MC-16-488 Miami Shores Village
10050 N.E.2nd Avenue NE „g`
Miami Shores,FL 33138-0000 "
Phone: (305)795-2204 s£.
a�l Expiration: 0812912016
Project Address Parcel Number Applicant
100 NE 105 Street 1121360130690
Miami Shores, FL 33138-2033 Block: Lot: SUSAN TREVISA
Owner information Address Phone Cell
SUSAN TREVISA 100 NE 105 Street (305)992-3134
MIAMI SHORES FL 33138-
100 NE 105 Street
MIAMI SHORES FL 33138-
Contractor(s) Phone Cell Phone Valuation: $ 1,400.00
AIR SYSTEMS A/C LLC (786)208-3484
Total Sq Feet: 0
Tons: Available Inspections:
Additional Info:RETURN REGISTER AND SUPPLIES VENTIL Inspection Type:
Classification:Residential Final
Approved:In Review Rough Duct
Comments: Date Approved::In Review Review Mechanical
Date Denied: Type of Work: Review Mechanical
Scanning:1 Underground
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $1.20
DBPR Fee $2 25 Invoice# MC-2-16-58775
DCA Fee $2.25 02/22/2016 Check#:1012 $50.00 $110.70
Education Surcharge $0.40 03/02/2016 Check#:1221 $ 110.70 $0.00
Permit Fee $150.00
Scanning Fee $3.00
Technology Fee $1.60
Total: $160.70
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 ssume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECT AL PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work.
OWNERS AFFID IT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction d in Futhermore horize the above-named contractor to do the work stated.
March 02,2016
AuthhZ er—_1 Applicant / Contractor / Agent Date
Building epartment Copy
March 02,2016 1
Miami Shores Village
. Building Department xM" Its,tell:
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949 S�.k
�FBC 20 PA
BUILDING Master Permit No. ZC-15 " 111' l
PERMIT APPLICATION Sub Permit No. X11 G 1 (—,.n—
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ZMECHANICAL ❑PUBLICWORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: %00 —C
City:HI&ALfbAMiami Shores County: Miami Dade zip:
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
(�- _
OWNER:Name(Fee Simple Titleholder):_ ' 1 ��'-� Phone#: , S
Address: I U Q& 10S tf:�
City: State: TA Zip:
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: A �o 9W—C,-MMS LLC_ Phone#:_'� &9 i 1 NCS
��
Address: ` as &)(A)
City: DW —L irk A, —State: VL e Zip: q _
Qualifier Name: , l,{�� 10)�� Phone#: BO f 1( (0
State Certification or Registration#: ertificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City State: Zip:
Value of Work for this Permit:$ ('AM . ®0 Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace ❑ Demolition
Description of Work:_20 r^--POW<1-k(L &'N(A
Specify color of color thru tile: ( n
Submittal Fee$SO-(1� Permit Fee$ t t), CCF$ CO/CC$
Scanning Fee$_6 ,_r-t--% Radon Fee$ DBPR$ 5 Notary$
Technology Fee$�^ (� Training/Education Fee$ 0 �`f 0- Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$ d{ C) •�C�
(Revised02/24/2014)
r V
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.
t
Signature Signature
_ t.'
OWNER or AGENT CON CTOR
The foregoing instrumen was acknowledged before me this The foregoing instrument was acknowledged before me this
►—day of 20 ,by �_day of W 20�(�,by
S`a,who s personally known to s L who is personally known to
me or who has produced as me or who has produc d VE014 nA DI&W/ &S,d..lC.as
identification and who did take an oath. identification and whCEPC�AIpEpEE pam
NOTARY UB NOTARY PUBLIC: .' Puff-oftof Fiotpt
�#FF Rion
my Coaxo.Ex*n up 11.8019
Sign: Sign
Print: Print• -�
��.••�,n�,a•.,, e
Seal: $�~� �-,commISSION#FF025143 Seal:
vA '1rc EXPIRES:
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APPROVED BY v lans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
eN°.R s y Miami Shores Village
Building Department
mull URN?" 10050 N.E.2nd Avenue
Miami Shores, Florida 33138
RIDp 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): 6 ,o-'5-
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: '59Jir, C_ Phone:::3o�r-.,olg i 109,0
State Certificate or Ygistration No._(!4cjP`33 5-4 Certificate of Competency)No.
I
Signature Date: _ �1�' I 1 (0
(Qualffiees signature)
(Revised02/24/2014)