MC-12-569 (2) Miami Shores Village AM 0 3 2010
Building Department BY-----K
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel: (305)795.2204 Fax: (305)756.8972
INSPECTION'S PHONE NUMBER: (305)762.4949
FBC 20 10
BUILDING Permit No..w 1 -5(09
PERMIT APPLICATION Master Permit No.—A,-
Permit Typ MECHANICALS
JOB ADDRESS:
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: /'/— -3 945 — a2S-r
Is the Building Historically Designated:Yes NO Flood Zone:
zzc
OWNER:Name Fee Sim le Titleholder): 1W01'9fi/t%9 '✓ 1I&?Z /)r7S ~ Phone#: (36
Address: �v-7 :X�/1 "
City: ��C/17/w. /('alert state.; Zip:
Tenant/Lessee Name: CLQ Phone#:
Email:
CONTRACT/OR: Company Name: C F//Yl 5 �r t(2 �� Phone#:
Address: jCW�y -//.3
City: elW il-O P>12e,�g State: Zip:
Qualifier Name: 0l �`1 y Phone#: �s
State Certification or Registration
#: 7 � �� Certificate of Compej>ency#:
Contact Phone#: �_ �7S- d�d Email Address:
DESIGNER: Architect/Engineer: rl `h Phone#:
Value of Work for this Permit: $ A/J 019.00 Sare/Linear Footage of Work:
Type e of Work: OAddress ❑Alteration fY a P P
❑Re air/Re lace ❑Demolition
Description of Work: /' ��� 1�677
;sv*
Submittal Fee$ Permit Fee$ CCF$ CO/CC$ /
Scanning Fee$ Radon Fee$ DBPR$ Bond$
Notary$ Training/Education Fee$ Technology Fee$
Double Fee$ Structural Review$
TOTAL FEE NOW DUE$
Bonding Company's Name(if applicable) �CAI
Bondittg Company's Address
City State Zip
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 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 inspecti whit rs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will no a roved and a ' spection fee will be charged.
Signature Signature
caner or A nt �/�� �j� Contractor
The foregoing instrument was acknowledged before me this 4f(�1 The for oin instrument was acknowledged befor me this
day of'� '20�,by FG-i� f iW* �1'L d(day of L ,209, 1y -
whois rsonally kno to me or who has produced iMM��Ywho is personally known tome or who has produced /
identification and who did take an oath. as identification and who did to oath.
NOTARY PUBL C: OTARY P I
Sign: Sign:
Print: Ile /() �� L Print: Osz3ya—
My Commission Expires: JULIA AMOSOVA� My Commissio --�-A AMO80VA
MY COMMISSION#D0913804
JULIA
EXPIRES August 04,2013 *_ MY COMMISSION#DD913804
t sere .tom '-�'i EXPIRES�tAuugguust 04,2013
********************* ******************* *ori `****�t�ie9e�k'ke�`i50taryJOikit�.rd�'.eY1Vh**fie**
(407)398-0153
Flor a
APPROVED BY /' Plans Examiner Zoning
Structural Review Clerk
w.
(Revise'd 2/201*XR8wi§a107/10/07)(Revised 06/10/2009)(Revised 3/15/09)
5NOIR193iES
Miami Shores Village
—�.
Building Department
'_toRmp 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): 4W All 7
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 ❑
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 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: y / Phone:
State Certificate or Registration N. � %�% y���2 Certificate of Competency N.
Signature Date:
(Qual' s signature only)
CANCELLED