MC-17-85Project Address
Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Pe
pit
Permit NO. MC -1-17-$5
Perrnit Type: Mechanical - Residential
Work Classification: A/C Replacement
Permit Status: APPROVED
Issue Date:1/20/2017
Expiration: 07/19/2017
Parcel Number
Applicant
390 NE 91 Street
Miami Shores, FL 33138-
1132060190190
Block: Lot:
KENNETH WILKINSON
Owner Information
Address
Phone
Cell
KENNETH WILKINSON
FL
(973)632-2529
Contractor(s)
COOL FREEZE AC CORP
Phone
(305)591-9794
CeII Phone
Valuation:
Total Sq Feet:
$ 500.00
0
Tons: 2.5
Additional Info: LEGALIZING EXISTING A/C UNIT
Classification: Residential
Approved: In Review
Comments:
Date Denied:
Scanning: 3
Date Approved:: In Review
Type of Work: LEGALIZING EXISTING A/C UNIT
Fees Due
CCF
DBPR Fee
DCA Fee
Education Surcharge
Permit Fee
Scanning Fee
Technology Fee
Total:
Amount
$0.60
$2.00
$2.00
$0.20
$100.00
$9.00
$0.80
$114.60
Pay Date Pay Type
Invoice # MC -1-17-62596
01/20/2017 Credit Card
01/12/2017 Credit Card
Amt Paid Amt Due
$ 64.60 $ 50.00
$ 50.00 $ 0.00
Available Inspections:
Inspection Type:
Final
Review Mechanical
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 forego' • ormation is .ccurate and that all work will be done in compliance with all applicable laws regulating
construction and zoning. Futhermore, I autho ' - the abov- - j., tractor to do the work stated.
January 20, 2017
Authorized Signature: Own - / Applicant ontractor / Agent ate
Building Department Copy
January 20, 2017 1
BUILDING
PERMIT APPLICATION
.84M6114€ ❑ ELECTRIC
❑PLUMBING yMECHANICAL
JOB ADDRESS:
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
Master Permit No.
Sub Permit No.
JAN .1,,,2 2017
BY
s
FBC 2O'
MC i &5
❑ ROOFING ❑ REVISION ❑ EXTENSION
0PUBLIC WORKS CHANGE OF ❑ CANCELLATION
CONTRACTOR
❑ RENEWAL
❑ SHOP
DRAWINGS
City: Miami Dade Zip: f7/41p
Folio/Parcel#: // 1'& �0 /%O%d/O Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
Miami Shores County:
OWNER: Name (Fee Simple Titleholder):
Address: /?,..P-40
City: A47,2 /� State:
Zip: 27/31
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: Qr G 1 Fr e,e2-e-- /A C
Address: 9133 6 4.i LA.i$ S% i v
City: State: F L
Qualifier Name: E Jii -s lIL2
State Certification or Registration #: CA- 1611 rs- Z�2
DESIGNER: Architect/Engineer: Phone#:
Address:��`` City:
,%O
Value of Work for this Permit: p Square/Linear Footage of Work:
c ze fz
Phone#: 3Orr?' -�
Zip: 3 3 1 6 6'
Phone#: S'6 �y +-/OLl3`�
Certificate of Competency #:
State: Zip:
Type of Work: ❑ Add' n ❑ teration ❑ New t4 Repair/Replace ❑ Demolition
Description of Work:. %.,: (42-,11/-04:, €. r
L
v
a, :7! ..ar'F' :3 • ' .,•+s' 4 4., •
ti i.Yga .+4 is r+" -1' �', .• f t
Specify calor of color thru #,le ' `,#�r•
SubmittalFde+$•-�..--'- -- ii e:-$.,+ 1 t V(J
Permit`Fee
Scanning Fee $ 67t Radon Fee $ 2
Technology Fee $ • OO • Training/Education Fee $
Structural Reviews $
(Revised02/24/2014)
3JS s, 7 !. A.0 �•..
CCF $ • COO CO/CC $
DBPR $ 2 Notary $
• Z'Q Double Fee $
Bond $
TOTAL FEE NOW DUE $
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, POdLS,
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.
Signature_-' Signature
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing/instrument was acknowledged beforemethis
�'2- day of J v�L!/1 , 20 ) -7 , by i! L--/ day of d/Ec e w v o� , 20 l G , by
/N,✓4 /Ai�F,s0_�/ /, who is personally known to i1 /` J�? A- , who is personally known to
me or who has produced JP as
identification and who did take an oath.
NOTARY PUBLIC:
L
1 /
Sign: _ / i Sign: /
Print: ° �'l^!�'L;��y(;«,' Print: antvel i.I W4I Nm
:w
YOANED SANTANA
Seal: w �� .•' My COMMISSION K FF06t00S 1( Seal: •r: My COMMISSION • FF0140
EXPIRES „ ^ ,. EXPFebruary 23. 2020
4• , .;4i, -r: • s ► RESnb►., ,;,,,,, • ... ` EXPIRES September 01. 2010
ow) 3114 13 Flonde adrMves ow
*****************************#ice******************�ki��k*** RSR*********i�R.F***************f�k�k*******************
me or who has produced cam/ as
identification and who did take an oath.
NOTARY PUBLIC:
APPROVED BY \p\lExaminer
(Revised02/24/2014)
Zoning
Structural Review Clerk
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
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): .;94i2 �� Q�
City: Miami Shores Village County: Miami Dade Zip Code: ��/-70
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
04110(
AHU or PKG. UNIT MODEL #.-
0 L(2 — J P
COND. UNIT MODEL #
t1 .53(130360-D
KW HEAT
3'
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 NI
YES
NO
REPLACING THERMOSTAT
YES 1
YES
NO
NEW 4"CONCRETE SLAB
YES ► •
YES
NO
NEW ROOF STAND
YES r a
YES
NO
NEW RETURN PLENUM BOX
YES NI
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: Phone:
State Certificate or Registration No. Certificate of Competency No.
Signature Date:
(Qualifier's signature)
(Revised02/24/2014)