MC-13-1907 • • • �Yv' � l4VJd ���R
Muni Shores 'Village aus i 20n ,ra
Building Department °000000
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 No.M U?) -" C
PERMIT APPLICATION Master Permit No.U. �`Id
FBC 20
Permit Type: MECHANICAL
OWNER:Name(Fee Simple Titleholder): E Q .e s,c l V 6!w c a 7.1 A n Phone#:
Address: 29-7s- y s". /a dh s a'° s44®f-G l/(
City:Aim 1 oa(I State: Zip:
Tenantnessee Name•
Phone#:
Email:
CU
JOB ADDRESS: /V.A d0 St°
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#:
Is the Building Historically Designated:Yes NO Flood Zone:
CONTRACTOR:Company Name: A 4 ado A;eL Phone#:.30 S 401
Address/: /0 4 C-/ ,O1, W m /-? 5 f• 4 V
City:#1A-- c'AA 9-66WEAJ State: R, Zip:_ t 4
Qualifier Name: o 6e it"f- Sandu^4 Phone#:
Stine Certification or Registration#: ` Certificate of Concy#•
Contact Phone#: Email Address:
DESIGN12 `Architect/Engineer: Phone#:_
Value of Work for this Permit: Square/Linear Foo e tag of Work:
_ _ `''vim.:- :6v -^.-._ •., .
Type of Work: OAddress iheration � ONew ORepair/Replace �. ODemolition
Description-of Work: �-. ,��. V1 G� .t' t9 'Q, •rL ( [ �
MOP vlpe4E
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ci6sd1011 IU
• _' '"�'+e�ai�*�� oak+��$�****w°�,s * ********t�**F�wt�t**�*****x�*!*se+t***�!********�***rte*******
Submittal Fee$ Permit Fee$ CCF$ �>�� CO/CC$
Scatioing Fee$ Radon Fee$_ DBOR$ 3 -Bond$
Notary$ TraininglEducation Fee$ Technology Fee$_ -t k 0
Double Fee$ $trnctural Review$
TOTAL FEE NOW DUE$ IM, Z�
�C "
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
O .
t Y
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.4eliyered 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 ap roved and a reinspection fee will be charged
Signa
O er or Agent Contractor
The foregoing instrument was acknowledged before me this The foregoing instrument was 40mowle4ged before me this_8—
day of ,20®-7,by AbeV®9"°t_ day of l S 20 13 .by
who i ally known me or who has oduced who i rsonall —knowborne,orwhQ has eed /
As identification and who did take an oath. as identification and who did take an oath.
NOTAR UBLIQ NOTARY PUBLIC:.
„i'.1 III
SA Y ROM RQ
Si
Rem-
Mm.Expires Jul 26,2015
My Commission My o Expireumly Rowo
p Notary PuNt-State of Florida
a My Comm.Expires Jul 26,2015
APPROVED BY Plans Examiner. Zoning
Structural Review clerk
(Revised 07/10/07)(Revised 06/1012009)(Revised 3/15109)
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel.(305) 795 2204
Fax.(305) 756.8972
AIR CONDITIONING REPLACEMENT DATA °
PERMIT NUMBER: MC
This form must accompany ALL air conditioning replacement permit applications.Each unit change-out must be on its own data
sheet.Multiple units on single sheets are not acceptable.
Job Address(where the work is being done): ol?, . e, 0 6&
S�-
City:�h_s VII a County: Miami Dade Zip Code:
r ,
ALL CONDENSING UNITS MUST BE ON-AA4 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 2 M.O.P AHU CU PKG
AHU CU PKG 3 VOLTS AHU CU PKG
PKG UNIT / I PKG UNIT / I
EERISEER
YES NO REPLACING DUCTS YES NO
YES NO REPLACING THERMOSTAT YES NO
YES NO NEW 4°CONCRETE SLAB YES NO
YES NO NEW ROOF STAND YES NO
YES NO NEW RETURN PLENUM BOX YES NO
1. Minimum Circuit Ampacity(Wire Size):
2. Maximum Overcurrent Protection(Fuse/Breaker Size):
3. Voltage of Circuit(208/2401480):
4. Size Disconnecting Means:
Contractor's Company Name: ®Rat Phone:
State Cenyfi istration N. OA t l ( Certificate of Competency N.
Signature Z�771 Date: AQ