RC-14-356'�A C" (5�) "�
BUILDING
PERMIT APPLICATION
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
❑BUILDING ❑ ELECTRIC ❑ ROOFING
Master Permit No._�®s
Sub Permit No. c9 S 2
❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: _ `V4 ®� N E _ A-\/
City: Miami Shores County: Miami Dade Zio:
Folio/Parcel#:1-� — ®g I - 00 _30 Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): aaow Phone#: L/C
Address: �� 1% -T-H LA Nc—
City: S u N `�t-S R)c h U State: ' Zip: ? � 6 c)
Tenant/Lessee Nerve: Phone#:
Email: -
CONTRACTOR: Company Name: L`� 5�� � ���- Phone#: S -To -74R
Address: �1 ® Sil+
City: VKLA (N- State: Zip:
Qualifier Name: &10c k6 Phone#•
State Certification or Registration #: Certificate of Competency #: C.) Q7 9$1q
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ Z 1 D Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ jAlteration ❑ New epair/Replace ❑ Demolition
Description of Work: lY�s�� 11 `"� AUA yv-
j
Specify color of color thru tile:
Submittal Fee $ ��o Permit Fee $
CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Notary $
Technology Fee $ Training/Education Fee $ . Double Fee $
Structural Reviews $ Bond $
TOTAL FEE NOW DUE $ "
(Revised02/24/2014)
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
State
RE
Zi
at
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 ELECTRIC, PLUMBING, SIGNS, POOLS,
FURNACES, BOILERS, HEATERS, TANKS, 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 Gornmencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issu . In abse a of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature
NT
The foregoing instrument was acknowledged before me this
day of 20 Z- , by
, who is personally known to
me or who has produced * as
identification and who did take an oath.
NOTARY PUBLIC:
SI
Print:
Seal: ;or "goy. Notary Public State of Florida
Joanna M Feliciano
My Commission FF 082753
�'oF�o`° Expires 01/12/2018
APPROVED BY
(Revised02/24/2014)
CONTRACTOR
The foregoing instrument was acknowledged before me this
`�2A� day of 20 CS , by
GCZ-110 ispersonallyknown to
me or who has produced ' � as
identification and who did take an oath.
NOTARY PUBLIC:
\iluini��
\o\
�.
Sign:
`.. . a � w .• � _
R7
Print:
z C>
Seal:
Plans Examiner Zoning
Structural Review Clerk
0
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: 5) 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
City: Miami Shores Village County: Miami Dade
0 et
Zip Code:
AIL -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
AHRI DATA SHEET REQUIRED
Change disconnecting means: YES ❑ NO ARHi Sheet Attached: YES NO ❑ Contract Attached: YES
1. Minimum Circuit Ampacity (Wire Size). X
2. Maximum Overcurrent Protection (Fuse/Breaker Size):
3. Voltage of Circuit (208/240/480):
4. Size Disconnecting Means:
Contractor's Company Name: �� f ;.AS� .S Phone: "l lLt, a-7® 1�36
1A A
State Certificate or Registration No. �5�5� Certificate of Competen No.
Signature Date: '716 1
(Revised02/24/2014)
UNIT BEING REPLACED
DATA
NEW UNIT
MANUFACTURER
AHU or PKG. UNIT MODEL #
COND. UNIT MODEL #
i
-s jh
KW HEAT
L
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 4
AHU
CU
PKG
PKG UNIT /
/
PKG UNIT
EER/SEER
YES
NO
REPLACING DUCTS
YES
N
YES
NO
REPLACING THERMOSTAT
YES
N
YES
NO
NEW 4"CONCRETE SLAB
YES
N
YES
NO
NEW ROOF STAND
YES
YES
NO .
NEW RETURN PLENUM BOX
YES
1. Minimum Circuit Ampacity (Wire Size). X
2. Maximum Overcurrent Protection (Fuse/Breaker Size):
3. Voltage of Circuit (208/240/480):
4. Size Disconnecting Means:
Contractor's Company Name: �� f ;.AS� .S Phone: "l lLt, a-7® 1�36
1A A
State Certificate or Registration No. �5�5� Certificate of Competen No.
Signature Date: '716 1
(Revised02/24/2014)
TEMPERATURE SYSTEMS INC.
13110 sw 8TH ST DAVIE FLA.33325
Ft Lauderdale 954-370-7436. Tampa 813-728-0327
e.mail.tempsyst@aol.com www.airconditionplumber.com
STATE CERTIFIED CONTRACTORS SINCE 1988
AIR CONDITIONING PLUMBING MECHANICIAL SOLAR
CAC045884 CFC1427652 CMC1429899 CVC56778
SERVICE INVOICE
SERVICE PERFORMED. Date IZ/ 1 /14
4;-2,6 0 c)
Warrante:standard contractor warrante: 1 yr parts and labor repair orreplace materials and
provide labor to completed work.repairs for normal operation,damages or improper operation
of equiptment not included.
Excluded from wan -ante:
warrant standard includes: factory:manufacture of: 1 ® -� M CC*P
TOTAL$ �. i� 0 6
PAYMENT.TERMS DEPOSIT OF % _$ l3 O 0% 21'D PAYMENT $t' 17 "*o 3"
PAYMENT
PAYMENT OF CONTRACT.OWNER/BUYER AGREES ALL PAYMENTS TO BE MADE AS AGREED
ABOVE BUYER/OWNER AGREES TO CONTRACT AND TERMS BY SIGNITURE PAYMENTS NOT
MADE AS PER CONTRACT COULD RESULT IN BREACH OF CONTRACT,SUSPENSION/OR
TERMINATION OF WORK. LIENS AND OR JUDGMENTS TO SECURE PAYMENT.ALL LEGAL
COST FOR COLLECTION WILL BE ADDED TO UNPAID BALANCE TO BE PAID BY ONVNER.
Work was perforz7--:
tisfactory condition and accepted by owner. 4
OWNER xANAGER I
.
This combination quillfiesfor a Federal Enerr,
Efficiency Tax Cr4dit when placed in servil
between Fab j17, 2009 and Dec 31, 201
Product Ratings
AHRI Certified Reference Number: 3799429 Date: 1/20/201'5
Product: Split System: o ed Condensing Unit, Coil with Blower
Outdoor Unit Model umber:14AJM4
Indoor Unit Model Number: RH LL-HM4821 +RCSL-H*4821
Manufacturer: RHEEM SALES COMPANY, INC.
Trade/Brand name: RHEEM; RUUD; WEATHERKING
Series name:
Manufacturer responsible for the rating of this system combination is RHEEM SALES COMPANY, INC.
Rated as follows in accordance with AHRI Standard 2101240-2'008 for Unitary Air -Con itioniing and Air -Source
Heat Pump Equipment and subject to verification of rating accuracy by AHRI sponsotled, Independent, third
party testing:
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' ROW90 folfowod by an asterisk (y indlceta a voluntary rerato orproviously published data, unless seCompenlod wish a WAS, which Indicates tnvolun�+ry relate.
DISCLAIMER
Z,Z:a6pd
AHRI does not endorse the products) listed on this Certificate and makes no represenwilops, warranties orguarantees as to, and issuntesino
the product(s) listed on this Certificate. AHRi expressly disclaims all Ilsbflity for damages of any kind arising out of the use or perr0
If
responsibilitfor
ancs f the
unauthorized alteration of data listed on this Certificate. Certified rating's arc valid only for models And configurations listed in the
directory at www.abridirectoryorg
TERMS AND CONDITIONS
This Certificate and Its contents are preprtotary products of AHRI. This certificate shall only be used for individual, personal and
i0N1NG'iHEMxQ'
Conlidcntial rcfercacc purposes. The Contents of this Ccrtificata may not, In whole or in part, be reproduced; copled; dfsselttinated;
entered Into a Computer database; or otherwise uVitzed, In any form or manner or by any means, except for the user's Individual,
personal and eorAdential reference.
AIR ND
CERTIFICATE VERIFICATION
The Information for tha modal cited on tMs certificate can be verified at www.alfrldiraetory orR, eilok on "Verify Oorttflcato• link
& liR RIOURATiON INSMM
and enter the AHRI Certified Reference Number and the date on which the certificate was issued,
wr. make IICe beaer'
Which is listed above, and the Certificate No., Which Is listed at bottom right- -OF. r .,.:_. :.. .
(9)2014 Air -Conditioning, Heating, and Refrigeration Institute �RTIFIC ? T N
R
13 .852477024507'
.: , _ .
2L689SLSOET:o1 :woad 00:20 GT08-T2-NUt