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MC-13-1651Miami 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 Permit No. Master Permit No. City: JA v &AAA Tenantjixasee Name: Email: State: 7F� L— Zip: Phone#. JOB ADDRESS: City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: _ t -39,1-Ok559SO Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: f9A�hone#: Address: � �^ City: VA _ State: 7'�—e gip; Qualifier Name: Phone#:ft'a& 5— State Certification or Registration #: Certificate of Competency #: Contact Phone#: Email Address: DESIGNER: Architect/Engineer: Phone#: Work for Permit: 0 4quarelLinear Value of this $ Footage of Work • ., O Type of Work: Address rl teration ONew ,A RtepWr/Replace ODemolition Description of Work: 2t L � _ x AAn— , A' c`U"L �.D Submittal Fee $ Permit Fee $ � CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Double Fee $ Stractural Review $ Technology Fee $ TOTAL FEE NOW DUE $ �u 4 Bonding. Company's Name (if applicable) Bonding Company's Address City State Tp 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 COM ENCEMENT.' 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 abse a of Lh osted notice, the inspection will not be approved and a reinspection fee will be charged Si atwe, ' Si ature gn Signature— Owner Owner or Agent The foregoing instrument was acknowledged before me this day of —4--, 209—,by N1.4M(V..! 2[&0A6#1J , who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUB Notary Public State of Florida Emile Van Den Bergh My Commission EE 195282 or E)*" OSM2/2016 Sign: Print: My Commission Expires: 0�; 102120 f/0 The foregoing instrument was acl nowledgpd before me thisT day of 20 Eby who is person known to me or who has produced as identification and who did take an oath. APPROVED BY )-AI V Is Examiner Structural Review (Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) NOT' r Notary Public State at Florida t: Emilce Van Den Bergh My Commission EE 195282 Sign: u>rw Expires 051=016 Print --e Ho - My Commission Expires: beS102l2V lk 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): 30 t k7t f— R ( GTRACF City: Miami Shores Village County: Miami Dade Zip Code: 331 ; 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 ❑ N0 ARHI Sheet Attached: YESNO ❑ Contract Attached: YESXr 1. Minimum Circuit Ampacity (Wire Size): 2. Maximum Overcurrent Protection (FuseBreaker 3. Voltage of Circuit (208/240/480): 4. Size Disconnecting Means: Contractor's Company Name: Phone: State Certificate or Registration N. rQ. Certificate of Competency N. SignatureDate: /Z -3/I. Y, 8k oaf UNIT BEING REPLACED DATA NEW UNIT MANUFACTURER AHU or PKG. UNIT MODEL #®`4 COND. UNIT MODEL # S D l ® KW HEAT 5 NOM TONS AHU CU PKG 1 M.C.A 50 AHU CU PKG AHU CU PKG 2 M.O.P o 0 AHU CU PKG AHU CU PKG 3 VOLTS 2 e) ® AHU CU PKG PKG UNIT / I PKG UNIT I I EE SEE YES NO REPLACING DUCTS YES N YES NO REPLACING THERMOSTAT NO YES NO NEW 4°CONCRETE SLAB YES(Na YES NO NEIN ROOF STAND YES N0) YES NO NEW RETURN PLENUM BOX YES 0 1. Minimum Circuit Ampacity (Wire Size): 2. Maximum Overcurrent Protection (FuseBreaker 3. Voltage of Circuit (208/240/480): 4. Size Disconnecting Means: Contractor's Company Name: Phone: State Certificate or Registration N. rQ. Certificate of Competency N. SignatureDate: /Z -3/I. Y, 8k oaf '` ililk�!EX * I Product: Split System: Air -Cooled Condensing Unit, Coil with Blower Outdoor Unit Model Number: ASXC180601A* Indoor Unit Model Number: AVPTC426014A* Manufacturer: AMANA HEATING AND AIR CONDITIONING Trade/Brand name: ASXC18 SERIES Manufacturer responsible for the rating of this system combination is AMANA HEATING AND AIR CONDITIONING 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): 58000 EER Rating (Cooling): 11.75 SEER Rating (Cooling): 16.00 * 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 this Certificate and makes no representations, warranties or guarantees as to, and assumes no responsibility for, the product(s) listed on this Certificate. AHRI expressly disclaims all liability for damages of any kind arising out of the use or performance of the product(s), or the unauthorized alteration of data listed on this Certificate. Certified ratings are valid only for models and configurations listed in the directory at www.ahridirectory.org. TERMS AND CONDITIONS This Certificate and its contents are proprietary products of AHRI. This Certificate shall only be used for individual, personal and confidential reference purposes. The contents of this Certificate may not, in whole or in part, be reproduced; copied; disseminated; entered into a computer database; or otherwise utilized, in any form or manner or by any means, except for the user's individual, personal and confidential reference. CERTIFICATE VERIFICATION The information for the model cited on this certificate can be verified at www.ahridirectory.org, Air -Conditioning, ideating, click on "Verify Certificate" link and enter the AHRI Certified Reference Number and the date on MIS ILEand 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.: 130191392081538595 One Hour Air Conditioning & Heating #156 655 NW 1 18 h Street Miami, FL 33168 Ph. 305-865-1220, Fax. 305-865-7779 Licensed and Insured CACI 813298 www.onehourairmiami.com Proposal submitted to: Matthew Strongin 301 NE 96th Street Miami Shores, FL 33138 Job type: Replace A/C system Date: July 24, 2013 WE PROPOSE TO FURNISH AND INSTALL THE FOLLOWING: • Furnish and install new Air Conditioning Unit • Adjust Air supply plenum to new AC layout • New Digital Thermostat • Star up and system operating check up. • All labor, materials & supervision Comfort System Package for: 5 Tons Premier Split A/C System "Premier" Package Variable Capacity Control Two Stage Variable Speed Air Handler Yes SEER (Super Hi -Efficiency) Yes Warranty Years Labor 10 Warranty Compressor Lifetime Warr anty.,Years Parts 10 Safety One Package: e Kisting slab, auxiliary drain pan, low voltage, sound package, hurricane tie downs, mechanical attachments, Float switch to help prevent water leaks. New Environmental refrigerant R-410. New Digital Thermostat Start- up and check operation.-- yes Dehumidification Better Inside Unit Air Handler Insulated Florida Power Light rebate -$1,005 Thermostat Digital Existing set of refrigerant lines 3/4 & 7/8 insulated with Armaflex Yes One full year Schedule Maintenance/ Comfort Club Membership Yes Final Investment with Taxes after rebates $4,950. - Miami Shores Permit fees NO ©2010 One Hour Air Conditioning U10 Exclusions ✓ Any/ All dry wall, painting, plastering. ✓ Any/All electrical work ✓ Any/All demolition non related to AC system All equipment and material will be new, and installed according to accepted engineering practice. Any alteration or deviation from the above proposal and bid documents will be executed only upon change orders, and will become an extra charge. The warranties provided herein are in lieu of all other warranties or obligations expressed or implied, and it neither assumes nor authorizes any other person to assume for it any liability concerning the sale of this equipment. All warranty service calls will be made during normal working hours Monday through Friday. Emergency service calls made outside of normal working hours will be charged at the standard over -time rate. It is agreed that the seller shall not be responsible for any loss, damage, or delay caused by malfunctioning equipment, acts of government, fire, explosion, theft, rain, floods, water damage, strikes, war, civil commotion, malicious mischief, acts of God, any cause beyond its control, or in any event for consequential damages. Ownership of the above equipment and materials shall remain in the seller's name and title is retained until payment is made in full. In the event purchaser does not pay within the time and manner as set forth below, the seller, at its option, may remove said equipment. The purchaser will sustain costs incurred from non-payment of billing including court costs and attorney's fees. Purchaser agrees to a late payment fee of $25.00 per occurrence and 1.5% per month to be added to unpaid balances 30 days past due. One Hour Air Conditioning may withdraw this proposal if not accepted within 30 days. Accepted for urchaser (Principle/Owner Signature) Print Name/Title Accepted fore Hour Matias Torroija Print Name/Title 24, 2013 Date 24, 2013 Date Olq