MC14-2659 Miami Shores Village i.�- , -
f �D
Building Department ' DEC 05 2014
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305)795-2204 Fax:(305)756-8972 J_
INSPECTION LINE PHONE NUMBER:(30S)762-4949
FBC'�(20 l 0
BUILDING Master Permit No. I��i-I — 2MO?
PERMIT APPLICATION Sub Permit No.M 02-1y
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION DRENEWAL
❑PLUMBING 0 MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
//�� CONTRACTOR DRAWINGS
JOB ADDRESS: " O I NE 9-7 ST
City: 1 Miami Shores County: Miami Dade Zip: 53 15&
Folio/Parcel#: 1 -8�)(p -f.) " '3 10 Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name(Fee Simple Titleholder): �� H � I I LL.L_. Phone#: ��J � 07 -4(_-415
Address: 1040 tAF— me-
City: $4 j 1M) f)"o State: FA- zip: 33 l 38
Tenant/Lessee Name: Phone#:
Email: &AC
CONTRACTOR:Company Name: Tc'G tSCifi /[ L°L Phone#:
Address:445.2-/ M0 -33KO AtIcs-_
City: State: Z__C Zip:
Qualifier Name: c,JC, Phone#: 3es_35sf-4 Z%7
State Certification or Registration M Ab 5-3 7� Certificate of Competency M
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ ✓ r Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration New ❑ Repair/Replace ❑ Demolition
Description of Work: '
Specify color of color thru the
Submittal Fee$ Permit Fee$ ��r� CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$ _ l
TOTAL FEE NOW DUE$ ✓y
(Revised02/24/2014) W
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
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 commencement must be pos ed at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the abse of su osted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature Signature
NER or AGENT
7tru
RACTOR
The for going instrument was acknowledged before me this The fore oing insacknowledged before me this
day of � 20!, by F day of 20 , by
who is personally known to who is personally known to
me or w as pro uce as me or ho has produce as
identifica Ion and who did take oath. identification and who di ake an oath.
NOTARY PUBLIC, NOTARY PUBLIC:
Sign: Sign:
Print: Print:
t an Not Public State of Florida ,a+puy Notary Public State of Florida
Seal: ; Maxine Y Gomez Seal Maxine Y vomer
o` AAV Commission EE 939239 WV ommission F.c 339239
'?ov�,o° Exp res 09/30/2016 'ica�oP Expires 09/30/2016
************************************************************************************************************
i
APPROVED BY _ , i Pl ins Examiner Zoning
Structural Review Clerk
(kevised02/24/2014)
`SNORES Miami Shores Village
Wc-1932
Building Department
l.,, 10050 N.E.2nd Avenue
Miami Shores, Florida 33138
4��—�.a„o Tel: (305) 795.2204
OR 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.7
Job Address(where the work is being done): "/ ►4 /
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
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: c 4C� Phone: 3D5='��1
State Certificate or Registr o o. Certificate of Competency No.
Signature Date: _'Z Z
r s sign re) ---
(Revised02/24/2014)