MC-10-622‘k\\\'',4)
BUILDING
PERMIT APPLICATION
FBC 2004
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
Permit Type: Mechanical
Owner's Name (Fee Simple Titleholder) ROBERT & JANIE DOMLESKY
Owner's Address 285 NE 91ST ST.,
city MIAMI SHORES State FLORIDA Zip 33138
Tenant/Lessee Name Phone #
E - MAIL:
Job Address (where the work is being done) 285 NE 91ST ST.
City Miami Shores Vill age County Miami -Dade
FOLIO / PARCEL # 11- 3206 - 013 -3460
Is Building Historically Designated YES NO
Permit No. I 0
Master Permit No.
Phone # 305 - 796 -2223
Contractor's Company Name ALL YEAR COOLING & HEATING Phone # 954- 5664644
Contractor's Address 6781 W. SUNRISE BLVD
Ci PLANTATION State FL Zi 33313
Qualifier Name GRETA B. SMITH Phone # 954 - 5664644
State Certificate or Registration No. CACO58160 Certificate of Competency No. CMC511
E - MAIL:
Architect/Engineer's Name (if applicable) N/A
Value of Work For this Permit $ 4,900.00
Type of Work: ❑Addition ['Alteration ['New ❑ Repair/Replace ❑ Demolition
Describe Work: REPLACE CENTRAL NC SYSTEM.
Structural Review. $
Phone #
Square / Linear Footage Of Work
Zip 33138
****** ******* *****e * ® *w * * * * * *a *a *a**aa* F x***** ****************** *** *** * * ***
Submittal Fee $ Permit Fee $ G t CCF $ ,00 CO /CC
Notary $ Training/Education Fee $ i • 0 0 Technology Fee $ 4 .0
Scanning $ 2 J 6 (-I Radon $ DPBR $ Zoning $
Bond $ Code Enforcement $ Double Fee $ 11 1 • ` T)
Total Fee Now Due $ 359, 00
See Reverse side -+
1003II1719
1111 13101A
BY.
i3 C2ig
Bonding Company's Name (if applicable) N/A
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable) N/A
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 Plyi Signature v as '1-e , 4. ,i744.;i%
Owner or Agent
The foregoing instrument was acknowledged eed before me this ) )-. The foregoing instrument was acknowledged before me this ION
day of " F' n• 1 , 2 0 l ®, by Q: Q I� i' 1�1) t l , day of 20 L. by 6r-e f..� - Gm i',4
who is personally known to me or who has produced who i me or who has produced
APPLICATION APPROVED BY:
(Revised 02/08/06)
As identification an d who did take an oath.
NOTARY;.' UBLIC:
ORION KAS McKNIGHT E
PO% Comm# DDO$450411 5
ftetlassa IIUilU! NO
Tres: a- I
141
Contractor
as identification and who did take an oath.
'NOTARY PUBLIC:
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H ***w** **e * * * * *. ** * e * * ***
`t/0 10
Plans Examiner
Engineer
Zoning
Inspection Number: INSP- 140477
Scheduled Inspection Date: September 28, 2010
Inspector: Perez, JanPierre
Owner: DOMLESKY, ROBERT
Job Address: 285 NE 91 Street
Miami Shores, FL 33138-
Project: <NONE>
Contractor: ALL YEAR COOLING AND HEATING
Building Department Comments
REPLACE CENTRAL NC SYSTEM
Q
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
September 27, 2010
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
For Inspections please call: (305)762 -4949
Permit Number: MC -4 -10 -622
Permit Type: Mechanical - Residential
Inspection Type: Final
Work Classification: A/C Replacement
Phone Number
Parcel Number 1132060133460
Phone: (954)566 -4644
Page 3 of 22
.or et"
The following information is required for replacement of mechanical equipment and must be •
available for the inspectorattime of inspections, Two (2) copies shall be provided. One (1) to be
on the job site plans for inspections and one (1) to be filed with PZ &B/Records.
PR#
Air Conditioning System
SEER /(,. 5 or EER
DOE - covered products are central, air - source, one -phase systems having capacities under
65,000 BTUH
Replacement System Components
Manufacturer [4- -
Air Handler Model No. V C 66
Voltage )--3�
Heat Strip. l C KVA/KW
Min. Circuit Ampacity �p
HACR Breaker /Fuse size:
Min. • Max
Wire size (A.W,G.)
Manufacturer
Air Handler Model No. �fJi1lG — ,L/
Voltage
Heat Strip l 0 KVA/KW
Min. Circuit Ampacity �A
HACR Breaker /Fuse size:
, /
Signature of Applicant Date
�tkS Au�Erali�r� ski: Ia
W441 Palm Baoatt, Pi..5iao,tia4a0
Phan *: (561) 233 -5130 Fax: (661) 233.5144
Planning, Zoning & Building Department
Porrnit Cantor
Building Division
Florida HVAC Efficiency Card Form
Condenser Unit Model No. ..2zi ii'e-#3 1 / F
Voltage � - D
Size f tons
• Min. Circuit Ampacity 35
HACR BreakerlFuse size:
Min. •
Wire size
Required if the Air Handier can be equipped with more than one Evaporator Coil
Evaporator Coil Unit Model Number
Existing System Components
Required if the Air Handier can be equipped with more than one Evaporator Coil
Evaporator Coll Unit Model Number
Condenser Unit Model No.
Voltage .2
Size �/ • tons
Min. Circuit Ampacity 3S
HACR Breaker /Fuse size:
Max
(A.W.G.)
Min. Max. Miri. Max
Wire size l (a — (A.W.G.) Wire size (0 /D--- (A.W.G.)
Certification
With the authorization of the installing Contractor, I certify that the information entered on this
form accurately represents the system(s) installed,
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