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MC-11-582Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Project Address Parcel Number Applicant 165 NE 98 Street 1132060132330 GILBERTO MEJIA Miami Shores, FL 33138- Block: Lot: GILBERTO MEJIA 165 NE 98 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone COLD SPOT AC INC (954)567 -1924 Info: A/H & DUCT WORKS ion: Residential oved: In Review ments: Denied: Fees Due Amount CCF $4.20 DBPR Fee $3.63 DCA Fee $3.63 Education Surcharge $1.40 Permit Fee $241.50 Scanning Fee $3.00 Technology Fee $5.60 Total: $262.96 Date Approved:: In Review Type of Work: MECHANICAL Valuation: $ 6,900.00 Total Sq Feet: 0 Pay Date Pay Type Amt Paid Amt Due I Invoice # MC-4- 1140512 09/06/2011 Check* 1005 $ 262.96 $ 0.00 Available Inspections: Inspection Type: Final In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable taws regulating construction and zoning. Futhermore, I authorize the above -named contractor to do the work stated. September 06, 2011 Authorized Signature: Owner / Applicant / Contractor / Agent Date Building Department Copy September 06, 2011 1 Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Project Address Parcel Number Applicant 165 NE 98 Street 1132060132330 GILBERTO MEJIA Miami Shores, FL 33138- Block: Lot: Owner Information Address Phone cell GILBERTO MEJIA 165 NE 98 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone COLD SPOT AC INC (954)567 -1924 Additional Info: A/H & DUCT WORKS Classification: Residential Approved: In Review Denied: Fees Due Amount CCF $4.P0 DBPR Fee $3.63 DCA Fee $3.63 Education Surcharge $1.40 Permit Fee $241.50 Scanning Fee $3.00 Technology Fee $5.60 Total: $262.96 Valuation: $ 6,900.00 Total Sq Feet: 0 Pay Date Pay Type Amt Paid Amt Due Invoice # MC -4-11 -40512 09/06/2011 Check #: 1005 $ 262.96 $ 0.00 Available Inspections: Inspection Type: Final Applicant Copy For Inspections, Call (305) 762 -4949 or Log on at https:H bldg .miamishoresvillage.com /cap /. Requests must be received by 3 pm for following day inspections. NOTICE: In addition to the requirements of this permit, there may be AND THERE MAY BE ADDITIONAL PERMITS REQUIRED FROM OTHER additional restrictions applicable to this property that may be found to GOVERNMENTAL ENTITIES SUCH AS WATER MANAGEMENT the public records of this county. DISTRICTS, STATE AGENCIES, OR FEDERAL AGENCIES. September 06, 2011 2 BUILDING PERMIT AP FBC 20 Permit Type: ME1 Owner's Name (Fee Owner's Address City ` Tenant/Lessee Name Email Job Address (where the City Miami S FOLIO / PARCEL # Is Building Historically Contractor's Company Contractor's Andress — City Qualifier MAC State Certificate or Regi; Contact Phone 57Se Architect/Engeer's NE Value of World For Type of Work: [ Describe Work: I Mi m a i Sh; )rQs Village �� EECEIV Building e artment p AUG 2 2 2011 10050 N.E.2nd Avenue, iami Slhores, Florida 33138 Tel: (305) 795.22 Fax: (105) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 ' — "�— Permit loo. 'LIGATION Master Permit No 'HANICAL )le Titleholder) Phone # X86 $-�/ S State is being done) YES L No. (if applicable) Phone # County Miami-badt NO Flood Zone Phone # 6 T Zip X7®�� _Phone # Certificate of Competency No. E- Permit $ fig Square'/ Linear Footage Of Work: dition DAlteration Ngw " [epair/Replace ❑Demolition r - r ; e k�Y�k4r�rkBerk � �YBr:@ Ie4edt3e3zsYsfriY�r .ksk9e�'e9eae3t�k4edtia9r k:Far" � aY3r ' 3eFrzYi: 3: 3nYdtAr�F: Y�Y3esa�eue�e: trikeY�Y�Y�kya�Yae &iF4e�Y &9ek3c3r4c�r3e�Y4e�Y Submittal Fee A21 Permit Fee $ I CCF $ CO /CC $ Notary $ Training/Education Fee $ Technology Fee $ Scanning $ Radon $ D BR $ ! Bond $ Double Fee $ !: Violation date: Structural Review. $ Total Fee Now Due $ See Reverse side; 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. ii -y 0, 1 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 M COMMENCEENT 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 wh ch occurs seven (7) days after the building permit is issue . t e ence of such posted notice, the inspection will not be appr wed and a reinspection fee will be charged. Signatur Signature Owner r Agent " y ontractor The r ent w I as a o e fo me s The f 0o' instrument wT ackno a ed be r m this g g day 0 j o t (/J r 1 Y ._iL, day o , 20 , b ho 's personally known to me or who has produced w o i personall known] me or who has produced�� As identification and who did take an oath. fication and who did take an oath N Sign: Print: My Commission Expires: APPROVED BY (Revised 07 /10 /07XRevised 06 /10/2009) My Commission Expires: Engineer Clerk checked i ♦ . ] 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): 045` 48 51- City: Miami Shores Village County: Miami Dade Zip Code: ALL CONDENSING UNITS MUST BE ON A 4 INCH SOLID CONCRETE SLAB ALL UNITS MUST COMPLY WITH F.E.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 ❑ 1. 2. 3. Minimum Circuit Ampacity (Wire Size): Maximum Overcurrent Protection (Fuse /Breaker Size): Voltage of CircuitJ208 /240 /480): 4. Size Disconnecting Means: Contractor's Company Name: State Certificate or Registration N Signature (Qualifier's signature only) Certificate of Competency N Phone: Date: 9/. Z/ 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 MAP AHU CU PKG AHU CU PKG 3 VOLTS AHU CU PKG PKG UNIT / I PKG UNIT I l 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 Minimum Circuit Ampacity (Wire Size): Maximum Overcurrent Protection (Fuse /Breaker Size): Voltage of CircuitJ208 /240 /480): 4. Size Disconnecting Means: Contractor's Company Name: State Certificate or Registration N Signature (Qualifier's signature only) Certificate of Competency N Phone: Date: 9/. Z/ RooMts 1 Nwobar d " Tax Amy TMWW Fee NW Fee pdw Yowl camow cm Tom Paid 27.00 0.00 0.00 0.00 0.00 - -0 -00 r __ . 27700 d TM RAPT NRJST BE PCNnW CONSPICUOUSLY IN YOM PLACE OF SLISRAM 44 TIM BECCIMI A TAX RECE PT This teat in b ied W the wk4w of doing Wwnsw wittim and is mw%ufefory do nature . You must meet WMM VALIDATED and zoning requirements. This Tax PaGW must be Vandarmd wl the business a soK Wairim name has dwqpd or you how moved ft This raaW don not Waift the go buerwe is IMM of the A is In compliance wdh Soft or kxW hrAs and migulaftm NO" Address. ss JOHN SBTTON t #322 -09- 00007364 2646 SK 7 AVE said 07/27/2010 27.00 POMPANO BEACH, FL 33060 201 -2011 a >�'. "T"!�"w �`y f� xis _ _�` 'T.�^,•an:�,li�vi`ns �s "_ ti,.�r:, +,,.�� r. -;_r ,a4 :3M?`� , -yw.7 , .. , •• •ft t ';'z IC L 0 1',2 330 9itiiPW,f 1/99 i1to 1646 SW 7th Avenue Pompom Beaoh, FL 33060 954 -567 -1929 License CAC057730 Prod May 10, 2011 4 Mejia residue in !�'11 �. r� S �� J N We are pleased to provide our proposal for the work at above home: Install new Rheem 4 ton 13 seer air conditioning system with ductwork as shown on print Total price $6900 No other modifications to the climate control system are included. Air handler to be installed in garage with supply duct into attic and return through living room wall. Condensing umit on outdoor walkway. Duct system to be standard flex with no fire dampers. Any changes, especially work required to upgrade the struchme to new codes, required by any governmental agency, will result in additional charges to owner Smoke detectors, if required to be charged at $ 300. Any shop drawings done by the contractor will be provided at no charge; any engineering work requested will be billed to ownez No provision is included for cutting, patching, tenting, or electrical. Heat load calculations, if required to be charged at $300 per system. This agreement will be governed by the generally accepted principles of construction as described inA1A doccm a tA201 -1997. Permits and fees to be paid by owner 44U1 Y %ll Date g 3I zo�i 33t _ ,k ,I �- �'�...,'� �Ye■� •�r :f < ;' 1 y � • FI � � a �Y; AHRI Certified Reference Number: 4526115 Date: 8/24/2011 Product: Split System: Air - Cooled Condensing Unit, Coll with Blower Outdoor Unit Model Number.13AJN48 Indoor Unit Model Number: RHLL- HM4821 +RCSL -H *4821 Manufacturer. RHEEM MANUFACTURING COMPANY TradelBrand name: RHEEM 13AJN SERIES Manufacturer responsible for the rating of this system combination is RHEEM MANUFACTURING COMPANY 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): 46500* EER Rating (Cooling): 11.50 SEER Rating (Cooling): 14.00* • Ratings followed by an asterisk (ry indkate a voluntary rerate of previously putted data, unless accompanied with a WAS, which indicates an it mluntary mate 02011 Air- Conditioning, Heating, and Refrigeration Institute CERTIFICATE NO.: AERICertificate COLDSPOT.pdf - Powered by Google Does AHRICertificate COLEA Re View III F--- Page 1 of I Save In Google Docs Share https:lldocs.google.comtvig-,wer?a=v&pid=gmafl&attid=0.1&thid=131fdb5c1 d8ab49b&mt... 8130/2011 �L �► CERTIFICATE OF LIABILITY INSURANCE �- 2910TENO 99284 A6/0112100064- 999284 POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAM CLAIMS. INSA 06 0 1 2 PM PRODUCER H3ghpoint Risk Services LLC 5530 LSJ FREEWAY, SMTE 1200 Dallas, TX 75240 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR (800) 632 -5096 (972) 715 -0959 LIMITS INSURERS AFFORDING COVERAGE INSURED: PPS 1 /c /f: INSURER A: Co=anion Property and Casualty Insurance C INSURERS: COLDSPOT A/C INC 1646 SW 7 AVE POMPANO BEACH, FL 33060 INSURER C: INSURER D: (954) 560 -9097 Fax: (954) 933 -7103 INSURER E: COVERAGES 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 RESPECTTO WHEN THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DES RNED HERON IS SUBJECT TO ALL THE TERM, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAM CLAIMS. INSA TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY 156RUTS LIMITS LIAg)LRY EACH OCCURRENCE $ FIRE DAMAGE (Arty One Fire) $ COMMERCIAL GENERAL LIABILITY CLAIMS MADE M OCCUR MED EXP (Any orre person) $ ..� PERSONAL & ADV INJURY $ GENERALAGGREGATE $ GENL AGGREGATE I &T APPLIES PER: PRODUCTS - COMP/OP AGO $ POLICY M 29 LAC AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMB (Ea acddwd) $ BODILY NUURY (� Iron) $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY tNURY (Per acrd) $ HIRED AUTOS NON -OWNED AUTOS PROPERTYDAMAGE (Perr rt) $ GARAGE LIABILITY AUTO ONLY- EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO $ AUTO ONLY: AGO EXCEED LIABILITY EACH OCCURRENCE $ OCCUR MCLAIMSMADE AGGREGATE $ DEDUCTIBLE $ $ RETENTION $ WORIQ;RSCOMPENSATWNAND EMPLOYEW LIABILITY CPMU12044 01/01/2011 01/01/2012 X WCSTATU X OTT+ EL EACH ACCIDENT $ 1000000 A EL DISEASE - EAEMPLOYEE $ 1000000 EL DISEASE - POLICY UAUT $ 1000000 OTHER LIATS $ LIMITS $ DESCRIPTION OF OPERATIONSAAMTIDNSNEHLLESMXCLUSUM ADDED BY ENDORSEMENTISPECIAL PROVISIONS 1. This certificate remains in effect, provided the client's account is in ood standing with PPS. Coverage is not provided for any em toyee for which the client is not reportingg wagges o PPS. Applies to 100% of the employees ofpPPS leased to COLDSPOT A/C INC effective 01/0 /2011 2. Insured is afforded Workers Compensation & Employers liability as a co- employer under the policy for employees leased from PPS. MIAMI SHORES BUILDING DEPARTMENT 10050 NE 2ND AVENUE MIAMI SHORES, FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATETHmEOF, THE L9SImmwRER WDI.ENDEAVOR ToLWL 30 DAYS WLRTTTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LIST, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR UMUW OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. ACORD 25-S (7/97) ® ACORD CORPORATION 1988 Permit N. /// ® S • ' Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CHANGE OF CONTRACTOR / ARCHITECT Owner's Name (Fee Simple Title Holder): Phone #: 79A Owner's Address: City: State Zip Code: Job Address (Of where work is being done): /6 :!r I" VS s 1�- City: Miami Shores State:_Flodda Zip Code: Contractor's Company Name: �' ®11 5'0'V1 & kc Phone #: Address: A_r<, u i~, 5 u9 1-7 i City: VS2!n, Qualifier's Name: Architect/ Engineer of Record Name: Address: City: State: V—C, Lic. Number: State: Phone Zip Code: S-jQb0 Zip Code: Describe Work: *a� e (Wu- 6445"1 k 110 tx i 0'- , �- \-J3 , Pc, off- V3cv' ... I hereby certify that the work has been abandoned and/or the contractor /architect is unable or unwiping to complete the contract. I hold the Bulding Official and the I' hores harmless for all legal inv v t. Signat Signature ct rorArchitect The foregoin no led d be m The fo ing in ent s aknowledge fore m this 4dab , �G' this ! �— day o 20�> b 6q ,Xho ' ersonall knoo n to me_ or who has produced as indentification. Nota u a s 9 Sign: Seal: ho ' ersonally know to me w��h�o'�yh produced Ti z 46 'd �l� as indent I_ Notary Sign:. Seal: 6/27/11 Temperature Rising 6725 Woods Island arcle Port St. Jude, FI 34952 Dear Mr. Gonzalez, This letter Is to Mom you that unfortunately, we will not proceed with your company at Ws time at the job located at 165 NE 99 St. Miami, FL 33138 because use have dwsen the sendces of another company- We apologize for any incormenlence that use have caused but would still like t0 do buslrHM with your company In the rtear future. PJ,,TA j pMC -STATE OF FLOWA Ad: pla Jaynes I Co. !-nim #DD839899 wv .° EIpi es: n NOV 19, 2012 B�En r�o �tataxtc sorm�a �, nvc. Any 1& s PERRINE COSTAL STORE tcAm�,, Flurida _ 332575400 i;58S41)128 -0097 06/28/2011 ,8oc, `5••8777 04:09:26 Ptd Salts ' cei Pt —°--'- Sale Unit Final Prc;:iuct Descripti<.., l;ty Price - Price 1+1IANI FL :3180 Zone -0 $0.44 First -Class Letter 0.50 oz� Expected Delivery: !ied 06,29/11 Return Rcpt (Green Card) $2,30 $2.85 Certified Label #: 4 '"" ,2780000117892085 mmmmmmmm Issue PVI: $5.59 PORT SAILI LUCIE FL $0.44 34952 Zov�, 2 First -Cld.a Letter 0.50 oz. Expected Delivery: Thu 06/30/11 2.30 Return gcpt (Green Card) $2.85 CBrtifiW0 Label #: 70102780000117892092 mammmmmm Issue PVI: $5.59 JACKSON HEIGHTS NY $0.6• 11372 Zone -6 First -Class Letter 1.70 oz. mmmmmmm® Issue PVI: $0.64 Total: $11.82 Paid by: $11.82 MasterCard XXXXXXXXXXXX2946 Account #: 45866P Approval #: Transaciio" #: 476 23 r`35204L7 Ord- tamps at USPS.com /shop or call 1 atamp24. Ga to USPS.com /clicknship to print shippia.. labels with postage. For other information call 1- 800 - ASK -USPS. wrrrrwwwwwwxw *ww * * *ww,aw * * * * * *wwwwwwwwwwwww wwwwwwwww *ww *w,+ ,vx * * * * * *wwxww.atwwwwwwwww Get your mail ti.ien and where you want it with a secure .'ost Office Box. Sign up for a box online at. usps.c0lfi oxes. wwwwww* wwwwwwwx *x * * * * * *ww * *wx * * * *wwwwwxw .wwwwxFrexx.,... Bill #: 1000303757883 Clerk: 06 All Thank you for your business w, awwwwwww* ww *wwwwwwww *ww *wwrrwwwwwwwwwwww vwwwwwwww� * *w *xw *wwwwww *ww *wwwwwwwwwwwww HELP US SERVE YOU BETTER Go to: https: / /postalexperience.com /POs ABOUT YOUR CENT EXPERIENCE STALL YOUR OPINION COUNTS wwwwwwwwx� * * * *xwwwwwwvrwwwwwwwwwwwwawwwww wwwwwwwww� , *w *x *ww *wwwwxwwwwwwwwwwwwwwwww Customer Copy [T' - -- ca P Mge $ r- X2.$5 06 r-1 CeNed Fee rq Return R�eiPt Fee �� •3i, 1 FL- OG (Endo:.ZRM Required? ® (RErrcelorse tRegWred) � C3 q co Total Postage & Fees $ �. ru r63 1-4-ef r-q r-3 orree� sox No. 6,7 � �.. _ ... O or PO �`' CnY Vie• ziwaL?ir� �- �� /P a . . 1 Postmark E USPS Tracking Results Page I of 1 UNITED STATE'S' �,4 1TENS �- , �? Z-- S JOP®STALSERVICE& 1,�OZO,WDi EXPIIE�' SE"OCE EMS Tracking EMS China Services Tools Blog Widgets AdChaxes 11> USPS Tracking Results a GPS Hee Deta AutionF Expe� t, Trawwnq Vow our short vhbo to see how Sags QLwst begs ft cmrqKCJm E� Envinarmiriented Ask, USPS He1[9inp 4 USPostal Service ExpertsOnline. PostalServiceArtswersTodW 37. usmj--M—com Cw0fiance, made easier• see do iv; op t Ea* compare Prices & Sm. 1`1nd the Bad Deal 9 Sam Todayl sommoft%m AdCh=05 D> Tracking Number- 7010278=1 1 78M uses ShTpinq Tracking Yox Rom was reburied to ft swxler on August 16, 2DI I becouse it was not daftned by the addressee. Find U*s ddppbV beft ustrig waticnowler.coin Activity Dallernine L xwwwpbpm,lercpm Undefined August 16 2011,12:13 pin PORT SAINT LLXV- FL hicemabonal Pa,1,.,agc, Notice Left jurm 29 2011. 03M pm PORT SAINT LWF– FIL 34952 ShOOV Access 10 Search Engiries At Once www,lfft, oar Acoeph— Jurw2821111111,04,Npart MIAN, FIL @ ems-tracking.net http://usps.ems-fteking.net/usps-fteldng.php?number--70102780000117892092 8/16/2011 Shoytent Locafim on Maps Mad Processing Equj The Quality Afflardable Afterrieffft Haskir Maft Systems Lnter& Track Work Orders Managework ceder & nt resmffcw with fift EAM-Free derno. d. Up. Track Another Number Submit QLw 30 Day Ffc,,, ALI t':, Ffl ate d � rd e n:,„ man 1ge w'-11". Onk To OF ------- -- -- ------ - ---------- ------- -1 onset LISPS @ ems-tracking.net http://usps.ems-fteking.net/usps-fteldng.php?number--70102780000117892092 8/16/2011 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 f ; ��j u � APR 0A2011 Permit No. � ,T Master Permit No. d y U OWNER: Name (Fee Simple Titleholder): �� : ,� Phone #: �� i } 5 Z 3 Address: f65 S f City: sty, State: l° X41 -Z),a zip: 3,31 3 8 Tenant/lessee Name: Phone#: Email: JOB ADDRESS:-( 6 5 $ 5 City: Miami Shores County: Miami Dade Zip: 33 3 8 Folio/Parcel #: d- 3 2436 - f 3- 2 3 3 Is the Building Historically Designated: Yes CONTRACTOR: Comvanv Name: ,7r; 4eZATuZE Address: (P7zc � Nd.00 S - 'sC� C1 ,o gC1 E City: NO Flood Zone: 56' 1- EG6°71tot 3 1 71CL Qualifier Name: Phone#: State Certification or Registration #: -''° z Certificate of Competency #: Sp 701 y q q Z Contact Phone #: nail Address: _ DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $__ i e�;_& 0 . 0 Square/Linear Footage of Work: Type of Work: (]Address DAlteration Description of Work: Submittal Fee $ Permit Scanning Fee $ Notary $ Radon Fee q- BPR $ Bond $ Technology Fee $ ODemolition Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ 4e 51� �K� FT 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 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection wh' occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will noLhe appr ved and a reinspection fee will be charged. 1 Signatfinstrumen1twaas Sign e er or Agent Contra or The fo acknowledged before me this The foregoing instrument was acknowledged befo a me this day of , by t- day of & 2v , 20 L l , by who is personally known to me or who has produce ZibL who is personally known to me or who has produced —1 LL- [ ckiL,r1,5Le As identification and who did take an oath, as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign Sign: Print: Print: My Commission Exp' :,,o�,Y " <'a ., JOSIANE DA SILVA My Corn •'r ° ;` Notary Public - State of Florida 9 My Comm. Expires Dec 14.2014 Commission # EE 49027 ok$ t�Dksk 'ksksksksk=kskokekds:k�Iak dada {�'sk�A�1%'skskDk�iakskskeksk ekaReksk�kdsskshKadada5t:ksksk �aR' k' k9k' kekda�dadsdesk�ksksk =k$�d�sksksk�a$$�tk�N APPROVED BY A A Plans Examiner Structural Review (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) Notary Public - State of Florida my Comm. Expires Dec 14, 2014 Commission M EE 49027 Zoning Clerk Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel. (305) 795.2204 AIR CONDITIONING REPLACEMENT DATA Fax: (305) 756.8972 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): , k � fle 64- :Qoe..es p- City: Miami Shores Village County: Miami Dade Zip Code: °53139 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 ❑ 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: State Certificate or Registration N. Certificate of Competency N. Phone: Signature 4�N? Date: (Qualifier's signature only) 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 / / 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 I 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: State Certificate or Registration N. Certificate of Competency N. Phone: Signature 4�N? Date: (Qualifier's signature only)