL or ETL certificate, or FM Placard, specifically identifying this protected premise by address, and uniquely identifying _ d ®mil, this building's fire alarm system, is attached. 13 If the company that issued the existing certificate or placard for this building's fire alarm system is different than the company applying for this permit; is the required Affidavit to Work on another Company's Certificated or Placarded Fire Alarm System Provided? 14 This is a NEW Certificated ( ) of Placarded ( ) "Central Station Service Are Alarm System" and stated as such on the plans. 15 If this is a NEW "Central Station Service Fire Alarm System," a copy of the UL or ETL certificate of FM placard from the contractor, or from the Central Station Service Company, issuing the building certificate /placard, is attached. 16 This is an "EXISTING Remote Supervising Station Fire Alarm System" and is stated as such on the plans. AHJ will require documentation of prior approval of system as a Remote Supervising Station Fire Alarm System in the form of the original Fire Dept. approved job copy set of fire alarm plans or certified microfilm copy of same. 17 This is an "EXISTING "Sprinkler Waterflow and Supervisory System" only and is stated as such on plans. 18 This is a NEW "Sprinkler Waterflow and Supervisory System" only and is stated as such on plans. The system is monitored off -site and provides emergency forces notification through a Certificated ( ) or Placarded ( ) "Central Station Service Fire Alarm" and is stated as such on the plans. 19* A complete detailed statement of the "SCOPE OF WORK" is stated on the plan. Please note that the complete tenant space, in its entirety, will be inspected for compliance with NFPA 72 (2007) and NFPA 101 (2009), or prior editions of these codes if applicable. Also outline scope of work with bolded dashe nes on floor plan and riser for existing systems. 20 The building is "New" ( ) or "Existing" and is indicated as such on the plans. 21 A description of the building is provided, ink mg fire sprinkler systems, fire suppression systems, number of stories, square footage per floor, and elevation of the last occupied floor if over 5 stories. A location Key is provided showing the area of proposed work within the building. Also provided is a site key for projects with multiple buildings showing locations of all buildings with addresses X. 23 All interconnected Fire Alarm Control Panels are arranged to function as a single system and monitored for integrity per NFPA 72. 24 The class/style is shown for all Initiating Device Circuits (IDC), Signal Line Circuits (SLC) and Notification Appliance Circuits (NAC). 25 The maximum number of each device type is provided for each IDC based on device load or each SLC, based on class and style, per NFPA 72 and the manufacturer's specifications. 26 A specific "Sequence of Operation" including all alarm, supervisory, trouble and control functions such as fire sprinkler, door release, smoke control, elevator recall, suppression systems, and transmission of signals offsite, etc. are specified on the plan. 27 The type of monitoring station, (Listed Central Station, Remote Supervising Station, Listed Proprietary Supervising Station), where alarm, trouble, and supervisory signals are transmitted to, is clearly and concisely stated in the "Sequence of Operations" 28 The method of communication to the monitoring station is included on the riser. 29 If this building contains elevators that are not capable of recall, it shall be stated as such on plans and written documentation on elevator contractor's letterhead stating that "Elevators are not capable of providing recall function ", is provided, 30 If this building does not contain a fire alarm system, and the fire alarm panel is used exclusively for elevator recall; plans shall clearly designated panel as "Elevator Recall Control and Supervisory Panel" 31 Manufacturer, model number and unique symbol for each model number is provided for each device, module, relay, component, power supply and fire alarm control panel is specified in the symbol legend. 32 Each device, module, appliance and component is identified with its own unique number and indicated on the floor plans and riser. 33 Floor plans are drawn to 1/8" scale or, if using another scale, all device coverage is diagrammed on the floor plan and all room dimensions are included. Designed by: Signature: Vi P ,N+ F-412:6171 Phone#: 1 ,' ?� 7 -7/(// Created by: MDFR 08 / 2012 THIS IS A REQUIRED DOCUMENT ON ALL FIRE ALARM PLAN SUBMITTALS 10F2 Miami -Dade Fire Rescue Fire Alarm Pre - Submittal Checklist Based On NFPA 72 2007' Ed. & NFPA 1 and 101 2009' Ed. MIAM 34 All rooms & spaces are labeled indicating their use, and the occupant load has been provided for all assembly use rooms with an occupant load of 50 or greater. 35 All new, existing, replaced or relocated devices are indicated on the floor plans and a complete riser diagram showing all new and wdsting devices of the entire fire alarm system is provided. 36 Ceiling type and height is provided for all ceiling mounted devices. X 37 All devices and components located in areas in which the voltage, temperature, and humidity variations exceed those conditions stated in NFPA 72, are listed for conditions and all such areas are identified. 38 A note is provided on the plans stating "Room containing FACP, Booster Power Supply, Voice Evacuation and Amplifier panel(s), Dialer, or Radio is mechanically ventilated ', as applicable. 39 The FACP or Remote Annunciator and as applicable EVAC panel or Remote Microphone is located at the main entrance/lobby in single tenant buildings, or in a common area main entrance/lobby of a multi- tenant building. 40 The FACP, Communicators, Amplifiers, NAC Panels and all sub - panels are protected with a smoke detector. 41 If a complete automatically activated system, not less than one manual fire alarm pull box shalt be provided to initiate system. The pull box shall be located where AHJ specifies. 42 If a manually activated system, the travel distance to reach a pull station is less than 200' feet and within 5' feet of all required floor and/or building exits. 43 All automatic initiating devices are shown and are located in accordance with NFPA 72, the manufacturer's specifications, and accepted engineering practices. 44 Area smoke detectors, if used, shall provide coverage throughout the entire smoke compartment. 45 All visual notification appliances are placed per tables in NFPA 72 and each strobe has its candela rating on the floor plan and riser. X 46 All corridor spaced strobes are placed a maximum of 100' feet apart and within 15' feet from the ends of the corridor. X 47 All spaces throughout the entire building shall meet the audible characteristics of NFPA 72 and NFPA 101. A 48 Bell used for water flow annunciation is shown on floor plan, riser and legend. Bell shall be located so as to be visible and heard from roadway or parking area within close proximity to Fire Dept. Connection (FDC). 49 Flow Bell sequence of operations shall state as follows: A) Flow bell shall activate upon water flow only. B) Flow bell shall continue to sound as long as water is flowing. C) FACP shall not be capable of silencing Flow Bell. 50 The location of Backflow Preventer (BFP), Post Indicating Valve (PIV) and Fire Dept. Connection (FDC) are indicated on the floor plans, riser and legend for sprinkled buildings. 51 Walls, partitions, racks, shelves and equipment that do not extend to ceiling, are shown with their heights indicated on floor plan. O 52 Duct detectors or relays for duct detectors are shown on the floor plan and riser for all systems greater than 2000 CFM supply or greater than 15,000 CFM return. Duct detectors shall derive their 24 volt dc power source from the Fire Alarm System to satisfy the monitoring for integrity requirements of NFPA 72.4.4.7, for devices and conductors. Please show compliance on riser. 53 A complete system riser diagram is provided showing each floor of the building with all zones and circuits labeled. 54 The conductor size, type, and quantity are provided for each circuit on riser. 55 The fire pump is monitored for. A) Pump or Motor Running, B) Loss of phase, C) Phase reversal, and, if applicable, D) Controller connected to an alternate source; and are indicated at ( ) a continuously manned location, or (_J the supervised fire alarm system. 56 Show all relays on floor plan and clarify function on riser. (Sprinkler, Wet Chem., Dry Chem., Clean Agent, Foam, Elevator Shunt - Trip, Music Shut -Down, Door Release and other building control functions. 57 The AMPACITY of each Power Supply and Notification Appliance Circuit is specified for each FACP & Power Supply Panel on plans. In addition, the individual device current is specified on riser for each notification appliance (Homs / Speakers / Strobes). 58 The total "ACTUAL" footage to the last device along with voltage drop calculations are provided on plans for each NAC for each power supply. 59 The wattage tap is indicated for all speakers. X 60 The wattage capacity and load is provided for each amplifier. 5( 61 All load values for "STANDBY" &ALARM" used in calculations are high- lighted on the manufacturer's specification or installation sheets. Also AMPACITY of equipment/components and circuits are high- lighted on manufacturer's sheets. 62 This system includes Emergency Voice Evacuation and is provided with 15 minutes of secondary alarm power. Required in all high rises and assembly occupancies with an occupant load greater than 300. �s !D 63 This system is being provided back up power by an emergency generator and will provide 4 hours of standby power plus the appropriate secondary alarm power. Battery calculations, detailed in chart form, showing all information required per NFPA 72.4.4.1.5.3.1 are provided on plans for each back -up power supply. 65 The replacement of the Fire Alarm Control Panel with anything other than the exact same make and model number panel; or the addition of a Fire Alarm Control Panel which will provide or replace any of the functions of the existing FACP, shall require the fire alarm system to be up- graded to current code standards, per code of Miami -Dade County, Part III, Chapter 14, Article Ill, Section 14-66 (9) & (10) 6 X 66 If the scope of work includes greater than one -half of the entire fire alarm system's devices, then the entire fire alarm system shall be up- graded to current code standards, per code of Miami -Dade County, Part III, Chapter 14, Article III, Section 14-66 (9). Designed by: / t1)',/LP -"+ Ft [ G'% Phone #: ?T I gel l 7/ Signature: Yoe Created by: MDFR 08 / 2012 Y ff'7Xr THIS IS A REQUIRED DOCUMENT ON ALL FIRE ALARM PLAN SUBMITTALS 20F2 FLORIDA STATE SECURITY, INC. 6221 Pembroke Road Hollywood, FL 33023 Miami -Dade (305) 653 -2627 • Broward (954) 987 -7141 • 1- 800 - 338 -1487 Fax: (954) 987 -4483 • Email: customerservice @fssecurity.com • Web: www.fssecurity.com Providing Security Products and Services that ensures the protection of your Property, Employees, Business and Livelihood Families, Homes and Treasured Belongings are safe and secured. Proposal September 19, 2012 Shores Pediatrics Attn: Cynthia 9715 NE 2nd Ave Miami Shores 33138 Job Type: Fire Alarm Modification Florida State Security, Inc. (FSS) is pleased to provide this quote for the Fire Alarm System modifications: Scope of Work FSS will provide and install list of equipment below needed for new area under constructions. FSS will reprogram the existing fire alarm panel to report to our monitoring station and to operate the additional devices need for the system. FSS will provide a Runner Service, Annual Inspections and, Monitoring Agreement as required by Miami - Dade. System to include pipe, wire and miscellaneous hardware where needed. This will include shop drawing plans and documents for city permitting. Price includes final walk -thru, system test and final certification with local Fire Marshall. List of Equipment Two (2) Pull Stations Five (5) Smoke Detectors One (1) Duct Detector (To be installed by customer's mechanical contractor) Three (3) Horn/Strobes Six (6) Strobe Lights * Relocate one Horn/Strobe Total Cost: $3,750.00 plus city permit fees. NFPA Fire Alarm Monitoring fee: $30.00 a month Annual Inspection Agreement fee: $15.00 a month Price is for quoted system and subject to Fire Marshall's approval. Price will not include any changes or additions made by owner of AHJ. Customer to provide floor plan layout drawings in AutoCAD for us to produce our fire plans. Customer to provide original plans and/or permits of the existing fire alarm system to prove to city the existing system was permitted as a remote station monitored system. If documents can't be obtained, then Miami -Dade will require a UL certificated system. FSS can provide said UL certificate at an additional cost of $20.00 a month. ACCEPTANCE OF QUOTATION The above prices, specifications and conditions are satisfactory and are hereby accepted. You are aut ed to do the work as specified. Upon acceptance aontract will be submitted for implementation. tQ 12- /2 Authorized Signature Date Florida State Security, Inc. Vincent Falzetti Date P1 s mg Board Sta J Report PLANNIN REARING nand Shares Wage To Hall Cannon CAS Inn NE zd Avenue Maid Shores x 13, 2»11 Meeting Titre 710 P.M. P11-i1253 11-3205-013-4220 Odandoa LLC.. 9300 1�3 A FL 33169 Shorn 1- 370 3Y3101 FL 33130 9713 WE 2 AVE Legal Derniptiao M AAS SHORES SEC 1 AMD PE 10-70 LOT 12 BLK 31 LOT SIZE ; X 130 CAC 223437 -1674 05 2805 4 OR 73432 -1674 0505 01 B1 Gametal Office Yea 1 A IA 1946 din Ate, Erma lit use; Piyaieien'a office. a Approve with Conditiors, Gr1A, to ApperahnA to retain pa&ing Special Site plan review & approval David A. Deo:pi= A1CP: Zoning Plansting Village Building Peseta DERM or Dot of Health October 6 2011 MIAMI DADS COUNTY APPROVED BY: DEPARTMENT OF REGULATORY & ECONOMIC RESOURCES LEE HEFTY, ASSISTANT DIRECTOR DATE: June 13, 2012 SE'.. A L NO.: M2012007052 IW5 # /DERM #: to be assigned • 0 #: 11- 3206 - 013 -4220 1 NOTE: THIS APPROVAL IS NOT INTENDED TO C'% STRUCTURAL DESIGN. NO CONSTRUCTION SHALL TAKE PLACE ON CO AMINATED GROUND. . INDUSTRIAL FACILITIES SECTION ONLY For the Director: Tomas Fonte, Engi PROJECT NAME: Shores Pediatrics ADDRESS (APPROX.): 9713 -15 NE 2 Avenue Miami Shores, FL CONDITIONS: 1. This approval is granted for proposed expansion of a medical pediatrics facility with additional medical rooms, break room, receiving rooms, filling room, closets, bath rooms, vestibule, play room, and private bath rooms with locations as shown on plans. 2. Be advised that due to the facility 9713 -15 NE 2 Avenue still being served by a septic tank system the following conditions become part of this approval. • Any type of x -rays to be performed on site will be that from a digital design system without any wet processing. • Facility will be permitted to collect of blood, and other specimens/ samples, however there will be no testing permitted onsite. • Any bio hazardous waste will be required to be stored in red sharps. containers and red bags inside of the facility. All of this type of waste will be required to be disposed of by a DERM certified waste hauler company. 3. Any discharges to the septic tank system will be that of domestic waste only, no other liquid waste will be generated, stored and disposed by the facility. Page 1 of 2 4. Operations at this facility shall be conducted without any discharges to open ground or to the storm sewer system. Improvements: If at any time this facility is found to be Performing inadequately, the owner shall provide the required corrections and /or additional equipment to operate in compliance with Chapter 24, Miami -Dade County Code. Approval is hereby granted for: expansion of Medical Pediatrics offices, as described above. Construction is completed according to approved plans. There may be county, municipal, or other local regulations or restrictions to be complied with by the owner prior to construction of the facilities represented by these plans. We recommend that appropriate local agencies be consulted before starting construction. No construction shall take place on contaminated soil. If contamination is encountered during construction, contact the Pollution Remediation Section of the Department of Environmental Resources Management (DERM). cc: Xiomara Lopez - DERM Page 2of2 16, ELkAY. SPECIFICATIONS Wall . Mount Water Coolers Barrier -Free Access (Adult & Child) NSF /ANSI 61 Compliant Models EZ4, EZ8, EZS4, EZS8, EZSD and EZD GENERAL Self - contained, wall hung electric refrigerated water cooler. Chilling capacity of 50 °F drinking water, based upon 80 °F inlet water and 90 °F ambient. Models EZS4 and EZS8 have self - closing Easy -Touch Controls on front and both right and left sides. Models EZ4 and EZ8 each have self- closing Easy -Touch Controls on the front only. Model EZSD is non- refrigerated. Same as EZS8 without cooling system. (Requires outlet for power cord.) All models have a hooded stream projector with Easy -Touch Controls that require Tess than 3 pounds of force to activate. Valve with built-in flow regulator provide constant stream from 20 to 105 psi, water pressure. Bubbler orifice fully protected to meet all sanitary codes. Non - pressurized stainless steel cooling tank is standard. Non - pressurized water tank is located after bubbler valve, so that tank is subject to line pressure only when Easy -Touch Control is p ADA COMPLIANT These Water Coolers comply with the requirements of A.D.A. (Americans with Disabilities Act) when properly installed. Also meets the guidelines for children's environments providing the floor to orifice height is 30° or Tess and proper clear floor space is provided for parallel approach. (Based on Architectural and Transportation Barriers Compliance Board final ruling.) Check Local and State Codes. NO LEAD DESIGN These Water Coolers are certified to be lead -free as defined by the Safe Drinking Water Act Elkay Water Coolers are manu- factured with a waterway system utilizing copper components and completely lead -free materials. These waterways have no lead because all lead materials, such as leaded brass, have been removed. All joints are brazed using silver solder only. No lead solder is permitted. A strainer with an easily cleanable screen is provided to allow trapping and convenient removal of waterborne particulate of 140 microns and larger prior to their entry into the water cooler. CAPACITIES CHART Mehl Number Base Rate R eel WI BrinitIng Water Rated Watts Ful Lead Amps I Filer Option Wt. Lb e. ban Temperature ¶ 7e'F fle°F BWF EZS4 4.0 5.0 4.4 4.0 370 4.0 Yes 56 EZS8 8.0 9.7 8.8 8.0 370 4.0 Yes 56 EZ4 4.0 5.0 4.4 4.0 370 4.0 Yes 56 EZ8 8.0 9.7 8.8 8.0 370 4.0 Yes 56 EZSD — — — — — — Yes 18 EZD — — — — — — Yes 18 "Based on 80 °F inlet water temperature. glass filler available at extra cost. Requires factory preparation to receive glass filler. Rated watts shown are based on operational (run) time, in compiance with A.R.I. Standard 1010 conditions. Specific applications wl0 determine the actual watts consumed will based on people per hour s and temperature. COOLING SYSTEM Motor Compressor. Hermetically sealed, reciprocating type, 115V, 60 Hz single phase. Sealed -in lifetime oil supply. Equipped with electric cord and three prong molded rubber plug (domestic models). Condenser. Fan cooled, copper tube with aluminum fins. Fan motor is permanently lubricated. In keeping with our policy of continuing product improvement; Elkay reserves the right to change product specifications without notice. Please visit elkayusacom for most current version of Bay product specification sheets. Model MS RATED FOR INDOOR APPLICATIONS ONLY Cooling Unit Combination tube -tank type. Self cleansing. Tube portion is continuous coil of copper tubing. Tank is stainless steel. Fully insulated with EPS foam which meets Underwriters Laboratories Inc. requirements for self- extinguishing material. Refrigerant Control: Refrigerant HFC -134a is controlled by accurately calibrated capillary tube for positively trouble -free operation. Temperature Control: Enclosed adjustable thermostat is factory pre -set. Requires no adjustment other than for altitude require- ments. Easily accessible. CONSTRUCTION Frame: Galvanized structural steel chassis supports refrigera- tion system and fastens to wall. Provides increased structural integrity and rigidity to cooler. Stainless Steel Basin: One piece polished to a uniform Elkay bright luster finish. Basin has integral drain grid, embossed bubbler pad. No exposed fasteners. Exclusive Fiexi- Guards Safety Bubbler*: Innovative design utilizes an infused anti - microbial pliable polyester elastomer to prevent accidental mouth injuries. Flexes on impact, then returns to original position. Strong. Abrasion-resistant. Anti-sweat. Keyed in location to prevent rotation. Upper Shroud: Contoured shock-absorbing, provides additional protection against accidental injury. No exposed fasteners. Lower Shroud: One piece easy to remove and replace. Mows access to internal components from three sides. Cabinet: Cabinet design allows for flush to wall mounting. No recess space is required. Color Selection: Unless otherwise specified cabinet is two -tone gray on upper shroud with textured gray lower shroud. Stainless Steel lower shroud available at extra cost Protected by Elkay's 5 Year Limited Warranty on the refrigera- tion system of the unit Elkay Pressure -Type Water Coolers are designed to operate on 20 psi to 105 psi supply line pressure. If inlet pressure is above 105 psi, a pressure regulator must be installed in the supply tine. Any damage caused by reason of connecting this product to sup- ply line pressures lower than 20 psi or higher than 105 psi is not covered by the warranty. STANDARDS Bkay Electric Air Cooled Water Coolers are listed c us by Underwriters Laboratories Inc. and comply with both Canadian and U.S. requirements. These units comply with A.R.I. Standard 1010. This cooler is certified by WQA to lead-free compliance including NSF /ANSI 61 -ANNEX G, AB 1853. This specification describes an Bray product with design, quality and fmcfional benefits to the user. When making a comparison of other producers' offerings be certain these features are not overlooked Elkay elkayusa.c om 2222 Camden Court Oak Brook, IL 60523 Printed In U.S.A. ©2011 Elkay (Rev. 4/11) 12 -23F Wall Mount Water Coolers Barrier -Free Access (Adult & Child) NSF /ANSI 61 Compliant Models EZ4, EZB, EZS4, EZS8, EZSD and EZD LkAY, ROUGH-IN DIMENSIONS 114° O.D. TUBE 3h3" O.D. TUBE CONNECT WATER INLET TO COOLER COLD WATER BUILDING WATER SUPPLY INLET 1 ° in mow • NOTE: WATERFLOW DIRECTION SERVICE STOP (NOT FURNISHED) OPERATION OF QUICK CONNECT FITTINGS SIMPLY PUSH IN TUBE IS SECURED PUSH IN COLLET TUBE TO ATTACH IN POSITION TO RELEASE TUBE 110 ■ 9/32° (7mm) 0 HOLES(6) *21 -718° (556mm) B E D PUSHING TUBE IN BEFORE PUWNG IT OUT HELPS TO RELEASE TUBE rough-in n hIoue liih� foun- tains and coolers with this �c�er when rough-in l within the outlishown. When the cooler is mounted as shown the location available is from 15° to 21- 11116° from floor and 1 -1/16° to 7 -1 /4" from the left of centerline. Space Is also available from 21- 11/16° to 24 -5/8" from floor and 2-3/4° to 7 -1/4° from the left of centerline. Additional space is also available from 24 -5/8° to 26- 11/16° from floor and 3-314° to 7 -1/4° from the left of centerline. Connections approaching the limits of these areas may be restricted and should only be considered for use until after an examination of the cooler has been made. IMPORTAN71 INSTALLER PLEASE NOTE: This water cooler has been designed and built to provide water to the user which has not been altered by materials in the cooler waterways. The grounding of electrical equipment such as telephone, computers, etc., to water Giles is a common procedure. This grounding may be in the building but may also occur away from the building. This grounding can cause electrical feedback into a water cooler creating an electrolysis which creates a metallic taste or causes an increase in the metal content of the water. This condition is avoidable by installing the cooler using the proper materials as shown below. NOTICE This water cooler must be connected to the water supply using a dielectric coupling. The cooler is furnished with a non - metallic strainer which meets this requirement. The drain trap which is provided by the installer should also be plastic to completely Isolate the cooler from the building plumbing system. RATED FOR INDOOR APPLICATIONS ONLY FRONT VIEW 18 -3/8° (467mm) 6-3/8° 6-3/8° (162mm) (162mm) *19° (483mm) *17 -7/16° (443mm) LEGEND A = RECOMMENDED WATER SUPPLY LOCATION. SHUT -OFF VALVE (NOT FURNISHED) TO ACCEPT 3/8 O.D. UNMATED COPPER TUBE. 3° (76mm) MAXIMUM OUT FROM WALL B = RECOMMENDED LOCATION FOR WASTE OUTLET 1 -1/4° O.D. DRAIN STUB 2 IN. (51mm) OUT FROM WALL C = 1-1/4° TRAP NOT FURNISHED. D = ELECTRICAL SUPPLY (3) WIRE RECESSED BOX. E = INSURE PROPER VENTILATION BY MAINTAINING 6° (152mm) (MIN.) CLEARANCE FROM CABINET LOUVERS TO WALL F = 7/16° BOLT HOLES FOR FASTENING UNIT TO WALL *REDUCE HEIGHT BY 3 INCHES FOR INSTALLATION OF CHILDRENS ADA COOLER. 2° (51mm) 3 -7/8° (98mm) 5-3/4° (146mm) (1788mm) (178mm) SIDE VIEW 2" (51mm) *32 -7/8° (835mm) ORIFICE HEIGHT *28- 13/16° (732mm) *13- 15/16° (354mm) r *31 -5/16° m) RI 96mHEIGHT 19" (483mm) HANGER BRACKET —r Co 8 -1/16° (205mm) *27° (686mm) REQUIREMENT 5 -718" (150mm) • 1/2° (3 Smm) \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ 3° (76mm) Elkay 2222 Camden Court Oak Brook, IL 60523 12 -23F (Rev. 4/11) elkayusa.com Printed In U.S.A. ©2011 Elkay NOTE: ALL SHEET MUST BE REVIEWED MIAMI -DADE COUNTY BUILDING AND NEIGHBORHOOD COMPLIANCE DEPARTMENT Herbert S. Saffir Permitting and Inspection Center 11805 SW 26th Street (Coral Way) • Miami, Florida 33175 -2474 • (786) 315 -2100 APPLICATION FOR MUNICIPAL PERMIT APPLICANTS THAT REQUIRE PLAN REVIEW FROM MIAMI -DADE FIRE RESCUE ND /OR DEPARMENT OF ENVIRONMENTAL RESOURCES MANAGEMENT `', ' L., PROVIDE MUNICIPAL PROCESS NUMBER HERE LOCATION OF IMPROVEMENTS Job Address CA 7t W 24o Ave.. CONTRACTOR INFORMATION Contractor No. . Last four (4) digits of Qualifier No. Folio Il • •32�' 0 tai' �20 Contractor Name Lot 12, Block J1 Qualifier Name ,,..tt��,,,,,,,.,,,,..�� Subdivision 1 at•1r t� �PB o f i? ID pg 1 Address . , — 111 Metes and bounds City State Zip TYPE OF IMPROVEMENTS [ ] New Construction on / Vacant Land �1 Alteration Interior [ ] Alteration Exterior [ ] Relocation of Structure [ ] Enclosure [ ] Repair [ ] Repair Due to Fire ]Demolish [ ] Shell Only [ ] Addition Attached [ ] Addition Detached [ ] Re -Roof [ ] Foundation Only property t 1 M ` Current use of �"l �'I`v Description of Work FAVDTNSUC/■S' c Sq. Ft. 644 Units _ Floors t- Value of Work 4Q006 PERMIT TYPE )(OVIBLD* „ ategory v REVIEW STATUS [ ] Chg. Contractor [ ] Re -Issue [ ] Re -Stamp [ ] Revision [ ] Not Applicable for Fire OWNER'S NAME Owner' !J Address i'V% 'Ci: =� • gr.r. i.. ;.'' !IV/. City ht_ � S State. Zi . 3 ) [ ] MELE Phone x,'31 b '3631, [ ] MLPG Last four (4) digits of Owner's Social Security No. 42b3 [ ] MMEC [ ] FIRE PERSON TO PICK UP PLANS Name \A MP— J. ? RLLC ARCHITECT ENGINEER Owner ,GrOe-LI . Ems.. _ Address i 0 4E (Of sr (aT Address3lO Kee. tow -x `m- Mt� City MI4As-� C Stag 3d Zip j' p City Any, c 30ii S Stat ' s Zip �✓1.5 ,l Phone 3�• �10` J Phone �'3Q•C7 FIRE SPECIAL REQUEST PLAN REVIEW (SRI) I am requesting a Special Request Plan Review (SRI) to be scheduled as soon as possible at the rate of $190 for the first hour and $65 per each additional hour in addition to the review fees. Minimum charge one -hour. 1st Request: Date: 2 °d Request: Date: 3ro Request: Date: DERM OPTIONAL PLAN REVIEW (OPR) I am requesting Optional Plan Review (OPR) to be scheduled as soon as possible at the rate of $75 for each discipline. Additional review fees may apply. 1 at Request: Date: 2 ^d Request: Date: 3ro Request: Date: 8123_01 -192 12/09 4 BUILDING PERMIT CATEGORIES CATEGORY DESCRIPTION PERMIT TYPE 4 BUILDING 01 GENERAL BUILDING — COMMERCIAL MBLD 02 SUB — GENERAL BUILDING — RESIDENTIAL MBLD 08 CANVAS AWNING MBLD 10 COMMUNICATION TOWER MBLD 15 DEMOLITION MBLD • 29 ; METAL AWNING & STORM SHUTTER , e .MBLD 48 ' ` • SCREEN ENCLOSURES • - " ; . - .. MBLD 55 SWIMMING POOL ;, .e ' MBLD, 56 TENNIS COURTS (SURFACE PAVING) MBLD • 86 TRAILER TIE DOWN ,,NJ,BLD 88 WALK -IN COOLER ` ±E • `� ��`. -� , 91 MARINAS MBLD 92 LOW SLOPE APPLICATIONS (GRAVEL, SMOOTH R ' iyipDIFIED, SINGLE PLY) MBLD 95 SHINGLES (ASPHALT, FIBERGLASS) MBLD 96 SHINGLES (METAL ROOFS/WOOD SHINGLES & SHAKE) MBLD 97 • • r STAGE 2 VAPOR RECOVERY SYSTEM MBLD 99 ' 6IL IMPROPEMENT` ; MBLD 0100 BULK SJOf A E PROPANE TANK MBLD 0101 I3EMQVABLE STORM PANELS MBLD 0107 TILE ROOF MBLD 0110 ' -. W ER AI•N MBLD ` 114-11,- °,1 �. -.i- �•,LT .R MBLD '1 — L OOFtipVENT /EXHIBIT MBLD ELECTRICAL:': j`' ' ''' ,'4::. es ; 04 FIRE ALARM SPECIALTY MELE 16 .7 e, - SPECIALTY WIRING MELE 38 GENERATORS MELE • LPGX 01 ` _ • - ' 4,' ` . IQUEFIBD PETROLEUM GAS _ °:.M�ISSELL fsNEOUS 04` - `' , 't1Q EFlrD PETROL. GAS/STATE MECHANICAL 09 • MUG ML.P,Ca . { MLPG'' ABOVE/BELOW GROUND TANKS /PUMPS & POLLUTANT STORAGE SYSTEM MMEC 38 COMMERCIAL HOODS MMEC 43 FIRE CHEMICAL MMEC 46 SPRAY BOOTHS . MMEC 48 SMOKE CONTROL MMEC 52 RESIDENTIAL ELEVATOR MMEC FIRE 32 FIRE SPRINKLER FIRE