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MC-16-3112 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores,FL Phone:(305)795-2204 Fax: (305)756-8872 Inspection Number: INSP-273366 Permit Number: MC-11-16-3112 Scheduled Inspection Date: December 21,2016 Permit Type: Mechanical-Residential — Inspector: Perez,JanPlerre Inspection Type: Final Owner: , Work Classification: AJC Replacement Job Address:29 NE 96 Street Miami Shores, FL 33138- Phone Number Project <NONE> Parcel Number 1132060130830 Contractor. FREEZE AIR CORP Phone: 786-412-3308 Building Department Comments EXACT A/C REPLACEMENT 3.5 TONS Passe omments INSPECTOR COMMENTS False I2,A V� Inspector Comments Passed El Failed Correction Needed Re-Inspection Fee No Additional Inspections can be scheduled until re-Inspection fee is paid December 20,2016 For inspections please call: (305)762-4949 Page 30 of 46 y Miami Shores Village t 'e 10050 N.E.2nd Avenue NE �� !R Miami Shores,FL 3313&0000 ? ' oma° Phone: (305)795-2204 'E1# 212#i Expiration: 06/2112017 d Project Address Parcel Number Applicant 29 NE 96 Street 1132060130830 CARRINGTON MORTGAGE SER' Miami Shores, FL 33138- Block: Lot: Owner Information Address Phone Cell CARRINGTON MORTGAGE SERVICES, 1601 E ANDREWS Place CA 92705- 1601 E ANDREWS Place CA 92705- Contractor(s) Phone Cell Phone Valuation: $ 3,500.00 FREEZE AIR CORP 786-412-3308 .__ . ...,..._ . ,. ...., . ,_ _._.. .... ....:.... Total Sq Feet: 0 Tons:3.5 Available Inspections: Additional Info:EXACT A/C REPLACEMENT 3.5 TONS Inspection Type: Classification:Residential Final Approved:In Review Review Mechanical Comments: Date Approved::In Review Date Denied: Type of Work:EXACT A/C REPLACEMENT 3.5 TON Scanning:3 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $2.40 DBPR Fee Invoice# MC-11-16-62059 $2.00 11/22/2016 Check#:1493 $96.90 $50.00 DCA Fee $2.00 Education Surcharge $0.80 11/15/2016 Credit Card $50.00 $0.00 Notary Fee $5.00 Permit Fee $122.50 Scanning Fee $9.00 Technology Fee $3.20 Total: $146.90 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 ify that all the foregoi information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoni . uthermore,I a nz above-named contractor to do the work stated. November 22, 2016 Ziidvrhorized Sig tures Owner / Applicant / Contractor / Agent Date Building Department Copy November 22,2016 1 Miami Shores Village Building Department Nov IS 2016 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 ZO "Ll BUILDING Master Permit No. t'lr'l CD `311 Z PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING [f MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 9& Sr City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: � BFE: r, FFE: OWNER:Name(Fee Simple Titleholder): C'/fili�)�G �7 i7 (a/7Ie� Si�y/C ZAone#: SJ7 /OX Address: A4. Set/7 - Sy City: &&f! State:Q4 Zip: 9>_ >6) Tenant/Lessee Name: Phone#: Email: r �1 CONTRACTOR:Company Name: rz e'_74 �� "�� Phone#: io Address: ?00/ tAl 36o—Am -w— City: yl rl.__u a,1x ./ _State: P)_V 1r!d'4 Zip: _3.je)/-i" Qualifier Name: e-,Ze of s l0ks `'e� Phone#: o o KOW/ f State Certification or Registration#: 2, Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: ,�° Value of Work for this Permit:$ •0 v Square/Linear Footage of Work: n /e Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace El Demolition Description of Work: X�1 Specify color of color thru tile: Submittal Fee$ 50_D_Permit Fee$ `�" & a� CCF$ Z 'y® CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ 7— Notary$ Technology Fee$ Training/Education Fee$. ' 90 Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ C1 1097 `— (Re�sedo2/aa/2oia) 4: Bonding Company's Name(if applicable) Bonding Company's Address P 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$250,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 certif I'ed 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 this day of E .20 / 6 ,by _day of N Oy •20_�,J ,by who Is personally known to i� jr)6fi� P1C�JUi'eS.who is personally known to me or who has produced as me or who has produ /ajsC identification and who did take an oath. identification and who did take an oath. NOTARYIP NOTARY PU C: Sign: Sig Print: 0 Print: C r� Seal' ""y POLLY A ANDREWS Sea[: Notary Public-State of Florida ' ?'•: MAFIARSSION#GG044 •: :•c -*; ;� MY COMMISSION#GG 044602 9• • Pc My Comm.Expires Jul 14,2018 g :a•, EXPIRES:November 2,2020 ;;off ��;'• Commission#FF 119162 % Nob �t a Bonded 7iw 'f>E � i-l- !!l--lilt!!!!##!!!#! APPROVED BY Mans Examiner Zoning Structural Review Clerk (RevisedOZ/24/2014) „�C"�I D E N TIA L �i�� in Erni uii�ni��1�ri��n�►�u i��i OR Fk 29396 Ps 3239. (1ps) RECORDED 11/18/2016 11205223 Recording Requested By: l HARVEY RUVINY CLERK OF COURT Bank of America MIAMI-DADE COUNTY► FLORIDA Prepared By:Diane De Avila LAST PAGE 800-444-4302 When recorded mail to: CoreLogie Map Stop:ASGN 1 CoreLegic Drive i ®ems DOOM# 9952264512721345 Property Address: 29 NE 96th Street Miami Shores,FL 33138 rra,W wsaa= roraarmna ocw�ua rmara�tmr,me ASSIGNMENT OF MORTGAGE For Value Received,the undersigned holder ofa,Mortgage(herein"Assignor-)whose address is 1800 TAPO CANYON ROAD,SEM VAIs FV,CA 93063 does hereby gr=4 sell,assign,transfer and wavey unto CARRINGTON MORTGAGE SERVICES,LLC whose address is 1610 E.ANDREW PI-SUITE 13150,SANTA ANA,CA 92705 all beneficial interest under that certain Mortgage described below together with the note(s)and obligations therein described and the money due and to become due thereon with Interest and all rights awnred or to accrue under said Mortgage. Beneficiary: MORTGAGE ELECTRONIC REGISTRATION SYSTEMS,INC.,AS NOMINEE FOR TAYLOR,BEAN 6i WHITAKER MORTGAGE CORP.,ITS SUCCESSORS AND ASSIGNS Original Borrower(s): JOSE ACOSTA Date of Mortgago: 12/3042098 Original Loan Amount: $421,448.00 Recorded in Miami-Dade County.FL on:14242009,book OR 26705.page 2358 and instrument number CFN 2409R0001888 INYb l L 3 Vf4111MOF,the undersigned has ceased this Assignment of Mortgage to be executed on BANK OF AMERICA,N.A. a By: ��- By: JtidHha artiw , woa ft a AashAftVits witness: FFAID—h Floran Witness:_ State of California County of Ventura On OCT 2 3 2014 before me Td”.to firm Notary Public,personally appeared Meroadts and arArd ttitrrnrdarrm .who proved to me on die basis of satisfactory evidence to be the person(s)whose name(s)is/are subscribed to the within Instrument and acknowledged to me that ha/she/they executed the some in his/her/their authorized ce4mcity(iea). and that by his/hu/their signature(s)on the instrument the person(s),or the amity Spon behalf of which the person (s)anted,executed the inantm e.srL I certify ander PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph Is true and correct. WITNESS my head and official scat TRISHA JACKSON Notary Public (Sean ' rroT�mr Pueut) My Commission li�1S rob e t ri z CARRINGTON MORTtiA6E. ^ai IVICFS, Re: 29 NE 96th Street, Miami Shores FL 33138 To Whom it May Concern: Carrington Mortgage Services, LLC ("CMS") is currently servicing a mortgage loan secured by the above-referenced property. As the servicer, we require routine inspections to verify the condition and integrity of the property. if the property is found abandoned, we have the right under the Mortgage/Deed of Trust to take necessary actions and secure the property. We may do so by changing the locks, replace or board up doors and windows, drain water from pipes, eliminate building or other code violations or dangerous conditions, pull permits for repairs, and have utilities turned on or off. Based on the foregoing, please allow our vendor, Carrington Home Solutions, L.P., and their representative Christopher Gloin to pull permits for the work needed at this property. if you have any questions, please do not hesitate to call. Thank you, PATRICIA LAURA GOGUEN Commission#2099688 [name] `DAv r 7 S7U P,.-J iotary Public-ca torni z , grange County �- [title] A4 ^,;y Comm Expire reL 9. 19 l9 Carrington Mortgage Services, LLC See Attached p949.517.7000 1610 E.Saint Andrew Place,Suite B-150,Santa Ana,CA 92705 4 A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document,to which this certificate is attached and not the truthfulness,accuracy,or CALIFORNIA ALL — PURPOSE validitv of that document. CERTIFICATE OF ACKNOWLEDGMENT State of California County of Orange On September 27,2016 before me,Patricia Laura Goguen,Notary Public,personally appeared David Stupinwho proved to me on the basis of satisfactory evidence to be the person whose name is subscribed to the within instrument,and acknowledged to me that he executed the same in his authorized capacity, and that by his signature on the instrument the person,or the entity upon behalf of which the person acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. r;� a�;. PATRICIA LAURA GOGUEN r Commission#2099688 �l k Notary Public-Ca iforni `z orange County "= '4'r r. Signature �� ' (Seal) My Comm Expires reb 9. ^,19 Patricia Laura Goguen,Notary Public ADDITIONAL OPTIONAL INFORMATION INSTRUCTIONS FOR COMPLETING THIS FORM Am oub—*dgtuenr completed in CaWarala marc comam uVrbtaga araa(v as DESCRnMON OF THE ATTACKE'D$O DOCUMENT appows abery in dm notary seeuan or a separato 4cbw+ctedPwW;orm mast he CLa "",+ d omw 0 ba guards and Of In M14 a�m�n•ol'urname admouledgmeur verbiage as mqr be p tared on such a docume r so long as rho u erbuso docs not regnba rho wormy so do somodoW dmf is 19R941for a aotan°in Calobmlo(to.ear"Ing the amhomed capacity of die stgaer).Please cheek rise (Tale ordescrown of awtched doemunt eonumino doemmmtr cam�*A for proper notartai nordmg and attach rhes form tfreptred. *lumber Of Pages Document Date where- Saft and County axis=== --be the State and County the docuument ups)P—kaly befoee the notary public fur acro kdgmens. • Date of notariniam sonst be the daze&ar the signers)prtsonaay appeased which masa also be the same date the actomwkdiparm is completed (Additional infmmatioa) • The aamty Public must print his of her aame as u appears wahm hm or her conn umi m followed by a comma and the your title(notary public). • print the aane(s)of doctoom srgner(s)who Personally appear at the tune of oourb=ion CAPACITY CLAWED BY THE SIGNER • tad"e,dw correct siitgnlar or phual forms by cwsamg off mconect forms(t c W Individual(s) may,lead t cachag to rejectionthe r �Paitore m eermtly i�teate thof doonnent ordmg Corporate Officer • The rotary seal insipsessimt matt be clear and phowgtaphieatty repioducibie. hapnesum mast not cover ten at limes_If seal inPression smudges,ft-wat if a Crime) stfi eat arca pertaim othermsse complete a drffermt acimatvledgmmt fog C partner(s) • signature of the notary public mot match the signature on bre wt&the office of the county de& L Attorney-iu-Fact Addiuonal infm>aanon n not retptired but could" w ensure this C Tmstee(s) aetmawle ftmem is not misused or attached to a differew document- C Other + Indicate titte at type of attached docun mt.number of pages and date. A.- bAcate the capacity claimed by the siva.If the claimed cap arty is a u:mporAe offm.indwam the We(Le.CEO.CFO.Secretary). securely attach oris document to the signed document ORES evil o... Miami shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. COPY OF QUALIFIER'S STATE LICENCES B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF LIABILITY INSURANCE* D. COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICATE OF COMPETENCY OF QUALIFIER B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF STATE REGISTERED CONTRACTOR LICENSE OR MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT. D. COPY OF LIABILITY INSURACE* E. COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) *YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE AS FOLLOW: Certificate Holder: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 Certificate must specify the description of operations or contractor license number. BUSINESS NAME: C® BUSINESS ADDRESS: 700 lITY �/a��// STATES ZIP BUSINESS PHONE: 3 FAX NUMBER�) CELL PHONES D QUALIFIER'S NAME: QUALIFIER'S LIC NUMBER: 11 CERTIFICATE OF LIABILITY INSURANCE DATE( /YYY1f7 111/14/14D/16 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. If SUBROGATION IS WANED,subject to the terns and conditions of the policy,certain policies may require an endorsement. Astatement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER CONTACT NAME: MARY URREGO G-Mar Insurance PHONE , (305)267-4541 1 AA U.: (305)267.4543 8200 W 33 Ave#7 DDR quotes@gmarinsurance.com Hialeah,FL 33018 INSURER(S)AFFORDING COVERAGE MAIC 0 Phone (305)2674541 Fax (305)267-4543 INSURERA: GRANADA INSURANCE COMPANY INSURED INSURER 13: MADISON INSURANCE COMPANY FREEZE AIR CORP INSURER C: 7001 W 35 AVE #192 INSURER D: HIALEAH,FL 33018 (786)302-6779 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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. ILTR TYPE OF INSURANCE INSR WVO BR POLICY NUMBER MPMIDDY EFF PSD EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000.00 0 COMMERCUIL GENERAL LIABILITY DAMAGE TO RENTED 100,000.00 PREMISES Ea occurrerrcs $ ❑ ❑ CLAIMS-MADE © OCCUR 0185FL00062766 -2 MED EXP(Any one person) $ 5,000.00 A N N 09/15/2016 09/15/2017 ❑ PERSONAL&ADV INJURY $ 1,000,000.00 ❑ GENERAL AGGREGATE $ 2,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGO $ 2,000,000.00 0 POLICY ❑ PRO- ❑ LOC $ AUTOMOBILE LIABILITY COMBINF SINGLE LIMIT Ea acci ent ❑ ANY AUTO BODILY INJURY(Per person) $ ❑ ALL AAUTOS NED ❑ SOS ULED BODILY INJURY(Per accident) $ NON-OWNED PROPER DAMAGE ❑ HIRED AUTOS ❑ AUTOS Per acci�nt $ ❑ ❑ $ ❑ UMBRELLA LIAB ❑OCCUR EACH OCCURRENCE $ ❑ EXCESS LIAS ❑CLAIMS-MADE AGGREGATE $ ❑ DED ❑ RETENTION$ $ WORKERS COMPENSATION ❑WC TATU- tLIMrrS ❑OTH AND EMPLOYERS'LIABILITY Y/NER ANY PROPRIETOR/PARTNER/EXECUTIVE FRW C764875 E.L.EACH ACCIDENT $ 100,000.00 B OFFFIICCERR/Mdatory IE�NBFOR EXCLUDED? NIA N 10/02/2016 10/02/2017 If my describe under E.L.DISEASE-EA EMPLOYE $ 100,000.00 DESdffiPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT It 100,000.00 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,H more space Is required) AIR CONDITIONER CONTRACTOR LICENCE#CAC057312 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE MIAMI SHORE VILLAGE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN BUILDING DEPARTMENT ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2ND AVE AUTHORD:ED REPRESENTATIVE MIAMI SHORES,FL 33138 FAX#(305)756-8972 MARY URREGO ©1988-2010 AC CORPOA ION. All rights reserved. ACORD 25(2010/05)QF The ACORD name and logo are registered marks of ACORD W3622 Local Business Tax Receipt Miami—Dade County, State of Florida —THIS IS NOT ABILL—DO NOT PAY " 3852770 BT7-1 BUSINESS NAME&OCATION RECEIPT NO. EXPIRES FREEZE AIR CORP RENEWAL SEPTEMBER 30, 2017 7001 W 35 AVE 192 4022661 Must be displayed at place of business HIALEAH FL 33018 Pursuant to County Code Chapter SA-Art.9&10 OWNER SEC.TYPE OF BUSINESS PAYMENT RECEIVED FREEZE AIR CORP 196 SPEC MECHANICAL CONTRACTOR BY TAX CO -�CTOR C/O REINEIRO ROSALES PRES CAC057312 Worker(s) 1 $45.00 07/08/2016 CREDITCARr''-'•16-037413 This Local Business Tax Receipt only confirms payment of the Local Business Tax.The Receipt is not a license, permit,or a certification of the holders qualifications,to do business. Holder mast comply with any govermnwjl or nongovernmental regulatory laws and requirements which apply to the business. The RECEIPT N0.above must be displayed on all commercial vehicles—Miami—Dade Code Sac ea-276. For more information,visit www miamidade gov/ta collector RICK SCOTT, GOVERNOR KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD o� r� CAC057312 The CLASS B AIR CONDITIONING CONTRACTOR J� " Named below IS CERTIFIED Under the provisions of Chapter 489 FS. +'yD VWaR Expiration date: AUG 31, 2018 .,K ... ROSALES, REINEIRO ' 0 ■. FREEZE AIR CORP 7001 W 35 AVE UNIT 192x HIALEAH FL330118 a t ISSUED: 07/31/2016 DISPLAY AS REQUIRED BY LAW SECI# L1607310002504 OR 193 G Miami Shores Village Building Department X oil "Kill" 10050 N.E.2nd Avenue 41�. Miami Shores, Florida 33138 jDRIDA 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): 2 ? 6,--, 2� S 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 dARHI Sheet Attached:YES NO ❑ Contract Attached:YES ❑ UNIT BEING REPLACED DATA NEW UNIT MANUFACTURER C_WCI A41 -AO AHU or PKG. UNIT MODEL# COND. UNIT MODEL# KW HEAT D &,(G/ {�iC•tf NOM TONS J ftC() 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 ?Wo ® AHU CU PKG PKG UNIT / / PKG UNIT EER/SEER W- 0 .1 - YES - oYES 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 YES NO NEW RETURN PLENUM BOX YES NO 1. Minimum Circuit Ampacity(Wire Size): 2. Maximum Overcurrent Protection (Fuse/Breaker Size): CIOi/I,le 3. Voltage of Circuit(208/240/480): 2—AQ 4. Size Disconnecting Means: Contractor's Company Name: oe rim J��Z Phone: ?X6 J K6 0 6 d e State Certificate or Registr tion No. rtificate of Competency No. Signature - z Date: (Qualifier's signature) (Revised02/24/2014)