MC-14-1299s
Miami Shores Vi
Building De p artmen + JUN a "'
10050 N.E.2nd Avenue, Miami Shores, Florida 331
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4
BUILDING Permit No.
PERMIT APPLICATION Master Permit Nol± I
FBC 20
Permit Type: MECHANICAL
OWNER: Name (Fee
30S. 7s`& 011TS 11
City: ;622+ State: F\,Zip:
Tenant/Lessee Name: Phone#:
Email:
JOB ADDRESS: J —70
P 10 4
City: Miami Shores County: Miami Dade Zip
Folio/Parcel#: s
Is the Building Historically Designated: Yes
NO Flood Zone:
Jia
CONTRACTOR: Company Name: C i R /7 ► 1- C 0 INCI • ® • Phone#: _ 3 ® 1� 6 c14' 9 2 9 H
Address: 6 ®7�3 tj IBJ 16 7 � T C ' L4
a �
City: emn1 _ State: I Zip: ®��1
Qualifier Name: ® by"T T • C � d 1' -r Phone#: � U I W16 Z? 9 `I
State Certification or Registration #: e A C-014 `i 1 4 Certifi5fcate of Competency #: ® $j o 2 3
Contact Phone#: Email Address: C a tij R a C C 0 m pQn &Y ko (-. Ca /y,
DESIGNER: Architect/Engineer: Phone#:
60
Value of Work for this Permit: $ 01'z Square/Linear Footage of Work:
Type of Work: ❑Address ❑Alteration ❑New U Repair/Replace
Description of Work: r c1 jQ V - _
Submittal Fee $ Permit Fee $ U t7L/) K V
Scanning Fee $ Radon Fee $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
*4
CCF $ CO/CC $
DBPR $ Bond $
Technology Fee $
TOTAL FEE NOW DUE $
� (111//;7 A/
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.
"WARMING 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 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 Signature
Owner or Agent
The foregoing instrument was acknowledged before me this
day of73Rkne. 20 11, by C k t i 4 ft C4AS0r, ,
who i ersonally known o me or who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
Contractor
The foregoing instrument was acknowledged before me this
day of cA vy e 20 by g®be e"(' �sc �► c -y S �,
who i ersonally kno to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
Sign �Qk�Sign:
Print: 66 -e,"t sT Print:
My Commission Expires: f% ROBERT J. CHRYST
.r :. Commission # FF OWIF
ExFires May 24, 2918
. ea,wa neu Tey f as In�noe E0D38
APPROVED BY 1'7" Plans Examiner
Structural Review
(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)
2.
JANET KRW
My Commissio _ COrrlmisSW # EE 091937
Expires May 9, 2015
iljf, ,N�_ BondedflwTnq,Fahtl�aanae8�3&�r701!
Zoning
Clerk
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. A ,N
Job Address (where the work is being done): J ! 0
City: Miami Shores Village County: Miami Dade
Zip Code: - �. PS
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 Pf ARHI Sheet Attached: YES ❑ NO ❑ Contract Attached: YES ❑
1. Minimum Circuit Ampacity (Wire Size): 93-1 I
2. Maximum Overcurrent Protection (Fuse/Breaker Size):
3. Voltage of Circuit (208/240/480): 12o
4. Size Disconnecting Means://�� 4 0
Contractor's Company Name: C- +R i t• 0 n Cl ® Phone: _3 01 fs,5' 9
State Certificate or Registration N. CA( C)a � 41 Ll Certificate of Competency N.
Signaturea�Acm_ Date: 0- 19-)q
'4alffleH si nature only)
UNIT BEING REPLACED
DATA
NEW UNIT
h n
MANUFACTURER
AHU or PKG. UNIT MODEL #
(�1p
COND. UNIT MODEL #
PA 11 04
KW HEAT
NOM TONS
3
AHU
CU
PKG
1 M.C.A
AHU
CU)j XPKG
AHU
CU
PKG
2 M.O.P
AHU
CU 40 PKG
AHU
CU
PKG
3 VOLTS
AHU
CU:230PKG
PKG UNIT /
/
PKG UNIT I I
EERISEER
Tr
YES
NO
REPLACING DUCTS
YES
YES
NO
REPLACING THERMOSTAT
YES
YES
NO
NEW 4"CONCRETE SLAB
ry5s
N()
YES
NO
NEW ROOF STAND
YES
YES
NO
NEW RETURN PLENUM BOX
YES
0
1. Minimum Circuit Ampacity (Wire Size): 93-1 I
2. Maximum Overcurrent Protection (Fuse/Breaker Size):
3. Voltage of Circuit (208/240/480): 12o
4. Size Disconnecting Means://�� 4 0
Contractor's Company Name: C- +R i t• 0 n Cl ® Phone: _3 01 fs,5' 9
State Certificate or Registration N. CA( C)a � 41 Ll Certificate of Competency N.
Signaturea�Acm_ Date: 0- 19-)q
'4alffleH si nature only)
C&R C&R Air Conditioning Co. C&R
6073 NW 167`b Street Suite C-4 Miami Gardens, FL 33015-4330 < >
DAtnR• 305-6R5-6394 RRnWARD: 954-680-4494
CU T011QER
'
PHONE
HOME
DATE
6- I . 1 �"I
AD SSCL
10L,
�y
WORK •� ®�" 7 —�14 ®� ��
❑ UNDER CONSTRUCTION
1
Zip?
CELL
[?EXISTING STRUCTURE
We hereby propose to: Furnish, install and service the equipment and materials listed below with the conditions and specifications detailed below.
NEW EQUIPMENT
System 41 $1• System #2 $ System #3 $
Rebate/s
21 qS.
Your Investment
q e
Manufacturer
%►
Condensing Unit Model #
[��
f
a
q
Air Handler Model #
Package Unit Model #
RW
Heating KW
Btuh
S.E.E.R.
Warranties
Labor Yr. Parts l Yr. Labor Yr. Parts Yr. Labor Yr. Parts Yr.
Compressor_ Yrs. Compressor Yrs. Compressor Yrs.
❑ Condensing Unit Stand
MtSCELLANEOUS
❑ Air Handler Stand ❑ Float Switch ❑ Ref. Line cover ❑ Condensate Line
[Concrete Slab
❑ Thermostat S D PD ❑ Auxiliary Drain Pan [Ref. lines ❑ Fire Dampers
❑ Other
DUCT
SYSTEM ELECTRtC SYSTEM A
❑ Package Unit Changeout
Existing Reconnection
❑ Reconnect to Existing System
❑ New Electric
A qualified air conditioning expert will start and test the system and explain its operation. This proposal is good for a two week period from date or proposai and di
that time is subject to review. Title to the system shall remain in us until all sums due us have been fully paid. In the event the purchaser fails to comply with any
of the requirements of this contract and such default results in litigation, the Purchaser agrees to pay reasonable attorney's fees and all court costs and expenses
incident to such litigation. Delinquent payments shall bear 1.5% per month interest from due date until paid. All work is to be performed during our regular work
hours unless otherwise specified. This contract contains all agreements. Neither party shall be bound by any representation, warranties nor agreements, oral nor
written not herein contained. This proposal shall become a contract when accepted by you and approved in writing by our duly authorized corporate officer.
We agree to furnish and install the above described labor and materials on the terms indicated below for System #
TOTAL INVESTMENT $ 9,3c45 --o' 50% DEPOSIT $ 1
FPUDEALER REBATE $ - 50% DUE WHEN ®d
READY TO OPERATE $
YOUR INVESTMENT $ i s .
PERMIT
PURCHASER E NOT INCL ED DATE � . � /
REPRESENTATIVE
VALID FOR 2 WEEKS
JOB NOTES
Inspection Worksheet L
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-224858 Permit Number: MC -6-14-1299
Scheduled Inspection Date: May 20, 2015 Permit Type: Mechanical - Commercial
Inspector: Perez, JanPierre
Owner: CHURCH, MIAMI SHORES BAPTIST
Job Address: 370 GRAND Concourse
Miami Shores, FL 33138-2747
Project: CHURCH
Inspection Type: Final
Work Classification: A/C Replacement
Phone Number (305)758-0559
Parcel Number 1132060136040
Contractor: C&R AIR CONDITIONING CO Phone: 305-685-6394
6miamg ueparEment luomments
EXACT REPLACEMENT OF 3 1/2 TON CONDENSING
UNIT
Passed
Failed
Correction
Needed
Re -Inspection ❑
Fee
No Additional Inspections can be scheduled until
re -inspection fee is paid.
INSPECTOR COMMENTS
Inspector Comments
CREATED AS REINSPECTION FOR INSP-214475. need permit for other
two units
May 19, 2015 For Inspections please call: (305)762-4949 Page 4 of 40