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REV-16-392 �(p Miami Shores Village V I ng Department FEB 1Z 201 10 n Avenue, Miami Shores, Florida 33138 el:(30 795-2204 Fax:(305)756-8972 ON LINE PHONE NUMBER:(305)762-4949 Std FBC 201 I NG Master Permit No.RC-?-i 5 `1'3 q9 PERMIT APPLICATION Sub Permit No. :9E;V_V 16--,3':?Z ❑BUILDING ❑ ELECTRIC ❑ ROOFING [Y/REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP qCONTRACTOR DRAWINGS JOB ADDRESS: 1 /�L� �l ST2E,e::-7- City: Miami Shores County: Miami Dade Zip: 3N-32 Folio/Parcel#: 1152050"V(0 I Is the Building Historically Designated:Yes NO Occupancy Type:S.F11M Load: Construction Type: C13 Flood Zone: BFE: FFE: OWNER: Name(Fee Simple Titleholder): lgtw Phone#:(3'C* I657-?73 3 Address: 119'/ /JE L/ 5E City:M/A,41 i St/40 Q,�S T State: FL_ Zip: 3 3 1 3 Tenant/Lessee Name: Phone#: Email: rr CONTRACTOR:Company Name: ��yv"7 JLO �&dSZChi Phone#:CQ')G) Address: 2-3 -) OL if lv 2 C T City: ,✓¢A 6 f S dA't�S State: If L- Zip:-3-313P — Qualifier Name: 7 Phone#: S State Certification or Regist ation#: & 1331185 Certificate of Competency#: DESIGNER:Architect/Engineer: 5n. ' yzxj Phone#(q5-y*t? - -20q,? Address: 6,Sl( khjUro DI/ L_ JD 7 City:EJ� State: /�:?- Zip:313(7 Value of Work for this Permit:$ S-0110 Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alternation ❑ New [Repair/Replace ❑ Demolition Description of Work: i�Q Itl�� /�� Oc.�4 J&n-,x e--- Specify color of color thru tile:_ _ Submittal Fee$ Permit Fee$ V 4 C:)OCCF$ apt CO/CC$ d� Scanning Fee$ Radon Fee$ - DBPR$ \J Notary$ Technology Fee$ `J -� Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ (0p ' (Revised02/24/2014) 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 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 c�'C/ Signature a4t:�4A OW ER 41AGENT CONTRAC R The foregoing Orinstr ment was acknowledged before me this The foregoing instrument was acknowledged before me this day of 20 1(0 by (3V4"' day of 20 1 CO , by eDraAkfi,, \ who is personally known to who is personally known to me or who has produced as me or who has pro uced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: 1 ' Sign: Print: 2s Print: !' Seal: Seal: ,`a�fi t, Heather Mulroney ;�= COMMISSION#FF125227 y EXPIRES: May 21, 2018 y _ COMMISSION#FF125227 WWW.AARoNNoTARY.COM oil WWW.AARONNOTARY.COM �gr1�H Aar APPROVED BY xaminer Zoning Structural Review Clerk (Revised02/24/2014) it �sHO1 y� Miami Shores Village Building Department sell 10050 N.E.2nd Avenue Miami Shores, Florida 33138 04Oy ORTel: (305)795.2204 �liDp' 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. Job Address(where the work is being done): / 2q I ijfs 4 cy�7 _-: 7- City: City: Miami Shores Village County: Miami Dade Zip Code: 3 3© 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❑ NOP 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): -70� . 3 A 2. Maximum Overcurrent Protection (Fuse/Breaker Size): 3. Voltage of Circuit (208/240/480): ZD t7 ' /1- 3 y 4. Size Disconnecting Means: O 1 Contractor's Company Name: r, ,�— t1�9iJ GAS Phonetic ) State Certif' ate or R =a1ifier's C;�r ! z.a Certificate of Competency No. Signatu ' Date: 2 / ioe) (Revised02/24/2014) This combination qualifies for a Federal Energy Efficiency Tax Credit when placed in service rr between Feb 17,2009 and Dec 31, 2016. Certificate of Product Ratings AHRI Certified Reference Number: 5632103 Date: 2/10/2016 Product: Split System:Air-Cooled Condensing Unit,Coil with Blower Outdoor Unit Model Number: 24ACB760A**31 Indoor Unit Model Number: FV4CNB006 Manufacturer: CARRIER AIR CONDITIONING Trade/Brand name: CARRIER Region: All (AK,AL,AR,AZ, CA, CO, CT, DC, DE, FL, GA, HI, ID, IL, IA, IN, KS, KY, LA, MA, MD, ME, MI, MN, MO, MS, MT, NC,ND, NE, NH, NJ, NM, NV, NY,OH,OK,OR, PA, RI, SC, SD,TN,TX, UT,VA,VT,WA,WV,WI,WY,U.S.Territories) Region Note: Central air conditioners manufactured prior to January 1,2015, are eligible to be installed in all regions until June 30,2016. Beginning July 1, 2016,central air conditioners can only be installed in region(s)for which they meet the regional efficiency requirement. Series name: COMFORT 17 PURON AC Manufacturer responsible for the rating of this system combination is CARRIER 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): 59500 EER Rating (Cooling): 13.00 SEER Rating(Cooling): 16.50 IEER Rating (Cooling): '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, AM personal and confidential reference. AIR-CONDITIONING,HEATING, CERTIFICATE VERIFICATION &REFRIGERATION INSTITUTE The information for the model cited on this certificate can be verified at www.ahridlrectory.org,click on"Verify Certificate"link a make hte b,tt rj­ and enter the AHRI Certified Reference Number and the date on which the certificate was issued, which is listed above,and the Certificate No.,which is listed at bottom right ©2014 Air-Conditioning,Heating,and Refrigeration Institute � CERTIFICATE NO.: 1309%062105686523