MC-13-1518I big] 19 11
Miami Shores Village
Building Department JUL 0
10050 NM.2nd Avenue, Miami Shores, Florida 33138 a Y.-
Tel: (305) 795.2204 For. (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
FBC 20
Permit No..
PERMIT APPLICATION
Master Permit No
Permit Type: MECHANICAL
-3-z,o IU 0 1 15 s--J 0 ai S
JOB ADDRESS:
City: Miami Shores County- - Miami Dade
F o l i o / P a r c e l k 1 1 - -2-13 b - 000 - 00 L -D
Is the Building Historically Designated: Yes
OWNER-- Name (Fee Simple Titleholder):
Addrem- � I -; n o (-- Z ?(%.,) e-
City: ,A� C, �- C, � k U �S- - State:
NO Flood Zone:
A
-53 1 Le /
Tenant/Lessee Name: Phonek
Email:
CONTRACTOR: Company Name ®® Z, Phonek -7 L
---7 1
Address: / Le
City: VVk 10- %'1-
Qualifier Name:
State Certification or
Contact Phone#-
zip: 3 ?1 f � /
2 Y(P - 5 3 —YI 9-(f
I
%tration *0- "C OS te -72 OCJ Certificate of Competency #:
-qS3-L fft Fj* Address: S4 ic o e- G-, (-,, o a � tj 4 (L A e - C o M
DESIGNER: Architect/Engineer:
Value of Work for this Permit:
squarainear Footage of woria.
Type of Work: LIAddress
tcration
LiNew URepair/Replace
Description of Work:
dl-)
LIDemolition
Submittal Fee $ Permit Fee CCF$ CO/CC $
Scanning Fee $ Radon Fee it w
DBPR $ --Pond $
Notary $ TraininglEducation Fee $ _ Tecbnology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
State
Zip
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 met the standards of all laws regulating
construction in this juri.4diction. I understand that a separate permit must be secured for ELECTRICAL TRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOII ERS, 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 u condition to the issuance of u building permit with an estimated value exceeding $2500, the applicant roust
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 roust be ported 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. U�c� Signature
Owner or Agent I/ Contractor
The fore o g instrument was acknowl ed befo me this �' The foregoing instrument was acknowledged + before me this
day of , 202, by AA, Al 0.., ��r�t� ; — day of � 20 � by �T� � � e� ii eaNe�'
o i. . nally known tom or who has produced who is personal y known to me or who has produced
As identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC:
`
R 1A M. i
r�! A.Ilirw
My Commission Expires:
APPROVED
J
09 tg�
NOTARY
Sign:
Print: r
My Commission
JUDITH POL
Notary PublIC - State of Florida
MY Comm. Expires Aug 27, 2018
Commission #F EE 830550
Zoning
Structural Review Clerk
Revised 3 /12/2012KRev6ed 07 /10/07)(Revised 06/10/2009 )(Revised 3/15/09)
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 Ming done): 11300 NE 2nd Ave Miami, FL 33161
City: Miami Shores Village County: Miami Dade Zip Code: 33161
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 UBMITALS
ARI RI) DATA SHEET REQUIRED
Change Disconnecting means: YES [] NO ARHI Sheet Attached: YES NO ❑ Contract Attached: YES ❑
1. Minimum Circuit Ampacity (Wire Size):
2. Maximum Overcurrent Protection (Fuse /Breaker Size):
12 GAUGE
3. Voltage of Circuit (208/240/480): 208/230
4. Size Disconnecting Means: 30 AMP
Contractor's Company Name: COOL WATER AIC Phone: 305. 807.0288
State Certificate or R N. CMC 056710 Certificate of Competency N.
Signature Date: -7 li-a 1-tz'
(Q U Oft is r ly)
I xA101 '103
iS'A
UNIT BEING REPLACED
DATA
NEW UNIT
MANUFACTURER: RHEEM
o,'4 ?TM30
AHU or PKG. UNIT MODEL #
Q3 A Z.
COND. UNIT MODEL #
KW HEAT
�. T d �ii �' '& M303
NOM TONS
" ° C� -2- 30S
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 t
/
PKG UNIT
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):
12 GAUGE
3. Voltage of Circuit (208/240/480): 208/230
4. Size Disconnecting Means: 30 AMP
Contractor's Company Name: COOL WATER AIC Phone: 305. 807.0288
State Certificate or R N. CMC 056710 Certificate of Competency N.
Signature Date: -7 li-a 1-tz'
(Q U Oft is r ly)
I xA101 '103
iS'A
� ■ � � � ter,
AHRI Certified Reference Number: 5059028 Date: 7/1/2013
Product: Split System: Air - Cooled Condensing Unit, Coil with Blower
Outdoor Unit Model Number: 4TTM301SA1
indoor Unit Model Number: t3AF2A0A18811 +TOR
Manufacturer: AMERICAN STANDARD, INC.
Trade/Brand name: AMERICAN STANDARD 13
Manufacturer responsible for the rating of this system combination is AMERICAN STANDARD, INC.
Rated as follows In accordance with AHRI Standard 2101240 -2008 for Unitary Air- Conditioning and Air- Source
Heat Pump Equipment and subject to verification of rating accuracy by AHRI- sponsored, Independent, third
party testing:
Cooling Capacity (Btuh): 20400
EER Rating (Cooling): 12.00
SEER Rating (Cooling): 14.00
Ratings followed by an asterisk (•) Indicate a voluntary terate of previously published data, unless accompanied with a WAS, which indicates an Involuntary rerate.
DISCLAIMER
AHRI does not endorse the product(a) listed on Mis Cediflcate and makes no representations, warranties or guarantees as to, and assumes no responsibility for,
the product(s) listed on We Cerllfkate. AHRI expressly disclaims all liability for damages of any kind adshM out of the use or performance of the product(s), or the
unauthoriaed alteration of data listed on this Certificate. Certified ratings are valid only for models and configurations tilted M the directory at www.ahMlmctmy.org.
TERMS AND CONDITIONS
This Certtflcate amt its contents are proprietary products of AHRL This Certificate shall only be used for huRvtdua 1, personal and confidential reference purposes.
The contents of this Certificate may not M whole or In pot, be reproduced: copied; disseminated; entered into a computer database; or otherwise utilized, in any
form or manner or by any "marts, except for Une user's Individual, personal amf confidential reference.
CERTIFICATE VERIFICATION
The Information for the model cited on this certificate can be verified at w ww.ahridirectory org, w "IMP Alf- Conditioning, Heating,
click an "Verify Certificate" link and en W the AHRI Certified Reference Number and the date on A%0 no ILI and Refrigeration Institute
which the certificate was Issued, which Is listed above, and the Certificate No., which Is listed below.
02013 Air- Conditioning, Heating, and Refrigeration Institute CERTIFICATE NO.: 130171782339932405
1�
AHRI Certified Reference Number: 5058133 Date: 7/1/2013
Product: Split System: Air - Cooled Condensing Unit, Coil with Slower
Outdoor Unit Model Number. 4TTM303OAl
Indoor Unit Model Number: GAF2AOA30S21 +TDR
Manufacturer: AMERICAN STANDARD, INC.
Trade/Brand name: AMERICAN STANDARD 13
Manufacturer responsible for the rating of this system combination Is AMERICAN STANDARD, INC.
Rated as follows In accordance with AHRI Standard 210/240 -2008 for Unitary Air- Conditioning and Air - Source
Heat Pump Equipment and subject to verification of rating accuracy by AHRI- sponsored, Independent, third
party testing:
Cooling Capacity (Btuh): 30200
EER Rating (Cooling): 11.50
SEER Rating (Cooling): 13.75
° Ratings followed by an asterisk (*) Indicate a voluntary rerate of previously published data, unless accompanied with a WAS, which indicates an involuntary rerate.
DISCLAIMER
AHRI does not endorse the product(s) listed on tit Certificate and makes no representations, warranties or guarantees as to, and assumes no responsibility for,
the product(s) listed on this Certificate. AHRI expressly disdains all Iiabiftty for damages of any kind arising out of the use or perranaurce of the produeft or the
tmauttwrbxei alteration of data Rated on this Certificate. Certified ratings are valid only for models and configurational Rated In the directory at www.ahnidirectory org.
TERMS AND CONDITIONS
This Certificate and its contents are proprietary produces of AHRi. This Certificate shall ordy be used for individual, personal and confidential reference purposes.
The contents of this Cerdfcate may not In whole or in part, be reproduced; copied; disseminated; entered Into a computer database; or otinerwise utilized, In any
form or manner or by any means, except for the user's individual, personal and cornflderntial reference.
CERTIFICATE VERIFICATION
The Information for the model cited on this certificate can be verified at www.ahridirectoryorg, it Air- Condifloning, Heating,
click on "Verify Certificate" link and enter the AHRI Certified Reference Number and the date on � ■® ® and Refrigeration Institute
which the certificate was Issued, which Is listed above, and The Certlttcate No., which Is listed below.
02013 Air - Conditioning, Heating, and Refrigeration Institute CERTIFICATE NO.: 136171761714756150
Barry Uni
11950 NE
Miami, Fl,
Attn: Ron
RE: 20d F1
The follm
Scope of
Note: All:
Note: All
This price
Lorn
Payments
TERMS AN
retains title 1
price has to
or affix said
until the foil
Finance chat
seller, at its
costs and da
property, wt
it liable. No
not be consi,
this agm u t
other restrica
performed d
upgrades on
i' South Shore Orive Miami Beach F1 3 3141
Phone 305 80 -0288 Fax 305-865-0800
June 19, 2013
Avenue
a 33161
14uest / Gene
Of Build Out
is a turn key proposal to inst#112 new American Standard split systems a (2.5) & (1.5) ton.
Provide and install (2) new
erican Standard split systems (1.5) & (2.5) ton.
Provide and install (2) air ha
i dler stands.
Provide and install (2) Alum
um wall mount condenser stands.
Provide and install all new c
per refrigerant lines including insulation.
Provide and install all news
ply air ductwork.
Provide and install new digi
1 thermostats.
Leak -check all connections,
acuate system, charge with refrigerant.
Start -up unit and check for p
per operation.
nary electrical work will be #erformed by customer provided electrician-
to be performed during no al business hours, 8:00 am to 5:00 pm Monday through Friday
include: all material, labor, it and applicable sales tax.
price for this scope of work
mit add an additional ---- --
be made as follows: 35% deposit
CONDITIONS OF THIS CONTRACT
the above- described property. In additio
paid Said property shall be and remain
werty to any realty so that it does not h
urchase price thereof has been paid. The
m will be applied to all late payments. L
tion, may declare the attire balance of t
ages including a reasonable attorney's fi
her suit be brought or not Purchaser he
arranties, representations, or promises n
red executed or binding to the seller unt
is subject to force majeure and its conti
ins impaled by any Government or Gov,
ing normal working hours Monday thro
tisting equipment. All quotes are good f
MI.:
$ 10,300.00
—$900.00
vith the balance due upon completion
n is expressly understood and agreed that Cool Water Air Conditioning Inc.
, it shall not pass or become vested in the purchaser until the entire purchase
ersonai property and retain its character as such and purchaser shall not attach
e its character as personal property nor shall purchaser resell said property
iurchase price shall be due and payable as provided under `terms" above.
on the failure of the purchaser to make any payments on the due elate, the
purchase price due and payable. In case of default, purchaser shall pay all
incurred by seller in cWleeting this account or repossessing the descnibed
by waives presentments, demand, and all other pre - requisites required to mute
appearing in writing in this contract shall be recognized.. This agreement shall
duly accepted by an authorized officer of the seller. The execution by seller of
gent upon strikes, accidents, acts of God, weather conditions, regulations, or
nmental agency or other delays beyond seller's control. All work to be
01 Friday S: 00 am to 5:00 pm. Curless otherwise specified. Excludes any code
- 30 days from date.
Authorized i- gnature 11 Date PO