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MC-15-1354 Miami Shores Village 10050 N.E.2nd Avenue NE "• ? Miami Shores,FL 33138-0000 Phone: (305)795-22043 a Expiration: 1710512015 Project Address Parcel Number Applicant 1700 NE 105 Street Number: 204 1122300500230 MARGARET JENKINS Miami Shores, FL Block: Lot: Owner Information Address Phone Cell MARGARET JENKINS 1700 NE 105 ST#204 MIAMI FL 33138-2139 Contractor(s) Phone Cell Phone Valuation: $4,330.00 EDD HELMS AIR CONDITIONING AND (305)653-2530 Total Sq Feet: 00 Tons: Available Inspections: Additional Info: Inspection Type: Classification:Residential Final Approved:In Review Rough Duct Comments: Date Approved::In Review Review Mechanical Date Denied: Type of Work:REPLACE WATER SOURCE PUMP H Underground Scanning:3 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $3.00 Invoice# MC-6-15-55831 DBPR Fee $2.27 06/08/2015 Check#:6206 $123.09 $50.00 DCA Fee $2.27 Education Surcharge $1.00 06/04/2015 Chock#:6205 $50.00 $0.00 Permit Fee $151.55 Scanning Fee $9.00 Technology Fee $4.00 Total: $173.09 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 aut h bove-named contractor to do the work stated. June 08,2015 Authorized Signature:Owner / Applicant / Contractor / Agent Date Building Department Copy June 08,2015 1 I� Miami Shores Village Building Department ' 'E'er. 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 JUN 0 4 2015 Tel:(305)795-2204 Fax:(305)756-8972 BY: INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 201® BUILDING Master Permit No.He z 6� PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL F-IPLUMBING /MECHANICAL PUBLIC WORKS CHANGE OF CANCELLATION SHOP CONTRACTOR DRAWINGS JOB ADDRESS: ZAP JJ& fd S' rQ City: Miami Shores County: Miami Dade 7 Zip: Folio/Parcel#: 11—Z 2 30- OSD A O2 3 U Is the Building Historically Designated:Yes NO Occupancy Type:InFG Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): Ai arcia 1`0 J �q e/yis Phone#: Address: 17vv IJi- los- S City: l atn' State: Zip: 331.3 Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: Phone#:305 f 3_1 p y (lJS � C Address: J /1d J City: 6A State: h, Zip: 13't0 Qualifier Name: A),- 6(r (Gc)tea 3Phone#: State Certification or Registration#: U2:) Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ 'c,���•C209 Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace ❑ Demolition Description of Work: uAtie c-bore S. to '�y rtiCi Specify color of color thru tile: Submittal Fee$ Permit Fee$ I CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ (Revised02/24/2014) P1lly$ 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 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 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 Contractor The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me thin? day of G ,20,Bby /hQ r�IGrJ TR"k),)C day of_ 20S-,by M©rr,, /.ccnn a�bep,., who is personally known to me or who has produced �L who is pe na�Ien ho has produced As identification and who did take an oath. and who did tale an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: W Signe Print: �_°' "a = NotaryPublic-State of Florida Pmt. Publig State 91 FIOF!dft ?�eR pO4<<- NADINE AUSTERFIELO N My Commission Expires Nov 7,2017 M Commission L9. P�°c' M Commi i0" �`MY Commission Expires Nov 7,2017 YP �P�l�o�,• Commission#FF 55651 Y ;o Yo.o Commission#FF 55651 *��+�+x���xx�����x�x��xa�x��*�� ���•xa��n kx �� �x�� +��*�x+x*�+xxxxx�s����xx�s�xxax+a������a�n+x�r�+x�xxxa�x��mx APPROVED BY P Examiner Zoning Structural Review Clerk Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) on Miami Shores Village Building Department ..o. .� 10050 N.E.2nd Avenue Miami Shores, Florida 33138 4' � °yam 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): 7Q� N/= 1195 ��f CPO 91 City: Miami Shores Village County:. Miami Dade Zip Code: 331 3!r ALL CONDENSING UNITS MUST RE 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❑ NC ARHI Sheet Attached:YES5Z�.NO❑ Contract Attached:YES UNIT_BEING REPLACED DATA NEW UNIT °pry4fe' C MANUFACTURER i• &1e' AHU or PKG.UNIT MODEL# G O COND.UNIT MODEL# KW HEAT J.5 NOM TONS , AHU CU 1)M.C.A AHU CU PKG AHU CU 2)M.O.P AHU CU PKG AHU CU PK 3)VOLTS AHU CU PKG PKG UNIT / / PKG UNIT EER/SEER YES NO REPLACING DUCTS YES YES NO REPLACING THERMOSTAT S YES NO NEW 4"CONCRETE SLAB YES - YES NO NEW ROOF STAND YES 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): _ qjaT(Z3 a 4. Size Disconnecting Means: // Contractor's Company Name: 614o /Ze, CA"., Phone:R5 653-d-5 t?O State Certificate or Registration No. Certificate of Competency No. Signature Date: (Qualifier's signature) (Revised02/24/2014) _ s This combinationualifles for a Federal Ener " „ g Efficiency Tax Credit when placed In service between Jan 1,2006 and Dec 31,2016 and used In h r GWHP application point. Certificate to AHRI Certified Reference Number: 7425621 Date: 6/1/2015 tStatus:Active Product:Water/Brine to Air Heat Pump Packaged Unit Model Number:TCHN018A Manufacturer: CLIMATE MASTER, INC. Trade/Brand name:TRANQUILITY 16 Rated as follows In accordance with ANSUAHRUASHRAE/ISO Standard 13256-1 for Water-to-Air and Brine-To-Air Heat Pumps and subject to verification of rating accuracy by AHRI-sponsored,Independent,third party testing: Air Flow Rate-Cooling: 600.0/600.0 Air Flow Rate-Heating: 600.0/600.0 WLHP(Water-Loop Heat Pumps) Full Load Cooling Capacity(Btuh) 17300/17300 Cooling EER Rating(Btuh/watt) 14.30/14.30 Cooling Fluid Flow Rate(gpm) 4.50/4.50 Heating Capacity(Btuh) 21500/21500 Heating COP(. r tt/watt) 6.00/5.00 Heating Fluid:Fldw Rate(gpm) 4.50/4.50 GWHW Ground-Water Heat Pumps) Coolingpacity(Btuh) 20600/20600 Cooling EER Ratiog(Btuh/watt) 24.20/24.20 Cooling Fluid Flow Rate(gpm) 4.50/4.50 Heating Capacity(Btuh) 17200/17200 Heating COP(watt/watt) .4.40/4.40 Heating Fluid blow Rate(gpm) 4.50/4.50 GLHP (Ground-Loop-Heat Pumps) CoolingCapac Stuh 18400/18400 CoolinEER ating(Btuh/watt ) 16.30/16.30 Cooling Fluid Flow Rate(gpm) 4.50/4.50 Heating Capacity(Btuh) 13900/13900 Heating COP(watt/watt) 3.40/3.40 Heating Fluid Flow Rate(gpm) 4.50/4.50 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.ahvidirectory.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 a form or manner or p any by any means,except for the user's individuate personal and confidential reference. AIR-CONDITIONING.HEATING, CERTIFICATE VERIFICATION A REFRIBERATWN INSTITUTE The information for the model cited on this certificate can be verified at www.abridirectory.org,click on"Verify Certificate"link We Mahe life better" 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 . ............. 02014 Air-Conditioning,Heating,and Refrigeration Institute CERTIFICATE NO.: 130776418825240937