MC-16-2567 Miami Shores Village
o ii r
�ClBflt ..
10050 N.E.2nd Avenue NE "
' Miami Shores,FL 33138.0000i?
'ate` Phone: (305)795-2204 ' jdlS
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3
Expiration: 03/19/2017
Project Address Parcel Number Applicant
1700 NE 105 Street Number: 506 1122300500820
Miami Shores, FL Block: Lot: SUZANNE MAULE
Owner Information Address Phone Cell
SUZANNE MAULE 1700 NE 105 ST UNIT 506
MIAMI SHORES FL 33138-2142
Contractor(s) Phone Cell Phone Valuation: $ 4,750.00
EDD HELMS AIR CONDITIONING AND (305)653-2530
Total Sq Feet: 0
Tons:2.5 Available Inspections:
Additional Info:REPLACE 2.5 TON WSHP Inspection Type:
Classification:Residential Final
Approved:In Review Review Mechanical
Comments: Date Approved::In Review
Date Denied: Type of Work:MECHANICAL
Scanning:3
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $3.00
DBPR Fee Invoice# MC-9-16-61374
$2.49 09/20/2016 Check M 6371 $ 138.23 $50.00
DCA Fee $2.49
Education Surcharge $1.00 09/16/2016 Check*6370 $50.00 $0.00
Permit Fee $166.25
Scanning Fee $9.00
Technology Fee $4.00
Total: $188.23
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 ' orma. n accurate and that all work will be done in compliance with all applicable laws regulating
construction and zoning. Futhermore,I authorize the ed to do the work stated.
September 20, 2016
Authorized Signature:Owner ractor / Agent Date
Building Department Copy
September 20,2016 1
Miami Shores Village
Py 16 2016
5��` �►� Building Department BY:
V` 10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 20 jq
BUILDING Master Permit No. �/Ic ` I 0 +Z Sb
PERMIT APPLICATION Sub Permit No.
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
F-1 PLUMBING MECHANICAL [:]PUBLICWORKS [:] CHANGE OF ❑ CANCELLATION ❑ SHOP
ryq� CONTRACTOR DRAWINGS
JOB ADDRESS: 0 Io0 ljr JOS_
o'° .
City: Miami Shores 4t�ts� County: Miami Dade Zip:
V� 3�f
Folio/Parcel#: I b�- Is the Building Historically Designated:Yes NO os'�
Occupancy Type: Load: Construction Type: �� Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder):��Z ,d'`,C a4 C%t > A� c� Phone#:
Address: 1'16D /`( � ISS o�-. � �
City: (WNM-zj State: Zip: 33[BID
Tenant/Lessee Name: Phone#:
Email: `` jr•�
CONTRACTOR:Company Name: r��V 1��` ,S Phone#:wJ —4�' 9 5Jo
Address: 1-)'9-$70 N F- Z5—
/ A*
City: U � o ` State: rcl Zip:
33lb-2-
Qualifier Name: 4f)r
Phone#:
State Certification or Registration#:(l%CD'2\ Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
�t
Value of Work for this Permit:$ -1(-cb�:Ste Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace F-1 Demolition
Description of Work: �e.O Gi%dr_ Z. S Aa-)n 5 1�{�
Specify color of color thru tile:
Submittal Fee$15 Permit Fee$ CCF$ 3' �Q CO/CC$
Scanning Fee$ �'( Radon Fee$ a ' �""I DBPR$ f Notary$
Technology Fee$ LC Od Training/Education Fee$ O' Q Double Fee$
Structural Reviews$ Bond$ 9)
TOTAL FEE NOW DUE$ `2�8 . L^�
(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.
Signatur Signature'
WNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
I , ;IS day of �n'1,d.1 .20 U by 8 _day of V 6J)tCM)Xr 20( by
I k1
MQIMA�who is personally known torn .Q� .,who is personally known to
me or who has produced_M Z%VW 19 2-40 as me or who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY PU IC: NOTARY PU LIC:
n Sign:
Print: Print:
a
Seal: H•,, MARILYNCHANG Seal: 47* %,
W COMMIS.StON it FF 041617 WILYN CHANG
EXPIRES:August 1,2017 � �twdw Thtu PUM Undvftbm d ThM
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
This instrument prepared by:
CHRISTOPHER P.KELLEY,Esquire
11098 Blecayrie Boulevard,Suite 206
Miami,FL 33181
RESIGNATION AND ACCEPTANCE
1,SUZANNE H. MAULE,the Tnistee of the SUZANNE H. MAULE REVOCABLE
TRUST AGREEMENT dated July W.1995, as amended, do hereby resign as Trustee of said
j Trust EFFECTIVE IMMEDIATELY.
I understand that EFFECTIVE IMMEDIATELY,RICHARD TERRY VAULE shall be
the sole Trustesof said Trust.
da of IN TNESS WHEREOF, the parties have signed and seal these presents the
Y
Signd delivered In the presence 0.
,434 3U H.MULE
printf ted + as Trustee of the SUZANNE H.MAULE
iD REVOCABLE TRUST dated July 28, 1995,
as amended
pfi"nt o s-'l"a.. y �cd�so
A
RICHARD T Y MAULS
STATE OF FLORIDA )
COUNTY OF MIAMI-BADE
I HEREBY CERTIFY that on thisday,before me,an officer duly authorized.in the State and
County aforesaid-to take a0knowledgments; personally appeared SUZANNE H. MAULE,as the
Trustee of the S,UZANNE H.MAULE REVOCABLE TRUST AGREEMENT dated July 28,1995,
who produced_aak&&A;ye Z ..&A�g as Identification, and who executed the foregoing
Resignation and she ackwMedged before me that she executed the same freely and voluntarily
for the purposes therein expressed.
WITNESS my hand and official seal In the County and State last aforesaid this
day of 2013.
P '
NO ARY PUBLIC, Stat6bf FLORIDA at Large
My commission expires:
d
STATE OF FLORIDA ) 811t1J1-0
j COUNTY OF MIAMI-DADE )
I HEREBY CERTIFY that on this day,before me,an officer duly authorized in the State and
County aforesaid to take acknowledgments,personally appeared RICHARD TERRY MAULS,as
Successor Trustee of the SUZANNEM:MAULE REVOCABLE TRUST AGREEMENT dated July
28,1995, who prOdWed as Identification, and who executed the
foregoing Acceptance, and he solmowledged before.me that he executed the same freely and
voluntarily for the purposes tharein expo.
WITNFSS my hand and official amal in the(minty and State laat afnraaaid thin �'
a ,
a
i
/ I /
pL
6UZASWE H. MAUL
print_ � �.-. j �,L�4- as Trustee of the SUZANNE H.MAULE
REVOCABLE TRUST dated July 28, 1995,
as amend
A
RICHARD TEMY MAULS
STATE OF FLORIDA
COUNTY OF MIAMI-DADE )
I HEREBY CERTIFY that on this day.before me,an officer duly authorized in the State and
County aforesaid to take acknowledgments, personally appeared SUZANNE H.MAULE , as the
Trustee of the SUZANNE H. MAULE REVOCA13LE TRUST AGREEMENT dated July 28, 1896,
who produced ,,,-, as identification, and who executed the foregoing
Resignation and the acknowledged before me that she executed the same freely and voluntarily
for they purposes therein expressed.
WITNESS my hand and'official seal in the County and State last aforesaid this
day of 2013.
NO ARY PUBLIC, Stu FLORIDA at Large
My commission expires: Awt.
STATE OF MofWA
STATE OF FLORIDA ) 8114
COUNTY OF MIAMI-DADE )
I
I HEREBY CERTIFY that ort thie day,before me,an officer duty authorized in the State and
County aforesaid to take acknowiedgments, personally appeared RICHARD TERRY MAULE, as
Successor Trustee of the SUZANN H.MAULE REVOCABLE TRUSTAGREEMENT dated July
28,1995, who produced np iyiw- as identification, and who executed the
foregoing Acceptance, and he acknowledged before me that he executed the same freely and
voluntarily for the purposes therein expressed.
da WIT ESS•my hand and official seal in the.County and State last aforesaid this
y , 2013.
ibiy commission expires: NbPARY PUBLIC, StgA of FLORIDA at Large
e�
STATE of FLOWA
$EP 1 � 10111
,yH CIT Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel:(305)795.2204
Fax:(305)756.8972
AIR CONDITIONING REPLACEMENT DATA
PERMIT NUMBER: MC 1 —?��
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): 1100 dA' I bS- —q4— "tr'54NP
City: Miami Shores Village County: Miami Dade Zip Code: 391312::,
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�HI Sheet Attached:YESNO❑ Contract Attached:YES
UNIT BEING REPLACEP DATA NEW UNIT
MANUFACTURER Z jkyzr-Teav
p AHU or PKG.UNIT MODEL#
COND.UNIT MODEL#
KW HEAT
NOM TONS
AHU CU PKG ® 1)M.C.A 20 AHU CU PKG C>
AHU CU PKG 2)M.O.P AHU CU PKG
AHU CU PKG 3)VOLTS Zo AHU CU PKG
PKG UNIT / / PKG UNIT
EER/SEER {�
YES REPLACING DUCTS YES
YES REPLACING THERMOSTAT YES
YES NEW 4"CONCRETE SLAB YES
YES NEW ROOF STAND YES
YES NEW RETURN PLENUM BOX YES 0
1. Minimum Circuit Ampacity(Wire Size): W/0
2. Maximum Overcurrent Protection (Fuse/Breaker Size): &0
3. Voltage of Circuit(208/240/480):
4. Size Disconnecting Means: /_ "
Contractor's Company Name: a,�nS Phone:
State Certificate or Registration No. Certificate of Competency No.
Signature Date:
(Qualifier's signature)
(Revised02/24/2014)
"K3
vz 4�
Certificate of Product Rating's
AHRI Certified Reference Number- 7368712 Date: 9/12/2016 tStatus: Active
Product:Water/Brine to Air Heat Pump Packaged Unit
Model Number: TCHN030A
Manufacturer: CLIMATE MASTER, INC.
Trade/Brand name:TRANQUILITY 16
Rated as follows in accordance with ANSIIAHRI/ASHRAE/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: 1000/ 1000
Air Flow Rate- Heating: 1000/ 1000
WLHP(Water-Loop Heat Pumps) Full Load
Cooling Capacity(Btuh) 28100/28100
Cooling EER Rating(Btuh/waft) 13.40113.40
Cooling Fluid Flow Rate(gpm) 8.00/8.00
Heating Capacily(Btuh) 35100136100
Heating COP(wattfwatt) 460,1460
Heating Fluid Flow Rate(gpm)-, , 8 CSI
GW bud-Water Heat Pumps}-,
cooling J 3fT
20JO120LIO
Cooling Ems'�Ra"t "'AV
8"
Cooling ;00
ld Flow,Rate(gpm): "�4 �61`8 00
Heati 00 1,5600
Heating,C0P(*itVwatt) 01
Heating Fluid Flow Rate(qprnj-,��--,,� 0.60"ttbo
GLHP (Ground-Loop"f1eptpqN.
J
M
Cooling Capaaty(fth) 288 28
... ....
Cooling'EER Rating.(Bt -�-� -f6.'1.
uh/waftl""' ,�"" 0`"/�` 16.10
... ...
.
Cooling Fluid'Flow Rate(gpm) 8.00/;8.00
Heating Capacity(Btuh) 23400/23400
Heating COP(watt/watt) 3.40/3.40
Heating Fluid Flow Rate(gpm) 8.00/8.00
Indoor Blower Motor Fan Type: PSC
Sold In: USA;Canada
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 responsibliftyfor,
the product(s)listed on this Certificate.AHRI expressly disclaims all Ilablilty 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,
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.abridirectory.org,dick on'Verify Certificate"link we make 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.
t]401k
@2014 Air-Conditioning,Heating,and Refrigeration Institute CElk NO.:
a
SHORES
1.. NUQ1N11N11)M APARTMENTS
WORK REQUEST APPLICATION
Owner's Nam T`C e-,l 6 -To- Unit
G7
I hereby request approval from the Board of Directors for the following
modification or alteration to my unit that will be performed by a licensed
contractor.
Electrical work Plumbing work
Carpet installation "Windows
Tile installation Other work
n of the work �-
)escnrtia .__ .._.
Before yon decide to upgrade your apartment(other than paint or carpet)you most
obtain'permission from the Board of Directors and/or Miami Shores Village.
A copy\of the plans, specifications and permits, and a description of the licensed
work to be performed must be submitted for consideration and approval by the
Miami Shores Village Building Depart n(vt(305-795-2204).
It is the owner's responsibility to ensure that the contractor removes all excess
construction material or building debris. It cannot be placed in the dumpsters.
"Window frames must be gray in color to look like aluminum. Windows must be
Two (2) panels over Two (2) panels. Glass must be clear color.
1, as the unit owner acknowledge responsibility for any damage to the building or
personal injuries that may occur during the project. The Shores Condominium Inc.
its officers and employees are in no way responsible for damage or theft to my
apartment or my belongings. (A $200.00 deposit is required and will be refunded if
no damage to the property is reported.)
fully understand and agree to the statements made above.
Unit ' signature Date
Approved by: ate: