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MC-12-1487 v r Miami Shores Village .k 6, CE 1VE AUG 0 02012 Building Department i 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel: (305)795.2204 Fax:(305)756.8972 INSPECTION'S PHONE NUMBER:(3055)762.4949 FBC 20 BUILDING Permit No. Ion 14n PERMIT APPLICATION Master Permit No.V(7 Permit Type: MECHANICAL JOB ADDRESS: � 0 0 2 rj4 le— �E 5t City: Miami Shores County: Miami Dade Zip: 3-31.3 Folio/Parcel#: Is the Building Historically Designated:Yes NO V, Flood Zone: rr OWNER:Name(Fee Simple Titleholder): e X0L rJ k C R o R i , Phone#: Address: 2325 MagnoG'a br. CirorD a State: E- : Zip: 331$1 Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Namel&\;i�40 w C !�e yz td 1 c e-s Phonem(M)a6 o "5 2227 Address: B�3 W- :7 1 5+, City: -State: °� Zip: 1 T Qualifier Name: � � .�``�� Phone#• ,T33t60-3_7 7 State Certification or Re istration#: CAS 111 (9 0 3 c Certificate of Competency#: Contact Phone#: �� Email Address: I" o �by-�G i DESIGNER:Architect/Engineer: Phone#: Value of Work for this Permit:$ N Square/Linear Footage of Work: Type of Work: ❑Address DAlteration WNew ❑Repair/Replace n ©Demolition Description of Work:, phd ' (nj�-0 aJ S 4�-a c .o cj cam'A Div.9 Gi C-t, G f L,��J ✓°'�-S Submittal Fee$ Permit Fee$ CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Bond$ Notary$ Training/Education Fee$ Technology Fee$ Double Fee$ Structural Review$ TAL FEE NOW DUE$ ` r 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 reinspect'wjee will be charged. Signature Signature a( it, e Agent Contractor The foregoing ins ent was acknowledged before me this .3 The foregoing instrument was acknowledged before me this day of ,20�,by &xQm6 RbdtL-r day of 6111A ,20/2 ,by Ta"q who is personally known to me or who has produced who is personally known to me or who has produced Pt- L.ieense As identification and who did take an oath. Li'MISe as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: �Y P� aria Elizabeth Raiszadeh �g, COMMISSION PDD895323 th Raivadeh 9= �°,:p(PIRES: SEP.22,2i?Sign:C� �° M ION#D Sign: ��i�° Wyy11+,AARONNOTARYeom PrintAinct P &s t ig EXPIRES: SEP.22,2013 of con. Print:A" E, P16 ESzact4iE+ My Commission Expires: /3 My Commission Expires: 412,113 APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) y0 Miami Shores Village nn nm� „�. Building Department loRi ► 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel. (305) 795 2204 Fax. (305) 756.8972 AIR CONDITIONING REPLACEMENT DATA PERMIT NUMBER: MC This form must accompany ALL air conditioning replacement permit applications. Each unit change-out must be on its own data sheet.Multiple units on single sheets are not acceptable. Job Address (where the work is being done):. 0 0`l City: Miami Shores Village County: Miami Dade Zip Code: -33 (39 ALL CONDENSING UNITS MUST BE ON A 4 INCH SOLID CONCRETE SLAB ALL UNITS MUST COMPLY WITH F.E.M.A MINIMUM FLOOD ELEVATION A COPY OF THE CONTRACT IS REQUIRED WITH ALL SUBMITALS ARI(AHRI)DATA SHEET REQUIRED Change Disconnecting means:YES ❑ NO❑ ARHI Sheet Attached:YES❑ NO❑ Contract Attached:YES ❑ UNIT BEING REPLACED DATA NEW UNIT MANUFACTURER AHU or PKG.UNIT MODEL# COND.UNIT MODEL# KW HEAT NOM TONS AHU CU PKG 1 M.C.A AHU CU PKG AHU CU PKG Z M.O.P AHU CU PKG AHU CU PKG 3 VOLTS AHU CU PKG PKG UNIT I I PKG UNIT ! / EER/SEER YES NO REPLACING DUCTS YES NO YES NO REPLACING THERMOSTAT YES NO YES NO NEW 4"CONCRETE SLAB YES NO YES NO NEW ROOF STAND YES NO YES NO NEW RETURN PLENUM BOX YES NO 1. Minimum Circuit Ampacity(Wire Size): 2. Maximum Overcurrent Protection(Fuse/Breaker Size): 3. Voltage of Circuit(208/240/480): 4. Size Disconnecting Means: Contractor's Company Name: )Rini rj bo.`j A C- ,Tpjc=t Phone: h_ \ )-5-9 27 State Certificate or Registration N Cam-C I '( 6 0 N-F Certificate of Competency N. Signature/� C=t-f Date: (Qualifier's signature only) t?AC2 Q$O % t3640.34-A tap.PZDVIOIMW:Of 12" F f'- adti @4ta3'AQ{s tf32, $OI2 --u-001"0D93ff= ; -HAM _ h T` - ...,. n. b3�i2S1 2t A. RA114DOW Alts yCQ ?I7!IOHIA1t`3 SVItS: STA 1343 W 72 ST 33014 HIALEAH" . +ate RAINBOW AIR CMI'i idkl.W SERVICE sec.�y +ofi 8 WORKERJS 19b SPEC HmECHMC-AJ..COiITRACTOR 1 MM:19 QNLV A LMOL _. TAX � or WE DO IM FORVMFW oc�sro vro ., NElBdt6Y LAS; IRAIMM AIR CONDITIONING SERVICES =AMA or 7m ammas . MESA CATA PRES 1343 w 72 ST parrrr>i HIALEAH FL 33014 . . - 040�O4�►3t�O�: • QO00`f�wOt� - "}ra�au��a��setaao���i��aa f�ai`n�au�ara�a'�aa�ar��i SEE O9'Ft M sME ___ 08/13/2012 17'04 93'759 P- 0091006 CERTIFICATE LIABILITY -- 4b"kwurOft a be 1216 E. 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