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MC-16-306 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-252176 Permit Number: MC-2-16-306 Scheduled Inspection Date: February 17,2016 Permit Type: Mechanical - Residential Inspector: Perez,JanPierre Inspection Type: Final Owner: WOLLMANN,ADOLPH Work Classification: A/C Replacement Job Address:54 NW 110 Street Miami Shores, FL 33168- Phone Number (305)758-5901 Parcel Number 1121360030050 Project: <NONE> Contractor. ALL STAR APPLIANCE AND AIC 2SERVICE INC Phone: (305)962-8603 Building Department Comments NEW AC 4 TON Infractio Passed Comments INSPECTOR COMMENTS False TO REPLACE ME2003-104 1 G� V m Inspector Comments B Passed t. ? �•,c '� Failed Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. February 16,2016 For Inspections please call: (305)762-4949 Page 20 of 40 7 Miami Shores Village , �"Identlall t­�' : �� 10050 N.E.2nd Avenue NW e r � INt f C G/aSSt it a A/i (aci8rno"!t. ""'C' Miami Shores,FL 33138-0000 a=, y� Phone: (305)7952204 " PIPROVED' tORlt►�' Issue Date:2t1212016', Expiration: 08/10/2016 Project Address Parcel Number Applicant 54 NW 110 Street 1121360030050 Miami Shores, FL 33168- Block: Lot: ADOLPH WOLLMANN Owner Information Address Phone Cell ADOLPH WOLLMANN 54 NW 110 ST (305)758-5901 MIAMI SHORES FL 33168-4319 Contractor(s) Phone Cell Phone Valuation: $ 5,408.00 ALL STAR APPLIANCE AND A/C 2SEF (305)962-8603 Total Sq Feet: 0 i i Tons:4 Available Inspections: Additional Info: Inspection Type: Classification:Residential Final Approved:In Review Review Mechanical Comments: Date Approved::In Review Date Denied: Type of Work: Scanning:3 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $3.60 DBPR Fee Invoice# MC-2-16-58558 $2.64 02/03/2016 Check#:1534 $50.00 $168.56 DCA Fee $2.84 Education Surcharge $1.20 02/12/2016 Check* 1537 $ 168.56 $0.00 Notary Fee $5.00 Permit Fee $189.28 Scanning Fee $9.00 Technology Fee $4.80 Total: $218.56 In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting,this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS.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. Futhermore,I authorize the above-named contractor to do the work stated. February 12, 2016 Authorized Signature:Owner / Applicant / Contractor / Agent Date Building Department Copy February 12,2016 1 FOR: ADOLPH WOLLMAN _ 54 NW 110 ST MIAMI SHORES, FL. 33168 C/U SECURED TO 4" CONCRETE SLAB 305-758-5901 USING ANGLE BRAKET 1"#8 NAILS BY: SEARS ROEBUCK& CO. SHOT DOWN THRU BASE AND 2-22G , 6801 W. SUNRISE BLVD. METAL STRAP IN A GIFT MANNER, WITH oo PLANTATION, FL. 33313 ONE SIDE SCREW TO ABLE TO SERVICE fib. QUALIFIER: DANIE . VAYDA UNIT. EQUPMENT SCHEDULE CAC013320 EQUIPMENT: CARRIER SIGNATURE: 38BRC048*** NOTAY: 54 FK4DNF006 DATE: SEER: 14 SC: 33600 FL. ROOM LC: 14400 30X9 BA H TC: 48000 CFM: 1600 603 CFM 3 KW: 8 __ 3-10"X6" O/L it 12 3 3 -- REF LINES: 3/8"SUC. ;3/8"LIQ - �, 1/2"ARMAFLEX INSL. DRAIN LINES: 3/8" PVC. BR 3 TH KIT. 12X12 5 8X12 \4-DINEE DUCT WORK: R-6 FLEX. CF 13X13 4' 6" I Y (*) R/AGRILL ON ALL BR DOOR (8"X8") 12 Jig 8 CFM 9 174 CFM "X6" 10"X8" 135 CFM == ) 101IX611 AH/U ON EXISTING SUPPORT OR SUPPORT J`` STAND. LINES THROUGHT ATTIC AS SHOWN OR THROUGH CRALW SPACE IF NOTED. ��'jn (* Ali {*) LoDEAN -- "' 115 CFM 9X11 182 CFM 118 Q " 10"X8" 10"X6" ly 158 CFM LOQ ATa� 12 - DEOTION ° L0 (1 10"X6" O/L 18 b FAH RECTION I� (*) BR 1 LIVING F,LT£RAGO£By BR 2 12X10 13X13 AG4I 5tvhd). 12X12 SCALE '/4=1" oar. SHEET 1 OF 1 12 12 12 18 s. • ,� � 4 i l��C,�1���l�� �� f� ��o�� �. /3. a 3 Project Summary Entire House BY: SEARS HEATING AND COOLING 6801 W.SUNRISE BLVD,PLANTATION,FL 33313 Phone:305-552-1590 Fax:305.552-6895 i For: ADOLPH WOLLMAN 54 NW 110 ST, MIAMI SHORES,FL 33168 Phone:305-758-5901 Notes: Weather: Miami, Intl AP,FL, US Winter Design Conditions Summer Design Conditions Outside db 50 OF Outside db 90 OF Inside db 70 OF Inside db 75 OF Design TD 20 OF Design TD 15 OF Daily range L Relative humidity 50 % Moisture difference 56 gr/lb Heating Summary Sensible Cooling Equipment Load Sizing Building heat loss 16669 Btuh Structure 28776 Btuh Ventilation air 62 cfm Ventilation 1009 Btuh Ventilation air loss 1354 Btuh Design temperature swing 3.0 OF Design heat load 18023 Btuh Use mfg.data Rate/swing multiplier 0.95 Infiltration Total sees.equip.load 28265 Btuh Method Simplified Latent Cooling Equipment Load Sizing Construction quality Average Fireplaces 0 Internal gains 1200 Btuh Ventilation 2331 Btuh Heating Cooling Infiltration 2212 Btuh Area(ft2) 1252 1252 Total latent equip.load 6149 Btuh Volume(ft3) 10016 10016 Air changes/hour 0.75 0.35 Total equipment load 34415 Btuh Equiv.AVF(cfm) 125 58 Req.total capacity at 0.70 SHR 3.4 ton Heating Equipment Summary Cooling Equipment Summary Make Make Carrier Trade Trade WeatherMate 38BRC Model Cond 38BRC04830/33 Coil FK4DNF006 Efficiency 80 AFUE Efficiency 14 SEER Heating input 0 Btuh Sensible cooling 33600 Btuh Heating output 0 Btuh Latent cooling 14400 Btuh Temperature rise 0 OF Total cooling 48000 Btuh Actual air flow 1600 cfm Actual air flow 1600 cfm Air flow factor 0.096 cfm/Btuh Air flow factor 0.056 cfm/Btuh Static pressure 0.00 in H2O Static pressure 0.00 in H2O Space thermostat Load sensible heat ratio 83 % Printout certified by ACCA to meet all requirements of Manual J 8th Ed. wnghtsofjt RightSuite Residential J8 5.8.23 RSR31452 2003-Jun-03 21:26:56 CAMy DocumentslWrightsofi HVAC%ADOLPH WOLLMAN.rrp Calc=MJS Orientation=N Page 1 Entire House Right- 8Xorksheet Job: o j Date: By: SEARS HEATING AND COOLING 6801 W.SUNRISE BLVD,PLANTATION,FL 33313 Phone:305-552-1590 Fax:305-552-6895 1 Room name Entire House LIVING 2 Exposed wall 143.0 ft 13.0 ft 3 Ceiling 8.0 ft d 8.0 ft heat/cool 4 13.0 x 13.0 ft 5 Room area 1252.0 f12 169.0 fl2 Ty Construction U-value Or HTIVI Area (f12) Load Area (" Load number (Btuhfft2-*F) (Btuh/ft2) or perimeter (ft) (Btuh) or perimeter (ft) (Btuh) Heat Cool Gross NPIS Heat cool Gross N/P/S Heat Cool ............ ...... 6A .0240 ....... .............. ..... ........ ....... n .... X1372 1432 42 ** 3 i ................ .. .................. 110¢ 0: ........ Q 0. ..... ...... I—.... :;::I Q ­X.X.X- 0 0 0-40 ::x: 11 %Ih 12A 4)sw 0.240 e 4.81) 7.37 33 -45 0 0 0 0 IIA-clorn 1.270 e 25.40 67.47 78 13 1981 4741 0 0 0 0 1A-clomd 1.270 a 25.40 67.47 0 0 0 0 0 0 0 0 11J0 0600 e„. ....12.00 .....18142. 0 ..... 0 .......0 ...... ........0 ........ Q 0- 0 0,240' 61: :X 7 X.. . ............ .... .. X: . ....... IBM :,,Xxx Q �:x X::x. :�:::�::o :12 72: X., AArolomd: 1,270 v -0 :0 0 0 t1 XX xx X .......... ............ . ....... ... 1202sw 0.186 w 3.72 5.71 13 -5 -19 -29 0 0 0 0 IA-clorn 1270 w 25.40 60.73 is 3 467 985 0 0 0 0 IA-clornd 1270 w 26.40 67.47 0 0 0 0 0 0 0 0 IIJO 0.600 w 12.00 18.42 0 0 0 0 0 0 0 0. C 160-7E' x: M.412: .224: 834 982 z 169 469 379: C 17A-Oad 0.287 5.74 18.71 270 270 1550 5052 a 0 0 0 22A_1ph: 1.365 27 OW 3631: .. ....................... ....... .... . ............. ............. ............ ....... . ........ .................. ....... ............. .. ........ .........................................*.. ...... ....... ........................... .. ......... . ................... ......... ....... .......... ... .. ............ . ........... ....... . ........ .. ....... ..... X: ........... ........... ................ .......... ....... . .... .. ...... ....... ....... . .......... ............. .......... ........... .......................... ........ ... ....... ......... .......... ...... ....... ....... ...... ........ X XX ........ ............... ... ........... ............. ........ ............. ...... . ............ .......... Envelope loss/gam 12898 21707 1041 1730 12 a) Infiltration 2753 957 250 87 b) Ventilation 0 0 0 0 13 Internal gains: Occupants @ 2210 6 1380 0 0 Appliances @ 1200 1 1200 0 0 Less external toad 0 0 0 0 Less transfer 0 0 0 0 Redistribution 0 0 0 0 14 Subtotal 15651 25244 1292 18171 15 Duct loads 7% 114% Iola 3531 7% 14% 84 254 Total room load 16669 28776 1376 2071 Air required(cftn) 1600 16001 132 115 Printout certified by ACCA to meet all requirements of Manual J ft Ed. NOW"4_=J"V�--oft Right-Suite Residential J85.8.23 RSR31452 2003-Jun-03 21:26:56 A=k CAMy DocurnentsWrightsoft HVAGAIDOLPH WOLLMAN.rrp Calc=MJ8 Orientation=N Page 1 Right-J8 ight- 8 Worksheet Job: House s Entire j e: SEMS HEATING AND COOLING 6801 W.SUNRISE BLVD,PLANTATION,FL 33313 Phone:306-552-1590 Far.305-552-6895 1 Room name DINING BR 1 2 Exposed wall 0.0 ft 12.0 ft 3 Calling height 8.0 ft heallcool 8.0 ft heat/cool 4 Room dimensions 13.0 x 13.0 ft 12.0 x 10.0 ft 5 Room area 169.0 W 120.0 W Ty Construction LLvWue Or HTIVI Area (ft2) Load Area (ft2) Load number (Btuhift2-*F) (Btu or perimeter (ft) (Eltuh) or perimeter (ft) (Btuh) Heat Cool Gross N/P/S Heat Cool Gross N/P/S Hat Cool . ............... 4I 6 xx ......X, 0. 24", .0 a TZ A-0 1 1 2_.7-4, 26 xx 26 0 .......Q.:::*..*.,,.:%:z::: . ..... ...... ....... 0 0 ........ 11A0 .. ... .. ............ ................. ................. .... .. .......... ..... . .......... ... A7. 11 Vh12A-0sw 0240 a 4.80 7.37 0 6 0 0 0 0 0 0 1A-clom 1270 a 25.40 67.47 0 0 a 0 0 0 0 0 IA-clomd 1270 a 25.40 67.47 0 0 0 0 0 0 0 0 Ilia 0.600a 12. 8 0 0 0 a 0 ..............0...............0, v i ......... ......00 1-42 0 .... ....... 0 0 0 0 .. ......... 4W ...7i 0 ** ***** n :0 ::: x. 0 .......... ................. .........1. 1 .1 ..::;..a : ::-., ......... ... ............... .............. ......... ...... .......... ............................- JA,0110W, :::�xl 270. S::- 0 ... .................0 0 ............ .40 a 12A-2sw 0.186 w 3.72 5.71 0 0 0 0 0 0 0 0 IA-clorn 1270 w 25.40 60.73 0 0 0 0 0 0 0 a 1A-clomd 1270 w 25.40 67.47 0 0 0 0 0 0 0 0 ilia 0.600 w- 12.00 18.42 .0 0 0 0 0 0 0. C I F 16A Tat:: t #12X 8,3 jo 69 379 14D4:::1:::::: 420 1 C 17A-Oad 0287 5.74 18.71 0 0 0 0 0 0 0 0 XXXVA �ajm: ::::41" p .......... ........... ............ ............... ...... ............ ....... ..... ............ ............. ...... ... ... . .... .......... ........... ........... . .......... ................ ........ ................................. ......................... .. ................. .......... ---.......... .................. ...... ..... .................................. .......... .... .... ........ .......... .......... ............. ......... ............. ........ .. ................. ..... .............. ................. .......... ...... ........ .. ........ .......... .......... . .. ....... ..... ........ ....... ................. . ........... ........... .. ..................... . ..... .. ...... ...............I...... ......... .......... ........... ....... .......... ........... .............. ............ .... .............. ...... ....... ............. .......... ... . ............ Envelope loss/gain 379 14041 900 1316 12 a) Infiltration 0 0 231 so b) Ventilation 0 0 1 0 0 13 Internal gains: Occupants @ 230 0 0 2 460 Appliances @ 1200 0 0 0 0 Low external load 0 0 0 0 Less transfer 0 0 0 0 Redistribution 0 0 0 0 14 Subtotal 379 1404 1131 1856 15 Duct loads 7% 14% 25 196 7% 14% 74 2601 Total room load 403 ISM 1204 2115 Air required(cfm) 39 89 1161 118 Printout certified by ACCA to meet all requirements of Manual J ft Ed. %Owr-240"lltff�- ft Right-Suite Residential J8 5.8.23 RSR31452 2003-Jun-03 21:26:56 CAMy DocumentsWrightsoft WACOMLPH WOLLMAN.rrp Calc=MJ8 Orientation=N Page 2 Entire House Bghttir- 8 �orksheet Job: j e: SEMS HEATING AND COOLING 6801 W.SUNRISE BLVD,PLANTATION,FL 33313 Phone:305-552-1590 Fax:305-55243895 I Room name BR BR 3 2 Exposed wall 24.0 ft 23.0 ft 3 Ceiling 8.0 111 heat/cool 8.0 ft heal/cool 4 n jons 12.0 x 12.0 111 11.0 x 12.0 ft 5 Room area 144.0 f[2 132.0 ft2 Ty Construction U-value Or KTIVI Area (ft) Load Area (ft2) Load number (Btuh/ft?*F) (Btu or perimeter 00 (Btuh) or perimeter (Fl) (Btuh) Heat Cool Gross N/IPIS Heat Cool Gross N/P/S Heat Cool 40 -7.37 6 ...... ........... v 4M. .......... _42, :26AO ZOV, 32. 04:: 1�227 26V ... ...... . ... ................ ....►.................. ...... ... .... 4 IA*,%� 4M,...fi- 14-0. 11 12A4)sw 0240 a 4.80 7.37 12 0 0 1 0- 1 1 2 0 0 0 1A-clorn 1270 a 25.40 67.47 12 2 305 729 12 2 305 729 IA-clomd 1270 a 25.40 67.47 0 0 0 0 0 0 0 0 1140 ?QQ 0 0 .............0 .............0. ......1.8.42 .............0 ..... 0 0 0 a... 12 ;:* X **: - . ::::: ............ 1As1om 1270 �:�,0 02-40. --.-i".4.0'..-::::::-.-.TAT .......... .............. ........... ....... ...... ........ 142 318: 0 ........... ...... .............. IA-ajomd.: 22 0 fl 0 0 00....... 11 q XXXX.,- 12A-2sw 0.186 w 3.72 5.71 0 0 0 0 0 0 0 0 1A-clorn 1270 w 25.40 60.73 0 0 0 0 0 0 0 0 IA-clomd 1270 w 25.40 67.47 0 0 0 0 0 0 0 0 0.600...w...._12.00..._.18.42...............0....... _0 0 0 0 0 ....0. ;X::. 144. 144 X. C, X ...... ....... 11w7a .2.24. C 17A-Dad 0287 5.74 18.71 0 0 0 0 0 0 0 0 1w ................................. ...... .......... ............... .............. .......... ............ ........... ................................. ...................... ....................................... ........... ...... . ....... ................. ............. ......... ......... ............................... ...........- .............................. ................ ......... ........... .......... ............ ...... .............. ........ ..................... ............. ....... ..... .. .... . .... .. ............ ...... .............. ........... .............. .......... ... ............... ....... ..... ....... ......... ............ .. ............... .... .......... ............................. ............. ............... ..... . ...... .. . ................. .......................... ............... ....................... . ................ ................ . ................. .......... .....I...I...- ...... ........... ................ ................ ........... .. .. .................... ....... ............. ...... ........... . .......... . ............. ..... .............. Envelope loss/gain 1584 2244 1525 2137 12 a Infiltration 462 161 443 154 Ventilation 0 0 1 0 0 13 Internal gains: Occupants @ 230 2 460 2 460 Appliances @ 1200 0 0 0 0 Low external load 00 0 0 Less transfer 0 0 0 0 Redistribution 0 0 0 0 14 Subtotal 2046 2865 1 968 2751 15 Duct loads 7% 14% 133 4011 7% 14% 128 Total room load 2179 3266 2096 3136 Air required(cftn) 209 1821 201 174 Printout certified by ACCA to meet all requirements of Manual J 8th Ed. NOW"SJVMS�- ft Right-Suite Residential J8 5.1123 RSR31452 2003-Jun-03 21:26:56 AMk CAMy DocumentslWrightsoft WACODOLPH WOLLMAN.rrp Calc=MJ8 Orientation=N Page 3 Right-J8 R - Worksheet Job: Entire J8 Dalte: in e House By: SEARS HEATING AND COOLING 6801 W.SUNRISE BLVD,PLANTATION,FL 33313 Phone:305-552-15W Fax:305-552-6895 1 Room name BATH I MCHEN 2 Exposed wall 5.0 ft 5.0 ft 3 Coiling height 8.0 ft hest/cool 8.0 ft heal/cool 4 Room dimensions 5.0 x 7.0 ft 8.0 x 12.0 ft 5 Room area 35.0 ft' 96.0 ft' Ty Construction U-value Or HTIVI Area (f12) Load Area (ft2) Load number (Btuh/ft2-*F) (Btu or perimeter (ft) (Btuh) or perimeter (ft) (Btuh) Heat Cool Gross N/PIS Heat Cool Gross N/P/S Heat Cool ............... 7 61 1*2A-0sw::: 02x4r0a nn X4841(11 276352 0a 0a a . ....... ... ............. ... ............ ........ ..... . .......... 1Xo1*md*....... V 41fl fl fit 13 ..... ... .. 11 12A-0sw 0240 0 4.80 7.37 0 0 0 0 0 0 0 0 1A-clorn 1.270 a 25.40 67.47 0 0 0 0 0 0 0 0 IA-clomd 1270 9 25.40 67.47 0 0 0 0 0 0 0 0 �0161001...e. .....1200. , . ......110 ..............0 Q Q ....-_0 ............Q 0 0, ............ 737 ........ ....... 1Aat1om 4270 ........... ..... 3 76T. 3 .............. ...... .......... ........................ .............. ..... ? 40 30 a0 ......... ....... V ...... IIAW, M— 44, .0. 12A-2sw 0.186 w 3.72 5.71 0 0 0 0 0 0 0 0 1A-clorn 1270 w 25.40 60.73 0 0 0 0 0 0 0 0 IA-clomd 1270 w 25.40 67.47 0 0 0 0 0 0 0 0 11J0 0600 18.42 0 0 0 0 0 0 7raE ...... 1w, 78 29t 9& gs: C 17A-Cad 0287 5.74 18.71 0 0 0 0 0 a 0 0 Xxx: -"136: ........... ........... ....... ........... .............................. ...... .............. ............. ............. ...... .............. ........................ ............. .......... ...... .......... ...... ................................. ................ ................................ ... ......... .... ..1.11............. ........................ ........... ...... ................. ............ .......... ...... .............. .. .................................. ........ ...... . . . .. ........................ ........... .......... ................................. ....... ................... ............ ......... ...I....... . ......... ........... ..... ................................. ......... ......... ............... . ....... .......... ........................................ ...... ..........--........ ............... ....... ..... .................. ....... ............... .......... ...... ....... ......... . ...... . .. .......... .. ...... .......... .. ............. .... ... . ......... ........ ........... .... ... .... . ...... ...... ............... ... ........ . ...... . ..... ................ ......... .......... ..................... . ......... ................. .... ............ ................. ............ ..... ..... ........ ........ ... . ................. ........ ... ....... ........ .......................... ... ... . ................. .......... ...... .............. ......... ...............X . .... .............. .............. ... ......... ....... ... ....... ....................... ........ ..........---....... ............. .............. ............ .............. ............ . ................ ... .... .......... ................ ............ ... .........—..... ............... ................ ............ ... ....... .............. ........... Envelope kms1gam 300 385 437 892 12 a) Infiltration 96 33 96 33 b) Ventilation 0 0 0 0 13 Internal gains: Occupants @ 230 0 0 0 0 Appliances @ 1200 0 0 1 1200 Less external load 0 0 0 0 LOW transfer 0 0 0 0 Redistribution 0 0 0 0 14 Subtotal 396 419 533 2126 15 Duct loads 7% 14% 26 w 7% 14% 35 297 4771 5W 242 Air required(cfm) 27 54 135 41 -iF Total mom load 422 3 Printout certified by ACCA to meet all requirements of Manual J 8th Ed. Right-Suite Residential J8 5.1123 RSR31452 2003,Jun-03 21:26:56 CAMY DocumentaWrightsoft HVAC\ADOLPH WOLLMAN.rrp Cato=MA Orientation=N Page 4 Right-J8 Worksheet Job: E Date: Entire House By: SEARS HEATING AND COOLING 6801 W.SUNRISE BLVD,PLANTATION,FL 33313 Phone:305-552-1590 Fax:305-552-6895 1 Room name FL.ROOM DEAN 2 Exposed wall 39.0 ft 22.0 ft 3 Coiling height 8.0 ft heat/cool 8.0 ft heat/cool 4 Room dimensions 30.0 x 9.0 ft 9.0 x 13.0 ft 5 Room area 270.0 ft' 117.0 f12 Ty Construction U.-value Or HTM Area (ft2) Load Area Load number (Btuhtft2_*F) (Stuhm or perimeter (ft) (Btuh) or perimeter (ft) (Btuh) Heat Coal Gross N/P/S Heat Cool Grow NIPIS Heat Cool ........... .... .. ........ 6 12A flaw: ...... w .......... W.M 0: O� Ilt a 457 4": ...... ..... 0: :Ilkolomd... : ::*::::::m .��.": AO .......... .......... ................. ::X:0 41 41A '0 11 12A-0sw 0.240 e 4.80 7.37 9 45 -216 -332 0 0 0 0 A-clom 1270 a 25.40 67.47 54 9 1372 3282 0 0 0 0 IA-clomd 1270 a 26.40 67.47 0 0 0 0 0 0 0 0 Q.6W 12.00 18.42 0 0 0 0 Q ..........0 ......0 ..............0 ....... ........................... ...... ........... .......... .7 X A:::.- ...... .7 ...........- .... ................................ ........... .... .... ................. .. ........ ..... ......... ....... :54 :1M 14-32: 1A lord .... ...... ... .......... ...... ....... .......... ......... ........ . ......................... ....................................... .........- ... ................ ..................... ...........- .......... .......... .. 0, p Xclothdr: 0 .......... .......... ....... 11A06:11M 6 0.4.76. 0. N12A-2sw 0.186 w 3.72 5.71 0 0 0 0 13 -5 -19 -29 1A-clom 1270 w 25.40 60.73 0 0 0 0 18 3 457 985 IIA-clomd 1270 w 25.40 67.47 0 0 0 0 0 0 0 0 iijo 0.600 w 1200. 18.42 0 0 0 0 0 0 0 0 ............. ............ ... . .. .... .......... WA-7w �x: ::.:,a 31.. x............xxxo: 972 X 0,142. C 17A-0ad 0287 5.74 18.71 270 270 1550 5052 0 0 0 0 :::Am 2:"h 8: 0.0: 27fl 3$ ..... ............. ............. ............ . ........................... .... ........... ........... . ..... ........ .... . .................. .......... . . ........ ............................. .............. .. .............. ...... ............ ... .... ... ............. ..... ........... . ...... . . ........ ......... ..... ............. ................ ........ ... ..... ... . ....... ........ ............... ....... .... ...... ............ .. ....- ......... . ................ ........ .. ....... ............ .......... . ....... ............ ....... . .... . ................. .. ....... .............. .......... ............ . . ....... ........... . . . ..... ....... .. ....... .... . ..... ............ .......... ....................... ............ . ........... .. .-............ ..... ..... .............. ........... ...... ...... ......................... ..........- ...................... ...... ................ ...................... ........... ................... ........ . ....... ............... .............. .. ..................... . ................ . ...... ...... ................ ...... ....... ........................................... ........ ................ ............ . ......... . ..... ..... ..................... ............... .............. ....... ......... ...... ........ .............. ....... ..................... ................ ............... ................ ............... .... . .......... .......... .. ...... ........................... ................ ............ . . .... ................ ............ ........... .......... ............ ......... ... ...... ...... ................... ................. .... . ...............................- ............... ...-11.1-- . .............. ...... ............... ........... ................... .... . .............................- - -....... ............ -... 11..........- ............ ....-....11... 1. ..... ... ....... . ............ .............................. .............. .. ......................................-.... ... ..... ..... ........... ... . ........... ............ .............................. ........ ............... ........................ ............ ....111.11,11,� .. .......................................1-1-........... . . .. ................................ .......... .........................I--........................ ................... ...... .. ........ ................ ........... ........- ........... .......... ...... ...... ..............................................- ...... ........... ...... ......................I...... ...... .................-....-......... --- ........... . ..................................... .... ........................................... . .............. ........................................ ...... .............. ......... .... ............111 ... ......... . . ....... ........ ........... ....... ................................................ ................ .... ........... ........ ..... ....I.............- ..... ..... .. .......... ...... ....... ................. ............... ..... .......... . ........ ...... ............... ................... ................. ....... ................ ..... ... ........ .................. ............. ............ .................... ........................... ............... ...... ............ .......... ............... ............. ......... ....... ....... ... ...... .............................. ....... ............... .......... ...... .......... ............................... ......... ............-.....I.......... ........ . .............. .............. ............ . ........... ....... .......... ..... ......... .............................................. ........ ........................... ...... Envelope kxWgain 5021 9259 1712 2340 12 a) Infiltration 751 261 424 147 b) Ventilation 0 01 0 0 13 Internal gains: Occupants @ 230 0 0 0 0 Appliances @ 1200 0 0 0 0 Less external load 0 0 0 0 LOSS transfer 0 0 0 0 Redistribution 0 0 0 0 14 Subtotal 5772 9520 2136 2487 is Duct loads 7% 14% 375 1332 7% 14% 139 348 Total room load 6147 10851 2276 2835 Air required(dm) 1 5901 603 218 158 Printout certified by ACCA to meet all requirements of Manual J 8th Ed. 'VW"401hlttv�ift Right-Suite Residential J85.&23RSR31452 2003-Jun-03 21:26:56 CAMy DocurnentsWrightsoft HVAC\ADOLPH WOLLMAN.rrp Cato=MJ8 Orientation=N page 5 \� Miami Shores Village Building Department artment ' ►= z�1 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 j Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 201`1 BUILDING Master Permit No PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ® MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 5 y' A V%, l L (n. A— " City: Miami Shores County: Miami Dade zip: c3 ° ) 4 8 Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name(Fee Simple Titleholder): toG, rY'w4,6 W o Phone#: x-6-6 act 3 —`++- Address: 5 AlL /V VV / /a 54 City: cz 611 f leo res State: f`` zip: 33 16Y Tenant/Lessee Name: /1,-/f4 Phone#: Email: CONTRACTOR:Company Name: P1/;rte &14-- 4�-d RIC 5 10V- Zle Phone#: Address: LFA /UL- /!,)- S% City: )VI?L-th,/ State: rleg1A�-I Zip: /4 Qualifier Name: �dY,OJ�G ��d"��C-11� Phone#: State Certification or Registration#: Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New .L❑ Repair/Replace ❑ Demolition scri 10 Ig �? Specify color of color thru tile: Submittal Fee$ Permit Fee$ II. CCF$ 3 ° G® CO/CC$ Scanning Fee$ Xly, Radon Fee$ DBPR$ 2- Notary$ �( Technology Fee$ 4 ' n Training/Education Fee$ ( Double Fee$ � Structural Reviews$ Bond$ _ TOTAL FEE NOW DUE$ (Revised02/24/2014) �1 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. SignatureG � �� G % �i�,2/ Signature OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this �—day of ` 20 1�0 by -_day of ' �� '20 by is personally known to AV-4()g4_ L-4ZUj–t6– who is personally known to me or who has produced ily�_ as me or who has produced �� �–lV 1-L2, as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: ��� �'�'° r'' /%, NOTARY PUBLIC: Sign: '� ,�'G Sign: _ O 12016 yp � � _ = Oi�RV PU9 - Print: Print: ommission # Seal• EE173059 Seal: OR D OF F CJ /III 111\0 APPROVED BY –2, 4Pans Examiner Zoning Structural Review Clerk (Revised02/24/2014) �s�jO1 i Miami Shores Village Building Department o... 10050 N.E.2nd Avenue ,,nom Miami Shores, Florida 33138 �ivoR[up 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. Job Address(where the work is being done): 5&1 /d/ d lta si City: Miami Shores Village County: Miami Dade Zip Code: 3P6'e 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# 39,ARCDYk3�67� KW HEAT NOM TONS !d -Fo A15 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 U PKG PKG UNIT / / PKG UNIT EER/SEER YES NO REPLACING DUCTS NO YES NO REPLACING THERMOSTAT NO YES NO NEW 4"CONCRETE SLAB Y N YES NO NEW ROOF STAND YES O YES NO NEW RETURN PLENUM BOX E O 1. Minimum Circuit Ampacity(Wire Size): 2. Maximum Overcurrent Protection (Fuse/Breaker Size): 3. Voltage of Circuit(208/240/480): 6 k/ 4. Size Disconnecting Means: y� P_�s- Contractor's Company Name:_ giz_ A!/— �)&P.7 r- If& � ��J done: ��� /��2 State Certificate or Registration No. Certificate of Competency No. Signature Date: (Qualifier's signature) (Revised02/24/2014) Report Viewer Page 1 of 1 JEff CHHEF AMARCM OFFIGM STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORI(IRS'COMPENSATION *`CERTIFICATE OF ELECTION TO BE EXEWT FROM FLORIDA WORI9S'COMPENSATION LAW• CONSTRUCTION INDUSTRY EXEMPTION Tht certifies that the uOviclual listed below has end to be exempt from Fiords%brkeW Compensation hoar. EFFECTIVE DATE 6/25!2014 EXPIRATION DATE: 6!26/2016 PERSON: LAROCHE ANDRE A FEIN: 223976327 9 BUSINESS NAME AND ADDRESS: ALL STAR APPLIANCE AND AIR CONDITIONING 2 SERVICE INC 585 NE 112 STREET MIAMI FL 33161 SCOPES OF BUSINESS OR TRADE: HEATING,VENTILATION, AIR-GOND Panvevtm Cbap0er4 G 14�,F.8.an affieerofa cmpm�7envdmeloft mis mnnmie dm I awt arelecOm mdwffik�may notmwuerbeaefas�em nundmffiis dmpar Pmeuedm 44D�It2).F.B.,C�sateletlmamm appq w�nmesmpa cfBmbas6masmlmde�edantAea afeks�n m be eaB�t.PUlsuWtmt:d of 14F.8.NdF;asafe mEea= eeddteameaf mbBt abep OewEjedma $eI ergr Braa e&�B/e al9re aa.. asoaDraotthe meWear b as lenges the tequtremm@�fRt3 seclba(m ate The depmtrnmdsba Wwakaaoe etaaytemfarfmlaa offfie pp peteW named WtMee+bBmmmenedtlmref9deseel�a uP P DFSF2-OWC-252 CERTWWATE OF ELECTION TO BE EX@APY fmdlsm 07-12 QUEMION8?(OW13169 9 � RICK SCOTT,GOVERNOR KEN LAW_SON,SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD ' rCAC,056323 The CLASS B AIR CONDITIONING CONTRACTOR ti Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31,2016 LA ROCHE,ANDRE ALBERT ALL STAR APPLIANCE&AIR CONDITIONING 2 SERVICE INC 565 NE 112 ST MIAMI FL 33161 ISSUED: 08/11/2014 DISPLAY AS REQUIRED BY LAW SEQ# L140811000090 https://apps8.fldfs.com/crreportviewer/reportViewer.aspx?data7—kdvpginc9D7Q3gH6TER6... 5/22/2014 Local Business Tax Receipt Miami—Dade County, State of Florida THIS IS NOT A BILL-QO NOT PAY LBT 6251771 BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES ALL STAR APPLIANCE&AIR RENEWAL SEPTEMBER 30, 2016 CONDITIONING 2 SERVICE INC 6516356 Must be displayed at place of business 565 NE 112 ST Pursuant to County Code MIAMI,FL 33161 Chapter 8A-Art.9&10 GVMER SEC_TYPE OF BUSINESS ALL STAR APPLIANCE&AIR 196 SPEC MECHANICAL sv TAX COYMENT RiLEi=o R CONTRACTOR 75.00 07/19/2015 Worker(s) 1 CAC056323 CREDITCARD-15-037158 Title Local Basiaess Tax Recelpt only wallrom payment of*e Local 8081aesa Tax.Tho Receipt B cot a license, permit,or a certification of the bold s qualification.to do bodne .Holder mast comply with any governmental or aoagovsrnmental nWtdM jaws aa>1 regnhdmeata which apply to the haslnow. The RECEIPT N8.alum meat be displayed on a8 commom al valticiea-Miami-Bade Code Sec Be-276. ® for Mon I mretion viskwwwad addaftubwleamr �1 ACORU® DATE(MMIDD/YYY1) CERTIFICATE OF LIABILITY INSURANCE 2/2/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. N SUBROGATION IS WAIVED,subject to the terms and Conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CT NAS Fannie Baez Jacksori Insurance Agency PHONENo.Extj: (305)824-3464 FNC :(305)822-8535 LAT2075 West 76th St ADDS:fbaez@jacksonagency.com INSURER(S) AFFORDING COVERAGE NAIL# Hialeah FL 33016 INSURERA Arch Specialty ins Cc INSURED INSURER B: All Star Appliance And Air Conditioning 2 Service INSURERC: 565 Ne 112th Street 94SURERD: INSURER E Miami FL 33161 INSURER F: COVERAGES CERTIFICATE NUMBER2015-2016 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE POLICY NUMBER ICY EFF LICY EXP LIMITS g COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 NTW A CLAIMS-MADE �OCCUR PREMISES R occurrence) $ 100,000 ASLOO13236-01 4/29/2015 4/29/2016 MED EXP(Any one pion) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY F-1 JE a LOC PRODUCTS-COMP/OP AGG $ 1,000,000 OTHER: Employee Benefits $ AUTOMOBILE LIABILITY C�MBI�Na DtSINGLE LIMB $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident UMBRELLA LIAROCCUR EACH OCCURRENCE $ EXCESS LIAR HCLAIMS-MADE AGGREGATE $ DED I I RETENTION $ WORKERS COMPENSATIONPER OTH- AND EMPLOYERS'LIABILITY Y/N ST TUTS ER ANY PROPRIETOR/PARTNER/EXECUTIVE ❑NIA E.L.EACH ACCIDENT $ OFRCER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOY $ If yes,describe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(MORD 101,AddfHonal Remarks Schedule,may be attached B more space Is requbed) Qualifier's name: Andre Laroche Qualifier's License # CAC056323 This certificate is solely for the use as " Evidence of Insurance" CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village Bldg Dept. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 10050 NE 2nd Avenue ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores, FL 33138 AUTHOR®REPRESENTATIVE Ed Jackson/FANNIE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(gouon , l,,, Miami shores Village Building Department �OAIUp' 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305)795.2204 Fax: (305)756.8972 Notice to Owner — Workers' Compensation Insurance Exemption Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05 allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to obtaining a building permit. Pursuant to the Florida Division of Workers'Compensation Employer Facts Brochure: An employer in the construction industry who employs one or more part-time or full-time employees,including the owner,must obtain workers'compensation coverage. Corporate officers or members of a limited liability company (LLC) in the construction industry may elect to be exempt if 1. The officer owns at least 10 percent of the stock of the corporation, or in the case of an LLC,a statement attesting to the minimum 10 percent ownership; 2. The officer is listed as an officer of the corporation in the records of the Florida Department of State,Division of Corporations;and 3. The corporation is registered and listed as active with the Florida Department of State,Division of Corporations. No more than three corporate officers per corporation or limited liability company members are allowed to be exempt. Construction exemptions are valid for a period of two years or until a voluntary revocation is filed or the exemption is revoked by the Division. Your contractor is requesting a permit under this workers'compensation exemption and has acknowledge that he or she will not use day labor,part-time employees or subcontractors for your project.The contractor has provided an affidavit stating that he or she will be the only person allowed to work on your project.In these circumstances,Miami Shores Village does not require verification of workers'compensation insurance coverage from the contractor's company for day labor,part-time employees or subcontractors. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature: �G4��J� zn csl/ Owner State of Florida County of Miami-Dade The foregoing was acknowledge before me this day of ,20_�6 N ^.),,,,,, who is personally known to me or has produced a id®atific�yti'on. Notary: Cn __ SEAL: l o . _ , �• rb , ALL STAR APPLIANCE AND AIR CONDITIONING 2 SERVICE Inc. 565 NE 112 Street, Miami, FL 33161 Office 305 3612811; CELL 305 962 8603 LIC AND INS. CAC056323 ANDRE LA ROCHE, PRESIDENT i Date: Febraury 2, 2016 o State of Florida County of Miami-Dade Before me this day personally appeared Andre LaRoche who being sworn, deposes and says: That he or she will be the only person working on the project located at 54 NW 110th Street, Miami Shores, FL 33168 ,Sworn to (or Affirmed) ande subscribed before me this 2nd day of February, 2016 by -aZ, ,e, Personally know OR Produced lentifcation J� Type of Identifcation Produced _ t=_ A20cmr,. Print,Type or Sta€ amefo C , t PERMIT APPLICATION FOR MIAMI SHORES VILLAGE 10050 N.E.2nd Avenue•Miami Shores,Florida 33138.305-795-2204 Date_4� Job Address 6!q OW 110 5T Tax Folio 11 Legal Description Historically Designated: Yes No e Owner/Lessee/Tenet mL Master Permit# M 7� �� Ow'ner's Address 5 A J 110 57 Phone 7519 "690, Contracting-in! o. ;,��,QQ� 1�0 !� <l-l�(� Address_�$�1 w / G Qualifier h! � �,J V«•�� SS# Phone.,Vo—ZZ] i"t}Q6 11 Stat`#_C000133 Zo Municipal# Competency# Ins.Co. IF T}`MU,, IS NO PER: LL PACKAGE ACCESSIBLE ON THE JOB SITE FOR INSPECTORS TO VERIFY, THERE WILL BE NO INSPECTION. RE-INSPECTION FEE IS $50.00 AND MUST BE PAID IN ADVANCE BEFORE CALLING FOR ANOTHER INSPECTION. Permit Tape (circle one): BUILDING ELECTRICAL PLUMBING MECIiANICAL ROOFING WORK DESCRIPTION: Square Ft. Estimated Cost(value)_ &V XARNIN<; TO Opt' NTER:YOU INdUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY RESULT IN YOUR PAYING TWICE FOP, I_ -PROVEXIENTS TO YOUR PROPERTY(IF YOU INTEND TO OBTAIN FIP:ANCI`a'G, CONSULT WITII IiEF:,"E RECORDING YOUR NOT"Cis OF COM YIENC1?MEiliY.) Ap Ali( tion i;t rcby tnadc m obtain , Vor d installatign as indicated above,and on the attached addendum(if arplicable). I certify that a.l ,v�„l.. ill [formed to meet the sta rskg' e cul tt onst,ucdon in t;.is jurisdiction.I understand that separate rermits are required i 4for alt ds.,cirlines. --1 } OWNERS AI- IDAVI'f: 1 ccnil' that all the foregoing information is accurate and that all wort: will be done in compliance with all applicable laws regulating construction and zoning.Furthermore, 1 authorize the above named contractor to do the work stated. ,3-d3 ignature of o er and/or 4ndo Pres Gc�e <Ja Date Signa tur Contra Date va z i,CC0o10.�p' WRUM • ;,ota+y a to O 'ne ~' a sidert .....o;'a.• ..,. Date Notary a.to ontractor or CJfvn rdet••••••�•••.�...•,,' Date M'ly Commission EA My Commission Expires J FEES: PERMIT__ RADON C.C.F NOTARY BOND APPROVED: • TOTAL DUE Zoning Building Electrical Mechanical Plumbing _Structural Engineer