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MC-09-908 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 I nspection Number: INSP - 116702 Permit Number: MC -6 -09 -908 Inspection Date: February 02, 2010 Permit Type: Mechanical - Residential Inspector: Perez, JanPierre Inspection Type: Final Owner: RAGE, RICHARD Work Classification: A/C Replacement Job Address: 1276 NE 94 Street Miami Shores, FL Phone Number Parcel Number 113205010015 Project: <NONE> Contractor: COMFORT AIR Phone: (305)956 -9687 Building Department Comments REPLACE EXISTING A/C SYSTEM Inspector Comments Passed CREATED AS REINSPECTION FOR INSP - 115466. unit must be above fema floor level jpp Failed El Elevation of equipment OK per Norm. Correction Needed Re- Inspection ❑ Fee No Additional Inspections can be scheduled until re- inspection fee is paid. For Inspections please call: (305)762 -4949 March 02, 2010 Page 1 of 1 oAE Inspection Worksheet s Miami Shores Village y , y 10050 N.E. 2nd Avenue Miami Shores, FL JUN 1 2 1 D ¢ ' Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: I'NSP -'11 X66 , ', Permit Number MC -6 -09 -908 Scheduled Inspection Date: June 09, 2009 Permit Type: Mechanical - Residential Inspector: Perez, JanPierre Inspection Type Final Owner: HAGS, RICHARD Work Classification: New Job Address: 1276 NE 94 Street Miami Shores, FL Phone Number Parcel Number 1132050100150 Project: <NONE> Contractor: COMFORT AIR Phone: (305)956 -9687 Building Department Comments Inspector Comments Passed El Failed VV,� Correction ❑ Needed Re- Inspection ❑ Fee No Additional Inspections can be scheduled until re- inspection fee is paid. ...__ An An P1_-_ An _L •n i5 s 3S D . 5 yt�� y■ O Miami Shores Village R8t1t.. 10050 N.E. 2nd Avenue 3 " Miami Shores, FL 33138 -0000 r Phone: (305)795 -2204 eR 9 R � Expiration: 11/3 uw I . P roject Address Parcel Number Applicant L 1 276 94 Street 1132050100150 RICHARD HAGE iami Shores, FL Block: Lot: Owner Information Address Phone Cell RICHARD HAGE 1276 NE 94 ST MIAMI SHORES FL 33138 -2947 Contractor(s) Phone Cell Phone Valuation: $ 5,0 00.00 COMFORT AIR (305)956 -9687 Total Sq Feet: 0 Tons: Available Inspections: Additional Info: Inspection Type: Classification: Residential Ventilation Approved: In Review Final Comments: Date Approved:: In Review Rough Date Denied: Type of Work: Hood Rough Duct Smoke Test Smoke Det Test Fees Due Amount Invoice # Total Amt Paid Amt Due CCF . $3.00 MC -6-09 -34948 $ 186.38 $ Education Surcharge $1.00 Permit Fee - Additions/Alterations $175.00 MC -6-09 -34948 $ 186.38 $ 186.38 $ 0,00 Scanning Fee $3.00 Check #: 5915 Submittal Fee $50.00 Submittal Reversal Fee ($50.00) Technology Fee $4.38 Total: $186.38 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 information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore, I authorize the above -named contractor to do the work stated. June 05, 2009 Authorized Signature: Owner / Applicant / Contractor / Agent Date Building Department Copy June 05, 2009 1 �I��► k' Miami Shores Village g Building Department JUN o 2 Zoos � - 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 B Y. ° - °° Tel: (305) 795.2204 Fax: (305) 756.8972 BUILDING Permit No.m _ C) o� PERMIT APPLICATION Master Permit No. FBC 2001 Permit Type Mechanical Owner's Name (Fee Simple Titleholder) `1? ; Phone # Owner's Address & - City O�� State Zip �� Tenant/Lessee Name Phone # E -MAIL: Job Address (where the work is being done) (�', City. Miami Shores Village County ty M yam i-Dade Zip FOLIO:/ PARCEL # Is Building Historically Designated YES NO ' r Contractor's Company yName rU f I Phone# has °., Contractor's Address A'1 City ,(, State Qualifier Name —AU9Al !b . OtV I LAAii Phone# ? 7 State Certificate or Registration No. _r", 6 / jrj (, Certificate of Competency No. ' E -MAIL: Architect/Engineer's Name (if applicable) Phone # Value of Work For this Permit $ 10 00 Square / Linear Footage Of Work: Type of Work: ❑Addition ❑Alteration [- epair / Reece El Demolition 0 Describe Work: No 0 2 PAyl k'" Y' Y' Y' 4iY'"" � Y'" ' 9¢ FeesM'� xBexxoYA xxxxxoexxx4cxotxxxoY dcxxx4r eY dcx4cxdedex4exaY�xae ub m ittal F $ �' Permit Fee $ � � ' 7 5 CCF $ � CO /CC Notary $ Training/Education Fee $ ( Technology Fee $ Scanning $ 1 Radon $ DPBR $ Zoning $ Bond $ Code Enforcement $ Double Fee $ Structural Review. $ Total Fee Now Due $ � Reverse side --> 1 b /71 Bond lng,,Colnpany's Name (if applicable) :2x o-. 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 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the. building permit is issued In the absence of such posted notice, the inspection will not be approved and a reinspectn fee will be charged Signature Signature Owner or Agent � Contractor The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me thisz t day of 200, by Ufa / l 6 A 6 /, day of 200�, by who is personally known to me or who has produced who is personally known to me or who has produced ° ' h� As identification and who did take an oath. Dn'.ers LM Widentification and who did take an oath. NOTARY PUBLIC: NOTARY PUB Pu idataN Public State of Florida Brand Bello MY i D788788 Sign: 0 nub sinto of Florida Sign: Brenda Bello Print: �� Q MY commission OD788788 Print: xn res oalz 1 712012 My Commission Expires: My Commission Expires: (p1� xxaFxx& ux& 4exx9e, kxxXSexdzxxx ,Y,Yuxxdaxdexxx,Yxxxxxie ix& &iexxx,tx,:xx,4x &xtexxxziexdeaY r. tie 9cxeYxxxxuxdc &xxxae kxxak ieacx$exaYxxx4cxxxxxx APPLICATION APPROVED BY: Plans Examiner Engineer Zoning (Revised-02/08 /06) t n RVICE ORDER ° 3 �! DATE ORDERED S VICE ❑ PICKUP PAIR !N STALL El DELIVERY OME ❑SH / - ❑ C.O.D. CHARGE Name / JS 7-fl Address Y State zip City MAKE MODEL SERIAL NO. PROMISED SERVICE REQUESTED El RR WARRANTY L CONTRACT tsff� fit' ❑ EST !MATE p ! %!;/4 730 3 A MAW :54 MA SERVICEPE O D TIME START TOTAL MATERIAL . LABOR AND . TIME FINISH SERVICE TAX HOURS DEL CHARGE OR WLEAGE DATE COMPLETED ON COMPLETION OF WORK T OTAL . conditlon. 1 hereby a P t above performance, and charges, as being satisfactory and acknowledge that equipment has been fait in good TECHNICIAN'S SIGNATURE CUSTOMER'S SIGNATURE THANK YOU VICE ORDER JUN 0 2 2009 1 g � oeF S 8 l o ...... ORIDA CUMULATIVE SUBSTANTIAL IMPROVEMENT VERIFICATION WORK SHEET In accordance with FEMA regulation and Miami Shores Village Flood Damage Prevention Ordinance the costs of all improvements must be monitored. The costs of any improvements in the past 12 months and the costs of any proposed improvements must be shown on the worksheet. The cost of improvements must include demolition, raw and finished materials (include those donated), labor (including volunteer and self - performed), construction supervision and management, and overhead and profit. A list of items the costs of which are to be included as well as those excluded is attached for your reference. (A Copy of the Contract must be attached) PROPERTY OWNER: L� G PERMIT # _ k(— j6 a 61 f Q f ADDRESS: `J L I FOLIO NUMBER: 1 2 Do D FLOOD ZONE: BASE FLOOD ELEVATION: FREEBOARD: EAST OF FL.CCCL: COST OF PAST IMPROVEMENTS (12 MONTHS): COST OF PROPOSED IMPROVEMENTS: (ATTACH COPY OF CONTRACT) TOTAL CUMULATIVE COST OF IMPROVEMENTS (past and proposed): VALUE OF PRINCIPAL STRUCTURE attach ap rain OWNERS SIGNATURE: DATE: `D y PLAN REVIEWER: PLAN REVIEWER SIGNATURE: DATE: 11 -12 -08